To save content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about saving content to .
To save content items to your Kindle, first ensure no-reply@cambridge.org
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about saving to your Kindle.
Note you can select to save to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
To describe the rare combination of findings where a left aortic arch and aberrant right subclavian artery are associated with a vascular ring, which is in the setting of a right-sided arterial duct.
Methods:
Analysis of all prenatally diagnosed cases of left aortic arch and right-sided arterial duct (between 2016 and 2025) at three fetal cardiac centres (2 UK and 1 Austrian) with documentation of aortic arch branching pattern.
Results:
In 5/6 cases, aberrant right subclavian artery was identified. Genetic abnormality was identified in 50% of cases (22q11 microdeletion). Three fetuses had a ventricular septal defects, and two cases had vascular abnormalities (with further characterisation on postnatal CT). No fetuses had extracardiac abnormalities.
Conclusion:
Left aortic arch with aberrant right subclavian artery is not uncommon in the general population but when associated with other abnormalities may also be a marker for chromosomal and genetic abnormalities. If not fully understood, patients may be incorrectly counselled regarding the likelihood of respiratory and swallowing symptoms of a vascular ring. An understanding of the circumstances in which a ring can arise is needed. Our study adds to the limited published data on this condition, with a view to improving clinician understanding and guiding accurate prenatal counselling.
This study addresses the hypothesis that bedding selection on UK dairy farms is captive to existing manure management infrastructure rather than being driven primarily by clinical evidence of material performance. The management of dairy cow resting areas is a critical determinant of animal welfare and farm productivity. While academic research often focuses on the biological properties of bedding materials in isolation, commercial selection is frequently constrained by fixed infrastructure and logistical realities. A comprehensive online survey was conducted among 228 dairy farms across the UK (median herd size: 194 lactating cows) to evaluate the interplay between housing infrastructure, bedding selection and manure management. Data were collected on barn design, flooring, manure transport mechanisms and the economic and operational management of primary bedding materials. Cubicle (freestall) housing was near-universal (97%), with 77% of farms using hybrid systems consisting of a synthetic mattress topped with a loose bedding layer. Sawdust was the predominant material (56%), followed by sand (20%) and straw (15%). Although sand was recognised for its clinical benefits, 11% of current sand users expressed an intention to transition away from the material, citing mechanical wear on machinery and slurry sedimentation as primary drivers. Straw use exhibited a distinct bimodal distribution, with application rates nearly 10 times higher in loose-housed yards (12–14 kg/cow/d) than in cubicle systems (1.6 kg/cow/d). Notably, 70% of respondents were unwilling to pay a financial premium for sustainably sourced bedding, prioritising operational compatibility and animal hygiene over environmental labels. These results demonstrate that bedding choice in the UK is constrained by existing manure management infrastructure. Future research and policy must bridge the gap between clinical excellence and mechanical viability, focusing on engineering solutions that allow farms to use high-comfort materials without compromising logistical efficiency.
This work presents high-fidelity simulations of the aerodynamic noise characteristics of a forward-flight propeller ingesting turbulent wakes of cylinders. Two cylinders with different diameters are employed to generate turbulent wakes with distinct turbulence intensity and length scales, namely small-scale turbulence (SST) and large-scale turbulence (LST). The lattice Boltzmann–very large-eddy simulation solver, PowerFLOW, coupled to an impermeable surface Ffowcs Williams–Hawkings formulation, is used for the forward-flight propeller configuration, matching that of an earlier experimental study. The aerodynamic results show that SST ingestion preserves a coherent tip–vortex path and confines elevated fluctuations to a limited portion of the blades. In contrast, LST ingestion disrupts the tip–vortex trajectory over a wide azimuth and spreads axial-velocity root-mean-square across the disk. Correspondingly, ingesting SST produces a series of discrete tonal sidebands at $m\mathrm{BPF}\pm nf_0$ (where $m, n \in \mathbb{N} = \{1,\, 2,\,3,\, \ldots \}$, $\textrm{BPF}$ is blade passing frequency and $f_0$ is the cylinder shedding frequency), while the LST case primarily yields notable noise increases in broadband components with clear haystacking around the blade passing frequency harmonics. Blade-level correlation and modulation intensity analyses confirm that the SST case gives rise to compact amplitude modulation, whereas the larger turbulence length scales in LST lead to redistribution of the turbulent energy via haystacking and broadband humps, linking inflow scale and coherence to the observed noise characteristics and generation mechanism. Hemispherical change in overall sound pressure level maps confirm axis-aligned rises in noise levels with turbulence ingestion. These results establish how the scale and coherence of ingested turbulence are crucial to both the near-wake dynamics and the radiated sound of propellers.
