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This study aimed to identify the factors associated with mortality and the duration of hospital and paediatric intensive care unit (PICU) stay in children diagnosed with acute myocarditis (AM).
Methods:
This multicentre retrospective study was conducted across 11 PICUs over an 18-month period. Cases were classified as survivors or non-survivors, and comparisons were made between the two groups. The factors influencing hospital and PICU length of stay (LOS) were analysed only among survivors.
Results:
A total of 90 patients were included, of whom 54 (60%) were female. The PICU mortality rate was 21.1%. Significant differences between survivors and non-survivors were observed in sex distribution, presence of chronic disease, presenting symptoms (exercise intolerance and vomiting), hypoxia, hypotension, and tachycardia at admission, hospital LOS, intensive care scores, initial and peak pro-brain natriuretic peptide levels, initial and final left ventricular ejection fraction (LVEF), presence of cardiogenic shock, need for respiratory support, and use of inotropic agents (p < 0.05). Among survivors, younger age and lower initial LVEF were associated with longer PICU LOS, whereas higher intensive care scores and elevated cardiac biomarker levels showed positive correlations with both hospital and PICU LOS.
Conclusion:
In paediatric patients with AM, younger age, lower initial LVEF, and higher intensive care scores and cardiac biomarker values are associated with prolonged PICU stay. Early identification of these factors may help predict clinical course and optimise intensive care management.
Colchester Museums has collected Roman-period medical instruments from the town since the late nineteenth century. Brought together here, along with items from the town housed in other institutions, their typological links or differences are explored, along with their wide range of uses. They are set in a variety of contexts, including a conquest-period British Doctor’s kit from Stanway, near Colchester, the alloys used in their manufacture, their distribution across the town and its suburbs, the diseases evident from late Romano-British human remains in the town’s cemeteries, and herbal remedies and other treatments. Interpretation of a previously enigmatic collyrium stamp attests to an eye infection not previously recorded in Roman Britain.
Self-concept in adolescence plays a key role in psychological adjustment, yet its development in twins remains underexplored — especially in Central Europe. While previous studies suggest minor differences between monozygotic (MZ) and dizygotic (DZ) twins, cultural and contextual influences may affect how twins perceive themselves. This mixed-method study examined 336 Czech adolescent twins (168 twin pairs; 32 MZ, 136 DZ) aged 11–15 years. Participants completed three standardized instruments: the Behavioral and Psychological Adjustment Questionnaire (BPQA), the School Performance and Adjustment Scale (SPAS), and the Rosenberg Self-Esteem Scale (RSES). Quantitative analyses included t tests, Analyses of Variance (ANOVAs), and Pearson correlations. To triangulate findings, focus group interviews were conducted with three twin pairs and analyzed thematically. No statistically significant differences were found between MZ and DZ twins across BPQA, SPAS, and RSES measures. However, small, nonsignificant trends suggested slightly higher emotional self-concept scores in MZ twins. A modest gender difference emerged: girls reported more internalizing symptoms. Correlational analysis showed that lower behavioral difficulties were associated with higher school adjustment and self-esteem. Thematic analysis from focus groups confirmed key patterns such as the emotional safety of twinship and the struggle for individuality. Zygosity does not appear to be a major predictor of self-concept in early adolescence. Instead, self-perception in twins is shaped by a complex interplay of mental health, family dynamics, and peer context. Future research should compare twin self-concept development across cultures to further examine sociocultural influences.
In preparation for a planned change of Emergency Medical Services triaging of suspected stroke dispatch in Alberta, we conducted a modeling exercise to predict the return on investment (ROI) of switching from the current endovascular thrombectomy (EVT) within a 6 h window to a 24 h window.
Methods:
Using the Alberta Health Services administrative databases, we estimated the health service utilization (HSU) (including inpatient, outpatient, physician services and prescription drugs) cost of patients with stroke treated with EVT24h following the case-mix group plus methodology. The impact of EVT on HSU cost avoidance (B) and the cost (C) of EVT24h implementation were estimated, including costs for EVT procedure, diagnostic imaging and ambulance for all suspected strokes. Finally, ROI was calculated as the benefit divided by the cost (ROI = B/C). Threshold, deterministic and probabilistic sensitivity analyses were performed.
