To save content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about saving content to .
To save content items to your Kindle, first ensure no-reply@cambridge.org
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about saving to your Kindle.
Note you can select to save to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
In the aftermath of the Second World War, Poland faced immense public health challenges amidst widespread destruction and political transformation. This article explores the largely overlooked medical mission of the Unitarian Service Committee (USC) in Poland, situating it within both humanitarian and geopolitical contexts. Drawing on archival research and press accounts, the study reconstructs the USC’s multifaceted aid efforts, including its Medical Teaching Mission, the establishment of the Piekary Śląskie hospital, and tuberculosis control initiatives. The analysis highlights how the USC combined direct medical assistance with educational outreach, aiming to support long-term recovery. However, operating behind the Iron Curtain, the Committee’s activities were subject to both surveillance and propaganda, revealing the entanglement of health and politics in Cold War Europe. This case offers new insights into the role of non-governmental actors in shaping postwar public health and diplomacy in Eastern Europe.
Bipolar disorders (BD) rank among the most disabling conditions, affecting millions worldwide. Cognitive impairment in BD is linked with brain changes and worse functional outcomes. Obesity and metabolic syndrome (MetSy) are overrepresented in BD and are associated with more pronounced brain structural and cognitive alterations in the general population. Here, we studied for the first time the contribution of metabolic dysfunction to both brain and cognitive alterations in BD.
Methods
We recruited 163 participants (76 individuals with BD, 87 controls). We used principal component analysis (PCA) to derive a composite measure of metabolic health from WHR, BMI, HOMA-IR, HbA1c, TGC, HDL, LDL, systolic, diastolic BP, and to derive a composite cognitive measure from the California Verbal Learning Test and Digit Span. Brain structure was indexed using machine-learning-predicted BrainAGE derived from T1-weighted MRI.
Results
Obesity, hypertension, insulin resistance, and dyslipidemia contributed most strongly to variance in metabolic health in this sample. This MetSy-associated risk cluster predicted higher BrainAGE (β = 0.75 ± 0.29, p = 0.011) and lower cognitive performance (β = −0.19 ± 0.09, p = 0.037), accounting for 30% of the association between BD and higher BrainAGE and 25% of the association between BD and worse cognitive performance. These effects were independent of symptoms, medications, illness course, and duration.
Conclusions
MetSy, particularly obesity, was closely linked with brain/cognitive impairments in BD. While the need for metabolic monitoring should be informed by the diagnosis of BD, screening for MetSy can also help track brain health and cognitive functioning.
The European Union’s Artificial Intelligence Act introduces a novel regulatory category of “unacceptable risk,” prohibiting specific AI practices that are deemed fundamentally incompatible with human rights and ethical principles. While much attention has focused on the regulation of high-risk AI systems, particularly in medical contexts, the AI Act’s outright bans under Article 5 have received far less scrutiny. This paper addresses that gap by examining how these prohibitions apply to healthcare and public health, which are domains defined by rapid technological uptake, structural vulnerability, and ethically sensitive decision-making. Drawing on the European Commission’s 2025 interpretative Guidelines, the paper argues that several health-related AI applications, such as emotion recognition tools, biometric categorisation systems, and technologies that influence or target vulnerable populations, may fall within the scope of the bans. It also shows that the Act’s medical and safety exceptions risk weakening the vulnerability protections that the prohibitions aim to secure. By integrating legal analysis with real-world health examples, the paper offers a framework for interpreting these prohibitions and assesses how they should guide the ethical boundaries of AI in healthcare, within and beyond the European context.
Health technology assessment (HTA) is a multidisciplinary, policy-oriented process designed to inform evidence-based, transparent, and value-based decision making in health systems. Across the Middle East and North Africa (MENA), HTA development remains heterogeneous and unevenly institutionalized. This manuscript reports on a Health Technology Assessment international (HTAi)-led Policy Dialogue designed to identify shared challenges, priorities, and opportunities to strengthen HTA systems across the region.
Methods
Insights were generated through an in-person meeting held in Tunisia in 2025, alongside the HTAi MENA Regional Meeting. The dialogue was complemented by an online survey and a follow-up virtual meeting. Data sources included structured survey responses from experts across twelve countries and qualitative inputs from multi-stakeholder discussions involving policymakers, HTA practitioners, academics, and international organization representatives. Findings were synthesized descriptively to capture perceived challenges, priorities, and expectations for regional and international collaboration.
Results
Participants emphasized HTA’s role in improving resource allocation, transparency, and access to high-value technologies. Key challenges included limited access to high-quality data, workforce capacity constraints, fragmented governance, and weak legal and institutional frameworks. The highest-ranked priorities were establishing formal legal mandates for all actors involved in HTA processes, building technical and system capacity (including institutional governance, processes, and coordination mechanisms), and strengthening health data infrastructure. Strong support emerged for regional cooperation through joint training, shared assessments, and HTA networking, alongside expectations for international organizations to play a catalytic role.
