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A key finding to emerge from the ongoing work of the special rapporteur of the International Law Commission (ILC or Commission) on subsidiary means for the determination of rules of international law1 concerns the systemic lack of diversity in the use of teachings.2 This finding carries important implications for the legitimacy of using subsidiary means, particularly regarding whose voices are privileged or silenced in legal determination.3 The special rapporteur noted that international courts such as the International Court of Justice (ICJ) had used teachings from a remarkably narrow cohort of predominantly Western, male voices from elite institutions—perspectives that inevitably reflect a limited range of viewpoints and cultural contexts.
This article examines how Miskitu King Robert Charles Frederic (1824–42) used colonial contracts with foreign merchants to advance his political agenda in Moskitia, on Central America’s Caribbean coast. Drawing on European and Central American archives, this study challenges narratives that portray Indigenous leaders as passive actors in colonial expansion, highlighting how the king strategically wielded contracts to facilitate the import of foreign capital through concessions and loans. His mastery of international finance enabled resistance to imperial domination while allowing him to consolidate power, maintain independence, and participate in nineteenth-century Atlantic political transformations. However, this strategy compelled him to facilitate the entry of financial capitalism into Moskitia, subsequently defining his kingdom’s fiscal governance and external relations. By examining Robert Charles Frederic’s learning process in navigating Caribbean political and Atlantic financial systems, this article contributes to scholarship on Indigenous agency in colonial encounters and reveals how peripheral actors mediated the global spread of economic institutions.
While the growing representation of women in diplomacy is often celebrated, scholarship on occupational feminisation warns that feminisation can trigger a devaluation of professional work. This article focuses on two conditions identified as inhibitors of such devaluation – the overall status of the occupation and the value accorded to female labour within the occupation – and traces how these two conditions have varied over time and interacted with feminisation in diplomatic work. We contend that in the transition from a classical to a polylateral mode of diplomacy, feminisation has not led to devaluation, as it coincided with an increase in the status of diplomatic work and reinforced the salience of ‘feminine’ skills. However, currently, the rise of populism is undermining these safeguards against devaluation in diplomatic work by constraining the autonomy of diplomats and delegitimising their expert knowledge. To illustrate these dynamics, the article examines the Turkish Ministry of Foreign Affairs (TMFA). We show that the growing diversification and ambition of Turkish foreign policy in the 2000s enhanced the status of diplomatic work and the value of female labour in it. However, by the mid-2010s, these safeguards against devaluation for a more gender-equal TMFA have weakened in the populist–authoritarian political context. Thus, in the context of rising populism in Turkey as well as globally, it is imperative for initiatives to increase women’s representation to be accompanied by strategies that preserve and elevate the status of diplomatic work.
Menopausal transition is a period of psychological vulnerability, yet suicidality remains underassessed. Hormone replacement therapy (HRT) may influence mood symptoms, but its mental health effects – particularly regarding suicidality – are poorly understood.
Aims
To evaluate changes in depressive symptoms, menopause-related distress and suicidality among menopausal women attending a specialist clinic, and explore whether outcomes differed across HRT regimens and baseline risk factors.
Method
We analysed routinely collected data from 957 women attending a UK menopause clinic. All participants received some form of treatment following their initial consultation. Participants completed the Patient Health Questionnaire-9 (PHQ-9) and Menopause Depression Rating Scale (MENO-D) at baseline and follow-up (2–6 months later). Mixed-design analyses of variance assessed changes over time, including interaction effects for HRT type and baseline risk factors (body mass index (BMI), smoking, suicidality, antidepressant use).
Results
Depressive symptoms and menopause-related psychological distress significantly declined over time (around 46% reduction on average). The largest improvements were observed among women receiving oestrogen–progesterone–testosterone combinations, although similar gains were also seen in oestrogen–progesterone and oestrogen–testosterone groups. Suicidality (PHQ-9 item 9) decreased by 92% among those with baseline ideation, but this was not moderated by HRT type. Self-worth (MENO-D item 4) also improved, but similarly showed no significant moderation by HRT regimen. Higher BMI was associated with worse baseline mental health, but did not moderate treatment outcomes.