Results:
There were 288 patients treated with EVT24h between 2021/22 and 2023/24. The HSU cost per patient in the year following EVT treatment was estimated at $92,201. Given the impact of EVT was 30%, the benefit of EVT was estimated at $39,515. The cost of EVT24h implementation was $24,358 per EVT patient. Accordingly, ROI was estimated at 1.6 (ranged 0.7−2.0), and cost avoidance per patient was $15,157 (ranged − $8013 to $25,362). Given that there were 96 EVT24h per year, the cost avoidance for the health system would be $1.5 million annually. The probabilistic sensitivity analysis showed that the probability for EVT24h to be cost-avoidable (or ROI > 1) was 88.5%.
Conclusion:
The expansion of EVT from 6 to 24 h is expected to result in a positive ROI.
Over the last 20 years, many countries have experienced the rise of radical right-wing populist (RRP) actors that threaten democratic governance, including in Latin America. These actors have deployed a variety of discursive frames based on economic grievances and (perceived) changing social values. The 2018 elections in Costa Rica were part of this phenomenon: a right-wing populist outsider presidential candidate deployed several frames and earned the most votes in the first round of voting. We analyze support for this candidate to understand which sectors of society were galvanized by the deployment of economic, anti-establishment, and cultural frames. We find that economic frames had much weaker traction than anti-establishment and cultural frames and that opposition to same-sex marriage was the frame with the strongest galvanizing effect across a wide range of demographic groups, beyond the expected ones. These findings support extant scholarship demonstrating the effective politicization of cultural issues by RRP actors for electoral purposes.
Currently, market demand indicates a trend towards the use of milk proteins in food products. Technological innovations in milk protein production have facilitated the development of new products that can be adapted to various food systems. Despite the growing use of milk protein concentrates (MPCs), much remains to be understood regarding how the interactions between these proteins can lead to a more cost-effective ratio and better utilization of their properties. Although a variety of MPCs are available in the market, the industry may face difficulties replacing one brand's product with another. This is because although the products have the same protein content, their production history can interfere with their technological properties. Therefore, the objective of this study was (a) to create a protocol for analyses that allows the segregation of MPCs based on their key characteristics and, using these results and statistical treatments, (b) to develop a diagram to guide the industry, research and development sectors, and/or procurement departments on the potential application of these products and even the possible substitution of one MPC for another. To this end, nine MPC brands were classified based on their rehydration capacity, browning potential, foaming ability and thermal stability. The results of each analysis were scored to generate a rating that classified the samples and enabled the creation of a technological application diagram.
Freyberg Place in Auckland’s central business district has emerged as a focal site for youth cultural gatherings. Within this space, university students have localised transnational popular culture, generating new cultural meanings, identities, and affiliations. Over the past decade, Hallyu, and K-pop in particular, has expanded significantly in Aotearoa, New Zealand. This study draws on personal accounts from university student K-pop fans of diverse backgrounds, with attention to their involvement in Auckland’s K-festival, random play dances, and the University of Auckland K-pop Planet club and its Konstellation dance crew. These narratives demonstrate how participation in K-pop activities facilitated adaptation to the residential, social, and academic challenges of university life, while simultaneously fostering peer networks and community belonging. Engagement in these events also enabled students to acquire leadership experience and transferable skills relevant to future employment. Face-to-face fan practices and embodied participation through dance provided an avenue for affective immersion, reinforcing identification with global fan networks. For these students, K-pop constituted both an alternative to Western popular music and a medium through which they articulated transnational identities, positioning themselves as globally connected cultural consumers.
