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Clinical trials provide valuable treatment insights but often fail to represent real-world outcomes. This is particularly true for advanced laryngeal cancer patients, who face significant co-morbidities and socioeconomic challenges. This study evaluates whether outcomes from research datasets in The Cancer Imaging Archive reflect real-world survival in a regional cohort from North-East England.
Methods
This retrospective analysis compares outcomes between The Cancer Imaging Archive (n = 198) and North-East England (n = 222) cohorts. Demographics, treatment modalities and five-year disease-specific survival were assessed via Kaplan–Meier curves and Cox regression.
Results
North-East England had a lower five-year disease-specific survival (59.2 per cent vs. 76.9 per cent; p = 0.0018) and was characterised by greater co-morbidity burden and upfront surgery with adjuvant therapy (51 per cent), whereas The Cancer Imaging Archive patients received upfront chemoradiotherapy (53 per cent) or radiotherapy alone (41 per cent).
Conclusion
The poorer real-world outcomes reflect the challenges of generalising research data to heterogeneous populations. Bridging the gap between research efficacy and real-world effectiveness is critical to delivering equitable care for advanced laryngeal cancer.
China’s gun-free society is maintained through a paradox—while the state’s disciplinary apparatus unmakes any exceptions to the norm by continuously disarming the wayward, it simultaneously perpetuates exaggerated narratives of threats posed by clandestine gun makers in the ethnic frontier regions. This article investigates the state’s construction of Hualong, in Northwest China’s Qinghai, as ‘the capital of China’s ghost guns’. By debunking the quasi-historical claim that Hualong was a major firearms manufacturing hub in the early twentieth century, the article reveals how the modern Chinese state uses this narrative to reinforce an ethnopolitical reset—placing the Han in exclusive control of both firearms’ regulation and the sovereign right to punish violators. Drawing on multiple archival sources, the article argues that monoethnic control of arms was a central tenet of twentieth-century ethnic nationalism. Furthermore, this article demonstrates that early twentieth-century Qinghai was adept in taking advantage of the mobility and fluidity of arms afforded by a trans-imperial infrastructure in its state-making enterprise. That infrastructure included Western missionary networks, treaty ports and foreign concessions inherited from the late Qing, a revitalized maritime hajj route, Japanese imperialism, as well as an expansionist Chinese nationalism struggling to find a foothold in the former empire’s legacy frontiers.
Foreign national courts are categorically prohibited from prosecuting a head of state of another country. From the beginning of the twenty-first century until very recently, this view was nearly unanimous. A 2002 decision of the International Court of Justice, in the Arrest Warrant case, strongly supports it. According to the court, heads of state enjoy ‘full immunity’ from foreign criminal jurisdiction. Thus, the prohibition to prosecute foreign heads of state even extends to those who perpetrate aggression and other war-related crimes. That view is based on a twenty-first century myth. According to the myth, heads of state have long – ‘from time immemorial’ – enjoyed an absolute personal immunity from foreign jurisdiction. This article identifies the origin of the myth and parses through crucial historical facts that disprove it, particularly, the indictments against Hitler as the sitting head of state of Germany, their endorsement by the United Nations War Crimes Commission, and the judgment of the International Military Tribunal. A proper debunking of this myth is not only important as a matter of setting the historical record straight but is also relevant for present-day debates about the prosecution of heads of state (or heads of government) who – like Vladimir Putin, Bashar al-Assad, Min Aung Hlaing, and Benjamin Netanyahu – might be responsible for aggression, genocide, war crimes, crimes against humanity, and other crimes.
