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This chapter examines the formal relationship between medical professionalism and compassion, looking at codes of ethics and practice guidelines, chiefly for medical professionals but also with reference to other healthcare workers. The chapter starts by exploring the importance accorded to compassion in ethical guidance for doctors in the United Kingdom (UK), Ireland, the United States, Australia, and New Zealand. It then examines guidance specifically aimed at psychiatrists, including documents published by the Royal College of Psychiatrists in the UK, the College of Psychiatrists of Ireland, and the American Psychiatric Association. Many of these guides emphasise the importance of compassion and related values, with the Royal College of Psychiatrists providing particularly detailed suggestions about building and sustaining compassion in mental healthcare. Compassion and related values also feature commonly in codes of practice and ethical guidance for other clinical professionals, such as nurses, midwives, social workers, occupational therapists, and others. This chapter concludes that, taken together, these statements of practice values and ethical principles reflect a welcome and growing emphasis on compassion in guidance for healthcare professionals across many clinical domains.
Ocean submesoscales, flows with characteristic size $10\,\text{m}{-}10\,\text{km}$, are transitional between the larger, rotationally constrained mesoscale and three-dimensional turbulence. In this paper, we present simulations of a submesoscale ocean filament. In our case, the filament is strongly sheared in both vertical and cross-filament directions, and is unstable. Instability indeed dominates the early behaviour with a fast extraction of kinetic energy from the vertically sheared thermal wind. However, the instability that emerges does not exhibit characteristics that match the perhaps expected symmetric or Kelvin–Helmholtz instabilities, and appears to be non-normal in nature. The prominence of the transient response depends on the initial noise, and for large initial noise amplitudes, saturates before symmetric instability normal modes are able to develop. The action of the instability is sufficiently rapid – with energy extraction from the mean flow emerging and peaking within the first inertial period ($\sim\! 18\ \text{h}$) – that the filament does not respond in a geostrophically balanced sense. Instead, at all initial noise levels, it later exhibits vertically sheared near-inertial oscillations with higher amplitude as the initial minimum Richardson number decreases. Horizontal gradients strengthen only briefly as the fronts restratify. These unstable filaments can be generated by strong mixing events at pre-existing stable structures; we also caution against inadvertently triggering this response in idealised studies that start in a very unstable state.
Bubbles entrained by breaking waves rise to the ocean surface, where they cluster before bursting and release droplets into the atmosphere. The ejected drops and dry aerosol particles, left behind after the liquid drop evaporates, affect the radiative balance of the atmosphere and can act as cloud condensation nuclei. The remaining uncertainties surrounding the sea spray emissions function motivate controlled laboratory experiments that directly measure and link collective bursting bubbles and the associated drops and sea salt aerosols. We perform experiments in artificial seawater for a wide range of bubble size distributions, measuring both bulk and surface bubble distributions (measured radii from $30\,\unicode{x03BC} \mathrm{m}$ to $5\,\mathrm{mm}$), together with the associated drop size distribution (salt aerosols and drops of measured radii from $50\,\mathrm{nm}$ to $500\,\unicode{x03BC} \mathrm{m}$) to quantify the link between emitted drops and bursting surface bubbles. We evaluate how well the individual bubble bursting scaling laws describe our data across all scales and demonstrate that the measured drop production by collective bubble bursting can be represented by a single framework integrating individual bursting scaling laws over the various bubble sizes present in our experiments. We show that film drop production by bubbles between $100\,\unicode{x03BC} \mathrm{m}$ and $1\,\mathrm{mm}$ describes the submicron drop production, while jet drop production by bubbles from $30\,\unicode{x03BC} \mathrm{m}$ to $2\,\mathrm{mm}$ describes the production of drops larger than $1\,\unicode{x03BC} \mathrm{m}$. Our work confirms that sea spray emission functions based on individual bursting processes are reasonably accurate as long as the surface bursting bubble size distribution is known.
This chapter contends that Italy was exceptionally wealthy during the Early Empire, both in real and nominal terms. Italy’s prosperity stemmed from several sources: substantial booty, taxes, and rents were diverted from the provinces to the empire’s core; provincial elites engaged in imperial politics were expected to spend lavishly in Rome and its environs; and returns on Italian land were relatively high. Additionally, high prices in Italy for both real estate and commodities augmented Italy’s wealth in nominal terms.
This chapter argues that men with the requisite wealth for political office outside the political orders contributed to the stability of the Roman timocratic political system by serving as a reserve pool from which new magistrates and councillors were recruited. Correspondences between the surpluses of wealthy households at the senatorial, equestrian, and curial levels of the political system, and evidence of shortages of candidates at these levels, substantiate this argument.
