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This article reviews the history and current evidence of systematic pharmaceutical industry corruption. It draws on studies by the OECD on international corruption; reports of the Securities and Exchange Commission; studies of the Public Citizen health Research Group of settlement agreements between federal and state authorities and pharmaceutical firm; the history of the Medicare and Medicaid Anti-Kickback Act; professional and industry codes of ethics; the literature on institutional corruption; and studies of conflicts of interest. These sources support findings of systemic corruption since the mid-20th century. The paper also explores the relationship between classic corruption, institutional corruption and conflicts of interest in medicine and pharmaceutical policy.
Intravenous (IV) to oral (PO) antimicrobial stewardship initiatives can be implemented by various healthcare providers in conjunction with clinical decision support tools. Our study evaluated the impact of a prescriber-facing IV to PO alert on azithromycin and doxycycline prescribing, acquisition cost, and waste generated.
Methods:
Our institution implemented an IV to PO alert at order entry for IV azithromycin and IV doxycycline with alternative dosage forms included. All emergency department and inpatient IV and PO azithromycin and doxycycline administrations were included during May 12, 2024 – September 28, 2024 (pre-group) and October 13, 2024 – March 1, 2025 (postgroup). The primary outcome was the change in PO azithromycin and doxycycline administrations over time. Secondary outcomes included cost savings and waste generated.
Results:
A total of 25,529 azithromycin (56% IV, 43% PO) and 40,584 doxycycline (27% IV, 73% PO) administrations were included in the pre-group. The postgroup included 32,505 azithromycin (22% IV, 78% PO) and 44,601 doxycycline (12% IV, 88% PO) administrations. An increase of almost 38.9% (95% CI 34.9 to 43.0%) in the proportion of PO azithromycin and 17% (95% CI 14.4 to 19.6%) in the proportion of PO doxycycline was observed immediately after alert implementation. Azithromycin and doxycycline total waste decreased by 270.3 and 230.6 kg, respectively. Monthly savings of USD 28,739.48 were calculated for azithromycin and USD 46,637.87 for doxycycline.
Conclusion:
A prescriber-facing IV to PO alert led to increase PO administrations of azithromycin and doxycycline with reduction in cost and waste generated.
This article reexamines the Harlem Renaissance by emphasizing Florida’s crucial yet often overlooked contribution to its development. Focusing on influential figures like Zora Neale Hurston, James Weldon Johnson, and Augusta Savage—whose lives and work exemplify Florida’s impact—the study explores how Florida’s Black communities served as both catalysts and sustainers of the movement’s creative and cultural legacy. Using a multidisciplinary approach that combines archival research, visual art analysis, and regional cultural history, the narrative demonstrates that Florida was more than a peripheral region; it was a vibrant hub for artistic innovation and intellectual exchange. Through the recounting of two curated exhibits, the authors highlight Florida’s rich cultural landscape by showcasing artworks, manuscripts, and oral histories that emphasize regional storytelling’s influence on national and global Black cultural movements. By tracing migration patterns, community resilience, and artistic networks, this work reveals how Florida’s Black towns fostered resilience amid systemic oppression, producing key figures who shaped Harlem’s legacy while cultivating a distinctive regional identity. This investigation underscores the importance of reclaiming regional histories to deepen the broader story of Black art and culture. It also highlights implications for contemporary efforts in cultural preservation, community empowerment, and representation. Ultimately, this article affirms Florida’s integral role in the ongoing narrative of Black cultural renaissance and innovation.
Major depression is a common and disabling disorder, and individuals with subthreshold depression represent a key at-risk group. We previously demonstrated that specific cognitive behavioural therapy (CBT) skills training delivered via a smartphone app (behavioural activation, cognitive restructuring, problem solving, assertion training and behavioural therapy for insomnia) improved depressive symptoms for up to 26 weeks.
Aims
To evaluate the long-term effects (up to 50 weeks) of CBT skills and their combinations for preventing major depressive episodes and reducing the total burden of depression (TBD).
Method
Participants were adults from the general population with subthreshold depression. A master protocol trial with four 2 × 2 factorial trials was used to randomise 3280 participants to one of nine intervention arms or a self-check control group. The primary outcome was time to onset of major depression by week 50.
