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This article discusses the question whether the use of ὄργανον as a title to designate Aristotle’s logical treatises as a unitary bibliographical entity can be traced back to the ancient commentators or emerged as late as in the Renaissance. A review of the ancient and medieval evidence locates the earliest certain traces of this use in the eleventh or twelfth century.
This study quantifies the viscous interaction between propeller tip vortices and a turbulent boundary layer developing over a semi-elliptic leading-edge plate, located downstream. The experimental wind-tunnel set-up is designed to be representative of the tractor–propeller–wing configuration. Using stereoscopic particle image velocimetry and static wall-pressure measurements, the near-wall flow topology is resolved over the plate, semi-immersed in the propeller slipstream. The results show that the interaction exhibits high spatio-temporal coherence and is dominated by a coupling between primary and secondary vortical structures. Two distinct interaction regions are identified relative to the tip-vortex core: on the inboard side, towards the slipstream interior, the boundary-layer flow experiences strong velocity gradient transitions and amplified near-wall vorticity. The flow on the outboard side, moving out of the slipstream, exhibits wall-parallel velocity deficits and vorticity lift-up consistent with unsteady vortex-induced separation mechanisms. Spanwise velocity induced by the wall-normal component of the primary vortex connects these two regions, with the secondary vortex structure identified as enhancing boundary-layer lift-up on the outboard side. Although no local flow reversal occurs under the tested conditions, localised shear amplification and vorticity roll-up indicative of separation-like behaviour were observed. These findings advance the understanding of viscous slipstream–boundary-layer interaction and its implications for tractor–propeller–wing integration.
Professional guidelines recommend an early switch from intravenous (IV)-to-oral antibiotics for community-acquired pneumonia (CAP) to facilitate early discharge and prevent hospital-related complications. However, it is unknown how often these IV-to-oral switches occur in clinical practice.
Design:
We performed a retrospective cohort study across 124 acute-care Veterans Administration hospitals to measure the frequency of early switches.
Patients:
Patient-admissions during 2018–2023 who had CAP and were started on IV antibiotics upon admission.
Methods:
We measured the percentage of hospitalized patients with CAP who had an early switch from IV-to-oral antibiotics, i.e., within 72 hours of admission. In addition, we calculated an observed-to-expected ratio for early switches at each hospital and compared a composite outcome (mortality and/or hospital readmission within 30 days of discharge) at hospitals with switch rates that were higher and lower than expected.
Results:
Of 31,183 patient-admissions for CAP, 17,282 (55.4%) were switched to oral antibiotics by day three of therapy. Overall, 5,629 (18.1%) died and/or were re-admitted within 30 days. The O:E ratio for early antibiotic switches ranged from 0.78 among hospitals in the lowest quartile to 1.23 in the highest quartile. There was no difference in the composite outcome across quartiles.
Conclusion:
Early switches from IV-to-oral antibiotics for CAP occurred in half of eligible cases. The frequency of these switches varied widely across facilities. Outcomes among patients at hospitals with high switch rates were comparable to outcomes at hospitals with low rates, thereby supporting the safety of early switches. More concerted efforts to promote these switches are needed.
The increasing diversity of the UK’s population, along with significant inequalities in health outcomes among diverse cultural and ethnic groups, highlights the critical need for healthcare providers, including physiotherapists, to deliver culturally competent care. Research demonstrates that cultural competency (CC) in healthcare can enhance patient outcomes, improve treatment adherence, and address health inequalities. This quality improvement project aimed to evaluate the impact of a brief training intervention on perceived CC among physiotherapists engaging in cross-cultural, clinical encounters.
Methods:
The design of this project was informed by principles of the Plan-Do-Study-Act (PDSA) cycle. Musculoskeletal physiotherapists voluntarily participated in this educational intervention by completing a CC e-learning course developed by Health Education England. A retrospective evaluation method was used, where participants rated their awareness, knowledge, and skills in providing care to diverse patient groups after completing the training as compared to before.
