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Standard presentations of the fine-tuning argument for theism require that we have a priori insight, on the basis of moral considerations, into what God is likely to do. Standard versions of the sceptical theist response to the evidential problem of evil deny that we have such insight (at least to any significant extent). These facts call into question whether sceptical theists can consistently endorse the fine-tuning argument. In this paper, I present a version of the fine-tuning argument that sceptical theists may consistently endorse, as it does not rely on our ability to make a priori judgements concerning divine intentions.
Do voters punish local politicians for raising taxes? In California, proposed tax increases must be approved via local ballot measures. Using a regression discontinuity design that exploits the narrow passage of local tax initiatives, we find that incumbents do not generally suffer a penalty when cities raise taxes, with the notable exception of business taxes. We explore several mechanisms behind this result and uncover suggestive evidence that business interests may be particularly likely to mobilize following a tax increase. These results suggest that interest groups likely play an important role in determining whether new taxes generate voter backlash.
A 10 m-thick and laterally extensive, mixed siliciclastic–carbonate heterolithic unit occurs between coastal quartz arenites (Banaganapalle Formation) and open marine outer-shelf carbonate platform (Narji Limestone) in the Mesoproterozoic Kurnool sea, India. While the dynamics of mixed siliciclastic–carbonate systems are well studied in the Phanerozoic, comparable Proterozoic examples remain poorly documented and are notably absent from the Indian subcontinent. High-resolution stratigraphic, facies, and petrographic analyses of this heterolithic unit reveal a progressive transition from outer-shelf to storm-dominated middle-to inner-shelf settings, periodically disrupted by episodic high-energy depositional events. Two distinct mixing modes are identified: (i) lithofacies to microscopic-scale strata mixing (Punctuated Mixing), linked to high-frequency sea-level oscillations, and (ii) bed-scale compositional mixing (In-Situ Mixing) of nearshore siliciclastics and subtidal carbonate mud. These findings demonstrate that repeated siliciclastic influx did not inhibit contemporaneous carbonate precipitation, documenting previously unrecognized mixed sedimentation between the Banaganapalle siliciclastics and the Narji carbonates, and advancing understanding of mixed-system dynamics in Proterozoic sedimentary rocks. The widespread occurrence of mixed heteroliths in the Kurnool sub-basin is interpreted to have formed during a phase of rapid subsidence that drove marine transgression, plausibly associated with a rise in sea-level, linked to post-Columbia breakup. Lithostratigraphically correlative heterolithic intervals in the intracratonic Bhima, Pranhita–Godavari and Kurnool basins suggest a regionally extensive, basin-wide Mesoproterozoic transgressive event across the Southern Indian Block. This heterolithic deposit may provide a key stratigraphic marker for regional correlation and yield new insights about the resilience of a Proterozoic non-skeletal carbonate factory and its interaction with episodic siliciclastic input.
Adverse childhood experiences (ACEs), including abuse, neglect and household challenges, have been linked to various mental health outcomes, including psychosis and bipolar symptoms. Research indicates a 57–80% increased risk of psychosis among individuals exposed to ACEs.
Aim
This study examines the relationship between ACEs and psychotic/bipolar symptoms in Kenyan adolescents, assessing resilience as a potential moderator or mediator.
Method
This cross-sectional study was conducted in Nairobi and Kiambu counties, Kenya. A total of 1972 youth, aged 14–25 years, were recruited and completed questionnaires focusing on ACEs (Trauma and Distress Scale), psychosis/bipolar symptoms (Washington Early Recognition Center Affectivity and Psychosis screen) and resilience (Adult Resilience Measure +16). Descriptive statistics, Pearson correlation and multiple linear regression were used to assess the relationships between ACEs and psychosis/bipolar symptoms. SPSS Process macro was employed to examine the moderating/mediating role of resilience.
Results
Emotional abuse and physical abuse were significantly associated with higher psychosis and bipolar symptoms (P < 0.001). Emotional neglect negatively impacted bipolar symptoms (P = 0.042). Resilience moderated the relationship between sexual abuse and psychosis, but not bipolar symptoms. Mediation analysis showed that resilience partially mediated the relationships between sexual abuse and both psychosis and bipolar symptoms.
Conclusions
ACEs, particularly emotional and physical abuse, are significant predictors of psychosis and bipolar symptoms in Kenyan youth. Resilience may play a key role in moderating and mediating these relationships, particularly in cases of sexual abuse. Developing resilience-focused interventions could help mitigate the long-term effects of ACEs on mental health.
Crime has significant impact on older victims. High rates of anxiety and depression may be associated with crimes.
