Recent scholarship often dismisses entrapment, arguing that there are hardly any identifiable cases; and that powerful states (protectors) can sidestep it by narrowing the treaty conditions under which they have to intervene to defend their weaker allies (protégés). Consequently, alliances and partnerships are nearly always considered risk-free assets. However, this paper argues that several types of entrapment are present. The paper is foremost concerned with classic entrapment, a type referring to a purposeful effort by the protégé to drag the protector into a conflict serving primarily the protégé’s interests. The protégé entraps the protector by placing itself deliberately in danger of defeat and by manipulating the protector’s domestic audience costs. Classic entrapment is likely to succeed under two conditions: (a) when the protégé’s allegiance confers the protector an advantage in a competition against other powerful states; and (b) in informal arrangements, in which there is no clear cut-off point to the protector’s commitment. The paper provides an illustration in the Ottoman Empire’s entrapment of Britain in the crisis preceding the Crimean War. The conclusion considers classic entrapment’s feasibility in present world politics, particularly in the context of Taiwan.

The making of mistakes by organisms and other living systems is a theoretically and empirically unifying feature of biological investigation. Mistake theory is a rigorous and experimentally productive way of understanding this widespread phenomenon. It does, however, run up against the long-standing ‘functions’ debate in philosophy of biology. Against the objection that mistakes are just a kind of malfunction, and that without a position on functions there can be no theory of mistakes, we reply that this is to misunderstand the theory. In this paper we set out the basic concepts of mistake theory and then argue that mistakes are a distinctive phenomenon in their own right, not just a kind of malfunction.

Background: The ADI Accreditation Programme, launched in December 2020, aims to support all Alzheimer and dementia associations and other organizations, in improving care for people living with dementia. By providing a standards-based approach to knowledge and skills, ADI establishes benchmarks that program providers must adhere to. Successful completion of an evaluation allows carers, trainers, and program providers to earn ADI Accreditation, indicating that they have reached the required global standard for their training and learning activities, including culturally appropriate context to improve care quality. ADI Accreditation is open to ADI members, as well as other organizations including universities and training colleges.

Activities: Our Global Review Panel (GRP) Members consists of multi-discipline, cultural and regional experts in the global dementia field. Successful completion of an evaluation process: initial application, evaluation report, virtual/in-person or hybrid visit from our Global Review Panel Members, the program or providers can earn ADI Accreditation. The first provider to be accredited was Kiang Wu Nursing College (KWNC) of Macau on January 25, 2021. The pilot project involved Discussions on external and internal governance, trainers and program committees, students, graduates, and other stakeholders. A 3-day virtual visit to KWNC in September, including evaluation, involved carers, trainers, students, and collaboration with other organizations and people living with dementia, followed by a final review by the Global Review Panel in October andNovember.

Silverado Memory Care Communities became the first program to be accredited for their Dementia Care Program on December 22, 2022. In-person visits took place on August 16-17, 2022, involving trainers, stakeholders, family members, caregivers, associates, and staff. University of Bradford in the UK became the first university in UK/Europe to be accredited their Centre for Dementia Applied Science on December 22, 2022. In-person visits took place on June 20-21 June 2023, involving trainers, stakeholders, family members, caregivers, associates, and staff.

Wicking Dementia Research and Education Centre at the University of Tasmania received their accreditation after virtual visit on 29-30 August 2023. involving trainers, stakeholders, associates, andstaff.

As of 2024 Dementia Australia Is currently undergoing the accreditation process along with some new potential opportunities.

Results: In 2 years, Kiang Wu Nursing College of Macau, Silverado Memory Care, University of Bradford and University of Tasmania received ADI Accreditation. Kiang Wu Nursing College of Macau received 5 times more applicant.

Throughout the program, there has been an increase in awareness and understanding of the importance of high- quality culturally contextualized carer training achieved through accreditation.

Introduction: Desatar Argentina is an interdisciplinary group of professionals dedicated to eliminating the use of physical restraints in gerontological care settings. Since its foundation in 2017 under the auspices of the Argentine Society of Gerontology and Geriatrics (SAGG), the group has been committed to promoting respect and dignity for older adults, guided by the International Convention on the Rights of Older Persons.

