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Mental health difficulties affect the well-being of doctors and compromise the delivery of healthcare. However, large-scale data on doctors’ mental health needs are limited.
Aims
Describe patterns of self-referrals for mental health support among doctors in England and explore associations with demographic factors, speciality, neurodevelopmental and mental health indicators.
Method
Observational study using data from doctors who self-referred for mental health difficulties to a national service in England over a 4-year period. Logistic regression was used to explore associations between speciality and mental health indicators.
Results
Of the 16 815 doctors who self-referred during the study period, 80% were under the age of 49 and 70.6% were female with the two largest ethnicities being 65.1% White and 22.7% Asian. Women were more likely to report higher scores for depression (odds ratio 0.90, 95% CI = 0.84 to 0.97), anxiety (odds ratio 0.78, 95% CI = 0.72 to 0.84) and psychological distress (odds ratio 0.78, 95% CI = 0.70 to 0.87), but males were more likely to screen positive for attention-deficit hyperactivity disorder (ADHD) symptoms. Doctors in general practice accounted for 46.3% of referrals. Compared with them, doctors in most other specialities had higher odds of elevated mental health scores across all measures, including ADHD.
Conclusions
The findings highlight a significant mental health burden among self-referring doctors, particularly for females and doctors in non-general practice specialities. Tailored and easily accessible support strategies that account for both demographic and professional contexts are essential to address the diverse mental health needs of the medical workforce.
This article explores how internally displaced persons (IDPs) in Benue State, Nigeria, reconfigure everyday life under conditions of governance deficits, insecurity and institutional neglect. Drawing on ethnographic research in Naka, Daudu II and Abagana camps, I examine how displaced populations mobilize social networks, religious ties, informal economies and everyday improvisations as infrastructural responses to life in displacement. Grounded in the theoretical frameworks of people as infrastructure and camps as urban political space, I situate IDP camps not as peripheral sites of humanitarian crisis but as laboratories of African urbanism. By foregrounding the ordinary – cooking, parenting, trading, negotiating aid – the article shows how IDPs enact governance from below, transforming camps into dynamic sites of infrastructural negotiation, resilience and survival. The study contributes to scholarship on urban governance and displacement by reframing camps as enduring socio-political spaces where infrastructure, power and agency are constantly reassembled.
This article analyzes how A. Dean Byrd, an assistant commissioner of LDS Social Services, advanced reparative therapy for Latter-day Saint (LDS) men at the turn of the twenty-first century. Byrd argued that Mormon men’s “unwanted same-sex attractions” stemmed from deficient gender identities that could be “repaired” by cultivating traditional masculinity. Rather than originating these ideas, he synthesized gender-essentialist themes from LDS pastoral discourse into a systematic therapeutic program grounded in the doctrine of eternal gender. Reading Byrd’s writings along the grain, this article shows how his model masculinized Mormon patriarchs while rendering women less visible as therapeutic subjects, framing conversion therapy in LDS contexts as a gendered project aimed at restoring male ecclesiastical authority. Byrd’s collaborations with Catholic and evangelical therapists through organizations such as the National Association for Research and Therapy of Homosexuality further reveal reparative therapy as a shared gender ideology that united conservative Mormons with a broader family values coalition amid a moral panic over homosexuality. Yet Byrd’s distinctly Mormon cosmology exposed the limits of conservative Christian ecumenism. Situating Byrd at the intersection of LDS soteriology, gender, and the religious right, this article illuminates how one Mormon therapist participated in and unsettled the networks shaping late twentieth-century responses to queer belonging.
This paper provides a close reading of Phylarchus Fragment 44 (Ath. 4.20–1, 141F–42f) against the backdrop of the Hellenistic discourse of kingship, on the one hand, and the developments in the Spartan kings’ approach to monarchical rule, on the other. It argues that the characterisation of Cleomenes in Fragment 44 is rooted in a discourse on kingship that was contemporaneous with Phylarchus, and that his text’s prevailing theme is the king’s σωφροσύνη as opposed to ὕβρις.
