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The authors describe an international project to improve quality of electroconvulsive therapy (ECT) provision in a low- to middle-income territory. Shortcomings in professional training and delivery of clinical care had been identified, including staffing limitations, outdated ECT machines and use of unmodified treatment. The UK Royal College of Psychiatrists, the charity Medical Aid for Palestinians and the Palestinian Ministry of Health collaborated to provide new equipment, deliver specialist training and develop a modern service protocol. The resulting improvements, such as the introduction of electroencephalogram monitoring and stimulus dosing, are detailed, along with obstacles encountered, lessons learnt from the project and aspirations for the future.
This study investigates the effect of visually perceived gestures on the overall (multimodal) prominence of naturally occurring stimuli extracted from a multimodal corpus of Maltese conversations. Experiment participants were required to rate the prominence of target words in sentences presented to them as audiovisual and audio-only stimuli. In half of the stimuli, the target word was accompanied by a co-speech hand gesture. The results of the experiment show (i) that words produced with a co-speech gesture were rated as more prominent than words that were produced without one and (ii) that this was the case independently of whether raters could see those gestures (audiovisual condition) or not (audio-only condition). An acoustic analysis of the data shows that the presence of a co-occurring gesture has a significant effect on the pitch of the target vowel. The study suggests that gestures may provide the listener with an additional but not necessary cue to perceiving prominence.
The thesis of this chapter is that there is a new standard for the signs used to communicate the excess of critical nutrients in processed food. The standard, created in Chile and used by all the Pacific Alliance member states, is composed of octagonal warning signs and, for its simple and clear form, will likely influence other legislations. In this sense, these signs constitute a contribution to International Trade Law. The purpose of this chapter is twofold: first, to explore patterns in the legislative trends observed in Pacific Alliance countries regarding the labelling of foods containing certain ingredients related to non-communicable diseases, and second, it examines whether this new approach can evolve into a new legal standard that other countries in the region are likely to follow.
Suicide prevention is an under-prioritised public health issue in Bangladesh. Recently, it has received academic attention substantiated by an increasing number of publications. Along with that, the Mental Health Act (2018), National Mental Health Policy (2022) and National Mental Health Strategic Plan (2020–2030) have come out. There are many challenges facing suicide prevention efforts in the country, such as suicide’s criminal legal status and associated stigma, lack of a national suicide prevention programme, inadequate clinical services, and most important, the absence of a national database on suicide. This paper analyses documents critically considering initiatives for suicide prevention, highlights the urgent necessity for suicide prevention strategies in the country and identifies prominent stakeholders. A national suicide database in which law enforcement agencies have a prominent stake is urgently needed. In the long term, suicide prevention should be considered in the lens of public health.
This article theorises Indigenous feminist relational freedom that emphasises the ways in which relations and structures of domination disproportionately impact women and gender-diverse people, including through gender-based violence and environmental harm. The theory of relational freedom critiques both one-dimensional conceptions of Indigenous relationality and the conventional framing of Indigenous sovereignty and self-determination through the lens of non-interference, a concept rooted in political autonomy grounded in liberal thought. While non-interference correctly emphasises the need for Indigenous autonomy from state intervention, it falls short in addressing the deeper aspects of Indigenous freedom. Western interference has long impacted Indigenous life, which has led Indigenous self-determination discourses to focus on avoiding state intervention. However, while this emphasis on political autonomy is valid, it does not account for structural forms of domination, particularly underlying inequalities that perpetuate subordination within these structures. These structures range from state institutions that dispossess Indigenous communities to internal systems of gender-based domination that marginalise Indigenous women and LGBTQ+ individuals. The persistence of these structures significantly impedes the full realisation of Indigenous self-determination. The article ultimately theorises Indigenous feminist relational freedom within broader frameworks of feminist relational autonomy and citizenship and Indigenous gift relations, exploring practical approaches for applying the principles of relational freedom within Indigenous governance.
