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Treatment guidelines recommend evidence-based psychological therapies for adults with intellectual disabilities with co-occurring anxiety or depression. No previous research has explored the effectiveness of these therapies in mainstream psychological therapy settings or outside specialist settings.
Aims
To evaluate the effectiveness of psychological therapies delivered in routine primary care settings for people with intellectual disability who are experiencing co-occurring depression or anxiety.
Method
This study used linked electronic healthcare records of 2 048 542 adults who received a course of NHS Talking Therapies for anxiety and depression in England between 2012 and 2019 to build a retrospective, observational cohort of individuals with intellectual disability, matched 1:2 with individuals without intellectual disability. Logistic regressions were used to compare metrics of symptom improvement and deterioration used in the national programme, on the basis of depression and anxiety measures collected before and at the last attended therapy session.
Results
The study included 6870 adults with intellectual disability and 2 041 672 adults without intellectual disability. In unadjusted analyses, symptoms improved on average for people with intellectual disability after a course of therapy, but these individuals experienced poorer outcomes compared with those without intellectual disability (reliable improvement 60.2% for people with intellectual disability v. 69.2% for people without intellectual disability, odds ratio 0.66, 95% CI 0.63–0.70; reliable deterioration 10.3% for people with intellectual disability v. 5.7% for those without intellectual disability, odds ratio 1.89, 95% CI 1.75–2.04). After propensity score matching, some differences were attenuated (reliable improvement, adjusted odds ratio 0.97, 95% CI 1.91–1.04), but some outcomes remained poorer for people with intellectual disability (reliable deterioration, adjusted odds ratio 1.28, 95% CI 1.16–1.42).
Conclusions
Evidence-based psychological therapies may be effective for adults with intellectual disability, but their outcomes may be similar to (for improvement and recovery) or poorer than (for deterioration) those for adults without intellectual disability. Future work should investigate the impact of adaptations of therapies for those with intellectual disability to make such interventions more effective and accessible for this population.
The scale function plays a significant role in the fluctuation theory of Lévy processes, particularly in addressing exit problems. However, its definition is established through the Laplace transform, which generally lacks an explicit representation. This paper introduces a novel series representation for the scale function, utilizing Laguerre polynomials to construct a uniformly convergent approximation sequence. Additionally, we conduct statistical inference based on specific discrete observations and propose estimators for the scale function that are asymptotically normal.
This article examines the evolution of Soviet operatic conventions during Khrushchev’s Thaw. The first opera to be prematurely cancelled from the Bolshoi Theatre since Stalin was Rodion Shchedrin’s 1961 opera Not Love Alone, and as such, it set the standard for what would be deemed unacceptable in Thaw-era opera. Using this opera as a case study, I employ extensive archival material, including never-before-accessed audience surveys and internal Bolshoi Theatre meeting minutes, to analyse the opera’s path to official acceptance – and then official rejection. I thus illuminate the competing demands that composers, Party bureaucrats, and audiences expected of the Soviet opera project, and the convergences and divergences with the Stalin-era. Finally, I demonstrate why the project of creating a robust repertoire of contemporary-themed Soviet opera failed during the Thaw, never to be revived with such fervour, and demonstrate why Shchedrin’s opera was the attempt closest to achieving enduring success.
Norm contestation has become an established research programme in International Relations. However, scholars have yet to scrutinise the form and effect of radical contestation. I argue that radical contestation is a disruptive form of contestation, distinguished by (1) the extensive scope that attacks a specific norm and wider normative order, institutions, and actors sympathetic to the norm, and (2) high emotional intensity in animating contestation. To bring these features of radical contestation together, I use insights from the study of emotions and backlash movements to advance a new ‘emotional backlash’ framework and explain the construction, mobilisation, and outcome of radical contestation. I subsequently apply this framework to analyse the emotional backlash against Rohingya refugees during Covid-19. Cultivated by resentment, the emotional backlash against the Rohingya contests refugee protection norms and extends to radically challenge human rights advocates, United Nations agencies, and the larger humanitarian and cosmopolitan principles. In doing so, backlash supporters aim to restore a society without refugees and their sympathisers, and instead to promote racism as a ‘normal’ organising principle. By capturing radical contestation, this contribution steers norms scholarship towards a new research terrain and highlights the implications that the backlash has for the international refugee regime.