Mission: Desatar Argentina’s mission is to raise awareness about the harm caused by physical restraints and to promote strategies for their elimination, generating a cultural change within health and social care organizations. We aim to sensitize both society and healthcare professionals about the importance of respecting the dignity of older adults.

Trajectory: Since its inception, Desatar Argentina has undertaken numerous activities, including:

• In 2018, the first “Desatar para cuidar’’ event at LedorVador.

• In 2019, presenting the research on the effectiveness of a multicomponent intervention program to eliminate physical restraints in a long-term care facility (which also obtained an award) at the XVI Argentine Congress of Gerontology andGeriatrics.

• Publications in the SAGG Journal and other media to widely disseminate the group’s message.

• Training courses for care home professionals, focusing on tools and strategies to eliminate the use of physicalrestraints.

Future Perspectives: Desatar Argentina will continue to work to:

• Promote research and dissemination of new care modalities that prioritize the fundamental rights of olderadults.

• Foster ongoing training of health and social care professionals on the risks and alternatives to restraints.

• Promote sustainable cultural change within care centers to ensure a restraint-free environment focused on respect and dignity for older adults.

• Undertake the evaluation and assessment of chemical restraints.

• Promote the elimination of physical restraints in the hospital environment.

Conclusions: Desatar Argentina has shown that it is possible to eliminate physical restraints in long-term care facilities, significantly improving the quality of life for older adults. Continuous training and awareness-raising are essential to promote restraint-free care and transform organizational culture in favor of the rights and dignity of older adults.

Objectives: More than 80% of all long-term care services globally are provided by informal caregivers. However, they are often overlooked, underrecognized and insufficiently supported. This study analyses how providing informal care affects mental health and how the negative effects may be prevented or mitigated.

Methods: A cross-sectional study was conducted among informal caregivers in Serbia. Compassion fatigue and compassion satisfaction (CS) were measured with the Professional Quality of Life Scale (ProQOL) version 5. Compassion fatigue is a concept from the formal care setting, a known work-related phenomenon linked to secondary trauma from prolonged work with suffering/ traumatized patients. ProQOL subscales demonstrated good reliability with a Cronbach alpha coefficient of 0.917 on the CS subscale, 0.891 on the burnout (BO) and 0.857 on the Secondary Traumatic Stress (STS) subscale.

Results: A total of 187 informal caregivers participated, with an average age 56.95 ± 12.86 years. 74.9% of the participants were female; the majority married or partnered (62.6%). The median time spent in caregiving was 4 years, ranging from several months to 50 years. The majority of the sample had a moderate compassion satisfaction (72.2%) with moderate levels of compassion fatigue, represented by the BO (67.4%) and STS (64.2%) subscales. Very few participants scored high on CS (3.7%) and high on STS (5.3%). Sex based differences were found for CS and BO domains, with both CS and BO being higher among women (p = 0.002 and p = 0.026, respectively). BO was found to be higher among singles (p = 0.049). Differences were found regarding urban/rural community, with CS being higher among informal caregivers in urban community (p = 0.041) and STS being higher in rural community (p = 0.004). There was no correlation between age and years spent in caregiving and ProQoL domains.

Conclusions: Over the coming decades, in the absence of a proactive approach, the increasing needs for care will significantly increase the burden of informal caregivers and intensify its consequence on mental health, by pushing moderate levels of burnout and STS towards higher values.

Introduction and Objectives: The affected functional domains in patients with degenerative dementias serve as clues to trace with varying levels of certainty the underlying neuropathology (1) and the negative impact on their autonomy reveals part of the clinical diagnosis of the disease. Healthcare professionals often rely on tools that measure this functionality, allowing them to distinguish between mild cognitive impairment and actual dementia (FAQ (2), CDR(3)).

According to the science fiction author Philip K. Dick, Kipple is a useless object like advertising cards, matchboxes after the last match has been used, yesterday’s newspaper wrapper, etc. Considering that the deterioration in the autonomy of dementia patients negatively impacts their connection with the environment, it is expected that the kipple around them will be few. The aim of this work is to create a low-cost, simple, and quick tool that allows the physician to measure the negative impact of the patient’s cognitive failures on their functionality.

