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Persistent affective disturbance is a core, disabling feature of major depressive disorder (MDD), thought to stem from a dysfunctional interaction between emotional bias and cognitive control. However, the underlying neural dynamics are debated, with studies reporting both hyper- and hypoactivation. This study utilized high-temporal-resolution electroencephalogram (EEG) to resolve this discrepancy by examining distinct stages of emotional information processing.
Methods
We recruited 175 medication-free patients with MDD (Hamilton Depression Rating Scale-17 ≥ 14) and 101 healthy controls (HCs) who completed an emotional Stroop task while an EEG was recorded. We analyzed event-related potentials reflecting conflict monitoring (N250), inhibition (N450), and resolution (LSP) using a 2 (group) × 2 (valence) × 2 (congruency) analysis of variance.
Results
Results revealed a stage-specific neural cascade. Compared to HCs, the MDD group showed: (1) hypoactivation during initial conflict monitoring (attenuated N250 amplitude); (2) compensatory hyperactivation during conflict inhibition (a significant N450 interaction revealed generalized conflict activity in MDD, unlike the context-specific response in HCs); and (3) subsequent hypoactivation during conflict resolution (reduced LSP amplitude for negative stimuli). Crucially, altered N450 correlated with depression severity, and the entire neural cascade predicted behavioral performance.
Conclusions
The apparent contradiction in the literature reflects a multistage process. MDD is characterized by an inefficient neural cascade: an initial deficit in conflict monitoring is followed by compensatory overactivation during inhibition, which ultimately proves insufficient, leading to impaired late-stage resolution. This temporally specific model advances our understanding of the pathophysiology of depression and identifies potential stage-specific targets for intervention.
In 1988, during the abolition centennial in Brazil, Verdi’s Aida and Carlos Gomes’s Lo schiavo were perceived and pitched as abolitionist operas thanks to events that unfolded at their stagings one hundred years earlier in Rio de Janeiro. Both operas stirred controversy by being recreated in productions intended to correct historical inaccuracies and unjust erasures, primarily in the context of African slavery, but with unexpected cultural and political repercussions. This article examines connections between operatic performances and social activism, discussing the role of opera singers in promoting an aesthetic of sensibility within the abolitionist movement of the 1880s, but also considering how the most controversial aspects of the nineteenth-century abolitionist movement resonate with issues debated in the 1988 productions.
A self-binding directive (SBD) can be included in mental health advance decision documents to request future involuntary treatment. SBDs are supported by service users but controversial and empirical evidence on their application is scarce. Here we present a first case report which describes the experience of a service user with bipolar disorder (hereafter ‘bipolar’) who has chosen to use an SBD. We compare the findings of the case report with results from a systematic review of reasons for and against SBDs. We discuss that the experience of the service user supports SBDs as a tool to maximise autonomy and challenge criticisms around negative liberty, implementation, capacity assessment, and harms. We conclude that this case report adds to mounting evidence that SBDs are a feasible, ethically justifiable intervention, supported by service users. Policy makers should consider supporting SBD implementation strategies within crisis care.
Bipolar disorder and attention-deficit/hyperactivity disorder (ADHD) share overlapping clinical symptoms and cognitive deficits. Up to 20% of individuals with bipolar disorder also meet the criteria for ADHD (bipolar disorder + ADHD), a subgroup that may experience greater cognitive and functional impairments than those with bipolar disorder or ADHD alone.
Aims
To (a) characterise cognitive profiles in bipolar disorder, ADHD and bipolar disorder + ADHD compared with healthy controls; (b) examine associations between cognitive and occupational functioning; and (c) investigate associations between cognitive function and polygenic scores (PGS) for bipolar disorder, ADHD and educational attainment.
Method
In this observational study, 477 euthymic individuals with bipolar disorder (including 78 with bipolar disorder + ADHD), 59 adult individuals with ADHD and 171 healthy controls completed standardised neuropsychological testing. Full-scale IQ and final school grades indexed current and premorbid cognitive ability, respectively. Occupational functioning was evaluated both cross-sectionally and through 5 years of registry-based follow-up. PGS were available for 295 bipolar disorder and 132 healthy control participants.
Results
All patient groups performed significantly below healthy controls across most cognitive domains. Bipolar disorder + ADHD exhibited poorer working memory than bipolar disorder (d = −0.35, 95% CI [−0.66, −0.03]). Occupational function was lowest in bipolar disorder + ADHD (versus bipolar disorder, d = −0.44, 95% CI [−0.69, −0.19]). In bipolar disorder, poorer executive function (standardised regression coefficient (standβ) = 0.20, 95% CI [0.09, 0.31]) and older age predicted reduced occupational outcomes. PGS for educational attainment was associated positively with cognition in both bipolar disorder (working memory: standβ = 0.19, 95% CI [0.08, 0.30]) and healthy controls (executive function: standβ = 0.20, 95% CI [0.09, 0.32]), while PGS for bipolar disorder or ADHD were not significantly associated with cognitive performance.
