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Legal provisions in trade agreements, including those related to intellectual property (IP), can impede access to medicines. The 12-party Comprehensive and Progressive Agreement for Trans-Pacific Partnership (CPTPP) is currently undergoing a review. This provides an opportunity to update the CPTPP’s Intellectual Property Chapter to remove certain provisions that were negotiated in the context of its precursor, the Trans Pacific Partnership (TPP), many of which have been suspended. These include several ‘TRIPS-Plus’ provisions – IP provisions exceeding the requirements of the Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS). This paper reviews the CPTPP’s TRIPS-Plus provisions, including those suspended and those still in place, and argues for their removal based on evidence of their likely effects on medicines access and recent changes in the political environment. Since the CPTPP was signed in 2018, accumulated evidence has demonstrated that TRIPS-Plus provisions negatively impact access to medicines. Lack of access to COVID-19 medical products in low- and middle-income countries has highlighted major problems with TRIPS. Furthermore, the US has diverged from a TRIPS-Plus agenda, rendering the suspended provisions obsolete. Removing the CPTPP’s TRIPS-Plus provisions, while challenging, would preserve Parties’ policy flexibility to design their laws in ways that protect access to medicines.
In this paper, we study the class of polytopes which can be obtained by taking the convex hull of some subset of the points $\{e_i-e_j \ \vert \ i \neq j\} \cup \{\pm e_i\}$ in $\mathbb {R}^n$, where $e_1,\dots ,e_n$ is the standard basis of $\mathbb {R}^n$. Such a polytope can be encoded by a quiver Q with vertices $V \subseteq \{{\upsilon }_1,\dots ,{\upsilon }_n\} \cup \{\star \}$, where each edge ${\upsilon }_j\to {\upsilon }_i$ or $\star \to {\upsilon }_i$ or ${\upsilon }_i\to \star $ gives rise to the point $e_i-e_j$ or $e_i$ or $-e_i$, respectively; we denote the corresponding polytope as $\operatorname {Root}(Q)$. These polytopes have been studied extensively under names such as edge polytope and root polytope. We show that if the quiver Q is strongly-connected, then the root polytope $\operatorname {Root}(Q)$ is reflexive and terminal; we moreover give a combinatorial description of the facets of $\operatorname {Root}(Q)$. We also show that if Q is planar, then $\operatorname {Root}(Q)$ is (integrally equivalent to) the polar dual of the flow polytope of the planar dual quiver $Q^{\vee }$. Finally, we consider the case that Q comes from the Hasse diagram of a finite ranked poset P and show in this case that $\operatorname {Root}(Q)$ is polar dual to (a translation of) a marked order polytope. We then go on to study the toric variety $Y(\mathcal {F}_Q)$ associated to the face fan $\mathcal {F}_Q$ of $\operatorname {Root}(Q)$. If Q comes from a ranked poset P, we give a combinatorial description of the Picard group of $Y(\mathcal {F}_Q)$, in terms of a new canonical ranked extension of P, and we show that $Y(\mathcal {F}_Q)$ is a small partial desingularisation of the Hibi projective toric variety $Y_{\mathcal {O}(P)}$ of the order polytope$\mathcal {O}(P)$. We show that $Y(\mathcal {F}_Q)$ has a small crepant toric resolution of singularities $Y(\widehat {\mathcal {F}}_Q)$ and, as a consequence that the Hibi toric variety $Y_{\mathcal {O}(P)}$ has a small resolution of singularities for any ranked poset P. These results have applications to mirror symmetry [61].
The Kurdish movement in Turkey illustrates a complex struggle for political recognition and decolonization. The article examines this dual strategic orientation, focusing on the peace process initiated in October 2024 between the Turkish state and Kurdish representatives. Through a detailed and symptomatic reading of the two texts by Abdullah Öcalan, February Call and Perspektif, the article aims to demonstrate that the movement both interacts with the state to secure democratic prerequisites for political participation and continues to promote a radical critique of capitalist modernity and nation-state structures. Drawing upon Axel Honneth’s recognition theory and Étienne Balibar’s concept of “equaliberty,” the struggle for recognition is no longer seen just to result in a depoliticization through governmental control, but is rethought as building the capacity to stage an ongoing, performative process that manages the constitutive tension between equality and autonomy within Kurdish decolonial practice. This approach raises questions about how the movement navigates state structures while promoting alternative social institutions and epistemic spaces, including the problematic site of communes as a form of democratic autonomous experimentation.
