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In Western democracies the decision to go to war is made in ways that ensure decision-makers can be held accountable. In particular, bureaucracies rely on the production of a range of documents such as records of meetings to ensure accountability. Inserting AI into the decision-making process means finding ways to make sure that AI can also be held accountable for decisions to resort to force. But problems of accountability arise in this context because AI does not produce the type of documents associated with bureaucratic accountability: it is this gap in documentary capacity which is at the core of the troubling search for accountable AI in the context of the decision to go to war. This paper argues that the search for accountable AI is essentially an attempt to solve problems of epistemic uncertainty via documentation. The paper argues that accountability can be achieved in other ways. It adopts the example of new forms of evidence in the International Criminal Tribunal for Yugoslavia (ICTY) to show that epistemic uncertainty can be resolved and accountability apportioned without absolute epistemic certainty and without documentation in the sense commonly associated with accountability in a bureaucratic context.
In this article, we maintain that the anticipated integration of artificial intelligence (AI)-enabled systems into state-level decision making over whether and when to wage war will be accompanied by a hitherto neglected risk. Namely, the incorporation of such systems will engender subtle but significant changes to the state’s deliberative and organisational structures, its culture, and its capacities – and in ways that could undermine its adherence to international norms of restraint. In offering this provocation, we argue that the gradual proliferation and embeddedness of AI-enabled decision-support systems within the state – what we call the ‘phenomenon of “Borgs in the org”’ – will lead to four significant changes that, together, threaten to diminish the state’s crucial capacity for ‘institutional learning’. Specifically, the state’s reliance on AI-enabled decision-support systems in deliberations over war initiation will invite: (i) disrupted deliberative structures and chains of command; (ii) the occlusion of crucial steps in decision-making processes; (iii) institutionalised deference to computer-generated outputs; and (iv) future plans and trajectories that are overdetermined by past policies and actions. The resulting ‘institutional atrophy’ could, in turn, weaken the state’s responsiveness to external social cues and censure, thereby making the state less likely to engage with, internalise, and adhere to evolving international norms of restraint. As a collateral effect, this weakening could contribute to the decay of these norms themselves if such institutional atrophy were to become widespread within the society of states.
Gender, as a sociostructural factor, may shape child development through social norms that influence family dynamics. We examined whether more egalitarian parental relationships are associated with better developmental outcomes. Using data from the Pelotas 1993 birth cohort (Brazil), we adapted a population-level gender inequality metric to characterise parental relationships. The Couple’s Gender Inequality Index (CGII) was derived from maternal health, parental education and income. Associations between CGII and educational attainment, quality of life, and depression at age 18 were assessed using linear regression models adjusted for family income, gestational age, birth weight, parental cohabitation and race. The sample comprised 2,852 participants (1,446 women). Higher CGII scores, indicating greater equality within couples, were associated with significantly higher educational attainment in both females and males. Higher quality of life at age 18 was observed in the second and fourth CGII quartiles compared with the most unequal. Greater equality was associated with lower risk of depression at age 18, although this association was not robust to adjustment. Among girls, a similar pattern was observed for emotional symptoms at age 15. Overall, greater couple-level gender inequality was associated with poorer developmental outcomes in offspring.
Mental health legislation across Africa has evolved significantly from colonial-era frameworks. An adapted version of the FOSTREN* (Fostering and Strengthening Approaches to Reducing Coercion in European Mental Health Services) instrument, which is a comprehensive assessment tool based on the World Health Organisation Mental Health Legislation Checklist and the United Nations Convention on the Rights of Persons with Disabilities, was used to analyse mental health laws from Nigeria, Egypt, Ghana, Cabo Verde and Kenya. The comparative analysis showed varying alignment with international human rights standards, reflecting complex interactions between global frameworks and local realities. All the mental health laws analysed show movement towards rights-based approaches, although implementation challenges related to resource constraints, service delivery capacity and cultural integration remain significant barriers. Ghana’s formal integration of complementary and alternative medicine into its mental health framework, which requires cooperation between the Mental Health Authority and Traditional and Alternative Medicine Council, and the inclusion of people with lived experience of mental health conditions in review panels are examples of innovative approaches that show promise for regional adoption. While some form of supported decision-making is available, none of the countries offer advanced care directives. The study highlights that legislative reform alone is insufficient without addressing contextual factors like poverty, healthcare financing and integration of traditional healing practices in developing rights-based mental health care systems.
