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Lesbian, gay, and bisexual (LGB) individuals are more than twice as likely to experience anxiety and depression compared with heterosexuals. Minority stress theory posits that stigma and discrimination contribute to chronic stress, potentially affecting clinical treatment. We compared psychological therapy outcomes between LGB and heterosexual patients by gender.
Methods
Retrospective cohort data were obtained from seven NHS talking therapy services in London, from April 2013 to December 2023. Of 100,389 patients, 94,239 reported sexual orientation, 7,422 identifying as LGB. The primary outcome was reliable recovery from anxiety and depression. Secondary outcomes were reliable improvement, depression and anxiety severity, therapy attrition, and engagement. Analyses were stratified by gender and employed multilevel regression models, adjusting for sociodemographic and clinical covariates.
Results
After adjustment, gay men had higher odds of reliable recovery (OR: 1.23, 95% CI: 1.13–1.34) and reliable improvement (OR: 1.16, 95% CI: 1.06–1.28) than heterosexual men, with lower attrition (OR: 0.88, 95% CI: 0.80–0.97) and greater reductions in depression (MD: 0.51, 95% CI: 0.28–0.74) and anxiety (MD: 0.45, 95% CI: 0.25–0.65). Bisexual men (OR: 0.67, 95% CI: 0.54–0.83) and bisexual women (OR: 0.84, 95% CI: 0.77–0.93) had lower attrition than heterosexuals. Lesbian and bisexual women, and bisexual men, attended slightly more sessions (MD: 0.02–0.03, 95% CI: 0.01–0.04) than heterosexual patients. No other differences were observed.
Conclusions
Despite significant mental health burdens and stressors, LGB individuals had similar, if not marginally better, outcomes and engagement with psychological therapy compared with heterosexual patients.
Sulfur stable isotope ratios (δ34S) have become increasingly common in archaeology for studying paleodiet, especially in occasions where there is a need to identify aquatic resource consumption more accurately. This is particularly relevant in the Baltic Sea region, where brackish conditions tend to mask “typical” marine carbon isotopic signals. Here we report new δ34S values for 126 human bone collagen samples which will be analyzed together with previously published data to investigate the potential of sulfur isotopes as an alternative proxy for aquatic resource consumption in historic period Estonia (ca. AD 1100‒1800). Bayesian statistical programming was used to provide quantitative dietary estimates, suggesting that the diet of the general population was predominantly terrestrial. The inclusion of δ34S as an additional dietary proxy produced generally comparable model results to the scenario that excluded δ34S. A sub-selection of samples was also radiocarbon dated and calibrated to take into account potential reservoir effects. For burials of commoners, the average contribution of 10% fish to dietary carbon does not significantly alter calibrated date ranges, even in the occasion where data on local reservoir effects is insufficient. This study has demonstrated both the potential and the pitfalls of using δ34S in this temporo-spatial context, and the new stable isotope and 14C data have shed light onto individual site-histories but also to broader cultural processes and changes that occurred during these turbulent times in this region.
New educational curricula are emerging to train physicians for healthcare in the 21st century. The University of Massachusetts Chan Medical School T.H. Chan School of Medicine (UMass Chan) implemented an MD curriculum redesign in the fall of 2022 that included seven educational pathways, including Entrepreneurship, Biomedical Innovation, and Design. This new pathway curriculum introduces students to the principles of innovation, entrepreneurship, basic engineering principles, and technology commercialization. It is modeled after the I-Corps curriculum with added material regarding engineering principles. I-Corps was initially developed by the National Science Foundation (NSF) to help scientists understand the commercial potential of their inventions. Major elements include the Business Model Canvas and Customer Discovery [19-22]. First-year (Class of 2027) and second-year (Class of 2026) pathway students were invited to participate in online surveys evaluating course material and their knowledge of course content. Initial results show that the program was well received and student self-assessment demonstrated significant improvement. Objective student knowledge also significantly improved. Novel curricula have the potential to transform medical education and prepare future physicians to practice healthcare in the 21st Century.
