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While it is vital to agree to a set of global objectives and targets to reduce plastic pollution as part of the Global Plastic Treaty, past negotiations have been troubled by differences in regional and national priorities and needs. To take these different priorities and needs into account, this letter proposes the adoption of an interdisciplinary source-to-sea approach. A source-to-sea approach emphasizes the connected nature between land-based sources of marine plastic pollution along the life cycle of plastic products on the one hand, and air, soil, and water cycles that determine marine plastic flows and associated sustainability risks on the other hand. It takes into account how we know more about the way in which production, use and plastic waste contribute to the pollution of rivers and seas in one location (e.g. in Europe), than we do for rivers and seas in other places (e.g. Africa). There are also regional and national differences in how much awareness exist about plastic pollution and how it is governed and regulated. These differences translate in different priorities and needs in terms of how to most efficiently and effectively reduce plastic pollution. The letter argues that these differences should be embraced and that an interdisciplinary source-to-sea approach can help to develop tailor-made regional and national targets and measures that in turn contribute to achieving the global ambitions of the Global Plastic Treaty. A key role is foreseen for existing governance institutions, such as river basin commissions and regional seas conventions (coordinated by UNEP Regional seas Programme), while the Global Plastic Treaty can become a platform for sharing of approaches, lessons and strategies between regions and countries so that over time, plastic pollution will be reduced worldwide.
The world is facing multiple interconnected crises, from climate change and economic instability to social inequalities and geopolitical tensions. These crises do not occur in isolation; instead, they interact, reinforce each other, and create unexpected ripple effects – forming what is known as a polycrisis. Traditional ways of analysing problems often fail to grasp these interdependencies, making it difficult to find effective responses. We draw on system archetypes to describe and exemplify three polycrisis patterns. These provide a structured way to analyse how multiple crises unfold and interact, as well as insights into how to navigate such complexity.
Technical summary:
The concept of a polycrisis describes the complex interconnections between global issues, which can lead to unexpected emergent behaviours and the possible convergence of undesirable impacts. Understanding these dynamics is crucial for anticipating compounded effects and for identifying leverage points for effective intervention. We propose that system archetypes – generic structures in system dynamics that capture recurring patterns of behaviour – can serve as a useful analytical tool to study polycrises. Specifically, we reinterpret three key system archetypes in this context: Converging Constraints (based on the Limits to Growth system archetype), Deepening Divides (based on Success to the Successful system archetype), and Crisis Deferral (drawing from the Policy Resistance system archetype). These patterns illustrate how resource limitations, structural inequalities, and short-term solutions can sustain or worsen crisis dynamics. Using real-world examples, we show how polycrisis patterns can be employed to map feedback structures between interacting crises and to guide effective interventions. Our work contributes to a more structured and systemic understanding of polycrises, by providing a tool to help researchers and policymakers better anticipate, navigate, and mitigate their effects.
Social media summary:
‘Polycrisis patterns reveal how crises like climate change, economic instability, and inequality interact, amplifying their impacts’.
The pelagic thresher shark Alopias pelagicus is an Evolutionarily Distinct and Globally Endangered species primarily threatened by overfishing. Indonesia is the world's largest shark fishing nation, and in Alor Island, thresher sharks have been a primary target for small-scale fishing communities for decades, sustaining subsistence livelihoods and serving as a protein source. With thresher shark populations continuously declining, there is a need for conservation measures to reduce shark mortality from fishing, while also securing the well-being of coastal communities. This study presents results and lessons learnt from a multi-faceted effort to reduce communities’ dependence on this Endangered shark species through a livelihood-based intervention complemented by collaborative species management and community outreach. Using a theory-based and statistical research design, we describe the approach taken in our intervention and its conservation outcomes. Total thresher shark catches were 91% lower among fishers who participated in our intervention compared to non-participants. Participating fishers also experienced increases in their income, in some cases by up to 525% relative to the income before the intervention. Occasional violations and challenges in the form of socio-political conflicts also occurred, yet these incidents acted as catalysts for regulatory change and reinforced stakeholder collaboration. This suggests overall positive outcomes and the potential for continued social change in shark conservation in the region over the long term. Our findings outline some generalizable lessons learnt for designing and implementing bottom-up livelihood-based interventions in other contexts.
