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Cognitive therapy for PTSD (CT-PTSD) is an efficacious treatment for children and adolescents with post-traumatic stress disorder (PTSD) following single incident trauma, but there is a lack of evidence relating to this approach for youth with PTSD following exposure to multiple traumatic experiences.
Aims:
To assess the safety, acceptability and feasibility of CT-PTSD for youth following multiple trauma, and obtain a preliminary estimate of its pre–post effect size.
Method:
Nine children and adolescents (aged 8–17 years) with multiple-trauma PTSD were recruited to a case series of CT-PTSD. Participants completed a structured interview and mental health questionnaires at baseline, post-treatment and 6-month follow-up, and measures of treatment credibility, therapeutic alliance, and mechanisms proposed to underpin treatment response. A developmentally adjusted algorithm for diagnosing PTSD was used.
Results:
No safety concerns or adverse effects were recorded. Suicidal ideation reduced following treatment. No participants withdrew from treatment or from the study. CT-PTSD was rated as highly credible. Participants reported strong working alliances with their therapists. Data completion was good at post-treatment (n=8), but modest at 6-month follow-up (n=6). Only two participants met criteria for PTSD (developmentally adjusted algorithm) at post-treatment. A large within-subjects treatment effect was observed post-treatment and at follow up for PTSD severity (using self-report questionnaire measures; ds>1.65) and general functioning (CGAS; ds<1.23). Participants showed reduced anxiety and depression symptoms at post-treatment and follow-up (RCADS-C; ds>.57).
Conclusions:
These findings suggest that CT-PTSD is a safe, acceptable and feasible treatment for children with multiple-trauma PTSD, which warrants further evaluation.
This study explored the prospective use of the Ages and Stages Questionnaires-3 in follow-up after cardiac surgery.
Materials and Method:
For children undergoing cardiac surgery at 5 United Kingdom centres, the Ages and Stages Questionnaires-3 were administered 6 months and 2 years later, with an outcome based on pre-defined cut-points: Red = 1 or more domain scores >2 standard deviations below the normative mean, Amber = 1 or more domain scores 1–2 standard deviations below the normal range based on the manual, Green = scores within the normal range based on the manual.
Results:
From a cohort of 554 children <60 months old at surgery, 306 participated in the postoperative assessment: 117 (38.3%) were scored as Green, 57 (18.6%) as Amber, and 132 (43.1%) as Red. Children aged 6 months at first assessment (neonatal surgery) were likely to score Red (113/124, 85.6%) compared to older age groups (n = 32/182, 17.6%). Considering risk factors of congenital heart complexity, univentricular status, congenital comorbidity, and child age in a logistic regression model for the outcome of Ages and Stages score Red, only younger age was significant (p < 0.001). 87 children had surgery in infancy and were reassessed as toddlers. Of these, 43 (49.2%) improved, 30 (34.5%) stayed the same, and 13 (16.1%) worsened. Improved scores were predominantly in those who had a first assessment at 6 months old.
Discussion:
The Ages and Stages Questionnaires results are most challenging to interpret in young babies of 6 months old who are affected by complex CHD.
The relation between perception and production in social meaning is often taken to be transparent, with social meaning associations learned from observations of language use. However, recent work has suggested that this relation is often more complex than previously thought. Here, we present new data comparing the social meaning of realized variable liaison in spoken French, couched within the framework of the pragmatic sociology of critique. We recall data from a recent matched guise experiment showing that listeners associate the realization of liaison with meanings like “professionalism”, specifically in social situations where efficacy and expertise are at issue. Basing ourselves on this finding, we use a production task, presenting these same social situations to amateur and professional actors. We find that our participants do not exploit the social meaning potential of variable liaison, producing liaison at lexically-determined rates on a par with previous corpus studies. We discuss this discrepancy between perception and production, which suggests that the link between the two is dependent on the linguistic variable under investigation.
