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.
What is compassion? Although a fundamental value in healthcare, this concept is often misunderstood and difficult to navigate. The authors of this book aim to answer this fundamental question, as well as offer a practical approach to how to use it in medicine. Comprised of two parts, the first part of this book explores the background to compassionate healthcare, examines how it differs from other concepts and outlines its relationship to medical professionalism. The second part offers a practical guide full of strategies and exercises to assist healthcare workers in practicing compassion by cultivating mindfulness and awareness, deepening compassion in care. This book is essential reading for medical professionals and trainees across healthcare, providing a guide to incorporating compassion into daily practice to deliver better, more compassionate care for the benefit of all. This title is also available as open access on Cambridge Core.
The radome of weather radars can be covered with a layer of water, degrading the quality of the radar products. Considering a simplified setup with a planar replica of the Swiss weather radars’ radome, we measure and model analytically its scattering parameters, with and without water. The measured reflectance of the dry radome replica agrees well with the one modeled according to the manufacturer specifications. Water forms droplets on the hydrophobic surface, but water films thicker than 1 mm can be created. Meteorologically more realistic thinner water films are expected on old radomes that have become hydrophilic with aging. Using hygroscopic silk and cotton tissues, we empirically imitate water films as thin as less than 0.1 mm. The measurements align with the simple analytical model of uniform plane wave incidence on the radome and water film but could be further improved by taking refraction and bending of the radome replica into account. Simulations with the General Reflector Antenna Software Package (GRASP) from TICRA complement the study for a representative setup with a spherical radome.
Bipolar disorders are a major cause of disability worldwide, with most of the disease burden attributed to those in low- and middle-income countries, including Nigeria. There is limited evidence on culturally appropriate interventions for bipolar disorders in Nigeria.
Aims
The study aims to examine the feasibility, and acceptability of culturally adapted psychoeducation (CaPE) for treating bipolar disorders.
Method
A randomised controlled trial (RCT) compared CaPE plus treatment as usual (TAU) with TAU alone among 34 persons with bipolar disorders in Jos, Nigeria. CaPE comprised 12 group sessions of in-person psychoeducation lasting approximately 90 min each, delivered on a weekly basis by clinical researchers supervised by clinical psychologists and consultant psychiatrists. The primary outcome was feasibility, measured by participants’ recruitment and retention rates. Other outcomes included acceptability as measured by the Service Satisfaction Scale (SSS), Brief Bipolar Disorder Symptom Scale (BBDSS), Patient Health Questionnaire (PHQ-9) and Quality-of-Life scale (EQ5D). Outcomes were assessed at baseline and weeks 12 and 24. Focus group (n = 10) and individual interviews (n = 5) were conducted with the CaPE + TAU group, recorded, transcribed verbatim and analysed using interpretative phenomenological analysis.
Results
The CaPE+TAU group (n = 17) recorded a high participant recruitment and retention rate of 86% across 12 sessions, and also recorded a higher level of satisfaction with SSS compared with the TAU alone group; 87.5% indicated very satisfied compared with 66.7% indicated not sure in the TAU group. In terms of clinical outcomes, for PHQ-9 scores the intervention group showed a reduction from baseline to end of intervention (EOI) and follow-up, with differences of −12.01 and −7.39, respectively (both P < 0.001). The EQ5D index showed a notable improvement in the intervention group at both EOI and follow-up (P < 0.001). Lastly, BBDS scores decreased significantly in the CaPE+TAU group at both EOI and follow-up, with differences of −21.45 and −15.76 (both P < 0.001).
Conclusions
The RCT of CaPE is a feasible, acceptable and culturally appropriate treatment option for bipolar disorders in Nigeria. Further adequately powered RCTs evaluating the intervention’s clinical and cost-effectiveness are warranted.
Emotional eating, the tendency to eat in response to negative emotions, is rising among adolescents and linked to obesity and mental health issues. While negative life events contribute to emotional eating, the roles of self-control and social support remain unclear.