We present the results of a theoretical investigation of orbital stability in pilot-wave hydrodynamics, wherein a droplet bounces and self-propels across the surface of a vertically vibrating liquid bath. A critical notion in pilot-wave hydrodynamics is that the bath plays the role of the system memory, recording the history of the droplet in its wave field. Quantised orbital motion may arise when the droplet is confined by either an axisymmetric potential or the Coriolis force induced by system rotation. We here elucidate the dependence of the stability of circular orbits on both the form of the confining force and the system memory. We first provide physical insight by distinguishing between potential- and wave-driven instabilities. We demonstrate that the former are a generic feature of classical orbital dynamics at constant speed, while the latter are peculiar to pilot-wave systems. The wave-driven instabilities are marked by radial perturbations that either grow monotonically or oscillate at an integer multiple of the orbital frequency, in which case they are said to be resonant. Conversely, for potential-driven wobbling, the instability frequency may be resonant or non-resonant according to the form of the applied potential. Asymptotic analysis rationalises the different stability characteristics for linear-spring and Coriolis forces, the two cases that have been explored experimentally. Our results are generalised to consider other potentials of interest in pilot-wave hydrodynamics, and elucidate the distinct roles of wave- and potential-driven instabilities. Our study highlights the limitations of prior heuristic arguments for predicting the onset of orbital instability.
The present paper studies how to encourage longer careers by reducing labor income taxes for older workers. The analysis relies on numerical experiments within a general equilibrium overlapping generations (OLG) model that is calibrated to an average economy of the organisation for economic co-operation and development (OECD). I find that the policy can delay retirement and increase tax revenue and the capital stock if treatment occurs close to, and before, the preferred retirement age. A non-trivial share of the increased post-treatment labor supply can be explained by the substitution of hours worked from the pre-treatment career to the post-treatment career. Lowering the treatment age only leads to small changes in the aggregate labor supply, but is increasingly costly for the government in terms of forgone revenue. Tax shifting toward higher consumption taxes always increases welfare, while tax shifting toward higher capital or labor income taxes paid by younger workers only increases welfare if treatment occurs sufficiently late in the career.
We consider Shimura varieties associated to a unitary group of signature $(n-s,s)$ where n is even. For these varieties, we construct smooth p-adic integral models for $s=1$ and regular p-adic integral models for $s=2$ and $s=3$ over odd primes p which ramify in the imaginary quadratic field with level subgroup at p given by the stabilizer of a $\pi $-modular lattice in the hermitian space. Our construction, which has an explicit moduli-theoretic description, is given by an explicit resolution of a corresponding local model.
Neurosurgery is a demanding specialty, and a trainee’s exposure to its tenets is usually achieved through residency. Medical students only access neurosurgical knowledge via brief stints in clerkships/electives and often lack mentorship and early exposure. This study sought to investigate the varying expectations about neurosurgical training held by Canadian medical students, with the goal of determining the impact of early exposure through educational opportunities and mentorship in developing interest and familiarity in the field.
Methods:
A cross-sectional study across Canada was conducted where students were provided with a 35-point questionnaire pertaining to mentorship, educational opportunities and interests regarding neurosurgery through REDcap. Questions were open-ended, closed-ended (single choice) or five-point Likert scale (matrix format). Interest in pursuing neurosurgery was selected as the primary outcome of this study and was dichotomized into high or low interest. Predictors of interest were determined using multivariable logistic regressions.
Results:
A total of 136 students from 14 accredited Canadian medical schools responded to the study. Most (55.9%) had prior exposure, and the most commonly reported deterring factors were work–life balance (94.5%) and family (84.6%). Predictors of interest included participation in relevant case-based discussion (OR = 2.644, 95% CI [1.221–5.847], p = 0.015) and involvement in neurosurgical research encouraged by home institution (OR = 1.619, 95% CI [1.124–2.396], p = 0.012).
Discussion
Future efforts to improve student interest should focus on early exposure to the field such as developing pre-clerkship neurosurgical electives or medical student groups focused on neurosurgery.
Mosquito-borne California serogroup orthobunyaviruses Inkoo (INKV) and Chatanga (CHATV) are known to be endemic in Finland with a high seroprevalence. We developed a novel multiplexed reverse transcription quantitative polymerase chain reaction method for discriminating between the INKV and CHATV. This assay was used along with traditional serological tests to study a set of summertime patients during the years 2021, 2023, and 2024 to assess the epidemiology and prevalence of acute INKV and CHATV infections in Finland. Altogether, 1470 samples were screened, and there were 16 patients who had an acute infection based on serological findings and/or nucleic acid test. The orthobunyavirus-IgG seroprevalences were 18% (2021), 20% (2023), and 30% (2024), being lower than that in studies from 20 years ago. Neutralization tests were carried out, and all but one acute case had more than four-fold higher titre to INVK vs. CHATV, indicating specificity to INKV infection. The results suggest that epidemiology has changed from previous studies, and INKV should be considered a causative agent of summertime infections in Finland. The symptom diversity in mild disease outcomes should be studied to guide orthobunyavirus recognition by clinicians. The use of molecular assay discriminating INKV and CHATV aids in understanding disease associations.
This chapter examines the development of the Italian economy over the first two centuries CE. It re-evaluates two prevalent narratives– declining economic performance and increasing inequality– using proxy data. The evidence indicates that both trends were relatively modest, began only towards the end of this period, and were marked by significant regional and local variation.
