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Promoting mental health, preventing mental disorders and providing effective treatments are public health priorities. Randomized controlled trials (RCTs) frequently evaluate mental health and psychosocial support interventions to achieve one or more of these objectives. Distinguishing between RCTs focused on mental health promotion, prevention or treatment remains conceptually and methodologically challenging. No standardized tool exists to position RCTs along a promotion-to-treatment continuum in mental health. We aimed to develop and validate the VErona-LUgano Tool (VELUT) for distinguishing RCTs along the promotion-to-treatment continuum.
Methods
An interdisciplinary tool development group (TDG) was established. The Population, Intervention, Comparison and Outcome framework was used to define key constructs. Items in the tool were devised, categorized and reduced through qualitative and quantitative methods. Finally, we performed a preliminary validation of the VELUT applying item response theory (IRT) using data from 180 RCTs.
Results
The TDG generated 33 items for the initial version of the VELUT, reduced to 16 through review, cognitive interviews and psychometric analysis. Analyses of 180 RCTs using the 16-item tool showed high internal consistency (α = 0.94) and unidimensionality. Following item reduction and IRT, a final 8-item version was retained, and IRT models confirmed strong item discrimination for the 8 items and high scale reliability (marginal reliability >0.90 across most of the range of the scale), good response distribution, item performance and alignment with the Institute of Medicine (IOM) promotion-to-treatment continuum.
Conclusions
The VELUT addresses methodological gaps in global mental health research by helping to position RCTs of MHPSS interventions along the IOM promotion-to-treatment continuum.
The purpose of this study is to reveal the impact of pilot free trade zones (PFTZs) on local governance quality (LGQ) to provide a reference for driving governance reforms in China. Based on provincial panel data from 2004 to 2020 in China, the impact of the establishment of PFTZs on LGQ is analyzed by employing the multi-period difference-in-difference (DID) method. The results show that the establishment of PFTZs can significantly enhance the governance quality of local governments, but there is heterogeneity in location and establishment batches. PFTZs improve LGQ through the effects of institutional spillover, factor allocation, and talent agglomeration. FDI spillover can partially substitute for promoting the effect of PFTZs on LGQ, and economic growth pressures can distort the positive effect of PFTZs on LGQ. Therefore, policymakers should clarify the functional positioning of PFTZs and leverage their effects, which are institutional spillover, factor allocation, and high-end factor agglomeration, to enhance LGQ.
The Food Access Research Atlas (FARA) is a common measure of food access developed by the US Department of Agriculture. However, its sole focus on supermarkets lacks specificity for culturally appropriate food. This ecological study assesses the relationship of FARA and our novel Yelp-based Ethnic Store Measure with diabetes rates among Asian Americans and Native Hawaiians or Pacific Islanders (AAPI).
Design:
This study leveraged crowd-sourced Yelp data to develop six culturally appropriate food access variables and compare them with FARA at the census tract (CT) level. Estimates of CT AAPI diabetes rates were calculated from hospital and emergency department discharge data. Spatial trends were examined visually and with Moran’s I. Ordinary least squares (OLS) and spatial lag regression (SLR) models assessed covariate-adjusted z-score standardised associations between food access measures and AAPI diabetes rates.
Setting:
San Diego, California, USA
Subjects:
All 626 CT in San Diego, CA
Results:
Most food access variables showed strong spatial autocorrelation. The FARA measure – percent of AAPI population beyond 0·5 miles of a supermarket – was positively associated with AAPI diabetes in OLS (1·88; 95 % CI 0·76, 3·0; P = 0·001) but not SLR. Our Yelp-based variable – number of AAPI restaurants per AAPI population – was negatively associated with AAPI diabetes in both OLS (–1·15; 95 % CI –2·17, –0·13; P = 0·03) and SLR (–1·32; P = 0·004). No other variables were significantly associated with diabetes.
Conclusion:
Area-level, culturally sensitive measures of food access offer valuable insights into the role of culturally appropriate food access on cardiometabolic health among racial and ethnic minorities.
