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The objective of this study was to compare embryonic morphokinetic parameters and clinical outcomes of two controlled ovarian stimulation (COS) protocols in women of advanced maternal age (AMA): Pergoveris (r-hFSH:r-hLH, 2:1 ratio) versus r-hFSH monotherapy (GONAL-f). This retrospective, non-interventional descriptive study was conducted at a private university–affiliated IVF center and included 136 ICSI cycles performed in AMA patients between March 2019 and May 2020. Patients were grouped by COS protocol (GONAL-f, n = 64; Pergoveris, n = 72), and embryo morphokinetics and ICSI outcomes were extracted from the clinic’s database; the main outcome was time to complete blastulation (tB, hours). Embryos from the Pergoveris group reached tB earlier than those from the GONAL-f group (mean 109.3 h vs 112.6 h), and all morphokinetic milestones occurred sooner with Pergoveris, alongside lower multinucleation rates at the 2-cell and 4-cell stages. Although blastocyst development was higher in the GONAL-f group, Pergoveris was associated with higher oocyte yield and maturity, higher implantation, clinical and ongoing pregnancy rates, and lower miscarriage and OHSS rates; Pergoveris cycles also required higher gonadotropin doses and longer stimulation. Overall, embryos from the r-hFSH:r-hLH group exhibited faster morphokinetic timings and improved implantation and pregnancy outcomes, and prospective studies are warranted to confirm these observations.
This article is about the recent transformation of two powerful, paradoxical, and inseparable narratives of progress that developed in the postwar period: aesthetic autonomy and Holocaust remembrance. As far-right and illiberal parties have gained power across Europe, they adapted these foundational narratives of the liberal-democratic West to assert their own legitimacy and to reimagine the cultural inclinations of the European Union. This article examines how this process has taken place in the reception of Jonathan Glazer's Zone of Interest (2023) and Agnieszka Holland's Green Border (2023)—both international co-productions produced during the repressive eight-year reign of the Law and Justice Party (PiS) in Poland. A close reading of these films and their reception in different contexts, exposes a world more complicated than one-dimensional dichotomies between the liberal and the illiberal. Likewise, the reception of the two films makes apparent the entanglement of the national and transnational, as well as a process of translation and mistranslation that takes place as cultural materials move across geographical and ideological boundaries. Understanding such dynamics helps us to comprehend the options for criticism available to artists working within repressive contexts.
This work compares the use of palace diplomacy and propaganda by the rulers of Constantinople and Mexico-Tenochtitlan. It builds on studies of the cultural exchange between the Roman and Sasanian empires from the third to sixth centuries a.d., which led to a diplomatic protocol shared by these two realms. This protocol and Liudprand of Cremona’s account of diplomatic receptions are the basis for comparative analysis. Drawing on Hernando Alvarado Tezozómoc’s Crónica Mexicana and other sixteenth-century sources, this study identifies key characteristics of diplomacy in Mesoamerica. It explores how Mexico-Tenochtitlan employed palace diplomacy and propaganda from the reign of Motecuhzoma Ilhuicamina to Motecuhzoma Xocoyotzin. Through this analysis, we find that the diplomatic and propaganda objectives of Constantinople and Mexico-Tenochtitlan had distinct focuses. The Byzantine rulers aimed to maintain their existing empire, while the Tenochca rulers sought not only to preserve but also to expand their domain. As a result, Constantinople’s strategy emphasized palace diplomacy, whereas Mexico-Tenochtitlan’s focused more on propaganda. Despite these differences, both approaches share several similarities. Both began with invitations, and their protocols included the same components: visual (architecture, wealth, and terror), ceremonial (including aural, olfactory, gustatory, ludic, haptic, somatic, and terror elements), and diplomatic (interviews and gift exchanges).
On an Adventide Sunday in 1523, a visitor to Milan’s Duomo witnessed something unexpected. Lay congregants halted high mass by yelling at the priests, demanding that attention remain fixed on their favoured preacher. This and similar episodes are recounted in the Cronica Milanese by the shopkeeper Giovan Marco Burigozzo. Using Burigozzo’s accounts alongside overlooked evidence from the Duomo’s archives, this article traces moments when customary rituals broke down under lay intervention. Such episodes reveal how ordinary congregants experienced, contested and redirected the cathedral’s functions, reshaping the church’s sonic and liturgical space in ways that diverged from its intended purposes.
