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Recent research highlights the dynamics of suicide risk, resulting in a shift toward real-time methodologies, such as ecological momentary assessment (EMA), to improve suicide risk identification. However, EMA’s reliance on active self-reporting introduces challenges, including participant burden and reduced response rates during crises. This study explores the potential of Screenomics—a passive digital phenotyping method that captures intensive, real-time smartphone screenshots—to detect suicide risk through text-based analysis.
Method
Seventy-nine participants with past-month suicidal ideation or behavior completed daily EMA prompts and provided smartphone data over 28 days, resulting in approximately 7.5 million screenshots. Text from screenshots was analyzed using a validated dictionary encompassing suicide-related and general risk language.
Results
Results indicated significant associations between passive and active suicidal ideation and suicide planning with specific language patterns. Detection of words related to suicidal thoughts and general risk-related words strongly correlated with self-reported suicide risk, with distinct between- and within-person effects highlighting the dynamic nature of suicide risk factors.
Conclusions
This study demonstrates the feasibility of leveraging smartphone text data for real-time suicide risk detection, offering a scalable, low-burden alternative to traditional methods. Findings suggest that dynamic, individualized monitoring via passive data collection could enhance suicide prevention efforts by enabling timely, tailored interventions. Future research should refine language models and explore diverse populations to extend the generalizability of this innovative approach.
We argue that editorial independence, through robust practice of publication ethics and research integrity, promotes good science and prevents bad science. We elucidate the concept of research integrity, and then discuss the dimensions of editorial independence. Best practice guidelines exist, but compliance with these guidelines varies. Therefore, we make recommendations for protecting and strengthening editorial independence.
The economic and social welfare of people living in Australia has been shaped by different sets of laws: Indigenous laws that meant individual welfare was ensured by family and kin, British laws that decreed welfare a distinct domain for managing the casualties of a hierarchical social order, and a settler colonial adaptation of the British system in which the colonial state provided the infrastructure for growth. This chapter argues that while state investment worked in positive ways for settler economies, it acted as the motor of Indigenous dispossession – though Indigenous communities maintained customary law and adapted settler welfare for their own well-being. White women were marginalised in settler economies but feminist agitation focussed on state welfare as the source of reform. The last 30 years have seen social investment in retreat, though it was revived during the Global Financial crisis and against Covid-19. The early 21st century has also witnessed the increasing dissemination of Indigenous ideas of well-being. The histories of these enduring strands provide some clarity on how we might approach what some have argued is impending automation and a ‘post-work future’.
To examine the costs and cost-effectiveness of mirtazapine compared to placebo over 12-week follow-up.
Design:
Economic evaluation in a double-blind randomized controlled trial of mirtazapine vs. placebo.
Setting:
Community settings and care homes in 26 UK centers.
Participants:
People with probable or possible Alzheimer’s disease and agitation.
Measurements:
Primary outcome included incremental cost of participants’ health and social care per 6-point difference in CMAI score at 12 weeks. Secondary cost-utility analyses examined participants’ and unpaid carers’ gain in quality-adjusted life years (derived from EQ-5D-5L, DEMQOL-Proxy-U, and DEMQOL-U) from the health and social care and societal perspectives.
Results:
One hundred and two participants were allocated to each group; 81 mirtazapine and 90 placebo participants completed a 12-week assessment (87 and 95, respectively, completed a 6-week assessment). Mirtazapine and placebo groups did not differ on mean CMAI scores or health and social care costs over the study period, before or after adjustment for center and living arrangement (independent living/care home). On the primary outcome, neither mirtazapine nor placebo could be considered a cost-effective strategy with a high level of confidence. Groups did not differ in terms of participant self- or proxy-rated or carer self-rated quality of life scores, health and social care or societal costs, before or after adjustment.
Conclusions:
On cost-effectiveness grounds, the use of mirtazapine cannot be recommended for agitated behaviors in people living with dementia. Effective and cost-effective medications for agitation in dementia remain to be identified in cases where non-pharmacological strategies for managing agitation have been unsuccessful.