This Element introduces the study of forensic linguistics, particularly in southern Africa, but also in Africa more generally. In the past six decades, there has been clear evidence that the discipline of forensic linguistics is, or was, unknown to general linguists, legal linguists, and applied linguists on the African continent. Now, however, the situation is rapidly changing, with forensic linguistics studies gaining momentum in various parts of Africa. In this Element the authors introduce the topic, define the discipline, address the language of record issue in southern Africa, as well as critically debate the state of court interpreting and translation of documentation into African languages, address police interviewing techniques, while also looking at possible future developments in the discipline of forensic linguistics. This title is also available as Open Access on Cambridge Core.
This Element examines clientelism and its impact on democratic institutions and markets, emphasizing that, alongside electoral competition, politics hosts two additional arenas: one where political actors seek campaign resources and active supporters, and another where socioeconomic actors pursue access to state-distributed resources. Clientelism emerges from reciprocal exchanges between these actors. Political parties use clientelism to incentivize collective action and organize campaigns. Playing this 'clientelist game', no party can reduce clientelistic practices without risking electoral defeat or internal fragmentation. Clientelism weakens the provision of public goods and skews policymaking to benefit clients over general welfare. Eventually, it generates an economic 'tragedy of the commons', as state resources are overexploited and the economy suffers, while formal institutions often fail to constrain it. Even in advanced democracies like the United States, political competition is not only electoral, targeting voters, but structurally clientelist. This title is also available as Open Access on Cambridge Core.
While international humanitarian law (IHL) offers protections for infrastructure indispensable to civilian survival, the personnel who operate, maintain and repair these systems remain largely invisible in legal frameworks and humanitarian discourse. Drawing on operational experience, this article examines the systemic threats faced by essential services personnel in contemporary urban warfare, including direct attacks, mobility constraints and the cumulative effect of protracted conflict, all of which undermine the resilience of essential services. Through exploring existing legal frameworks, recent political initiatives and practical measures already undertaken by humanitarian actors and service providers to enhance personnel safety, the article argues that safeguarding essential services personnel is not only a legal and moral imperative but also an operational necessity for preserving civilian life during conflict. While the authors acknowledge the lack of explicit special protection of essential services personnel under IHL, they advocate for a principled, good-faith interpretation and application of IHL that embraces its humanitarian spirit, arguing that the protection of “objects indispensable to the survival of the civilian population” must logically extend to the people who keep those objects and services functioning. The article concludes by proposing future avenues for strengthening protection, including improved visibility, multidisciplinary and essential service provider-centred preparedness planning, and the potential recognition of a distinctive sign for essential services personnel. Ultimately, the article calls for essential services personnel to be better recognized as indispensable to the survival of civilian populations and urges all actors to move beyond infrastructure to protect the systems – including the people – that sustain life in war.
The fast-changing nature of sustainable mobility and the exponential growth of electric vehicles (EVs) have now placed battery supply chains (SCs) at the forefront of environmental concern. This review article examines 84 peer-reviewed studies published between 2008 and 2025, highlighting that 78% of the studies were published from 2020 to 2025, reflecting the rapid acceleration of EV battery sustainability research in recent years. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses method, the review has identified significant environmental hotspots and trade-off issues across six phases of the battery SC, as well as inconsistencies regarding methodology, such as functional units of measurement, and missing data in relation to the Global South. Hotspots are most prominent in South America and Central Africa (extraction), China and South Korea (manufacturing) and Southeast Asia (end-of-life). New contributions include a comparison of the life cycle assessment approaches, using new data from 2023 to 2025, adding updated insights on policy evolution, improved recycling efficiencies and digital traceability technologies that enhance supply-chain transparency. Furthermore, this review highlights ignored areas, such as informal recycling of batteries and unfair regulations across borders, and it provides recommendations, which are relevant to policymakers, industry and academia, to improve transparency in the SC, better compliance with environmental, social and governance requirements and sustainability initiatives.
Collective memories of intergroup history persist as dynamic structures that shape how societies perceive foreign others. This article proposes a framework for understanding stereotypes rooted in collective memory as both premises for journalistic coverage – guiding story selection – and tools within it, offering adaptable templates for framing. Analysing Israeli media’s coverage of Poland across two decades of conflict, conciliation, and routine reporting, I show how journalists reproduce and renegotiate stereotyped perceptions, clarifying their dual role as memory agents: sustaining stereotype-laden perceptions anchored in collective memory, while recalibrating these perceptions in light of shifting political and narrative contexts. The study foregrounds journalism’s dual role in carrying forward and adapting the collective memory structures through which foreign nations are perceived.