Chapter 2 contextualises the mēchanē within the broader picture of rich visual theologies that existed both on the tragic stage and within the context of the Great Dionysia. The mēchanē should be interpreted alongside actors playing gods, statues depicting gods, and altars denoting sacred places. The plurality of visual theologies in the theatre and in the festival context parallels broader cultural norms in ancient Greece. This is important, on the one hand, to understand how the machine existed within broader religious and cultural expectations. On the other hand, putting the mēchanē and mechanical epiphany among other, contemporary strategies also helps to demonstrate the deus ex machina’s unique material, theatrical and theological characteristics.
Breaking wave impacts on rigid structures have been extensively studied, yet the role of structural elasticity in shaping the impact and response remains insufficiently understood. In this study, we experimentally investigate the hydroelastic behaviour of a vertical cantilever plate subjected to multimodal solitary breaking wave impacts. The plate is mounted near the still water level on a 1 : 10 sloping beach, and the wave height-to-depth ratio ($H/h$) is varied from 0.15 to 0.40 to systematically control the impact type from non-breaking to highly aerated wave impacts. We show that aeration significantly affects hydroelastic impacts. The spatio-temporal extent of the impact pressure on the elastic plate increases with air entrapment, while the peak pressure becomes highly sensitive as the wave approaches the flip-through regime. Pressure oscillations associated with bubble formation induce high-frequency structural vibrations, particularly under low-aeration conditions. Furthermore, we find that the elasticity has a limited effect on the peak pressure, impact duration and impulse, but increases the maximum quasi-hydrostatic force on the plate for the scenarios investigated. Following the impact, two distinct free-top deflections are identified, i.e. a deflection $\Delta x_{\textit{imp}}$ with high acceleration induced by the impact pressure and a deflection $\Delta x_{{hp}}$ with high magnitude caused by the maximum quasi-hydrostatic pressure. These deflections scale with the Cauchy number as $\Delta x_{\textit{imp}}/l \sim Ca_{\textit{imp}}/6$ and $\Delta x_{{hp}}/l \sim Ca_{{hp}}/12$ (where l is the plate length), exhibiting parabolic and linear trends with $H/h$, respectively. This work presents a benchmark dataset and introduces a predictive law for structural deflection, providing practical insights into hydroelastic effects across various impact regimes.
This chapter aims to articulate a positive-rights paradigm that marshals contemporary, historical, and international legal frameworks to argue that government should have an affirmative duty to guarantee meaningful access to news and information for everyone. Drawing from democratic, legal, and economic theories, the chapter builds on a long lineage of argumentation – from Alexander Meiklejohn and Jerome Barron to more recent arguments advanced by C. Edwin Baker and Martha Minow – for why the First Amendment does not forbid government interventions that promote journalism. If we assume that press freedom is rendered meaningless without a press to protect, we arguably should go even further to compel the government to make targeted and democratically determined interventions into the media marketplace to guarantee public alternatives when private commercial media institutions fail to serve democratic needs.
Astrobiology is a scientific field that is very interdisciplinary and developing very fast, with many new discoveries generating a high level of attention in both the scientific community and the public. A central goal of astrobiology is to discover life beyond Earth which is, with our current instrumentation and knowledge, arguably within our reach. However, knowledge exchange crossing disciplinary boundaries is becoming increasingly challenging due to different usage of nomenclature and scientific controversies often limited to subdisciplines. There have been some efforts to compile organized databases of terms, concepts and other relevant material within some of the subfields contributing to astrobiology, for example through manually curated online portals designed to benefit students, teachers and practitioners of astrobiology-related research. However, the developments within the subfields and the potentially premature communication of research findings are too fast for objective research portals to remain reliable and up-to-date enough to enable well-informed scientific discussions. We suggest here a novel strategy for developing an online tracers portal as a self-maintaining and self-updating information platform, that would allow not only for a relatively unbiased selection of research results, but also provide fast access to latest scientific discoveries together with potential controversies, such that users of the tracers portal can form their own opinion on all available data rather than obtaining an already filtered and potentially biased selection of information.