Anti-reclamation movements are common in Indonesia, but their effectiveness varies. Such movements, which oppose the infilling of coastal waters and wetlands, consistently draw support from environmentalists, fisherfolk, and coastal residents. To succeed, however, they must transcend these constituencies and mobilize broad coalitions. In this paper, I apply the concept of political opportunity to explain variation in the ability of anti-reclamation movements to achieve this goal. Specifically, I argue that the opportunity to build broad coalitions depends on the positioning of political, economic, and communal elites. Disagreement among these groups creates opportunities for activists to recruit some of them as allies in the construction of economically diverse, cross-class coalitions. Consensus, by contrast, excludes elites as potential allies, forcing activists to build geographically expansive but class-based coalitions. To develop my argument, I draw on local news archives and primary source documents to compare similarly situated anti-reclamation movements in Bali and Makassar. In Bali, the movement flourished by cultivating an alliance with communal elites and local businesses. In Makassar, the movement withered because public officials, local businesses, and communal elites all welcomed reclamation. My findings imply that anti-reclamation movements are most likely to succeed when they emphasize communal identities with cross-class appeal. Yet such tactics alienate parallel movements from one another and undermine national activism. As a result, anti-reclamation movements fight the same battles over and over without achieving national reforms that would empower coastal communities to participate in coastal planning. Under such conditions, reclamation deepens the vulnerability of coastal communities to climate change.
Clostridioides difficile (C. difficile) is one of the most common causes of healthcare-associated infections (HAIs). Elimination of C. difficile spores is difficult as they are resistant to common hospital-grade disinfectants. Copper-impregnated surfaces provide continuous reduction of multiple pathogens, potentially lowering the risk of infections. This manuscript aims to evaluate the efficacy of copper-impregnated surfaces on C. difficile spores.
Methods:
Control (no copper) coupons and copper coupons containing 20% copper-oxide were inoculated with C. difficile spore loads ranging from 105 to 107 spores, with or without 5% fetal bovine serum soil load. After 4 hours of contact time, the C. difficile spores were recovered, plated on C. difficile growth media, and colony forming units were counted. The efficacy of copper (log10 kill) was estimated using a Bayesian latent variables model.
Results:
After 4 hours, unsoiled copper bedrail and copper table coupons at mean spore inoculation resulted in a 97.3% and 96.8% reduction in spore count (1.57 and 1.50 log10 kill, respectively). That of soiled bedrail and table coupons showed a 91.8% and 91.7% reduction (1.10 and 1.10 log10 kill, respectively).
Conclusions:
Copper coupons can substantially reduce C. difficile spores after 4 hours, but results vary depending on the initial spore concentration and presence or absence of organic material. Higher initial spore loads or excess organic material may prevent spores from contact with copper surfaces, thus decreasing kill efficacy. Continuous sporicidal effect of copper-impregnated surfaces may decrease spore burden and help prevent transmission of spores.
This article examines street-level bureaucrats’ positions between the institutional system and their clients with a forced migration background in their sensemaking of trust. Situated at the frontline of the institution, street-level bureaucrats are crucial agents for forced migrants settling in Nordic welfare states. Drawing on individual interviews with street-level bureaucrats in Finland and Sweden and theoretically leaning on street-level bureaucracy, positioning theory, and trust, this article explores how street-level bureaucrats navigate these encounters. By identifying five non-exclusionary ways in which street-level bureaucrats position themselves between the migrant client and the institutional system through their sensemaking of trust, I propose a typology of positions: resisting warrior, empathic carer, neutral mediator, pushing steerer, and critical questioner. Further, these positions reflect ambiguous narratives of being simultaneously an agent of the citizen and an agent of the state.
Amazon parrots stand out as one of the most illegally traded Psittacids in the neotropics. However, the lack of effective tools for determining the geographical origin of confiscated individuals has impeded the development of well-informed release programmes. In this study, we evaluated the efficacy of the cytochrome oxidase subunit I (COI) gene to identify phylogeographical groups and infer the origins of seized individuals across six Amazon parrot species. Through comprehensive genetic and phylogenetic analyses of 140 COI sequences from individuals with documented geographical origin, a genetic reference database was assembled. The most likely origin of 156 seized parrots was inferred by comparing their genotype to this database. Within the Yellow-headed Parrot Amazona ochrocephala species complex, our analyses revealed the presence of seven distinct phylogeographical groups, exposing a notable poaching impact in the Middle Magdalena’s river valley. For the Southern Mealy Amazon A. farinosa, three distinct genetic groups were identified, with seized individuals showing comparable proportions originating from both the Cis- and Trans-Andean regions. Noteworthy genetic differentiation was observed between individuals of Festive Amazon A. festiva from the Caquetá–Amazon Rivers and those from the Meta River, with two seized individuals assigned to the former. The Scaly-naped Amazon A. mercenaria exhibited genetic divergence between individuals from the central Andes and the Sierra Nevada de Santa Marta. In contrast, the Orange-winged Amazon A. amazonica and Red-lored Amazon A. autumnalis did not display significant phylogeographical structure. However, analyses of seized individuals of A. amazonica suggested a potential underestimation of its genetic diversity and structure. This study illustrates the utility of mitochondrial molecular markers in determining the most probable area of origin for confiscated Amazon parrots, aiding in release programmes and enhancing the monitoring of natural populations.
