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Oral anticoagulation (OAC) prevents stroke in atrial fibrillation, yet a residual stroke risk remains. In this single-center retrospective analysis of acute ischemic stroke patients despite OAC, suboptimal OAC treatment is common (30%: inappropriate dosing (17%); patient non-adherence (13%)). Other causes of stroke included OAC interruption (14.5%), a competing stroke mechanism (11.0%), and undetermined breakthrough stroke in 44.5%. Overall, easily modifiable causes of ischemic stroke despite OAC are common. Accordingly, strategies to improve treatment compliance, including appropriate dosing along with guideline-based risk factor and periprocedural OAC management, should be emphasized to improve secondary stroke prevention in this patient population.
East Central Europe played a crucial role in shaping the development of sexual science from the 1870s onwards. The life-histories of influential and well-known figures such as Sigmund Freud (born in Freiberg/Příbor), Magnus Hirschfeld (born in Kolberg/Kolobrzeg) and Karl Maria Kertbeny (born in Vienna, based in Budapest) reveal the imperial interconnectedness of East Central Europe with what would become Western Europe. By 1932, when the World League for Sexual Reform held its congress in Brno (following previous meetings in Berlin, London, Vienna, and Copenhagen), the society had established branches across the region, including Poland, Austria, and Czechoslovakia. In that same year, Poland decriminalised homosexual acts. Yet, East Central Europe is often neglected in the history of sexology and little is known about how sexual science in these regions shaped, and was shaped by, global networks of knowledge production. Indeed, despite recent attempts to demonstrate the ways in which sexual science was a truly global enterprise, East Central Europe remains to be fully incorporated into our mapping of the global networks of sexological dialogue and exchange.1 This is especially true of scholarship on the period after the Second World War. Historians have tended to misconstrue the transnational nature of sexual science in East Central Europe both before and after 1945. First, the contribution of East Central Europeans to European cultures of scientific exchanges has been obscured by the tendency of much historical writing to focus on a small number of key pioneers (Krafft-Ebing, Magnus Hirschfeld, Sigmund Freud and Havelock Ellis). Second, it is assumed that East Central European sexual science was largely cut off from international networks of knowledge exchange after the Second World War following the onset of the Cold War.2 Third, there are preconceived notions that communist authoritarian governments, having curtailed political freedoms and economic entrepreneurialism, must have also taken a repressive stance against sexual expression.3 Fourth, the dominance of 1989 as the fundamental caesura has encouraged a periodisation that fails to draw enough attention to the shifts in transnational patterns of knowledge exchange around sexual politics during the period 1945 to 1989 and fails to identify key continuities that link the sexual politics of the contemporary world with those of the communist period. None of these assumptions can withstand scrutiny, as the articles in this forum reveal. Building on a recent boost in scholarly interest in the sexual histories of the region,4 we present a collection of papers that each detail the transnational connections of local sexual experts in creating sexual knowledge both before and during state socialism.5
A key question in the theory of migration and in public debates on immigration policies is when migration can be said to be voluntary and when, conversely, it should be seen as nonvoluntary. In a previous article, we tried to answer this crucial question by providing a list of conditions we view as sufficient for migration to be considered nonvoluntary. According to our account, one condition that makes migration nonvoluntary is when people migrate because they lack acceptable alternatives to doing so. In this article, we take the opportunity to further explore and clarify this crucial condition. More specifically, we focus on two main sets of questions. First, we ask whether migration is always voluntary when it serves goals that are voluntarily chosen, and whether those who decide to migrate voluntarily but only have the option of choosing among a limited set of dangerous, harmful, or illegal means for doing so, can be said to be forced to choose those means. Second, we ask whether what counts as “nonacceptable” alternatives should also include cases in which people could have their needs and fundamental rights met, but at the cost of betraying their moral principles or conceptions of the good.
Mosquito-borne disease is a significant public health issue and within Australia Ross River virus (RRV) is the most reported. This study combines a mechanistic model of mosquito development for two mosquito vectors; Aedes vigilax and Aedes camptorhynchus, with climate projections from three climate models for two Representative Concentration Pathways (RCPs), to examine the possible effects of climate change and sea-level rise on a temperate tidal saltmarsh habitat in Perth, Western Australia. The projections were run under no accretion and accretion scenarios using a known mosquito habitat as a case study. This improves our understanding of the possible implications of sea-level rise, accretion and climate change for mosquito control programmes for similar habitats across temperate tidal areas found in Southwest Western Australia. The output of the model indicate that the proportion of the year mosquitoes are active increases. Population abundances of the two Aedes species increase markedly. The main drivers of changes in mosquito population abundances are increases in the frequency of inundation of the tidal wetland and size of the area inundated, increased minimum water temperature, and decreased daily temperature fluctuations as water depth increases due to sea level changes, particularly under the model with no accretion. The effects on mosquito populations are more marked for RCP 8.5 when compared to RCP 4.5 but were consistent among the three climate change models. The results indicate that Ae. vigilax is likely to be the most abundant species in 2030 and 2050, but that by 2070 Aedes camptorhynchus may become the more abundant species. This increase would put considerable pressure on existing mosquito control programmes and increase the risk of mosquito-borne disease and nuisance biting to the local community, and planning to mitigate these potential impacts should commence now.
