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Intonation units (IUs) are a fundamental prosodic unit of all known human languages, and as such they likely constitute an absolute universal property of language. IUs are chunks defined by a specific pattern of syllable delivery, together with resets in pitch and articulatory force. In this chapter we discuss IUs from four different perspectives and introduce them within the context of rhythms of speech, language, and the brain. First, we provide a detailed description of how IUs are defined. Second, we review linguistic research on the roles of IUs in communication, including their cross-linguistic applicability. This body of research suggests that IUs provide a universal structural cue for the cognitive dynamics of speech production and comprehension at a timescale of ~1 Hz. Third, we synthesize the linguistic perspective with findings from the study of brain rhythms and cognition. Finally, we review the existing algorithmic tools for IU identification from speech acoustics, to facilitate the incorporation of IUs in experimental and quantitative research.
The goal of this chapter is to provide the reader with broad guidance on the many points of intersection between child abuse, diagnostic imaging, the legal system and the radiologist.
The radiologist’s involvement begins before the report in setting up department protocols and supervising the acquisition of images. Communication of important and unexpected findings should occur before finalization of a report. The radiology report is a medicolegal document – the report should be correct, complete, conclusive, cogent and clean. Issues related to reporting are addressed in detail.
Radiologists have a duty to educate other members of the healthcare team and trainees about the diagnostic imaging of child abuse and its differential diagnoses.
Child abuse cases produce an uncomfortable intersection of medicine and the law for the involved radiologist. This chapter provides guidance on all aspects of preparation for possible court testimony. The importance of preparation cannot be understated. In court, the role of testifying radiologists is to provide reputable information and to educate the court.
Sincerity is essential to communication: without a norm of sincerity, we could hardly trust what other people tell us. But what does it take to be sincere, exactly? And why is sincerity so important? Sincerity and Insincerity offers a comprehensive review of existing philosophical work on the nature of sincerity and its epistemic value. It puts forward a novel, fine-grained account of what sincerity and insincerity are, and dives into the grey area between the two, identifying various ways in which speakers can be partially sincere. Integrating ideas from different philosophical subfields and traditions, it offers an updated perspective on what makes sincerity epistemically valuable, giving serious consideration to the idea that sincerity is the norm of assertion. Overall, this Element provides a novel, informed perspective on what sincerity is, how it works, and why it matters.
Edited by
Liz McDonald, East London NHS Foundation Trust,Roch Cantwell, Perinatal Mental Health Service and West of Scotland Mother & Baby Unit,Ian Jones, Cardiff University
Talking with women in the pre-conception or perinatal periods about psychotropic medication is an essential, sometimes difficult, part of the work of the perinatal psychiatrist. Understanding the current evidence base; knowing how and when to acknowledge the uncertainty inherent in current knowledge and how that translates to the individual woman; balancing risks of medication with risks of not treating and benefits of treating; sharing decision-making while not putting all of the responsibility on the woman; communicating with the woman, her partner, other professionals, services and agencies; and knowing when and how to seek further help or advice, are all essential components of good practice when prescribing in pregnancy and breastfeeding.
Early integration of pediatric palliative care (PPC) offers significant benefits for children with cancer, yet referrals often occur late in the child’s cancer trajectory.
Objectives
As part of a larger project looking at barriers and facilitators to early integration of PPC, this study explored the perspectives of healthcare providers (HCPs) on the pros and cons of a universal referral system where all children with cancer are referred to PPC at diagnosis.
Methods
Using the grounded theory method, semi-structured interviews were conducted with 66 oncology and PPC providers across 4 tertiary cancer centers in Canada. Interviews were coded line-by-line to explore patterns and themes across the dataset.
Results
Three key benefits emerged that included: reducing stigma and normalizing PPC as standard care, fostering early relationship building with patients and families, and minimizing HCP subjectivity in making PPC referrals. Cons included the idea that universal referral was a poor use of resources, particularly for children with curable cancers, and that this system lacked usefulness for patients and families.
Significance of results
Universal referral can promote equitable, timely, and family-centered integration of PPC in pediatric oncology. However, these types of referral systems face substantial challenges, particularly around resources. There was also wide variation of opinions and acceptability of universal referral among providers. The adoption of standardized or tiered referral criteria, guided by disease risk, prognosis, or symptom burden, may represent a practical middle ground. Future work should evaluate the impact of such criteria-based referral models on patient and family outcomes, provider experiences, and healthcare resource use.