Results
Hazard ratios for the interventions ranged from 0.52 (95% CI: 0.29–0.94) to 0.63 (95% CI: 0.36–1.10), with behavioural activation + assertion training showing the greatest preventive effect (number needed to treat: 23.3 (95% CI: 12.2 to 250)), followed by behavioural therapy for insomnia, behavioural activation + behavioural therapy for insomnia and cognitive restructuring. All interventions reduced TBD scores compared with control, with behavioural activation + cognitive restructuring exhibiting the largest reduction. Effect sizes at week 50 ranged from −0.34 to −0.07 and behavioural activation + cognitive restructuring was the most effective. No serious adverse events were reported.
Conclusions
The current findings indicated that specific CBT skills – particularly behavioural activation +assertion training , behavioural activation + cognitive restructuring and behavioural therapy for insomnia – effectively prevented the onset of depression and reduced the TBD at 50 weeks. Given its brevity, portability, accessibility and scalability, smartphone-based CBT is promising as a preventive intervention.
The blockchain economics literature often models consensus participants as anonymous, interchangeable agents operating without institutional context. This paper argues that this ‘permissionless’ assumption describes open admission but abstracts from governance over rule change. Once governance is restored, mutable blockchain systems face a standard commitment problem: rule-changing coalitions may revise protocol rules after participants make chain-specific investments. The paper develops this claim through a comparative-institutional analysis of eight public blockchain systems and two illustrative cases: the BTC Core governance episode and the Ethereum DAO intervention. TCP/IP provides the institutional comparator: technical systems can evolve extensively while preserving base-layer semantic fixedness. Once governance is included, blockchain security is constrained not only by consensus costs but also by institutional commitment conditions: base-layer fixedness, coalition concentration, coordination thresholds, and identity-linked accountability.
On 31 August 2024, tickets for the Oasis reunion tour went on sale. The outcome was predictable. Prospective purchasers waited online for hours to buy tickets, many were disappointed. Tickets soon appeared on secondary sites at prices which greatly exceeded originally advertised prices. The resulting outcries fed into the new Government’s manifesto promise to ‘put fans back at the heart of events by introducing new consumer protections on ticket resales’. The best solutions to address the popular concerns are: (1) to improve the allocation of tickets in the primary market; and (2) add a greater degree of consumer protection to reduce information asymmetry in the primary market. The former reform requires no regulatory intervention. As a second-best solution I suggest rethinking regulation of the secondary market, as most of the current and proposed regulatory efforts in this market are either unworkable or exacerbate fan frustration. Regulatory interventions on basis of ‘fairness’ or ‘putting fans first’ exacerbate these market failures. The source of the problem is market failure in the primary market, and it is towards this that regulatory effort should be directed. Intervention in the form of secondary market price caps will undermine efforts to protect fans.
Child abuse and low parental affection are established risk factors for higher adulthood panic disorder (PD) severity, but their plausible sleep mediators are under-investigated. We thus examined how actigraphy indices mediated the links between child parental abuse and affection deficits to adulthood PD severity.
Methods
Community-dwelling adult participants (N = 1,054) completed a series of self-reports on child parental abuse and affection at Wave 1. An eight-day actigraphy protocol was conducted at Wave 2, 9 years later. Telephone-administered clinical interviews assessing PD symptoms were conducted in W1 and Wave 3, separated by 18 years. A series of bias-corrected, bootstrapped causal mediation analyses was performed.
Results
Paternal, but not maternal abuse, predicted higher rest- and sleep-stage actigraphy markers after 9 years (βs = 0.263–469.79, p < .001), comprising more activity counts, longer wake time, higher wake time percentage, and wake bouts. These markers, thereby, mediated the trajectory from paternal abuse to higher PD severity (average causal mediation effects (ACMEs): βs = 0.003–0.020, 95% CIs excluding zero, p < .001). Likewise, paternal affection deficits predicted greater disturbances in rest- and sleep-stage actigraphy (all p < .05), thereby mediating the link to greater PD severity (ACMEs: βs = 0.001–0.002, p ≤ .04). Neither maternal abuse nor affection was a significant mediator.
