To save content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about saving content to .
To save content items to your Kindle, first ensure no-reply@cambridge.org
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about saving to your Kindle.
Note you can select to save to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
Patient portals (PPs) are digital healthcare programs providing patients with access to their electronic health records with features aiding patients in managing their care. Although PPs are now widely used in primary care (PC), the desirability of its features is less known.
Aim:
This study aims to describe the current and anticipated use of PP features and the socio-demographic profile of PP users accessing these features.
Methods:
A cross-sectional survey of patient and caregiver experiences with virtual care in PC in Ontario, Canada, was conducted from December 2022 to March 2023. A survey section captured use/anticipated use of PP features: ‘communicating with practice’, ‘viewing records’, ‘entering record information’, ‘receiving practice information’, and ‘scheduling appointments’. We report on respondents with/without PP access and their use/anticipated use of PP features, and analyzed associations between respondent socio-demographic data and the current use of a number of PP features using Pearson chi-square test.
Findings:
A total of 970 responses (743 patients (P) and 227 caregivers (C)) were obtained with respondents having PP access (P:57%; C:62%) and indicating using all (P: 43%; C:45%), some (P:55%; C:52%), or no (P: 2%; C:4%) PP features. For those with PP access, age (65+ years (14%) compared to <65 years (1%)), employment status (unemployed (6%) compared to employed (1%)), and language at home (non-English (9%) compared to English (1%)) were significantly associated with not using any PP features (percentages represent those not using any PP feature). Our findings provide insights into equity aspects to be considered for future PP implementation.
Earthquakes and the destruction they wreak on communities and landscapes are regular features of both modern news output and historical accounts. Archaeology can add to our understanding of such disasters, demonstrated here in the discussion of architectural damage noted during recent excavations at Panaztepe, an Early Bronze Age settlement in Western Anatolia. Distinct destruction horizons illustrate the primary and secondary impacts of two earthquakes during the third millennium BC: the first was followed by reconstruction and adaptation, the second by abandonment. By focusing on evidence of seismic activity, the authors examine the resilience of communities inhabiting this geologically fragile region.
Let $\Omega _1, \ldots , \Omega _m$ be probability spaces, let ${\mathbf \Omega }=\Omega _1 \times \cdots \times \Omega _m$ be their product and let $A_1, \ldots , A_n \subset {\mathbf \Omega }$ be events. Suppose that each event $A_i$ depends on $r_i$ coordinates of a point $x \in {\mathbf \Omega }$, $x=\left (\xi _1, \ldots , \xi _m\right )$, and that for each event $A_i$ there are $\Delta _i$ other events $A_j$ that depend on some of the coordinates that $A_i$ depends on. Let $\Delta =\max \{5,\ \Delta _i\,:\, i=1, \ldots , n\}$ and let $\mu _i=\min \{r_i,\ \Delta _i+1\}$ for $i=1, \ldots , n$. We prove that if ${\mathbb P}(A_i) \lt (3\Delta )^{-3\mu _i}$ for all $i$, then for any $0 \lt \epsilon \lt 1$, the probability ${\mathbb P}\left ( \bigcap _{i=1}^n \overline {A}_i\right )$ of the intersection of the complements of all $A_i$ can be computed within relative error $\epsilon$ in polynomial time from the probabilities ${\mathbb P}\left (A_{i_1} \cap \ldots \cap A_{i_k}\right )$ of $k$-wise intersections of the events $A_i$ for $k = e^{O(\Delta )} \ln (n/\epsilon )$.
Few studies have examined how differing diagnostic criteria for mild cognitive impairment (MCI) relate to neuroimaging markers of cerebrovascular disease and neurodegeneration in Veterans. We compared three MCI diagnostic schemes on their associations with white matter hyperintensity (WMH) burden, hippocampal volume, and cortical thickness in nondemented Vietnam-era Veterans.
Methods:
228 Veterans (mean age = 69.65) were classified using: (1) Alzheimer’s Disease Neuroimaging Initiative (ADNI) criteria (subjective memory concerns, impaired Logical Memory, global Clinical Dementia Rating = 0.5); (2) neuropsychological criteria (>1 standard deviation [SD] below norms on two tests within a domain or one test across three domains); and (3) typical criteria (subjective memory concerns and >1.5 SD below norms on one test). Regression models predicting WMH burden adjusted for age and intracranial volume and included MCI status and hippocampal volume; ADNI-based models also included posttraumatic stress disorder symptom severity.