Conclusions
Individuals with bipolar disorder + ADHD showed disproportionate working memory and functional impairment compared with bipolar disorder or ADHD alone. Executive function is a key predictor of occupational outcomes in bipolar disorder and is partly shaped by genetic propensity for educational attainment. These findings highlight the importance of considering ADHD comorbidity and cognitive profiles when evaluating functional prognosis and tailoring interventions.
This article focuses on unilateral sovereignty referendums pursued by territorial autonomies. Due to their unilateral character, such referendums are unlikely to gain external recognition and, as a result, fail to effect or prevent any de jure change in sovereignty. However, they are still pursued despite these constraints, suggesting that they serve purposes other than formal changes in sovereignty. To explain this phenomenon, the article proposes a framework of seven potential motivations. The framework is examined through the case of Gagauzia’s 2014 referendums, which addressed two key issues: Moldova’s foreign alignment and Gagauzia’s deferred independence. The analysis follows three referendum stages — proposal, initiation, and implementation — focusing on the dual leadership of the executive and legislative branches. Drawing primarily on newspapers affiliated with these branches, the study finds empirical support for three key motivations: advancing the individual and collective political interests of autonomy leadership, strengthening Gagauzia’s ties with its patron (Russia), and empowering the territorial autonomy vis-à-vis the parent state (Moldova). This article contributes a framework of motivations for unilateral sovereignty referendums tailored specifically to territorial autonomies, going beyond existing explanations developed for all polities. It also provides a detailed account of one of the most significant political events in Gagauzia’s history.
For much of imperial Chinese history, chroniclers and explorers understood a maritime land called Liuqiu to be the Ryūkyūs. In the early twentieth century, however, a new dynastic history claimed that Liuqiu was in fact Taiwan. This article explores how and why an uncontested and unambiguous understanding of Chinese maritime history was suddenly rewritten in the modern world, becoming the accepted interpretation and shaping twenty-first century geopolitics. While scholars have weighed the veracity of Liuqiu as either Taiwan or Ryūkyū, this article focuses on how the Liuqiu–Taiwan thesis was produced and transmitted, showing how scientific methodology, imperialism, and nationalism worked to reshape geographical history. The article further contributes to an understanding of the shaping of the borders and claims of the modern Chinese nation: whereas scholars have investigated late Qing and early Republican debates over the western frontier and ethnicities, this article shows that questions over Taiwan were just as important.
The European praying mantis, Mantis religiosa (Linnaeus, 1758) (Mantodea: Mantidae), is an introduced predatory insect established in southwestern and southeastern Canada and much of the United States of America. Despite over a century of records, the geographic origins of North American populations have remained unclear. We analysed 807-bp fragments of the mitochondrial CO1 gene from 17 sequences from southern Quebec and Ontario, Canada, comparing them to 175 sequences from western, eastern, and southern Europe. Population genetics analyses revealed that Canadian samples carry haplotypes from two divergent lineages that co-occur in a localised region of western France. These haplotypes showed the closest affinities to others also found in France, strongly supporting a French origin. Historical records from Rochester, New York, United States of America, where M. religiosa was first documented in 1899, suggest introduction via the 19th-century horticultural trade. The low haplotype diversity in Canada may reflect founder effects or environmental filtering, though additional, undetected introductions remain possible. This study clarifies the likely French source of M. religiosa in southeastern Canada and underscores the value of combining molecular data and historical accounts to track invasion pathways.
Let $f \in \mathbb{Q}[x]$ be a square-free polynomial of degree at least $3$, $m_i$, $i=1,2,3$, odd positive integers, and $a_i$, $i=1,2,3$, non-zero rational numbers. We show the existence of a rational function $D\in \mathbb{Q}(v_1,v_2,v_3,v_4)$ such that the Jacobian of the quadratic twist of $y^2=f(x)$ and the Jacobian of the $m_i$-twist, respectively, $2m_i$-twist, of $y^2=x^{m_i}+a_i^2$, $i=1,2,3$, by $D$ are all of positive Mordell–Weil ranks. As an application, we present families of hyperelliptic curves with large Mordell–Weil rank.