Diflufenican is a selective phenyl ether, Group 12 herbicide. Limited information exists on the weed control efficacy of diflufenican and the potential improvement in weed control when it is co-applied with isoxaflutole. Three field studies were conducted in Ontario to evaluate preemergence applications of isoxaflutole and diflufenican alone and in combinations for weed control in corn. Isoxaflutole applied at 52.5, 79, and 105 g ai ha−1 provided effective control of velvetleaf (83% to 89%, 91% to 98%, and 92% to 97%), green pigweed (73% to 85%, 85% to 91%, and 94% to 97%), common ragweed (81% to 86%, 93% to 97%, and 95% to 97%), and common lambsquarters (88% to 89%, 96% to 99%, and 98% to 100%), respectively when evaluated at 2, 4, and 8 wk after treatment (WAT). Diflufenican applied alone at 75 to 150 g ai ha−1 provided ≤3% control of velvetleaf, ≤38% of green pigweed, ≤7% of common ragweed, and ≤20% of common lambsquarters. Isoxaflutole applied alone provided 16% to 75% control of barnyardgrass, while diflufenican was ineffective (<3%). The co-application of isoxaflutole + diflufenican improved control to 34% to 86%, with synergistic effects of barnyardgrass control observed at several rates. Isoxaflutole and diflufenican, applied alone controlled green foxtail by 15% to 72% and 0% to 12%, respectively. The co-application of isoxaflutole + diflufenican improved green foxtail control to 25% to 89% with synergistic responses at some rates and evaluation timings. There was minimal corn injury with these treatments. Weed interference reduced corn yield by up to 69%. Weed interference with diflufenican applied alone resulted in corn yields of 4570 to 4750 kg ha−1, which is similar to yields from the nontreated control (3.33 T ha−1). Reduced weed interference with isoxaflutole alone and in mixtures with diflufenican resulted in corn yields of 8.36 to 10.83 T ha−1, which is higher than yields from both the nontreated control plots and those that received diflufenican treatments. Overall, isoxaflutole provided consistent broadleaf weed control, while synergistic interactions with diflufenican enhanced barnyardgrass and green foxtail suppression.
This study aimed to explore the many roles of palliative care (PC) nurses in addressing the needs of patients with life-limiting illnesses in the acute inpatient setting in New Zealand.
Methods
A scoping review was undertaken, informed by the Joanna Briggs Institute guidelines and utilizing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework. In December 2024, a comprehensive search using Pubmed, Scopus, and CINAHL was conducted for peer-reviewed articles published in English between the years 2014 and 2024, with full text available, that focused on PC nursing in the acute setting in New Zealand, Australia, Canada, Ireland, or the United Kingdom. These countries were chosen because their health care systems are similar. Citation searches were undertaken. Grey literature from New Zealand hospitals was also searched.
Results
After selection, 25 pieces of literature were eligible for the review. Nine key areas were found where PC nurses and teams play key roles in the ongoing management of patients and their coordination of care within the last months to last days of life in the acute inpatient setting. The areas were care-coordination, communication facilitation, decision-making, goals and expectations, discharge planning, physical symptom management, holistic symptom management, finances, environment, education, and rapid review. The findings suggest that PC nurses in the acute setting are no longer involved in single episodes of symptom management and ward-based end-of-life nursing, but are responsible for multiple facets of care, facilitated across several different services.
Significance of results
Understanding the complex roles involved in PC nursing can impact the health care outcomes of patients with a life-limiting illness. The scoping review can help inform future staffing requirements and the skill mix and knowledge levels required to provide timely and appropriate PC in the acute environment in New Zealand hospitals.
Despite overlapping diagnostic criteria and aetiology, the frequency of complex post-traumatic stress disorder (C-PTSD) in people being treated for borderline personality disorder (BPD) is unknown.
Aims
To establish the frequency and correlates of probable C-PTSD in people meeting the diagnostic criteria and being treated for BPD.
Method
C-PTSD was assessed in 87 patients meeting the diagnostic criteria for BPD and initiating treatment in out-patient personality disorder services in the UK, using the Structured Clinical Interview for DSM-IV Axis II Personality Disorders diagnostic interview, items from the Structured Interview for Disorders of Extreme Stress – Self Report and other measures. The cross-sectional association between C-PTSD and demographics, trauma and clinical variables was evaluated with logistic, ordinal and linear regression.
Results
A total of 93% of participants reported a trauma history (95% CI 88–98%), and 57% met the criteria for probable C-PTSD (95% CI 47–67%). Previous sexual trauma increased the odds of probable C-PTSD (odds ratio 6.22, 95% CI 2.21–17.54, P < 0.001). Probable C-PTSD was associated with an increased odds of self-harm in the past 12 months (odds ratio 9.41, 95% CI 1.87–47.27, P = 0.01) and higher levels of abandonment fears (odds ratio 2.78, 95% CI 1.17–6.55, P = 0.02), abandonment–avoidant behaviour (odds ratio 4.25, 95% CI 1.30–13.91, P = 0.02) and identity instability (odds ratio 4.39, 95% CI 1.79–10.78, P < 0.01).
