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Under the network meta-analysis (NMA) framework for aggregate data, there are limited possibilities for evidence synthesis across multiple treatment doses or timepoints. Model-based network meta-analysis (MBNMA) has been recommended as a framework for either evidence synthesis across multiple dose levels or across multiple timepoints to circumvent the limitations of the NMA. A joint dose–response and time–course MBNMA (DT-MBNMA) is proposed that combines the strengths of both DT-MBNMA. This framework allows for combining data at multiple timepoints from studies in early clinical development with a broad range of doses to late-stage clinical studies with a limited range of doses. The method respects randomization and allows for assessment of consistency and hence satisfies the requirements from reimbursement agencies. The method was validated in a simulation study, showing that the drug effect parameters and therefore indirect treatment effects could be recovered without bias, while the precision of the treatment effects was dependent on the simulated network. Compared with a standard NMA, the methodology increased the statistical efficiency of the indirect treatment comparison (ITC). The use of the method was further illustrated on a dataset consisting of seven randomized clinical trials (RCTs) (26 treatment arms) in the treatment of obesity with Glucagon-like peptide-1 receptor agonists (GLP-1 RAs), with a broad range of doses and follow-up times. The method integrated phase 2 and 3 data seamlessly into the meta-analysis and provided greater precision on the treatment effects compared to NMA. Finally, the statistical framework may be used to support clinical decision-making, providing a framework for ITC during drug development.
Migrants use less mental healthcare than non-migrants, but it is unclear how much this reflects differing needs and whether this gap has changed over time. We examined differences in mental healthcare use by migrant status between 2006 and 2022 while considering probable mental healthcare needs.
Methods
We used data from four cross-sectional surveys conducted in Stockholm County (2006, 2010, 2014 and 2021) in which self-reported need indicators, including psychological distress, were measured. Survey participants, 81,650 adults (18–64), were linked to administrative registries to estimate differences in mental healthcare use (both likelihood and frequency), within 6 months of survey response. Logistic regression and zero-truncated negative binomial regression were used, with survey weights and adjustments for sex, age, income, education, psychological distress (main need-indicator), general health status and long-term limiting illness.
Results
Non-Nordic migrants were more likely to report increased levels of psychological distress but were less likely to use services than non-migrants. The gap in mental healthcare use was initially marginal but increased with adjustment for mental healthcare needs, as well as over time (2006–2022). The odds ratios comparing the likelihood of mental healthcare use between European migrants with Swedish-born individuals decreased from 0.93 (95% confidence intervals: 0.77–1.11) in 2006/2007 to 0.48 (0.39–0.59) in 2021/2022, adjusting for sociodemographic factors and psychological distress. For non-European migrants, the corresponding odds ratios decreased from 0.72 (0.62–0.85) to 0.46 (0.39–0.54). Further adjustments for general health status and long-term limiting illness widened the gap even more. In 2021/2022, the gap was larger in secondary than in primary care and for online than in-office services.
Nordic-born migrants had similar utilization patterns as Swedish-born individuals. Differences in the frequency of outpatient visits between migrants and Swedish-born individuals, conditional on having at least one visit, were marginal. For instance, the rate ratios comparing non-European migrants with Swedish-born individuals changed from 0.67 (0.48–0.93) in 2006/2007 to 0.90 (0.65–1.26) in 2021/2022.
Conclusions
Despite indicating greater needs, non-Nordic migrants faced persistent inequities in mental healthcare access, but differences in intensity/continuity of care were marginal among those who accessed services. Inequities in access grew over the study period and were largest during the COVID-19 pandemic, particularly in access to online mental healthcare services and specialized care. These findings should be interpreted cautiously given potential selection bias from declining survey participation and changes in distress scales.
