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Most mental health difficulties have their onset in early adolescence. Increasingly, community based primary care is recognised as a critical pathway to early intervention. Despite encouraging initial evaluations, there is an ongoing need for evidence of the outcomes of primary care youth mental health programmes delivered at scale. This brief report examines reliable improvements in psychological distress and user satisfaction data from a national primary care youth mental health programme in the sustainment phase of implementation.
Methods:
This report takes a multi-methods approach to routine evaluation data. Young people (aged 12–25; N = 8,721) completed Clinical Outcomes Routine Evaluation (CORE-10 and YP-CORE) pre- and post-treatment. Clinical cut offs and a reliable change index (based on established guidelines) were used to report rates of reliable improvement. The analysis examined differences in outcomes based on age, gender, and clinical need. Satisfaction was measured using the youth service satisfaction survey (N = 4,267). Natural language processing techniques were employed to objectively analyse qualitative user feedback.
Results:
Most young people presented in the clinical range, with almost two-thirds reporting moderate to severe distress. Statistically significant reductions in distress were observed with large effect sizes (d = 1.08–1.28). Young people in the clinical range demonstrated significantly higher rates of reliable improvement compared to those who presented in the healthy range. In line with similar evaluations, young adults were more likely to achieve improvement and report higher satisfaction. Sentiment analysis of satisfaction data indicated a strong skew towards positive sentiment, with trust, anticipation and joy being predominant. Qualitative feedback pointed to waiting times as an improvement area.
Conclusion:
The absence of a control group limits our ability to evaluate the effectiveness of the service interventions. Nonetheless after a decade of service delivery, these results indicate that large scale national youth mental health programmes can achieve satisfaction and clinical outcomes in line with international standards. Further research is needed on the predictors of reliable change, differences across demographic groups and approaches to improving waiting times in primary care.
This paper renews the contemporary and enduring salience of archaic and discredited concepts of spatiality and physical geographic determinism, but historicises, repurposes and reworks them: it is an essay in critical and decolonial palaeo-territorialisation. Concreteness may well have been misplaced, but place – and space – might not have been altogether mis-concretised. Rethinking the global is an opportunity to step back and think about macro-scales and macro-scalarity more broadly. This paper exhumes and decolonially/critically reappropriates Carl Schmitt’s Großraum concept (re-examining, along the way, if not quite rehabilitating the Meer und Land thesis and Mackinder’s ‘geographical pivot’ (Mackinder 1904)) as a heuristic device to explore the overlooked scales of continents and continentality in the genealogy of a global geographic imaginary that is as much geotectonic as geo-historical. ‘The Global’ would then come to signify pre-eminently – or perhaps has always signified – as the intercontinental rather than the international: a space or set of spaces in some ultimate sense conditioned by the configuration of the planetary crust yet nonetheless produced through historical processes. We may never have been global, but we have been (inter)continental for the last half-millennium. State sovereignty, (racial) capitalism, colonialism, imperialism, public international law, fascism, communism and neoliberal globalisation have all been projects or formations – directly or indirectly, by design or accident – producing, pursuing, exploiting, organising and ordering continental Großräume. Contemporary regional trade blocs, regional international governmental organisations, regional human rights systems, military alliances and even putative civilisational divides all reflect the perdurable continental horizons of our ostensibly global imaginary.
An association between second-hand smoke exposure and depressive symptoms has been reported; however, further research is needed for clarity.
Aims
This 20-year prospective cohort study aimed to longitudinally explore the relationships of smoking and second-hand smoke exposure with incident depressive symptoms in community-dwelling middle-aged and older adults.
Method
Data of adults aged ≥40 years were collected from the National Institute for Longevity Sciences – Longitudinal Study of Aging database (third to ninth waves). Participants with baseline (third wave) depressive symptoms, missing data or no follow-up participation were excluded. Baseline data on current cigarette smoking and second-hand smoke exposure were collected. Depressive symptoms were defined as a Center for Epidemiologic Studies Depression Scale score ≥16. Generalised estimating equation models evaluated longitudinal relationships of smoking and second-hand smoke exposure with incident depressive symptoms.
