To save content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about saving content to .
To save content items to your Kindle, first ensure no-reply@cambridge.org
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about saving to your Kindle.
Note you can select to save to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
We study the singularities of varieties obtained as infinitesimal quotients by $1$-foliations in positive characteristic. (1) We show that quotients by (log) canonical $1$-foliations preserve the (log) singularities of the MMP. (2) We prove that quotients by multiplicative derivations preserve many properties, amongst which most F-singularities. (3) We formulate a notion of families of $1$-foliations, and investigate the corresponding families of quotients.
Clozapine is the only licensed medication for treatment-resistant schizophrenia, although it is underused. Healthcare professionals (medical and non-medical professionals) play a crucial role in the management of clozapine. Consultant psychiatrists are accountable for the initiation of clozapine, whereas non-medical professionals are often responsible for the monitoring, the management of side effects and patient education. It appears that healthcare professionals‘ (HCPs) competence and confidence may have an effect on clozapine underutilisation.
Aim:
To synthesise the most pertinent literature examining the factors influencing HCPs competence and confidence in the management of clozapine and how these factors influence variation in prescribing practice.
Methods:
A review of the literature focusing on these elements was conducted. The Population, Context, Outcome (PCO) framework was adopted to support the literature search. The databases Medline, Psychinfo, Scopus, Cinahl, Pubmed, Embase, British Library, Ethos e-thesis, Google Scholar, Dart Europe e-thesis were consulted; the search was completed in January 2025. Screening, selection, data extraction and quality assessment were conducted independently by two researchers. Thematic analysis was used to investigate and compare the data emerging from the studies.
Results:
Thirty-four articles were included in the review. Six themes were identified: attitude toward and knowledge about clozapine, misconceptions (regarding side effects, monitoring and co-morbidities), guidelines, education, training and experience. HCPs self-reported as competent with guidelines (local and national), yet they expressed less confidence in their ability to adhere to them and were uncertain about managing side effects. Lack of education, training and insufficient exposure to clozapine management were significant factors impacting competence and confidence, resulting in clozapine underuse and variance in prescribing practice. The review highlighted a gap in the literature, as only a few studies involving non-medical professionals were found.
Conclusions:
A general lack of education and training related to clozapine use was identified amongst all professionals.
The impact of educational programmes on improving competence and enhancing confidence was considered positive, however when integrated with clinical practice.
The studies identified in this review were lacking in the involvement of non-medical professionals. Given their crucial role in managing side effects and educating patients and carers, it is evident that their inclusion in future research is imperative.
The paper outlines Czech constitutional law and the development of emergency law. Initially, the legislature did not expect emergencies to occur, perhaps due to the idealistic optimism associated with the general atmosphere of the collapse of the Eastern Bloc in 1989 and the “End of History” thesis. As a result, emergencies were not regulated by Czech law in the 1990s. This changed after the great floods at the end of the 1990s, when “history returned,” and the need for some special rules for emergencies became clear. The first decades of this century showed that Czech emergency law worked well for short-term natural disasters. The game-changer came in 2020, with the emergence of the COVID-19 pandemic and the need for a long-term state of emergency. It soon became clear that the rules that worked for floods and other disasters did not work for long-term global pandemics. In other words, the legal system was not prepared for a situation in which emergencies were the rule rather than the exception. Legislators were unable to prepare a long-term legislative response to fill this gap. The memory of COVID-19 is fading fast, and there are no plans to reform the relevant legislation. Accordingly, any new pandemic or similar event will lead to the same problems that the Czech legal system had to deal with from 2020 to 2022.
Ketamine, originally synthesized in 1962, has gained increasing attention due to its rapid and sustained antidepressant effects in treatment-resistant depression (TRD). Unlike traditional antidepressants, ketamine acts on multiple neurotransmitter systems, including NMDA receptor antagonism and AMPA receptor potentiation, offering a novel mechanism for mood regulation. Beyond psychiatry, ketamine remains a valuable anesthetic and analgesic agent with applications in acute and chronic pain management. Its anti-inflammatory, neuroprotective, and potential antitumor properties further underscore its versatility in clinical medicine. Despite its therapeutic promise, ketamine poses challenges due to its dissociative and hallucinogenic effects, contributing to widespread recreational use. Chronic misuse is associated with adverse health outcomes, including bladder dysfunction and hepatobiliary complications. As a result, ketamine has been subject to increasing regulatory scrutiny, balancing its medical utility with concerns about abuse potential. The rediscovery of ketamine’s antidepressant effects in the early 2000s has revolutionized psychiatric treatment, particularly in TRD and suicidality. Recent studies have also explored its efficacy in bipolar depression, posttraumatic stress disorder, obsessive-compulsive disorder, and substance use disorders, expanding its therapeutic applications. Additionally, ongoing research aims to elucidate its long-term effects and optimize dosing regimens to maximize clinical benefits while minimizing risks. This review highlights ketamine’s multifaceted pharmacological properties, its evolution from an anesthetic to a novel psychiatric treatment, and its broader medical applications. As research advances, a comprehensive understanding of ketamine’s mechanisms and clinical implications will be crucial for optimizing its therapeutic potential while mitigating its risks.