Joshua Lowe, San Antonio Military Medical Center,Rachel Bridwell, Uniformed Services University of Health Sciences,John Patrick, San Antonio Military Medical Center,Alec Pawlukiewicz, Carl R. Darnall Army Medical Center,Gillian Schmitz, Uniformed Services University of Health Sciences,Michael Yoo, University of Texas Health San Antonio
This clinical vignette guides learners through the emotionally complex task of delivering bad news in the emergency department. After stabilizing a critically ill patient with a life-threatening variceal GI bleed, the physician must update the patient’s spouse with honesty, empathy, and professionalism. This case models how to initiate these conversations using the SPIKES framework and demonstrates the importance of setting, pacing, and word choice when conveying grave prognoses. Learners are introduced to the emotional “residue” left behind by such encounters and are encouraged to process it using Dr. Cline’s DR5 model for reflective practice. By observing and emulating this structured, compassionate approach, trainees develop the communication tools necessary to lead with clarity and kindness; skills that define maturity in emergency medicine and build trust in times of crisis.
This contribution to understanding friendship as a distinct social relationship examines the distinction between friendship dyads and groups of friends by focusing on the communicative dynamics of intimacy and discretion. Drawing on the work of Simmel and Luhmann, I argue that dyadic friendship supports intimate communication characterized by immediacy, mutual disclosure, and the suspension of self-consciousness. The addition of a third party, however, shifts interaction into public mode, requiring increased discretion and greater communicative management. I offer a formal account of how the number of participants alters the quality of interaction and suggest that while intimacy is not a constant feature of friendship, it nevertheless remains a constitutive potential. To conclude, I argue that groups of friends can be intimate social formations only insofar as endogenous, “private” dyadic bonds are formed.
In “A Nice Derangement of Epitaphs,” Donald Davidson argues against the view that conventions fix the meanings of our words and for the position that a speaker’s intentions play a fundamental role in fixing what she means by her words. However, he is clear that he still holds to the externalism, holism, and literalism argued for earlier in his career. Lepore and Stone (Philosophical Perspectives, 31, 245–265, 2017) and Camp (Inquiry, 59, 113–138, 2016) suggest that the resulting picture is contradictory. In this article, I take up Lepore, Stone, and Camp’s arguments to clarify Davidson’s position and motivate an anti-conventional literalism about meaning.
Palliative and end-of-life (EOL) care is gaining increasing importance in Saudi Arabia due to the rising burden of chronic and life-limiting illnesses. Nurses play a central role in delivering comprehensive, culturally appropriate palliative care; however, their practices are influenced by educational preparation, institutional support, and sociocultural and religious contexts. To date, evidence on palliative nursing care in Saudi Arabia remains fragmented and insufficiently synthesized.
Aim
This systematic review aimed to synthesize existing evidence on palliative and EOL nursing care in Saudi Arabia, with a focus on nursing practices, challenges, cultural and spiritual influences, and patient and family outcomes.
Methods
A systematic literature search was conducted in January 2025 using PubMed, Scopus, CINAHL, Web of Science, Google Scholar, and Saudi grey literature sources. Empirical qualitative, quantitative, and mixed-methods studies addressing palliative or EOL nursing care in Saudi Arabia were included. Study selection followed PRISMA guidelines, and methodological quality was appraised using appropriate critical appraisal tools. A narrative thematic synthesis was undertaken due to heterogeneity among studies.
Results
Fourteen studies met the inclusion criteria. Findings indicated that nurses are actively involved in symptom management, therapeutic communication, psychosocial support, spiritual care, and family-centered care. However, substantial barriers were identified, including gaps in knowledge and training, limited formal palliative education, emotional burden, ethical challenges related to nondisclosure, and inconsistent institutional policies. Cultural and religious norms strongly influenced communication practices and decision-making processes. Studies also showed that structured palliative care services, particularly home-based and multidisciplinary programs, were associated with improved patient comfort, dignity, and family satisfaction, although access to such services varied across regions.