As the use of carbon dioxide (CO2)-enhanced oil recovery continues, understanding its impacts on the in situ oil well microbial communities is important. In this study, we update the already substantial investigation into five oil wells of the Olla and Nebo Hemphill fields in the southeastern United States with metagenomics. The Olla field has undergone CO2 injection, whereas the Nebo Hemphill field has not. Under anoxic conditions in Nebo Hemphill, our data suggest that methanogenic archaea are in competition with fermentative bacteria for shared substrates, leading to reduced biogenic methane production. However, in the Olla wells that had introduced CO2, we find genomic evidence for the growth and replication of bacteria able to respire oxygen. Based on the co-occurrence and potential replication of methanogens in these wells, we hypothesise that there are still anoxic niches for methanogens. Oxygen-utilising microbes may utilise phenolic substrates, creating a situation where more material is available for anaerobic growth, counterintuitively increasing the capacity for methane production in these wells. Our data suggest that this consortium may be the reason that greater methanogenesis is seen in these CO2-affected wells, and we hypothesise that the gas injection may have had contaminating air. Therefore, using existing wells for processes such as enhanced oil recovery or carbon capture and storage will not only depend on well history and in situ conditions, but also on the development of in situ microbial networks within modified wells.
The population status of Adélie penguins (Pygoscelis adeliae) on the Antarctic Peninsula highlights opportunities for the Commission for the Conservation of Antarctic Marine Living Resources (CCAMLR) to address uncertainty more directly and effectively in its conservation efforts. The heightened uncertainty posed by climate change is testing CCAMLR’s commitment to balancing science and international cooperation in decision-making. Uncertainty underpins some of the justification to postpone reaching a consensus on the establishment of Marine Protected Areas, leaving Adélie penguins vulnerable to change. Two key opportunities to adapt current management approaches emerge: 1) reduce uncertainty by systematically identifying knowledge gaps within CCAMLR’s processes; and 2) integrate uncertainty more explicitly into decisions through a standardized approach to assessing and communicating it.
McEuen Cave (AZ W:13:6 (ASM)) is a large bedrock rockshelter located within an andesitic rocky ash flow tuff/ignimbrite within the Bureau of Land Management’s Fishhooks Wilderness Area near Fort Thomas, Arizona. Exceptional preservation at the site has produced an extensive assemblage of perishable artifacts, including a tremendous quantity of cultigen remains radiocarbon dated between 3600 BP and 1250 BP. In this paper, we provide the results of a new radiocarbon dating effort aimed at identifying additional early Silverbell Interval cultigens and clarifying the intensity and persistence of Early Agricultural Period occupation. Our goal is to better understand the age and extent of early cultivation activities within this high-elevation wilderness and contextualize the remains from this site with the more thoroughly understood co-eval Early Agricultural Period villages evidenced along major riverways such as the San Pedro and Santa Cruz in southern Arizona. [Spanish language abstract: La cueva McEuen (AZ W:13:6 (ASM)) es un gran refugio rocoso de lecho rocoso ubicado dentro de una toba/ignimbrita de flujo de cenizas rocosas andesíticas dentro del área silvestre Fishhooks de la Oficina de Administración de Tierras cerca de Fort Thomas, Arizona. La preservación excepcional en el sitio ha producido un extenso conjunto de artefactos perecederos, incluyendo una tremenda cantidad de restos de cultígenos fechados por radiocarbono entre 3600 BP y 1250 BP. En este documento, proporcionamos los resultados de un nuevo esfuerzo de datación por radiocarbono destinado a identificar cultígenos adicionales del Arcaico tardío-medio y aclarar la intensidad y persistencia de la ocupación del Período Agrícola Temprano. Nuestro objetivo es comprender mejor la edad y el alcance de las actividades de cultivo tempranas dentro de este desierto de gran altitud y contextualizar los restos de este sitio con las aldeas coeval del Período Agrícola Temprano mejor entendidas evidenciadas a lo largo de las principales vías fluviales como el San Pedro y el Santa Cruz en el sur de Arizona.]
Cross-country regressions suggest that protectionism supported industrialization. I leverage novel and highly granular data covering Swedish manufacturing firms to estimate the impact of Sweden’s shift toward protectionism after 1891 on establishment-level development. Using mainly two-way fixed effects regressions, I show that tariff increases had a heterogeneous impact across establishments: initially low-productivity establishments increased their productivity, while initially high-productivity establishments experienced a relative decline. I suggest that tariffs differentially shaped the incentives of managers in low- and high-productivity establishments to innovate and (re)organize production. Consistent with modern trade theory, heterogeneous establishment-level dynamics underlie a potential tariff-growth paradox.