Results:
Neuropsychological criteria were associated with greater WMH burden (β = 0.45, p = .024), whereas typical and ADNI criteria were not. Sensitivity analyses found that meeting neuropsychological criteria for amnestic MCI interacted with lower hippocampal volume to predict greater WMH burden (β = −0.001, p = .028). No criteria were associated with cortical thickness.
Conclusions:
Neuropsychological criteria more sensitively identified Veterans with greater WMH burden and demonstrated a small, hippocampal volume-dependent effect in amnestic MCI. These findings support the clinical utility of multi-test neuropsychological approaches for detecting complex brain changes in high-comorbidity populations, with implications for risk stratification and targeted intervention in aging Veterans.
This paper introduces the concept of the regulatory ethos to describe some common values and ideals that underscore the close connection between validation and regulation that this issue of BJHS Themes explores. We identify the primary motivation for this ethos as making knowledge production processes traceable, and define the regulatory ethos as valuing plans over situated actions, uniformity over heterogeneity, auditing over communication, and validation over validity. Standard operating procedures, reporting checklists, preregistrations, compliance rules and monitoring are key means through which this ethos is enacted. While regulators have been instrumental in promulgating this ethos, it is not confined to the regulatory sphere. We argue that reforms aimed at enhancing rigour and reproducibility are an example of how the practices and values associated with regulatory science have diffused out into academic science. Identifying this ethos as regulatory in origin – rather than wholly new or as part of a broader process of modernization – allows us to see that alternatives are not unscientific per se, and better identify the strengths and weaknesses of the regulatory ethos of science, such as the risk that data produced through these procedures will be replicable, statistically rigorous, and transparent, but not meaningful.
This paper describes a prototype test harness that has been developed to evaluate the use of large language model retrieval-augmented generation systems for humanities and social science research, with an emphasis on collections held in the galleries, libraries, archives and museum sector. We propose the development of new modes of research software engineering oriented towards the values and principles of those communities, and rigorous modes of software testing grounded in industry best practices.
Archaeological knowledge of Indigenous human–plant relationships within the Canadian northern plains is comparatively limited to more southern areas of the Great Plains. This is partly due to a lack of standardized requirements and methodologies for paleoethnobotanical research in Canadian cultural resource management; in addition, often such research is only routinely practiced by paleoethnobotanists, of which there are few in the study region. However, deep-rooted traditions of Eurocentric Western ontologies have also shaped archaeological knowledge of precolonial Indigenous human–plant relationships. This article illuminates how archaeological knowledge of precolonial Indigenous Ways-of-Being has been highly influenced by early historical, anthropological, and settler-colonial logics. We then collate and reevaluate archaeological evidence of Indigenous plant management from the Canadian northern plains (e.g., paleoethnobotanical evidence) and problematize contemporary archaeological approaches to past Indigenous human–plant relationships in the study area. To conclude, we suggest pathways for expanding archaeological knowledge of Indigenous human–plant relationships in the Canadian northern plains through engaging with Indigenous Knowledge, dismantling remnant colonial foundations in archaeological practices, and expanding archaeological science approaches.
The primary objective of healthcare personnel involved in end-of-life care is to ensure a good and dignified death. However, end-of-life care is delivered across various healthcare settings. This qualitative study aimed to identify the priorities and concerns related to end-of-life care shared by healthcare personnel working in hospitals, nursing homes, and municipal home care.
Methods
Twenty-two healthcare personnel from across Norway participated in virtual focus group interviews. Participants represented 3 distinct healthcare settings and had diverse professional backgrounds. Each interview was audio-recorded and transcribed verbatim. Qualitative content analysis was conducted and informed by theory on professional competence.
Results
The analysis demonstrated that ensuring a good death was a shared focus among participants. Across settings, they expressed aligned priorities and concerns regarding end-of-life care. They likened their role to that of a pilot boat skipper, guiding the end-of-life process with a clear focus on: 1) offering support and information, 2) providing symptom relief, and 3) ensuring a presence at the bedside. Each of these themes highlights a key priority in end-of-life care across healthcare settings, along with its associated concerns.
