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Individuals with schizophrenia experience significantly higher rates of chronic physical health conditions, driving a 20-year reduction in life expectancy. Poor diet quality is a key modifiable risk factor; however, owing to side-effects of antipsychotic medication, cognitive challenges and food insecurity, standard dietary counselling may not be sufficient for this population group.
Aim
To evaluate the feasibility, acceptability and preliminary effectiveness of two dietary interventions – pre-prepared meals and meal kits – for individuals with schizophrenia.
Method
The Schizophrenia, Nutrition and Choices in Kilojoules (SNaCK) study is a 12-week, three-arm, cross-over, randomised controlled trial. Eighteen participants aged 18–64 years diagnosed with schizophrenia or schizoaffective disorder will be recruited from community mental health services in Australia. Participants will be randomised to receive pre-prepared meals, meal kits or a supermarket voucher as a control, crossing-over at the end of weeks 4 and 8, so that all participants experience all three study arms. Primary outcomes include feasibility (recruitment rate and retention, number of days participants use pre-prepared meals or meal kits, adherence to meals as prescribed, difficulty in meal preparation and meal wastage) and acceptability (meal provision preference ranking and implementation) of the nutrition interventions. Secondary outcomes include the effects of the intervention on metabolic syndrome components, dietary intake, quality of life and food security measures.
Conclusions
Feasible, acceptable and effective dietary interventions for people with schizophrenia are urgently needed. Findings from this trial will inform future larger randomised controlled trials that have the potential to influence policy and improve health outcomes for this vulnerable population.
Static analysis is an essential component of many modern software development tools. Unfortunately, the ever-increasing complexity of static analyzers makes their coding error-prone. Even analysis tools based on rigorous mathematical techniques, such as abstract interpretation, are not immune to bugs. Ensuring the correctness and reliability of software analyzers is critical if they are to be inserted in production compilers and development environments. While compiler validation has seen notable success, formal validation of static analysis tools remains relatively unexplored. In this paper we present checkification, a simple, automatic method for testing static analyzers. Broadly, it consists in checking, over a suite of benchmarks, that the properties inferred statically are satisfied dynamically. The main advantage of our approach lies in its simplicity, which stems directly from framing it within the Ciao assertion-based validation framework, and its blended static/dynamic assertion checking approach. We demonstrate that in this setting, the analysis can be tested with little effort by combining the following components already present in the framework: 1) the static analyzer, which outputs its results as the original program source with assertions interspersed; 2) the assertion run-time checking mechanism, which instruments a program to ensure that no assertion is violated at run time; 3) the random test case generator, which generates random test cases satisfying the properties present in assertion preconditions; and 4) the unit-test framework, which executes those test cases. We have applied our approach to the CiaoPP static analyzer, resulting in the identification of many bugs with reasonable overhead. Most of these bugs have been either fixed or confirmed, helping us detect a range of errors not only related to analysis soundness but also within other aspects of the framework.
Many aspects of migration policy involve hard moral dilemmas. Whether the dilemmas are concerned with refugee accommodation and integration, temporary labor migration, or the prospects of rejected asylum seekers, policymakers must sometimes make tough choices between competing and equally compelling moral values. Through in-depth discussion of various concrete examples, contributions to this roundtable argue that recognition and systematic analysis of the “ethics of migration policy dilemmas” can both increase philosophical and social-scientific understanding of public debates and policymaking on migration and provide ethical guidance for migration policy. Before introducing the roundtable’s individual contributions, this essay argues for the distinct epistemic value of the Dilemmas perspective by contrasting it with an approach that emphasizes the “busting” of myths; that is, the empirical uncovering of influential falsehoods in public and policy debates, often in the hope of improving policymaking through stronger evidence. We argue that while such myth busting can be valuable, it is insufficient and sometimes unhelpful for understanding how migration policy comes about and can be improved. Policymaking is not just shaped by empirical facts and understandings but also by interests and goals, including moral ones, that give empirical considerations deeper meaning and action-guiding potential. Often, these moral goals are numerous, similarly or equally compelling, and in profound tension with one another. Where this is the case, we should not simply introduce more and more accurate factual descriptions; we must also analyze dilemmas.