Conclusions
HTA is gaining prominence across MENA, but most countries remain in early phases of institutional development. Progress will require coordinated action on governance, capacity, data systems, and implementation.
Taking Singapore’s Nanyang University (Nantah) as a case study, this article examines Cold War American efforts to reshape higher education in Southeast Asia, and the efforts of local elites to leverage these resources for their own agendas. Best known as the only ‘Chinese’ university outside of mainland China, Taiwan, and Hong Kong, Nantah has been variously critiqued as an institutional home for leftist-student activism and Chinese communal interests in decolonizing Southeast Asia. This article argues that it was also a centrepiece in an American-led political agenda to contain communist China by supporting ‘Free Chinese’ educational facilities in the diaspora. It demonstrates how American policies aimed at supporting Chinese higher education outside of the People’s Republic of China (PRC) encountered the local politics of decolonization in Singapore, producing new educational infrastructures in the region oriented towards American universities. While Nanyang University was initially the locus of American attention in the early Cold War, its strategic significance as a ‘Chinese’ university in Southeast Asia was increasingly sidelined by an assertive Singapore government eager to leverage American resources for its own developmental needs. Arguably, the longer term legacies of this episode can be discerned through Singapore’s centrality in the globalization of American higher education in Asia, and the broader reorienting of intellectual networks and epistemologies in Singapore which endures to the present day.
Infradiaphragmatic total anomalous pulmonary venous return is a rare CHD often requiring emergent cardiac surgery. Options are limited for premature infants. We describe successful transcatheter palliation of a premature infant utilising stenting of the ductus venosus followed by transhepatic portal venous access for stent placement in an obstructed vertical vein with hepatic tract closure using the VASCADE Vascular Closure System (Cardiva Medical Inc., Santa Barbara, CA).
Community structure in networks naturally arises in various applications. But while the topic has received significant attention for static networks, the literature on community structure in temporally evolving networks is more scarce. In particular, there are currently no statistical methods available to test for the presence of community structure in a sequence of networks evolving over time. In this work, we propose a simple yet powerful test using e-values, an alternative to p-values that is more flexible in certain ways. Specifically, an e-value framework retains valid testing properties even after combining dependent information, a relevant feature in the context of testing temporal networks. We apply the proposed test to synthetic and real-world networks, demonstrating various features inherited from the e-value formulation and exposing some of the inherent difficulties of testing on temporal networks.
Bureaucratic agencies hold enormous power to affect citizens’ lives through agency rulemaking. These rules hold the force of law, though the officials writing them do not serve in elected positions. Resulting concerns about bureaucratic policymaking have given rise to prolific literature on political control by executives and legislatures seeking to limit the opportunity for moral hazard. I contend that other factors may restrain rulemaking that do not arise directly from other government institutions. Specifically, I assess whether and how state political culture checks bureaucratic power by affecting the number and content of regulatory proposals. Using a large dataset containing the nearly 200,000 proposed regulations from agencies in every US state over a 10-year period, I test the degree to which states with varying cultures utilize bureaucratic rulemaking. I then evaluate whether culture impacts the topics covered by regulation using a subset of six states representing each cultural type. Findings suggest that agencies in traditionalistic states issue fewer regulations than those in moralistic or individualistic states, but proposed rules in individualistic states cover a broader range of policy areas. These results deepen our understanding of the factors influencing regulatory politics, expanding the universe of bureaucratic control beyond government institutions to the broader environment.
RUCAI is an AI-based open-source software platform designed for humanities and social sciences educational workflows that require traceability to assigned course materials. RUCAI has a teacher-only workspace in which teachers can curate class exercises grounded in curriculum documents (articles, book chapters, and notes). From here, the teacher can set up workspaces grounded explicitly in curriculum materials, learning outcomes, and course requirements for students to use throughout the course. The system is set up to run on institution-controlled infrastructure using FastAPI, PostgreSQL, and a local LLM model serving via Ollama, and is intended to be deployable on a GPU-enabled virtual machine. RUCAI’s primary contributions are practical: (1) it presents a software architecture for local-first, source-grounded educational AI that treats the course as the primary software object; (2) it documents concrete implementation choices for reliable ingestion and retrieval across heterogeneous course materials, including a three-tier extraction pipeline, word-based chunking, and intent-aware retrieval; and (3) it describes a publish-to-student mechanism that lets teachers freeze course context and prompt constraints into student-facing instances. The paper also reports pilot observations, current limitations, and future development directions.
We aimed to describe the development and evaluation of the Brazilian Dietary Guidelines Adherence Score (BraScore).