Conclusions
Combined HRT, including formulations with testosterone, was associated with substantial improvements in mental health outcomes. Suicidality was a distinct symptom profile, often underdetected by general depression scores. However, findings are exploratory and should be interpreted cautiously because of the lack of a control group, observational design and small sample sizes in some subgroups. These results highlight the need for menopause-sensitive mental health assessments and integration of psychological screening into routine menopausal care.
The development of electroacoustic music in China over the past four decades has been shaped not only by the nation’s modernisation strategies but also by the interplay of historical contexts, temporal frameworks and cultural connotations. While certain achievements have been made in the current phase, the entrenched dualistic framework of ‘China versus the West’ and a lack of critical inquiry fundamentally constrain the potential for further advancement in China’s electroacoustic music. Positioning ‘Chineseness’ as a central strategy in electroacoustic music composition has proven effective in specific historical contexts. However, with the evolution of the times, this strategy requires re-examination and reassessment within contemporary contexts. This paper seeks to trace the developmental trajectory of electroacoustic music in China and analyse existing academic research to identify and unpack its deeper, underlying issues. By introducing a broader ecological perspective, the paper aims to transcend the rigid, dichotomous framework dominated by Chinese-Western dualism, deconstruct cultural essentialism and critically reassess the positioning of Chinese electroacoustic music within these constructs. Finally, it will explore the potential possibilities and responses of an ecological perspective in practice, based on a selection of compositional practices, including my own work Mixobloodify.
Left ventricular assist devices are increasingly used in paediatric patients with end-stage heart failure. Although they improve survival and functional capacity, serious complications can occur.
Case:
We report an 11-year-old girl with dilated cardiomyopathy supported by a left ventricular assist device (HeartMate 3) as a bridge to transplant. Despite periodic education about the use of a left ventricular assist device, she entered the sea, leading to driveline and battery seawater exposure. She presented with device alarms but was initially stable. Given the risk of corrosion, emergent battery and lead replacement were performed under intensive monitoring with inotropic support. She experienced transient hypotension during left ventricular assist device cessation but recovered uneventfully.
Conclusion:
This is the first paediatric case describing left ventricular assist device seawater exposure. The case highlights the importance of repeated education, psychological support, and preparedness for high-risk interventions. This case also underlines potential infectious and corrosive risks following seawater exposure.
An increasing number of reports highlight the potential of machine learning (ML) methodologies over the conventional generalised linear model (GLM) for non-life insurance pricing. In parallel, national and international regulatory institutions are accentuating their focus on pricing fairness to quantify and mitigate algorithmic differences and discrimination. However, comprehensive studies that assess both pricing accuracy and fairness remain scarce. We propose a benchmark of the GLM against mainstream regularised linear models and tree-based ensemble models under two popular distribution modelling strategies (Poisson-gamma and Tweedie), with respect to key criteria including estimation bias, deviance, risk differentiation, competitiveness, loss ratios, discrimination and fairness. Pricing performance and fairness were assessed simultaneously on the same samples of premium estimates for GLM and ML models. The models were compared on two open-access motor insurance datasets, each with a different type of cover (fully comprehensive and third-party liability). While no single ML model outperformed across both pricing and discrimination metrics, the GLM significantly underperformed for most. The results indicate that ML may be considered a realistic and reasonable alternative to current practices. We advocate that benchmarking exercises for risk prediction models should be carried out to assess both pricing accuracy and fairness for any given portfolio.
The contribution that coal miners made to the reconstruction of Europe is hard-wired into popular memory, with widespread tales of the selfless sacrifice that saw miners conduct extra shifts and work longer hours for the nation. This article compares three conflicts that arose when miners were ordered to go the extra mile: the campaign to have miners in the Nord-Pas-de-Calais basin (France) make up public holidays in early 1945, the extension of the Saturday shift in the coal mines of the Ostrava-Karviná basin (Czechoslovakia) in late 1946, and the calls on miners in the Ruhr basin (Germany) to conduct extra shifts to provide the population with coal for the winter of 1946/47. Where trade unionists invoked patriotic sentiments and, when that failed, ethnic resentments to motivate miners to go the extra mile, this article shows that generational conflict between old and young miners was the driving force behind these disputes.