Significance of results
This study demonstrates that healthcare personnel across hospitals, nursing homes, and municipal home care share core priorities of what constitutes a good and dignified death. The findings challenge setting-specific assumptions in end-of-life care and support an emphasis on shared core competencies in education and practice. Overall, the study contributes to a more unified understanding of end-of-life care by highlighting foundational care values that transcend organizational boundaries and professional backgrounds, thereby supporting policies that promote continuity and coherence across care environments.
In this paper, we consider catastrophe stop-loss reinsurance valuation for a reinsurance company with dynamic contagion claims. To deal with conventional and emerging catastrophic events, we propose the use of a compound dynamic contagion process for the catastrophic component of the liability. Under the premise that there is an absence of arbitrage opportunity in the market, we obtain arbitrage-free premiums for these contracts. To this end, the Esscher transform is adopted to specify an equivalent martingale probability measure. We show that reinsurers have various ways of levying the security loading on the net premiums to quantify the catastrophic liability in light of the growing challenges posed by emerging risks arising from climate change, cyberattacks, and pandemics. We numerically compare arbitrage-free catastrophe stop-loss reinsurance premiums via the Monte Carlo simulation method. We also compare them with those from generalized compound Hawkes/compound Cox cases. Sensitivity analyses are performed by changing the retention level, the Esscher parameters, and the intensity parameters.
The civil society organizations (CSOs) in Bangladesh that came into the limelight for their activities during the COVID-19 pandemic are relatively new. Their formation, platform building, support expansion, fundraising, and coordination took place within the virtual network. Moreover, this new generation of civil society is engaged in digital advocacy. Under these new circumstances, it has become important to undergo a systematic study on this new generation of CSOs. The present article has conducted a content analysis of the websites (105) and Facebook pages (20) of sampled CSOs that have registered with the NGO Affairs Bureau of Bangladesh from 2011 to 2021. Their digital activities have been analyzed under four broad headings, namely, information and transparency, participation, networking, and mobilization. It has been found that although a few CSOs have come into the limelight for their digital performance, 81% of the CSOs are not using any official website. CSOs that are active on digital platforms are mostly concerned with providing information about themselves rather than engaging in online advocacy or mobilization. Among the different types of CSOs, youth groups have been found to be the most active users of Facebook, whereas service-providing NGOs and environmental CSOs have been observed to be disinterested in utilizing the digital facilities. Though digital culture has already taken root in the socio-political and economic life of Bangladesh, the CSOs seem to be in a transitional phase of digitalization, and their efforts to advocate for and deliver services through the digital space are at an initial stage.
We integrate provenance, sedimentological and tectonic analyses to reconstruct sediment sources, transport pathways and hydroclimatic evolution of the Rotliegend Group in the Norwegian North Sea. The study also evaluates implications for basin development and reservoir quality in this key reservoir interval. Detrital zircon U–Pb geochronology from nine wells integrated with facies analysis, dipmeter- and image-derived palaeocurrent data and a palinspastic restoration reveals that sediment sources were closer to the basin than today and that inherited structural highs compartmentalized drainage and aeolian fields. Facies trends record a transition from arid dune fields to semi-arid mixed dune, interdune, flash-flood and playa-lake systems, reflecting increasing hydrological connectivity and base-level rise during the early Permian. Detrital zircon spectra define three main provenance domains with Caledonian-derived aeolian sand transported from the west–northwest, Sveconorwegian-sourced alluvial-fan systems along the eastern basin margin and hybrid basement-fed systems along northern and southern highs. Mixed zircon-age populations indicate substantial recycling of Devonian Old Red Sandstone basin fills and convergence of multiple sediment transport pathways within the basin interior. Converging transport pathways enabled interaction between long-distance and short-range detrital zircon input, whereas sustained pathway partitioning maintained distinct first-order provenance domains at basin scale. Provenance influences reservoir quality through its control on sediment composition, texture and depositional facies, with quartz-rich Caledonian-derived aeolian deposits retaining anomalously high porosities and feldspathic Sveconorwegian-derived alluvial-fan deposits displaying consistently lower porosity. Integrating provenance, facies, palaeocurrents and restored basin geometry therefore provides a predictive framework linking sediment transport, tectonic inheritance, and reservoir distribution in ancient continental basins.