Conclusions
C-PTSD symptoms are likely to be common in people diagnosed with BPD, and are associated with higher overall psychiatric severity, with potential implications for formulation and treatment.
As technology continues to shape how we engage with the world, museums are increasingly encouraged to adapt in order to appeal to younger audiences. Promoting exhibits through platforms such as Instagram and TikTok can be an effective way to attract visitors, but that doesn’t mean museum spaces themselves need to become more digitally driven. For a generation already saturated with screens, adding more technology to exhibitions may actually detract from the experience. In this essay, I explore the effects that excessive screen use has on us and argue that museums can offer something more meaningful by providing a break from the digital overload. To support my argument, I conducted a straw poll survey to better understand how other young people feel about technology in museum settings.
Podcasting, with its focus on voices, remains a compelling topic for African studies research, which has historically put orality at the center of the field. Recognizing sparse audience inclusion in existing research on African podcasting, the authors conducted focus groups with listeners in urban Ghana to document consumption practices and attitudes toward this form of new orality. Using the concept “deep listening” drawn from participant comments, the researchers theorize that listeners and producers experience a form of sound-mediated, affective resonance from podcasts that utilize audience collaboration and local sonic aesthetics, linking the affordances of openness and freedom to the medium.
During World War II, a prolific Kiowa composer named Lewis Toyebo initiated a new choreo-musical genre called War Mother songs for the Kiowa War Mothers Chapter 18 as a means of encouragement while their sons deployed overseas. This article examines how these songs simultaneously evoke pre-reservation and post-reservation chronotopes of Kiowa martial motherhood. Through ethnographic research with Kiowa Elders, singers, War Mothers, and descendants of Kiowa composers, I analyze how War Mother songs express these chronotopes through musical (War Journey drumbeat), functional (preparing warriors for deployment and honoring returning veterans), and linguistic means (blending “Old Kiowa” and “Modern Kiowa”). Analysis of these chronotopes reveals how Kiowas creatively responded to settler colonialism to maintain gendered roles and personhoods that were important to their cultural identity. This article provides an ethnomusicological perspective on how chronotopes of gender are expressed through dynamic forms of music and dance.
Contemporary historiography of philosophy addresses the philosophy produced in Greek after the Fall of Constantinople and until the Modern Greek Enlightenment through two frameworks: that of post-Byzantine philosophy and that of Corydallism, preceded by a ‘pre-Corydallic’ and followed by a ‘post-Corydallic’ period. Despite their differences, both frameworks posit a continuity of this philosophy with Byzantine philosophy. I argue that the structure and contents of the treatises and handbooks of logic produced in the Heptanese and in Ottoman Greece during the seventeenth and eighteenth centuries can by no means be accounted for with reference to Byzantine philosophy.
Depersonalisation (DP) and derealisation (DR) experiences can cause clients and therapists a lot of confusion and anxiety. Therapist confusion has led to the under-recognition of DP and DR symptoms, under-confidence in working therapeutically with this client group and unequal client access to effective cognitive behavioural therapy (CBT) interventions. Client confusion has resulted in missed opportunities to engage in meaningful discussions with therapists about their DP and DR experiences and under-confidence that CBT can be of help. This article seeks to provide clarity for clinicians and clients around key misconceptions we have identified from the authors’ clinical experience of using CBT to treat DP/DR, both when presenting as symptoms in the context of other diagnoses and when presenting as a primary depersonalisation derealisation disorder (DDD). In addressing symptom misconceptions, we want to increase clinicians’ confidence when assessing DP and DR. We hope this will lead to productive discussions with clients and the inclusion of these symptoms in clinical formulations. We draw attention to client misconceptions in the hope that this facilitates better therapeutic dialogues about DP and DR and the potential benefit of CBT. Finally, we address therapist misconceptions about the use of CBT with this population in the hope that we can encourage more CBT therapists to work more proactively, confidently and effectively with DP and DR.
Key learning aims
(1) To help therapists better recognise depersonalisation (DP) and derealisation (DR) symptoms when in the context of another disorder and when presenting as primary depersonalisation derealisation disorder (DDD).