This article examines how the California Reparations Task Force (2021–23), a government advisory body, grappled with the question of which Black Americans should be eligible for reparations. Some Task Force members and activists advocated a lineage approach that restricts eligibility to people whose ancestors were enslaved in the United States. Others supported a Pan-African approach that includes all Black residents. The Task Force voted narrowly for the lineage approach. Surprisingly, however, and not acknowledged by most observers, most of the Task Force’s Final Report implicitly adopted a tiered approach, which follows the lineage approach for some policies and the Pan-African approach for others. It also includes universal policies for all, as long as they include a reparatory dimension. The Final Report thus challenged the assumption that all reparations policies would follow a single standard of eligibility. The tiered approach emerged in part because it complies with United Nations guidelines on reparations. It appears more likely than the other approaches to increase public support for reparations.
This essay describes the elaborative model of knowledge production that is both the topic of Kathy Psomiades’s Primitive Marriage and its method. The annotative procedure of (as Psomiades puts it) “adding” to what has come before is dialectical insofar as it understands any concept to emerge from the historical conditions enabling it; it is collaborative insofar as it links thinking agents across bounds of difference; and it is political in that it offers to locate the preconditions for thought in time but then find supplements, blank spots—openings for change. The essay closes with a biographical example of this model in action, in a scene of feminist mentorship from the early 2000s.
Despite almost a century and a half of excavation, the dynamic landscape into which the temple complex of Karnak was embedded is not well understood. Presenting the results of the first comprehensive geoarchaeological survey of the area, the authors show that Karnak was built upon a fluvial terrace segment surrounded by river channels in an island configuration potentially recalling the ‘primeval mound’ of Egyptian creation myths. Permanent occupation of the site became possible after 2520 BC ±420 years, likely during the Old Kingdom. Subsequent landscape changes were dramatic, with the occupants of the island responding both opportunistically and proactively.
We prove new weighted decoupling estimates. As an application, we give an improved sufficient condition for almost everywhere convergence of the Bochner-Riesz means of arbitrary $L^p$ functions for $1<p<2$ in dimensions 2 and 3.
The Association of Otolaryngologists in Training wanted to assess the experiences of bullying, harassment and raising concerns in their otolaryngology posts.
Methods
An online survey of otolaryngology trainees, with 190 responses out of 350 targeted, included questions on bullying and harassment.
Results
Many respondents had experienced or witnessed a range of bullying, harassment and sexual harassment behaviours, including: unrealistic expectations about workload, responsibilities or level of competence; inadequate or absent supervision; and undervaluing someone’s contribution (in their presence or otherwise). However, very few (5 per cent or less) had reported them. Twenty-one per cent would not feel confident in reporting bullying/harassment or sexual harassment problems, and 40 per cent do not feel safe raising concerns. Just 10 per cent said the existing reporting mechanisms are sufficient.
Conclusion
A number of initiatives have been introduced recently in the UK to address bullying and harassment within the medical workplace, but there is still potential for further development.
The FUSION project (an acronym for FUsion StudIes of prOton boron Neutron-less reaction in laser-generated plasma) was launched in 2022 by researchers from INFN (Istituto Nazionale di Fisica Nucleare) and ENEA. This project marks the first scientific initiative funded by INFN in the field of Inertial Confinement Fusion (ICF). The main objectives of FUSION are to develop a new generation of solid targets designed to enhance the $^{11}B(p,\alpha)2\alpha$ fusion reaction rate, being this reaction a potential candidate for future ICF schemes. FUSION will also focus on designing novel diagnostic techniques for measuring reaction products and, ultimately, estimating alpha and proton cross-sections in a plasma environment.
The project will be carried out through two experimental campaigns at a laser facility equipped with a high-energy, long-pulse (picosecond) laser. In the proposed experimental setup, the $^{11}B(p,\alpha)2\alpha$ reaction will be triggered simultaneously ‘in target’ by the protons generated in the laser matter interaction and 11B present in the same expanding plasma and in the ‘pitcher-catcher’ configuration. In FUSION, a set of measurements will also be dedicated to a first estimation of the proton and alpha-stopping power in a plasma. FUSION will enable a comprehensive understanding of the reactions and will help in optimize the conditions for future applications in inertial nuclear fusion with the $^{11}B(p,\alpha)2\alpha$ reaction.