Seismic imaging in 3-D holds great potential for improving our understanding of ice sheet structure and dynamics. Conducting 3-D imaging in remote areas is simplified by using lightweight and logistically straightforward sources. We report results from controlled seismic source tests carried out near the West Antarctic Ice Sheet Divide investigating the characteristics of two types of surface seismic sources, Poulter shots and detonating cord, for use in both 2-D and 3-D seismic surveys on glaciers. Both source types produced strong basal P-wave and S-wave reflections and multiples recorded in three components. The Poulter shots had a higher amplitude for low frequencies (<10 Hz) and comparable amplitude at high frequencies (>50 Hz) relative to the detonating cord. Amplitudes, frequencies, speed of source set-up, and cost all suggested Poulter shots to be the preferred surface source compared to detonating cord for future 2-D and 3-D seismic surveys on glaciers.
Environmental plastic pollution comprises partially degraded particles representing a continuum of sizes, shapes, polymer types and chemical compositions. Owing to their potential for biological uptake, small microplastic particles (sMP; <100 μm) and nanoplastics (NPs) are considered to be a potential risk to organisms. Understanding how sMPs and NPs behave in the environment, and how environmental matrices affect their detection, is fundamental to quantifying exposures, assessing hazards and understanding these risks. For this purpose, high-quality, well-characterised and environmentally relevant test and reference materials are crucial. The current lack of environmentally relevant sMP and NP reference materials has resulted in many studies applying commercially available spherical, homogenous and monodisperse particles, typically produced for specific purposes and without environmental relevance. There is a need for sMP and NP test/reference materials for fate and effects assessments and analytical protocol validation that more accurately represent the sMP and NP present in the environment. To date, feasible methods for producing relevant sMP and NP test materials in sufficient quantities for environmental fate and effects studies remain lacking. The current review provides an overview and comparison of the available methods, highlighting those that show the most promise for producing environmentally relevant sMP and NP with further development and optimisation.
Meta-analyses demonstrate that the quality of early attachment is modestly associated with peer social competence (r = .19) and externalizing behavior (r = −.15), but weakly associated with internalizing symptoms (r = −.07) across early development (Groh et al., Child Development Perspectives, 11(1), 70–76, 2017). Nonetheless, these reviews suffer from limitations that undermine confidence in reported estimates, including evidence for publication bias and the lack of comprehensive assessments of outcome measures from longitudinal studies in the literature. Moreover, theoretical claims regarding the specificity of the predictive significance of early attachment variation for socioemotional versus academic outcomes had not been evaluated when the analyses for this report were registered (but see Dagan et al., Child Development, 1–20, 2023; Deneault et al., Developmental Review, 70, 101093, 2023). To address these limitations, we conducted a set of registered analyses to evaluate the predictive validity of infant attachment in two landmark studies of the Strange Situation: the Minnesota Longitudinal Study of Risk and Adaptation (MLSRA) and the NICHD Study of Early Child Care and Youth Development (SECCYD). Across-time composite assessments reflecting teacher report, mother report, and self-reports of each outcome measure were created. Bivariate associations between infant attachment security and socioemotional outcomes in the MLSRA were comparable to, or slightly weaker than, those reported in the recent meta-analyses, whereas those in the SECCYD were weaker for these outcomes. Controlling for four demographic covariates, partial correlation coefficients between infant attachment and all socioemotional outcomes were r ≤ .10 to .15 in both samples. Compositing Strange Situations at ages 12 and 18 months did not substantively alter the predictive validity of the measure in the MLSRA, though a composite measure of three different early attachment measures in the SECCYD did increase predictive validity coefficients. Associations between infant attachment security and academic skills were unexpectedly comparable to (SECCYD) or larger than (MLSRA) those observed with respect to socioemotional outcomes.
We present seismic measurements of the firn column at Korff Ice Rise, West Antarctica, including measurements of compressional-wave velocity and attenuation. We describe a modified spectral-ratio method of measuring the seismic quality factor (Q) based on analysis of diving waves, which, combined with a stochastic method of error propagation, enables us to characterise the attenuative structure of firn in greater detail than has previously been possible. Q increases from 56 ± 23 in the uppermost 12 m to 570 ± 450 between 55 and 77 m depth. We corroborate our method with consistent measurements obtained via primary reflection, multiple, source ghost, and critically refracted waves. Using the primary reflection and its ghost, we find Q = 53 ± 20 in the uppermost 20 m of firn. From the critical refraction, we find Q = 640 ± 400 at 90 m depth. Our method aids the understanding of the seismic structure of firn and benefits characterisation of deeper glaciological targets, providing an alternative means of correcting seismic reflection amplitudes in cases where conventional methods of Q correction may be impossible.