Aims
This study examined the relationship between negative life events and emotional eating in adolescents, testing self-control as a mediator and perceived social support as a moderator.
Method
A sample of 740 Chinese high school students (aged 14–18) completed validated measures of negative life events, self-control, perceived social support, and emotional eating. Data were analyzed using SPSS 25.0 (IBM Corp., Armonk, New York, USA)and PROCESS macro for mediation/moderation effects.
Results
Negative life events predicted higher emotional eating (β = 0.11, p < 0.01), while lower self-control mediated this relationship (β = −0.15, p < 0.001). Perceived social support moderated the association (β = −0.09, p < 0.05), weakening it among adolescents with stronger support.
Conclusions
Negative life events increase emotional eating, but self-control and social support play key roles. Interventions targeting these factors may reduce emotional eating and improve adolescent well-being.
We investigated whether executive functions (EFs) are engaged in bilingual language control in Finnish speakers with different degrees of Swedish language experience and proficiency, including early bilinguals, late high-proficiency bilinguals and low-proficiency learners of Swedish. In an online experiment, language switching was measured with a cued naming (CN) paradigm, and a Simon task was used to assess EF performance. Following the skill-learning (task specificity) hypothesis, we expected that language switching may be automatized and no longer rely on EFs in bilinguals with high language proficiency, but not for those with lower proficiency. Thus, we expected significant associations between the tasks in the lower proficiency participants only. Our results showed no CN switching–EF associations in the more experienced L2 speakers, but a significant association in lower-proficiency participants. This suggests that language switching engages EFs only in participants with lower proficiency in whom these processes are not yet automatized.
Child and youth mental health is an international public health and research priority. We are an interdisciplinary and cross-sectoral network of UK-based early career researchers (ECRs) with an interest in child and youth mental health research. In this paper, we reflect on ongoing challenges and areas for growth, offering recommendations for key stakeholders in our field, including researchers, institutions and funders. We present a vision from an ECR perspective of what future child and youth mental health research could look like and we explore how the research infrastructure can support ECRs and the wider research field in making this vision a reality. We focus specifically on: (a) embracing complexity; (b) centring diverse voices; and (c) facilitating sustainable research environments and funding systems. We present recommendations for all key partners to consider alongside their local contexts and communities to actively and collaboratively drive progress and transformative change.
Rates of youth anxiety, depression, and self-harm have increased substantially in recent years. Expansion of clinical service capacity is constrained by workforce shortages and system fragmentation, and even substantial investment may not achieve the scale of growth required to address unmet need. Preventive strategies – such as strengthening social cohesion – are therefore essential to alleviate mounting pressures on the mental health system, yet their potential to compensate for these constraints remains unquantified.
Methods
This study employed a system dynamics model to explore the interplay between service capacity and social cohesion on youth mental health outcomes. The model was developed for a population catchment characterized by a mix of urban, suburban, and rural communities. Primary outcomes were prevalence of psychological distress and mental disorders, and incidence of mental health-related emergency department (ED) presentations among young people aged 15–24 years, projected over a 10-year time horizon. Two-way sensitivity analyses of services capacity and social cohesion were conducted.
Results
Changes to specialized mental health services capacity growth had the greatest projected impact on youth mental health outcomes. Heatmaps revealed thresholds where improvements in social cohesion could offset negative impacts of constrained service capacity. For example, if services capacity growth was sustained at only 80% of baseline, improving social cohesion could still reduce years lived with symptomatic disorder by 6.3%. To achieve a similar scale of improvement without improvements in social cohesion, the current growth rate in services capacity would need to be more than double. Combining a doubling of service capacity growth with reversing the decline in social cohesion could reduce ED presentations by 25.6% and years with symptomatic mental disorder by 19.2%. A doubling of specialized, headspace, and GP services capacity growth could prevent 24,060 years lived with symptomatic mental disorder among youth aged 15–24.
Conclusions
This study provides a quantitative framework for understanding how social cohesion improvements can help mitigate workforce constraints in mental health systems, demonstrating the value of integrating service expansion with social cohesion enhancement strategies.
