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Academic medical center in Los Angeles, California.
Patients:
Patients whose bronchoalveolar lavage (BAL) cultures grew M. mucogenicum from 2020–2024.
Methods:
We performed an institutional outbreak investigation of M. mucogenicum, reviewed electronic medical records of a subset of affected patients (2023–2024), and assessed the operational impact.
Results:
The incidence of M. mucogenicum in BAL cultures at Hospital A increased from 6.1% (29/473) in 2020 to 18.6% (29/156) in the first quarter of 2024. Epidemiologic investigation revealed non-sterile ice baths used to cool uncapped sterile syringes during bronchoscopy procedures as the contamination source. Next generation sequencing linked clinical isolates to M. mucogenicum recovered from a perioperative ice machine. Nearly all (157/160) clinical isolates grew from nocardia media rather than acid-fast bacilli media. Among 154 patients, including 51 (33.1%) who were highly immunocompromised, no true infections were identified. Thirty-nine (25.3%) patients were referred to infectious diseases for consultation, seven (4.5%) underwent additional workup, and only one received targeted treatment. The pseudo-outbreak incurred 458 hours of microbiology technologist and infection preventionist time and cost the laboratory $88,426.
Conclusions:
A four-year pseudo-outbreak of M. mucogenicum traced to contaminated ice baths used during bronchoscopy resulted in unnecessary infectious disease referrals and substantial operational and financial burden to the institution. Avoidance of non-sterile ice use in procedures prevents costly and burdensome pseudo-outbreaks of environmental mycobacteria in healthcare settings.
We present a mathematical model for tsunami and induced magnetic anomalies originating from a time-dependent seabed deformation in an otherwise quiescent ocean over a conductive seafloor. The deformation is assumed to be a slender fault, whose lateral extension is much larger than the longitudinal scale. Using a perturbative method with multiple time scales and Green’s function approach, we examine the slow evolution of the wave field and induced magnetic anomaly over transoceanic distances from the fault. The model is validated against deep-ocean observations from the 2011 Tōhoku-oki tsunami. Our study reveals that lateral propagation in two horizontal dimensions decreases the period of both the surface wave and induced magnetic signal compared with one-horizontal-dimension scenarios. Over time, initially longitudinal wave propagation alters as wave fronts bend and stretch, affecting the magnetic signal accordingly. Interestingly, the magnetic anomaly gradually separates from the leading tsunami wave and travels ahead of the tsunami by a distance proportional to the fault’s longitudinal scale. We show that increased lateral propagation reduces the detectability of magnetic anomalies. Finally, we derive an asymptotic formula valid for the long leading wave that travels ahead of the dispersive group over transoceanic distances. This formula holds promise for the rapid assessment of tsunami risk. These findings advance fundamental understanding and may inform the development of future tsunami early warning systems relying on magnetic field detection.
A nuclear detonation resulting in radiation exposure to a large population can cause acute radiation syndrome (ARS). Bone marrow colony stimulating factors (CSF), also known as cytokines, are FDA approved to treat hematopoietic-acute radiation syndrome (H-ARS). This review characterizes the use of CSFs (filgrastim, pegfilgrastim, romiplostim, and sargramostim) and stem cell therapies for H-ARS.
Methods
Using identified keywords, the literature search was conducted on biomedical databases from January 1996-July 2022 and returned 7452 articles. However, after review based on PICO and exclusion criteria, a total of 39 animal studies were included in this systematic review.
Results
Data synthesis using vote counting demonstrated that 34 of 39 studies reported benefit with CSFs or stem cell therapies based on an increase in percent survival or physiological improvement in the experimental group when compared to the control (87% [95% CI 71.77%-95.18%], P = <0.001).
Conclusions
While studies looking at efficacy of CSFs given after 24 hours were limited, 2 studies included in this review showed that delayed administration of CSFs up to 120 hours may be beneficial compared to no treatment. Lack of standardization in experimental study design (e.g. radiation doses, animal species, interventions) between studies prevented direct comparisons using meta-analytic statistical approach.