Results
The final analysis included 1697 participants (mean (s.d.) age, 58.7 (11.2) years; mean follow-up, 12.9 years). Depressive symptom incidence ranged from 8.0% (wave 4) to 6.5% (wave 9). Compared with non-current smokers, current smokers showed no significantly higher risk of incident depressive symptoms (multivariable-adjusted odds ratio (95% CI): 1.27 (0.96−1.68)). Subgroup analysis revealed higher risks in male current smokers (adjusted odds ratio (95% CI): 1.40 (1.00−1.94)) and current smokers aged ≥65 years (adjusted odds ratio (95% CI): 1.62 (1.00−2.63)). Current smokers exposed to second-hand smoke had a higher depressive symptom risk than unexposed non-smokers (odds ratio (95% CI): 1.50 (1.05−2.14)) and greater risk (odds ratio (95% CI): 1.39 (1.00−1.94)) than unexposed current smokers.
Conclusions
Smoking, combined with second-hand smoke exposure, is associated with future depressive symptoms in community-dwelling middle-aged and older adults.
Psychiatrists and anthropologists both rely on observation, discourse analysis and access to participants’ internal and external worlds. Ethnographic fieldwork, a key method in medical anthropology, offers a powerful tool to establish a robust evidence base of how to address mental health inequalities in ethnic minority communities.
Depth-averaged systems of equations describing the motion of fluid–sediment mixtures have been widely adopted by scientists in pursuit of models that can predict the paths of dangerous overland flows of debris. As models have become increasingly sophisticated, many have been developed from a multi-phase perspective in which separate, but mutually coupled sets of equations govern the evolution of different components of the mixture. However, this creates the opportunity for the existence of pathological instabilities stemming from resonant interactions between the phases. With reference to the most popular approaches, analyses of two- and three-phase models are performed, which demonstrate that they are more often than not ill posed as initial-value problems over physically relevant parameter regimes – an issue which renders them unsuitable for scientific applications. Additionally, a general framework for detecting ill posedness in models with any number of phases is developed. This is used to show that small diffusive terms in the equations for momentum transport, which are sometimes neglected, can reliably eliminate this issue. Conditions are derived for the regularisation of models in this way, but they are typically not met by multi-phase models that feature diffusive terms.
After World War II, Japan was severely degraded, and its people were generally devastated. For the country’s very survival, the beleaguered Japanese people sought to rebuild economically and reputationally. During this postwar period, Japanese business, union, and government leaders grappled with lagging progress and the necessary abandonment of prior transwar social and business arrangements. They sought new strategies to stimulate advancement in the wake of a governmental vacuum, labor unrest, and the threat of communism. In this context, Moral Re-Armament (MRA) took root in some areas of Japan during the period when Japan’s gross domestic product (GDP) grew from $102 billion in 1945 to $420 billion by 1961. MRA introduced Western-oriented societal values, intended to help nurture individual and societal change, including collaborative relations between unions and management. Of the first eight Japanese prime ministers after World War II, six either worked openly with or endorsed the MRA movement.
Childhood maltreatment can lead to poor socioemotional development, which may undermine parental functioning in adulthood. Having a large social network of relatives and friends, however, might buffer the effects of childhood maltreatment on parents. This prediction was examined using prospective data from the Minnesota Longitudinal Study of Risk Adaptation (N = 173). Early childhood maltreatment was assessed prospectively at ages 0 – 5. Socioemotional competence during middle childhood and adolescence (ages 5 – 16) was assessed via teacher reports. Adult parenting was assessed using a semi-structured interview at age 32 (N = 106) and dyadic parent-child observations at various ages (N = 85). At age 32, participants also wrote the names of friends and relatives in their inner, middle, and outer social circles. In a moderated mediation analysis, childhood maltreatment forecasted low socioemotional competence, which in turn predicted more negative parental orientations (greater hostility and lower emotional connectedness and involvement) and lower observed parental support in adulthood. However, having a large social network and having friends in one’s inner circle buffered this effect. These results highlight the significance of social networks in supporting parents who were maltreated in childhood, and primarily the importance of close friends.
Aotearoa New Zealand’s recognition of the Whanganui River as a legal person in 2017 has generated a lively debate. While advocates argue that ascribing personhood to natural entities is a powerful tool for redressing historical injustices against Indigenous peoples and for protecting the environment, critics argue that it is incompatible with Western legal and political systems. In this article, we use Thomas Hobbes’s theory of personhood to develop a novel account of ecological personhood. Hobbes explains how natural entities can be empowered to speak and act through authorized representatives, much as states, corporations, and wards do. Our Hobbesian account has three main payoffs. First, it offers a bridge between different legal orders and ontologies of nature. Second, it explains how “ecoship” is normatively different from corporate personhood and guardianship. Third, it highlights both the transformative potential of ecological persons and the ways in which they can be coopted and subverted.