This paper investigates the emergence, development and creative potential of three-dimensional musical scores, examining their transformation from physical layered media to contemporary mixed reality implementations. Through analysis of key historical works and recent technological innovations, it explores how depth and spatial materiality in musical notation create new possibilities for compositional organisation, performance practice and aesthetic expression. The study examines pioneering works utilising transparent overlays and physical depth by composers such as Cage and Takemitsu, before analysing contemporary applications in augmented and virtual reality environments that enable dynamic, interactive score generation and networked performance possibilities. Drawing on phenomenological perspectives and spatial theory, the research demonstrates how three-dimensional scores challenge traditional temporal-spatial relationships in musical notation while suggesting new frameworks for understanding musical structure and interpretation. Technical affordances and limitations of current mixed reality platforms are evaluated, alongside consideration of their implications for future developments in notation and composition. The paper argues that while three-dimensional scores offer compelling new creative possibilities, their successful implementation requires both technological expertise and collaborative approaches that may reshape traditional models of compositional practice.
This article explores African identity through the lens of incompleteness and motion. By challenging the traditional nation state-centric view of belonging, it offers a nuanced framework for analysing diasporic cultural production. This framework acknowledges the complex realities of individuals with multilayered identities shaped by interconnected geographies and hierarchies at both local and global levels. The discussion expands the concept of diaspora beyond the confines of nation states, recognizing the multiplicity of ‘homes’ and ‘dislocations’ in the contemporary world. It highlights how ongoing conflicts and liberation struggles blur the lines between home and diaspora, demonstrating the fluidity of belonging in an ever shifting global landscape. Ultimately, it encourages a critical reassessment of diasporic experiences and emphasizes the interconnectedness of ‘frontier homes’ and ‘frontier diasporas’ within and beyond the nation state.
Anorexia nervosa is characterised by the fear of gaining weight and a disrupted relationship with food but atypical if the body mass index is within normal limits. Semaglutide is a glucagon-like peptide-1 receptor agonist, indicated in patients with diabetes type 2 and obesity. An adolescent girl was diagnosed with atypical anorexia nervosa. She had a fear of gaining weight, she increased her exercise and decreased her caloric intake. The adolescent was admitted to the paediatric ward with bradycardia and pericardial effusion. During her hospital stay she admitted to having used semaglutide. Semaglutide was prescribed by her general practitioner because she was previously on the verge of being overweight with weight-related dysphoria. After 3 months she stopped using semaglutide, she kept losing weight. The adolescent girl went back to her normal life but after a panic attack caused by gaining 1 kg, she was admitted to an eating disorder ward. Semaglutide can affect mental health in patients who are prone to mental disorders. The importance of restrictively prescribing semaglutide for the right indication with caution and strict follow up is emphasised.
Building upon recent research on the motif of Sappho’s leap from the Rock of Leucas in ancient iconography and texts, this article explores its background in greater depth, raising new issues and proposing new solutions. The first section locates the iconographic project of the so-called Porta Maggiore ‘Basilica’ in its historical context, through the comparison with another coeval and contiguous building in Rome. The second section focuses on the issue of the relationship between the story of Sappho’s unhappy love for Phaon and the corpus of Sapphic poems, arguing that the theme is unlikely to have been represented in the standard edition of the poetess and offering an explanation for the origin of the tradition of alternative Sapphos. The third section identifies the third text of the famous Sappho’s Cologne papyrus as a post-classical poem in the voice of Sappho, where the poetess takes leave from Phaon and faces a journey toward the Underworld while holding in her hand Orpheus’ lyre. Finally, I argue that this poem provides an important missing link that can help understanding the background of the representation of the poetess in the Porta Maggiore ‘Basilica’.
The American Law Institute (ALI) recently approved its first ever Restatement of Medical Malpractice law. One Restatement subsection embraces the position that an authoritative clinical practice guideline, if admissible and sufficiently relevant, can be prima facie evidence of a provider’s compliance with the standard of care. This article responds to a forceful critique of that position by two of the Restatement’s advisors, who are nationally esteemed members of the plaintiff’s bar. They argue that caselaw does not support this provision, that it is unsound public policy, and that the provision is unfair because it does not afford the same prima facie proof status to plaintiffs’ use of practice guidelines.
This article addresses each of those critiques. It starts with the observation that, at bottom, this opposition is fundamentally at odds with the primary governing principle of professional liability, namely, that professional standards have greater force in medical liability cases than do industry standards in general negligence cases. Because professional standards determine professional negligence, a relevant clinical practice guideline that speaks with authority for a relevant segment of medical professionals, if admissible, should be sufficient to support a jury finding of non-negligence for a doctor who complies.