Skinfold prediction equations (SF-PE) are used to estimate percent body fat (%BF), but it is unclear which SF-PE are most accurate among different age/sex groups. The purpose was to assess accuracy of estimating %BF from SF-PE in young, middle-age and older male and female adults and compare %BF from SF-PE to Inbody770 (IB770), a selected bioelectrical-impedance criterion reference. Two hundred two healthy males (n 96) and females (n 106) had %BF assessed from twelve SF-PE for females, thirteen SF-PE for males, and IB770. Repeated-measures 1-way ANOVA (P< 0·01) were employed for three age groups for males and females, and Bland–Altman plots were employed to evaluate the agreement between IB770 and SF-PE. Based on statistical assessment and Bland–Altman plots, similarity, agreement and accuracy observed in %BF between IB770 and SF-PE were determined. Consequently, based the following similar %BF comparisons between IB770 and SF-PE, the SF-PE recommended to use to estimate %BF in young males (YM), middle-age males (MM), older males (OM), young females (YF), middle-age females (MF) and older females (OF) are: (1) YM: IB770 = 16·2 %; Durnin 1974 (DW) = 16·3 %; Williams 1992 (W) = 16·2 %; Lean 1996 (L) = 16·6 %; (2) MM: IB770 = 19·7 %; W = 19·7 %; DW = 22·3 %; (3) OM: IB770 = 24·4 %; DW = 25·3 %; W = 22·4 %; (4) YF: IB770 = 24·9 %; Jackson 1985 (JP3b) = 23·8 %; (5) MF: IB770 = 25·2 %; Jackson 1980 = 25·0 %; JP3b = 26·1 % and (6) OF: IB770 = 36·6 %; Peterson 2003 = 36·2 %. Given that SF-PE underestimated, overestimated or accurately estimated %BF compared with IB770 emphasises the importance of using SF-PE that are appropriate for different age/sex groups and provide as accurate as possible estimates of %BF. Assessing %BF accurately is important given excessive %BF increases cardiometabolic disease risk.
According to various sources, Tenochtitlan was founded at the intersection of crags and caves from which two springs flowed. The east–west spring was known as “the fiery waters, the place where the waters burn” (tleatl atlatlayan), whereas the north–south spring was called “the blue and yellow waters” (matlalatl toxpalatl). The same metaphor of blue and yellow waters also appears in the early colonial sources in other contexts. It was associated with gods like Tlazolteotl or Tloque Nahuaque (identified with Tezcatlipoca), who cleansed people with these waters. Likewise, the blue and yellow waters rested in the hands of the tlatoani, who bathed his vassals in them. Finally, they played an essential role in the dedication of newborns to water, which the Spaniards likened to baptism. Although the presence of blue and yellow waters at the Mexica capital is often seen as a reinterpretation of the metaphor atl tlachinolli, “water, burnt land,” symbolizing war, other contexts featuring matlalatl toxpalatl are justice (in the ruler’s duties) and purification. This article proposes a unified interpretation of the Nahuatl metaphor matlalatl toxpalatl, suggesting that it symbolizes completeness, abundance, and the beginning of a new era, as well as carrying the Toltec heritage. Furthermore, this study embeds the metaphor in question in the Mesoamerican conceptual framework.
This article illuminates the variety and diversity of mechanisms and strategies of (European) identification that were used by Ranga Reinhardt Kaundinya. The Indo-German was born into a German Indian (Brahmin) family in service of the Protestant Basel Mission from Switzerland. Having spent his youth in India, Germany, and Switzerland, he later became a planter in India before managing a cotton plantation in German East Africa (GEA). Producing his identity in a visual source and two German publications released during WWI, the examination of Kaundinya’s sources offers a perspective on how an individual developed an (European) identity in colonial frameworks and dynamics of power across three continents and two empires. In the field of tension between race, class, gender, and religion, he drew on the image of a virile, white colonial hunter and on the self-image of an experienced colonial planter. He further attempted to distance himself from his Brahmin descent and to exploit the Christian part of his family history instead. Moreover, he criticized British colonial rule of India. He even envisioned his own European identity and a vague Indo-German alliance. Amalgamating major ideas of Orientalism, racist thought, and geopolitical theories prominent at the fin du siècle, he called this alliance ‘Indo-Germania.’