Older adults (≥65 years) are the fastest growing population group. Thus, ensuring nutritional well-being of the ‘over-65s’ to optimise health is critically important. Older adults represent a diverse population – some are fit and healthy, others are frail and many live with chronic conditions. Up to 78% of older Irish adults living independently are overweight or obese. The present paper describes how these issues were accommodated into the development of food-based dietary guidelines for older adults living independently in Ireland. Food-based dietary guidelines previously established for the general adult population served as the basis for developing more specific recommendations appropriate for older adults. Published international reports were used to update nutrient intake goals for older adults, and available Irish data on dietary intakes and nutritional status biomarkers were explored from a population-based study (the National Adult Nutrition Survey; NANS) and two longitudinal cohorts: the Trinity-Ulster and Department of Agriculture (TUDA) and the Irish Longitudinal Study on Ageing (TILDA) studies. Nutrients of public health concern were identified for further examination. While most nutrient intake goals were similar to those for the general adult population, other aspects were identified where nutritional concerns of ageing require more specific food-based dietary guidelines. These include, a more protein-dense diet using high-quality protein foods to preserve muscle mass; weight maintenance in overweight or obese older adults with no health issues and, where weight-loss is required, that lean tissue is preserved; the promotion of fortified foods, particularly as a bioavailable source of B vitamins and the need for vitamin D supplementation.
We compared survival in four cohorts of dementia patients– Lewy body (LBD), Parkinson's (PDD), Vascular (VD) and Alzheimer's dementia (AD) - in patients referred into Cambridge and Peterborough NHS Foundation Trust (CPFT) mental health services.
Additionally, we investigated reasons for variation in survival in the four cohorts.
Method
Using electronic records we identified retrospective cohorts of patients referred into services from 2013 onwards. Cases of LBD and PDD were identified using text searches, and comparison cohorts with AD or VD identified using ICD10 diagnosis codes ((F00.*) or (F01.*) respectively).
We collected referral (date of referral and service referred into), demographic (date of birth and gender) and diagnosis data on the patients in the four cohorts. Dates of death were available, through central NHS reporting to Trusts.
We used date of first referral as start of the follow-up and end of follow-up, death or 31/12/19. We used Kaplan-Meier and Cox survival analysis to compare survival in the four cohorts.
The cohorts were crossed with Hospital Episode Statistics (HES) data to extract hospital admission diagnoses. We extracted diagnoses of pneumonia due to aspiration and recurrent falls from hospital admissions data using ICD codes (J69.0 and R29.6 respectively). We calculated prevalence of these diagnoses in the dementia groups, in males and females separately.
Result
In Cox analysis (controlling for age at referral, gender and service referred into), the hazard ratio (HR) for death was highest for the PDD group (HR 2.0 (95% CI 1.7–2.4)), followed by LBD (HR 1.4 (95% CI 1.3–1.6)), then VD (HR 1.2 (95% CI 1.0–1.3)), with the AD group as reference. In the same analysis repeated separately for males and females, the highest HR was found in males with PDD (HR 2.3 (95% CI 1.8–2.8)).
Referrals to liaison psychiatry were associated with reduced survival compared to other mental health services (HR 1.7 (95% CI 1.5–2.0)).
The AD cohort showed the lowest rates of pneumonia due to aspiration and recurrent falls in males and in females. The highest rate of pneumonia due to aspiration was found in the male PDD group (27%).
Conclusion
In patients with dementia referred into mental health services, those with AD survive longer compared to other dementia groups, with PDD patients at highest risk of death. Physical frailty including risk of aspiration, is likely to account for some of this difference in survival.
In the last twenty years, the involvement of women's organizations in the campaign for Irish independence has featured prominently in publications and public discourse. But this article asks, did women serve the cause for independence in other ways? This article focuses on the careers of Irish women who worked for the Irish Department of Foreign Affairs in the period 1919–22, pressing Ireland's case for autonomy from British rule. The work of these early women abroad has been largely ignored by historians who have concentrated on the diplomatic activities of men in this period. This article first argues that these women who worked towards achieving independence for Ireland through the use of diplomacy and propaganda merit attention, but secondly they can be considered providing further insights into how women's work for the cause of Irish freedom did not warrant them a place in the diplomatic service in the new Irish Free State.