My research on dietary protein and the regulation of proteostasis in muscle and the whole body during growth and adult maintenance is reviewed. Growth control involves both permissive and regulatory roles of protein acting with genetic determinants and functional demand, to mediate substrate flow into metabolic consumption, energy storage and growth. In 1995 a Protein-Stat hierarchical model for control of the fat-free mass was proposed and is updated here with special emphasis on the skeletal muscle mass. Control is exerted in large part through a central aminostatic appetite mechanism sensing changes in free amino-acid patterns in response to the balance between their supply in relation to their demand. This acts primarily to maintain skeletal muscle mass at a level set by the linear dimensions of the organism, which in turn is controlled by genetic programming and mediated by the developmental hormones acting together with an appropriate anabolic drive deriving from dietary protein. This, together with other important nutrients like zinc, calcium and vitamin D, provides the regulatory stimulus for growth and protein deposition in all tissues. The applicability of this model to childhood growth and development will be described as well as the maintenance of the adult phenotypic muscle mass within populations with protein intakes varying over a wide range, work which resulted in an adaptive metabolic demand model for protein and amino acid requirements and values for apparent adult protein and lysine requirements. Finally current understanding of aminostatic mechanisms of amino-acid sensing in the brain will be reviewed.
Flight Data Monitoring (FDM) programmes have become a key part of every major airline’s safety management system. They are primarily based on learning from unwanted deviations in flight parameters encountered during normal flight operations. Owing to its unique nature, anomaly detection of FDM presents distinct problem complexities from the majority of analytical and learning tasks. This methodology, while useful, concentrates only on a small part of the operation, leaving most of the data unprocessed, and does not allow for analysing events that had the potential to go wrong but were recovered in time by the crews. This research focused on analysing an FDM dataset of 1332 approaches between January 2018 and July 2022 at Tenerife South Airport (Spain), where there is a known phenomenon of increasing headwinds during the final approach. The flights were clustered using self-organising maps (SOM) by patterns of increasing headwinds, and the clusters were assessed in terms of clustering performance. The clusters were well differentiated. A further comparison between the results from the airline showed that 88 flights were affected by wind shifts, while 27 flights were picked up by the airline. The results demonstrate that SOMs are a meaningful tool for clustering flight data and can complement the current FDM analysis methodology. Combining both methodologies could shift FDM data analysis to look beyond exceedances into what went well, thus shifting the FDM paradigm towards a more safety-II-based method.
This work tackles a significant challenge in dynamo theory: the possibility of long-term amplification and maintenance of an axisymmetric magnetic field. We introduce a novel model that allows for non-trivial axially symmetric steady-state solutions for the magnetic field, particularly when the dynamo operates primarily within a ‘nearly spherical’ toroidal volume inside a fluid shell surrounding a solid core. In this model, Ohm’s law is generalised to include the dissipative force, arising from electron collisions, that tends to align the velocity of the shell with the rotational speed of the inner core and outer mantle. Our findings reveal that, in this context, Cowling’s theorem and the neutral point argument are modified, leading to magnetic energy growth for a suitable choice of toroidal flow. The global equilibrium magnetic field that emerges from our model exhibits a dipolar character. The central insight of the model developed here is that if an additional force is incorporated into Ohm’s law, symmetric dynamos become possible.
The Lower Jurassic (Toarcian) Posidonienschiefer Formation of southwestern Germany is a classic konservat lagerstätte, yielding some of the world’s best-preserved fossils of marine vertebrates, including ichthyosaurs, thalattosuchian crocodylomorphs, plesiosaurs and fishes. Despite numerous studies concentrating on the taphonomy of ichthyosaurs in this formation, less taphonomic work has focussed on the thalattosuchians of the assemblage. Multiple thalattosuchian species displaying a wide range of body sizes have been recovered. We investigated indicators for seafloor arrival position in thirteen Macrospondylus bollensis and one Platysuchus multiscrobiculatus specimens representing various body sizes using three-dimensional (3D) photogrammetric models. False-colour depth maps were used to interpret the relative topography (depth level) of bone penetration into the sediment and were aligned on the XY plane, making them parallel to the stratigraphic plane. Our results show both headfirst and non-headfirst seafloor arrivals in observed specimens, with headfirst seafloor arrivals exhibiting deeply buried skulls, displacement of select cervical vertebrae and/or characteristic fractures in the cranium and mandible. We (1) interpret seafloor landing types in teleosauroids; (2) recognize and list specific characteristics that are consistently attributed to either a headfirst or non-headfirst seafloor arrival; (3) discuss possible factors that may have contributed to these features, such as body shape and size, substrate and velocity; and (4) provide a new definition for headfirst seafloor arrival that can be readily attributed to other marine vertebrates from various formations. Lastly, our results show that observers must carefully consider how historical specimens might have been prepared, as this may influence taphonomic interpretations.
