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Psychotic disorders are severe mental health conditions frequently associated with long-term disability, reduced quality of life and premature mortality. Early Intervention in Psychosis (EIP) services aim to provide timely, comprehensive packages of care for people with psychotic disorders. However, it is not clear which components of EIP services contribute most to the improved outcomes they achieve.
Aims
We aimed to identify associations between specific components of EIP care and clinically significant outcomes for individuals treated for early psychosis in England.
Method
This national retrospective cohort study of 14 874 EIP individuals examined associations between 12 components of EIP care and outcomes over a 3-year follow-up period, by linking data from the National Clinical Audit of Psychosis (NCAP) to routine health outcome data held by NHS England. The primary outcome was time to relapse, defined as psychiatric inpatient admission or referral to a crisis resolution (home treatment) team. Secondary outcomes included duration of admissions, detention under the Mental Health Act, emergency department and general hospital attendances and mortality. We conducted multilevel regression analyses incorporating demographic and service-level covariates.
Results
Smaller care coordinator case-loads and the use of clozapine for eligible people were associated with reduced relapse risk. Physical health interventions were associated with reductions in mortality risk. Other components, such as cognitive–behavioural therapy for psychosis (CBTp), showed associations with improvements in secondary outcomes.
Conclusions
Smaller case-loads should be prioritised and protected in EIP service design and delivery. Initiatives to improve the uptake of clozapine should be integrated into EIP care. Other components, such as CBTp and physical health interventions, may have specific benefits for those eligible. These findings highlight impactful components of care and should guide resource allocation to optimise EIP service delivery.
The digital twin approach has gained recognition as a promising solution to the challenges faced by the Architecture, Engineering, Construction, Operations, and Management (AECOM) industries. However, its broader application across some AECOM sectors remains limited. A significant obstacle is that traditional DTs rely on deterministic models, which require deterministic input parameters. This limits their accuracy, as they do not account for the substantial uncertainties that are inherent in AECOM projects. These uncertainties are particularly pronounced in geotechnical design and construction. To address this challenge, we propose a probabilistic digital twin (PDT) framework that extends traditional DT methodologies by incorporating uncertainties and is tailored to the requirements of geotechnical design and construction. The PDT framework provides a structured approach to integrating all sources of uncertainty, including aleatoric, data, model, and prediction uncertainties, and propagates them throughout the entire modeling process. To ensure that site-specific conditions are accurately reflected as additional information is obtained, the PDT leverages Bayesian methods for model updating. The effectiveness of the PDT framework is showcased through an application to a highway foundation construction project, demonstrating its potential to integrate existing probabilistic methods to improve decision-making and project outcomes in the face of significant uncertainties. By embedding these methods within the PDT framework, we lower the barriers to practical implementation, making probabilistic approaches more accessible and applicable in real-world engineering workflows.
Studying rotating convection under geo- and astrophysically relevant conditions has proven to be extremely difficult. For the rotating Rayleigh–Bénard system, van Kan et al. (J. Fluid Mech., vol. 1010, 2025,A42)have now been able to massively extend the parameter space accessible by direct numerical simulations. Their progress relies on a rescaling of the governing Boussinesq equations, which vastly improves numerical conditioning (Julien et al., arXiv:2410.02702). This opens the door for investigating previously inaccessible dynamical regimes and bridges the gap to the asymptotic branch of rapidly rotating convection.
We address the anti-trans/queer panic integral to the ascendance of authoritarian politics in America and respond by calling on all political scientists to “queer” political science by undoing the cisheteronormativity of the discipline. We contend that this is not the special obligation of LGBTQ scholars but all political scientists. In this we follow Eve Sedgwick’s orientation away from a “minoritizing” to a “universalizing” epistemological perspective that situates this responsibility relative to resisting democratic decline.
Knowledge of environmental triggers for migraine attacks is limited and has mostly been acquired by studies using emergency room (ER) visits. However, it is unlikely that ER visits are a random sample of migraine events, even within strata of migraine severity. Additionally, time lags between attack onset and ER visits may vary across the population, posing challenges for assessing causal links of migraine with community-level or ecologic exposures.
Objective:
Our objective was to assess the relationship between demographic and geographic measures and self-reported migraine-related ER visits.
Methods:
We analyzed a targeted non-probability survey of ER use related to migraine in Canada and the USA. The 18-question online survey addressed ER use and behaviors related to recording attacks.
Results:
The final dataset included 389 respondents (Canada = 164 [42.2%], USA = 225 [57.8%]); 51 (13.1%) were Migraine Buddy app users who shared their diaries. In both countries, participants reported similar migraine symptoms. Barriers to attending the ER included cost and wait times. There was more variability in delays between attack onset and arrival to the ER than between onset and recording in the smartphone app. Younger participants and participants living in Canada were significantly more likely to present to the ER.