Child characteristics, family factors, and preschool factors are all found to affect the rate of bilingual children's vocabulary development in heritage language (HL). However, what remains unknown is the relative importance of these three sets of factors in HL vocabulary growth. The current study explored the complex issue with 457 Singaporean preschool children who are speaking either Mandarin, Malay, or Tamil as their HL. A series of internal factors (e.g., non-verbal intelligence) and external factors (e.g., maternal educational level) were used to predict children's HL vocabulary growth over a year at preschool with linear mixed effects models.
The results demonstrated that external factors (i.e., family and preschool factors) are relatively more important than child characteristics in enhancing bilingual children's HL vocabulary growth. Specifically, children's language input quantity (i.e., home language dominance), input quality (e.g., number of books in HL), and HL input quantity at school (i.e., the time between two waves of tests at preschool) predict the participants’ HL vocabulary growth, with initial vocabulary controlled. The relative importance of external factors in bilingual children's HL vocabulary development is attributed to the general bilingual setting in Singapore, where HL is taken as a subject to learn at preschool and children have fairly limited exposure to HL in general. The limited amount of input might not suffice to trigger the full expression of internal resources. Our findings suggest the crucial roles that caregivers and preschools play in early HL education, and the necessity of more parental involvement in early HL learning in particular.
To code-switch or not to code-switch? This is a dilemma for many bilingual language teachers. In this study, the influence of teachers’ CS on bilingual children's language and cognitive development is explored within heritage language (HL) classes in Singapore. Specifically, the relationship between children's language output, vocabulary development, and cognitive flexibility to teachers’ classroom CS behavior, is examined within 20 preschool HL classrooms (10 Mandarin, 6 Malay, and 4 Tamil). Teachers’ and children's utterances were recorded, transcribed, and analyzed for CS frequency and type (i.e., inter-sentential, intra-sentential). 173 students were assessed with receptive vocabulary and dimensional card sort tasks, and their vocabulary and cognitive switching scores assessed using correlational and mixed effects analyses. Results show that inter-sentential and intra-sentential CS frequency is positively and significantly related to children's intra-sentential CS frequency. Overall, findings revealed that teachers code-switched habitually more often than for instructional purposes. Neither inter-sentential nor intra-sentential CS was significantly related to children's development in HL vocabulary, and intra-sentential CS was found to positively and significantly relate to children's growth in cognitive flexibility. These findings reveal the multi-faceted impact of teacher's CS on children's early development.
Simulation plays an integral role in the Canadian healthcare system with applications in quality improvement, systems development, and medical education. High-quality, simulation-based research will ensure its effective use. This study sought to summarize simulation-based research activity and its facilitators and barriers, as well as establish priorities for simulation-based research in Canadian emergency medicine (EM).
Methods
Simulation-leads from Canadian departments or divisions of EM associated with a general FRCP-EM training program surveyed and documented active EM simulation-based research at their institutions and identified the perceived facilitators and barriers. Priorities for simulation-based research were generated by simulation-leads via a second survey; these were grouped into themes and finally endorsed by consensus during an in-person meeting of simulation leads. Priority themes were also reviewed by senior simulation educators.
Results
Twenty simulation-leads representing all 14 invited institutions participated in the study between February and May, 2018. Sixty-two active, simulation-based research projects were identified (median per institution = 4.5, IQR 4), as well as six common facilitators and five barriers. Forty-nine priorities for simulation-based research were reported and summarized into eight themes: simulation in competency-based medical education, simulation for inter-professional learning, simulation for summative assessment, simulation for continuing professional development, national curricular development, best practices in simulation-based education, simulation-based education outcomes, and simulation as an investigative methodology.
Conclusion
This study summarized simulation-based research activity in EM in Canada, identified its perceived facilitators and barriers, and built national consensus on priority research themes. This represents the first step in the development of a simulation-based research agenda specific to Canadian EM.
By using the League of Nations and United Nations as case studies, this article identifies the women working at the diplomatic level in the Irish Department of External Affairs (D.E.A.) in the period 1923–76. Drawing on gender analysis, the article assesses where men and women were positioned in Irish diplomacy and asks if the role of women in the D.E.A. was shaped by a gendered viewpoint. It argues that there were more opportunities for women within the United Nations than the League of Nations and it questions if these increased diplomatic opportunities were reflective of women's changing status within the D.E.A. in the period under investigation. Overall, the article offers a new perspective on the conduct of Irish foreign policy between 1923 and 1976.