To evaluate ultraviolet-C (UV-C) disinfection, we interviewed 34 personnel at 22 Veterans Affairs (VA) hospitals. Barriers included safety concerns, patient volumes, staffing, and costs. Facilitators included education and interprofessional communication. An implementation toolkit, interprofessional collaboration, and leadership support could optimize UV-C integration into VA infection prevention.
Ecological momentary assessment (EMA) is increasingly recognized as a vital tool for tracking the fluctuating nature of mental states and symptoms in psychiatric research. However, determining the optimal sampling rate – that is, deciding how often participants should be queried to report their symptoms – remains a significant challenge. To address this issue, our study utilizes the Nyquist–Shannon theorem from signal processing, which establishes that any sampling rate more than twice the highest frequency component of a signal is adequate.
Methods
We applied the Nyquist–Shannon theorem to analyze two EMA datasets on depressive symptoms, encompassing a combined total of 35,452 data points collected over periods ranging from 30 to 90 days per individual.
Results
Our analysis of both datasets suggests that the most effective sampling strategy involves measurements at least every other week. We find that measurements at higher frequencies provide valuable and consistent information across both datasets, with significant peaks at weekly and daily intervals.
Conclusions
Ideal frequency for measurements remains largely consistent, regardless of the specific symptoms used to estimate depression severity. For conditions in which abrupt or transient symptom dynamics are expected, such as during treatment, more frequent data collection is recommended. However, for regular monitoring, weekly assessments of depressive symptoms may be sufficient. We discuss the implications of our findings for EMA study optimization, address our study’s limitations, and outline directions for future research.
As populations age rapidly, understanding the psychological benefits of sustained employment has become increasingly important. In South Korea, where the suicide rate among older adults is one of the highest among Organisation for Economic Co-operation and Development (OECD) countries, identifying modifiable social determinants, such as employment, may inform effective prevention strategies.
Methods
This retrospective cohort study used data from the Korean Welfare Panel Study (2009–2024), a nationally representative longitudinal survey. Individuals with depressive symptoms or suicidal ideation at baseline were excluded. The main exposure was participation in a government-led senior employment program. We employed discrete-time survival analysis using a generalized linear model with a complementary log–log link function, which appropriately handled the interval-censored structure of the panel data.
Results
Older adults who participated in the employment program had a significantly lower risk of developing depressive symptoms (adjusted hazard ratio [HR] = 0.76, 95% confidence interval [CI]: 0.67–0.86) and suicidal ideation (adjusted HR = 0.60, 95% CI: 0.45–0.81) compared to those who did not participate. Subgroup analyses revealed that the strength of the association was particularly strong among individuals aged ≥80 years, those with chronic illness, poor self-rated health, and those who were previously or never married.
Conclusion
Structured government-supported employment may mitigate the risk of depressive symptoms and suicidal ideation in later life. These findings support the potential of senior employment programs as effective mental health promotion and suicide prevention strategies for aging populations.
People with severe mental Illness (SMI) bear an excessive burden of periodontal disease, which can exacerbate their mental and physical multimorbidity. Therefore, improving and sustaining good oral hygiene is key.
Aims
To co-create a theory-driven oral hygiene intervention for people with SMI.
Method
A two-stage, eight-step method was followed drawing on the Behaviour Change Wheel. Stage 1, understanding the problem, involved evidence review and stakeholder consultations. Stage 2 focused on identifying theoretical barriers and facilitators through semi-structured interviews (n = 20) and co-designing the intervention content alongside people with SMI, carers, primary care, mental health and dental professionals and clinical leads. Interview data were analysed using framework analysis. Identified barriers and facilitators were mapped to the Capability, Opportunity, Motivation–Behaviour model and Theoretical Domain Framework. Intervention functions, policy categories and behaviour change techniques were identified and mapped accordingly.
Results
The target behaviour of twice-daily toothbrushing was addressed through understanding the consequences of improving oral health and brushing, forming a brushing habit, brushing instructions and demonstration with consideration of cognitive capacity and exploring the need for financial and social support. Recommendations for intervention delivery included integrating it into the SMI physical health checks, training and remunerating primary care and mental health professionals to deliver it as part of a personalised and integrated care approach to rebuilding broader lifestyle routines; and maintaining engagement through follow-up appointments.
Conclusions
This is the first study to co-create a theory-driven toothbrushing intervention for people with SMI, delivered by primary care and mental health professionals.