Law and society scholars have examined how nonlegal actors, or “legal intermediaries,” construct the meaning of compliance as they translate law into organizational practice and policy. This article applies the legal intermediaries framework to analyze how higher education professionals navigate federal and state immigration law to mitigate the impact of illegality on undocumented students at the institutional level. We find that staff work within the underdefined, flexible, and often complex dimensions of immigration law by developing “creative solutions,” or university-specific policies and practices that interpret and apply existing legal frameworks in ways that broaden access to opportunities for undocumented students. Staff proceed through four steps within this process: developing an understanding of one’s legal and professional context, implementing and troubleshooting solutions, raising awareness and mobilizing support across and beyond the institution, and institutionalizing workarounds. In the process, staff shape broader understandings and organizational treatment of (il)legality at their respective institutions. Through this analysis, we extend the literature on legal intermediaries to the immigration context. We also refine the processes involved in the organizational intermediation of compliance and identify the set of contextual factors that may facilitate or hinder the creative solutions process within and beyond higher education.
The article examines the Slovenization of public space in the Habsburg crownland of Gorizia and Gradisca from the late nineteenth century to the outbreak of the First World War. As in other ethnically mixed regions of the empire, public space became a contested arena shaped by the rise of nationalism, with competing national groups seeking to inscribe their ideologies onto the urban landscape. The Slovene national movement aimed to assert its identity and political aspirations through symbolic spatial interventions. However, owing to the specific circumstances of the Slovene community in the region—characterized by a predominantly rural population and internal divisions between liberal and conservative currents—Slovene spatial politics exhibited distinctive features compared to other nationally driven spatial strategies. The article traces the gradual assertion of a Slovene presence in local public space, from the first nationally inspired monument erected in 1898 to the construction of the national hall in the center of the provincial capital, Gorizia.
Mainstream artificial intelligence (AI) ethics primarily takes vertical approaches: top-down, principle-driven and expert-led frameworks that often exclude the very publics affected by algorithmic systems. This paper explores whether citizen juries (CJs) can function as a horizontal alternative empirical ethics method that emphasizes participation, situated knowledge and epistemic justice. We conducted a citizen jury with Brussels residents to deliberate on the use of an AI system for electricity distribution during brownouts. The jury process combined guidance ethics, speculative fiction, and generative AI tools to scaffold inclusive deliberation. Using affordance theory, we analyze how the citizen jury method structurally mediates certain forms of participation and ethical reasoning. We evaluate its normative value through the lenses of epistemic justice and effective performativity. Our findings show that citizen juries can foster testimonial inclusion and support hermeneutical sense-making, offering a partial corrective to abstract, generic AI ethics. However, we also identify critical constraints: problem-posing was narrowed, alternative epistemologies discouraged, and the outputs risked reproducing the generic performativity forms of vertical ethics. While citizen juries hold promise for doing AI ethics otherwise, their transformative potential hinges on reflexively examining their own methodological affordances and institutional framing.
Ruination studies allow one to see the past not as a fixed “thing” but as living landscapes. Over the past two decades, Mesoamerican scholars have increasingly recognized that ruins were an integral part of ancient Mesoamerican peoples’ experiences in and with the world and not just a modern invention of cultural heritage. Any understanding of ancient Maya ruins must consider the Indigenous ontologies, cosmologies, and myths of peoples of that region. Indigenous approaches highlight the affective and dynamic nature of ruins, perspectives that can be put in conversation with metaphysical or posthumanist ideas more generally. One particularity of ruins in the Maya area is that they often were, and in many cases still are, entangled with forest beings that are both feared and revered. This article reviews some of the ways in which ancient Maya peoples lived with ruins, drawing a number of case examples from the Maya site of Ucanal in Petén, Guatemala, and then contextualizes these findings with the darker side of ruins. This darker side of ruins was part of the making of moral communities that were—and are—in a constant state of motion.