In the UK, around 1 in 4 adults over 65 years suffers from depression. Depression case finding followed by alerting patients and their general practioners (GPs) (screening + GP) is a promising strategy to facilitate depression management, but its cost-effectiveness remains unclear.
Aims
To investigate the cost-effectiveness of screening + GP compared with standard of care (SoC) in northern England.
Method
Conducted alongside the CASCADE study, 1020 adults aged 65+ years were recruited. Participants with baseline Geriatric Depression Scale (GDS) ≥5 were allocated to the intervention arm and those >5 to SoC. Resource use and EQ-5D-5L data were collected at baseline and 6 months. Incremental cost-effectiveness ratio was calculated. Non-parametric bootstrapping was performed to capture sampling uncertainty. The results are presented using cost-effectiveness acceptability curves. Sensitivity analyses were conducted to assess the robustness of primary findings. Subgroup analyses were undertaken to examine the cost-effectiveness among participants with more comparable baseline characteristics across treatment groups.
Results
Screening + GP incurred £37 more costs and 0.006 fewer quality-adjusted life years than SoC; the probability of the former being cost-effective was <5% at a £30 000 cost-effectiveness threshold. Sensitivity analyses confirmed the base-case findings. Subgroup analyses indicated that screening + GP was cost-effective when patients with baseline GDS 2–7, 3–6 and 4–5, respectively, were analysed.
Conclusions
Screening + GP was dominated by SoC in northern England. However, subgroup analyses suggested it could be cost-effective if patients with more balanced baseline characteristics were analysed. Economic evaluations alongside randomised controlled trials are warranted to validate these findings.
The prevalence of psychiatric disorders in people with epilepsy is as high as 43% and, among them, psychoses represent a severe comorbidity.
Aims
This is a narrative review discussing the interplay between epilepsy and psychosis and identifying challenges in diagnosing and managing psychotic symptoms in epilepsy, focusing on the past 10 years.
Method
Articles published between June 2014 and December 2024 were identified through searches in PubMed using the search terms ‘psychosis’, ’seizure, epilepsy and convulsion’, ‘epile*’, ’seizure*’ and ‘convuls*’.
Results
The association between epilepsy and psychosis was shown to be bidirectional, with people with psychosis being at increased risk of epilepsy. In epilepsy, psychotic symptoms may occur in three clinical scenarios, with clinical presentation and management varying in relationship to these: seizure-related (peri-ictal), treatment-related or independent of the former.
Conclusions
There are no guidelines for the management of psychotic symptoms in epilepsy, but it is possible to apply policies for the treatment of psychoses, taking into account the peculiarities and needs of people with epilepsy.
This article contributes to understanding how inexperience and lack of commitment to evidence-based decision making may undermine an otherwise broadly functional framework for constitutional risk management. As part of a focus on the “Visegrád Four” countries, it also helps understand regional dynamics since the COVID-19 pandemic as the most visible emergency after 1989. The article starts with a brief elucidation of the political contexts that have shaped Slovakia’s constitutional risk management, focusing on the developments from 2020 through early 2025. An analysis of mechanisms of emergency risk management in the constitutional framework follows, that helps identify key state authorities attempting to make decisions under serious time pressures. The implementation of the constitutional framework during the COVID-19 pandemic demonstrates the creation of new avenues for restricting rights and bolstering executive competence, with the formally powerful constitutional review mechanisms struggling to challenge these decisions. Ultimately, political context emerges as key: Slovakia entered the COVID-19 pandemic with a governing coalition enjoying constitutional majority and an aura of reform and hope. The emergency mismanagement not only facilitated the breakup of this coalition and early elections, but also a rise in emergency conspiracies openly hostile to institutions and actors committed to evidence-based decision making.