(2) To recognise therapist misconceptions leading to under-confidence in working with clients whose presentation includes symptoms of DP/DR and/or diagnoses of DDD.
(3) To understand misconceptions clients might hold about their DP and DR experiences and how these may impact engagement with CBT.
(4) To help therapists engage with clients in helpful discussions about the effectiveness of CBT to help with DP and DR, both when experienced in the context of another disorder and when conceptualised as DDD.
Cet article examine l’important rôle du Canada dans le développement du mécanisme de règlement des différends de l’Accord général sur les tarifs douaniers et le commerce, puis de l’Organisation mondiale de commerce. Face à un système initialement bloqué par le consensus, le Canada a œuvré dès les années 1980 à sa transformation en un cadre plus contraignant, transparent et juridictionnalisé. Ses propositions ont influencé les réformes du cycle de Tokyo, la réforme intérimaire de 1989, et ont été intégrées aux négociations du cycle d’Uruguay. Le Canada a notamment été moteur dans la juridictionnalisation de la procédure de règlement des différends, dans l’instauration du consensus inversé et dans la création d’un organe d’appel. Depuis 1995, le Canada demeure un acteur actif de l’Organe de règlement des différends par sa participation à de nombreux différends et par la présence d’experts canadiens dans les panels et à l’Organe d’appel. Face à la paralysie actuelle de ce dernier, le Canada a initié des solutions provisoires telles que l’Arrangement multipartite pour une procédure arbitrale d’appel provisoire et il continue de jouer un rôle moteur dans les négociations en cours sur la réforme du mécanisme, combinant attachement au multilatéralisme et pragmatisme. Son engagement illustre une volonté constante de défendre un système commercial multilatéral fondé sur la règle de droit et prévisible.
The conventional design method for high-performance concrete (HPC) mixture proportion requires a large amount of trial mixing work to obtain the desired HPC mixture proportion, which consumes a lot of manpower, material resources, and time resources during the trial mixing process. In recent years, an intelligent scheme for HPC mixture proportion design has been developed. To more effectively optimize HPC mixture proportions, this article proposes a novel intelligent HPC mixture proportion design method. Firstly, this article establishes a hybrid multi-objective optimization (MOO) method for HPC mixture proportion design problem, called CNN–NSDBO–EWTOPSIS. In this MOO framework, there are three objective functions, namely the compressive strength (CS) of concrete, cost, and carbon dioxide emissions. Among them, based on the various components of concrete, this article constructs a convolutional neural network (CNN) regression prediction model for predicting the CS of concrete. The calculation of cost and carbon dioxide emissions involves the utilization of two polynomials. Additionally, dung beetle optimizer (DBO) is used to optimize the hyperparameters of the CNN. Furthermore, this article incorporates the constructed CNN regression prediction model and two polynomials as the three objective functions for HPC mixture proportion design problem. This three-objective optimization problem is solved using a non-dominated sorting dung beetle optimizer (NSDBO). Finally, based on the obtained Pareto front, this article obtains a good solution using the entropy weight technique for order preference by similarity to an ideal solution (EWTOPSIS) method. The experimental results indicate that the proposed CNN–NSDBO–EWTOPSIS approach can achieve HPC mixture proportion design.
This paper investigates the effects of the German national minimum wage introduction and its subsequent up-rating on job finding rates of unemployed welfare recipients. While the literature is inconclusive on the sign of overall employment effects of the minimum wage, the range of estimates suggests that if effects are negative, they are likely to be rather small. However, such overall effects may mask negative effects on employment prospects of unemployed welfare recipients, who tend to be only loosely attached to the labour market. For the analysis, this paper uses a sample of unemployed welfare recipients based on high-quality administrative data and employs a difference-in-differences strategy by exploiting regional variation in the bite of the minimum wage in order to estimate the effects of the minimum wage. While theoretically ambiguous, estimates show that minimum wages had a beneficial and rather homogeneous impact on job finding rates of unemployed welfare recipients. Sensitivity analyses highlight the robustness of these findings.
We exploit heterogeneity in decreasing returns to scale (DRS) parameters across mutual funds to analyze the importance of scalability for investors’ capital allocation decisions. We find strong evidence that steeper DRS attenuate flow sensitivity to performance. We calibrate a rational model of active fund management and show that a large fraction of cross-sectional variation in assets-under-management is due to investors anticipating the effects of scale on return performance. We conclude that DRS play a key role in achieving equilibrium in the intermediated investment management market.