The Dwarka Basin in the Kathiawar Peninsula, western margin of the Indian subcontinent, offers crucial insights into marine sedimentation processes and faunal evolution during the Miocene epoch. This research employs a combination of biostratigraphy, microfacies analysis and geochemical data to examine the Gaj Formation, a major stratigraphic unit of the Dwarka Basin, with the aim of reconstructing the paleoclimatic and depositional conditions. Foraminiferal biostratigraphy suggests that the Gaj Formation ranges from the Aquitanian to the Langhian stage, with the intermediate Burdigalian stage comprising most of the succession. Microfacies analysis reveals that the formation was primarily deposited in shelf environments, influenced by regional tectonic and climatic factors. The fossil assemblages and morphological adaptations observed in foraminiferal shells provide clear evidence of the Middle Miocene Climatic Optimum (MMCO). Climate-driven global warming during this climatic phase caused morphological evolution (e.g., dwarfism) and decreased faunal diversity in response to environmental stress. This study also aims to reconcile discrepancies in stratigraphic classification in the basin through lithostratigraphic data and high-resolution faunal analyses. Results highlight the dynamic nature of marine depositional environments as impacted by global sea-level changes, regional tectonics and climatic fluctuations. The study foregrounds the importance of multi-proxy analyses in reconstructing complex depositional histories and Miocene climatic transitions and their effects on regional marine ecosystems.
This article presents the results of excavations in Early Bronze Age levels at the site of Hamoukar in northeastern Syria. During the 2008 and 2010 field seasons, excavations in the lower town at Hamoukar uncovered evidence for three distinct architectural phases dating to the second half of the third millennium B.C. Prior to these excavations, attention had been focused on the final phase of Early Bronze Age occupation in the lower town, when the settlement was violently destroyed and then abandoned. It is now possible, however, to provide a backstory for the settlement’s violent end and also a more complicated––if still preliminary––account of exactly how the urbanisation process played out at the site. This article presents a summary of the Early Bronze Age stratigraphic sequence in the lower town at Hamoukar and, at the same time, a description of new evidence for the evolution of social, economic, and ritual practice across three phases of urban development. A brief comparison with urban trajectories at two other contemporary sites highlights the heterogeneity of cities and urban dynamics in Early Bronze Age northern Mesopotamia.
The use of multiplex polymerase chain reaction (PCR) panels for diagnosis of clinical syndromes is rapidly growing despite limited data on optimal use cases. We retrospectively reviewed the clinical impact and consequences of the inclusion of herpesvirus targets on the meningitis/encephalitis PCR panel.
This research note explores an iconic female fraudster, who achieved celebrity criminal status with a substantial fanbase, by analyzing her status as an empowering female figure and the sociocultural context in contemporary Japan. In due course, we attempt to fill the notable research gap regarding the phenomenon of a female fraudster becoming a “celebrity criminal” from a post-feminist perspective. By analyzing online and interview materials, this article demonstrates that the highlighted otherness in Young’s “transgressive other” (Young 2007, 2011) is hardly applicable. We shed light on instrumentalized femininity shared among young women challenging the pre-existing normative femininity in contemporary Japan.
This review explored whether and how prescribers modify their prescribing behaviour for older people (≥65) with hearing, visual or dual impairment (hereafter referred to as sensory impairment) in primary care settings and identified what evidence sources exist to inform prescribing for these specific patient populations.
Background:
Older people with sensory impairment may experience substantial challenges with medicines management compared with older people without sensory impairment. The prevalence of sensory impairment and medicine use increases with age, as such, practitioners may need to consider how to modify their prescribing behaviour to improve the safe and effective use of medicines.
Methods:
This study was conducted to reflect the Joanna Briggs Institute [JBI] methodology for scoping reviews. Electronic databases were searched: MEDLINE (Ovid), EMBASE (Ovid), Cochrane Library, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Google, and Google Scholar. Qualitative and quantitative studies were included if published between January 2012 and April 2023. Grey literature sources, including Google and Google Scholar, were also searched. Studies were eligible for inclusion if they focussed on prescribing behaviour for older people with sensory impairment in primary care settings. Independent duplicate data extraction was undertaken of details about the participants, concept, context, study methods, outcomes, and key findings relevant to the review question.
Findings:
A total of 3,590 records were identified through database searching and 10 full text articles were retrieved. Grey literature identified a further 61 records. On examination, none of the articles fulfilled the inclusion criteria for this review.
Conclusions:
This review has highlighted a gap in the evidence regarding prescribing for these high risk patient populations. There may be a need for the development of resources, such as evidence based guidelines, to support the safe and effective use of medicines for these specific patient populations.