Conclusion:
The sample of patients presenting to the ER for migraine may be biased toward younger patients and depend on the jurisdiction. Smartphone app records may have fewer barriers to creation and more consistent time lags compared to ER visit records.
This study explores the impact of heatwaves on emergency calls for assistance resulting in service attendance in the Australian state of Queensland for the period from January 1, 2010 through December 31, 2019. The study uses data from the Queensland Ambulance Service (QAS), a state-wide prehospital health system for emergency health care.
Methods:
A retrospective case series using de-identified data from QAS explored spatial and demographic characteristics of patients attended by ambulance and the reason for attendance. All individuals for which there was an emergency call to “000” that resulted in ambulance attendance in Queensland across the ten years were captured. Demand for ambulance services during heatwave and non-heatwave periods were compared. Incidence rate ratio (IRR) and 95% confidence intervals (CI) were constructed exploring ambulance usage patterns during heatwaves and by rurality, climate zone, age groups, sex, and reasons for attendance.
Results:
Compared with non-heatwave days, ambulance attendance across Queensland increased by 9.3% during heatwave days. The impact of heatwaves on ambulance demand differed by climate zone (high humidity summer with warm winter; hot dry summer with warm winter; warm humid summer with mild winter). Attendances related to heat exposure, dehydration, alcohol/drug use, and sepsis increased substantially during heatwaves.
Conclusion:
Heatwaves are a driver of increased ambulance demand in Queensland. The data raise questions about climatic conditions and heat tolerance, and how future cascading and compounding heat disasters may influence work practices and demands on the ambulance service. Understanding the implications of heatwaves in the prehospital setting is important to inform community, service, and system preparedness.
The Supreme Court issued its first decision on affirmative action in Regents of the University of California v. Bakke in 1978. Like most conflicts about civil rights in this era, the fight over affirmative action is presumed to involve primarily Black and White Americans. But Bakke cannot be understood without including Latino participants in the origin story. During the 1970s, Latinos’ rates of university enrollment increased more than those of any other group, especially in California, where the case originated. So when Bakke’s legal challenge threatened that access, Latino lawyers, students, and higher education advocates collaborated on a strategic defense of affirmative action. They drafted legal briefs, formed regional and national committees, and took to the streets. First in California and then in the East and Midwest, Latinos worked to shape the national discussion over the value of affirmative action and to protect their hard-won gains in higher education.
Although nudges have been shown to influence many choices, it is possible that nudging may also result in undesirable consequences compared to other choice architectures (e.g., educational boosts). Here, we present evidence of one such case involving recycled water acceptance. In two experiments, we compared the effects of a popular nudge (i.e., defaults designed to increase acceptance) with an educational boost (e.g., a brief video designed to support informed decision making). Results revealed that both defaults and educational boosts substantially increased choices related to recycled water acceptance (e.g., >60% increase in enrollment in a hypothetical recycled water program across experiments). However, the educational boost also promoted choice-consistent effects on attitudes, intentions, and knowledge, while default nudges resulted in attitude inconsistency (e.g., expressing worry about recycled water; intending to protest and avoid water recycling). Results add to research on practical and ethical risks of nudging and the potential benefits of comparing the costs of nudges with other options.
Integrating trees and shrubs into agroecosystems increases soil nutrients and organic matter, which helps in the recovery of degraded tropical soils. However, selecting the most appropriate tree and shrub species as sources of nutrients and organic matter requires knowledge of their productive potential. The study aimed to evaluate litter productivity and nutrient input to the soil of three tropical silvopastoral fodder bank species. Litter input from Tithonia diversifolia, Leucaena leucocephala, and Moringa oleifera was quantified monthly for one year. We found that the litterfall amount was greatest (p < 0.05) from T. diversifolia (1.81 t ha–1 yr–1) compared to L. leucocephala (1.26 t ha–1 yr–1) and M. oleifera (118 t ha–1 yr–1). Indeed, T. diversifolia had a greater (p < 0.05) input of biomass from leaves (1.36 t ha–1 yr–1) compared to L. leucocephala (0.901 t ha–1 yr–1) and M. oleifera (0.869 t ha–1 yr–1). The highest biomass input (p < 0.05) occurred in September to the three species, T. diversifolia (0.516 t ha–1), L. leucocephala (0.243 t ha–1), and M. oleifera (0.233 t ha–1), and the lowest biomass input occurred in March. Furthermore, the greatest annual input of carbon (0.687 t ha–1 yr–1), nitrogen (0.030 t ha–1 yr–1), and phosphorus (0.006 t ha–1 yr–1) to the soil originated from T. diversifolia. Our study showed that T. diversifolia had the greatest capacity to produce biomass that potentially can reintroduce nutrients and contribute to the recovery process of degraded soil due to its high litter productivity, besides, a combination of these three species also improves soil nutrients in fodder banks when do not hauling forage for livestock, contributing to sustainability of system.