Regionally dominant extractive sectors - including Brazilian cattle ranching, Amazonian narco-gold mining, and Finnish paper pulping - provide the foundation for this book's analysis of the range of motivations for deforestation. This framing allows for a discussion of the global political economy and ecology in general, and an in-depth examination of the varieties of extractivisms that define land and resource use. The chapters take an interdisciplinary approach, drawing on political ethnography and world systems analyses across the Global North-South divide. The book develops and applies a new theory that identifies regionally dominant political-economic systems as the driving forces behind deforestation. This book is essential reading for advanced students, researchers, and policy makers working in (de)forestation, environmental studies, environmental law, economics, conservation, climate change, and sustainability, leading to a deeper understanding of why our planet's forests are under threat. This title is also available as Open Access on Cambridge Core.
Antimicrobial resistance (AMR) is a global health crisis exacerbated by policies like China’s Volume-Based Procurement (VBP), which may inadvertently increase antimicrobial overuse. This study evaluates a clinical pharmacist-led Antimicrobial Stewardship (AMS) program with prospective audit for special-restricted antimicrobials under VBP.
Methods:
A retrospective quasi-experimental interrupted time-series analysis compared pre-intervention (2022) and post-intervention (2023–2024) data at Tongji Hospital, a tertiary hospital in Wuhan, China. Key metrics included Antimicrobial Use Density (AUD), prescription rationality, antimicrobial costs, and multidrug-resistant infection rates.
Results:
The intervention significantly improved prescription appropriateness for special-restricted antimicrobials (80.24% vs. 93.83%, P < 0.005) and reduced AUD (47.87 vs. 34.25, P < 0.001). Total antimicrobial costs decreased by 41.26%, with a reduction in the incidence of multidrug-resistant infections from 0.084% to 0.062% (P < 0.05). Carbapenem use correlated with CRKP isolation rates (R = 0.62, P < 0.05). Clinical pharmacists rejected 10.24% of prescriptions, all accepted by physicians.
Conclusion:
Pharmacist-led prospective audits optimize antimicrobial use under VBP, mitigate resistance risks, and reduce costs, while acknowledging that concurrent infection control measures may have contributed to these trends. This model may inform similar interventions in other institutions, particularly those in resource-limited settings.
There is a considerable overlap in clinical features and genetics between schizophrenia (SZ) and bipolar disorder (BD). Previous neuroimaging research has demonstrated common and distinct brain damage patterns between relatives (RELs) of SZ and BD patients, suggesting shared and differential genetic influences on the brain. Despite an increasing recognition that disorders localize better to distributed brain networks than individual brain regions, studies investigating network localization of genetic risk for SZ and BD are still lacking.
Methods
To address this gap, we initially identified brain functional and structural damage locations in SZ- and BD-RELs from 103 published studies with 2364 SZ-RELs, 864 BD-RELs, and 4114 healthy controls. By applying novel functional connectivity network mapping to large-scale discovery and validation resting-state functional MRI datasets, we mapped these affected brain locations to four disorder-susceptibility networks.
Results
SZ-susceptibility functional damage network primarily involved the executive control and salience networks, while its BD-counterpart principally implicated the default mode and basal ganglia networks. SZ-susceptibility structural damage network predominantly involved the auditory and default mode networks, yet its BD-counterpart mainly implicated the language and executive control networks. Although these networks showed cross-disorder inconsistencies when focusing on either imaging modality alone, the combined SZ- and BD-susceptibility brain damage networks had a substantially increased spatial similarity.
Conclusions
These findings may support the concept that SZ and BD represent distinct diagnostic categories from a neurobiological perspective, helping to clarify the common network substrates via which the shared genetic mechanisms underlying both disorders give rise to their overlapping clinical phenotypes.