The quality by design (QbD) framework holds promise for improving success rates for completion of clinical studies, which often fail to complete on time. Initially used in manufacturing, the framework is now frequently applied to clinical trials to anticipate risks and avoid challenges that impact study completion or the credibility of results. The Southern California Clinical and Translational Science Institute created and implemented a program based on QbD to increase the success of research studies, including clinical trials and other study designs, being conducted by scholars in our Mentored Career Development Program and awardees in our Pilot Grant Programs. The program’s three components are QbD Design Studios, project management, and team science support. The overall goal is to increase study quality and efficiency, thereby improving study completion success rates and, ultimately, driving innovations in healthcare and public health. The current article describes QbD program elements in detail, along with preliminary results from initial implementation, approaches for evaluating the program’s implementation and impact on study success, and plans to disseminate the program widely.
In recent years, there has been a skyrocketing success of global histories of states and regions that have not been the traditional foci of global history. Since 2017, a series of volumes has appeared on the global history of Sicily, Catalonia, Spain, Portugal and Hungary, among others. In this article, we offer some cautionary tales and challenges; we explore emerging directions in the field, as well as its potential limitations, and advocate for a dynamic approach, which allows us to see how East-Central and Southern European societies played a crucial if not always glorious part at specific historical turning points and eras, be it in the first era of globalisation before 1914, during the First and Second World Wars or in the Cold War. In the absence of the Southern and East-Central European perspective, the global history of colonialism, decolonisation or modern warfare is at best incomplete; at worst, skewed.
This article examines the interdependent relationship between the state, law, and market in early modern China. Focusing on usury statutes, it analyzes how the Chinese state in the sixteenth and seventeenth centuries employed its legal framework to regulate a burgeoning money economy. The study underscores the critical role of law as an instrument of statecraft, essential for sustaining market functionality and social stability. Law’s multifaceted nature—encompassing legislation, specialist interpretations, adjudication, legal education, professional manuals, and popular knowledge—challenges the simplistic view of Confucian values as inherently anti-commerce. Instead, it shows how these values supported the uniformity and practicality of legal interpretations and judicial decisions. Moreover, the Chinese case points to a broader analytical framework with cross-cultural relevance: economic justice and market efficiency are not inherently opposed but can be mutually reinforcing when grounded in a shared set of values and legal regulations.
A three-valued logic is subclassical when it is defined by a single matrix having the classical two-element matrix as a subreduct. In this case, the language of can be expanded with special unary connectives, called external operators. The resulting logic is called the external version of , a notion originally introduced by D. Bochvar in 1938 with respect to his weak Kleene logic. In this paper we study the semantic properties of the external version of a three-valued subclassical logic . We determine sufficient and necessary conditions to turn a model of into a model of . Moreover, we establish some distinctive semantic properties of .
We hypothesized that semaglutide, a glucagon-like peptide-1 receptor agonist (GLP-1 RA) and treatment currently U.S. Food and Drug Administration (FDA) approved to reduce worsening of kidney disease and kidney failure may protect against lithium-induced nephrotoxicity.
Methods
Renal adverse events (AEs) reported to the FDA Adverse Event Reporting System (FAERS) between December 2003 and December 2024 were analyzed using the validated OpenVigil 2.1 platform. Reporting odds ratios (RORs) were computed for the MedDRA terms renal impairment, renal failure, chronic kidney disease (CKD), end-stage renal disease (ESRD), and acute kidney injury (AKI) in association with lithium, semaglutide, and their co-reporting. A disproportionality signal was considered statistically significant when p < 0.05, and the lower bound of the information component (IC025) was greater than 0.
Results
Lithium was associated with significantly elevated reporting odds across all renal AEs, with each outcome exceeding statistical signal thresholds (p < 0.0001, IC025 > 0). In contrast, semaglutide demonstrated inverse associations for renal impairment, renal failure, CKD, and ESRD (RORs = 0.25–0.54), and a neutral association for AKI (ROR = 0.96); however, none met the criteria for a disproportionality signal (IC025 < 0). Co-reported use of lithium and semaglutide did not yield a significant signal for any renal outcome, including AKI (ROR = 5.81, p = 0.015, IC025 < 0).
Conclusions
This observation, provides impetus to conduct adequate, thorough, mechanistic, clinical, and observational studies to determine whether semaglutide (and/or other incretin receptor agonists) could possibly mitigate the risk for, and/or modify the trajectory of, lithium-induced nephrotoxicity.