Increasing disease outbreaks and declining biodiversity underscore the need for understanding the impact pathogens have on wildlife populations. To understand how zoonoses impact wild animal welfare, we created a severity index. Using signs of disease information from a bacterial zoonotic disease database, we quantified severity of each sign of disease combined with the number of welfare domains and body systems the pathogen impacts to find the severity index value (SIV) of each unique host-pathogen relationship. We then investigated the effects of host-pathogen richness and conservation status against SIV. We found there to be a strong, negative correlation between increasing pathogen richness and SIV. Species of least concern (LC) were not significantly more likely to have higher SIV than species of conservation concern (CC), but CC species did not have a significant decline of SIV with increasing pathogen richness. This study provides an insight into the relationships between pathogen richness and the risk of pathogen infections to wildlife.
Moyamoya disease (MMD) is characterized by progressive carotid fork steno-occlusion and the development of “puff-of-smoke” collaterals on angiography. However, a subset of patients present with similar vascular changes but lack these hallmark collaterals, complicating both diagnosis and management. This “smokeless” phenotype, associated with ring finger protein 213 (RNF213) gene variants, challenges the traditional description of MMD. We describe a series of such patients who responded favorably to revascularization.
Methods:
In this ambispective observational study, we evaluated 12 patients with carotid fork steno-occlusive disease but without “puff-of-smoke” collaterals. Clinical, radiological and genetic assessments were assessed. Structural modeling of RNF213 protein variants was conducted through 3D homology modeling, validated via Ramachandran plots and further refined with COOT and PyMOL. Functional insights were derived through ConSurf analysis.
Results:
Of the 12 patients, 9 carried the RNF213 p.R4810K variant, 1 harboured a novel variant, 1 had both p.R4810K and a novel variant and 1 had p.R4859K. Initial misclassification as intracranial atherosclerosis or vasculitis led to inappropriate treatment. Following genetic confirmation, 9 patients underwent revascularization, with no stroke recurrence and a favorable clinical outcome. Structural modeling revealed minimal functional impact for the Val1529Met variant, whereas other variants significantly disrupted RNF213 stability and functionality.
Conclusions:
“Smokeless moyamoya,” characterized by carotid fork steno-occlusion without typical angiographic collaterals, represents a distinct clinical phenotype responsive to revascularization. RNF213 genetic screening enhances diagnostic precision, reshaping traditional paradigms and supporting tailored therapeutic approaches.
Behavioural activation (BA) is recommended for the treatment of depression but most research focuses on working age adults and there is a dearth of literature concerning the delivery of BA with people with co-occurring depression and mild cognitive impairment (MCI). This case study outlines a BA intervention with a male in his late 60s with depression and MCI and describes appropriate adaptations that were useful. Treatment consisted of psychoeducation of depression and BA, formulation, activity monitoring and scheduling, tackling self-critical thoughts and rumination, and relapse planning. The 12-session BA treatment resulted in a decrease in both depressive symptoms and psychological distress as well as an increase in the individual’s engagement with meaningful activities. This case study adds to the literature and strengthens the argument for the use of BA in the treatment of depression in older adults with MCI. Adaptations, conclusions and limitations are discussed.
Key learning aims
(1) To gain an understanding of the use of behavioural activation (BA) in the treatment of depression in older adults with mild cognitive impairment (MCI).
(2) To illustrate treatment of depression using BA with an older adult utilising the current evidence base.
(3) To outline adaptations that can be made to BA to help deliver this treatment with an older adult who has MCI.