This article discusses the question whether the use of ὄργανον as a title to designate Aristotle’s logical treatises as a unitary bibliographical entity can be traced back to the ancient commentators or emerged as late as in the Renaissance. A review of the ancient and medieval evidence locates the earliest certain traces of this use in the eleventh or twelfth century.
The legume pod borer, Helicoverpa armigera (Hübner), is one of the pervasive and destructive pests of legume crops, causing significant yield losses. In this study, we evaluated the nutritional performance and digestive enzyme activities of H. armigera when fed on ten mung bean varieties, including Baghmalek, India, Veys, Omrani, Parto, Simite1, Simite2, VC6371, VC3960, and VC6368. Additionally, biochemical profiling of these mung bean varieties, assessing starch, protein, anthocyanin, total phenolic and flavonoid content, was conducted to explore potential correlations with the nutritional physiology of H. armigera. The findings indicated that the larvae fed on Parto had lowest approximate digestibility, efficiency of conversion of ingested food, and relative growth rate, while those fed on VC6371 had the highest values. The values of efficiency of conversion of digested food were lower on Baghmalek and Parto and higher on VC6368 and VC6371. The lowest value of larval gain weight was on Parto. The highest proteolytic and amylolytic activities of larvae were observed on Veys and India, respectively; while the lowest enzyme activities were recorded on Parto. Our findings indicate that the low protein content combined with high levels of anthocyanin, total phenolics, and flavonoids may contribute to the potential tolerance of mung bean varieties against H. armigera. Cluster analysis revealed that VC6368 and VC6371 were the most suitable varieties for H. armigera development, whereas Baghmalek and Parto were nutritionally less suitable and may severe as promising candidates for breeding or cultivation to minimise damage caused by this pest.
Professional guidelines recommend an early switch from intravenous (IV)-to-oral antibiotics for community-acquired pneumonia (CAP) to facilitate early discharge and prevent hospital-related complications. However, it is unknown how often these IV-to-oral switches occur in clinical practice.
Design:
We performed a retrospective cohort study across 124 acute-care Veterans Administration hospitals to measure the frequency of early switches.
Patients:
Patient-admissions during 2018–2023 who had CAP and were started on IV antibiotics upon admission.
Methods:
We measured the percentage of hospitalized patients with CAP who had an early switch from IV-to-oral antibiotics, i.e., within 72 hours of admission. In addition, we calculated an observed-to-expected ratio for early switches at each hospital and compared a composite outcome (mortality and/or hospital readmission within 30 days of discharge) at hospitals with switch rates that were higher and lower than expected.
Results:
Of 31,183 patient-admissions for CAP, 17,282 (55.4%) were switched to oral antibiotics by day three of therapy. Overall, 5,629 (18.1%) died and/or were re-admitted within 30 days. The O:E ratio for early antibiotic switches ranged from 0.78 among hospitals in the lowest quartile to 1.23 in the highest quartile. There was no difference in the composite outcome across quartiles.
Conclusion:
Early switches from IV-to-oral antibiotics for CAP occurred in half of eligible cases. The frequency of these switches varied widely across facilities. Outcomes among patients at hospitals with high switch rates were comparable to outcomes at hospitals with low rates, thereby supporting the safety of early switches. More concerted efforts to promote these switches are needed.