The article examines the relationship between perceived distributive justice and trust in the welfare system within complex and self-contradictory policy setting. Based on thirty-three in-depth interviews with social assistance users in Poland and Czechia, we find that policy assemblages in those countries are experienced as confusing ‘institutional enigmas’. We identify four patterns linking perceptions of welfare system’s distributive justice and trust in this context: perceived rationality of the system combined with trust; perceived lack of system’s empathy combined with distrust; concerns about ‘undeserving claimants’ overusing the system linked to distrust in welfare system; and unexpected (non)receiving of benefits causing surprise and shaping (dis)trust. We argue that in contradictory institutional embedding, achieving users’ trust is challenging due to complex distributive justice principles they adhere to and numerous instances of those principles being violated. Trust can still be fostered when users are well informed or experience receiving meaningful support.
In the presence of fetal cardiomegaly, when there is no cardiac malformation or dysfunction, systemic or pulmonary arteriovenous malformations that may cause volume loading should be sought. We aimed to present a fetus who had cardiomegaly and left pulmonary artery-left atrial fistula and who underwent transcatheter closure in the early postnatal period.
Case presentation:
23-week fetus referred because of severe cardiomegaly on screening obstetric ultrasonography. Fetal echocardiography revealed fistulous connection between dilated left pulmonary artery and left atrium with high velocity continuous flow at the left atrial orifice of fistula and retrograde flow from the ductus arteriosus to the pulmonary artery. Initially, the fetus followed by one-to-two weeks intervals for fetal heart failure and hydrops fetalis. Pregnancy was uneventful and the baby was born by caesarean section at 37 weeks, and oxygen saturation level was 95 %. Transthoracic echocardiography confirmed the prenatal diagnosis of a fistula between the left pulmonary artery and the left atrium (CTA showed left lung aplasia. Transcatheter closure was performed from antegrade route with Amplatzer Piccolo® Duct Occluder due to hypoxaemia. The baby showed normal growth and development at 15 months of ageThere is no pulmonary hypertension during the 15-month follow-up.
Discussion:
Pulmonary artery-to-left atrial fistula is a rare anomaly and is frequently described between the right pulmonary artery and the left atrium. Presentation of age depends on the size of the fistulous connection. Patients with large connections are presented in fetal age with cardiomegaly and heart failure or presented in early infancy with profound cyanosis. Although lung hypoplasia has been reported in patients with pulmonary artery-to-left atrial fistula/connection lung aplasia has never been reported in these patients. Surgical or transcatheter closure can be achieved successfully in these patients at neonatal period or early infancy like in our case.
Neurotransmitter release via synaptic vesicle fusion with the plasma membrane is driven by SNARE proteins (Synaptobrevin, Syntaxin, and SNAP-25) and accessory proteins (Synaptotagmin, Complexin, Munc13, and Munc18). While extensively studied experimentally, the precise mechanisms and dynamics remain elusive due to spatiotemporal limitations. Molecular dynamics (MD) simulations—both all-atom (AA) and coarse-grained (CG)—bridge these gaps by capturing fusion dynamics beyond experimental resolution. This review explores the use of these simulations in understanding SNARE-mediated membrane fusion and its regulation by Synaptotagmin and Complexin. We first examine two competing hypotheses regarding the driving force of fusion: (1) SNARE zippering transducing energy through rigid juxtamembrane domains (JMDs) and (2) SNAREs generating entropic forces via flexible JMDs. Despite different origins of forces, the conserved fusion pathway – from membrane adhesion to stalk and fusion pore (FP) formation – emerges across models. We also highlight the critical role of SNARE transmembrane domains (TMDs) and their regulation by post-translational modifications like palmitoylation in fast fusion. Further, we review Ca²⁺-dependent interactions of Synaptotagmin’s C2 domains with lipids and SNAREs at the primary and tripartite interfaces, and how these interactions regulate fusion timing. Complexin’s role in clamping spontaneous fusion while facilitating evoked release via its central and accessory helices is also discussed. We present a case study leveraging AA and CG simulations to investigate ion selectivity in FPs, balancing timescale and accuracy. We conclude with the limitations in current simulations and using AI tools to construct complete fusion machinery and explore isoform-specific functions in fusion machinery.