This study investigates how children aged 4 to 12 years participate in /u/-fronting, a phonetically conditioned change in Ontario English in which the high back vowel /u/ is initially more fronted after coronal consonants than in other contexts. A picture naming task was used to elicit vowel tokens from children and their parents, and F1 and F2 measurements were extracted using FAVE. Children in all three age groups (4-6, 7-9, 10-12 years) were found to have significantly higher F2 values for /u/ (indicating more fronting) than adults in the non-coronal environment. This pattern does not appear to follow the predicted pattern of incrementation of sound change by older children. Instead, the findings may reflect overgeneralization of /u/-fronting, with young children extending the change to a new phonetic context during acquisition, or an earlier start to the incrementation of this variable in this population.
Systematic reviews (SRs) synthesize evidence through a rigorous, labor-intensive, and costly process. To accelerate the title–abstract screening phase of SRs, several artificial intelligence (AI)-based semi-automated screening tools have been developed to reduce workload by prioritizing relevant records. However, their performance is primarily evaluated for SRs of intervention studies, which generally have well-structured abstracts. Here, we evaluate whether screening tool performance is equally effective for SRs of prognosis studies that have larger heterogeneity between abstracts. We conducted retrospective simulations on prognosis and intervention reviews using a screening tool (ASReview). We also evaluated the effects of review scope (i.e., breadth of the research question), number of (relevant) records, and modeling methods within the tool. Performance was assessed in terms of recall (i.e., sensitivity), precision at 95% recall (i.e., positive predictive value at 95% recall), and workload reduction (work saved over sampling at 95% recall [WSS@95%]). The WSS@95% was slightly worse for prognosis reviews (range: 0.324–0.597) than for intervention reviews (range: 0.613–0.895). The precision was higher for prognosis (range: 0.115–0.400) compared to intervention reviews (range: 0.024–0.057). These differences were primarily due to the larger number of relevant records in the prognosis reviews. The modeling methods and the scope of the prognosis review did not significantly impact tool performance. We conclude that the larger abstract heterogeneity of prognosis studies does not substantially affect the effectiveness of screening tools for SRs of prognosis. Further evaluation studies including a standardized evaluation framework are needed to enable prospective decisions on the reliable use of screening tools.
On what policy areas and with what strategies should businesses and their leaders be involved in political activity? Advocates of “stakeholder capitalism” endorse companies and their leaders taking stances on social, environmental, and economic issues that advance the interests of their communities, not just of their shareholders. We juxtapose this view with two alternatives: companies and their leaders should a) stay out of politics or b) advocate only for their narrow business interests. We survey the mass public and business leaders. The public has little appetite for corporate leader engagement. However, business leaders, especially Democratic ones, endorse more active engagement from their firms on most issues, though they favor their firm leaders engaging in behind-the-scenes strategies rather than those that mobilize employees or customers. We find there is an elite appetite for business leaders to move beyond particularistic lobbying and to influence broader economic and social policy.
We prove the existence of a model companion of the two-sorted theory of c-nilpotent Lie algebras over a field satisfying a given theory of fields. We describe a language in which it admits relative quantifier elimination up to the field sort. Using a new criterion which does not rely on a stationary independence relation, we prove that if the field is NSOP$_1$, then the model companion is NSOP$_4$. We also prove that if the field is algebraically closed, then the model companion is c-NIP.
There has been debate about the frequency and severity of antidepressant withdrawal effects.
Methods
We set out to appraise and reanalyze an influential systematic review by Henssler and colleagues that concluded that withdrawal effects are not particularly common and rarely severe. We repeated the meta-analysis, including only studies where data were derived from systematic measures of withdrawal symptoms.
Results
Most data in the Henssler review are derived from pharmaceutical industry–sponsored efficacy studies in which withdrawal was a minor consideration. Shortcomings of the review include the use of spontaneously reported adverse events to estimate withdrawal symptoms, potential misclassification of withdrawal symptoms as relapse, inclusion of data from retrospective case-note studies, short duration of prior antidepressant use, short observation periods, the overlooking of differences between placebo and drug withdrawal effects, and the use of questionable proxies for severe withdrawal. There were also discrepancies and uncertainties in some figures used. In our reanalysis, we included only the five studies that used a systematic and relevant method to assess the incidence of any withdrawal symptom. Prior treatment was short-term (12 weeks or less) in all but one of these. The pooled percentage was 55% (95% confidence interval, CI, 31% to 81%; N = 601) without subtracting nocebo effects, with high heterogeneity.