Results:
The pre-and post-training responses assessed three constructs of CC: awareness, knowledge, and skills. Significant increases were observed in the mean scores for each construct, as well as in the overall aggregate CC score, indicating measurable improvements following the training.
Conclusions:
Improvement in CC is viable and achievable through targeted training. CC is a lifelong, dynamic process that requires ongoing education. Therefore, further PDSA cycles are recommended with more advanced educational sessions. Additionally, future projects should assess the impact of enhanced CC on patient outcomes and experiences. Cultural competency must encompass cultural issues beyond racial and ethnic differences.
The Atrato slider Trachemys medemi is a freshwater turtle endemic to the Atrato River basin in the Urabá region of north-west Colombia. Although there is limited information about the species, it was provisionally categorized as Vulnerable on the IUCN Red List by the IUCN Turtle Taxonomy Working Group in 2021 because of its restricted distribution. This study aimed to estimate the potential distribution of T. medemi, identify relevant climatic factors affecting its geographical range and predict its probable future distribution under different climate change scenarios. We recorded its occurrence along the Atrato River and in the surrounding areas, and we employed an ecological niche modelling approach to predict species distribution based on our field data and literature records. Our model indicated that the aquatic distribution of the Atrato slider encompassed the lower, middle and upper Atrato River. This distribution was influenced by air temperature, water temperature and hydrological slope. Our climate change models predicted a dramatic loss of suitable habitat in future, leading to > 50% reduction in T. medemi populations within 30 years. Considering the threat from climate change together with the cultural tradition of harvesting wild turtles for human consumption, we suggest (1) a conservation focus on areas of potential habitat already protected under the National System of Protected Areas in Colombia, (2) empowering local community-based programmes that protect biodiversity, and (3) encouraging reforestation to improve connectivity amongst habitats in the turtle’s geographical range, particularly in degraded areas.
Geoforensic analyses complement archaeological resource crime investigations, cultural resource damage assessments, and other investigations involving sediments. Civil and criminal litigation may hinge on attributions of sediments recovered from persons, equipment, objects, and localities to specific source deposits, including altered cultural resources. Geoforensic fieldwork often entails fluid interplays among geological, archaeological, and investigative factors, and few scientists have experience working in such contexts. Geoforensic specialists may be tasked to swiftly investigate unfamiliar regions to obtain representative specimens and to present expert reports grounded in scientifically reliable principles and methods. For these reasons, systematic preparation is needed to improve geoforensic fieldwork effectiveness and efficiency. We present recommended procedures and field-tested assets for five pre-fieldwork steps: (1) commit to the teamwork, discretion, and professionalism required for crime scene investigation and case resolution; (2) gather geological and archaeological background information; (3) assemble the sediment sampling tool kit; (4) prepare sediment sampling documentation and specimen collection forms; and (5) obtain necessary permits and law enforcement, landowner, or attorney guidance for participation in crime scene reconnaissance, survey, or resurvey. Completion of these five steps will optimize the prospects for geoforensic contributions to cultural resource damage assessments and to just resolution and remediation of unauthorized cultural resource alterations.
Garnet-bearing silicic volcanic rocks are rare in fossil orogens and usually record a transient stage from regional compression to extension. This study reports newly identified 839 ± 3 Ma garnet-bearing dacitic volcanic rocks associated with the Fuchuan ophiolite complex (FOC) in the eastern Jiangnan Orogen (JO), Southeast China. The presence of these unusual rocks provides new constraints on the late Neoproterozoic tectonic evolution of the orogen.
The garnet-bearing dacitic volcanic rocks of the garnets are weakly peraluminous and exhibit trace element and Nd isotopic signatures similar to those of post-orogenic, strongly peraluminous granites in the eastern JO, indicating a similar crustal source. The garnets are almandine-rich (76–79 wt%) and characterized by low CaO (<2.5 wt%), MnO (<2.6 wt%) and TiO2 (<0.1 wt%), consistent with garnets in peraluminous S-type volcanic rocks globally. Integrated petrological, geochemical and zircon Hf isotopic evidence indicates that the primary magma originated from partial melting of a heterogeneous lower-crustal source, comprising both juvenile basaltic and ancient pelitic components. High zircon saturation temperatures (>900°C) further imply the heating of coeval underplating mantle-derived mafic magma, analogous to the mechanism forming ‘hot granites’.