Chapter 3 discusses the key methodological and theoretical issues relevant for Balkan linguistics as a specific manifestation of complex language contact. On the one hand, other proposed linguistic areas are discussed, such as Amazonia, Araxes-Iran, the Caucasus, Ethiopia, Mainland Southeast Asia, Meso-America, the Northwest Coast of North America, and parts of Papua New Guinea and Australia. In that regard, the Balkans represent not only the most studied such case but also the most studiable, in that of all the sprachbunds that have been discussed in the literature, the Balkans offer the greatest amount of, and the longest time-depth for, information on the linguistic history of the area, the social history of the peoples in the region, and relevant reconstructible linguistic prehistory. On the other hand, mechanisms of, and relevant factors for, contact-induced change are presented, including multilingualism, interference, accommodation, simplification, pidginization and creolization, code-switching, borrowing, calquing, and language ideology. Further, other methodologies, including the Comparative Method, linguistic geography, and typological assessments offer additional sources of information for both Balkan linguistic prehistory and Balkan dialectology.
Edited by
Lisa Vanhala, University College London,Elisa Calliari, International Institute for Applied Systems Analysis, Vienna and Euro-Mediterranean Centre on Climate Change, Venice
Emission line galaxies (ELGs) are crucial for cosmological studies, particularly in understanding the large-scale structure of the Universe and the role of dark energy. ELGs form an essential component of the target catalogue for the Dark Energy Spectroscopic Instrument (DESI), a major astronomical survey. However, the accurate selection of ELGs for such surveys is challenging due to the inherent uncertainties in determining their redshifts with photometric data. In order to improve the accuracy of photometric redshift estimation for ELGs, we propose a novel approach CNN–MLP that combines convolutional neural networks (CNNs) with multilayer perceptrons (MLPs). This approach integrates both images and photometric data derived from the DESI Legacy Imaging Surveys Data Release 10. By leveraging the complementary strengths of CNNs (for image data processing) and MLPs (for photometric feature integration), the CNN–MLP model achieves a $\sigma_{\mathrm{NMAD}}$ (normalised median absolute deviation) of 0.0140 and an outlier fraction of 2.57%. Compared to other models, CNN–MLP demonstrates a significant improvement in the accuracy of ELG photometric redshift estimation, which directly benefits the target selection process for DESI. In addition, we explore the photometric redshifts of different galaxy types (Starforming, Starburst, AGN, and Broadline). Furthermore, this approach will contribute to more reliable photometric redshift estimation in ongoing and future large-scale sky surveys (e.g. LSST, CSST, and Euclid), enhancing the overall efficiency of cosmological research and galaxy surveys.
Edited by
Lisa Vanhala, University College London,Elisa Calliari, International Institute for Applied Systems Analysis, Vienna and Euro-Mediterranean Centre on Climate Change, Venice
Edited by
Lisa Vanhala, University College London,Elisa Calliari, International Institute for Applied Systems Analysis, Vienna and Euro-Mediterranean Centre on Climate Change, Venice
As the second lowest-lying country in the world, and because of its fragile economy and social and environmental vulnerabilities, Tuvalu is severely affected by the impacts of climate change. The country has been very active in developing ways of responding to these challenges at the national policy level and has also included the issue of loss and damage in official documents since 2012. At the same time, Tuvalu has played an active role in international loss and damage negotiations, including advocating for a separate article on loss and damage in the Paris Agreement. This chapter explores how Tuvalu’s policy actors make sense of and attempt to govern loss and damage at the national level. Using interpretive policy analysis and thirteen semi-structured interviews, it suggests that loss and damage in Tuvalu is developing as a “complex governance system” with competencies and agency spanning across multiple scales. The chapter finds that loss and damage does not feature as a stand-alone policy domain, nor is it explicitly distinguished from adaptation, but rather is treated as an issue which cuts across different sectors and policy areas, including climate-induced human mobility, infrastructure investment, national sovereignty and the protection of the country’s exclusive economic zone.