Conclusions
Henssler’s review is based on unreliable data and does not provide an adequate basis for the evaluation of antidepressant withdrawal effects. Further good-quality research on antidepressant withdrawal is required.
The ‘Age of Anxiety’ has emerged as a common narrative trope in International Relations scholarship, particularly within the sub-field of ontological security studies. This narrative frames recent global crises – such as climate change, COVID-19, and declining Western-liberal hegemony – as ushering in a new era of existential uncertainty. The article critiques the universality of this thesis, arguing that it overgeneralises from the Western-liberal experience and neglects spatial and temporal diversity in the global experience of anxiety.
Methods
The article employs a critical-interpretivist methodology, drawing on postcolonial theory, the history of emotions, and ontological security studies. It draws on illustrative examples to interrogate the spatial and temporal assumptions underpinning the Age of Anxiety thesis.
Results
The article shows how the Age of Anxiety thesis reproduces Eurocentric periodisations, presenting the affective experiences of the liberal-Western lifeworld as universal, thereby marginalising subaltern experiences of anxiety. The article also identifies significant spatial and demographic variation in the circulation of anxiety, such as the uneven distribution of climate anxiety, and introduces the concept of postcolonial anxiety to foreground longue durée, haunting forms of insecurity that elude Western-centric framings.
Conclusion
The article concludes by calling for a pluriversal approach to ontological security that recognises diverse emotional communities and alternative temporalities through which anxiety can be experienced. It urges scholars to adopt more reflexive, empirically grounded, and historically sensitive analyses that decentre the Western-liberal subject.
This article explores how staff at the UN Regional Economic Commission for Europe (ECE) tried, with mixed success, to incorporate Soviet knowledge and experts into their activities and how these challenging efforts, paradoxically, created a space in which economics could be a shared language of communication across the Cold War divide, both within UN spaces and in adjacent academic networks. This conceptual move allowed economics knowledge to pool between East and West, even though the divide between the blocs was originally expressed in economic terms. In the 1960s, with the global transformations of decolonisation, the ECE’s experts, including those embedded in British academic networks, worked to export their shared knowledge beyond Europe, using the triangulated international space of the UN to promote – and continue gathering – economic information from the Soviet Union.
Electron-only reconnection (E-REC) is a process recently observed in the Earth’s magnetosheath, where magnetic reconnection occurs at electron kinetic scales, and ions do not couple to the reconnection process. Electron-only reconnection is likely to have a significant impact on the energy conversion and dissipation of turbulence cascades at kinetic scales in some settings. This paper investigates E-REC under different intensities of strong guide fields (the ratio between the guide field and the in-plane asymptotic field strength is 5, 10 and 20, respectively) via two-dimensional fully kinetic particle-in-cell simulations, focusing on electron heating. The simulations are initialized with a force-free current sheet equilibrium under various intensities of strong guide fields. Similarly to previous experimental studies, electron temperature anisotropy along separatrices is observed, which is found to be mainly caused by the variations of parallel temperature. Both regions of anisotropy and parallel temperature increase/decrease along separatrices become thinner with increasing guide fields. Besides, we find a transition from a quadrupolar to a hexapolar (six-polar) to an octopolar (eight-polar) structure in temperature anisotropy and parallel temperature as the guide field intensifies. Non-Maxwellian electron velocity distribution functions (EVDFs) at different locations in the three simulations are observed. Our results show that parallel electron velocity varies notably with different guide field intensities and finite parallel electron heat flux density is observed. The three simulations exhibit features of the Chew–Goldberger–Low theory, with the level of consistency increasing as the guide field strength increases. This explains the electron parallel temperature variations and the shape of the EVDFs observed along the separatrices. This work may provide insights into the understanding of electron heating and parallel heat flux density in E-REC observed in the turbulent magnetosheath.