Discussion
These outcomes aligned with, but do not verify, a causal mediation argument wherein actigraphy-derived nocturnal sleep–wake disturbances partially accounted for the trajectory from adverse paternal caregiving encounters to adulthood PD severity. Strategically targeting sleep disturbances may reflect a viable intervention approach for persons with past child paternal abuse learning histories.
Weaning pigs have increased iron requirements due to rapid growth and increased red blood cell production. Traditionally, iron is supplemented using inorganic sources, such as ferrous sulfate. However, a form of iron, SQM® iron, offers better bioavailability and may have benefits for growth and gut health and reduce pathogenic bacteria. This study aimed to compare the effects of SQM® iron and ferrous sulfate on growth performance, gut health, and iron concentration in feces in nursery pigs. A total of 320 pigs weaned at 21 ± 2 days were assigned to a 2 × 2 factorial design by sanitation condition (clean or dirty) and iron source (SQM® iron or ferrous sulfate; 100 mg iron/kg diet). Results showed that pigs fed SQM® iron had greater BW on day 14 and day 28 than those fed ferrous sulfate (P < 0.05), while pigs raised under clean sanitary conditions had greater BW on day 28 than those raised under dirty conditions (P < 0.001). SQM® iron also improved average daily gain during the first 14 days and increased average daily feed intake throughout the 28-day period (P < 0.05). Additionally, pigs fed SQM® iron had higher fecal iron levels on day 21 and improved fecal scores by day 27 (P < 0.05). Under dirty conditions, SQM® iron reduced gut microbiota alpha diversity compared with ferrous sulfate under clean conditions (P < 0.05). However, this decrease in diversity did not indicate dysbiosis, as there were no significant changes in pathogenic and commensal bacteria. In conclusion, SQM® iron led to improved growth performance and fecal score in weaning pigs. While it reduced gut microbiota diversity under dirty conditions, this did not negatively affect the pigs’ gut health, suggesting that SQM® iron could be a promising alternative to traditional iron sources in pig diets.
To evaluate the impact of requiring infectious source selection on systemic antimicrobial orders for stewardship tracking.
Design and Setting:
Multicenter, health system quality improvement project across 17 hospitals and 21 emergency departments.
Methods:
All inpatient and ED antimicrobial orders with an indication between September 1 and September 30, 2024 were analyzed. Primary outcome: Prevalence of selected infectious sources. Secondary outcomes: indication frequency, free-text use, and concordance between selected and documented sources in 500 random orders.
Results:
Among 57,118 orders, empiric indication was most common (71%). Top sources: respiratory (23%), urinary/renal (19%), skin/soft tissue (16%). Concordance was 95%. Free-text entries (2.6%) often matched existing options; dental/oral emerged as a new category.
Conclusion:
Infectious source selection was evaluated and supports future targeted stewardship interventions.
Technological leaps in the algorithmic processing of information are providing financial actors with new opportunities for transnational financial and legal management that optimize asset allocation. Global professional service firms are actively developing TaxTech to capture this market. How will this transformation change relationships between suppliers, clients, and regulators? A key development is a move away from deliberate opacity for secrecy purposes into systems that search for the optimal exploitation of legal affordances. This signals a transformation of the assumed information asymmetries between suppliers, clients, and regulators that sits at the heart of the Global Wealth Chains framework. It empowers owners of data and code. Here we reflect on this transformation, considering three examples of how algorithmic technologies are being used for international tax purposes: blockchains for instant trade verification; generative AI for automation of tax compliance; and algorithmic scenario planning for tax avoidance. These examples show an important shift in the governance of wealth chains – the creation of new forms of infrastructural power through which algorithmic models may become central nodes in tax governance.
Milrinone is commonly used after congenital heart surgery, yet its role following late repair of tetralogy of Fallot remains poorly defined. In many low- and middle-income country settings, children present for repair at older ages after prolonged exposure to right ventricular pressure overload and chronic cyanosis, resulting in post-operative physiology that differs fundamentally from early infant repair. Extrapolation from heterogeneous paediatric cardiac surgery populations may therefore be inappropriate. This review examines the pathophysiologic substrate of late-presenting tetralogy of Fallot and explores how milrinoneʼs pharmacologic profile intersects with dominant post-operative vulnerabilities.