We explore ${\rm CO}_2$ injection into a layered permeable rock consisting of high permeability reservoir layers, separated by low permeability mudstone, and taking the shape of an anticline within a laterally extensive aquifer. We first show how the storage capacity of the formation depends on the capillary entry pressure of the inter-layer mudstone, so that ${\rm CO}_2$ cannot flow from one layer into the next. We then consider a formation composed of two layers, overlain by a cap rock. For injection into the lowest layer, we show that the injection rate, capillary entry pressure and buoyancy driven flux through the mudstone determine whether the lower or upper layer fills to the spill point first. We also show that at the end of the injection phase, ${\rm CO}_2$ may continue to flow from the lower to the upper layer. This implies that injection should be stopped once the injected volume matches the static capacity of the formation in order to prevent spilling after injection. We present a series of analogue experiments of a two layered system that illustrate some of the principles described by the model, and assess the implications of the results for field scale systems.
Over the course of 2021, several local councils across the island of Ireland introduced motions recognizing the ‘Rights of Nature’. To date, little research has been conducted into these nascent Rights of Nature movements, even though they raise important questions about the philosophical, cultural, political, and legal drivers in pursuing such rights. Similarly, much remains unclear as to the implications of such initiatives, both in their domestic context and for Rights of Nature movements around the world. This article contributes to addressing this gap by exploring these themes through an analysis of interviews with key stakeholders conducted across the island of Ireland in June 2022. In particular, it explores the impact of international movements, colonial legacies, cultural heritage, and years of inadequate environmental governance, in motivating local councils to pursue a Rights of Nature strategy.
Climate change challenges the means of subsistence for many, particularly in the Global South. To respond to the challenges of climate change, countries increasingly resort to resettling those most affected by land erosion, heat, drought, floods, and the like. In this article, I investigate to what extent resettlement can compensate for the harm that climate-induced migration brings. The first harm I identify is that to individual autonomy. I argue that climate change changes the options of those affected by it to the point that the decision to migrate can no longer count as a voluntary one. In some cases, I argue, the conditions of climate change coerce individuals. Second, I suggest that climate-induced migration severs the ties to territory, explaining the constitutive nature of such ties for accounts of individual autonomy. Third, I argue that severing ties with a traditional and historical territory challenges the capacity to imagine a future for individuals. I conclude that resettlement, even if actively planned and chosen, possibly providing gains in individual well-being and human flourishing, nevertheless harms individual autonomy interests.
Analytical investigations of heat transfer during the vertical impingement of an unsubmerged axisymmetric liquid jet on a horizontal plate have been limited to the regions ahead of the jump. This limitation is due to the complex flow physics in the jump region arising from sudden changes in the flow field. This is addressed in here by extending the averaging theory (AT) introduced by Bohr et al. (Phys. Rev. Lett., vol. 79, issue 6, 1997, pp. 1038–1041) which was further developed by Watanabe et al. (J. Fluid Mech., vol. 480, 2003, pp. 233–265), to describe the heat transfer problem in circular hydraulic jumps including separation. The applicability of the resulting theory to determine the temperature field in the jump region is evaluated using the data available in the literature and also by means of fully resolved numerical solutions. Good agreement is observed for moderate Prandtl numbers. However, for sufficiently high Prandtl numbers, deviations become notable. The reasons for the deviations according to their relevance are (i) monotonically decreasing temperature profile inherent to the AT, whereas the fully resolved numerical solutions exhibit a local maximum in the temperature profile away from the plate; and (ii) inapplicability of the concept of dividing the flow field into a region affected and a region unaffected by heat transfer according to the thermal boundary layer thickness. This concept leads to the overestimation of the temperature close to the wall and to the existence of a threshold Prandtl number, for which the thermal boundary layer thickness does not meet the free surface anymore. Around this threshold Prandtl number, the temperature field shows a discontinuous behaviour.