Diet in the first years of life is a key determinant of lifelong disease risk and is highly affected by socio-economic status (SES). However, the specific relation between SES and food consumption in toddlers and preschoolers is poorly understood. This study assesses SES-related differences in food consumption in 1- to 5-year-olds in Germany using weighed food records (3 + 1 d) of a subsample of 887 children from the cross-sectional Children’s Nutrition Survey to Record Food Consumption (KiESEL) undertaken between 2014 and 2017. Children were categorised as having a low, medium or high SES depending on parental income, education and occupation. A two-step generalised linear model corrected for age and sex was applied to assess differences in food consumption, using bootstrapping to address unequal group sizes. Differences between SES groups were found for unfavourable foods (and the subgroups sugar-sweetened beverages and confectionary/desserts), fruit, bread/cereals and fats/oils (PBoot < 0·05). Mean daily consumption in the low-SES group as compared with the high-SES group was 84 g lower for total fruit, 22 g lower for bread/cereals and 3 g lower for fats/oils, while being 123 g higher for sugar-sweetened beverages and 158 g higher for unfavourable foods in total (based on bootstrap 95 % CI). In conclusion, this study suggests a social gradient in the diet of German toddlers and preschoolers, with lower SES linked to lower diet quality. To prevent adverse health trajectories, public health measures to improve early life nutrition should address all children, prioritising those of lower SES.
Previous research has highlighted abnormalities in the pulvinar region of the brain among individuals diagnosed with obsessive-compulsive disorder (OCD). Nevertheless, given the pulvinar’s complex structure, comprising four distinct subnuclei (PuA, PuI, PuL, and PuM), inconsistencies persist regarding both structural and connectivity alterations within this region.
Methods
3D T1-weighted magnetic resonance imaging (MRI) and resting-state functional magnetic resonance imaging (rs-fMRI) were used on a cohort consisting of 41 healthy controls and 51 individuals with OCD in order to compare pulvinar connectivity and gray matter volume. Our aim was to compare both connectivity patterns and gray matter volume (GMV) within the PuA, PuI, PuL, and PuM subnuclei between the two groups. First, we examined resting-state connectivity differences in these subnuclei, followed by an analysis of GMV discrepancies to elucidate the potential neuropathological role of the pulvinar in OCD.
Results
Our findings revealed significant connectivity differences in the left PuL, the right PuA, and the left PuA between OCD patients and healthy controls (p < 0.05). Furthermore, the left PuA exhibited both connectivity differences and increased GMV in the OCD group after applying multiple comparison corrections (p = 0.002).
Conclusions
Our study identified functional connectivity alterations within specific subnuclei, including the left and right PuA, and the left PuL, alongside GMV changes in the left PuA. These observations suggest that these distinct regions of the pulvinar may contribute to the pathophysiology of OCD through differences in both functional connectivity and GMV compared to healthy controls.
Previous studies have found substantial costs to be associated with depression and insomnia (as separate entities).
Aims
To estimate healthcare service use and costs associated with insomnia in Australian adults experiencing subthreshold depression or major depressive disorder (MDD).
Method
Healthcare service use and productivity loss were extracted from the cross-sectional 2020–2022 National Survey of Mental Health and Wellbeing data. Insomnia and depression were assessed using questions aligned with DSM-IV criteria. Weighted two-part models were used to calculate average annual costs (presented as 2021–2022 Australian dollars).