The GeneXpert® MTB/RIF nucleic acid amplification test has been proposed as an alternative method to smear microscopy in guiding de-isolation for patients with suspected pulmonary tuberculosis, given its convenience and higher diagnostic accuracy. Currently, there is no comprehensive review summarizing the evidence on the isolation duration using GeneXpert. This systematic review and meta-analysis addressed the length of airborne infection isolation in hospitalized patients initially suspected of having pulmonary tuberculosis where de-isolation decisions were guided by GeneXpert nucleic acid amplification test compared to traditional smear microscopy.
Methods:
We conducted a comprehensive search in databases (Medline, Embase, and Scopus) from January 1, 2001, to April 1, 2026, and applied median-based quantile estimation methods to determine the pooled difference in median times of isolation. We also assessed diagnostic accuracy as well as hospital length of stay as secondary outcomes.
Results:
We screened 746 titles and abstracts, of which 7 were eligible for inclusion. Five studies included in the meta-analysis involved 1,409 patients, all within low-incidence tuberculosis settings. The meta-analysis demonstrated that use of a single unconcentrated GeneXpert versus serial acid-fast bacilli smear microscopy resulted in a pooled reduction in median isolation duration by 38.8 hours (95% confidence interval 20.2–57.3 hours).
Conclusion:
Compared to serial microscopy, GeneXpert done on a single unconcentrated respiratory specimen reduces airborne infection isolation duration by over 1.5 days, on average, making it an attractive strategy for optimizing healthcare facility resources while evaluating persons for pulmonary tuberculosis.
Throughout the Syrian conflict (2011–2024), cultural heritage was both a deliberate target and an incidental casualty. Damage to the complicated relationships between communities and local and regional heritage has a much longer lineage. This article draws on oral histories conducted during the recent conflict to explore the relationship between the major archaeological site of Dura-Europos and local communities and stakeholders. It argues that some foreign-led excavations have had negative impacts upon Middle Eastern communities and their relationships with heritage, and that historic and ongoing community relationships to archaeological heritage need to be considered with increased attention and care.
On October 6, 2025, Trial Chamber I of the International Criminal Court convicted Ali Muhammad Ali Abd-Al-Rahman, also known as “Ali Kushayb,” of twenty-seven counts of war crimes and crimes against humanity arising from the 2003–2004 attacks on the Fur, Masalit, and Zaghawa communities of West Darfur. The judgment is the first conviction in the Darfur situation, the first in any situation referred to the Court by the United Nations Security Council, and the Court’s first conviction for gender-based persecution—on the novel basis that Fur men of fighting age were targeted because of a “perceived gender role” associating masculinity with combatant status. The decision confronts three doctrinal questions: Article 22(1) legality for nationals of non-states parties reached by Security Council referral; intersectionality of gender, ethnicity, and political identity under Article 7(1)(h); and fair trial guarantees under territorial-state non-cooperation. The judgment is nevertheless not final; the defence appealed on November 6, 2025; the reparations phase opened on December 9, 2025, the same day the twenty-year sentence was issued.
This article examines the relationship between formal tax systems and criminal governance, utilising the Northern Triangle of Central America as a case study to illustrate how gang-controlled territories challenge traditional notions of tax sovereignty and territoriality. By analysing the overlapping fiscal functions of state taxation and the extortion practices of criminal organisations, such as Mara Salvatrucha (MS-13) and Mara Barrio 18 (M-18), the article highlights the complexities that arise in regions with dual tax authorities. This exploration aims to broaden the scope of tax scholarship and social science research by encouraging further study into how these non-state actors influence tax compliance, the construction of legal norms, economic behaviour and state fiscal authority, including the potential recognition of criminal governance within formal tax systems.
Some researchers have recently argued that sound-symbolic requirements can cause phonological alternations, suggesting that sound-symbolic patterns and phonological patterns may be governed by similar – or perhaps the same – mechanisms. Against this theoretical development, this article further addresses the question of how similar phonological systems and sound-symbolic systems are, by focusing on their counting capability. It has been established that phonological constraints can count only up to two segments. To examine whether a similar restriction holds in sound-symbolic patterns, we experimentally addressed the question of whether three segments of the same sort can cause stronger sound-symbolic images than two segments. The results of three experiments using Pokémon names demonstrate that three segments do indeed cause stronger sound-symbolic meanings than two segments. The overall results suggest that phonological systems and sound-symbolic systems differ in that only the latter have a certain type of counting capability.