Let $r_5(N)$ be the largest cardinality of a set in $\{1,\ldots,N\}$ which does not contain 5 elements in arithmetic progression. Then there exists a constant $c\in (0,1)$ such that

\[r_5(N)\ll \frac{N}{\exp\!((\!\log\log N)^{c})}.\]

$U^4$

Rotor-stator flows are known to exhibit instabilities in the form of circular and spiral rolls. While the spirals are known to emanate from a supercritical Hopf bifurcation, the origin of the circular rolls is still unclear. In the present work we suggest a quantitative scenario for the circular rolls as a response of the system to external forcing. We consider two types of axisymmetric forcing: bulk forcing (based on the resolvent analysis) and boundary forcing using direct numerical simulation. Using the singular value decomposition of the resolvent operator the optimal response is shown to take the form of circular rolls. The linear gain curve shows strong amplification at non-zero frequencies following a pseudo-resonance mechanism. The optimal energy gain is found to scale exponentially with the Reynolds number $Re$ (for $Re$ based on the rotation rate and interdisc spacing $H$). The results for both types of forcing are compared with former experimental works and previous numerical studies. Our findings suggest that the circular rolls observed experimentally are the effect of the high forcing gain together with the roll-like form of the leading response of the linearised operator. For high enough Reynolds number it is possible to delineate between linear and nonlinear responses. For sufficiently strong forcing amplitudes, the nonlinear response is consistent with the self-sustained states found recently for the unforced problem. The onset of such non-trivial dynamics is shown to correspond in state space to a deterministic leaky attractor, as in other subcritical wall-bounded shear flows.

Introduction: Resilience is a dynamic process involving the interaction between risk and protective factors that act to modify the effects of adverse life events. Understanding the resilience of caregivers of patients with AD and its predictors is essential for the development of intervention strategies aimed at solutions that can contribute to the improvement of their emotional disorders, such as anxiety, stress, anddepression.

Methods: 93 dyads of patients diagnosed with AD, where 60 (64.5%) dyads had Late-onset AD (LOAD) and 33 (35.5%) dyads had Young-onset AD (YOAD). Patients were assessed for: quality of life (QoL), disease awareness, and depression. Caregivers were assessed for: resilience, depression, anxiety, burden, and QoL. Additionally, caregivers provided information about mood, neuropsychiatric symptoms, dementia severity, and patients’ activities of daily living.

Results: Caregivers showed moderate levels of resilience, with an average score of 140 (SD = 13.20), moderate level of burden 28.94 (SD = 14.74), low level of anxiety 7.56 (SD = 7.44), and low level of depressive symptoms 8.17 (SD = 6.34). Patients had an average cognition score of 18.81, 63.4% had mild dementia, low depression index .2 (SD = 5.78), low index of neuropsychiatric symptoms 16.11 (SD = 14.47), and partially compromised disease awareness 9.06 (SD = 5.12).

Conclusions: No relationship was found between caregivers’ resilience and patients’ clinical condition, indicating that resilience seems to be associated with caregivers’ individual characteristics. Interventions such as psychoeducational groups, behavioral or religious counseling, may stimulate or develop resilience characteristics in caregivers who exhibit avoidance or denial behaviors regarding the patient’s diagnosis.

The purpose of this short research note is to draw attention to two major pitfalls of working with databases of decisions of the Court of Justice of the European Union. The first one is technical in nature and relates to the discrepant coverage of the Curia and Eur-Lex databases. The second one is linguistic in nature and relates to the fact that most scholars using these databases work in English. New work on this front is capable of addressing the first issue but a change to research practices would be required to address the second.