This article proposes that, based on the evolution of international investment law and investment arbitration, umbrella clauses are substantially implicated in the interpretation of Chinese concession loan agreements in Nigeria. So far, the outcome of the oversight functions of the National Assembly of Nigeria indicates that umbrella clauses have not been considered a significant legal issue in the negotiation of these agreements. With the growing use of Chinese concession loan agreements in Nigeria, this article offers a historical analysis that should be a guide to organs of government, policy advisers and others charged with the sourcing and negotiation of concession loans for development projects in Nigeria. The article makes the case that a proper understanding of the evolution of umbrella clauses is germane to the negotiation and interpretation of these agreements, compared to standard immunity clauses that appear to have overtaken in the debate about these loans in Nigeria.
A graph G is called an $[s,t]$-graph if any induced subgraph of G of order s has size at least $t.$ We prove that every $2$-connected $[4,2]$-graph of order at least $7$ is pancyclic. This strengthens existing results. There are $2$-connected $[4,2]$-graphs which do not satisfy the Chvátal–Erdős condition on Hamiltonicity. We also determine the triangle-free graphs among $[p+2,p]$-graphs for a general $p.$
This paper obtains logarithmic asymptotics of moderate deviations of the stochastic process of the number of customers in a many-server queue with generally distributed inter-arrival and service times under a heavy-traffic scaling akin to the Halfin–Whitt regime. The deviation function is expressed in terms of the solution to a Fredholm equation of the second kind. A key element of the proof is the large-deviation principle in the scaling of moderate deviations for the sequential empirical process. The techniques of large-deviation convergence and idempotent processes are used extensively.
We use childhood exposure to disasters as a natural experiment inducing variations in adulthood outcomes. Following the fetal origin hypothesis, we hypothesize that children from households with greater famine exposure will have poorer health outcomes. Employing a unique dataset from Bangladesh, we test this hypothesis for the 1974–75 famine that was largely caused by increased differences between the price of coarse rice and agricultural wages, together with the lack of entitlement to foodgrains for daily wage earners. People from northern regions of Bangladesh were unequally affected by this famine that spanned several months in 1974 and 1975. We find that children surviving the 1974–75 famine have lower health outcomes during their adulthood. Due to the long-lasting effects of such adverse events and their apparent human capital and growth implications, it is important to enact and enforce public policies aimed at ameliorating the immediate harms of such events through helping the poor.
A compact, wideband, and high-gain circularly polarized array antenna is proposed based on substrate integrated gap waveguide (SIGW) using sequential rotational phase (SRP). The array antenna consists of four $2\times2$ corner-cutting corner patches and an SIGW-SRP feeding network. The SIGW-SRP feeding network is achieved by utilizing the spatial vector addition property to compensate for phase, aiming to improve the bandwidth and gain. Unlike the traditional SRP feeding network, the proposed feeding scheme is simpler and easier to fabricate, and each port can achieve more stable phase and bandwidth. In addition, benefiting from the surface wave suppression and in-phase reflection property of SIGW, the proposed array antenna has a stable radiation pattern and low cross-polarization covering wideband frequencies. The measured results indicate that the −10-dB impedance bandwidth ranges from 12.2 to 17.3 GHz (34.6%), the 3-dB axial ratio bandwidth ranges from 13.5 to 16.7 GHz (21.2%), and the peak gain is 16 dBic.
Inspired by the work of Bourgain and Garaev (2013), we provide new bounds for certain weighted bilinear Kloosterman sums in polynomial rings over a finite field. As an application, we build upon and extend some results of Sawin and Shusterman (2022). These results include bounds for exponential sums weighted by the Möbius function and a level of distribution for irreducible polynomials beyond 1/2, with arbitrary composite modulus. Additionally, we can do better when averaging over the modulus, to give an analogue of the Bombieri-Vinogradov Theorem with a level of distribution even further beyond 1/2.