L’année 2024 est marquée à la fois par la passivité de la pratique conventionnelle du Canada et l’hyperactivité de sa pratique contentieuse. L’apurement de l’arriéré des réclamations fondées sur le régime de règlement des différends entre investisseurs et États (RDIE) de l’Accord de libre-échange nord-américain entre le gouvernement du Canada, le gouvernement des États-Unis et le gouvernement du Mexique (ALÉNA) se poursuit.1 De nombreuses sentences sont aussi rendues dans des affaires portées par des investisseurs canadiens à l’étranger, des sociétés minières pour l’essentiel. Ces affaires permettent de tester les innovations juridiques visant à renforcer le droit de légiférer de l’État dans les traités plus récents du Canada. Une première sentence très attendue sur la question hautement controversée de la portée temporelle du régime transitoire de RDIE de l’Accord entre le Canada, les États-Unis et le Mexique (ACÉUM)2 est rendue dans l’affaire TC Energy et TransCanada c États-Unis (II)3 et se solde en faveur de l’État. La controverse sur la portée temporelle de ce régime transitoire fait l’objet d’une analyse détaillée dans la chronique cette année. Un tour d’horizon des principaux autres faits marquants de 2024 est d’abord effectué en ce qui concerne la pratique conventionnelle et la pratique contentieuse du Canada.
Academic research institutions using REDCap often face challenges aligning with U.S. FDA requirements for electronic records and signatures under 21 CFR Part 11 (Part 11). A National Center for Advancing Translational Sciences(NCATS) working group developed an implementation guide for Part 11 compliance in REDCap. Within six months after release, 259 individuals representing 164 institutions accessed the guide. Individuals who downloaded the guide reported reduced vendor reliance, improved documentation, and establishment Part 11-ready REDCap instances. This working group demonstrated how collaboration between technical and regulatory experts at many peer institutions is effective in improving regulatory compliance across the research enterprise.
This study investigates the impact of patent ductus arteriosus (PDA) status and treatment response on myocardial adaptation in preterm infants by comparing serial echocardiographic trajectories across three groups: high-risk infants with treatment success, high-risk infants with treatment failure, and low-risk infants not requiring treatment.
Methods:
In this prospective cohort study, preterm infants born < 29 weeks’ gestation were stratified using the EL-Khuffash PDA Severity Score and subsequent response to medical therapy. Echocardiographic assessments were performed at three timepoints: day 2, 2 weeks, and 36 weeks corrected gestational age. A range of structural and functional parameters was analysed.
Results:
Of 184 included infants, 58 were high risk with treatment success, 52 were high risk with treatment failure, and 74 were low risk. High-risk infants with treatment failure had persistent myocardial and haemodynamic alterations, including higher left ventricular wall thickness and lower coeliac artery velocities at follow-up. Treatment success was associated with improvements in strain metrics, systemic perfusion, and structural indices. Low-risk infants demonstrated spontaneous PDA closure and overall stable haemodynamics. Distinct differences in the evolution of myocardial trajectories between groups were apparent between day 2 and week 2 echocardiograms.
Conclusions:
Serial echocardiographic assessments highlight the dynamic impact of PDA treatment response on myocardial adaptation. Persistent ductal patency despite treatment is associated with sustained structural and functional changes. Early definitive ductal closure may promote haemodynamic stability and mitigate maladaptive remodelling in a subgroup of high-risk infants.
This study sought to obtain the views of doctors associated with the Royal College of Psychiatrists on the use of outcome measures in mental health services. An online survey was developed by the College’s working group on outcome measures and widely disseminated to psychiatrists through College channels.
Results
In total, 339 completed responses were received. Respondents were mostly consultant psychiatrists; based in England; and working in the National Health Service with working-age adults. Almost half said they used outcome measures routinely, with almost half finding outcome measures clinically useful. Lack of time and inadequate information technology systems were identified as the top barriers to using outcome measures.
Clinical implications
Based on our results, psychiatrists are generally keen to use outcome measures, but are often prevented from doing so effectively by pressures on services and lack of appropriate support. The Royal College of Psychiatrists and other relevant organisations could enhance the use of outcome measures in mental health services through improved guidance, providing additional resources and integration of measures into electronic patient records.