Past research indicates that support for conservatism increases when individuals perceive threat to their group’s social status – i.e., prestige and respect. However, the causal link between status threat and increased electoral support for conservative candidates has not been established. Most prior studies rely on observational data, and it remains unclear how the effect of status threat on candidate support varies depending on the specific conservative policies adopted by candidates. Additionally, previous research has not fully addressed whether and how these effects are constrained by voters’ party loyalty. This article investigates these questions by conducting a joint experiment combining vignette and conjoint designs. White Americans were randomly exposed to status threat communication, and then choose between different hypothetical candidates with varying degrees of conservatism on various issues. The results show large effects of candidates’ issue positions and partisanship, but very little effect of status threat.
This article examines cross-border inheritance transfers between the United States, Germany, and Russia between the 1840s and the late 1980s. These transfers were not only characterized by private considerations and kinship networks but were also strongly intertwined with national and international political developments. This article argues that the history of transnational inheritance transfers since the 19th century can be subdivided into three distinct periods. The first period, from the mid-19th century to 1914, witnessed the gradual development and expansion of professional networks and legal agreements designed to facilitate cross-border estate transfers. By contrast, the second period, from World War I and the October Revolution of 1917 through the late 1960s, was a time of unprecedented global disruption. Unlike the half-century before World War I, governments and probate courts complicated, delayed, and prevented inheritance transfers across state borders due to military and ideological conflicts. During the third period, beginning in the 1960s, governments, international organizations, lawyers, and families resumed efforts to create structures that would legally protect and enable cross-border estate transfers in an increasingly globalized world.
By examining a protracted instance of workers’ militant action in the city of Kanpur in the 1930s, the article will examine the significance of the neighbourhood in workers’ lives and its interplay with urban politics that often led to public order crises for the government. It will argue that such crises revealed shortcomings in colonial urban governance and will show that urban proximity accentuated precarity and brought a diverse set of workers together to agitate for their rights and stake claims to political power in the city.
Recent evidence from cross-situational learning (CSL) studies have shown that adult learners can acquire words and grammar simultaneously when sentences of the novel language co-occur with dynamic scenes to which they refer. Syntactic bootstrapping accounts suggest that grammatical knowledge may help scaffold vocabulary acquisition by constraining possible meanings, thus, for children, words and grammar may be acquired at different rates. Twenty children (ages 8 to 9) were exposed in a CSSL study to an artificial language comprising nouns, verbs, and case markers occurring within a verb-final grammatical structure. Children acquired syntax (i.e., word order) effectively, but we found no evidence of vocabulary learning, whereas previous adult studies showed learning of both from similar input. Grammatical information may thus be available early for children, to help constrain and support later vocabulary learning. We propose that gradual maturation of declarative memory systems may result in more effective vocabulary learning in adults.
Interventions based on testing and communication training have been developed to reduce antibiotic prescribing in primary healthcare (PHC) for the treatment of acute lower respiratory infections (ALRTIs). However, research based on the experiences of PHC clinicians participating in ALTRIs interventions to reduce antibiotic prescribing in Barcelona is scanty.
Aim:
This study aimed to explore the perceptions and experiences of clinicians (physicians and nurses) on an intervention to reduce antibiotic prescription in PHC in Barcelona (Spain). This intervention was a randomised controlled study (cRCT) based on three arms: 1) use of a C-reactive protein (CRP) rapid test; 2) enhanced communication skills; and 3) combination of CRP rapid test and enhanced communication skills. In addition, the study aimed to explore the impact of COVID-19 on the detection of ALRTIs.
Methods:
This qualitative study used a socio-constructivist perspective. Sampling was purposive. Participants were selected based on age, sex, profession, intervention trial arm in which they participated, and the socioeconomic area of the PHC where they worked. They were recruited through the healthcare centres participating in the study. Nine participants (7 women and 2 men) participated in two focus groups, lasting 65–66 min, in September–October 2022. Framework analysis was used to analyse the data.
Findings:
Three themes were identified: ‘(The intervention) gave us reassurance’: intervention experiences among health professionals. This theme includes accounts of clinicians’ satisfaction with the intervention, particularly with CRP testing to support clinical diagnoses; ‘We don’t have time in primary healthcare’: structural and community resources in healthcare services. This theme encompasses clinicians’ experiences on healthcare pressures and PHC organisational structures barriers to PHC interventions; and ‘I only did three CRP’: impact of COVID-19 pandemic on the intervention. The last theme focuses on the impact of the COVID-19 pandemic on the intervention’s implementation.
Conclusions:
CPR testing and promoting communication skills can be useful tools to support clinical decisions for ALRTIs. Structural barriers (e.g., healthcare pressures) and social inequities amongst service users were acknowledged as the main barriers for the implementation of ALRTIs interventions.