Negative symptoms in schizophrenia are critical to functional outcomes but remain difficult to assess reliably. The Brief Negative Symptom Scale (BNSS) was developed to address these challenges, though no validation exists in Romanian-speaking populations. To validate the BNSS in a Romanian clinical sample, explore its psychometric properties and compare BNSS-based and PANSS-based classifications of severe negative symptoms. Forty-seven inpatients with schizophrenia were assessed using Romanian versions of the BNSS, PANSS, CDSS and AIMS. Psychometric analyses included internal consistency, inter-rater reliability, factor analysis and correlation-based validity. Two classification schemes, moderate–severe negative symptoms, measured by BNSS (BNSS-MS), and predominant negative symptoms, measured by PANSS (PANSS-PNS), were compared. The BNSS showed excellent internal consistency (α = .94) and inter-rater reliability (ICC = .98). A five-factor structure was confirmed. BNSS total scores correlated strongly with PANSS negative (ρ = .90), but not with positive, depressive, or motor symptoms. Blunted affect emerged as the most prominent subscale. The BNSS-MS group captured more severe cases than PANSS-PNS and showed greater symptom burden and higher distress scores. The Romanian BNSS is valid and sensitive for detecting negative symptoms, outperforming PANSS in identifying clinically significant subgroups.
A welfare subject is an entity with a good of its own. Welfare subjects have interests. Things matter to them. It is uncontroversial that typical adult humans are welfare subjects. It is uncontroversial that rocks are not welfare subjects. Just what makes this so is a matter of controversy. The default view is that sentience is necessary for welfare subjecthood. A competing view is that teleological organization suffices for welfare subjecthood. This article challenges both views by developing a third view that sits between them. An autopoietic entity is one that engages in self-production in a way that is adaptive to its environment. An autopoietic entity sustains, maintains, and renews itself on an ongoing basis. This article argues that all autopoietic entities are welfare subjects. This view explains why sentient entities such as animals are welfare subjects. It explains why merely teleologically organized entities such as automobile engines are not.
The literature about values in healthcare contains many terms which are sometimes used interchangeably. These terms include ‘compassion’, ‘sympathy’, ‘empathy’, ‘kindness’, ‘communication skills’, and various other words which are intended to denote a caring, understanding attitude towards healthcare provision. Confusion between these terms adds significantly to the apparent heterogeneity of research in this area and raises the worrying possibility that some writing on this topic uses these terms interchangeably. This chapter starts by exploring specific terms which are often used as synonyms for ‘compassion’, such as ‘sympathy’, ‘empathy’, ‘kindness’, and ‘communication skills’, and then focuses on two of the so-called ‘near enemies’ of compassion: pity and ‘horrified anxiety’. We may be trying to cultivate compassion, but, at times, emotions can arise that may be mistaken for compassion and can have negative effects. Clarity about concepts and terms can help to understand their significance, their importance in healthcare provision, and ways in which they support, as well as differ from, compassion. Overall, this chapter echoes the main arguments of this book by emphasising that compassionate healthcare requires an all-of-system approach, rather than isolated changes, paper exercises, or tinkering around the edges. Reflecting on terminology can help greatly in this process.
The central Maya lowlands (CML) display an uncommon demographic history—the absence of a millennial population rebound from its former occupational peak, about 800 CE. Here we postulate why the loss of a well-populated CML during the Late Classic-Terminal Classic periods failed to regain substantial occupation during the subsequent 700-800 years before the Spanish conquest of the Maya realm. Updating the narrative of stressful human-environmental conditions, shifts in trade routes, and long-term paucity of occupation in the CML, we examine push-pull factors that affected Postclassic Maya population geography. These factors include population pressures, environmental hazards, resource conditions, and livelihood standards that existed in the Postclassic Period between northern and coastal lowlands and the CML. The advantages that the CML maintained before Postclassic times, foremost regaining superior environmental conditions for agriculture, were insufficient pull factors given the low levels of push factors in the northern and coastal lowlands. We draw attention to the under-treated problem—the failure of a population rebound in the CML—and encourage improvements in systematic data and analytics to address it, including consideration of non-material, socio-cultural factors.
English employs a variety of comparative formation strategies. Theoretical and corpus-based research has established that their distribution depends on a variety of factors. In this article, we take an experimental approach to test analytic, synthetic and double comparative forms in relation to register in American and British English. We report on a rating study investigating the appropriateness and interpretation in terms of evaluativity of the three comparative forms. Our findings confirm the hypothesis that the comparative variants are not considered equally appropriate, but the effect is not as strong as would be expected under the hypothesis that frequency of occurrence is directly related to linguistic judgments. The analytic and double comparative alternatives exhibit lower appropriateness levels than the synthetic comparative. Analytic and double comparative forms are rated as less appropriate in formal than in informal contexts, which did not show an effect on the synthetic form. Furthermore, the analytic variant shows a different behavior in terms of the interpretation than the other forms in that a stronger effect of evaluativity is detected. Limitations and future directions are discussed. Our study is the first to provide experimental evidence for certain hypotheses emerging from corpus-based research.