Aims
This paper aims to evaluate the cost-effectiveness of a victim improvement package (VIP) for the reduction of continued symptoms of depression or anxiety in older victims of community crime, from the societal perspective, in a three-step, parallel-group, single-blind randomised controlled trial.
Method
Participants (N = 131) were randomised to receive either the VIP intervention in addition to treatment as usual (TAU) (n = 65), or to TAU alone (n = 66). Service resource use was collected using the Client Service Receipt Inventory and health-related quality-of-life data via the EQ-5D-5L instrument at 3 months post-crime (baseline), 6 months post-crime (post-intervention) and 9 months post-crime (follow-up).
Results
The mean cost of the VIP intervention was estimated at £1330 per participant in the intervention arm. The mean difference in costs between the VIP and TAU arms over the 6-month trial duration was −£881 (95% CI: −£5947 to £4186). The mean difference in quality-adjusted life-years (QALYs) was −0.011 (95% CI: −0.042 to 0.020).
Conclusions
The addition of VIP to TAU for older victims of community crime generated a lower mean point estimate for costs, and failed to improve quality of life compared with TAU alone. While this places VIP in the south-west quadrant of the cost-effectiveness plane, the magnitude and significance of the QALY difference do not justify declaring VIP cost-effective or TAU not cost-effective. Future research is needed to identify the most cost-effective intervention.
Ascaridia galli and Heterakis gallinarum, the most prevalent nematodes of chickens, inhabit the small intestine and caeca, respectively, and often co-occur. Current excreta egg count (EEC) methods do not differentiate between their eggs, and although chickens produce two distinct excreta types – intestinal excreta (IE) and caecal excreta (CE) – the distribution of eggs of these species across them remains poorly understood. Forty Hy-Line Brown laying hens (40 weeks, mean body weight (BW) 2·07 ± 0·02 kg), cleared of prior nematode infection and artificially infected with A. galli (n = 20) or H. gallinarum (n = 20) were housed in separate floor pens and monitored for 26 weeks. Assessments included clinical signs, EECs from IE, CE and mixed excreta (ME), and worm recovery from subsets of birds at 8, 14, 20 and 26 weeks. Neither infection resulted in clinical signs, but A. galli slightly reduced BW gain (0·5 g/week/hen) than H. gallinarum (2·8 g/week/hen). Egg detection aligned with worm predilection sites: A. galli eggs were predominantly found in IE, while H. gallinarum eggs were largely confined to CE. In ME samples, egg counts were reduced by 45% relative to IE for A. galli and 60% relative to CE for H. gallinarum. EECs showed a negative but non-significant association with excreta moisture content. Natural re-infection produced a stable adult worm population in both infections. These findings demonstrate that analysing IE and CE separately provides a practical, non-lethal approach for differentiating these infections, while ME appears to have limited diagnostic utility. Further studies should evaluate these patterns across broader conditions and individual variation.
This study conducts a historical analysis tracing the evolution of climate change narratives from the late 1960s to the present. The analysis produces a comprehensive map of these narratives and identifies three key shortcomings that still need to be addressed in academic literature. First, there are inherent limitations to each narrative, which operate within the confines of their respective theoretical frameworks, shaped by their unique perspectives. Second, climate narratives are not isolated but interconnected; new narratives often emerge from earlier ones, forming a continuum that evolves over time. This dynamic corresponds closely to the three structural dimensions of narrative analysis. Third, existing climate narratives insufficiently incorporate perspectives from territories and cultural contexts beyond dominant Western geographies, thereby marginalising non-Western voices and experiences. As a result, many cultural and political factors that influence responses to climate change remain underrepresented, narrowing how we understand this global issue.
Inattentive survey respondents are a growing concern for social scientists who rely on online surveys for their research. While inattentiveness has been well documented in lower quality sample sources, there is less understanding of how common the phenomenon is in high-quality surveys. We document the presence of a small percentage of respondents in Cooperative Election Study surveys who pass quality control measures but still exhibit inattentive behavior. We show that these respondents may affect public opinion estimates for small subgroups. Finally, we present the results from an experiment testing whether inattentive respondents can be encouraged to pay more attention, but we find that such an intervention fails.