Algorithmic management (AM) is reshaping work in many industries. However, what is done to redress potential risks is little understood. This study explores how trade unions, employers, and government actors assess AM-related occupational safety and health (OSH) risks and their strategies to understand how industrial relations could influence the safety and health of workers managed by digital technologies. Drawing on the Pressure, Disorganisation and Regulatory failure (PDR) model and interview and document data from Sweden, we find a gradually increasing interest in AM in the early 2020s among the government and the social partners. Unions learn, inform, and bargain about AM; employers enact ‘healthy discipline’; and government agencies inspect digital risks in workplaces. Moreover, economic and reward pressures contribute to AM-associated OSH risks. Disorganisation manifests as a lack of knowledge about the OSH effects of AM, leading to ineffective OSH management. Regulatory failure is reflected in new EU regulations stalling national-level initiatives, since the overlapping regulations complicate the enforcement of existing OSH regulations. This study highlights the crucial role of trade unions in advancing the agenda on AM-related OSH risks. It also makes a theoretical contribution by extending the PDR model, offering insights into the driving forces shaping AM and compromising OSH beyond the workplace level – highlighting wider politico-economic and institutional dynamics influencing OSH.
We consider the Maxwell–Schrödinger equations in the Coulomb gauge describing the interaction of extended fermions with their self-generated electromagnetic field. They heuristically emerge as mean-field equations from nonrelativistic quantum electrodynamics in a mean-field limit of many fermions. In the semiclassical regime, we establish the convergence of the Maxwell–Schrödinger equations for extended charges toward the nonrelativistic Vlasov–Maxwell dynamics and provide explicit estimates on the accuracy of the approximation. To this end, we build a well-posedness and regularity theory for the Maxwell–Schrödinger equations and for the Vlasov–Maxwell system for extended charges.
Mobile health (mHealth) interventions offer promising ways to enhance access and continuity of mental health services in low-resource settings. However, little is known about the perspective of end users in routine primary care in Nigeria regarding the role of mHealth in mental health care. This qualitative study explored the perspectives of patients, caregivers and healthcare providers on the use of mHealth tools to support access to and continuity of mental health care in Nigeria. Seventeen participants, including persons with lived experience of depression (n=7), caregivers (n=3), and primary healthcare workers (n=7), were purposively recruited from nine primary health clinics in Ibadan. Interviews were conducted in Yoruba, transcribed, translated into English, and analysed inductively using NVivo 15. Participants identified phone calls, Short Message Service (SMS) reminders, and audiovisual content as key facilitators of engagement, self-care and adherence. Caregivers valued direct communication with providers, while healthcare workers used mobile tools for reminders, follow-up and patient education. Flexible use of next-of-kin contacts helped overcome digital barriers. The findings demonstrate that user-friendly mHealth tools are feasible for supporting mental health care in Nigeria, but their success depends on coupling technology with human-centred communication to ensure equitable and continuous care.
This article addresses the expansion of urban public services in major Nordic cities, from 1850 to 1920. We argue that changes in political discourse were the driving force that prompted politicians to act on behalf of the urban public, significantly before the rise of the universal welfare state. The discursive changes are explored through three analytic concepts: publicness, urban citizenship and the welfare city. We start by presenting a short overview of the development of urban public services. Then we demonstrate how these concepts may be used in conjunction to explain the historical changes. Finally, the material effects are discussed in three case-studies, addressing freshwater pipes, public transport and municipal health care, respectively.
Successful coordination around a Duvergerian equilibrium requires accurate and consistent information about parties’ expected electoral support. In practice, such information is often unreliable and rarely available at the local level, thus hindering voters’ coordination. In this paper, we leverage Argentina’s Open, Mandatory, and Simultaneous Primary Elections as a large-scale survey of voter preferences. Using data from 135 municipalities in the province of Buenos Aires (2011–23), we show that a narrower margin between the top-two placed parties in the primary increases both turnout and the proportion of positive votes in the general election, while decreasing electoral fragmentation. We further show that the second-placed party in the primary is substantially more likely to win the election than the third-placed one. Also consistent with theory, these effects are more pronounced (a) in concurrent elections; (b) in smaller municipalities; and (c) when the second-placed party is closer to the first-placed one.
Why do some events catch fire in the news, producing a media storm, while many similar events go all but unnoticed? This Element uses a fire triangle analogy to explain the necessary conditions of media storms. The “heat” is the spark: a dramatic event or discovery. The “fuel” is the political and cultural landscape, including similar items in recent news, and current debates that allow the event to be framed in a resonant way. The “oxygen” is the available news agenda space, plus attention the event receives beyond the news (by activists, politicians, people on social media, etc.). Media storms are not easily predictable; it takes the right event, at the right time, with the right momentum of attention. But when the political stars align and a media storm erupts, it can be a window of opportunity for change. This Element is also available as Open Access on Cambridge Core.