Adult medulloblastoma is a rare entity with a predilection for the development of radiation-induced malignant glioma (RIMG). Management of RIMG in the setting of prior craniospinal irradiation is a challenging scenario.
Case:
We report a case of a 51-year-old male with short-interval development of multicentric malignant glioma with MET mutation who previously underwent craniospinal radiation for adult medulloblastoma. Due to radiographic findings, linear accelerator (LINAC)-based fractionated stereotactic/IMRT was delivered to the right temporal lesion alongside systemic therapy. The patient had interval development of an IDH wildtype, high-grade left cerebellar glioma and underwent surgical resection and subsequent gamma knife stereotactic radiosurgery (GKRS) to the cavity.
Discussion:
GKRS targeting the surgical cavity was delivered with a fractionated regimen of 27 Gy in 3 fractions to the margin. One year after completion of GKRS, the patient had not developed any symptomatic radiation necrosis or neuroimaging changes reflective of treatment toxicity. In this patient, GKRS to minimise the integral dose exposure of normal tissues surrounding the target volume proved to be particularly advantageous in the setting of prior craniospinal irradiation.
Recommendation:
RIMG poses significant challenges for radiation oncologists, particularly in the reirradiation setting. Decision-making involving multidisciplinary input balanced the necessity of dose escalation achieved by GKRS, while minimising the cumulative dose in the setting of prior craniospinal irradiation.
The Supreme Court has consistently declined to interpret the First Amendment to extend exclusive protections for the press. Across areas like newsgathering, rights of access, and protection of confidential sources, the Court has repeatedly rejected the press’s claims to particularized constitutional treatment. Yet many states have pursued a different approach. Each state constitution contains independent press and speech provisions. These provisions diverge from the First Amendment – in their texts, drafting histories, and interpretive precedents – in ways that can be rights-expanding for the press.
This chapter argues that these state constitutional provisions have been underutilized by press advocates. These state constitutional press and speech protections, along with other related constitutional provisions, hold promise as a powerful source of independent protection for journalists. They can be used to fill gaps left by the Supreme Court’s often flimsy and scattershot First Amendment approach. They can be more easily amended to respond to new and growing threats to the press. And they can operate as a safety net to catch the press if the Roberts Court decides to withdraw critical First Amendment press protections. Moreover, the lessons of the state constitutional experience can be used to support expanded federal press protections under the First Amendment.
There is a conflict in law and in journalism ethics regarding the appropriateness of truthful but scandalous information: What should be published and what should be edited out? In the past, judges routinely gave the press the right to make such determinations and often sided with journalists even in surprising situations in which the privacy of the individual seemed clear. In modern internet times, however, some courts are more willing to side with the privacy of individuals over First Amendment press freedoms – and the case brought by professional wrestler Hulk Hogan against the Gawker website for publishing his sex tape without permission is one example. This chapter uses that scenario to explore the clash between an individual’s privacy rights and the rights of the press to decide what is news.
This article provides a brief Introduction to this special Journal of Benefit–Cost Analysis issue dedicated to comments filed by former presidents of the Society for Benefit Cost Analysis and editors of this journal on the Office of Management and Budget’s draft Circular A–4 on regulatory impact analysis guidelines.
The news industry today is no longer economically powerful: Newspapers are in peril, television and cable viewership are in decline, news deserts dot the landscape, and jaw-dropping numbers of journalistic staff cuts have drained expertise from newsrooms. Social media have cannibalized content and replaced scarcity of frequencies with scarcity of attention, and the news industry has far less political power.
Under these circumstances, the fate of the press’s functions is an existential question both for the news media as we know it and for contemporary American democracy. Managing the complexity of this kind of information environment calls for independent and principled engagement with issues of public concern by those who hew to journalistic values, such as truth, verification, completeness, investigation, and context. It also calls for appropriate legal protections.