Partisanship is the primary driver of voter decision-making in the United States. Partisans expect to prefer their party’s candidates’ issue stances and personal characteristics. Even when they learn negative information, motivated reasoning often keeps them from changing their candidate evaluations or vote choice. However, there is a “tipping point” at which partisans will update their priors and may vote against their preferred party’s candidate. This study seeks to determine whether voters are more likely to reach that tipping point when they see a woman in their party, and under what circumstances. We use a unique experimental design to vary a candidate’s gender, congruence with major elements of the party platform, and their participation in a scandal. We find that women are often evaluated more negatively and that subjects rely on substantive information more when evaluating women candidates. Our findings suggest that campaigns and campaign information may matter more for women candidates.
The extent to which EU competition law applies in the healthcare context remains a contested question. The contemporaneous publication of the European Commission’s Evaluation of State Subsidy rules for health and social services of general economic interest (SGEI) in December 2022, and of the Court of Justice of the European Union’s April 2023 judgment in Casa Regina Apostolorum regarding state support to hospitals in Italy, underscore uncertainty and appear to indicate an impasse. These publications unfold against the backdrop of two tensions: between state and market, and between the EU and national levels. Hospitals illustrate these tensions well due to the expansion of competition mechanisms into the hospital sector (notably expanding private provider delivery of public hospital services, often supported by “patient choice” policies), and of hospitals remaining typically local or regional in character rather than supranational. This article provides a timely and original analysis of the Casa Regina Apostolorum judgment in light of Commission policy regarding SGEI and hospitals and how EU Member States engage with this. It offers insights into the potential legacy of Casa Regina Apostolorum, and indicates where future legal challenges may focus.
Eddies within the meso/submeso-scale range are prevalent throughout the Arctic Ocean, playing a pivotal role in regulating the freshwater budget, heat transfer and sea ice transport. While observations have suggested a strong connection between the dynamics of sea ice and the underlying turbulent flows, quantifying this relationship remains an ambitious task due to the challenges of acquiring concurrent sea ice and ocean measurements. Recently, an innovative study using a unique algorithm to track sea ice floes showed that ice floes can be used as vorticity-meters of the ocean. Here, we present a numerical and analytical evaluation of this result by estimating the kinematic link between free-drifting ice floes and underlying ocean eddies using idealised vortex models. These analyses are expanded to explore local eddies in quasi-geostrophic turbulence, providing a more realistic representation of eddies in the Arctic Ocean. We find that in both flow fields, the relationship between floe rotation rates and ocean vorticity depends on the relative size of the ice floe to the eddy. As the floe size approaches and exceeds the eddy size, the floe rotation rates depart from half of the ocean vorticity. Finally, the effects of ice floe thickness, atmospheric winds and floe collisions on floe rotations are investigated. The derived relations and floe statistics set the foundation for leveraging remote sensing observations of floe motions to characterise eddy vorticity at small to moderate scales. This innovative approach opens new possibilities for quantifying Arctic Ocean eddy characteristics, providing valuable inputs for more accurate climate projections.
The use of community treatment orders (CTOs) has increased in many jurisdictions despite very limited evidence for their efficacy. In this context, it is important to investigate any differences in outcome by subgroup.
Aims
To investigate the variables associated with CTO placement and the impact of CTOs on admissions and bed-days over the following 12 months, including differences by diagnosis.
Method
Cases and controls from a complete jurisdiction, the state of Queensland, Australia, were analysed. Administrative health data were matched by age, sex and time of hospital discharge (index date) with two controls per case subject to a CTO. Multivariate analyses were used to examine factors associated with CTOs, as well as the impact on admissions and bed-days over the 12 months after CTO placement. Registration: Australian and New Zealand Clinical Trials Registry (ACTRN12624000152527).
Results
We identified 10 872 cases and 21 710 controls from January 2018 to December 2022 (total n = 32 582). CTO use was more likely in First Nations people (adjusted odds ratio = 1.14; 95% CI: 1.06–1.23), people from culturally diverse backgrounds (adjusted odds ratio = 1.45; 95% CI: 1.33–1.59) and those with a preferred language other than English (adjusted odds ratio = 1.21; 95% CI: 1.02–1.44). When all diagnostic groups were considered, there were no differences in subsequent admissions or bed-days between cases and controls. However, both re-admissions and bed-days were significantly reduced for CTO cases compared with controls in analyses restricted to non-affective psychoses (e.g. adjusted odds ratio = 0.77, 95% CI: 0.71–0.84 for re-admission).