This study tested the effects of the methylenetetrahydrofolate reductase (MTHFR) rs110692574 polymorphism and rumen-protected choline and methionine supplementation on biochemical parameters, milk yield, reproductive performance and health status during the transition period in Holstein cows raised in Türkiye. Genotypes of 356 cows were determined using the tetra-primer amplification refractory mutation system–polymerase chain reaction (ARMS-PCR) method. Following genotyping, 80 cows were selected and assigned to four groups based on nucleotide genotype at two loci (homozygous CC and heterozygous CT) and dietary supplement (choline or choline + methionine). Blood samples were collected on day 21 prepartum, on the day of parturition (day 0), and on day 21 postpartum to measure homocysteine, folic acid, vitamin B12, and non-esterified fatty acid concentrations. beta-hydroxybutyric acid (BHBA) values and production data were obtained from the farms’ routine monitoring records. Statistical analyses were performed using repeated-measures analysis of variance (ANOVA) to assess time-dependent effects, and a general linear model was used for between-group comparisons at the same time points. The frequency of the CT genotype was 12.64%. The polymorphism significantly affected folic acid and vitamin B12 concentrations across different stages of the transition period. Feed supplementation had a significant effect on folic acid concentrations on calving day and on day 21 postpartum, as well as on milk yield on days 100, 200 and 305. Moreover, the polymorphism was significantly associated with folic acid and vitamin B12 concentrations on day 21 prepartum and with BHBA values on day 7 postpartum. This variation was linked to specific health issues that could lead to decreased productivity. In conclusion, genotype-based nutritional strategies were found to play a key role in maintaining metabolic balance and enhancing productivity during the transition period.
International studies show that school food programs (SFPs) can improve children’s diets but evidence from Canada is nascent. We examined whether SFPs are linked to better dietary intake and diet quality among Canadian elementary schoolchildren. This cross-sectional study surveyed 2,366 grade 4-8 students (age 9-14 years; 48.9% girls) from 32 schools in socioeconomically disadvantaged communities in Alberta and Ontario, Canada. Students completed a 24-hour diet recall, recording foods and beverages consumed during school hours (breakfast, morning snack, lunch, afternoon snack), and their source (school, other). Multivariable linear models examined the association of accessing SFPs (≥1 meal/snack provided by school) with student daily intakes of vegetables and fruit, grains and grain products, milk and alternatives, meat and alternatives, free sugars, sodium, and diet quality, adjusting for relevant confounders. Only 293 (12.4%) students accessed SFPs. Overall, accessing SFPs was associated with higher intake of vegetables and fruit (β=0.4, 95% CI=0.1; 0.7) and better diet quality score (β=1.8, 95% CI=0.7; 3.0). Specifically, morning snacks provided by schools were associated with lower intake of free sugars (β=-8.9, 95% CI=-16.5; -1.4), while school-provided lunches were associated with higher intake of milk and alternatives (β=0.5, 95% CI=0.2; 0.8). Further, school-provided afternoon snacks were associated with higher intake of vegetables and fruit (β=1.1, 95% CI=0.6; 1.6), lower sodium intake (β=-258.4, 95% CI=-506.7; -10.0), and better diet quality (β=3.1, 95% CI=1.1; 5.1). One in eight elementary schoolchildren accessed SFPs. Students who accessed SFPs had better diets, highlighting the potential of SFPs (particularly snacks) in improving children’s diets.
Understand current Candidozyma auris prevention practices in the United States and identify opportunities to improve containment.
Design:
Electronic survey.
Setting:
Acute care hospitals.
Participants:
Society for Healthcare Epidemiology (SHEA) Research Network (SRN) facilities located in the United States.
Methods:
REDCap survey distributed via email exploring knowledge and perceptions related to C. auris screening methods, prevention practices, barriers to prevention, and tools needed to improve containment.
Results:
Responses were received from 51/96 (53%) U.S.-based SRN facilities, with 80% identifying as teaching hospitals. Two-thirds of facilities (34/51) reported first-hand experience with C. auris, with 15/34 also experiencing at least one C. auris outbreak. Routine C. auris screening occurred in 47% (24/51) of facilities. C. auris prevention practices commonly included patient isolation, signage to notify staff of isolation status, and placement in a single patient room. When asked to identify barriers to control of C. auris at their facility, participants ranked lack of communication between healthcare facilities, lack of infection control at outside healthcare facilities, and lack of training as the top three barriers. C. auris prevention resources or tools perceived to be most helpful in their facility included effective decolonization regimens, standardized protocols for C. auris screening, and improved communication between healthcare facilities.
Conclusion:
SRN facilities commonly used isolation practices to prevent the spread of C. auris. Development of additional tools to improve prevention practices should target effective decolonization strategies and standardized screening protocols to support C. auris containment.
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.