To examine whether different message frames increase public support for a community-identified policy solution to improve food security in remote Aboriginal and Torres Strait Islander communities in Australia.
Design:
An online experimental study in which participants were randomly assigned to one of three message frames: human rights, fairness or community-identified solution or a control condition. Logistic regression models were used to assess associations between message frames and support for an electricity subsidy policy. Interaction analyses explored whether participant characteristics moderated these effects.
Setting:
Australia.
Participants:
A nationally representative sample of 1555 Australian adults recruited through an online panel.
Results:
Message framing had limited overall impact on policy support. The human rights frame generated the highest support for the proposed subsidy, while the fairness frame generated the lowest; however, these differences were modest. We found that regardless of frame used, Greens supporters, those with postgraduate degrees or those who watched the news more frequently, tended to have higher levels of agreement with the policy solution.
Conclusion:
Although message framing is widely used in advocacy to increase policy support, its impact in this context appears constrained. These findings underscore the complexity of shifting public attitudes toward policies benefiting structurally disadvantaged communities and suggest that more targeted, audience-specific framing may be necessary. Further research should explore why certain frames underperform among particular groups and examine how agreement and emotional engagement jointly shape support for policy change.
Using data on interbank relationships and note holdings in Pennsylvania, I estimate the probability that a bank will redeem the notes of other banks by the distance separating them. If two banks were separated by 50 miles, there was a 40 percent probability that a bank would hold the notes of another at a given time. At 200 miles, the estimated probability is virtually zero. My analysis of notes discounted by a small-town, Connecticut banknote broker reveals that distant notes were offered by travelers and traders who moved along the era’s principal waterways.
Mathematical computation skills are a common vulnerability in those born very preterm (VP), but the underlying cognitive mechanisms have not been established. Using causal mediation methods, we aimed to investigate whether working memory, processing speed, and selective attention at 7 years of age could mediate the relationship between VP birth and mathematics computation performance at 13 and 20 years of age.
Methods:
Participants completed standardized measures of working memory, processing speed, and selective attention at 7 years. At 13 and 20 years, participants completed a standardized measure of mathematical computation. Using an interventional effects approach, we estimated the extent to which differences in mathematic performance could be reduced by hypothetically intervening on working memory, processing speed, and selective attention in childhood.
Results:
The VP group performed lower than the FT group on mathematic computation at 13 and 20 years. Improving working memory, processing speed, and selective attention separately in the VP group to the level of the FT group reduced the difference in mathematics performance at both 13 and 20 years. If all cognitive domains were to be simultaneously intervened on so that the VP group matched the FT group, there would be a reduction in difference in mathematic performance by 68.7% at 13 years and 44.1% reduction at 20 years.
Conclusions:
Findings from our causal mediation analyses suggest that interventions targeting working memory, processing speed, and selective attention in childhood for those born VP have potential for improving mathematical outcomes in adolescence born VP, especially if implemented concurrently.
This Article examines the evolving stance of Russia and China on the use of sanctions, highlighting a notable shift from their traditional opposition to unilateral coercive measures toward increasingly employing such tools themselves. While both countries have consistently criticized sanctions not endorsed by the UN Security Council, recent practices reveal a growing reliance on national legal frameworks to impose retaliatory and strategic sanctions. China, for instance, has introduced targeted measures against foreign officials and companies, particularly in response to perceived threats to its sovereignty, such as arms sales to Taiwan. Russia, in turn, has enacted counter-sanctions against Western states through export bans and travel restrictions. The Article explores this duality and analyzes its implications for international law, contending that the gap between rhetoric and practice may signal a reconfiguration of the normative landscape surrounding unilateral sanctions.
