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Why, What, Who, When are a set of questions, sometimes referred to as the ‘WH calibration questions’ that help interrogate a concept in terms of its application and utility. In this article these questions are used to evaluate decisions made by footballers around their mental health (MH) and wellbeing. They allow us to examine the help-seeking behaviours of footballers, such as: Why seek help? What help is available? Who to go to? When’s the right time? The article examines the psychotherapies, mainly CBT, suitable for football players and offers practical examples of how clubs have supported their players. The roles of multi-disciplinary team members involved in promoting the wellbeing of players are discussed. The content of this paper is based on a review of the literature and personal knowledge of the authors’ experiences as MH clinicians in professional football clubs.
Key learning aims
(1) To show the extent to which professional footballers experience mental health difficulties, and the nature of these problems.
(2) To highlight the thought processes of footballers during their management of their mental health.
(3) To provide a description of the therapies available to footballers, and highlighting the forms of CBT in common use.
(4) To emphasise the need for a holistic approach to MH provision, and clarify the roles of people within football clubs who provide MH support.
(5) To reflect on the need for ‘in-house’ specialist mental health input within professional football clubs.
Despite the increased awareness and action towards Equality, Diversity and Inclusion (EDI), the glaciological community still experiences and perpetuates examples of exclusionary and discriminatory behavior. We here discuss the challenges and visions from a group predominantly composed of early-career researchers from the 2023 edition of the Karthaus Summer School on Ice Sheets and Glaciers in the Climate System. This paper presents the results of an EDI-focused workshop that the 36 students and 12 lecturers who attended the summer school actively participated in. We identify common threads from participant responses and distill them into collective visions for the future of the glaciological research community, built on actionable steps toward change. In this paper, we address the following questions that guided the workshop: What do we see as current EDI challenges in the glaciology research community and which improvements would we like to see in the next fifty years? Contributions have been sorted into three main challenges we want and need to face: making glaciology (1) more accessible, (2) more equitable and (3) more responsible.
Does low mood have intentional content? If so, what is it? Philosophers have tried to answer both questions by appealing to low mood’s phenomenal character. However, appeals to phenomenology have not settled this debate. Thus, I take a different approach: I tackle both questions by examining low mood’s complex functional role in cognition. I argue that if we take this role into account, we have excellent reason to believe that low mood a) has content, and b) has the following indicative-imperative content: Good events are, on average, less likely to occur than bad events & Limit [the subject’s] resource expenditure!
Pathogenic CACNA1A mutations can result in paroxysmal attacks of encephalopathy, hemiplegia and cerebral edema. We report two patients with CACNA1A-associated encephalopathy, hemiplegia and contralateral hemispheric cerebral edema treated successfully with intravenous magnesium sulfate and dexamethasone. One patient met the clinical criteria for familial hemiplegic migraine. There is a paucity of guidance in the literature on how to manage these patients. Despite some discrepancies in the treatment protocols in our two cases, they indicate that magnesium and dexamethasone could be part of the treatment algorithm for these patients. Further research to delineate appropriate dosing and duration of therapy is needed.
This chapter is a comprehensive history of sexually-explicit literature drawn from books banned and prosecuted in Asia and Europe, sixteenth to twentieth centuries. The prurient treatment of sexual violence and the lewd mockery of authority form part of this discourse, yet law and censorship denied its literary value, reduced all erotica to the most basic “obscenity” or mere “pornography” (literally, “whore-writing”), and sometimes put the author to death. (Paradoxically the cultures richest in sex-writing also suppressed it most fiercely.) Here is a more complex history, hybridizing multiple genres: manuals of sexual positions, courtesans” autobiography, satire against hypocrisy and repression, philosophies of mind, body, and desire – normally homoerotic, though in China and the West true knowledge of sexuality is represented as female, passed down by mistresses of the secret arts providing instructions for the wedding night (and beyond). The phallus was even gendered female. Libertinism continued to explore same-sex desire (especially in Italy and Japan), while its heteronormative branch dissociated sexuality from procreation, insisting that biological sex should be transformed into an art of aesthetic “transmutation”, urging women to pursue erotic pleasure as a supreme end in itself – centuries before contraception made this realistic. Feminocentric and masculinist perspectives intertwine.