Recent work in variationist sociolinguistics has argued for greater interactional accountability in analyses of linguistic variation. The present article contributes to this line of inquiry by exploring the interactional conditioning of a relatively new pronoun – man – in two datasets: (i) a corpus of speech and social media data from young people in East London recorded in 2016/17 and (ii) a more recent social media corpus of fifty English-language TikTok videos and their comments. Analyses reveal that man is principally used as a third-person singular pronoun (man said ‘one two five’) and less often as a first-person singular pronoun (man’s doing that voice recording thing) contra to previous findings. I argue that third-person singular man is most commonly used in so-called moments of ‘byplay’ in which the interlocutor is temporarily excluded from the discourse. In this context, man draws attention to the actions or comments of an interlocutor, typically for ridicule or emphasis. I then briefly consider the relationship of man to the pronominal use of bro (bro said ‘he’s going to heaven’) before speculating that the interactional potentials of man/bro could, potentially, promote their diffusion beyond the communities in which they first emerged.
Proponemos un ajuste a la secuencia cronológica del Laja Alto, establecida originalmente por Braniff (1972). El resultado del ajuste es una cronología que inicia cuatro siglos más tarde que la propuesta inicial. La principal implicación de este ajuste es que muestra la invalidez de las propuestas que han considerado al tipo San Miguel Rojo sobre Bayo del río Laja como un proto Coyotlatelco o proto tolteca, que funcionaría como indicador de migraciones masivas del norte al centro de Mesoamérica. El ajuste a la cronología del Laja Alto y el reciente ajuste a la cronología de la región de Tula (Healan et al. 2021) muestran que el San Miguel Rojo sobre Bayo y el Rojo sobre Bayo Coyotlatelco aparecen de manera sincrónica en ambas regiones y su presencia se debe no a una migración masiva norte–centro sino a otro tipo de interacción social entre regiones donde el factor clave parece ser Teotihuacan. Por otro lado, existe suficiente evidencia empírica para proponer la correlación de la zona arqueológica Cañada de la Virgen con Colhuacan Chicomoztoc, el lugar de origen nahua norteño y santuario de peregrinación multi-étnico referido en las fuentes históricas de diferentes pueblos.
An underactuated nonholonomic autonomous robot with a Dubins car kinematics navigates through a planar environment that hosts an unpredictably moving rigid formation of point-wise targets. Both the number of the targets and their geometric configuration are unknown. The robot measures the relative positions of the targets within a limited sensing range but has no access to their velocities or other kinematic parameters. The robot has to approach the formation, and to subsequently move so that first, all targets are surrounded by the robot’s path, and second, a predefined distance to the currently nearest target is maintained. However, a lower bound on the turning radius of the robot typically makes perfect achievement of the second objective impossible since different targets become the nearest to the robot in the course of its movement. So a scheme for on-the-fly synthesis of a feasible and somewhat optimal approximation of the ideal circumnavigation path is offered. Based on this development, the paper presents a computationally efficient control law that accomplishes the mission as much as possible. The effectiveness of the advocated approach is justified by mathematically rigorous proofs of nonlocal convergence and is confirmed by simulation tests and experiments with real robots.
Traditional category theory is typically based on set-theoretic principles and ideas, which are often nonconstructive. An alternative approach to formalizing category theory is to use e-category theory, where hom sets become setoids. Our work reconsiders a third approach – p-category theory – from Čubrić et al. (Mathematical Structures in Computer Science 8(2) 153–192, 1998) emphasizing a computational standpoint. We formalize in Rocq a modest library of p-category theory – where homs become subsetoids – and apply it to formalizing algorithms for normalization by evaluation, which are purely categorical but, surprisingly, do not use neutral and normal terms. Čubrić et al. (Mathematical Structures in Computer Science 8(2) 153–192, 1998) establish only a soundness correctness property by categorical means; here, we extend their work by providing a categorical proof also for a strong completeness property. For this, we formalize the full universal property of the free Cartesian-closed category, which is not known to have been performed before. We further formalize a novel universal property of unquotiented simply typed $\lambda$-calculus syntax and apply this to a proof of correctness of a categorical normalization by evaluation algorithm. We pair the overall mathematical development with a formalization in the Rocq proof assistant, following the principle that the formalization exists for practical computation. Indeed, it permits extraction of synthesized normalization programs that compute (long) $\beta$$\eta$-normal forms of simply typed $\lambda$-terms together with a derivation of $\beta$$\eta$-conversion.