This study evaluated Medicaid claims (MC) data as a valid source for outpatient antimicrobial stewardship programs (ASPs) by comparing it to electronic medical record (EMR) data from a single academic center.
Methods:
This retrospective study compared pediatric patients’ MC data with EMR data from the Marshall Health Network (MHN). Claims were matched to EMR records based on patient Medicaid ID, service date, and provider NPI number. Demographics, antibiotic choice, diagnosis appropriateness, and guideline concordance were assessed across both data sources.
Setting:
The study was conducted within the MHN, involving multiple pediatric and family medicine outpatient practices in West Virginia, USA.
Patients:
Pediatric patients receiving care within MHN with Medicaid coverage.
Results:
MC and EMR data showed >90% agreement in antibiotic choice, gender, and date of service. Discrepancies were observed in diagnoses, especially for visits with multiple infectious diagnoses. MC data demonstrated similar accuracy to EMR data in identifying inappropriate prescriptions and assessing guideline concordance. Additionally, MC data provided timely information, enhancing the feasibility of impactful outpatient ASP interventions.
Conclusion:
MC data is a valid and timely resource for outpatient ASP interventions. Insurance providers should be leveraged as key partners to support large-scale outpatient stewardship efforts.
Despite the high prevalence of generalized anxiety among young adults, studies investigating factors that shape the course of these symptoms during the twenties are scarce. In addition, generalized anxiety can manifest in different ways, but it is unclear whether symptoms cluster under distinct dimensions in this age group. The current study addressed these gaps using data from the Twins Early Development Study. First, we examined genetic and environmental contributions to continuity and change in generalized anxiety symptoms in young adulthood and the heritability of a latent factor reflecting stability over this period. Next, to explore potential dimensions of generalized anxiety, we investigated the factorial structure of symptoms as well as etiological influences underpinning the different factors.
Methods
The sample comprised 6,429 twin pairs. Generalized anxiety was assessed at six waves (age 23–26 years).
Results
Genetic factors largely accounted for continuity and environmental factors for change in symptom severity. Furthermore, the heritability of stable generalized anxiety (60%) was substantially higher than that at any single time point (39–46%). Regarding the factorial structure of symptoms, we found evidence of two dimensions: worry-avoidance and somatic-distress symptoms. Genetic correlations (rG = 0.77–0.91) between the two dimensions were higher than environmental correlations (rE = 0.26–0.65).
Conclusions
The current findings suggest that extracting temporal stability provides the strongest opportunity to identify genetic influences on generalized anxiety. Moreover, the results indicate that differences between generalized anxiety dimensions are more likely attributable to environmental than genetic effects.
Supersonic free jets are extensively employed across a range of applications, especially in high-tech industries such as semiconductor processing and aerospace propulsion. Due to the difficulties involved in flow measurement, previous research on supersonic free jets has primarily focused on investigating near-field shockwave structures, with quantitative experimental analysis of the far-field zone being relatively scarce. However, physical understanding of the far-field flow, particularly post-shockwave energy dissipation, holds significant importance for the application and utilisation of these jets in vacuum environments. Therefore, this study aims to provide a robust experimental foundation for a rarefied supersonic free jet through the analysis of the flow field in both the near- and far-field zones. Nanometre-sized tracer particles and molecules were utilised to measure the rarefied supersonic jet flow field using particle image velocimetry and acetone molecular tagging velocimetry, respectively. The experiments revealed that in rarefied conditions, the supersonic jet exhibits a one-barrel shockwave structure in the near field, and after passing the Mach disk, a long annular viscous layer develops downstream. Experimental data on the jet velocity profile and width demonstrated a transition to a laminar flow regime in the far-field zone. This transition aligns with the theoretically inferred flow regimes based on the complex Reynolds number. The velocity profile and potential core length of the laminar flow regime could be modelled using a bi-modal distribution, which represents the summation of symmetric Gaussian distributions.