Fervent expressions of erotic desire, the beauty and terror of passionate arousal, are here uncovered in religious texts, creation myths, ‘arts of love’, poetry and fiction across four millenia and twenty-four cultures. The chapter starts with an example known throughout the world: the Hebrew love poem preserved as The Song of Songs or Song of Solomon, translated into many languages including German, Chinese and Yoruba, emulated by Oscar Wilde and Toni Morrison. It argues that the Song and related literature are significant for the frank celebration of mutuality and orgasm, and the psychological understanding of cruelty and loss, rather than for their supposed spiritual meanings. These central themes are traced back to the most ancient narratives of primal copulation (including the Sumerian Epic of Gilgamesh) and forward to intensely sexual episodes in Milton, Goethe, James Joyce, D. H. Lawrence and women authors from Mediaeval mystics up to the present. A closely related literary genre turns love-making into an art form, cultivated for its own sake: examples come from ancient Egypt and Rome, the Indian Kama Sutra, the Arabic Perfumed Garden, the Modi of Aretino in Renaissance Italy, and French, Chinese and Japanese novels of sexual instruction and adventure.
Adsorption of uranyl to SWy-1 montmorillonite was evaluated experimentally and results were modeled to identify likely surface complexation reactions responsible for removal of uranyl from solution. Uranyl was contacted with SWy-1 montmorillonite in a NaCIO4 electrolyte solution at three ionic strengths (I = 0.001, 0.01, 0.1), at pH 4 to 8.5, in a N2(g) atmosphere. At low ionic strength, adsorption decreased from 95% at pH 4 to 75% at pH 6.8. At higher ionic strength, adsorption increased with pH from initial values less than 75%; adsorption edges for all ionic strengths coalesced above a pH of 7. A site-binding model was applied that treated SWy-1 as an aggregate of fixed-charge sites and edge sites analogous to gibbsite and silica. The concentration of fixed-charge sites was estimated as the cation exchange capacity, and non-preference exchange was assumed in calculating the contribution of fixed-charge sites to total uranyl adsorption. The concentration of edge sites was estimated by image analysis of transmission electron photomicrographs. Adsorption constants for uranyl binding to gibbsite and silica were determined by fitting to experimental data, and these adsorption constants were then used to simulate SWy-1 adsorption results. The best simulations were obtained with an ionization model in which AlOH2+ was the dominant aluminol surface species throughout the experimental range in pH. The pH-dependent aqueous speciation of uranyl was an important factor determining the magnitude of uranyl adsorption. At low ionic strength and low pH, adsorption by fixed-charge sites was predominant. The decrease in adsorption with increasing pH was caused by the formation of monovalent aqueous uranyl species, which were weakly bound to fixed-charge sites. At higher ionic strengths, competition with Na+ decreased the adsorption of UO22+ to fixed-charge sites. At higher pH, the most significant adsorption reactions were the binding of UO22+ to AlOH and of (UO2)3(OH)5+ to SiOH edge sites. Near-saturation of AlOH sites by UO22+ allowed significant contributions of SiOH sites to uranyl adsorption.
To investigate the symptoms of SARS-CoV-2 infection, their dynamics and their discriminatory power for the disease using longitudinally, prospectively collected information reported at the time of their occurrence. We have analysed data from a large phase 3 clinical UK COVID-19 vaccine trial. The alpha variant was the predominant strain. Participants were assessed for SARS-CoV-2 infection via nasal/throat PCR at recruitment, vaccination appointments, and when symptomatic. Statistical techniques were implemented to infer estimates representative of the UK population, accounting for multiple symptomatic episodes associated with one individual. An optimal diagnostic model for SARS-CoV-2 infection was derived. The 4-month prevalence of SARS-CoV-2 was 2.1%; increasing to 19.4% (16.0%–22.7%) in participants reporting loss of appetite and 31.9% (27.1%–36.8%) in those with anosmia/ageusia. The model identified anosmia and/or ageusia, fever, congestion, and cough to be significantly associated with SARS-CoV-2 infection. Symptoms’ dynamics were vastly different in the two groups; after a slow start peaking later and lasting longer in PCR+ participants, whilst exhibiting a consistent decline in PCR- participants, with, on average, fewer than 3 days of symptoms reported. Anosmia/ageusia peaked late in confirmed SARS-CoV-2 infection (day 12), indicating a low discrimination power for early disease diagnosis.