Integrating our findings with regional geology, we propose that the garnet-bearing dacitic volcanic rocks associated with the FOC formed in an ensialic back-arc basin along the southeastern margin of the Yangtze Craton. The occurrence of the garnet-bearing magmatism records the onset of back-arc extension, likely following the ∼880–860 Ma arc–continent collision and subsequent subduction polarity reversal.
Understand current Candidozyma auris prevention practices in the United States and identify opportunities to improve containment.
Design:
Electronic survey.
Setting:
Acute care hospitals.
Participants:
Society for Healthcare Epidemiology (SHEA) Research Network (SRN) facilities located in the United States.
Methods:
REDCap survey distributed via email exploring knowledge and perceptions related to C. auris screening methods, prevention practices, barriers to prevention, and tools needed to improve containment.
Results:
Responses were received from 51/96 (53%) U.S.-based SRN facilities, with 80% identifying as teaching hospitals. Two-thirds of facilities (34/51) reported first-hand experience with C. auris, with 15/34 also experiencing at least one C. auris outbreak. Routine C. auris screening occurred in 47% (24/51) of facilities. C. auris prevention practices commonly included patient isolation, signage to notify staff of isolation status, and placement in a single patient room. When asked to identify barriers to control of C. auris at their facility, participants ranked lack of communication between healthcare facilities, lack of infection control at outside healthcare facilities, and lack of training as the top three barriers. C. auris prevention resources or tools perceived to be most helpful in their facility included effective decolonization regimens, standardized protocols for C. auris screening, and improved communication between healthcare facilities.
Conclusion:
SRN facilities commonly used isolation practices to prevent the spread of C. auris. Development of additional tools to improve prevention practices should target effective decolonization strategies and standardized screening protocols to support C. auris containment.
Persistent affective disturbance is a core, disabling feature of major depressive disorder (MDD), thought to stem from a dysfunctional interaction between emotional bias and cognitive control. However, the underlying neural dynamics are debated, with studies reporting both hyper- and hypoactivation. This study utilized high-temporal-resolution electroencephalogram (EEG) to resolve this discrepancy by examining distinct stages of emotional information processing.
Methods
We recruited 175 medication-free patients with MDD (Hamilton Depression Rating Scale-17 ≥ 14) and 101 healthy controls (HCs) who completed an emotional Stroop task while an EEG was recorded. We analyzed event-related potentials reflecting conflict monitoring (N250), inhibition (N450), and resolution (LSP) using a 2 (group) × 2 (valence) × 2 (congruency) analysis of variance.
Results
Results revealed a stage-specific neural cascade. Compared to HCs, the MDD group showed: (1) hypoactivation during initial conflict monitoring (attenuated N250 amplitude); (2) compensatory hyperactivation during conflict inhibition (a significant N450 interaction revealed generalized conflict activity in MDD, unlike the context-specific response in HCs); and (3) subsequent hypoactivation during conflict resolution (reduced LSP amplitude for negative stimuli). Crucially, altered N450 correlated with depression severity, and the entire neural cascade predicted behavioral performance.
Conclusions
The apparent contradiction in the literature reflects a multistage process. MDD is characterized by an inefficient neural cascade: an initial deficit in conflict monitoring is followed by compensatory overactivation during inhibition, which ultimately proves insufficient, leading to impaired late-stage resolution. This temporally specific model advances our understanding of the pathophysiology of depression and identifies potential stage-specific targets for intervention.