The impact of influenza and pneumonia on individuals in clinical risk groups in England has not previously been well characterized. Using nationally representative linked databases (Clinical Practice Research Database (CPRD), Hospital Episode Statistics (HES) and Office for National Statistics (ONS)), we conducted a retrospective cohort study among adults (≥ 18 years) during the 2010/2011–2019/2020 influenza seasons to estimate the incidence of influenza- and pneumonia-diagnosed medical events (general practitioner (GP) diagnoses, hospitalisations and deaths), stratified by age and risk conditions. The study population included a seasonal average of 7.2 million individuals; approximately 32% had ≥1 risk condition, 42% of whom received seasonal influenza vaccines. Medical event incidence rates increased with age, with ~1% of adults aged ≥75 years hospitalized for influenza/pneumonia annually. Among individuals with vs. without risk conditions, GP diagnoses occurred 2–5-fold more frequently and hospitalisations were 7–10-fold more common. Among those with obesity, respiratory, kidney or cardiovascular disorders, hospitalisation were 5–40-fold more common than in individuals with no risk conditions. Though these findings likely underestimate the full burden of influenza, they emphasize the concentration of disease burden in specific age and risk groups and support existing recommendations for influenza vaccination.
We report results and modelling of an experiment performed at the Target Area West Vulcan laser facility, aimed at investigating laser–plasma interaction in conditions that are of interest for the shock ignition scheme in inertial confinement fusion (ICF), that is, laser intensity higher than ${10}^{16}$$\mathrm{W}/{\mathrm{cm}}^2$ impinging on a hot ($T>1$ keV), inhomogeneous and long scalelength pre-formed plasma. Measurements show a significant stimulated Raman scattering (SRS) backscattering ($\sim 4\%{-}20\%$ of laser energy) driven at low plasma densities and no signatures of two-plasmon decay (TPD)/SRS driven at the quarter critical density region. Results are satisfactorily reproduced by an analytical model accounting for the convective SRS growth in independent laser speckles, in conditions where the reflectivity is dominated by the contribution from the most intense speckles, where SRS becomes saturated. Analytical and kinetic simulations well reproduce the onset of SRS at low plasma densities in a regime strongly affected by non-linear Landau damping and by filamentation of the most intense laser speckles. The absence of TPD/SRS at higher densities is explained by pump depletion and plasma smoothing driven by filamentation. The prevalence of laser coupling in the low-density profile justifies the low temperature measured for hot electrons ($7\!{-}\!12$ keV), which is well reproduced by numerical simulations.
The Promoting Activity, Independence and Stability in Early Dementia (PrAISED) is delivering an exercise programme for people with dementia. The Lincolnshire partnership NHS foundation Trust successfully delivered PrAISED through a video-calling platform during the COVID-19 pandemic.
Objectives
This qualitative case-study identified participants that video delivery worked for, and highlighted its benefits and challenges.
Methods
Interviews were conducted with participants with dementia, caregivers and therapists, and analysed through thematic analysis.
Results
Video delivery worked best when participants had a supporting carer, when therapists showed enthusiasm and had an established rapport with the client. Benefits included time-efficiency of sessions, enhancing participants’ motivation, caregivers’ dementia awareness and therapists’ creativity. Limitations included users’ poor IT skills and resources.
Conclusions
The COVID-19 pandemic required innovative ways of delivering rehabilitation. This study supports that people with dementia can use tele rehab, but success is reliant on having a caregiver and an enthusiastic and known therapist.
Choline plays a crucial role in lipid metabolism for fish, and its deficiency in aquafeed has been linked to compromised health and growth performance. A 56-d experiment was conducted to examine the effects of dietary choline on lipid composition, histology and plasma biochemistry of yellowtail kingfish (Seriola lalandi; YTK; 156 g initial body weight). The dietary choline content ranged from 0·59 to 6·22 g/kg diet. 2-Amino-2-methyl-1-propanol (AMP) (3 g/kg) was added to diets, except for a control diet, to limit de novo choline synthesis. The results showed that the liver lipid content of YTK was similar among diets containing AMP and dominated by NEFA. In contrast, fish fed the control diet had significantly elevated liver TAG. Generally, the SFA, MUFA and PUFA content of liver lipid in fish fed diets containing AMP was not influenced by choline content. The SFA and MUFA content of liver lipid in fish fed the control diet was similar to other diets except for a decrease in PUFA. The linear relationship between lipid digestibility and plasma cholesterol was significant, otherwise most parameters were unaffected. When AMP is present, higher dietary choline reduced the severity of some hepatic lesions. The present study demonstrated that choline deficiency affects some plasma and liver histology parameters in juvenile YTK which might be useful fish health indicators. Importantly, the present study elucidated potential reasons for lower growth in choline-deficient YTK and increased the knowledge on choline metabolism in the fish.