During mass-casualty incidents (MCIs), prehospital triage is performed to identify which patients most urgently need medical care. Formal MCI triage tools exist, but their performance is variable. The Shock Index (SI; heart rate [HR] divided by systolic blood pressure [SBP]) has previously been shown to be an efficient screening tool for identifying critically ill patients in a variety of in-hospital contexts. The primary objective of this study was to assess the ability of the SI to identify trauma patients requiring urgent life-saving interventions in the prehospital setting.
Methods:
Clinical data captured in the Alberta Trauma Registry (ATR) were used to determine the SI and the “true” triage category of each patient using previously published reference standard definitions. The ATR is a provincial trauma registry that captures clinical records of eligible patients in Alberta, Canada. The primary outcome was the sensitivity of SI to identify patients classified as “Priority 1 (Immediate),” meaning they received urgent life-saving interventions as defined by published consensus-based criteria. Specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated as secondary outcomes. These outcomes were compared to the performance of existing formal MCI triage tools referencing performance characteristics reported in a previously published study.
Results:
Of the 9,448 records that were extracted from the ATR, a total of 8,650 were included in the analysis. The SI threshold maximizing Youden’s index was 0.72. At this threshold, SI had a sensitivity of 0.53 for identifying “Priority 1” patients. At a threshold of 1.00, SI had a sensitivity of 0.19.
Conclusions:
The SI has a relatively low sensitivity and did not out-perform existing MCI triage tools at identifying trauma patients who met the definition of “Priority 1” patients.
We consider families of special cycles, as introduced by Kudla, on Shimura varieties attached to anisotropic quadratic spaces over totally real fields. By augmenting these cycles with Green currents, we obtain classes in the arithmetic Chow groups of the canonical models of these Shimura varieties (viewed as arithmetic varieties over their reflex fields). The main result of this paper asserts that generating series built from these cycles can be identified with the Fourier expansions of non-holomorphic Hilbert-Jacobi modular forms. This result provides evidence for an arithmetic analogue of Kudla’s conjecture relating these cycles to Siegel modular forms.
Scholars have identified several temporal challenges in foreign policymaking, such as variable time horizons and maintaining commitment or resolve over time. While the behavioural turn has emphasised leaders and their subjective perceptions, research often relies on rationalist conceptions of objective and linear time and struggles to assess leaders’ subjective perceptions of it. This paper theorises time as an intrinsic aspect of narrative reasoning in foreign policy, introducing a ‘temporal definition of the situation’ (TDoS) framework to capture leaders’ situation-specific subjective time perceptions. I then operationalise the TDoS framework’s key temporal features and show how it can be empirically examined. The value of the TDoS is illustrated by assessing the temporal perceptions of Bush and Obama regarding Iran’s nuclear programme, showing how their distinct definitions of the foreign policy situation shaped their subjective time perceptions and their corresponding responses. I conclude by discussing how this advancement can enhance behavioural research, provide insights into the ‘why now?’ questions surrounding leaders’ actions, and challenge existing understandings of time’s impact on foreign policymaking.
This paper documents the details of the design, verification, and certification of a novel technology: a remote monitoring system (digital twin) for a voyage data recorder, referred to as the HermAce Gateway. The electronic components, data transfer, and storage principle explain how the HermAce Gateway communicates and records safety-critical messages. Various prospective benefits to the industry are provided, primarily regarding the opportunities for remote support and testing that the digital twin facilitates. The HermAce Gateway was independently verified through a combination of semi-automated software in the loop and selected complimentary hardware in the loop tests. Different types of communication were simulated in multiple ways, including approximating real-world scenarios. Alarms contained in correctly formed messages were found to be detected and recorded by the HermAce Gateway, and a discussion of how this evidence can be quantified in the context of reducing uncertainty in the reliability of a digital twin. Certification of a digital system is a new concept in the maritime industry. The identification of functional requirements, which informed the verification testing, and the development of an AI register for what is expected to be an increasing number of such systems are also documented.