Design:
The process comprised multiple steps: defining guiding principles, identifying food components, setting scoring cut-off points and assessing validity and reliability.
Setting:
Nationally representative sample of the Brazilian population.
Participants:
46 164 Brazilians aged ≥ 10 years.
Results:
The BraScore has ten components: to be consumed (legumes; fruits; vegetables and diversity), to be limited (red meat; other animal-based foods; processed foods; table sugar and cooking salt) and to be avoided (ultra-processed foods). Scores range from 0 to 100, with higher values indicating greater adherence to the Dietary Guidelines. Analyses showed a weak correlation with energy intake (coefficient: –0·12) and substantial variability among individuals (1st percentile: 20·5; 99th: 77·7). Scree plot analysis revealed multidimensionality, indicating four distinct patterns. The scores differentiated population groups (older adults and rural residents had higher scores) and were high for diets developed by nutritionists (84·6–97·6 points). The reliability analysis yielded a coefficient of 0·6, suggesting acceptable internal consistency.
Conclusions:
The BraScore is a valid and reliable tool to assess adherence to the Dietary Guidelines for the Brazilian Population.
Developing the next generation of leaders in congenital cardiology is critical to advancing the field. Increasingly, it is recognised that earlier opportunities to establish professional networks, gain unique skills, and disseminate scientific work can be highly beneficial. While cross-institutional collaboration has been successful in supporting quality improvement, it has not been widely used in other areas. We describe our initial experience with a multi-centre congenital heart early-career exchange programme.
Methods:
Faculty (<10 years from training) among five participating congenital heart centres were eligible to apply. Applications were reviewed and matched with host sites. Visits (typically 3–5 days) included topics spanning research and collaboration, unique clinical programmes/skills, networking, and presenting a formal lecture. All participants were invited to complete an anonymous post-visit survey, with descriptive results reported.
Results:
Overall, 20/28 (71%) applicants over the initial two years of the programme were selected for participation. The majority were assistant professors; 75% were <5 years from training. There was an equal distribution of males and females and a diverse range of clinical specialties/areas of interest. Post-visit survey responses (75% response rate) were highly favourable, with 92% indicating “strongly agree” regarding the value of the programme across domains and highlighting valuable exposure to unique clinical and research opportunities, networking, and mentorship.
Conclusions:
Initial results from the congenital heart early-career exchange programme highlight the feasibility and positive impact of a collaborative approach to career development. Further efforts should be prioritised to foster broader engagement and impact.
Following recent work (Gonzalez & Taha 2022 J. Fluid Mech., vol. 941, A58; Peters & Ormiston 2025 AIAA J., vol. 63, pp. 6–20), this manuscript clarifies what the Gauss–Appell principle determines in incompressible, inviscid flow and how it connects to classical projection methods. At a fixed time, freezing the velocity and varying only the material acceleration leads to minimisation of a quadratic subject to acceleration-level constraints. First-order conditions yield a Poisson–Neumann problem for a reaction pressure whose gradient removes the non-solenoidal and wall-normal content of the provisional residual, precisely the well-known Leray–Hodge projection. Thus, Gauss–Appell enforces the instantaneous kinematic constraints and recovers Euler at the instant. Once the impressed physics is specified, for instance via external body forces, the reaction pressure is uniquely determined (up to an additive constant) as the Lagrange multiplier enforcing incompressibility and wall impermeability; it does no work on divergence-free, wall-tangent motions. This is the well-established interpretation of pressure in incompressible flow. The direct, fixed-time application of this principle determines the reaction pressure for an already-specified velocity field and does not, by itself, select circulation or stagnation points, because these are properties of the velocity state, not the instantaneous acceleration correction. The formal decomposition of the pressure into impressed and reaction components admits representational freedom that does not imply physical non-uniqueness of the constraint force. Orthogonality conventions such as Dirichlet orthogonality can fix the representational freedom as an additional modelling choice. This variational viewpoint also yields a simple computational diagnostic: the minimised Appellian equals a $L^2$ norm of the reaction-pressure gradient which vanishes for constraint-compatible updates and grows with the magnitude of divergence and wall-flux mismatch.
Post-traumatic stress disorder (PTSD) is a growing health problem whose neurobiology remains incompletely understood. Neuroimaging is useful in probing PTSD-related brain dysfunction, and techniques continue to evolve. Structural–functional coupling (SFC) offers a novel integrated perspective on PTSD neurobiology. We sought to define unique SFC alterations in PTSD and explore their associations with clinical symptoms, brain molecular architecture, and gene expression.
Methods
We studied 61 PTSD patients and 62 trauma-exposed non-PTSD controls (TENC) recruited from earthquake survivors. We compared SFC constructed from multimodal MRI data by an eigendecomposition method between the two groups. We explored the spatial correlation of SFC with molecular maps, used partial least squares (PLS) regression to associate them with Allen Human Brain Atlas gene data, and conducted enrichment analysis on the identified genes.