Conclusion
Palliative and EOL nursing care in Saudi Arabia demonstrates commitment and potential but is constrained by educational, emotional, cultural, and systemic challenges. Strengthening nursing education, enhancing culturally sensitive communication and spiritual care training, expanding home-based palliative services, and providing institutional support for nurses’ emotional well-being are essential to improving the quality and equity of palliative care nationwide.
Relationship satisfaction has major implications on individuals’ health and subjective well-being, and prominent theories in relationship research have assigned relationship satisfaction an important role. In this Handbook chapter, we first introduce conceptual perspectives on relationship satisfaction, showing that relationship satisfaction is a characteristic of both the individual and the relationship. We then provide an overview of the measurement of relationship satisfaction and discuss common affordances in its assessment. Next, we report empirical evidence on how relationship satisfaction evolves over time, showing that relationship satisfaction changes both normatively and depending on the eventual outcome of the relationship. We then report how relationship satisfaction is associated with different relationship-specific facets, such as perceptions, emotion regulations strategies, and communication styles. To conclude, we discuss a series of unresolved issues in the area of relationship satisfaction research and propose an agenda for future research, such as the usage of modern technologies.
This scenario is based on the Whakaari/White Island volcanic eruption that occurred on December 9, 2019, in New Zealand. The eruption, classified as a Stage III burn disaster, overwhelmed local and regional medical systems, necessitating a national and international response. The scenario focuses on the initial receiving hospital’s experience and the on-shift medical staff’s challenges. It aims to provide a realistic training module for healthcare professionals in volcanic regions, emphasizing the importance of preparedness and skill practice. The scenario includes a fictional patient case with severe burns and other injuries, requiring comprehensive emergency care, including decontamination, airway management, fluid resuscitation, and wound care. The scenario also highlights the critical role of teamwork, communication, and resource management in handling mass casualty incidents. By reflecting on the Whakaari disaster, this scenario serves as a tribute to the victims, their families, and the responders, offering valuable insights for future emergency preparedness and response efforts.
This chapter reads the criticism of I. A. Richards in relation to the tradition of scientific reading sketched in this book, positioning him as a theoretician of linguistic exactitude. Far from Empsonian ‘ambiguity’, Richards’s overall investment in the striving for linguistic clarity reconfigures how we should view his place in the history of the discipline. If close reading is a practice that today prizes ambiguity, contradiction and the play of the signifier, then Richards sits awkwardly as its founder – and, towards the end of his career, Richards would even wonder out loud whether a literary criticism based on exactitude could help facilitate a one-world liberal government. The chapter ends by returning to the question of artifice and the knowledge it can produce, focussing on the Cambridge-based poet Veronica Forrest-Thomson, who sought to reconfigure Richards’s concept of a linguistic instrument through her verse practice. Reading her poetry and criticism from the 1970s, the chapter shows how Forrest-Thomson localises the idea of poetry as a unique linguistic instrument in her conception of poetic artifice, which she sees as a form of knowing irreducible to scientific explanation.
The current chapter focuses on basic properties of communication that inform the ways that the study of communication and the study of relationships intersect. These properties include interdependence (the idea that messages simultaneously influence and are influenced by messages that precede and follow them), reflexivity (the notion that communication creates and is constrained by structure), complexity (the concept that communication conveys multiple messages and functions at different levels of analysis), ambiguity (the notion that any given message has various meanings), and indeterminancy (the idea that messages can have multiple and diverse outcomes on relationships). Research on relationship narratives, message features, multiple goals, and message processing, among other topics, is reviewed and challenges for researchers who study communication and relationships are discussed.
Relationship maintenance scholars have long attempted to understand the processes by which partners foster relationship growth. They have done so by focusing on defining and explaining key maintenance strategies that serve to initiate and preserve romantic relationships. In this chapter, we provide a brief history of the relationship maintenance literature. Then we identify the key theoretical contributions to the current understanding of relationship maintenance and discuss recent theoretical developments and known correlates. We conclude the chapter by highlighting the need to diversify and expand the maintenance literature by identifying possible avenues for future inquiry and proposing ways to integrate work across disciplines.