This study explores an emerging yet under-researched group within the Chinese bureaucratic system: grassroots female civil servants. Although there is a growing focus in academia on female officials in China, existing research mainly concentrates on the gender representation and career pathways of high-ranking female officials. This research delves into the work and life choices faced by female civil servants in local governments. Despite official discourse advocating for gender equality, interviews with 21 female public servants from a poverty-stricken county in northern China reveal that the demands of local government work and gender norms impose a double burden on them. Although the civil service is known for its stability, these women often have to put in extra effort into demanding and exhausting jobs, frequently sacrificing promotion opportunities to balance family and caregiving responsibilities. However, they seldom express dissatisfaction with this situation, reflecting the entrenched nature of gender role perceptions. This study provides a new explanation for the underrepresentation of female officials at higher levels from a grassroots perspective and reveals the impact of overloaded bureaucratic work on career mobility.
Edited by
Lisa Vanhala, University College London,Elisa Calliari, International Institute for Applied Systems Analysis, Vienna and Euro-Mediterranean Centre on Climate Change, Venice
The fat deposition and lipid composition directly influence meat quality and feed efficiency during pork production. Glutamate (GLU) is a major component of proteins and has been widely utilized in livestock production. However, the role of GLU in regulating lipid deposition and the lipo-nutritional quality of porcine fat remains unclear. This study aimed to investigate the effects of GLU on fatty acid composition and lipid profiles in subcutaneous fat (SF) and perirenal fat (PF) from Shaziling pigs. Forty-eight finishing pigs aged 150 days (31.56 ± 0.95 kg) were divided into the control (CON) group and the GLU-supplemented group (1% GLU), each consisting of 6 pens (4 pigs per pen). After 51 days, 6 pigs (1 pig/pen) from each group were slaughtered for analysis. Fatty acid analysis detected 46 species in SF and 40 in PF. In SF, 1% GLU significantly increased the content of C18:3n3 (P < 0.05), which was accompanied by an increase in n3 PUFA deposition (P < 0.05) and a decreased n6/n3 ratio (P = 0.06). In PF, GLU supplementation reduced the levels of C18:1n9t, C24:1, C22:6n3, and others (P < 0.05). The content of monounsaturated fatty acids (MUFAs) and n9 unsaturated fatty acids (UFAs) was significantly decreased in the GLU group (P < 0.05). Similarly, GLU significantly reduced the n6/n3 PUFA ratio in PF (P < 0.05). Lipidomics profiling identified 2264 unique lipids in fat tissues. GLU had minimal effects on lipid composition in SF but significantly reduced ceramides (Cer), phosphatidylserine (PS), and phosphatidylinositol (PIP) contents in PF (P < 0.05) compared to the CON group. Additionally, GLU influenced the acyl chain saturation degree, fatty acyl chain length, and individual acyl chain composition in glycerophospholipid (GP) pools of PF. These results demonstrate the regulatory role of GLU on lipid dynamics in porcine fat and provide insights into regulating fat deposition and liponutritional quality in indigenous Chinese pig breeds.
In this chapter we provide a general overview of trends in PTAs in Latin America (LA), with an emphasis on PTA design and diffusion. We base the chapter around four primary tasks. First, we review extant theoretical accounts underlying the motivations for LA countries’ engagement with PTAs. We classify countries into three groups – the liberal traders, post-liberals and anti-liberals – based on their approach to PTA partner selection and design. Second, we compare Latin America to other world regions. We show that countries in the region sign many PTAs on average, but that design features vary considerably within the region. Third, we show that PTA design in the region is influenced by both economic and political factors. Fourth, we use quantitative text analysis to analyse whether common models or templates can be observed in the region. We find some evidence that agreements involving the US have diffused within the region, but we fail to uncover strong evidence of a single template or templates that LA countries routinely adopt. Overall, our analysis paints a picture of a heterogeneous region where domestic political and economic factors affect how countries engage with the world economy through PTAs.