Environmental sensors are crucial for monitoring weather conditions and the impacts of climate change. However, it is challenging to place sensors in a way that maximises the informativeness of their measurements, particularly in remote regions like Antarctica. Probabilistic machine learning models can suggest informative sensor placements by finding sites that maximally reduce prediction uncertainty. Gaussian process (GP) models are widely used for this purpose, but they struggle with capturing complex non-stationary behaviour and scaling to large datasets. This paper proposes using a convolutional Gaussian neural process (ConvGNP) to address these issues. A ConvGNP uses neural networks to parameterise a joint Gaussian distribution at arbitrary target locations, enabling flexibility and scalability. Using simulated surface air temperature anomaly over Antarctica as training data, the ConvGNP learns spatial and seasonal non-stationarities, outperforming a non-stationary GP baseline. In a simulated sensor placement experiment, the ConvGNP better predicts the performance boost obtained from new observations than GP baselines, leading to more informative sensor placements. We contrast our approach with physics-based sensor placement methods and propose future steps towards an operational sensor placement recommendation system. Our work could help to realise environmental digital twins that actively direct measurement sampling to improve the digital representation of reality.
The management of alcohol withdrawal has become a national focus amongst psychiatry with recent POMH-UK audit data suggesting many aspects for improvement, whilst alcohol competencies have been reintroduced into the core training curriculum. The first part of this project was to evaluate the current standards of assessing and managing alcohol withdrawal on acute inpatient wards within Livewell South West and to survey doctors’ confidence levels in this area.
Methods
All admissions to the acute adult and older adult inpatient wards at Livewell SW between March and July 2022 were included in the initial data collection. An audit tool was designed to evaluate the initial assessment of alcohol use, the withdrawal risk and subsequent management. Guidance was provided to the authors assessing the records.
A survey to all doctors was conducted during a CPD session about this project which assessed confidence levels in the assessment and management of alcohol withdrawal.
Results
On initiation of this project, it was noted there was no trust guideline or policy to manage those presenting with possible alcohol withdrawal symptoms.
120 patient admissions were assessed against the audit tool. Half of these (53%) had alcohol intake documented on admission.
11 patients (9%) were found to be at risk of alcohol withdrawal symptoms (n.b 46% too little data). 5 (45%) of these were identified promptly and 4 (36%) were given thiamine (1 parental, 3 oral). Only 4 out of the 11 (36%) were prescribed benzodiazepines, these 4 patients were also considered for referral to alcohol services. Relapse medications were not considered for any patients. No significant incidents were noted.
Generally, trainee doctors feel confident in recognising and managing alcohol withdrawal in acute hospital settings but have difficulties on psychiatric inpatient wards. A major reason stated for this was the difficulty distinguishing between psychiatric and alcohol withdrawal symptoms and also concerns surrounding prescribing benzodiazepines
Conclusion
This project identified a need for a trust policy which has subsequently been developed and is currently being ratified.
The initial baseline results show poor assessment of alcohol use and low confidence amongst doctors in assessing and managing alcohol withdrawal in this population. Several interventions have been identified that could be trialled to improve these results. Further training has been given to junior doctors involved in initial assessment and other interventions planned include posters, electronic prompts, nursing survey and education. Furthermore, patient focus groups are planned to understand patients’ perspective and help guide further training.
Social learning is a critical adaptation for dealing with different forms of variability. Uncertainty is a severe form of variability where the space of possible decisions or probabilities of associated outcomes are unknown. We identified four theoretically important sources of uncertainty: temporal environmental variability; payoff ambiguity; selection-set size; and effective lifespan. When these combine, it is nearly impossible to fully learn about the environment. We develop an evolutionary agent-based model to test how each form of uncertainty affects the evolution of social learning. Agents perform one of several behaviours, modelled as a multi-armed bandit, to acquire payoffs. All agents learn about behavioural payoffs individually through an adaptive behaviour-choice model that uses a softmax decision rule. Use of vertical and oblique payoff-biased social learning evolved to serve as a scaffold for adaptive individual learning – they are not opposite strategies. Different types of uncertainty had varying effects. Temporal environmental variability suppressed social learning, whereas larger selection-set size promoted social learning, even when the environment changed frequently. Payoff ambiguity and lifespan interacted with other uncertainty parameters. This study begins to explain how social learning can predominate despite highly variable real-world environments when effective individual learning helps individuals recover from learning outdated social information.