Avocados are a widely consumed fruit and are part of many Latin American cuisines and plant-based diets globally. However, producing avocados is water-intensive, and plantations can cause soil erosion and water stress. In Chile, avocados are produced in semiarid zones and require irrigation. They are widely consumed locally but are increasingly exported to meet growing global demand. This causes significant local conflicts over water, especially because of the system of private water rights in Chile. There are many gaps in understanding the complex and interconnected system of avocado production and international markets, especially its impacts on local communities and biodiversity.
Technical Summary.
The popularity of avocados has increased globally in alternative diets, alongside its integral role in Latin American cuisine. In Chile, avocados are grown extensively and intensively in orchards in the dry and Mediterranean climate of Central Chile. Avocado is a water-demanding crop and the severe water crisis in Chile has called attention to the conflicts caused by its water use. As most of the pressure to produce avocado comes from international demand but results in impacts on native ecosystems and local communities, avocado production in Chile is an example of a telecoupled system. Here, we characterize avocado production as a telecoupled social–ecological system in order to identify gaps in knowledge, based on a review of key studies. Research priorities include how to improve water-use efficiency, especially in the context of climate change; the impacts on biodiversity; and the socioeconomic dynamics between local communities, trade, and governance. The analysis is constrained by limited access to data and few interdisciplinary studies on the matter. To reduce the impacts of avocado production and increase its sustainability, there is an urgent need to amplify the interdisciplinary research that emphasizes the interconnections between the social and ecological components in avocado production in Chile.
Social Media Summary.
Global avocado demand fuels local conflicts in Chile due to water stress and social–ecological pressures on communities.
Trevor Griffith and Adrian Kind argue that we should reject a standard interpretation of pain asymbolia, according to which asymbolics experience pain even though their pain lacks the affective-motivational element that typical pains possess. We make the case that Griffith and Kind’s reasons for rejecting the standard interpretation are relatively weak. We end by arguing that debates between the standard interpretation and alternative interpretations cannot be resolved without addressing the issue of how we should taxonomize pain asymbolia as a neurological condition.
We provide a complete characterization of theories of tracial von Neumann algebras that admit quantifier elimination. We also show that the theory of a separable tracial von Neumann algebra $\mathcal {M}$ is never model complete if its direct integral decomposition contains $\mathrm {II}_1$ factors $\mathcal {N}$ such that $M_2(\mathcal {N})$ embeds into an ultrapower of $\mathcal {N}$. The proof in the case of $\mathrm {II}_1$ factors uses an explicit construction based on random matrices and quantum expanders.
In this study, professional engineers and designers (n = 30) participated in a 1-hour-long design activity in which they brainstormed a list of ideas for two design problems (a smart grill and a smart laundry machine), created a sketched concept for each design problem, filled out a survey about their perceptions of the market for the concept they developed, participated in a bias mitigation intervention and then repeated the pre-intervention steps. The design problems were intended to trigger availability bias based on the participants’ occupations (engineers and designers at a kitchen appliance company) as well as conflict between the gender of the participants and the gender-stereotyping of the household tasks fulfilled by the smart machines. Based on correlations in the market survey, the participants, who were mostly men, displayed availability bias toward the smart laundry machine design problem. A key marker of availability bias – an association between participants’ personal enjoyment of the product and the belief that the product would be commercially successful – was eliminated after the bias mitigation intervention. Qualitative analysis of participants’ reflections indicated that the intervention primarily assisted designers in making additional considerations for users, such as increasing accessibility and building awareness of excluded user groups.
Baltic Sea ice coverage was modelled using a sea-ice thermodynamics and dynamics model coupled with a three-dimensional (3-D) PM3D hydrodynamic model. The validation for 1958–2007 showed the modelled maximum ice extents (MIEs) agree well with observations (r = 0.97) and the ice thickness less so, but satisfactory for most stations (r > 0.8). This enabled the production of cumulative ice thickness (CIT) maps and the determination of the spatial variation in sea-ice extent in the Baltic over the analysed period for four air temperature scenarios with a constant value reduction. This showed the spatial sensitivity of ice cover dynamics to temperature changes and allowed to distinct regions with different impact of change in temperature on CIT. The simulation for temperature of 2°C lower than 1958–2007 was consistent with the reconstruction of MIEs in the entire Baltic Sea for the end of the Little Ice Age (LIA) (1721–1860). For the western Baltic, the compliance was highest for temperature reduced by 3°C and 4°C. This indicates that climatic conditions may have differed between individual regions of the Baltic during the LIA, and the air temperature anomaly in the western Baltic may have been greater than indicated by previous studies