We investigate the unsteady lift response of compliant membrane wings in hovering kinematics by combining analytical inviscid theory with experimental results. An unsteady aerodynamic model is derived for a compliant thin aerofoil immersed in incompressible inviscid flow of variable free-stream velocity at high angles of attack. The model, representing a spanwise section of a hovering membrane wing, assumes small membrane deformation and attached flow. These assumptions are supported by experiments showing that passive membrane deformation suppresses flow separation when hovering at angles of attack up to $55^\circ$. An analytically derived expression is obtained for the unsteady lift response, incorporating the classical Wagner and Theodorsen functions and the membrane dynamic response. This theoretical expression is validated against experimental water-tank measurements that are performed on hovering membrane wings at angles of attack of $35^\circ$ and $55^\circ$. Data from membrane deformation measurements is applied to the theoretical lift expression, providing the theoretical lift response prediction for each of the available experimental scenarios. Results of the comparison show that the proposed theory accurately predicts unsteady lift contributions from membrane deformation at high angles of attack, provided the deformation remains small and the flow is attached. This agreement between inviscid theory and experimental measurements suggests that when flow separation is suppressed, the unsteady aerodynamic theory is valid well beyond the typical low-angle-of-attack regime.
Electroconvulsive therapy (ECT) is considered among the safest and most effective treatments for mental disorders. In Nepal, ECT is practised but data regarding its use, techniques and protocols are limited. The use of non-modified ECT in Nepal is also debatable concerning ethical issues and its outcomes.
Aims
To explore the characteristics of ECT practice, its availability in psychiatric services and to determine the standards and techniques of ECT practice in Nepal.
Method
A cross-sectional, descriptive study via an online survey with a questionnaire was used. All hospitals providing in-patient psychiatric services in Nepal were included in the study. Data were collected using Google Forms with a URL link. Questionnaires were sent to the psychiatrist at each facility. Ethical approval was obtained from Nepal Health Research Council (reference no. 2352).
Results
Of 32 centres, 31 responded (96.9%). ECT practice was employed in 23 (74.2%) of these; 14 (60.9%) had a written ECT protocol and 95.7% obtained written family consent. Pre-ECT work-up was performed in all cases. Brief-pulse devices were used in 81.8% (n = 18), with bitemporal placement being most common. Modified ECT was practised in 16 (69.6%) centres; 4 (17.4%) used both modified and unmodified ECT and 3 (13%) used only unmodified ECT – mainly due to lack of either equipment or an anaesthesiologist. Propofol (82.8%, n = 18) and ketamine (31.8%, n = 7) were the most commonly used anaesthetics, and all centres used succinylcholine for modified ECT. Catatonia (95.7%, n = 22) was recorded as the most common indication.
Conclusions
This nationwide survey shows that ECT is widely used in Nepal, mainly in the form of modified bitemporal ECT, although some centres are still relying on unmodified ECT due to limited resources.
This Element examines China's embrace of green development on the global stage, or 'Chinese global environmentalism.' It traces Chinese global environmentalism's historical evolution and motivations and analyzes its deployment through the governance tools of green ideology, diplomacy, economic statecraft, and international development cooperation. It conceives of Chinese global environmentalism as a wide-ranging economic and political strategy used to unsettle traditional views of China and bolster the legitimacy of Chinese power at home and abroad. This Element argues that Chinese global environmentalism, while not without its fits and starts, is enabling China to make inroads internationally with implications for China's rise and the natural environment that are only beginning to be appreciated. This title is also available as Open Access on Cambridge Core.
This article has a two objectives. The first objective is to investigate the history of identity politics in Bangladesh from the British and Pakistani periods to the post-independence era. It argues that the syncretic culture that flourished during the Muslim rule was deliberately disrupted by the British divide-and-rule policy of partitioning Bengal in 1905 along religious lines, fomenting such communal hatred between Hindus and Muslims that resulted in the partition of 1947, with East Bengal joining Pakistan. This also sowed the seeds of identity politics and a “pendulum syndrome” in future Bangladeshi politics, marked by a perpetual strife between advocates of ethnolinguistic nationalism on one side and religious nationalism on the other, which has become a perennial source of violence and volatility for the nation, hindering its growth and progress. The second objective is to explore how Nobel laureate Rabindranath Tagore has been drawn into this strife, facing accusations of being an Islamophobe and a Hindu chauvinist, and why there have been recurrent attempts to replace his song as the country’s national anthem. The article concludes with a rebuttal to such accusations based on evidence highlighting the song’s historical contributions to the nation despite the ongoing campaigns against it.
Lexical knowledge varies by modality, grammatical class, and, in Arabic diglossia, by the lexical distance between Modern Standard Arabic (MSA) and Spoken Arabic (SpA). We tested the effects of modality, grammatical class, and MSA–SpA distance on lexical knowledge, and interdependence between SpA and MSA. Palestinian Arabic (PA) speaking kindergarteners (N=30; mean age 5:9) completed picture naming tasks manipulating modality (comprehension and production), grammatical class (nouns and verbs), and lexical distance (identical, cognate, and unique). Scores were higher for nouns than verbs and for comprehension than production in both varieties. A graded distance effect was found (identical > cognate >unique). PA lexical knowledge predicted MSA lexical knowledge across conditions in production. These findings highlight the importance of the spoken variety in acquiring MSA vocabulary and show that linguistic distance constrains lexical acquisition in Arabic diglossia. We argue that models of vocabulary acquisition should incorporate linguistic distance and interdependence between varieties.