In a game with costly information acquisition, the ability of one player to acquire information directly affects her opponent’s incentives for gathering information. Rational inattention theory then posits the opponent’s information-acquisition strategy is a direct function of these incentives. This paper argues that people are cognitively limited in predicting their opponent’s level of information, and hence lack the strategic sophistication that the theory requires. In an experiment involving a real-effort attention task and a simple two-player trading game, I study the ability of subjects to (1) anticipate the information acquisition of opponents in this strategic game, and (2) best respond to this information acquisition when acquiring their own costly information. I study this by exogenously manipulating the difficulty of the attention task for both the player and their opponent. Predictions of behavior are generated by a novel theoretical model in which Level-K agents can acquire information à la rational inattention. I find an out-sized lack of strategic sophistication, driven largely by the cognitive difficulties of predicting opponent information. These results suggest a necessary integration of the theories of rational inattention and costly sophistication in strategic settings.
Vitamin B6 is implicated in multiple mental disorders, and accumulating evidence suggests an inverse relationship with depression; however, important aspects of the underlying dose–response patterns and the roles of individual circulating vitamin B6 metabolites remain incompletely understood. We analyzed data from the National Health and Nutrition Examination Survey (NHANES) 2005–2010. Depression was defined as a Patient Health Questionnaire-9 (PHQ-9) score ≥10. Vitamin B6 status was assessed using serum pyridoxal 5′-phosphate (PLP), the biologically active coenzyme form, and 4-pyridoxic acid (PA), the principal catabolic and urinary excretion product of vitamin B6. Among 12,620 participants, 1,070 (8.5%) met criteria for depression. After adjusting for relevant covariates, multiple logistic regression revealed that individuals in higher quartiles of serum PLP and PA (Q2-Q4) had significantly lower odds of depression compared to those in the lowest quartile (Q1). Restricted cubic spline analyses identified nonlinear relationships: L-shaped for PLP (P-nonlinearity=0.001) and U-shaped for PA (P-nonlinearity=0.017). Below the inflection points (90.7 nmol/L for PLP; 73.9 nmol/L for PA), both metabolites showed significant inverse associations with depression (PLP: OR=0.992, 95%CI: 0.988–0.996, P<0.001; PA: OR=0.994, 95%CI: 0.993–0.996, P<0.001). Above these thresholds, the association became non-significant for PLP (P=0.353), while PA demonstrated a positive association with depression (OR=1.008, 95%CI: 1.002–1.013, P<0.01). Subgroup analyses confirmed the robustness of these inverse associations across demographic categories. Serum vitamin B6 metabolites, PLP and its excretion product PA, exhibit non-linear associations with depression, with distinct threshold effects and metabolite-specific patterns that likely reflect both vitamin B6 availability and turnover.
A particular fashion and lifestyle aesthetic called kankokuppo (Koreaish) has gained popularity among young Japanese women in the early 2020s, who increasingly admire what they perceive to embody the “atmosphere (fun’iki)” of South Korea. This article examines the semiotic rendering of a sensuous perception of Korea identified as “Koreaish” through aesthetically embodied practices and mediatized discourses. The analysis reveals the centrality of what I call a “soft unity”: softness that arises from ambiguated boundaries, taken up across discrete objects, practices, and social value regimes. Alongside growing calls to change Japanese society from a divisive to a borderless one, this softness is valorized as the quality of idealized sociality despite its association with highly normative femininity. The emergent “Koreaish” is emblematic of the postfeminist reformulation of the feminine ideal in neoliberal Japan, which manifests as a nexus of the demanifestation of differences and the reversion to conservative feminine values.
Human papillomavirus (HPV) infection has a negative impact on quality of life (QoL) and sexual function, mainly owing to increased levels of anxiety and distress.
Aims
To examine the potentially moderating effects of general psychological health on the relationships between (a) HPV-related psychosocial burden and QoL and (b) HPV-related psychosocial burden and sexual function.
Method
The HPV Impact Profile, Female Sexual Function Index, General Health Questionnaire-28 and Life Satisfaction Inventory questionnaires were completed by 151 women.
Results
HPV-related psychosocial burden and general psychological health accounted for 23.2% of QoL variability. There was not strong evidence for a moderating effect of general psychological health on the relationship between HPV-related psychosocial burden and QoL. Higher HPV-related psychosocial burden predicted worse sexual function on average. However, HPV-related psychosocial burden accounted for only 4.1% of sexual function variability.
Conclusions
Higher HPV-related psychosocial burden is associated with lower QoL as well as worse sexual function. General psychological health predicts changes in QoL over and above HPV-related psychosocial burden; thus, a deep understanding of emerging mental health issues soon after diagnosis is crucial to improve counselling and enhance women’s mental empowerment to achieve a better psychological response.