This paper examines in what way providers of specialized Large Language Models (LLM) pre-trained and/or fine-tuned on medical data, conduct risk management, define, estimate, mitigate and monitor safety risks under the EU Medical Device Regulation (MDR). Using the example of an Artificial Intelligence (AI)-based medical device for lung cancer detection, we review the current risk management process in the MDR entailing a “forward-walking” approach for providers articulating the medical device’s clear intended use, and moving on sequentially along the definition, mitigation, and monitoring of risks. We note that the forward-walking approach clashes with the MDR requirement for articulating an intended use, as well as circumvents providers reasoning around the risks of specialised LLMs. The forward-walking approach inadvertently introduces different intended users, new hazards for risk control and use cases, producing unclear and incomplete risk management for the safety of LLMs. Our contribution is that the MDR risk management framework requires a backward-walking logic. This concept, similar to the notion of “backward-reasoning” in computer science, entails sub-goals for providers to examine a system’s intended user(s), risks of new hazards and different use cases and then reason around the task-specific options, inherent risks at scale and trade-offs for risk management.
The present paper provides a small–scale exploratory analysis of L2 English pronunciation and accent aims among secondary school students in Germany – with a focus on the bath and lot vowels, rhoticity, and T–flapping. The eight learners investigated in the current study show blended use of Standard Southern British English (StSBrE) and Standard American (StAmE) phonological variants with relatively high degrees of variation between learners. StSBrE–oriented productions were dominant overall. Agreement of accent aim and L2 pronunciation was largely feature–dependent and limited overall but varied between learners.
Participatory Design – an iterative, flexible design process that closely involves stakeholders, often end users – is growing in use across design disciplines. As more practitioners use Participatory Design (PD), it has become less rigidly defined, with stakeholders engaged to varying degrees through disjointed techniques. This ambiguity can be counterproductive when discussing PD processes. We performed a systematic literature review that builds shared, foundational knowledge of PD processes and techniques while also summarizing the state of PD research in the field, as a first step in supporting richer understandings of how best to equitably engage with stakeholders. We found that a majority of PD literature examined specific case studies of PD, with the design of intangible systems representing the most common design context. Stakeholders most often participated throughout multiple stages of a design process, recruited in a variety of ways, and engaged in several of the 14 specific participatory techniques identified. Our findings also identify leverage points for creators of PD processes and how the leverage points impact design equity, including: (1) emergent versus predetermined processes; (2) direct versus indirect participation; (3) early versus late participation; (4) one time versus iterative participation; and (5) singular versus multiple PD techniques.
Weight suppression represents the difference between highest and current body weight and predicts maintenance of bulimia nervosa and related syndromes (BN-S). This study tested a biobehavioral model of binge-eating severity in which greater weight suppression links to reduced leptin, which links to reduced glucagon-like peptide 1 (GLP-1) release, which links to both decreased reward satiation and increased reward valuation, which link, respectively, to excessive food intake and loss of control while eating – the defining features of DSM-5 binge-eating episodes.
Methods
Women (N = 399) who met DSM-5 criteria for bulimia nervosa or another eating disorder with binge eating (n = 321) or had no lifetime eating disorder symptoms (n = 78) participated in a multi-visit protocol, including structured clinical interviews, height, weight, weight history, percent body fat, fasting leptin, post-prandial GLP-1 response to a fixed meal, and self-report and behavioral assessments of food reward satiation (ad lib meal) and food and nonfood reward valuation (progressive ratio tasks).
Results
A structural equation model (SEM) demonstrated excellent fit to data with significant pathways from greater weight suppression to lower leptin, to blunted GLP-1 response, to lower reward satiation, to larger eating/binge-eating episode size, with significant indirect paths through leptin, GLP-1, and reward satiation. SEM with paths via reward valuation to loss of control eating demonstrated inadequate fit.