In March 2020, the World Health Organization (WHO) officially declared the spread of coronavirus disease 2019 (COVID-19) as a pandemic. Adolescence and early adulthood are peak times for the onset of mental health difficulties. Exposure to a pandemic during this vulnerable developmental period places young people at significant risk of negative psychological experiences. The objective of this research was to summarise existing evidence on the potential impact of a pandemic on the mental health of 12–25 year olds.
Methods:
A rapid review of the published peer-reviewed literature, published between 1985 and 2020, using PsycINFO (Proquest) and Medline (Proquest) was conducted. Narrative synthesis was used across studies to identify key themes and concepts.
Results:
This review found 3,359 papers, which was reduced to 12 papers for data extraction. Results regarding the prevalence of psychological difficulties in youth were mixed, with some studies finding this group experience heightened distress during an infectious disease outbreak, and others finding no age differences or higher distress among adults. Gender, coping, self-reported physical health and adoption of precautionary measures appear to play a role in moderating the psychological impact of an infectious disease outbreak. Most studies were conducted after the peak of an epidemic/pandemic or in the recovery period.
Conclusions:
More longitudinal research with young people, particularly adolescents in the general population, before and during the early stages of an infectious disease outbreak is needed to obtain a clear understanding of how best to support young people during these events.
A developing application of laser-driven currents is the generation of magnetic fields of picosecond–nanosecond duration with magnitudes exceeding $B=10~\text{T}$. Single-loop and helical coil targets can direct laser-driven discharge currents along wires to generate spatially uniform, quasi-static magnetic fields on the millimetre scale. Here, we present proton deflectometry across two axes of a single-loop coil ranging from 1 to 2 mm in diameter. Comparison with proton tracking simulations shows that measured magnetic fields are the result of kiloampere currents in the coil and electric charges distributed around the coil target. Using this dual-axis platform for proton deflectometry, robust measurements can be made of the evolution of magnetic fields in a capacitor coil target.
To synthesise evidence of urban dietary behaviours (macronutrients, types of foods, dietary diversity and dietary practices) in two African countries in relation to postulated changes in the context of nutrition transition.
Design:
Systematic review and meta-analyses, including six online databases and grey literature, 1971–2018 (Protocol CRD42017067718).
Setting:
Urban Ghana and Kenya.
Participants:
Population-based studies of healthy adolescents and adults.
Results:
The forty-seven included studies encompassed 20 726 individuals plus 6526 households. Macronutrients were within WHO-recommended ranges: mean energy intake was 1867 kcal/d (95 % CI 1764, 1969) and the proportions of macronutrients were carbohydrate 61·2 % (58·4, 64·0), fat 25·3 % (22·8, 28·0) and protein 13·7 % (12·3, 15·1). The proportion of population consuming fruit and vegetables was 51·6 %; unhealthy foods, 29·4 %; and sugar-sweetened beverages (SSBs), 39·9 %. Two-thirds (68·8 %) consumed animal-source proteins. Dietary diversity scores were within the mid-range. Meal patterns were structured (typically three meals per day), with evidence lacking on snacking or eating out.
Conclusions:
Population-level diets fell within WHO macronutrient recommendations, were relatively diverse with structured meal patterns, but some indications of nutrition transition were apparent. The proportion of population consuming fruit and vegetables was low compared to healthy-eating recommendations, and consumption of SSBs was widespread. A paucity of evidence from 1971 to 2010 precluded a longitudinal analysis of nutrition transition. Evidence from these two countries indicates which aspects of dietary behaviours may be contributing to increasing overweight/obesity, namely a low proportion of population consuming fruit and vegetables and widespread consumption of SSBs. These are potential targets for promoting healthier diets.