Results
The analytical sample meeting subthreshold depression or MDD criteria consisted of 1331 adults (aged 40.5 ± 16.1 years; 59% female; insomnia prevalence: 84%). Healthcare service use and healthcare costs between individuals with insomnia and those without insomnia were similar in the MDD group. For subthreshold depression, healthcare costs were significantly higher for those with insomnia compared with those without insomnia (Δ = A$990, 95% CI: 234 to 1747), but healthcare resource use was not significantly different. Productivity loss among employed people and reduced employment were much greater (although the difference did not reach statistical significance) in adults with insomnia compared with those without insomnia.
Conclusions
Healthcare resource use among adults with depression was similar in those with and without insomnia. However, higher healthcare costs associated with insomnia were observed in adults with subthreshold depression. Further studies are encouraged to understand the nature of the increased healthcare cost associated with insomnia in individuals with subthreshold depression and to optimise healthcare service use in people with comorbid depression and insomnia.
In this paper, we focus on a discrete physical model describing granular crystals, whose equations of motion can be described by a system of differential difference equations. After revisiting earlier continuum approximations, we propose a regularized continuum model variant to approximate the discrete granular crystal model through a suitable partial differential equation. We then compute, both analytically and numerically, its travelling wave and periodic travelling wave solutions, in addition to its conservation laws. Next, using the periodic solutions, we describe quantitatively various features of the dispersive shock wave (DSW) by applying Whitham modulation theory and the DSW fitting method. Finally, we perform several sets of systematic numerical simulations to compare the corresponding DSW results with the theoretical predictions and illustrate that the continuum model provides a good approximation of the underlying discrete one.
The high comorbidity of major depressive disorder (MDD), anxiety disorders (ANX), and post-traumatic stress disorder (PTSD) complicates the study of their structural neural correlates, particularly in white matter (WM) alterations. Using fractional anisotropy (FA), this meta-analysis aimed to identify both unique and shared WM characteristics for these disorders by comparing them with healthy controls (HC). The aggregated sample size across studies includes 3,661 individuals diagnosed with MDD, ANX, or PTSD and 3,140 HC participants. The whole-brain analysis revealed significant FA reductions in the corpus callosum (CC) across MDD, ANX, and PTSD, suggesting a common neurostructural alteration underlying these disorders. Further pairwise comparisons highlighted disorder-specific differences: MDD patients showed reduced FA in the middle cerebellar peduncles and bilateral superior longitudinal fasciculus II relative to ANX patients and decreased FA in the CC extending to the left anterior thalamic projections (ATPs) when compared with PTSD. In contrast, PTSD patients exhibited reduced FA in the right ATPs compared to HC. No significant FA differences were observed between ANX and PTSD or between ANX and HC. These findings provide evidence for both shared and unique WM alterations in MDD, ANX, and PTSD, reflecting the neural underpinnings of the clinical characteristics that distinguish these disorders.
Adverse childhood experiences (ACEs) are widely associated with mental health disorders, such as depression, post-traumatic stress disorder (PTSD), and suicidality. Resilience plays a role in mediation and moderation of these associations, yet there is limited data from Kenya on this. This cross-sectional study examined the role of resilience in the relationship between ACEs and mental health outcomes among 1,972 participants aged 14–25 years in the Nairobi Metropolitan area. Participants completed the Trauma and Distress Scale (ACEs), Patient Health Questionnaire-9 (depression), Columbia-Suicide Severity Rating Scale (suicidality), Harvard Trauma Questionnaire (PTSD), and Adult Resilience Measure-Revised (resilience). Analyses of moderation and mediation using Hayes Process Macro indicated that resilience moderated the association between ACEs with PTSD and depression, with minimal effect on suicidality. It also moderated specific associations, including emotional/physical neglect on ideation, physical abuse on lifetime behavior (p = 0.0479), and total ACEs on recent behavior (p = 0.0514). Resilience also partially mediated the effects of ACEs on PTSD and depression, and fully mediated suicidality for specific ACE domains (emotional neglect, physical neglect, and physical abuse on suicidal ideation and all ACEs on recent suicidal behaviors). Building resilience mitigates the effects of ACEs on depression, PTSD, and suicidality among Kenyan youth.