Physiologic Considerations:
Restrictive right ventricular physiology, combined with pulmonary vascular hyperreactivity and impaired ventriculo-arterial coupling, creates a fragile right ventricular–pulmonary arterial unit with limited reserve after repair. As a phosphodiesterase-3 inhibitor, milrinone produces coordinated effects on right ventricular lusitropy, pulmonary vasodilation, and inotropy that directly target these mechanisms, supporting selective use when diastolic dysfunction and elevated afterload predominate.
Current Evidence:
The existing evidence base is derived largely from infant cohorts and mixed CHD populations, with few data addressing older children undergoing late tetralogy of Fallot repair and none specific to low- and middle-income countries. In the absence of lesion-specific evidence, routine or prophylactic use cannot be justified. Instead, a pragmatic, physiology-guided approach is proposed.
Conclusion:
The central question is not whether milrinone is beneficial after tetralogy of Fallot repair, but in whom, when, and why. Addressing this gap will require pragmatic trials or prospective registries focused on late tetralogy of Fallot repair that integrate physiologic and clinically meaningful outcomes. Until such data emerge, selective, mechanism-based use represents a rational strategy in resource-variable settings.
This work presents a nonlinear system identification framework for modeling the power extraction dynamics of wind turbines, including both freestream and waked conditions. The approach models turbine dynamics using data-driven power coefficient maps expressed as combinations of compact radial basis functions and polynomial bases, parameterized in terms of tip-speed ratio and upstream conditions. These surrogate models are embedded in a first-order dynamic system suitable for model-based control. Experimental validation is carried out in two wind tunnel configurations: a low-turbulence tandem setup and a high-turbulence wind farm scenario. In the tandem case, the identified model is integrated into an adapted $ K{\omega}^2 $ controller, resulting in improved tip-speed ratio tracking and power stability compared to steady-state models, while also outperforming the BEM-based model in the present low Reynolds number setting, where aerodynamic predictions are more uncertain. In the wind farm scenario, the model captures the statistical behavior of the turbines despite unresolved turbulence. The proposed method enables interpretable, adaptive control across a range of operating conditions without relying on black-box learning strategies.
In an era characterised by a rise in cross-border litigation, India’s stance on the Recognition and Enforcement of Foreign Judgments (REFJ) reveals a complex contradiction. Although India’s REFJ regime appears to advocate a pro-enforcement stance, the inclusion of révision au fond – the practice of assessing foreign judgments based on their substantive merits – introduces considerable tension in the realm of cross-border dispute resolution. This paper explores the implications of India’s commitment to conducting merits review as a self-imposed obstacle to fostering international judicial collaboration. This paper elucidates how this practice not only complicates the enforcement of foreign judgments within India but also hinders the recognition of Indian judgments abroad, especially in those countries that require reciprocity for such purposes such as Japan, South Korea, Germany and China. Through a comparative analysis of national laws and multilateral instruments, this paper illustrates how India’s statutory révision au fond requirement poses reciprocal challenges for the enforcement of Indian judgments abroad, advocating a critical re-evaluation of India’s REFJ framework to conform with emerging international judicial cooperation standards.
As well as adopting a new Pandemic Agreement in 2025, the “legal reaction” of the international community to the COVID-19 pandemic also included the adoption in 2024 of a substantial set of amendments to the World Health Organization’s International Health Regulations, which had already been practically overhauled in 2005 from the previous model. The process was set in motion by the United States and ran in parallel with the negotiation of the Pandemic Agreement, thus creating evident political complexities but also laying the foundations for a synergistic and complementary relationship. The amendments entered into force on September 19, 2025, but their universality and effectiveness are still a work in progress.
Post-radiotherapy tissue changes in laryngeal cancer can hinder accurate imaging assessment of recurrence and tumour extent. We compared pre-operative magnetic resonance imaging staging performance in recurrent laryngeal cancer versus primary laryngeal cancer.
Methods.
Retrospective single-centre study of 51 total laryngectomy patients (2012–2021). Magnetic resonance imaging assessments of invasion/extension were compared with histopathology (reference standard) to compute accuracy, sensitivity and specificity.
Results.