Background: Psychosis represents a major unmet medical need in patients with Alzheimer’s disease (AD) dementia. With no approved medications for AD dementia psychosis (ADP), current treatment relies on off-label uses of antipsychotics with limited efficacy and significant safety concerns. Xanomeline is an M1/M4 preferring

muscarinic receptor agonist that has previously been shown to have antipsychotic effects in subjects with AD (Bodick et al., 1997). While xanomeline had promising efficacy for potentially treating psychosis in AD, cholinergic adverse events limited further clinical development of xanomeline. Xanomeline and trospium is an investigational treatment that combines xanomeline with trospium, an FDA-approved non- specific muscarinic receptor antagonist. Unlike xanomeline, trospium does not measurably cross the blood-brain barrier, providing a mechanism to mitigate peripheral cholinergic effects of xanomeline while maintaining its muscarinic receptor agonist activities in the brain.

Methods: ADEPT-2 trial is a phase 3, randomized, double-blind, placebo-controlled, parallel group study to evaluate the safety and efficacy of xanomeline and trospium for the treatment of ADP. Subjects aged 55-90 years with moderate to severe psychosis associated with mild to severe AD dementia will be enrolled into the study. Eligible subjects will be randomized to receive either xanomeline and trospium or placebo in a double-blinded manner for 12 weeks and subjects who complete the study will be eligible to participate in a one-year, open-label safety extension study.

Results: The primary efficacy endpoint of the study is change from baseline to end of Week 12 in the Neuropsychiatric Inventory-Clinical (NPI-C): Hallucinations and Delusions (H+D) score and the key secondary efficacy endpoint is change from baseline to end of Week 12 in the Cohen- Mansfield Agitation Inventory (CMAI). The safety endpoints include the evaluation of safety and tolerability of xanomeline and trospium compared with placebo in subjects with ADP. The study started in 2023 and will enroll approximately 360 subjects with psychosis associated with AD dementia.

Conclusions: ADEPT-2 is designed to assess the safety and efficacy of xanomeline and trospium for the treatment of psychosis in patients with AD dementia. If ADEPT-2 is successful, xanomeline and trospium have the potential to be the first in a new class of pharmacologic treatment for AD psychosis based on muscarinic receptor agonism.

Objectives: Swallowing dysfunction is a significant health concern among older individuals, prompting widespread efforts to prevent it. While articulation training using repeated syllables is a common approach, maintaining motivation and habituating to the practice can be challenging, particularly for those facing mental hurdles.

In contrast, the ancient practice of sutra chanting, which has been embraced for centuries, holds potential for improving well-being by offering mental tranquility through the recitation of meaningful Buddhist words, including non-daily vocabulary. While the health benefits of these vocalization techniques remain understudied, they are believed to have positive effects from a geriatric medicine standpoint.

Methods: Our intervention program consisted of 60-minute sessions held at a temple per week for 7 weeks, including homework tasks. Sessions involved group Discussions, preparatory exercises, multiple recitations of the Heart Sutra with loud voices, and talks by a Buddhist priest. This one-arm intervention study targeted older community residents. Pre- and post- assessments, including mental health questionnaires and measurements of swallowing and oral function, were conducted. Paired t-tests were used to compare the data. Post-intervention interviews were conducted by a psychologist and a priest. This study was approved by the Ethics Committee of Taisho University.

Results: Eighteen participants, with an average age of 76.1 ± 8.2 years (8 males, 10 females), showed significant improvements in maximum phonation time, hyoid bone displacement during swallowing, tongue pressure, and mental health. Interview narratives revealed improvements in mental well-being attributed to sutra chanting, including the alleviation of death anxiety and attainment of mindfulness.

Conclusions: The study suggests that the sutra-chanting program, consisting of immersive temple experiences, exposure to Buddhist priest talks, and training in breathing techniques and vocalization through sutra chanting, may contribute to improved mental and physical health.

Objectives: Experience of people with dementia falls between attempts to maintain a sense of self and normality and struggle with acceptance in order to integrate the changes within the self (Clare). The need for interventions, including spiritual care, targeting fear and loss of self is reported (Palmer). In Japan, Buddhist temples which hold peer-support café for the caregivers of the people with dementia are emerging, as those needs are not fully covered by the health care system (Okamura). For the better future psychogeriatrics-Buddhist temple collaboration, this study explores the views of the Buddhist priests who work in the secular health care system.