I analyze the main characteristics of the hierarchy of levels of selection as manifestors of adaptation (i.e., hierarchy of levels of evolutionary organization) and show that, while ranked, this hierarchy is nonnested. Secondly, I consider a potential objection to my approach derived from Eronen and Ramsey’s (2025) claim that levels of organization should be teased apart from levels of selection. I argue that their approach rests on a failure to distinguish between interactors and manifestors of adaptation, for while a hierarchy of interactors does not correspond to a hierarchy of levels of organization, a hierarchy of manifestors does.
The child quantity–quality (QQ) tradeoff is central to both household decision-making and long-run theories of economic development. Despite extensive research, there is little consensus regarding the sign of the effects of additional siblings on child outcomes. Most previous studies examine the relationship between family size and child quality indirectly through the consequences of the allocation of parental resources, such as educational and labor market achievements. Using Indian data, I present evidence of a quantity–quality tradeoff in direct parental monetary expenditures in shadow education (or private tuition). Exploiting the elder son preference typically observed in the study context, I instrument fertility with gender of the first child, two girls, and same-sex birth. IV estimates show a parity-specific quantity–quality tradeoff. The effects are heterogeneous. In wealthier families or those in urban areas, the trade-off is more pronounced.
Hospital-acquired infections (HAIs) pose significant challenges in the Asia Pacific region, where disparities in healthcare infrastructure and inconsistent infection prevention protocols may exacerbate patient safety risks. A recent survey of healthcare facilities across ten Asia-Pacific countries identified substantial gaps in compliance with international guidelines for sterilizing surgical implants, indicating a need for educational initiatives to drive improvement.
Methods:
The Asia Safe Surgical Implant Consortium was established through collaboration among regional professional associations and met in Tokyo, Japan, to formulate consensus recommendations.
Results:
The consensus process incorporated diverse expert perspectives and current evidence, resulting in three foundational documents that addressed quality assurance in sterilization, standardized management of loaner and implantable devices, and the implementation of a robust sterilization recall policy. These recommendations emphasize the integrated use of physical, chemical, and biological indicators, thorough documentation, and timely communication to enhance sterilization practices. Ongoing regional collaboration, investment in resources, and professional development were identified as critical for achieving consistent adoption of best practices and improving surgical outcomes.
Conclusions:
The consortium’s work provides a structured framework to support central sterile supply departments and elevate patient safety standards across the Asia Pacific region.
Learning from data is the point of making and using them. But how can scientists pass on to potential users what they have learned about their data? This chapter proposes answers to this question by focusing on the medium of data and its social uses. It argues that scientific data do not merely represent information but can be structured and presented to have a pragmatic function oriented to enable users’ understanding. It demonstrates this by describing how the MUWAGS collaboration, discussed in Chapters 6 and 7, designed its catalog – a table of the measured and estimated properties of galaxies –, to guide users to self-correct wrong uses and delimit itself from being held accountable for misuses. Some astronomers argue that catalogs encode their makers’ collective knowledge of their data. This chapter examines this claim ethnographically, suggests elements of a pragmatics of data reuse, and ends with a reflection on socio-computational orders – entanglements of the social and the computational in scientific work with large datasets.
Data-centric socialities are media-centric socialities. One way to make sense of the novelty of digital media is to ask what scientists can do with them that they could not do before. This chapter does so for digital imaging in astronomy. It explores two arithmetic operations – adding and subtracting digital exposures pixel by pixel – and their surprising practical and organizational consequences. Setting out from a lecture on image processing to undergraduate students, it traces astronomers’ understandings of digital data’s affordances. It argues that the introduction of charge-coupled devices in the 1980s provided solutions to a set of practical problems that astronomers had formulated with increasing clarity since the 1950s. Subsequently, new organizational possibilities for astronomical research emerged. These include mobilizing data beyond local contexts, rendering abstract time as an object of management, sharing data as nonrivalrous goods, assessing others’ work remotely, and building new forms of collaboration – elements of a novel medial middle ground in data-rich science.