Conclusions
Queenslanders from culturally or linguistically diverse backgrounds and First Nations peoples are more likely to be placed on CTOs. Targeting CTO use to people with non-affective psychosis would both address rising CTO rates and mean that people placed on these orders derive possible benefit. This has implications for both clinical practice and policy.
Drawing on the two-factor model of organizational justice and social exchange theory, this study investigates the mediating roles of procedural and distributive justice in the relationship between work locus of control (WLOC) and leader–member exchange (LMX). Using data collected from two cultural contexts – the United States and South Korea – this research further examines whether culture moderates the indirect relationship between WLOC and LMX through perceived justice. The findings indicate that subordinates with an internal WLOC tend to report higher-quality LMX relationships, and that both procedural and distributive justice partially mediate this relationship. Moderated mediation analyses reveal that the indirect effects of WLOC on LMX via justice perceptions are significantly stronger in the U.S. sample than in the Korean sample. These results contribute to the literature by identifying perceived justice as a key psychological mechanism linking individual traits to relational outcomes at work, and by highlighting how cultural values shape this process.
The original declarative procedural reflective (DPR) model is a well-established model of therapist knowledge and skill development. To date, although it has been used to guide reflection and discussion around personal and practitioner selves, it has not emphasised the various intersecting identities of practitioners and how these interact within wider concepts such as power, society, service contexts and the patient and supervisory relationships. The learning, development and implementation of CBT skills does not occur in a vacuum or separate to the practitioner identities however relatively little has been written on this. This paper aims to expand the original DPR model to illustrate potential ways that social context, identity and power could be considered within CBT training, delivery and supervision. It delineates and explores the additional components of the model (i.e. practitioner identity(s), context/society and power) and then provides examples of how this framework could inform key CBT activities (including low-intensity CBT).
Key learning aims
(1) We aim to (re-) familiarise the reader with the original DPR model of practitioner development and how this applies to CBT practitioners explicitly including low-intensity CBT practitioners (from novice learners through to expert).
(2) We aim to help the reader understand how the key elements of the original DPR model (declarative knowledge, procedural skills, reflective system and therapist stance) can be applied to specific content areas when working with individuals with minoritised identities.
(3) The reader will be introduced to an adapted DPR model which provides a framework for CBT practitioners to reflect on, and be able to conceptualise the influence of their own social identities, social context, power and how this may impact on their development and implementation of declarative knowledge, procedural skills and reflective skills.
(4) We aim to help the reader understand how an adapted DPR model can provide a helpful framework to guide skill development in working with difference and ensuring practitioners have the knowledge and skills required to provide sensitive and effective therapy, supervision and training to individuals with identities that may be different from the practitioner.
Eocene snakes of India have the potential to shed light on the nature of snake diversification on the subcontinent following the Deccan volcanism at the Cretaceous-Paleogene boundary (K-Pg), when India was still a northward-drifting isolated landmass prior to its collision with Asia. Here, we report a diverse snake fauna from the Eocene of Kutch, western India. The fauna, dominated by aquatic forms, includes palaeophiids, a giant madtsoiid, and a possible nigerophiid. The palaeophiids from the middle Eocene (late Lutetian) comprise ?Palaeophis Owen, 1841 and Pterosphenus rannensis n. sp. Together, these taxa enrich the record of fossil snakes in the poorly known late Lutetian of India and represent the youngest record of Palaeophiidae from the Indian subcontinent. Pterosphenus rannensis n. sp. shows intermediate morphology between Palaeophis and Pterosphenus-grade snakes and is phylogenetically the earliest-diverging member of Pterosphenus Lucas, 1898. Additionally, the middle Eocene Pterosphenus biswasi Rage et al., 2003 is reassessed and retained as a valid taxon based on pterapophyseal morphology and overall form. Biogeographic considerations highlight the importance of the Indian fossil record in understanding the origin and diversification of the genus Pterosphenus. The prevalence of niche partitioning is suggested for the palaeophiids, with Pterosphenus rannensis n. sp. recovered from a tidal setting and ?Palaeophis sp. indet. from a marsh/swamp setting. The new Indian madtsoiid from the middle Eocene (early Lutetian) represents a sympatric taxon with the terrestrial/semiaquatic giant Vasuki indicus Datta and Bajpai, 2024 coexisting in a back-swamp marsh setting. The early Eocene (Ypresian) nigerophiid is among the oldest Cenozoic occurrences of this family globally.