This paper presents an actuarially oriented approach for estimating health state utility values using an enhanced EQ-5D-5L framework that incorporates demographic heterogeneity directly into a Generalised Linear Model (GLM). Using data from 148 patients with Stage IV non-small cell lung cancer (NSCLC) in South Africa, an inverse Gaussian GLM was fitted with demographic variables and EQ-5D-5L domain responses to explain variation in visual analogue scale (VAS) scores. Model selection relied on Akaike Information Criterion, Bayesian Information Criterion, and residual deviance, and extensive diagnostic checks confirmed good calibration, no overdispersion, and strong robustness under bootstrap validation. The final model identified age, gender, home language, and financial dependency as significant predictors of perceived health, demonstrating that utility values differ meaningfully across demographic groups. By generating subgroup-specific estimates rather than relying on uniform value sets, the framework supports more context-sensitive cost-effectiveness modelling and fairer resource allocation. Although developed in the South African NSCLC setting, the methodology is generalisable and offers actuaries and health economists a replicable tool for integrating population heterogeneity into Health Technology Assessment, pricing analysis, and value-based care.
To determine associations between spiritual well-being (faith and meaning dimensions) with emotional suffering (anxiety, depression, hopelessness, and quality of life) in Latinos with advanced cancer and examine themes of existential coping.
Design
In a mixed-methods study, participants were recruited from cancer clinics in New York and Puerto Rico. Measures included the Functional Assessment of Chronic Illness Therapy – Spiritual Well-Being Scale, the Hospital Anxiety and Depression Scale, and the Beck Hopelessness Scale. A subset of participants completed in-depth semi-structured interviews exploring the roles of existential and religious factors in adjustment to cancer. Correlations were conducted, and the interviews were analyzed with a thematic analysis approach.
Results
A sample of 142 Latinos with advanced cancer participated (67.6% stage IV and 32.4% stage III). The spiritual well-being, faith and meaning factor were associated with anxiety and depression symptoms. Meaning was associated with lower hopelessness and showed stronger associations with emotional suffering than the faith dimension. Lower acculturation was associated with higher hopelessness but not with depression/anxiety. In semi-structured interviews (n = 24), recurrent themes were: (1) receiving existential support from counselors; (2) receiving spiritual support from family and/or friends; (3) focusing on being spiritual and finding purpose rather than on a specific religion or faith; (4) religious coping; and (5) spiritual coping, focused on self-growth, finding meaning, and helping others to cope. Patients identified sources of meaning, including helping others, having a fighting spirit, a spirit of learning, enjoying work, enjoying life, family and children, confidence in providers/treatment, God/faith, and spirituality.
Significance of results
Meaning had a more significant influence than faith on emotional suffering. Participants emphasized the importance of finding meaning and purpose, self-growth, and helping others as ways to cope with an advanced diagnosis. Interventions with a meaning-making approach, emphasizing finding purpose and growth, are needed for Latinos with advanced cancer.
To describe the revised APSIC Environmental Hygiene Guidelines for prevention of healthcare-associated infections inclusive of surface cleaning, air and water quality.
Design:
The revised guideline was developed by Infection Prevention and Control key opinion leaders from Asia Pacific.
Setting:
This guideline emphasizes on practical implementation of environmental hygiene for prevention of healthcare-associated infections inclusive of surface cleaning, air and water quality relevant to Asia Pacific settings.
Patients or participants:
Any patients hospitalized in healthcare setting.
Interventions:
Literature search was done for recent international updates in environmental hygiene inclusive of surface cleaning, air and water quality. Recommendations were evaluated for practical and feasible recommendation in low-resourced settings in Asia Pacific.
Results:
The key recommendations are listed in the best practices for cleaning patient care areas. Additional measures are recommended to improve the air and water quality in healthcare settings.
Conclusions:
Implementation of environmental hygiene in Asia Pacific should take into consideration of the air and water quality in addition of surface cleaning. Measures to assess the cleanliness should be performed using conventional visual assessment, environmental cleaning and disinfection checklist, auditing, and additional measures (e.g., environmental culture or fluorescence).