With the advent of digital technology, readers increasingly find themselves browsing through multiple sources of information. This chapter sheds light on some of the skills and processes that are needed for learners to comprehend multiple texts. The chapter also reveals some key conditions that may facilitate or hinder the application of these processes.
Both internal factors (e.g., nonverbal intelligence) and external factors (e.g., input quantity) are claimed to affect the rate of children's vocabulary development. However, it remains an open question whether these variables work similarly on bilingual children's dual language learning. The current paper examined this issue on 805 Singapore children (4 years, 1 month to 5 years, 8 months) who are learning English (societal language) and an ethnic language (Mandarin/Malay/Tamil). Singapore is a bilingual society; however, there is an inclination for English use at home in recent years, resulting in a discrepancy of input between English and ethnic languages in many families. In this study, internal and external factors were examined comprehensively with standardized tests and a parental questionnaire. Regression analysis was used to address the questions. There were statistically significant differences in language input quantity, quality, and output between English and ethnic language learning environments. Singapore children are learning English in an input-rich setting while learning their ethnic language in a comparatively input-poor setting. Multiple regressions revealed that while both sets of factors explained lexical knowledge in each language, the relative contribution is different for English and ethnic languages: internal factors explained more variance in English language vocabulary, whereas external factors were more important in explaining ethnic language knowledge. We attribute this difference to a threshold effect of external factors based on the critical mass hypothesis and call for special attention to learning context (input-rich vs. input-poor settings) for specific bilingual language studies.
From the Counter-Reformation to the present, women in a variety of contexts of colonization, decolonization, and slavery crossed the threshold from missionary congregation to missionary workforce to live in Catholic religious community. Comparative, transnational analysis provides insights from a variety of angles into the myriad local factors that fashioned their understandings of the relationship between the spiritual and material benefits so gained. Their experiences were uneven, shaped by the race, gender, and status politics of each ecclesiastical and secular context, by their usefulness to the wider missionary project and the state, and by shifts in ecclesiastical rulings that were prompted by changes in the Vatican’s temporal status. In the later twentieth century, some became activists and advocates, using their symbolic power to work in the interests of women and poor people, and to reform the patriarchy at the core of the church.
Ronald Mason’s hypothesis from the 1960s that the southeastern United States possesses greater Paleoindian projectile-point diversity than other regions is regularly cited, and often assumed to be true, but in fact has never been quantitatively tested. Even if valid, however, the evolutionary meaning of this diversity is contested. Point diversity is often linked to Clovis “origins,” but point diversity could also arise from group fissioning and drift, admixture, adaptation, or multiple founding events, among other possibilities. Before archaeologists can even begin to discuss these scenarios, it is paramount to ensure that what we think we know is representative of reality. To this end, we tested Mason’s hypothesis for the first time, using a sample of 1,056 Paleoindian points from eastern North America arui employing paradigmatic classification and rigorous statistical tools used in the quantification of ecological biodiversity. Our first set of analyses, which compared the Southeast to the Northeast, showed that the Southeast did indeed possess significantly greater point-class richness. Although this result was consistent with Mason’s hypothesis, our second set of analyses, which compared the Upper Southeast to the Lower Southeast and the Northeast showed that in terms of point-class richness the Upper Southeast > Lower Southeast > Northeast. Given current chronometrie evidence, we suggest that this latter result is consistent with the suggestion that the area of the Ohio, Cumberland, and Tennessee River valleys, as well as the mid-Atlantic coastal plain, were possible initial and secondary “staging areas” for colonizing Paleoindian foragers moving from western to eastern North America.
Inferencing is defined as 'the act of deriving logical conclusions from premises known or assumed to be true', and it is one of the most important processes necessary for successful comprehension during reading. This volume features contributions by distinguished researchers in cognitive psychology, educational psychology, and neuroscience on topics central to our understanding of the inferential process during reading. The chapters cover aspects of inferencing that range from the fundamental bottom-up processes that form the basis for an inference to occur, to the more strategic processes that transpire when a reader is engaged in literary understanding of a text. Basic activation mechanisms, word-level inferencing, methodological considerations, inference validation, causal inferencing, emotion, development of inferences processes as a skill, embodiment, contributions from neuroscience, and applications to naturalistic text are all covered as well as expository text, online learning materials, and literary immersion.