Conclusions
Findings specifically link reduced GLP-1 response to severity of binge-episode size and support weight history assessment in eating disorders, DSM-5 over ICD-11 criteria for binge eating, and may inform future clinical trials of GLP-1 agonists for BN-S.
What can we learn about organizational ethics from studying cemeteries as organizational/organized manifestations of our mutual, embodied vulnerability? How does, and how should, the ethico-political imperative of death and the deceased materialize in the cemeterial space? With reference to a comparative analysis of two island cemeteries, Venice’s San Michele and New York’s Hart Island, this paper makes three contributions to the emerging literature on organizational ethics of life and death. First, it makes an empirical contribution based on an organizational study of two “resting places” that highlights the importance of understanding organizational life and death with reference to ethics. Second, it makes a theoretical contribution to scholarship on the organization of death and on grieving as embedded in a politics and ethics of recognition. Third, the paper shows how our desire to be recognized as valid, viable subjects comes to be organized, and situated, in ways that perpetuate precarity and vulnerability, a point that is illustrated with reference to cemeteries as ethically significant organizational settings.
Major depressive disorder (MDD) is a leading cause of disability worldwide. Investigating early-stage alterations in cerebral intrinsic activity among drug-naive patients may enhance our understanding of MDD’s neurobiological mechanisms and contribute to early diagnosis and intervention.
Aims
To examine alterations in the amplitude of low-frequency fluctuation (ALFF) in first-episode, drug-naive MDD individuals and explore associations between ALFF changes and clinical parameters, including depression severity and illness duration.
Method
A total of 30 first-episode, drug-naive MDD individuals (mean illness duration 14 weeks) and 52 healthy controls were included in this study. Resting-state functional magnetic resonance imaging was used to obtain whole-brain ALFF measurements. Voxel-based ALFF maps were compared between MDD and healthy control groups using a two-sample t-test. Simple regression analysis was performed to assess associations between ALFF and clinical measures, including Hamilton Rating Scale for Depression (HAMD) scores and illness duration.
Results
MDD individuals exhibited significantly increased ALFF in the dorsal anterior cingulate cortex and vermal subregion V3 of the cerebellum. Additionally, ALFF in the right dorsolateral prefrontal cortex was negatively correlated with HAMD scores (r = –0.591, P < 0.001). However, no significant association was found between ALFF and illness duration.
Conclusions
This study demonstrates early-stage ALFF alterations in drug-naive MDD patients, particularly in brain regions implicated in cognitive and emotional regulation. These findings suggest potential neuroimaging biomarkers for the early diagnosis and intervention of MDD.
Heating, Ventilation, and Air Conditioning (HVAC) systems are major energy consumers in buildings, challenging the balance between efficiency and occupant comfort. While prior research explored generative AI for HVAC control in simulations, real-world validation remained scarce. This study addresses this gap by designing, deploying, and evaluating “Office-in-the-Loop,” a novel cyber-physical system leveraging generative AI within an operational office setting. Capitalizing on multimodal foundation models and Agentic AI, our system integrates real-time environmental sensor data (temperature, occupancy, etc.), occupants’ subjective thermal comfort feedback, and historical context as input prompts for the generative AI to dynamically predict optimal HVAC temperature setpoints. Extensive real-world experiments demonstrate significant energy savings (up to 47.92%) while simultaneously improving comfort (up to 26.36%) compared to baseline operation. Regression analysis confirmed the robustness of our approach against confounding variables like outdoor conditions and occupancy levels. Furthermore, we introduce Data-Driven Reasoning using Agentic AI, finding that prompting the AI for data-grounded rationales significantly enhances prediction stability and enables the inference of system dynamics and cost functions, bypassing the need for traditional reinforcement learning paradigms. This work bridges simulation and reality, showcasing generative AI’s potential for efficient, comfortable building environments and indicating future scalability to large systems like data centers.