In 1988, during the abolition centennial in Brazil, Verdi’s Aida and Carlos Gomes’s Lo schiavo were perceived and pitched as abolitionist operas thanks to events that unfolded at their stagings one hundred years earlier in Rio de Janeiro. Both operas stirred controversy by being recreated in productions intended to correct historical inaccuracies and unjust erasures, primarily in the context of African slavery, but with unexpected cultural and political repercussions. This article examines connections between operatic performances and social activism, discussing the role of opera singers in promoting an aesthetic of sensibility within the abolitionist movement of the 1880s, but also considering how the most controversial aspects of the nineteenth-century abolitionist movement resonate with issues debated in the 1988 productions.
A self-binding directive (SBD) can be included in mental health advance decision documents to request future involuntary treatment. SBDs are supported by service users but controversial and empirical evidence on their application is scarce. Here we present a first case report which describes the experience of a service user with bipolar disorder (hereafter ‘bipolar’) who has chosen to use an SBD. We compare the findings of the case report with results from a systematic review of reasons for and against SBDs. We discuss that the experience of the service user supports SBDs as a tool to maximise autonomy and challenge criticisms around negative liberty, implementation, capacity assessment, and harms. We conclude that this case report adds to mounting evidence that SBDs are a feasible, ethically justifiable intervention, supported by service users. Policy makers should consider supporting SBD implementation strategies within crisis care.
Bipolar disorder and attention-deficit/hyperactivity disorder (ADHD) share overlapping clinical symptoms and cognitive deficits. Up to 20% of individuals with bipolar disorder also meet the criteria for ADHD (bipolar disorder + ADHD), a subgroup that may experience greater cognitive and functional impairments than those with bipolar disorder or ADHD alone.
Aims
To (a) characterise cognitive profiles in bipolar disorder, ADHD and bipolar disorder + ADHD compared with healthy controls; (b) examine associations between cognitive and occupational functioning; and (c) investigate associations between cognitive function and polygenic scores (PGS) for bipolar disorder, ADHD and educational attainment.
Method
In this observational study, 477 euthymic individuals with bipolar disorder (including 78 with bipolar disorder + ADHD), 59 adult individuals with ADHD and 171 healthy controls completed standardised neuropsychological testing. Full-scale IQ and final school grades indexed current and premorbid cognitive ability, respectively. Occupational functioning was evaluated both cross-sectionally and through 5 years of registry-based follow-up. PGS were available for 295 bipolar disorder and 132 healthy control participants.
Results
All patient groups performed significantly below healthy controls across most cognitive domains. Bipolar disorder + ADHD exhibited poorer working memory than bipolar disorder (d = −0.35, 95% CI [−0.66, −0.03]). Occupational function was lowest in bipolar disorder + ADHD (versus bipolar disorder, d = −0.44, 95% CI [−0.69, −0.19]). In bipolar disorder, poorer executive function (standardised regression coefficient (standβ) = 0.20, 95% CI [0.09, 0.31]) and older age predicted reduced occupational outcomes. PGS for educational attainment was associated positively with cognition in both bipolar disorder (working memory: standβ = 0.19, 95% CI [0.08, 0.30]) and healthy controls (executive function: standβ = 0.20, 95% CI [0.09, 0.32]), while PGS for bipolar disorder or ADHD were not significantly associated with cognitive performance.
Conclusions
Individuals with bipolar disorder + ADHD showed disproportionate working memory and functional impairment compared with bipolar disorder or ADHD alone. Executive function is a key predictor of occupational outcomes in bipolar disorder and is partly shaped by genetic propensity for educational attainment. These findings highlight the importance of considering ADHD comorbidity and cognitive profiles when evaluating functional prognosis and tailoring interventions.
This article focuses on unilateral sovereignty referendums pursued by territorial autonomies. Due to their unilateral character, such referendums are unlikely to gain external recognition and, as a result, fail to effect or prevent any de jure change in sovereignty. However, they are still pursued despite these constraints, suggesting that they serve purposes other than formal changes in sovereignty. To explain this phenomenon, the article proposes a framework of seven potential motivations. The framework is examined through the case of Gagauzia’s 2014 referendums, which addressed two key issues: Moldova’s foreign alignment and Gagauzia’s deferred independence. The analysis follows three referendum stages — proposal, initiation, and implementation — focusing on the dual leadership of the executive and legislative branches. Drawing primarily on newspapers affiliated with these branches, the study finds empirical support for three key motivations: advancing the individual and collective political interests of autonomy leadership, strengthening Gagauzia’s ties with its patron (Russia), and empowering the territorial autonomy vis-à-vis the parent state (Moldova). This article contributes a framework of motivations for unilateral sovereignty referendums tailored specifically to territorial autonomies, going beyond existing explanations developed for all polities. It also provides a detailed account of one of the most significant political events in Gagauzia’s history.