We study transverse profiles and time fluctuations of turbulence dissipation rate, turbulence kinetic energy and integral length scales by means of high-speed stereoscopic particle image velocimetry in the turbulent wake of a 6 : 1 prolate spheroid that has its principal axis aligned with the incoming non-turbulent flow. This turbulent wake of a slender body differs from turbulent bluff body wakes in terms of transverse non-homogeneity of turbulence dissipation rate and because it is not axisymmetric even though it nominally is. Even so, both transverse profiles and time fluctuations of turbulence dissipation rate coefficients (inverse ratio between the rate with which the large scales lose energy and the rate with which the small scales dissipate energy) and of the Taylor length-based Reynolds number (ratio between the turbulent kinetic energy mostly in the large scales and the turbulent kinetic energy at the smallest scales) obey self-regulating non-equilibrium, as previously found in various other turbulent flows. However, the power law relating the transverse variations and the time fluctuations of these two ratios differs from previously reported self-regulating non-equilibrium power law scalings in other turbulent flows.
Social reproduction scholars have made headway in integrating the analysis of capitalism, class, gender, and care. We offer two contributions to this literature. First, we provide a novel framework with insights into companies as sites of decommodification, shaping childcare cost distribution and affecting childbearing rates. Second, we extend social reproduction research geographically to the oft-overlooked region of Eastern Europe. Eastern Europe is home to 15 of the world’s 20 fastest-declining populations, with low fertility as a prime cause. We argue that privatization catalyzes commodification, raising work intensity and financial-temporal uncertainty and eroding collective resources for social reproduction, thereby impacting childbearing. We explore this mechanism quantitatively by employing four distinct definitions of privatization across two datasets: one covering 52 Hungarian towns (1989–2006) and another spanning 29 postsocialist countries (1989–2012). We shed light on the details of the mechanism through a qualitative analysis of 82 life-history interviews in four Hungarian towns, surveying the lived experience of privatization.
Let $\omega (n)$ denote the number of distinct prime factors of a natural number n. In 1940, Erdős and Kac established that $\omega (n)$ obeys the Gaussian distribution over natural numbers, and in 2004, the third author generalized their theorem to all abelian monoids. In this article, we extend her theorem to any subsets of an abelian monoid satisfying some additional conditions, and apply this result to the subsets of h-free and h-full elements. We study generalizations of several arithmetic functions, such as the prime counting omega functions and the divisor function in a unified framework. Finally, we apply our results to number fields, global function fields, and geometrically irreducible projective varieties, demonstrating the broad relevance of our approach.
The co-occurrence of psychotic disorders and borderline personality disorder (BPD) complicates clinical management, with overlapping symptoms exacerbating morbidity and impairing therapeutic outcomes. This systematic review and meta-analysis aimed to estimate the prevalence of psychotic disorders and BPD co-occurrence, including with first-episode psychosis (FEP) and to describe associated sociodemographic and clinical characteristics.
Methods
Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, four databases were systematically searched from inception to June 2025. Eighteen studies met the inclusion criteria. Data extraction and quality appraisal (Effective Public Health Practice Project tool) were conducted independently by two reviewers. Random-effects meta-analyses estimated pooled prevalence rates.
Results
The pooled prevalence of BPD in people with psychotic disorders was 22.7% (95% CI: 14.2–34.3%), while 14.3% (95% CI: 5.5–32.1%) of individuals with BPD had a comorbid psychotic disorder. In FEP samples, 40.0% (95% CI: 21.9–61.3%) met the criteria for BPD. People with both conditions, often young women, showed greater emotional dysregulation, suicidality, psychotic symptoms, and social dysfunction. Trauma, dissociation and substance use emerged as frequent vulnerability factors. However, most studies were cross-sectional, with small samples and high heterogeneity (I2 > 80%), limiting generalizability.
Conclusion
This co-occurrence constitutes a distinct clinical subgroup with complex needs. Categorical diagnostic approaches may fail to capture the dimensional nature of overlapping affective and psychotic symptoms. Integrative and personalized care pathways, especially in early intervention settings, are warranted. This review was registered in PROSPERO (CRD42024577525).
The chatbot psychosis phenomenon is no longer just a hypothesis. We call for interdisciplinary frameworks to systematically investigate individual characteristics and artificial intelligence related factors which (on their own or in combination) cause or contribute to this phenomenon, underlying mechanisms and the psychoeducation, ethics, policy and practices needed to reduce harm.