Recent palaeobiological studies have emphasized the need for interpretations of the fossil record to consider spatial changes in environmental conditions (e.g. topography, climate). Establishing the role the environment plays in determining the distributions of extinct and existing organisms is complicated by biological evolution. Using available observations to ‘see through’ the randomness of biological evolution to determine contributions from environmental change is not trivial because of the sparsity of the fossil record, lack of precise information about rates of evolution, and because we obviously cannot physically re-run the evolutionary history that resulted in modern biodiversity or the fossil record. To address these issues, we establish scales and scenarios in which spatial environmental change is manifested in records of the number of species in a given area (richness) generated by eco-evolutionary simulation. Evolutionary processes that are likely to be random on the timescales of environmental change are included. Signals of environmental change that are likely to be hidden by the effects of ‘noisy’ evolutionary processes and those likely to emerge are identified. The ‘experiment of life’ is simulated many times, producing statistical insights. Results show that the spatial rate of environmental change is strongly correlated with species richness when the ability of organisms to disperse is high. Interaction between scale, dispersal and environmental structure is shown to determine both statistical and spatial distributions of richness. As a proof-of-concept, we compare predictions to bird species richness. The results emphasize the need to consider the randomness of evolution when interpreting the observations of extinct or present life on Earth.
It is a privilege to write a preface to this Symposium on Canada before International Courts and Tribunals, which includes many stimulating and insightful contributions. In this preface, I go back to the beginning and focus on Canada’s first cases at the International Court of Justice (ICJ) and before international arbitral tribunals.
We experimentally investigate the structure and evolution of planar, inertia-dominated intrusions from a constant source into linearly stratified ambients that are either quiescent or uniformly flowing. The source is either a negatively buoyant plume or a diffuser at the level of neutral buoyancy. The intrusions generated by plumes in a quiescent ambient form self-similar wedges, with constant thickness at the source $(2.5\pm 0.3)\sqrt {Q/N}$ and the wedge lengthening in time $t$ as $(0.32\pm 0.03)\sqrt {\textit{NQ}}\,t$, where $N$ is the buoyancy frequency, and $Q$ is the areal supply rate. In a flowing ambient, the intrusions remain self-similar with the same functional dependence on parameters. However, they become increasingly asymmetric as the ambient flow speed increases, and for speeds greater than approximately $0.3\sqrt {\textit{NQ}}$, there is no upstream propagation. Intrusions generated by diffusers are structurally different and not clearly self-similar. Immediately adjacent to the source, they thicken significantly through a turbulent, entraining hydraulic jump. Beyond this is a gently thinning region that lengthens over time. Ahead of this is a more rapidly tapering nose. Both the area of these intrusions and the front positions increase as power laws in time, with exponents between $0.6$ and $0.7$. With an ambient flow, this overall structure persists with asymmetry. We compare our experimental observations for plume-generated intrusions with predictions from the intrusive shallow-water model of Ungarish (2005, J. Fluid Mech., vol. 535, pp. 287–323). The model explains some of the observed behaviours, but does not provide an accurate description of the thickness profiles.
There are multiple intersecting crises afflicting society, from environmental devastation to the collapse of democracy, from economic exploitation to gratuitous violence, in the so-called “metacrisis.” Universities have both contributed to these crises in various ways, but have also tried to prevent them In this paper, we consider our responses to the metacrisis from our various disciplinary perspectives as four university educators from different scholarly traditions in one institution in Aotearoa New Zealand, We draw from our teaching experiences and our theoretical perspectives to engage in a reflective conversation with each other about how we may address the challenges of the metacrisis. Our conversation illustrates the potential benefits that such reflections, amongst colleagues who are intimately connected to a range of crises, may have to elucidate knowledge, power and performativity, and considers how humility, in a variety of forms, may be important to navigate the metacrisis.
Society faces an urgent need to move agriculture toward more environmentally sustainable practices to reduce greenhouse gas emissions, biodiversity loss, and water pollution. Mandatory policy tools, such as regulations, are unpopular with farmers, notoriously difficult to enforce, and politically challenging in the United States. Instead, social norms—descriptive, dynamic, and injunctive—may be critical levers for scaling up conservation practices. In this study, we analyze the predictive power of social norms on three practices, two of which benefit conservation (no-till and cover crops) and one that is likely harmful to conservation (fall nitrogen fertilizer application). Farmers (N = 585) in four U.S. states (Illinois, Indiana, Maryland, and Pennsylvania) completed a survey indicating perceived social norms and adoption of each practice. Logit models of practice adoption demonstrate that different types of social norms predict each of the three practices. We find that social norms are correlated with practices that are both helpful and harmful to conservation outcomes. Descriptive norms are associated with no-till adoption, while dynamic norms are associated with the use of cover crops. Both descriptive and injunctive norms are associated with fall nitrogen fertilizer application. In line with previous work, we also find that self-efficacy, response efficacy, farm size, and farm income are statistically significant predictors of the adoption of each practice. Future research would benefit from examining the role of different types of social norms in more contextually specific areas of farm management and at different junctures in the prevalence of management practices within a farming community, whether emerging, well-established, or declining in use.