Myopia is an increasing global health concern and a leading cause of visual impairment. Genetic factors play a major role, and polygenic risk scores (PRSs) may help identify children at high risk of developing myopia. However, most PRSs are based on European populations, and accurately predicting risk across ancestries remains a challenge. We developed and evaluated PRSs for spherical equivalent refractive error (SER) and myopia using multitrait and multi‑ancestry genomewide association study data. A multitrait analysis of SER‑correlated traits identified 709 genomewide significant loci. PRSs were generated with SBayesRC for each ancestry group and for a combined multi‑ancestry model, and validated in the Australian Twins Eye Study and non‑European participants from the UK Biobank. The European PRSs explained approximately 20% of SER variance in Europeans and 18% in admixed Europeans and showed good transferability to South Asian (14%), East Asian (13%), and African (8%) groups. A multi‑ancestry PRS further improved prediction in Africans, explaining 9% of the variance. Predictive accuracy for high myopia was strong in the admixed group (AUC = 0.82, 95% CI [0.78, 0.87]), with all ancestry groups achieving AUCs of at least 0.70; European ancestry data were not available. PRS also predicted axial length in children, particularly those aged 5–8 years, where individuals in the lowest 10% of the PRS distribution had significantly longer axial lengths (β = 0.81 mm, p = 5.71 × 10−3). These findings enhance genetic prediction of SER and myopia, showing the potential of multitrait, multi-ancestry PRS for early, equitable risk stratification.
Only less than 2% of bat species use modified leaves as roosts called ‘tents’. Few systematic surveys have been conducted to assess the abundance, diversity and density of tent-roosting bats and their tents. We present new records of plants used as tents and a new record of a tent-roosting bat species resulting from the first-ever bat tent survey conducted in the northern Atlantic Forest of Brazil. After two field visits for active search in the Murici Ecological Station (MES) in Alagoas state, 45 tents were found, with a density of three tents per hectare in a covered area of 3,340 m2 (0.34 ha). Three umbrella-type tents housed one individual of Artibeus obscurus each, all constructed on leaves of the hemi-epiphyte Philodendron ornatum (Araceae). This is the first record of A. obscurus using and probably modifying leaves to use them as a roost. One boat-type tent harboured two Vampyressa pusilla on the hemi-epiphyte Philodendron fragantissimum, representing the northernmost records of tents in the Atlantic Forest and for northeastern Brazil. The MES represents an important area for protecting tent-roosting bats in northeast Brazil, given the extensive historical deforestation and habitat loss within the Pernambuco Endemism Center and the northern Atlantic Forest.
Common law courts will enforce jurisdiction agreements unless they find ‘strong cause’ or ‘strong reasons’ not to. This article argues that the strong cause test is the product of the fact that jurisdiction agreements should generally be viewed as weighty factors under forum non conveniens. In particular, this is because a jurisdiction agreement reflects parties’ well-informed view that their chosen court is the appropriate forum for their dispute, to be departed from only in exceptional circumstances. This account explains various features of the strong cause test which otherwise prove difficult to rationalise, and also holds implications for the law’s treatment of non-exclusive jurisdiction agreements and contractual anti-suit injunctions.
This article reconsiders the prevailing “limited use norm” surrounding Canada’s notwithstanding clause, which holds that its invocation should be rare. Through a comprehensive analysis of archival documents, legislative debates and firsthand accounts, it demonstrates that the arguments for this norm proposed in the academic literature rest on a selective reading of framers’ intent, political practice and textual safeguards. Proponents of the norm rely disproportionately on statements from anti-notwithstanding clause framers such as Pierre Trudeau and Jean Chrétien while overlooking the instrumental role played by provincial premiers Peter Lougheed, Allan Blakeney and Sterling Lyon. These premiers opposed the entrenchment of the Charter of Rights and Freedoms and saw the notwithstanding clause as a legitimate tool to protect parliamentary sovereignty. By recovering this neglected alternative vision, the article offers a more complete historical account for understanding the provinces’ increasing willingness to invoke the notwithstanding clause today.