Health Technology Assessment (HTA) guides healthcare decision-making, while Implementation Research (IR) addresses challenges in operationalizing these decisions. The SAVING (Sustainable Access and Delivery of New Vaccines in Ghana) Consortium aims to enhance health intervention delivery in Ghana, focusing on HTA evidence. This study identifies barriers to the application of HTA-related evidence (cost analysis) in coronavirus disease 2019 (COVID-19) vaccine deployment in Ghana.
Methods
This qualitative exploratory study purposively selected 12 key stakeholders with high interest and power relating to COVID-19 vaccine deployment in Ghana. Through in-depth interviews, seven stakeholders from diverse sectors contributed insights into barriers to the application of HTA-related evidence. Thematic analysis was conducted with narrative reporting supported by direct quotes for substantiation.
Results
Six main barriers were identified: (1) timing and access to HTA reports, (2) technical complexities, (3) relevance of content, (4) political considerations and power dynamics, (5) health system fragmentation, and (6) poor responsiveness of decision-makers to research. Proposed solutions include engaging political decision-makers continuously, simplifying technical reports, aligning report content with policymakers’ needs, reducing political considerations, enhancing capacity building, fostering health system cohesion, and improving responsiveness to research.
Conclusions
HTA is vital for informed healthcare decisions. However, technical complexity, relevance of content, inappropriate timing, and lack of access to HTA reports, among other barriers, prevent the uptake of HTA findings. Continuous and improved engagement between HTA producers and policymakers, along with rapid production of HTA, has the potential to improve the uptake of HTA findings, even during public health emergencies.
To assess the feasibility of using large language models (LLM) to develop research questions about changes to the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) food packages.
Design:
We conducted a controlled experiment using ChatGPT-4 and its plugin, MixerBox Scholarly, to generate research questions based on a section of the U.S. Department of Agriculture (USDA) summary of the final public comments on the WIC revision. Five questions weekly for 3 weeks were generated using LLM under two conditions: fed with or without relevant literature. The experiment generated ninety questions, which were evaluated using the Feasibility, Innovation, Novelty, Ethics and Relevance criteria. t tests and multivariate regression examined the difference by feeding status, artificial intelligence model, evaluator and criterion.
Setting:
The United States.
Participants:
Six WIC expert evaluators from academia, government, industry and non-profit sectors.
Results:
Five themes were identified: administrative barriers, nutrition outcomes, participant preferences, economics and other topics. Feeding and non-feeding groups had no significant differences (Coeff. = 0·03, P = 0·52). MixerBox-generated questions received significantly lower scores than ChatGPT (Coeff. = –0·11, P = 0·02). Ethics scores were significantly higher than feasibility scores (Coeff. = 0·65, P < 0·001). Significant differences were found between the evaluators (P < 0·001).
Conclusions:
The LLM applications can assist in developing research questions with acceptable qualities related to the WIC food package revisions. Future research is needed to compare the development of research questions between LLM and human researchers.
The focus of existing research on perceived organizational support (POS) has largely been concentrated at the individual-level, leaving an understudied gap at a higher unit-level of analysis. This study aims to fill this gap by examining the multilevel relationship between employee POS and job satisfaction, emphasizing the moderating role of unit-level POS. We hypothesize, based on POS theory and social comparison theory, that unit-level POS serves as a contextual moderator for the relationship between individual-level POS and job satisfaction. Additionally, at the unit-level, we identify clan culture values and unit-satisfaction as correlates of unit-POS. We test our hypotheses using a Bayesian Multilevel Structural Modeling approach on 45 work units and 317 employees. The results show that at low levels of unit-level POS, individual-level POS is more important for employees’ job satisfaction. We furthermore found support for a positive association between unit-level POS, unit-clan culture, and unit satisfaction. Our results, and their notable theoretical and practical implications, are discussed.
In March 2019, flooding of the Missouri River and its tributaries destroyed infrastructure and farmland and affected communities, including those in the state of Nebraska. The objective of this study was to assess emergency preparedness and satisfaction with flood response, recovery, and relief efforts 5 years following the 2019 floods in rural eastern Nebraska.
Methods
Using stratified simple random sampling, this study surveyed 13 Nebraska communities to assess emergency preparedness and satisfaction with flood response, recovery, and relief efforts 5 years following the 2019 Missouri River Flood. Descriptive statistics are reported.
Results
Households impacted by the 2019 Nebraska flood reported worsening physical and mental health symptoms and identified major gaps in communication, long-term mental health support, and infrastructure resilience. Self-reported preparedness improved post-flood. Inadequate early warnings and poor information dissemination eroded trust.
Conclusions
There are persistent mental and physical health impacts resulting from exposure to the 2019 Missouri River floods that can impact communities’ ability to respond and recover from subsequent hazards. Evaluating the impacts of previous disasters is a critical component of increasing community resiliency and local public health and emergency preparedness capacity to serve these populations.