This chapter examines the development of the just war idea in Christian thought from its beginnings through its taking classic shape until the early modern period, when it became the basis for the idea of the law of nations while also remaining as a religious concept in both Catholic and Protestant thought.
The frescoes of Peruzzi, Raphael and Sodoma still dazzle visitors to the Villa Farnesina, but they survive in a stripped-down environment bereft of its landscape, sealed so it cannot breathe. Turner takes you outside that box, restoring these canonical images to their original context, when each element joined in a productive conversation. He is the first to reconstruct the architect-painter Peruzzi's original, well-proportioned, well-appointed building and to re-visualize his lost façade decoration‒erotic scenes and mythological figures who make it come alive and soar upward. More comprehensively than any previous scholar, he reintegrates painting, sculpture, architecture, garden design, topographical prints and drawings, archaeological discoveries and literature from the brilliant circle around the patron Agostino Chigi, the powerful banker who 'loved all virtuosi' and commissioned his villa-palazzo from the best talents in multiple arts. It can now be understood as a Palace of Venus, celebrating aesthetic, social and erotic pleasure.
This chapter examines the early evolution of Peruzzi’s own wall-painting and architectural decoration, including the St Helena Chapel in S. Croce in Gerusalemme, Rome, the Castello in Ostia, and the first of his frescoes for the Farnesina itself, in the Sala or Stanza del Fregio (‘the room of the frieze’). It will also review the influences studied in Chapter 1, from Peruzzi’s earliest work in Siena cathedral, comparing his innovations with those of Pinturicchio and the young Raphael. I see the Farnesina frieze as a pivotal work for Peruzzi, synthesising earlier study of antiquities (some close at hand) and looking forward to the more public astrological vault. Most observers stress the difference between these two projects, one intimate, animated and softly lit, the other bright, ‘cold and pale’, formal and stylised as befits its official function of proclaiming the patron’s destiny (n. 59 in this chapter). Here, in contrast, I will suggest affinities between them.
Peruzzi’s next figurative project after the Stanza del Fregio was to decorate the exterior of the new villa. This astonishingly ambitious design task involved not only the three-dimensional elements that still variegate the plain façade – austere pilasters and window-cases, topped by the spectacular cornicione or ‘great cornice’ with its acanthus brackets above a frieze of swags and putti moulded in stucco – but paintings that gave the illusion of sculptures and reliefs. The eyewitness Vasari, in the passage cited as my first epigraph, thought that the grace and natural beauty of Peruzzi’s architecture owed much to its being ‘adorned on the outside’ with storie or ‘histories’ by his own hand, some of them ‘molto belle’ (iv.318). We will see that Peruzzi himself called such narrative panels ‘Istorie’ and confronted the problem of ‘accommodating’ them to architecture.
Latin poems by Egidio Gallo and Blosio Palladio, set within a cluster of other verses, literary allusions and archival documents, let us grasp what might have been seen before the villa was complete, and how Chigi’s circle imagined his projected works. Using lost material brought to light in Chapter 3, plus legal records, visitors’ accounts of the building, overlooked details from sixteenth-century views of Rome, and neglected evidence still on the grounds, this chapter will correlate extant remains and poetic tributes, building an extensive picture of the estate as a multiplicity of buildings integrated into the landscape garden. Common themes unite painting, sculpture, architecture and topography. I recognise literary conventions and hyperboles, but I also argue for considerable insight and visual acuity in these authors; Blosio was so impressed that he later asked Peruzzi to design his own town house and the gardens of his ambitious villa, where he commissioned frescoes that echo the exterior paintings of the Farnesina – some of them still in situ (Figs. 4.1, 4.2).