The mental healthcare workforce supporting people with dementia and comorbid mental disorders requires specific skills and knowledge.
Aims
We co-designed and conducted a survey to understand key issues facing community mental healthcare services accessed by older adults.
Method
We invited all English National Health Service (NHS) older people’s community mental health teams (OPCMHTs) in England to complete the survey. We compared service structures, resourcing and waiting times between regions, and considered how responses might inform current policy priorities.
Results
A total of 182 out of 242 (75.2%) English NHS OPCMHTs participated. We estimated there were 120 233 referrals to OPCMHT services per year, with 77.5% of services reporting increasing referral rates. In a quarter of services (n = 46, 25.3%), clients waited over a month from referral to initial assessment. Most services (107/181, 59.1%) experienced difficulties accessing in-patient beds for people with dementia, with rural regions more likely to report these difficulties. Half of the services (n = 100, 55.2%) reported providing higher-quality care for people with dementia than 5 years ago, despite increasing caseload complexity. Resource limitations challenged opportunities for prevention, care quality and collaborative working, and respondents rated team relationships with social services (n = 86, 47.8%), general hospital in-patient (n = 74, 41.4%) and out-patient (n = 54, 30.2%) services, and primary care (n = 54, 30.2%) as poor or requiring improvement.
Conclusions
OPCMHT service leads are committed to integrated working, but services are insufficiently resourced to realise their potential. Addressing challenges related to workforce retention, training and ways of working could optimise OPCMHT contributions to integrated care for people with dementia.
Drawing from an interpretivist framework, this paper proposes Black Embodied Political Subjectivity (BEPS) as a conceptual framework that foregrounds the body, affect, and historical memory as critical to political subjectivity. BEPS draws on Black political thought to challenge dominant epistemologies that prioritize disembodied rationality and abstract ideological commitments over lived, felt, and corporeal political experiences. Rather than treating the body as an inert vessel or secondary site of politics, BEPS argues that the body is central to the ways Black people negotiate, contest, and reconstitute power in lived political contexts.
This article prefaces our Special Issue on “AI and the Decision to Go to War.” We begin by introducing the prospect of artificial intelligence (AI)-enabled systems increasingly infiltrating state-level decision making on the resort to force, clarifying that our focus is on existing technologies, and outlining the two general ways that this can conceivably occur: through automated self-defense and AI-enabled decision-support systems. We then highlight recent, on-going developments that create a backdrop of rapid change and global uncertainty against which AI-enabled systems will inform such deliberations: (i) the widespread tendency to misperceive the latest AI-enabled technologies as increasingly “human”; (ii) the changing role of “Big Tech” in the global competition over military applications of AI; (iii) a conspicuous blind spot in current discussions surrounding international regulation; and (iv) the emerging reality of an AI-nuclear weapons nexus. We suggest that each factor will affect the trajectory of AI-informed war initiation and must be addressed as scholars and policymakers determine how best to prepare for, direct, and respond to this anticipated change. Finally, turning to the pressing legal, ethical, sociotechnical, political, and geopolitical challenges that will accompany this transformation, we revisit four “complications” that have framed the broader project from which this Special Issue has emerged. Within this framework, we preview the other 13 multidisciplinary research articles that make up this collection. Together, these articles explore the risks and opportunities that will follow AI into the war-room.
This article explores the use of composition as a methodological tool in ethnomusicology. By reflecting on the creation, rehearsal, and performance of the Suíte Afro-Brasileira—an original piece blending a big band with choir, capoeira, samba, and Candomblé ensembles—the author contends that the knowledge gained through composition parallels that acquired through bi-musicality, the established ethnomusicological practice of learning to perform music for research purposes. The multiple musicalities developed by composer-researchers in cross-cultural projects such as the Suíte Afro-Brasileira result in a form of compositional poly-musicality. This application of composition, however, intensifies the ethical issues of bi-musicality, forcing composer-researchers to rethink representational issues.
Clinical work with people who are seriously unwell and overwhelmed by psychotic functioning can be profoundly rewarding yet uniquely demanding. Beyond visible symptoms lie powerful unconscious forces that affect all involved. Drawing on psychoanalytic theory from Bion, Money-Kyrle, Menzies Lyth and Lucas, this article explores how psychotic processes such as splitting, projection, denial and rationalisation are transmitted to those providing care. Recognising and working with these dynamics not only deepens clinical understanding, enabling meaning to be found in apparently chaotic presentations, but also enhances the capacity to engage therapeutically with distress. Reflective practice, supervision and organisational containment are identified as essential clinical interventions to help clinicians understand the unconscious impact of psychotic processes and to preserve their capacity for thought and compassion.