Research findings in linguistics have contributed to the development of the field of second language acquisition since its inception. However, it is only relatively recently that an interactional linguistics approach, conceptualizing language as a co-constructed semiotic resource and emergent phenomenon, has been utilized for research in the field. Our chapter introduces a rigorous method for the analysis of dialogic interaction (often spoken language data), called Conversation Analysis (CA), originally developed in the field of sociology. We discuss CA’s origins, core principles, and natural fit as a method for linguistic analysis. The chapter then surveys research that has used CA methods for understanding SLA including how CA methods played a role in reconceptualizing what it means to be competent in a language. Lastly, we present a short summary of one research study using CA methods, and two activities grounded in CA principles that language teachers might consider adding to their repertoire.
This introductory chapter details the purpose of the collection and its structure. This collection presents the state-of-the-art research in applied linguistics directly relevant to procedural and administrative law and practice, with an emphasis on how legal procedure is constructed, negotiated and implemented through language. Covering the themes around legal process and legal profession through the lens of linguistics, the focus of this collection is very firmly on the applicability of linguistic theory and methodology to the context of legal practice. The Introduction also outlines the chapters, which draw on distinct methods and data types to explore diverse aspects of professional practice across a number of jurisdictions. In doing so, the chapter highlights the immense potential for incorporating linguistic insights into the legal process and the benefits it can bring to law researchers and practitioners.
Chapter 5 addresses these weaknesses by combining STS with sociological systems theory, which provides a persuasive account of law in society, but has been criticised as technology-blind. This does not mean, however, that systems theory lacks the means to conceptualise the interface between the materiality of a distribution medium (e.g. the Internet) and the sociality of communicative systems (e.g. law), since structural coupling provides the means to explain how operatively closed systems can relate to each other, e.g. the sphere of technical materiality (the technosystem) and the sphere of communicative sociality (society and its subsystems). A separation between the material and the social is the prerequisite for adopting a critical or normative position vis-à-vis digital media, enabling us to empirically study the diverse interrelations between the two spheres in online communication. To do so, technologies must be understood as artefacts possessing affordances, that is possibilities and constraints, raising the question of how digital technologies acquire affordances. The final question concerns the concept of normativity in the digital ecosphere, namely whether normative expectations about digital technologies can emerge. Since normative expectations structure the legal system, our answer will explain the nature of the structural coupling between law and technology.
The rights of Deaf persons need to be respected in order to prevent discrimination and ensure equality in Kenya’s criminal courts. Inclusive communication in the country’s criminal justice system is key and can only occur when information that is passed and received is understood by both the Deaf and hearing parties. The aim of this article is to determine how Deaf people can be supported and accommodated in order to ensure their effective participation at all levels of Kenya’s criminal justice system. With the backdrop of the Convention on the Rights of Persons with Disabilities, the author contends that the State has an obligation to put in place reasonable accommodation and other accessibility measures that go beyond the provision of mere sign language interpretation, if the right to participation of Deaf witnesses is to be fully realized in the country’s criminal justice system.
Strategies to improve accrual and reduce barriers to cancer clinical trials participation are critical for the advancement and implementation of new treatments and processes to improve cancer patient outcomes. While researchers have identified several barriers to accrual from the perspective of health care providers and patients, mechanisms to address and alleviate these concerns are needed to increase participation and interest in clinical trials.
Methods:
A focus group of 9 people with lived experience of a cancer diagnosis were accrued randomly and provided with a hands-on research experience and educational resources about clinical trials, followed by a focused group discussion to capture perspectives and/or experiences with clinical trials. Focus groups were transcribed and analyzed via Braun & Clarke’s 6-phase reflexive thematic analysis.
Results:
Five key themes were identified as important to increase clinical trial accrual. These included a patient-centered approach, easily digestible educational resources, a personalized understanding of motivating factors, local outreach, and transparency on outcomes and progress of the work. Qualitative input also identified methods that could positively influence accrual rates.
Conclusions:
Providing participants with opportunities to see first-hand how research works and data are used was noted as an overwhelmingly positive experience that could improve clinical trial accrual rates. This work confirms several previous findings with respect to patient identified barriers to participation in clinical trials and provides support and a framework for development of knowledge translation strategies to increase awareness and knowledge of the importance of clinical research to improve health outcomes for cancer patients.