Why is Russia flexing its muscles in the Middle East?

Syria’s bloody civil war suddenly became even more tangled in September with the start of a massive Russian bombing campaign on targets in the country. Two historians offer their personal takes on why Vladimir Putin ordered airstrikes

Tanzanian scepticism of a militarised East African Federation and underlying military concerns

Attitudes towards a regional military force are of paramount importance when exploring public support for regional integration. Until now, however, scholarly research has not considered the influence of attitudes towards a regional military mechanism in the sub-Saharan African context. Using Afrobarometer data, we demonstrate that military concerns are vital when exploring Tanzanian attitudes towards the proposed political federation of the East African Community (EAC), the East African Federation (EAF). More specifically, opposition to military cooperation strongly influences Tanzanian scepticism of the EAF. This finding is highly relevant given that referendums in the participating member states must be passed to facilitate political integration. Heightened opposition towards military cooperation raises the possibility of the public rejecting a politically integrated EAC. This poses a potential obstacle to the implementation of joint security policies and crucial mechanisms to provide a more stable region at large. We account for alternative explanations of Tanzanian opinion formation and reflect on the strength of military-orientated concerns for investigating public support for the East African project specifically and regional integration in sub-Saharan Africa more widely.

Initiating advance care planning on end-of-life issues in dementia: Ambiguity among UK and Dutch physicians

Background
In dementia, advance care planning (ACP) of end-of-life issues may start as early as possible in view of the patient’s decreasing ability to participate in decision making. We aimed to assess whether practicing physicians in the Netherlands and the United Kingdom who provide most of the end-of-life care, differ in finding that ACP in dementia should start at diagnosis.

Methods
In a cross-sectional study, we surveyed 188 Dutch elderly care physicians who are on the staff of nursing homes and 133 general practitioners from Northern Ireland. We compared difference by country in the outcome (perception of ACP timing), rated on a 1–5 agreement scale. Regression analyses examined whether a country difference can be explained by contrasts in demographics, presence, exposure and role perceptions.

Results
There was wide variability in agreement with the initiation of ACP at dementia diagnosis, in particular in the UK but also in the Netherlands (60.8% agreed, 25.3% disagreed and 14.0% neither agreed, nor disagreed). Large differences in physician characteristics (Dutch physicians being more present, exposed and adopting a stronger role perception) hardly explained the modest country difference. The perception that the physician should take the initiative was independently associated with agreeing with ACP at diagnosis.

Conclusions
There is considerable ambiguity about initiating ACP in dementia at diagnosis among physicians practicing in two different European health care systems and caring for different patient populations. ACP strategies should accommodate not only variations in readiness to engage in ACP early among patient and families, but also among physicians.