Results
PTSD patients showed significant regional SFC alterations in multiple regions: lower SFC in PTSD versus TENC in the default mode network (DMN), frontoparietal network (FPN), dorsal attention network, sensorimotor network, visual network, and thalamus, and higher SFC in PTSD versus TENC in the DMN, FPN, and ventral attention network. Some changes were correlated with clinical symptom severity. In both groups, the spatial distribution of SFC was similarly correlated with molecular architectures. The second component of the PLS regression genes were linked to PTSD-specific SFC variations, enriched mainly in molecular functions and pathways related to synapses and neurotransmitter signaling.
Conclusions
This study yields new insights into PTSD pathophysiology by connecting macroscale SFC changes with their microscale molecular and transcriptional basis.
The rising incidence of antimicrobial resistance (AMR) underscores the urgent need for effective antimicrobial stewardship (AMS). This study assessed the impact of a tailored AMS initiative in Indian hospitals.
Methods:
An AMS surveillance program was implemented across 11 Indian hospitals (January 2022–June 2023). The intervention (July 2022–June 2023) included hospital-specific antibiograms, antibiotic policy design and implementation, monitoring antibiotic consumption, and tracking multidrug-resistant organisms (MDROs). Hospital staff were trained, and compliance audits with feedback were conducted. Implementation followed the Model for Improvement methodology over 18 months.
Results:
AMS surveillance revealed significant improvement in AMS knowledge and practices from the baseline to the postintervention phase. Antibiotic compliance increased from a baseline of 10% to 71% across hospitals, reaching 73%–91% in the subsequent period. Surgical prophylaxis compliance improved substantially, particularly in hospitals with initially low adherence. Optimizations in antibiotic selection, dosing, duration, intravenous-to-oral switching, and de-escalation were also observed, resulting in significant compliance gains across all domains. Use of antibiotics classified by the World Health Organization as safer first-line options with a narrow spectrum increased, while use of second- and third-line antibiotics, including those with broader spectra and higher resistance risks, decreased, reflecting a shift toward safer prescribing practices. However, MDRO incidence rates remained variable across sites, showing room for improvement.
Conclusion:
Locally tailored AMS interventions within a structured quality improvement framework can establish sustainable practices to mitigate AMR. These findings demonstrate effective strategies for optimizing antibiotic use and provide valuable insights for broader implementation of AMS.
This article re-examines the waqf al-dashīshah founded by the Mamluk sultan Qāʾitbāy (r. AH 872–901/1468–1496 CE) for the distribution of dashīshah (porridge) and bread in the Ḥaramayn (Mecca and Medina), particularly in Medina. Drawing on a comprehensive analysis of MS Arabe 1118 (Bibliothèque nationale de France) alongside related sources, it reconstructs the operational logic and historical trajectory of this endowment. The article argues that Qāʾitbāy’s waqf al-dashīshah functioned not merely as a personal charitable foundation but as a centrally managed provisioning system that channelled agrarian surplus from Egypt to the Hijaz. Its property base, transport infrastructure, and involvement of officials embedded the waqf within the administrative practices of the Mamluk or Cairo Sultanate, while the frequent use of state treasury land further blurred the boundary between public finance and pious endowment. Tracing the waqf’s continued operation and adaptation under early Ottoman rule, moreover, the article demonstrates its durability as an institutional mechanism. Overall, it shows that the waqf al-dashīshah served simultaneously as charity, governance, and political representation, articulating the Cairo Sultanate’s claim to authority as khādim al-Ḥaramayn (the server of the Ḥaramayn) within a context of intensifying inter-Muslim competition.
Many social welfare measures will sometimes rank a large population of very well-faring people below a very large population of barely well-faring people. Thus, they entail the repugnant conclusion. If such rankings are indeed repugnant, there must be some mistake behind measures that imply them. This paper discusses what that mistake might be. After rejecting other proposals, I suggest that the mistaken assumption is that welfare values that are insignificant for individuals, due to being small, could have significant impact on social welfare. To avoid this mistake, two new measures are introduced that aggregate significant and insignificant welfare values differently.
This paper overviews an overlapping generations financial cash flow valuation model that evaluates the financial sustainability of English NHS Trusts. It quantifies the financial sustainability constraints related to societal demographic shifts that affect their ability to maintain service delivery quality. The financial model computes a new long-term financial sustainability performance metric based on the notion of the Social Return on Investment (“SROI”). The measure evaluates the financial sustainability of two English acute care hospital foundation Trusts. Significant generational imbalances are identified for both sample NHS Trusts, both within different cohorts of existing generations, and between existing and future generational cohorts. Suggestions are provided for implementing these ideas and expanding actuaries’ expertise and skill sets.