This study addresses challenges in sensor fusion for accurate and robust joint orientation estimation in human movement analysis using wearable inertial measurement units (IMUs). A magnetometer-free refined Kalman filter (KF) approach is presented and validated to address various indoor environmental constraints and challenges posed by human movement. These include variability in motion and dynamics, as well as magnetic disturbances caused by ferromagnetic materials or electronic interferences. Our proposed approach utilizes a Kalman-filter-based framework that analyzes the accelerometer’s alignment with the Earth’s frame to estimate orientation and correct gyroscope readings, eliminating reliance on magnetometer inputs. The algorithm was tested on both controlled robotic movements and real-world upper-limb-motion-monitoring scenarios. First, a comparative analysis was conducted on the double-stage Kalman filter (DSKF) and complementary filter using the collected robot motion encoder data. The results demonstrated superior performance in orientation estimation, particularly in yaw measurements, where the proposed method significantly improved accuracy. It achieved a lower root mean square error (RMSE = $ {2.447}^{\circ } $) and mean absolute error (MAE = $ {2.006}^{\circ } $), outperforming both the DSKF and complementary filter approaches. Additionally, the study’s findings were validated against a standard motion capture system, revealing error metrics within generally acceptable ranges ($ \le 12.4\% $ of the joint range of motion [ROM]) and strong correlation coefficients ($ {r}^2>0.89 $). However, some deviations were observed during complex motion cycle intervals, highlighting opportunities for further refinement. These findings suggest that the proposed approach presents a promising alternative for human joint orientation estimation in industrial settings with magnetic distortions.
Paternity leave may promote greater gender equality in domestic labour. Though numerous studies show that paternity leave promotes greater fathers’ involvement in childcare, less is known about whether paternity leave-taking may facilitate fathers’ involvement in other forms of domestic labour such as housework. Using repeated cross-sectional data on different-gender partnered US parents from the Study on Parents’ Divisions of Labor During COVID-19 (SPDLC), this study examines the extent to which paternity leave-taking and length of paternity leave are associated with US fathers’ shares of, and time spent on, housework. Findings suggest that paternity leave-taking is positively associated with fathers’ shares of, and time spent on, housework tasks. Longer paternity leaves are also associated with fathers performing greater shares of housework. Overall, this study indicates that the benefits of paternity leave likely extend to fathers’ greater participation in housework, providing additional support for the belief that increased use of paternity leave may help to promote gender equality in domestic labour.
This study presents the most recent data on the incidence, prevalence, and years lived with disability (YLDs) due to anxiety disorders across the Middle East and North Africa (MENA) region from 1990–2021, analysed by sex, age, and sociodemographic index (SDI).
Methods:
We reported the burden of anxiety disorders using data sourced from the Global Burden of Disease 2021 study. The estimates of prevalence, DALYs, and YLDs are provided as numbers and age-standardised rates, accompanied by their 95% uncertainty intervals (UIs).
Results:
In 2021, the age-standardised point prevalence of anxiety disorders in the region was 5.95 thousand, with an incidence rate of 883.4 per 100,000. The number of YLDs in 2021 reached 4.5 million. From 1990 to 2021, the burden of anxiety disorders increased significantly. Lebanon had the highest burden in 2021. Among both sexes, the 10–14 age group had the highest incidence rate, while the 15–19 age group had the highest prevalence and YLD rates. In 2021, most age groups in the MENA region had YLD rates that were higher than the global average.
Conclusion:
This study highlights the urgent need for a multidisciplinary approach to prevent and manage anxiety disorders. Ensuring accessible and affordable treatment options for all affected individuals is crucial. Governments should prioritise supporting programmes to effectively address mental health issues, given the unique socioeconomic and geopolitical challenges in the MENA region. By including effective preventive methods alongside treatment in healthcare strategies, the burden of anxiety disorders can be significantly reduced.