Magnetic resonance imaging accuracy differed between groups. In the recurrent laryngeal cancer group, accuracy was highest for lymph node metastasis (88.5 per cent) and extra-laryngeal spread (76.9 per cent), whereas it was lowest for cartilage invasion (53.9 per cent) and paraglottic involvement (57.8 per cent). In the primary laryngeal cancer group, magnetic resonance imaging performed best for subglottic and supraglottic extension (76.0 per cent each) and cartilage invasion (72.0 per cent), but showed limited accuracy for extra-laryngeal spread (36.0 per cent) and lymph node metastasis (60.0 per cent).
Conclusion.
Magnetic resonance imaging tended to overestimate tumour extent in both groups. It was sensitive overall, but less specific in certain subsites, particularly the paraglottic region. Negative nodal findings may be reassuring, although conclusions regarding nodal status remain limited.
The Sustainable Development Goals (SDGs), endorsed by national governments, rely on local actors for effective implementation. While the nonbinding nature of the SDG agreement allows for adaptability, it also leads to varying localization across contexts, impacted by existing governance arrangements. This study provides a structured analysis of existing studies, discussions, and evidence that examines how SDG localization interacts with different governance dimensions across diverse contexts. Adopting a meta-perspective, it contributes to a deeper understanding of these variations in SDG localization and informs the development of strategies to accelerate SDG progress at the local level, both leading up to and beyond 2030.
Technical Summary
Cities and local actors have a critical role to play in implementing the SDGs, given their proximity to citizens and community-based challenges. Many regions and cities have undertaken SDG localization as a means to translate and implement global goals at the local level. However, the type and extent of SDG localization have varied a lot across contexts, and this variation is sometimes attributed to the varying governance contexts. Comprehensive studies of governance contexts and their impact on SDG localization are scarce, and the complexity of governance has led current literature to focus primarily on specific aspects – such as policies, strategic planning, or local initiatives – without providing a holistic perspective to fully explore their interconnections. This study addresses this gap by developing a conceptual framework to analyze their interactions at two levels: the intentional level, which examines images, instruments, and actions utilized by actors, and the structural level, which considers underlying conditions, enablers, or impediments. By integrating fragmented analyses and synthesizing insights in the literature, this study develops a more comprehensive understanding of how SDG localization interacts with existing governance contexts and what this means for accelerating progress on the SDGs and developing the next global agenda beyond 2030.
Social Media Summary
This research offers a structured analysis of existing studies, discussions, and evidence that examines how SDG localization interacted with existing governance contexts.
Was West Germany’s China policy economically driven, and since when? Amid growing concerns over value-based and systemic rivalry, recent scholarship has foregrounded the economic dimension of Germany’s China policy. This article argues that, although economic interests gained prominence in Sino–German relations by the late Cold War, they were fundamentally underpinned by strategic considerations. Focusing on the period from 1974 to 1990, it examines how China was integrated into Bonn’s strategic outlook prior to German unification, and how this strategic rationale gradually receded thereafter, giving way to the predominance of economic considerations. It also shows that West Germany, driven by optimistic expectations about China’s future, consciously downplayed ideological differences and value-based conflicts in bilateral relations. By the late 1980s, a symbiotic relationship had already formed between German firms and the Chinese market, rooted in long-term optimism and pragmatic engagement.
Amidst the pedagogical anxieties of the late Qing and Republican China, Tong Xiegeng’s yizhi puzzle (1862) emerged as a creative response to a rigid educational system that privileged rote memorization and dismissed play. This article argues that the puzzle and its accompanying books represent a sophisticated, bottom-up attempt to redefine traditional Chinese education by transforming the classical texts into an interactive, child-centered experience. Through an innovative 15-piece puzzle and a series of books, Tong created a multimodal “edutainment” ecosystem. The study highlights the puzzle’s core pedagogical method: a synergy of text and image (tuwen jiehe) that shifted the child from a passive recipient of memorized text into an active constructor of meaning. Learning was achieved through hands-on, embodied play, internalizing classical knowledge rather than merely reciting it. By challenging the traditional dismissal of play (xi wuyi), Tong’s work prefigured a modern, child-centered pedagogy and stands as a powerful example of private cultural synthesis as a form of educational reform.