Introduction: Our team developed “The Ottawa Troponin Pathway” (OTP) for Non-ST Elevation Myocardial Infarction (NSTEMI) diagnosis using serial conventional troponin (cTnI) 3 hours apart to aid in safe and early disposition of ED patients. The primary objective of this study is to validate the diagnostic accuracy of the OTP in the cohort of patients with cTnI values above the 99th percentile ( > 45ng/L). Methods: This study is a health records review conducted at the Civic and General Campuses of The Ottawa Hospital from August 2017 to December 2017. Adults (≥18 years) who presented to the ED with symptoms of ACS, and who had serial cTnI (at least two values 3 hours ±15 minutes apart) performed for diagnosis of NSTEMI and at least one cTnI value > 45ng/L were included. Patients with cardiac arrest, STEMI, unstable angina or those with TnI values ≤45ng/L were excluded. The outcomes were death due to unknown cause or NSTEMI adjudicated by two blinded investigators within 30 days. Data collected include baseline characteristics, ED management, length of stay, cTnI values and times of measurement, disposition, and outcome. We used descriptive statistics and test diagnostic characteristics to analyze our data. Results: We screened 53,077 patients, of whom 635 patients were included in the study (mean age 71.6 years; 57.6% males; 59.7% hospitalized; median ED length of stay 4.7 hours.). 107 patients (16.9%; 95%CI 14.1%-20.0%) were diagnosed with NSTEMI within 30 days. Among patients with TNI values above the 99th percentile, the OTP did not miss any patients diagnosed with NSTEMI. The sensitivity and the specificity of the OTP were 100% (95%CI 96.6%-100%) and 32.2% (95%CI 28.2%-36.4%) respectively. Conclusion: Our results show that the OTP is diagnostically accurate in ruling out NSTEMI among patients with cTNI values above the 99th percentile with symptoms concerning for ACS. Using the OTP will allow for early referral to consulting services for management, safe and early discharge home, and improve ED crowding.
Introduction: Guidelines recommend serial conventional cardiac troponin (cTn) measurements 6-9 hours apart for non-ST-elevation myocardial infarction (NSTEMI) diagnosis. We sought to develop a pathway based on absolute/relative changes between two serial conventional cardiac troponin I (cTnI) values 3-hours apart for 15-day MACE identification. Methods: This was a prospective cohort study conducted in the two large ED's at the Ottawa Hospital. Adults with NSTEMI symptoms were enrolled over 32 months. Patients with STEMI, hospitalized for unstable angina, or with only one cTnI were excluded. We collected baseline characteristics, Siemens Vista cTnI at 0 and 3-hours after ED presentation, disposition, and ED length of stay (LOS). Adjudicated primary outcome was 15-day MACE (AMI, revascularization, or death due to cardiac ischemia/unknown cause). We analysed cTnI values by 99th percentile cut-off multiples (45, 100 and 250ng/L). Results: 1,683 patients (mean age 64.7 years; 55.3% female; median ED LOS 7 hours; 88 patients with 15-day MACE) were included. 1,346 (80.0%) patients with both cTnI ≤45ng/L; and 58 (3.4%) of the 213 patients with one value≥100ng/L but both <250ng/L or ≤20% change did not suffer MACE. Among 124 patients (7.4%) with one value >45ng/L but both <100ng/L based on 3 or 6-hour cTnI, one patient with Δ<10ng/L and 6 of 19 patients with Δ≥20ng/L were diagnosed with NSTEMI (patients with Δ10-19ng/L between first and second cTnI had third one at 6-hours). Based on the results, we developed the Ottawa Troponin Pathway (OTP) with a 98.9% sensitivity (95%CI 96.7-100%) and 94.6% specificity (95%CI 93.4-95.7%). Conclusion: The OTP, using two conventional cTnI measurements performed 3-hours apart, should lead to better identification of NSTEMI particularly those with values >99th percentile cut-off, standardize management and reduce the ED LOS.
The family physician is key to facilitating access to psychiatric treatment for young people with first-episode psychosis, and this involvement can reduce aversive events in pathways to care. Those who seek help from primary care tend to have longer intervals to psychiatric care, and some people receive ongoing psychiatric treatment from the family physician.
Aims
Our objective is to understand the role of the family physician in help-seeking, recognition and ongoing management of first-episode psychosis.
Method
We will use a mixed-methods approach, incorporating health administrative data, electronic medical records (EMRs) and qualitative methodologies to study the role of the family physician at three points on the pathway to care. First, help-seeking: we will use health administrative data to examine access to a family physician and patterns of primary care use preceding the first diagnosis of psychosis; second, recognition: we will identify first-onset cases of psychosis in health administrative data, and look back at linked EMRs from primary care to define a risk profile for undetected cases; and third, management: we will examine service provision to identified patients through EMR data, including patterns of contacts, prescriptions and referrals to specialised care. We will then conduct qualitative interviews and focus groups with key stakeholders to better understand the trends observed in the quantitative data.
Discussion
These findings will provide an in-depth description of first-episode psychosis in primary care, informing strategies to build linkages between family physicians and psychiatric services to improve transitions of care during the crucial early stages of psychosis.