Ventilated cavities in the wake of a two-dimensional bluff body are studied experimentally via time-resolved X-ray densitometry. With a systematic variation of flow velocity and gas injection rate, expressed as Froude number ($\textit{Fr}$) and ventilation coefficient ($C_{qs}$), four cavities with different closure types are identified. A regime map governed by $\textit{Fr}$ and $C_{qs}$ is constructed to estimate flow conditions associated with each cavity closure type. Each closure exhibits a different gas ejection mechanism, which in turn dictates the cavity geometry and the pressure in the cavity. Three-dimensional cavity closure is seen to exist for the supercavities at low $\textit{Fr}$. However, closure is nominally two-dimensional for supercavities at higher $\textit{Fr}$. At low $C_{qs}$, cavity closure is seen to be wake-dominated, while supercavities are seen to have interfacial perturbation near the closure at higher $C_{qs}$, irrespective of $\textit{Fr}$. With the measured gas fraction, a gas balance analysis is performed to quantify the gas ejection rate at the transitional cavity closure during its formation. For a range of $\textit{Fr}$, the transitional cavity closure is seen to be characterised by re-entrant flow, whose intensity depends on the flow inertia, dictating the gas ejection rates. Two different ventilation strategies were employed to systematically investigate the formation and maintenance gas fluxes. The interaction of wake and gas injection is suspected to dominate the cavity formation process and not the maintenance, resulting in ventilation hysteresis. Consequently, the ventilation gas flux required to maintain the supercavity is significantly less than the gas flux required to form the supercavity.
Against the proliferation of large language model (LLM) based Artificial Intelligence (AI) products such as ChatGPT and Gemini, and their increasing use in professional communication training, researchers, including applied linguists, have cautioned that these products (re)produce cultural stereotypes due to their training data. However, there is a limited understanding of how humans navigate the assumptions and biases present in the responses of these LLM-powered systems and the role humans play in perpetuating stereotypes during interactions with LLMs. In this article, we use Sequential-Categorial Analysis, which combines Conversation Analysis and Membership Categorization Analysis, to analyze simulated interactions between a human physiotherapist and three LLM-powered chatbot patients of Chinese, Australian, and Indian cultural backgrounds. Coupled with analysis of information elicited from LLM chatbots and the human physiotherapist after each interaction, we demonstrate that users of LLM-powered systems are highly susceptible to becoming interactionally entrenched in culturally essentialized narratives. We use the concepts of interactional instinct and interactional entrenchment to argue that whilst human–AI interaction may be instinctively prosocial, LLM users need to develop Critical Interactional Competence for human–AI interaction through appropriate and targeted training and intervention, especially when LLM-powered tools are used in professional communication training programs.
The use of camera traps in wildlife conservation and ecological research is a popular method of data capture due in large part to the perceived low interference levels for the animals being studied. However, evidence exists that some species alter their behaviour when exposed to this technology. The primary aim of this study was to address whether researchers working with this technology in the ecology and forestry fields are making considerations for the possible impacts of cameras on animal behaviour. A secondary aim was to investigate how the use of this technology is framed in recent publications. In this rapid systematic literature review, we conducted a search on Web of Science and we identified 267 papers published in the last five years, in the fields of ecology and forestry, that met our inclusion criteria. We screened the studies for mentions of the impact of camera traps on the welfare of wildlife. Surprisingly, only 7.5% of the papers considered the possible animal welfare impacts of camera use on the wildlife species of interest in their study, with most comparing it to invasive methods and therefore framing this technology positively. We strongly encourage researchers working in this field to consider the impact of this technology on the specific species being studied. Whilst we recognise that the use of camera traps avoids direct handling of the animals, the short- and long-term effects of using this technology should not be ignored and should, at a minimum, be acknowledged in the limitations.
Psychotic-like experiences (PLEs) are associated with cognitive impairment and premature mortality, which may be indicative of accelerated biological ageing. Epigenetic clocks provide a measure of biological age based on DNA methylation, yet the long-term relationship between epigenetic ageing and PLEs remains largely unclear. We tested the relationship between epigenetic ageing and PLEs using a 17-year longitudinal approach.
Methods
Epigenetic ageing was calculated using four epigenetic clocks (DunedinPACE, Cortical EpiAge, Horvath, and PCGrimAge) in a sample from the Avon Longitudinal Study of Parents and Children (ALSPAC), a large population-based birth cohort (n = 1840, 56.8% females). We modeled epigenetic ageing from up to three repeated measures collected between ages 7 and 24 using a linear mixed-effects model to calculate (1) average epigenetic age [mean-centered intercept] and (2) rate of epigenetic ageing over this 17-year period [slope]. We then compared these two measures between individuals who developed PLEs in early adulthood (n = 95) against those who did not (n = 1745).
Results
Results showed that a faster rate (slope) of longitudinal PCGrimAge was predictive of PLEs (OR = 1.79, 95% CI [1.13–2.85], p = .014), although this association was no longer significant after adjusting for smoking. There was a non-significant effect in the same direction for other clocks. Average epigenetic age (mean-centered intercept) was not associated with PLEs.
Conclusions
Our findings suggest that the observed association between accelerated rate of epigenetic ageing, measured with PCGrimAge, from childhood to early adulthood, and the development of PLEs in early adulthood may be explained by smoking.