Cortical thickness reductions associated with chronic methamphetamine use exhibit a non-uniform spatial distribution across brain regions. A potential neurobiological mechanism underlying for this heterogeneous pattern may involve the structural and functional organization of cortical connectivity networks, which could mediate the propagation of neuroanatomical alterations. Here, we aimed to explore how brain network architecture constrains cortical thickness alterations and their clinical relevance.
Methods
The 3D-T1 images were acquired from 139 patients with methamphetamine use disorder (MUD) and 119 sex- and age-matched healthy controls. We first characterized distributed cortical thinning patterns in patients with MUD, then evaluated the relationships between regional atrophy and (1) multimodal nodal centrality measures (structural, morphological, and functional) and (2) atrophy profiles of structural connected neighbors. Individual network-weighted cortical abnormality maps were used to identify distinct MUD biotypes and related to clinical features through k-means clustering and partial least squares regression.
Results
Cortical thinning patterns demonstrated significant associations with nodal centrality across all modalities, as well as cortical thinning of connected neighbors revealing a network-dependent atrophy architecture. Fronto-temporal regions emerged as critical epicenters, showing both high nodal centrality and strong correlations with connected neighbors’ thinning severity. We found that the individual differences in network-weighted cortical abnormality corresponded to clinical symptom variability, and distinguished two MUD biotypes associated with drug use.
Conclusions
Our findings suggest that cortical thinning in MUD is influenced by the brain connectome architecture, providing a mechanistic framework for understanding individual variability in addiction progression.
In this article, we construct explicit spanning sets for two spaces of modular forms. One is the subspace generated by integral-weight Hecke eigenforms with nonvanishing quadratic twisted central L-values. The other is a subspace generated by half-integral weight Hecke eigenforms with certain nonvanishing Fourier coefficients. Along the way, we show that these subspaces are isomorphic via the Shimura lift.
We construct a monoidal version of Lurie’s un/straightening equivalence. In more detail, for any symmetric monoidal $\infty $-category $\mathbf {C}$, we endow the $\infty $-category of coCartesian fibrations over $\mathbf {C}$ with a (naturally defined) symmetric monoidal structure, and prove that it is equivalent the Day convolution monoidal structure on the $\infty $-category of functors from $\mathbf {C}$ to $\mathbf {Cat}_\infty $. In fact, we do this over any $\infty $-operad by categorifying this statement and thereby proving a stronger statement about the functors that assign to an $\infty $-category $\mathbf {C}$ its category of coCartesian fibrations on the one hand, and its category of functors to $\mathbf {Cat}_\infty $ on the other hand.
This paper investigates the magnitude and drivers of ethnic and religious disparities in Female Labor Force Participation (FLFP) in Syria. Using census data and the Gelbach decomposition method, the analysis reveals substantial FLFP gaps across groups, reaching up to 18 percentage points. To understand the factors underlying these gaps, the analysis exploits the heterogeneity in economic development, demographic profiles, educational attainment, and geography across towns and villages. The findings indicate that differences in age distribution, income levels, education, and public sector employment shares are the primary contributors to FLFP gaps. While social norms are often considered key determinants of FLFP, their role is assessed using gender parity indices for educational enrollment and attainment but shows little explanatory power for ethnic and religious disparities in FLFP. These results highlight the importance of structural economic and demographic factors over cultural constraints in shaping group differences in FLFP in Syria.
Over the past decade or so, ethical recruitment has become increasingly popular as an aspirational standard for addressing labour violations and human rights issues in the transnational recruitment of migrant workers. While multi-national corporations (MNCs) – both international buyers and their Tier 1 suppliers – have been quick to adopt and codify ethical recruitment principles in their company codes of conduct, the same cannot be said for the small and medium enterprises (SMEs) further down the supply chain. Grounded in a case study of a small packaging company in Penang, Malaysia, this article explores how SMEs navigate their human resources and financial constraints in their attempt to practise ethical recruitment. We conclude with some brief reflections on the role of recruitment agents and the (in)equitable allocation of costs across global supply chains in making ethical recruitment a realistic and achievable goal for SMEs.