Methods: Consecutive in-depth interviews were conducted with health care professionals such as medical doctors, psychologists, care workers, etc. who work in the secular health care system, and who are at the same time qualified as Buddhist priests. Verbatim transcripts were analyzed using a qualitative descriptive approach. Ethical considerations: The study was approved by the Taisho University ethics committee.

Results: Twenty-four subjects were interviewed. Some medical doctors expressed struggles as Buddhist priests concerning not being able to provide person-centered care in the medical setting, especially in intensive care units in early career training, due to the busyness. However, now that they are specialists, they are able to provide person-centered care. According to care workers, the effects of Buddhist priests in the residential care were; protecting burnout of the care staff; decreasing anxiety of the residents; increasing trust from the family; and making the inclusive care environment. All of them talked that the lack of practical knowledge teaching on aging, dementia, and death in the monk training program is a problem, but that there may be considerable resistance to changing a curriculum with a long history.

Conclusions: Discourses of the professionals of both territories, i.e., scientific care and spiritual care, are worth investigating for the future reform of the education of both territories.

Objectives: Patients with dementia (PWD) benefit from interdisciplinary care. Depression is a well-known risk factor for the progression of neurocognitive impairment and dementia; other psychiatric disorders (i.e. anxiety, post-traumatic stress disorder, bipolar disorder, psychotic disorders) also may confer an increased risk for dementia. PWD may also present with behaviours and psychological symptoms that overlap with psychiatric disorders. Our aim is threefold: (1) Review the current literature on managing psychiatric comorbidities in PWD. (2) Present an illustrative case series of PWD with psychiatric comorbidities. (3) Introduce a model of care on our Behavioural Neurology Unit (BNU) for treating PWD with psychiatric comorbidities.

Methods: Our BNU is a 20-bed quaternary inpatient unit for difficult-to-treat behaviours related to dementia. Psychiatric consultation is readily available to clinicians and often times for PWD with psychiatric comorbidities. We review best practices in managing these patients. We present a case series of PWD with psychiatric comorbidities predating their diagnosis of dementia who have significant behavioural and psychological symptoms and have failed other settings.

Results: Current guidelines for PWD do not discuss the management of psychiatric and neurologic comorbidities in detail. Among 26 cases, we highlight the judicious use of anticonvulsants, lithium, clozapine, and nabilone in PWD. We also demonstrate the importance of interdisciplinary care with primary care, neurology, psychiatry, and allied health support.

Conclusions: Dementia care is challenging and requires individualized attention and interdisciplinary collaboration. These challenges are augmented when dealing with psychiatric comorbidities. We advocate for increased attention and creative solutions to address these complex cases.

Objectives: Evaluate the chronobiological rhythm of elderly people with type I bipolar disorder (BD), stable and without dementia, compared to controls.

Methods: A cross-sectional study was performed with 20 patients diagnosed with type I bipolar disorder, diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, and 20 controls. Actigraphic records were gathered from all participants over 7 days, besides clinical and demographic information. Non-parametric chronobiological measurements were calculated to evaluate the activity-rest cycle. Comparisons between groups were evaluated using Student’s t-test or Mann-Whitney test, for data with normal and non- normal distribution, respectively. All procedures were conducted following the principles outlined in the Declaration of Helsinki.

Results: Compared to controls, patients with type I BD exhibited lower M10 values, which represent the average activity during the 10 hours of peak movement within 24 hours. Additionally, they showed increased daytime and nighttime inactivity, decreased exposure to nighttime light, and higher sleep fragmentation, as evaluated by the Hurst exponent. No differences were observed between the groups about L5 values, a parameter that indicates the average activity time in the 5 hours of least activity within 24 hours, exposure to daylight, and autocorrelation, a measure that assesses sleep synchronization.

Conclusions: Differences in chronobiological patterns were observed between elderly patients with type I BD and controls. In general, patients exhibited reduced activity levels, both during the daytime and nighttime. These findings may be related to the progression of the disease, as well as prolonged exposure to medications to treat BD, such as mood stabilizers and antipsychotics. The increased sleep fragmentation observed in patients may also be associated with these factors. To date, there is a lack of data assessing the chronobiological rhythm and sleep patterns in elderly individuals with TB, underscoring the need for further studies involving thispopulation.