In 2024, the Women and Equalities Select Committee in the UK Parliament published a report entitled Misogyny in Music. It included the recommendations that ‘music colleges, conservatoires and other educational settings need to do more to address the gendering of instruments, roles and genres and improve the visibility of and support for female role models’. While there is a dearth of policy levers available to implement this recommendation, this article critically analyses three existing policy/regulatory frameworks that could be used for its implementation in England. The article also highlights a significant limitation of the report – its exclusion of trans and non-binary musicians.
Between 2012 and 2014, a crew from the Pacbitun Regional Archaeological Project (PRAP) excavated a small mound located on the western periphery of the Pacbitun site, a medium-sized ancient Maya center located in west-central Belize. That mound consisted of a thick deposit of granite sand and debitage, revealing a record of the production of several thousand granite tools dating to the Late Classic period. Since those excavations, a total of 22 similar mounds have been recorded, with 11 tested. All tested mounds reveal a similar material record representing periodically used working platforms where granite tools were shaped and finished during the Late Classic period. The recorded granite debris mounds are distributed over an area of 1 km2 some 500 m from Pacbitun’s core, an area that we suggest represents a community of attached, part-time specialists making granite tools on a seasonal basis. Given the scale of granite tool production, we suspect this community made tools not just for local consumption, but also for consumption outside of Pacbitun as part of a strategy to navigate the dynamic political Late Classic landscape of the Belize River Valley.
The growing utility and availability of genome-scale sequencing has led to increasingly broad incorporation across specialty disciplines of clinical research. However, classification of clinical relevance of genetic variation is an inherently clinical task, and the expertise to perform the necessary analysis, confirmation and reporting of these variants is not available in all research teams; consequently, disclosure of genomic variants to research participants remains challenging for many researchers. Advancing genomic medicine as a standard of care first requires institutional commitment and partnerships in supporting genomics in varied research studies that are inclusive of return of results to participants.
Materials and methods:
The University of North Carolina at Chapel Hill has vast experience with genetics in both clinical and research realms. By utilizing historical experience and input from key players, the Clinical GENomic analYSIS (GENYSIS) core facility was created as a case study and aims to provide a roadmap for research organizations to implement their own genomic sequencing core facilities.
Results:
The core has established a molecular sign-out conference, partnered with other core facilities on campus, and provides five main services: bioinformatics, variant analysis, clinical reporting, post-test services, and consultation with project advising. This paper presents case examples with discussion of continuous methodology improvements and embedded educational activities.
Conclusion:
This novel shared research resource enables clinical researchers with limited staff and genomics expertise to provide clinically relevant results to their study participants, expanding the reach of genomics research.
Australia and Canada have parallel submission processes allowing companies to submit dossiers to the respective health technology assessment (HTA) body before marketing authorization is issued, aiming to provide more timely access to drugs. This study investigated the associations of submission strategies with new active substance (NAS) rollout times and HTA recommendations.
Methods
This retrospective observational study analyzed HTA appraisals by the Pharmaceutical Benefits Advisory Committee (PBAC) and Canada’s Drug Agency (CDA-AMC) for NASs that received their first HTA recommendation between 2019 and 2023. Regulatory and HTA dates were sourced from public records. We implemented logistic regression to examine associations of HTA recommendation (optimal vs non-optimal). Linear regression was used to test associations of rollout time. Models were adjusted for submission sequence, country, therapeutic area, expedited review, conditional review, top R&D spenders, and year of HTA recommendation.
Results
229 HTA appraisals (126/229 parallel) were included. Parallel submissions were associated with a 14.0-month shorter rollout time compared to sequential submissions (p < 0.001). Rollout times in Canada were 6.0 months longer than those in Australia. Parallel submissions were associated with higher odds of receiving an optimal recommendation compared to sequential submissions (OR: 2.2; 95 percent CI: 1.2–4.2; p = 0.013). The odds of obtaining an optimal first HTA recommendation were higher in Canada than in Australia.
Conclusions
NASs following parallel submission showed faster rollout times than those following traditional sequential submission. Moreover, parallel submissions were associated with higher odds of receiving an optimal recommendation. These findings highlight the value of aligning regulatory and HTA processes.