Installation of a percutaneous gastrostomy tube is often needed for patients with amyotrophic lateral sclerosis (ALS) who develop severe dysphagia. However, there is uncertainty regarding the optimal timing for this procedure, especially with regard to the decline in respiratory function. Several guidelines suggest that gastrostomy should be placed before the forced vital capacity (FVC) drops below 50%, since the procedural risks are heightened. However, multiple studies argue that this procedure could be safe in patients with an FVC of less than 50%.
Methods:
In this retrospective study, we reviewed the medical records of all patients with ALS who had a gastrostomy at our center between 2010 and 2023. Our primary objective was to identify the 30-day mortality rate and the incidence of complications after this procedure. Also, we investigated whether predictive factors of adverse outcomes could be identified, particularly to evaluate if there was an association with pulmonary function.
Results:
We included 54 patients. The 30-day mortality rate was 9.3%, and the incidence of major complications was 16.7%. There was no statistical difference in complications between percutaneous endoscopic and radiologically inserted gastrostomy procedures. Predictive factors for complications were pre-existing pulmonary disease, pre-procedural CO2 levels and, although not statistically significant, diabetes. There was no association between FVC and the occurrence of adverse outcomes, although only 70% of patients had a measure of pulmonary function.
Conclusion:
In our study, there was no correlation between FVC and the occurrence of adverse events from the gastrostomy procedure. This suggests that the traditional cutoff of 50% FVC level should be re-examined and explored further in future studies.
The European Union (EU) is implementing unilateral trade restrictions on imports that contain residues of pesticides banned for use within its borders. Several Latin American (LA) countries, among other EU trading partners, have criticized these measures, leading to a contentious debate that could escalate into a trade dispute before the World Trade Organization (WTO). This article aims to unpack this seemingly polarized debate by re-evaluating the trade concerns raised by LA WTO delegates through a human rights lens. It highlights the disconnect between trade policy positions and human rights commitments concerning pesticides, revealing a bias among WTO delegates in favour of commercial interests, often at the expense of broader societal and ecological concerns raised by human rights-holders in both LA and the EU. The article suggests procedural innovations at both the national and WTO levels that could broaden the trade policy discussion on pesticides, aligning it with human rights standards and urgent collective action for biodiversity stewardship.
Economic evaluation supports public funding decisions about the use of health technologies within the Portuguese National Health System (NHS). The methods guide for economic evaluation in Portugal serves both companies preparing economic evaluation submissions and the independent commission appraising the evidence submitted.
Methods
This article presents the revised methods guide for economic evaluation in Portugal. The revisions reflect advances in economic evaluation, updates to regulatory policies, and responses to the evolving economic context. The paper highlights the most significant changes to the guidance, comparing the new Portuguese guidelines to those from the United Kingdom and Canada. The discussion is framed around key comments received during public consultation.
Results
The updated guidelines recommend cost-effectiveness analyses based on quality-adjusted life years and advocate for long-term modelling, a 4 percent discount rate, and a focus on NHS costs. New features include guidance on the identification and management of uncertainty within a dynamic appraisal process with regular contract negotiations (which can trigger reappraisals). The guide also covers how cost-effectiveness models, typically centrally developed, should be adapted to the Portuguese context. It highlights the key role of structured expert elicitation to address uncertainties in evidence, including those related to model adaptation.
Conclusions
The revision was developed through stakeholder consultations and aligns with international best practices, offering more explicit and transparent methods to support health resource allocation decisions.
This article discusses the concepts of public order and good morals in the Chinese Civil Code. Under Article 153 of the Civil Code, a civil juristic act is rendered void if it violates these concepts. This article examines their substance, functions, and practical significance in determining the invalidity of civil juristic acts in Chinese civil law. Public order refers to interests relating to national security and matters fundamental to the social public order, and good morals refers to virtuous customs representing social morality, family ethics, and personal dignity. It is argued that the nuances of the concepts are purposeful, but they must be wielded by the judiciary with objectivity and precision. It shows, comparatively, that in Chinese jurisprudence, the concepts of public order and good morals are intended to be applied flexibly and are widely accepted as capable of addressing areas where the law remains underdeveloped. Chinese courts are therefore tasked with achieving justice for litigants in each case and social justice at the same time without compromising private autonomy. In the final analysis, these concepts can be viewed as part of a broader commitment to ensuring the law operates in line with social changes and continues to garner public support for the judicial system.