In this paper a fully coupled particle-size segregation model for granular flows (Barker et al., J. Fluid Mech., vol. 909, 2021, p. A22) is used to simulate the development of the patterns in a triangular rotating drum. The results are compared with the experimental patterns formed with bidisperse and tridisperse granular mixtures, and with varying compositions and fill heights. In all cases the agreement between the simulations and experiments is remarkably good. The experimental patterns are generated in a narrow gap between transparent front and back sidewalls. These prevent three-dimensional motion, but also impose friction on the flow, making it thinner and faster than it would otherwise be. This promotes segregation, as it simultaneously increases the shear rate and reduces the local pressure. To obtain the correct flow dynamics and segregation, width-averaged sidewall friction is incorporated into the two-dimensional simulations, which are performed in OpenFOAM$^{\circledR}$. The free-surface avalanche forms a boundary layer within which all the segregation occurs. Material in the lower reach of the avalanche is continuously deposited into an underlying solid body of grains, which rotates with the drum, and is eventually re-entrained into the avalanche along its upper reach. The changing geometry of the granular region (as the drum rotates) implies that the avalanche is constantly adjusting its length, position and depth. This generates a complex quasi-periodic flow, which when combined with particle-size segregation generates amazing patterns in the solid rotating granular body after only two drum rotations.
Management of primary headache (PHA) varies across emergency departments (ED), yet there is widespread agreement that computed tomography (CT) scans are overused. This study assessed emergency physicians’ (EPs) PHA management and their attitudes towards head CT ordering.
Methods:
A cross-sectional study was undertaken with EPs from one Canadian center. Drivers of physicians’ perceptions regarding the appropriateness of CT ordering for patients with PHA were explored.
Results:
A total of 73 EPs (70% males; 48% with <10 years of practice) participated in the study. Most EPs (88%) did not order investigations for moderate-severe primary headaches; however, CT was the common investigation (47%) for headaches that did not improve. Computed tomography ordering was frequently motivated by the need for specialist consultation (64%) or admission (64%). A small proportion (27%) believed patients usually/frequently expected a scan. Nearly half of EPs (48%) identified patient imaging expectations/requests as a barrier to reducing CT ordering. Emergency physicians with CCFP (EM) certification were less likely to perceive CT ordering for patients with PHA as appropriate. Conversely, those who identified the possibility of missing a condition as a major barrier to limiting their CT use were more likely to perceive CT ordering for patients with PHA as appropriate.
Conclusions:
Emergency physicians reported consistency and evidence-based medical management. They highlighted the complexities of limiting CT ordering and both their level of training and their perceived barriers for limiting CT ordering seem to be influencing their attitudes. Further studies could elucidate these and other factors influencing their practice.
The present paper deals with the first Ptochoprodromic poem's treatment of the early patristic tradition. Its focus is on the conjugal life of the Ptochoprodromic couple, whose interaction is compared to the precepts of the Byzantine Fathers on the ideal Christian marital life. Evidently, the poet parodies the tradition to which the said precepts belong, offering a comic image of the ideal Christian couple in which gender roles have been reversed. Moreover, the final scene of the poem, where the husband disguises himself, is linked to the hagiographical tradition of cross-dressing women, as well as of male saints in disguise.
A mixed Romano-Punic tomb discovered on private property to the west of Msallata contains many small stone chests containing cremated human remains. Some of these chests carry the name of the deceased written in the Latin or neo-Punic alphabet. Besides the stone chests, there are pottery jars containing animal remains. Figurative relief and religious symbols suggest the practice of rituals associated with the Tophet (sanctuary-necropolis) of Carthage. In addition to the stone chests and pottery urns there are many other objects that are typical of the grave goods usually buried with the Phoenician dead: oil lamps, tableware, coins, medals.
This review essay contrasts two of the most notable recent contributions to literature on space and society: Daniel Deudney's Dark Skies (2020) and Brian Patrick Green's Space Ethics (2022). The Green volume is a course textbook, geared to giving students an overview of some of the key ethical issues concerning space and how the arguments on these matters are shaping up. Its aim is to provide an overview rather than a specific line of argument. Deudney's text, by contrast, is an example of a book proposing space skepticism. It argues that we should relinquish many of our current ambitions for space expansion on the grounds that they will increase the already significant degree of extinction-level risk that we face. The essay marks the distinction between these texts by contrasting normal- and special-domain approaches. Normal-domain approaches seek to extend familiar ethico-political issues into the discussion about space expansion without regarding space expansion as the road to utopia or extinction. Special-domain approaches hold to some such optimistic or pessimistic view. The essay goes on to highlight the way in which Green's text would benefit from more social critique, along the lines of Deudney. Ultimately, the normal-domain approach presupposed by Green and rejected by Deudney is upheld.
To determine oncological and functional outcomes in patients with T3 and T4 laryngeal carcinoma, in which choice of treatment was based on expected laryngeal function and not T classification.
Methods
Oncological outcomes (disease-specific survival and overall survival) as well as functional outcomes (larynx preservation and functional larynx preservation) were analysed.