The coupling between Rayleigh–Taylor (R–T) and Saffman–Taylor (S–T) instabilities, when a gas displaces a high-viscosity liquid, remains challenging to elucidate due to the unclear roles of density and viscosity contrasts. Counterintuitively, our radial Hele-Shaw cell experiments revealed that viscosity contrast – typically considered a damping factor – serves as the primary driver of instability. We observed that the glycerin–air interface, despite its higher viscosity, exhibits significantly greater instability than the water–air interface. This anomalous behaviour arises from the S–T mechanism, which accelerates the onset of nonlinearity and induces an early transition to fingering. We applied a unified model to decouple the competing influences of surface tension oscillation and viscous damping on R–T instability and the S–T destabilisation. Moreover, we proposed criteria for either mostly enhancing or completely freezing the instability. These findings offer valuable insights into manipulating hydrodynamic instabilities in contracting/expanding geometries through surface tension and viscosity.
High-intensity focused ultrasound (HIFU) is a non-invasive alternative to traditional surgery for detection and treatment. When HIFU targets a specific area, ultrasonic cavitation occurs with mechanical stress, causing tissue damage, a process that is significantly influenced by the surroundings. This paper presents a numerical study on the cavitation initiation and evolution mechanisms under focused ultrasonic waves considering the influence of a solid surface. Firstly, the dynamic property of focused ultrasonic waves and the generation of diffraction waves is explained based on the Huygens–Fresnel principle, and the prefocused phenomenon is analysed. Notably, the scenario considering the existence of a solid wall is discussed, with the corresponding cavitation clouds in a ‘tree-like’ pattern that can be generally divided into three or four subregions. The different initiation mechanisms of the near-wall cavitation clouds under a different relative distance between the theoretical focal point and the solid wall are discussed in detail. Finally, by considering the effects of the incident waves, scattered waves and their reflected waves on the solid wall, a wave superposition model is established that can clearly explain the distribution characteristics of the near-wall cavitation clouds with different modes. The understanding of the ultrasonic cavitation mechanism may support precise control in future HIFU applications.
This study revisits the long-standing consensus that the number and nature of basic-level administrative units in imperial China remained static over two millennia. It argues that this view underestimates the size and sophistication of field administration during the Northern Song dynasty (960–1127). During this period, towns (zhen) emerged as administrative centers, undertaking roles akin to the predominantly rural counties but within urban settings. Through a systematic analysis of the administrative functions of towns, this article reveals that approximately 30 percent of the 1,891 towns documented in 1085 were staffed by imperial officials and played a crucial role in delivering urban public goods such as fire prevention and law enforcement. In doing so, they supported the Song state’s extraordinary reliance on commercial taxation. These findings prompt a reassessment of the prevailing view in Chinese urban history that a disconnect between administration and commerce began during the Tang-Song transition.
Institutional investors conduct more governance research and are less likely to follow proxy advisor vote recommendations when a company’s bonds comprise a larger share of their assets. These findings are driven by bond holdings, shareholder proposals, and companies where fixed-income managers are more likely to be attentive and share an interest with equity investors in improving governance. The findings do not concentrate on companies or shareholder proposals where creditor–shareholder conflicts are likely. Overall, the findings suggest that corporate bond holdings influence how actively institutions monitor their equity positions and contribute to institutions’ overall incentive to be engaged stewards.
Regional survey of the Mountain Pine Ridge Forest Reserve, Cayo, Belize by the Rio Frio Regional Archaeological Project has revealed an expansive, ancient Maya granitic-rock extraction and ground stone tool crafting industry distributed across an 11 km2 region. To date, 16 extraction-workshop sites of varying size and compositional complexity totaling 100 ha or 1 km2 have been identified through a combination of ground-based reconnaissance and aerial LiDAR survey. This article introduces the two largest recorded to date, Buffalo Hill Quarries and Moshy’s Hill. Discussing them, we present an overview of the common attributes of the Mountain Pine Ridge quarry workshops including types of extraction sites (quarry pits, strip mines, and cut faces), structural components (bedrock pits and erected blocks), cached tools (hammerstones and pics), and discarded products (half-loaf and full-loaf forms and metates) found at them. As the type of sites presented here are new to archaeology, the article concludes with a series of questions to guide future work.