For much of imperial Chinese history, chroniclers and explorers understood a maritime land called Liuqiu to be the Ryūkyūs. In the early twentieth century, however, a new dynastic history claimed that Liuqiu was in fact Taiwan. This article explores how and why an uncontested and unambiguous understanding of Chinese maritime history was suddenly rewritten in the modern world, becoming the accepted interpretation and shaping twenty-first century geopolitics. While scholars have weighed the veracity of Liuqiu as either Taiwan or Ryūkyū, this article focuses on how the Liuqiu–Taiwan thesis was produced and transmitted, showing how scientific methodology, imperialism, and nationalism worked to reshape geographical history. The article further contributes to an understanding of the shaping of the borders and claims of the modern Chinese nation: whereas scholars have investigated late Qing and early Republican debates over the western frontier and ethnicities, this article shows that questions over Taiwan were just as important.
The European praying mantis, Mantis religiosa (Linnaeus, 1758) (Mantodea: Mantidae), is an introduced predatory insect established in southwestern and southeastern Canada and much of the United States of America. Despite over a century of records, the geographic origins of North American populations have remained unclear. We analysed 807-bp fragments of the mitochondrial CO1 gene from 17 sequences from southern Quebec and Ontario, Canada, comparing them to 175 sequences from western, eastern, and southern Europe. Population genetics analyses revealed that Canadian samples carry haplotypes from two divergent lineages that co-occur in a localised region of western France. These haplotypes showed the closest affinities to others also found in France, strongly supporting a French origin. Historical records from Rochester, New York, United States of America, where M. religiosa was first documented in 1899, suggest introduction via the 19th-century horticultural trade. The low haplotype diversity in Canada may reflect founder effects or environmental filtering, though additional, undetected introductions remain possible. This study clarifies the likely French source of M. religiosa in southeastern Canada and underscores the value of combining molecular data and historical accounts to track invasion pathways.
Let $f \in \mathbb{Q}[x]$ be a square-free polynomial of degree at least $3$, $m_i$, $i=1,2,3$, odd positive integers, and $a_i$, $i=1,2,3$, non-zero rational numbers. We show the existence of a rational function $D\in \mathbb{Q}(v_1,v_2,v_3,v_4)$ such that the Jacobian of the quadratic twist of $y^2=f(x)$ and the Jacobian of the $m_i$-twist, respectively, $2m_i$-twist, of $y^2=x^{m_i}+a_i^2$, $i=1,2,3$, by $D$ are all of positive Mordell–Weil ranks. As an application, we present families of hyperelliptic curves with large Mordell–Weil rank.
In a game with costly information acquisition, the ability of one player to acquire information directly affects her opponent’s incentives for gathering information. Rational inattention theory then posits the opponent’s information-acquisition strategy is a direct function of these incentives. This paper argues that people are cognitively limited in predicting their opponent’s level of information, and hence lack the strategic sophistication that the theory requires. In an experiment involving a real-effort attention task and a simple two-player trading game, I study the ability of subjects to (1) anticipate the information acquisition of opponents in this strategic game, and (2) best respond to this information acquisition when acquiring their own costly information. I study this by exogenously manipulating the difficulty of the attention task for both the player and their opponent. Predictions of behavior are generated by a novel theoretical model in which Level-K agents can acquire information à la rational inattention. I find an out-sized lack of strategic sophistication, driven largely by the cognitive difficulties of predicting opponent information. These results suggest a necessary integration of the theories of rational inattention and costly sophistication in strategic settings.