The same conclusion does not apply, however, when a plaintiff presents a single relevant guideline that a physician failed to follow, for the simple reason that it is often the case that more than one approach can reasonably apply to a given clinical situation. Also, guidelines often set ideal rather than minimal standards. Thus, this provision’s differential effect is not fundamentally unfair. Instead, it flows directly from a plaintiff’s burden of establishing professional negligence, much like numerous other conventional legal rules can affect opposing sides of a case differently.
As accomplished advocates, it is no surprise these authors have made the strongest possible case against any enhanced legal status for defensive use of exculpatory practice guidelines. Thoughtful inspection and reflection reveal, though, that their analysis significantly misstates or over-states the Restatement’s position, and so their attacks are mostly misdirected. If this Restatement’s position were truly as radical or poorly considered as these authors portray, the ALI likely would not have adopted it. Nevertheless, engaging with this critique can better elucidate reasons that courts might view this Restatement provision as well-considered.
The present study compares the use of morphological case for argument interpretation between German L1 speakers in Norway and Germany to investigate whether and how processing may be affected by attrition. Participants were presented with a spoken sentence and pictures of two scenes, one showing an event as described by a transitive or ditransitive sentence and another showing the same event, with the roles of agent and patient (transitives) or recipient and theme (ditransitives) reversed. Their task was to select the scene that matched the sentence. End-of-sentence responses show no between-group differences in comprehension. Moreover, eye movements show that both groups exploit case marking on the first noun phrase in transitive sentences in the same way. However, differences in processing between groups emerge for the use of case marking on the first object following a ditransitive verb. While the home country group shows a higher likelihood of looks to the target after a dative-marked article than after an accusative-marked article prior to the second object, the reverse holds for the expat group, at least temporarily. Altogether, the results indicate subtle changes in the processing of alternating argument orders in ditransitive sentences in L1 German, potentially as a result of the bi-/multilingual experience.
Following the 2020 Karabakh War, the emerging geopolitical realities compelled Iran to recalibrate its South Caucasus policy, prompting a shift away from its longstanding posture of neutrality. Despite the potential for Tehran to engage in cooperation through proposed regionalist projects by other actors, a significant shift towards regionalism in Iran’s approach to the South Caucasus remains elusive. This article delves into two primary sets of factors to understand the reasons behind this absence of regionalism in Iran’s foreign policy towards the South Caucasus. The first set encompasses general approaches in Iran’s foreign policy and the impact of domestic political dynamics on their development. It discusses Iran’s perceived impossibility of aligning with the South Caucasus states, the absence of a robust neighborhood policy, and Iran’s strategic isolation in the region, attributed to its unique political system and the ideological stance of its ruling elite. The second set examines external dynamics, including constant international pressure on the Islamic Republic, Iran’s deep-seated ideological and security attachment to the Arab Middle East, and the fluctuating nature of Tehran’s relations with the West. Collectively, these factors significantly limit Iran’s capacity to craft a coherent strategy for regional integration in the South Caucasus.
The foundation of the Kantian theory of right is the one innate right to freedom. Here, I offer a comprehensive philosophical comparison between Kantian rightful freedom and the conception of freedom as negative liberty or non-interference, a hugely influential view in terms of which Kantian rightful freedom is often understood. This fruitful comparison clarifies the fundamental differences between the two views, emphasizing the resources the Kantian approach offers for contributing to contemporary debates on freedom as a distinctive rights-based republican view. This Kantian perspective also offers a useful lens for critiquing negative-liberty-based views, revealing a dilemma they face.
This research examines migration in Linares during the third quarter of the nineteenth century, focusing on migration chains. The city experienced a significant increase in population due to the mining boom, which led to an almost sixfold increase in the population over a period of 30 years. Using data from the 1873 population register, which includes more than 22,500 individuals, this study confirms the effectiveness of the migration chain framework in analyzing internal migration during the preindustrial and early industrialization periods. This approach has revealed the significant influence of this form of social capital in determining migratory flows to Linares, highlighting the importance of places of origin in the spatial distribution of the city and in the occupational specialization of the migrant population. The findings suggest that migratory chains played a key role in providing information about opportunities at the destination, as well as in reducing the costs associated with the search for employment and housing.