After collective violence, states often work to rebuild and repair the social fabric by promoting legal institutions and fostering peaceful relationships. The case of legal aid in post-genocide Rwanda provides insight into how legal aid providers manage cases in the context of overburdened courts and the state’s prioritization of reconciliation. This study relies on ethnographic and interview data with legal aid providers at legal aid centers throughout Rwanda to show how legal aid providers communicate the state’s moral vision of social cohesion to manage an overburdened court system through two interconnected strategies. First, legal aid providers orient people to moral beliefs about ways of being through community awareness-raising initiatives and extra-legal obligations that promote peaceful relations. Second, legal aid providers stall cases from going to court by counseling through narratives of forgiveness and reconciliation. These strategies prevent cases from reaching the courts by managing emotional expectations about the law’s limitations and reminding people of their societal obligations. Building on the law and culture literature, these findings highlight how social actors charged with interacting with vulnerable people creatively navigate the lasting ramifications of collective violence in everyday dispute resolution and conflict mediation.
Metabolic dysfunction-associated steatotic liver disease (MASLD) is now the most prevalent liver disease among children and is closely associated with insulin resistance and increased risk of developing type 2 diabetes (T2D). Early intervention in children with MASLD is essential to prevent progression to advanced liver disease and other metabolic disorders. The goal of this ongoing trial is to determine the effect of a weight-maintaining low glycemic, moderately carbohydrate-restricted diet (CRD) vs. fat-restricted diet (FRD) on changes in hepatic lipid content, insulin sensitivity, and metabolomic profile over a 6-month period in adolescents with MASLD. Eligible participants will be children ages 10-17 with a BMI > 75th percentile and a clinical diagnosis of MASLD. This randomized control trial (RCT) consists of two 12-week phases: a controlled feeding phase, during which food will be provided to the family, and a free-living phase. The CRD has a macronutrient composition of < 25% CHO: 25% Protein: > 50% fat, while the FRD is composed of 55% CHO: 25% Protein: 20% fat. Primary outcomes include change in hepatic lipid measured by MRI and MRS, and insulin sensitivity measured via euglycemic clamp and metabolomic profiling measured from fasting blood. Diet tolerance, body weight, and compliance were measured weekly by a Registered Dietitian (RD) during the controlled feeding phase, and then monthly in the free-living phase. Changes in study endpoints will be assessed between intervention groups and across study time points, assessing for effects by group, time, and the group-by-time interaction.
Here we present an updated version of radiocarbon concentrations measured in seeds from the Gatersleben Crop Plant Research institute. 14C-isotope measurements for wheat from 1946 to 2020, which were presented previously, have been complemented with 14C measurements made on soybean and continued until late summer 2025. Additionally, we measured δ13C in wheat samples.
A comparison of different 14C time series over the last 80 years from different regions such as the Colorado Plateau (herbaria archived annual plants; Carbone et al. 2023), England (Barley; Dunbar et al. 2024), and Germany (Gatersleben seed, this study) reveal 14C discrepancies during peak bomb-period with reference atmospheric 14C data, i.e., the Northern Hemisphere Zone 1 & 2, and may indicate a heterogenous atmospheric 14C composition, i.e., admixture of different air masses with a slightly divergent 14C composition.
Despite his role as colonial proprietor of Pennsylvania and an important voice in seventeenth-century debates concerning toleration, William Penn remains at the fringes of contemporary political theory. This is unfortunate because his story has a good deal to teach current readers about the promises and pitfalls of theorizing toleration in a pluralistic world. This article offers contributions to our understanding of the politics, philosophy, and history of the early modern Atlantic world by reconstructing Penn’s unique political theory of toleration in view of its colonial entanglements. It argues that the radical egalitarian impulse found in Penn’s thought was incompatible with the narrow catalog of “ancient rights and liberties of Englishmen” on which it is based, and explores the consequences of this disjuncture. The infant years of Penn’s “holy experiment” provide an enriching historical window into how English ancient constitutionalist ideals, transatlantic tolerationist discourses, and Indigenous practices of reciprocal treaty making were contested—rarely on equal footing—in the newly founded City of Brotherly Love.