In this chapter, I seek to explore the evolving mosaic of threats facing the American press and consider what, if any, legal “rights” wielders of the press function need in response. I begin by identifying a set of key threats facing the press – from economic, legal, technological, and audience-based developments. I then propose some initial responses to these threats along five dimensions: funding conditions, a mixed legal strategy, AI policy, industry restructuring, and trust enhancement. I also call for a commitment to press self-examination from the vantage point of fundamental journalistic values in a democracy.
This chapter offers in-depth case studies to display how playwrights both used and innovated with mechanical epiphany. Six ancient tragedies are discussed, grouped in thematic pairs. Euripides’ Helen and Bacchae, are taken together as plays that use the deus ex machina to comment on divine form. While the mēchanē in the Helen confirms divine form in a play otherwise full of illusion; the mēchanē in the Bacchae is presented as yet another epiphanic mode of the mimetically inclined patron god of theatre, Dionysus. Sophocles’ Philoctetes and Euripides’ Heracles use the mēchanē to explore issues of space, movement, and the connectedness of divine and mortal. Finally, Euripides’ Orestes and Medea both make use of the mēchanē to question divine epiphany by bringing to the fore issues of ontological boundaries between human and divine.
Modal concord refers to the phenomenon where the co-occurrence of two modal elements with the same flavor and force (e.g. may possibly, must certainly) gives rise to the interpretation of single modality. Given their (arguably) equivalent semantics, constructions with modal concord and single modal (e.g. may, must) can function as alternative choices in different contexts of use – how do speakers choose between them, and how is the choice perceived? In this article, we take a ‘Register’ approach and report an experimental study of MC in US English, addressing their linguistic and social meanings with versus without situational context. The results show that (i) modal concord constructions differ from single modal ones in linguistic meanings, which casts doubt on the concord assumption, and (ii) modal concord has distinct social meanings from those of single modal constructions. Our findings suggest a correlation between the meaning strength of a linguistic expression and the social perception about the speaker. Context, manipulated via the single situational parameter of interlocutor relation (close vs. distant), did not interact with the linguistic or social meaning of modal concord constructions, the implications of which are discussed in relation to the multidimensional nature of conversational situations and the method applied.
Rural communities make up 19% of the US population, yet are underrepresented in clinical trials. Community engagement methods can facilitate collaboration and trust with local healthcare personnel to enhance enrollment. The purpose of this manuscript is to describe community engagement methods and their impact on enrollment in a pragmatic clinical trial.
Methods:
We describe a variety of methods used in the Fibromyalgia TENS in Physical Therapy Study (FM-TIPS) to enhance enrollment in rural communities and low-enrolling clinics. Community engagement methods were implemented partway through the trial for selected groups: Targeted Rural (TR) (n = 10), Targeted Low Enrolling (TLE) (n = 6), and compared to Untargeted Groups (UT) (n = 13). The impact of these methods on inquiries, screening, and enrollment were evaluated by comparing actual enrollment to projected enrollment.
Results:
We trained and employed community engagement coordinators to implement strategies in TR and TLE physical therapy clinics. These included, posting flyers, community events, physician outreach, social media ads, and direct mailing. These methods increased study inquiries, screening and enrollment in the study. Specifically, when compared to projected values there were increases in enrollment for both the TR and the TLE groups, but not the UT group. Of those that passed screening 99% of rural and 32% of urban residents enrolled in the study.
Conclusion:
A multi-pronged and individualized community engagement approach can increase enrollment of rural residents in clinical trials. Building strong relationships and partnering with community clinics and local communities is essential to success.
If the press can claim rights different from those guaranteed to every speaker, it must be because we understand the Press Clause to serve constitutional values different from the freedom of speech clause and because these values require distinct forms of rights for their protection. In this short chapter, I explore four distinct constitutional values that at various times have been claimed to be uniquely served by the press: 1) the value of public discourse, 2) the Meiklejohnian value of distributing information, 3) the checking value, and 4) the value of the public sphere. Each of these values yields a different constitutional definition of the “press,” and each might imply a different array of rights that ought to accrue to the press. Although these values are distinct, the press may simultaneously serve one or more of them.