The author presents a commentary on the trilogy of papers by Damien Morris entitled ‘Behavioral Genetics and Human Agency: How Selectively Deterministic Theories of Free Will Drive Unwarranted Opposition to Behavioral Genetic Research and Undermine Our Moral and Legal Conventions’, published recently in this journal [PMID 40457806, 40963213, 41107251]. In addition to commenting on this specific set of papers, the author offers a broader perspective and defense of the field of behavioral genetics.
This paper investigates the lived experiences of individuals confined within two major European psychiatric institutions, Miguel Bombarda Hospital in Portugal and the Cadillac-sur-Garonne psychiatric hospital in France, between the nineteenth and twentieth centuries. Using a people-centred approach, we integrate spatial analysis, archival research, material culture and oral testimony to examine how these institutions worked as spaces of social segregation and emotional discipline. Rather than viewing psychiatric hospitals just as sites of medical care, we critically assess their roles in reinforcing sanist, classist and gendered systems of control. Internment partly erased legal, social and personal identities, to an extent attempting to render patients ‘non-persons’. We want to change the current perspective about the dimensions of institutional life by highlighting the dehumanization, mortality rate and emotional experiences of the individual inside these institutions. We support an archaeology that acknowledges the structural violence of such institutions and the resilience of those who lived within them, seeking to restore voice and dignity to marginalized histories.
The objectives of this study were to assess the potential effectiveness of far-UVC (222 nm) in reducing hospital-treated infections, antibiotic prescriptions, and mortality in long-term care facilities (LTCFs), as well as to evaluate the rationale for a future randomized controlled trial (RCT).
Design:
A six-month, nonrandomized, controlled, three-arm Phase II trial was conducted in LTCFs in Denmark. Facilities were allocated in a 10:1:1 ratio to usual care, far-UVC in common rooms, and far-UVC in common and residents’ rooms. The trial was conducted between November 2024 and April 2025. The primary outcome was LTCF-acquired infections treated in hospitals.
Results:
The study included 12 LTCFs with a total of 635 residents. In the usual care group (n = 470), 600 hospital-treated infections were identified with a incidence rate (IR) of 86.2 per 10,000 resident-days. In the common rooms group (n = 76), 12 infections were identified with a IR of 10.4 per 10,000 resident-days and an adjusted incidence rate ratio (aIRR) of 0.12 (95% CI: 0.04–0.34). In the common and residents’ rooms group (n = 89), 78 infections were identified with a IR of 59.1 per 10,000 resident-days and an aIRR of 0.69 (95% CI: 0.23–2.07). The aIRR for total antibiotic prescriptions was 0.52 (95% CI: 0.29–0.96) in the group with lamps in common rooms and 0.83 (95% CI: 0.50–1.37) in the group with lamps in common and residents’ rooms.
Conclusions:
Far-UVC potentially reduces hospital-treated infections and antibiotic prescriptions in LTCFs, but these results should be considered preliminary until confirmed by an RCT.
Indoor environments are continuously subject to the effects of thermal radiation: short-wave radiation that brings in solar heat, and long-wave radiation that acts to redistribute heat. However, the effects of the latter are often overlooked. To fully understand and predict the effects of long-wave radiation indoors, spatial variations in indoor temperature must be considered. This paper develops an analytical framework to describe coupled radiative and convective heat transfers within simple representations of thermally stratified rooms, a minimal description requiring only five thermally active bodies. The model, termed ‘AR5B’, predicts the coupled heat fluxes from each thermal body, enabling the effects of long-wave radiation to be simply mimicked within ventilation flow models. Data from six full-scale experiments show that predictions from AR5B are of suitable accuracy. Moreover, when the AR5B results are then used to mimic the effects of radiation within a simplified ventilation flow model, the resulting thermal stratification is reasonably predicted. We show this to be in stark contrast to comparable cases but without accounting for the effects of long-wave radiation – this finding underscores that long-wave radiation plays a significant role in determining indoor environments and should be incorporated more routinely in predictive models.