The objective of this chapter is to give insight in marine governance challenges, illustrated by Arctic shipping. To do this, this chapter presents a theory of marine governance as reflexive institutionalization, in which the structural properties of marine governance arrangements are (re)produced in interactions between governmental actors, maritime sectors and civil society actors within the structural conditions of the networked polity at sea. Based on an analysis of the institutionalization of shipping governance arrangements of three (possible) Arctic shipping routes; The Northwest Passage (NWP), the Northeast Passage and Northern Sea Route (NEP/NSR), and the Transpolar Sea Route (TSR) the following question will be answered, “What are the enabling and constraining conditions of marine governance as reflexive institutionalization?” In other words, what are the possibilities for public and private actors to challenge discursive spaces and to change the rules of the game, in order to find solutions for environmental, spatial, economic, and social problems at the Arctic Ocean? The analysis shows forms of institutionalization as structural reflectiveness in which the dominant discourse ‘shipping is allowed in the Arctic’ is not challenged. However, this form of reflectiveness showed how actors, such as China and Russia, are able the use rules from different institutional settings to strengthen their position.
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ObjectivesTo assess the independent association between health-related quality of life (HRQOL) at admission and mortality, functional decline, and institutionalization 3 and 12 months after admission in acutely hospitalized older adults.DesignPost hoc analysis of data from prospective cohort study, 2006 to 2009, 12-month follow-up.SettingEleven medical wards in three hospitals in the Netherlands.ParticipantsMedical patients aged 65 and older acutely hospitalized for 48 hours or longer (N = 473).MeasurementsOutcomes: mortality, functional decline, and institutionalization, 3 and 12 months after admission. Main determinant was HRQOL (utility based on the EuroQol-5D at admission, reflecting the relative desirability of a particular health state and is measured on a scale from 0 (death) to 1 (full health). Some health states are regarded as being worse than death, resulting in negative utilities, with a minimum of −0.330). Participants were split into two groups based on median utility at admission. Unadjusted and adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using Cox and logistic regression analyses, adjusted for sociodemographic and health variables.ResultsMedian utility was 0.775 (interquartile range 0.399–0.861). Utility greater than 0.775, indicating high HRQOL, was associated with lower risk of mortality (hazard ratio = 0.38, 95% CI = 0.18–0.83) and functional decline (OR = 0.47, 95% CI = 0.28–0.79) at 3 months in the adjusted models. At 12 months, these associations were statistically significant in the crude models but not in the adjusted models. Utility was not associated with risk of institutionalization at 3 or 12 months.ConclusionHigher HRQOL at admission was associated with lower risk of mortality and functional decline 3 months after admission. In older, acutely hospitalized individuals, the EQ-5D may provide a means of risk stratification and may ultimately guide individuals, their families, and professionals in treatment decisions during hospitalization.
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In the 1940s, Iran experienced dramatic changes in urban form, as worldwide modernization movements were embodied in new ‘modern’ neighborhood units in Tehran. Proposals for these neighborhoods, like those in other countries, not only included new housing typologies, but also aimed to alter existing social structures and facilitate nation building. Discussions and proposals regarding new neighborhoods centered on creating healthy, suitable, low-cost housing for new government employees – a group emblematic of Iran's newly established, modern middle class. However, the traditional lifestyle was an undeniable fact of society. Facing the modern socio-urban policies and socially traditional way of living led to both cultural change and landscape transformation. This paper discusses: how do regional architectural traditions transform the global modernity? How are Western conventions of how to be modern transformed by regional tradition and a different lifestyle? How does the institutionalization of modern neighborhoods, based on the lifestyles of its people, create an indigenous modernity? This paper illustrates how urban and social reformation practices towards modernization in the early twentieth century were embodied by Tehran's first modern neighborhood, Chaharsad Dastgah, as well as how domestic Iranian lifestyles influenced this neighborhood and distinguished it from its contemporaries.
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