Results
In 130 T3 and 59 T4 patients, there was no difference in disease-specific survival or overall survival rates after radiotherapy (RT) (107 patients), chemoradiotherapy (36 patients) and total laryngectomy (46 patients). The five-year disease-specific survival rates were 83 per cent after RT, 78 per cent after chemoradiotherapy and 69 per cent after total laryngectomy, whereas overall survival rates were 62, 54 and 60 per cent, respectively. Five-year larynx preservation and functional larynx preservation rates were comparable for RT (79 and 66 per cent, respectively) and chemoradiotherapy (86 and 62 per cent, respectively).
Conclusion
There is no difference in oncological outcome after (chemo)radiotherapy or total laryngectomy in T3 and T4 laryngeal carcinoma patients whose choice of treatment was based on expected laryngeal function.
What shapes a country’s foreign policy formation in times of crisis? This article explores the factors that were behind the response of Ukrainian decision makers in their relations with Russia and the European Union during the annexation of Crimea between February 21 and March 26, 2014. I view Ukraine’s foreign policy through the lenses of an analytical framework inspired by game theory, where the decision-making process is divided into four parts—information about others’ preferences, trust in interlocutors, everyone’s payoffs, and resources. This article employs a rigorous qualitative thematic analysis of 38 elite interviews, numerous primary documents, and media reports. The core finding suggests that the uncertain times and unpreparedness of Ukrainian decision makers obstructed them from a comprehensive analysis of the environment and formation of the country’s foreign policy strategy, which, consequently, facilitated Russia’s annexation of Crimea.
Despite the salience of corruption in elections in Latin America and beyond, it remains unclear what makes certain candidates attractive to voters as solutions to address corruption. Building on studies about the effect of candidates’ professional affiliation on voting behavior, we hypothesize that police and military officers are perceived to be more competent to address corruption. We test our theoretical expectations through an online survey of Brazilian voters with an image-based factorial experiment that presents respondents with three randomly generated handbills, varying candidates’ professional affiliations and potential confounders, such as economic policy, insider versus outsider status, and demographic features. Our results demonstrate that candidates affiliated with the police or the military are perceived to be more effective at reducing corruption, all else equal. The effect of police or military professions on candidates’ perceived effectiveness to fight corruption varies according to respondents’ ideology and is particularly significant among conservative voters.
Phase three trials of the monoclonal antibodies lecanemab and donanemab, which target brain amyloid, have reported statistically significant differences in clinical end-points in early Alzheimer's disease. These drugs are already in use in some countries and are going through the regulatory approval process for use in the UK. Concerns have been raised about the ability of healthcare systems, including those in the UK, to deliver these treatments, considering the resources required for their administration and monitoring.
Aims
To estimate the scale of real-world demand for monoclonal antibodies for Alzheimer's disease in the UK.
Method
We used anonymised patient record databases from two National Health Service trusts for the year 2019 to collect clinical, demographic, cognitive and neuroimaging data for these cohorts. Eligibility for treatment was assessed using the inclusion criteria from the clinical trials of donanemab and lecanemab, with consideration given to diagnosis, cognitive performance, cerebrovascular disease and willingness to receive treatment.
Results
We examined the records of 82 386 people referred to services covering around 2.2 million people. After applying the trial criteria, we estimate that a maximum of 906 people per year would start treatment with monoclonal antibodies in the two services, equating to 30 200 people if extrapolated nationally.
Conclusions
Monoclonal antibody treatments for Alzheimer's disease are likely to present a significant challenge for healthcare services to deliver in terms of the neuroimaging and treatment delivery. The data provided here allows health services to understand the potential demand and plan accordingly.
Let $\Sigma $ be a nonempty subset of the set of prime numbers which is either equal to the entire set of prime numbers or of cardinality one. In the present paper, we continue our study of the pro-$\Sigma $ fundamental groups of hyperbolic curves and their associated configuration spaces over algebraically closed fields in which the primes of $\Sigma $ are invertible. The present paper focuses on the topic of comparison between the theory developed in earlier papers concerning pro-$\Sigma $ fundamental groups and various discrete versions of this theory. We begin by developing a theory concerning certain combinatorial analogues of the section conjecture and Grothendieck conjecture. This portion of the theory is purely combinatorial and essentially follows from a result concerning the existence of fixed points of actions of finite groups on finite graphs (satisfying certain conditions). We then examine various applications of this purely combinatorial theory to scheme theory. Next, we verify various results in the theory of discrete fundamental groups of hyperbolic topological surfaces to the effect that various properties of (discrete) subgroups of such groups hold if and only if analogous properties hold for the closures of these subgroups in the profinite completions of the discrete fundamental groups under consideration. These results make possible a fairly straightforward translation, into discrete versions, of pro-$\Sigma $ results obtained in previous papers by the authors. Finally, we discuss a construction that was considered previously by M. Boggi in the discrete case from the point of view of the present paper.