In this study, we obtain the continuum equations of Arctic sea ice motion starting from the dynamics of a single floe and show that the rheology that emerges from floe–floe interactions is viscous – as conjectured by Reed and Campbell (J. Geophys. Res., vol. 67 (1), 1962, pp. 281–297). The motion of the floe is principally driven by the wind and ocean currents and by inelastic collisions with the neighbouring floes. A mean-field representation of these collisions is developed, neglecting any changes in the floe thickness due to thermal growth and mechanical deformation. This mean-field representation depends on the state of the ice cover, and is expressed in terms of ice concentration and mean thickness. The resulting Langevin equation for the floe velocity, or the corresponding kinetic equation (Kramers–Chandrasekhar equation (KCE)) for its probability density, provides a complete description of the floe’s motion. We then use the floe-scale dynamics to obtain a continuum description of sea ice motion through a Chapman–Enskog analysis of the KCE. The local equilibrium solution to the kinetic equation is found to be the Laplace distribution, in qualitative agreement with observations. Our approach also allows us to establish the dependence of pressure and shear viscosity of the ice cover on ice concentration and mean thickness. Lastly, we show that our results resolve a conflict associated with the choice of the value of shear viscosity in previous idealised numerical studies of Arctic sea ice motion.
This article examines the impact of generative artificial intelligence (GAI) on higher education, emphasizing its effects in the broader educational contexts. As AI continues to reshape the landscape of teaching and learning, it is imperative for higher education institutions to adapt rapidly to equip graduates for the challenges of a progressively automated global workforce. However, a critical question emerges: will GAI lead to a more inclusive future of learning, or will it deepen existing divides and create a future where educational access and success are increasingly unequal? This study employs both theoretical and empirical approaches to explore the transformative potential of GAI. Drawing upon the literature on AI and education, we establish a framework that categorizes the essential knowledge and skills needed by graduates in the GAI era. This framework includes four key capability sets: AI ethics, AI literacy (focusing on human-replacement technologies), human–AI collaboration (emphasizing human augmentation), and human-distinctive capacities (highlighting unique human intelligence). Our empirical analysis involves scrutinizing GAI policy documents and the core curricula mandated for all graduates across leading Asian universities. Contrary to expectations of a uniform AI-driven educational transformation, our findings expose significant disparities in AI readiness and implementation among these institutions. These disparities, shaped by national and institutional specifics, are likely to exacerbate existing inequalities in educational outcomes, leading to divergent futures for individuals and universities alike in the age of GAI. Thus, this article not only maps the current landscape but also forecasts the widening educational gaps that GAI might engender.
Palliative care is a critical component of healthcare, yet its integration into Nigeria’s health system remains limited. Despite the growing burden of life-limiting illnesses, palliative care is underdeveloped, primarily restricted to tertiary institutions. This review examines the evolution of palliative care in Nigeria, key milestones, persistent challenges, and future directions for strengthening its implementation.
Methods
This narrative review synthesized historical records, policy documents, and literature on palliative care in Nigeria. It examined leadership roles, institutional efforts, and government policies influencing Palliative care growth, while highlighting implementation gaps and opportunities.
Results
Palliative care in Nigeria has evolved from early grassroots efforts to structured institutional services. Key milestones include the establishment of the Hospice and Palliative Care Association of Nigeria (HPCAN), and policy advancements such as the National Policy and Strategic Plan for Hospice and Palliative Care. Despite these developments, challenges persist, including inadequate funding, workforce shortages, limited opioid access, policy implementation gaps, and socio-cultural barriers. Leadership engagement, targeted policy advocacy, and comprehensive capacity-building are essential to overcoming these barriers.
Significance of Results
Sustained efforts are needed to fully integrate palliative care into Nigeria’s healthcare system. Strategic interventions, including enhanced policy implementation, funding mechanisms, workforce development, and community engagement, are critical for ensuring equitable access to PC services. Strengthening collaborations between the government, healthcare institutions, and international partners will accelerate progress, ultimately improving the quality of life for patients with life-limiting illnesses.
Variation between general practices in the rate of consultations for musculoskeletal pain conditions may signal important differences in access to primary care, perceived usefulness, or available alternative sources of care; however, it might also just reflect differences in underlying ‘need’ between practices’ registered populations. In a study of 30 general practices in Staffordshire, we calculated the proportion of adults consulting for a musculoskeletal pain condition, then examined this in relation to selected practice and population characteristics, including the estimated prevalence of self-reported musculoskeletal problems and chronic pain in each practices’ registered population. Between September 2021 and July 2022, 18,388 adults were consulted for a musculoskeletal pain condition. After controlling for length of recruitment, time of year, and age-sex structure, the proportion consulting varied up to two-fold between practices but was not strongly associated with the prevalence of self-reported long-term musculoskeletal problems, chronic pain, and high-impact chronic pain.