Advances in cardiology and cardiac surgery have significantly improved survival rates among children with CHD, but these gains come with the need for long-term care that heavily involves parents. Understanding their life situation is essential for delivering effective family-centred and holistic healthcare. The study aimed to assess the life situation of parents of children with CHD in relation to sociodemographic factors and to explore their sources of support, emotional experiences, and the role of spirituality in coping.
Materials and method:
A web-based cross-sectional survey was conducted among 117 parents of children with CHD in the Slovak Republic. Data was collected between December 2024 and January 2025 using the standardised questionnaire Life Situation of Caregivers/Parents of Children with CHD and/or Other Cardiac Diseases.
Results:
Multivariable linear regression analysis revealed that lower parental education and a history of cardiac surgeries in the child were associated with lower scores on the life situation scale. Conversely, a higher number of previous hospitalisations was linked to higher scores (p < 0.05). The most reported emotions related to the child’s illness were fear (94.87%), sadness (67.52%), and anger (38.46%). Family members were identified as the primary source of support.
Conclusions:
These results highlight the need to identify parents at heightened psychosocial risk, particularly those with lower education and those whose children have undergone cardiac surgeries. In clinical practice, family support should be supplemented with structured psychological interventions as part of comprehensive care for families of children with CHD.
This paper focuses on two arguments William MacAskill discusses with approval in What We Owe the Future. Both arguments support the existentially unrestricted form of longtermism that MacAskill favors, and both rely on moral principles that reflect a particular way of resolving the decades-old, Narveson-inspired, value of existence controversy. But it is questionable whether that way of resolving the controversy — i.e., against Narveson — has ever in fact been entirely grounded. Instead, many in the population ethics mainstream have simply assumed that the controversy was happily put to bed soon after it first gained attention. Once we identify that assumption as mere assumption, we can see that the principles in question work, not as the solid underpinnings of an insightful resolution of the value of existence controvery, a resolution we ourselves are compelled to accept, but rather as dogma – thus the two dogmas of population ethics. That insight opens the door to an existentially restricted form of longtermism, a form that is arguably more attractive than MacAskill’s own.
Moral management with its three main elements – classification of patients according to the nature of their mental disorder, elimination of mechanical restraint, and employment and occupation of patients – was the basis of mental healthcare in Britain in the nineteenth century. Despite consistent doubts about its effectiveness, moral management was implemented throughout the British West Indies following a scandal in Jamaica. Based on annual reports submitted by British West Indies colonies, we created a cross-colony time-varying dataset of mental healthcare practices and patient outcomes from 1869 to 1942 to study the implementation of moral management and its success in the West Indies. Regression analyses reveal the importance of employment, religious services, and female attendants in reducing deaths and increasing cures among patients. Physical restraint, which was still used despite being discouraged, had positive effects on survival and cures among patients.
The trematode Maritrema gratiosum Nicoll, 1907 has a heteroxenous life cycle comprising a marine gastropod as its first intermediate host, a barnacle as its second intermediate host, and a bird as its definitive host. Globally, the species is widely distributed from subtropical waters of the South China Sea to arctic waters of the Barents Sea. In European waters (namely, western Europe and the Barents Sea), the complete life cycle of M. gratiosum is known. Elsewhere in its range, however, its life cycle remains incompletely understood. Clarifying its distribution and resolving unknown host associations are essential for advancing a more holistic view of host–parasite dynamics and their ecological role in intertidal ecosystems. In this study, M. gratiosum was detected using DNA-based assays in individuals of the barnacle Balanus glandula Darwin, 1854 that were collected from the rocky intertidal zone along the southern coast of British Columbia, Canada. This finding provides the first molecular evidence of this trematode species in the Pacific, complementing earlier records. The same molecular approach can be extended to identify region-specific hosts, such as the first intermediate (molluscan) host in the Pacific region, which remains unidentified.
To study any dynamical system, it is useful to find a partition that allows essentially faithful encoding (injective, up to a small exceptional set) into a subshift. Most topological and measure-theoretic systems can be represented by Bratteli–Vershik (or adic, or BV) systems. So, it is natural to ask when can a BV system be encoded essentially faithfully. Extending what was known previously for special diagrams and particular orders, we show here that for BV diagrams defined by homogeneous positive integer multivariable polynomials, and a wide family of their generalizations, which we call polynomial shape diagrams, for every choice of the edge ordering, the coding according to initial path segments of a fixed finite length is injective off of a negligible exceptional set.