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The impact of conotruncal anomalies on long-term outcomes after total cavopulmonary connection remains unclear, particularly regarding haemodynamic performance and dominant ventricular morphology.
Methods:
All patients who underwent total cavopulmonary connection between 1994 and 2023 at a single centre were reviewed. Conotruncal anomalies were defined as transposition of the great arteries, double outlet right ventricle, tetralogy of Fallot, truncus arteriosus, and interrupted aortic arch type B. Four endpoints were analysed: transplant-free survival, Fontan failure, tachyarrhythmia, and ventricular dysfunction. Multivariable Cox regression, inverse probability of treatment weighting, and subgroup analyses were performed to disentangle conotruncal anomaly effects from dominant ventricular morphology.
Results:
Among the 650 patients, 291 (44.8%) were identified with conotruncal anomalies. During a median follow-up of 6.3 years, no differences were observed in transplant-free survival (log-rank p = 0.136) or Fontan failure (p = 0.717) between groups. Dominant right ventricular morphology was independently associated with Fontan failure (hazard ratio: 2.20; p = 0.006) and tachyarrhythmia (hazard ratio: 3.22; p = 0.004). These findings were confirmed across all sensitivity analyses. No differences were detected in filling pressures, cardiac index, or peak oxygen uptake on post-operative catheterisation (n = 226) and cardiopulmonary exercise testing (n = 161). When stratified into four groups by conotruncal status and dominant ventricular morphology, freedom from Fontan failure clustered by morphology rather than diagnostic category (4-way log-rank p < 0.001).
Conclusions:
Conotruncal anomalies are not independently associated with adverse outcomes following total cavopulmonary connection. Dominant right ventricular morphology, not diagnostic category, is the principal determinant of long-term Fontan outcomes.
Little is known about implementation of antimicrobial stewardship (AMS) programs in retirement homes, a setting with an older adult population which is at increased risk of antibiotic-related harm. This study evaluated a pharmacist-led prospective audit and feedback (PAF) pilot program in retirement homes.
Methods:
This quasi-experimental study evaluated antibiotic use in 9 intervention homes and 396 control homes from June 2022 to May 2023 (baseline period), compared to June 2023 to December 2024 (intervention period). PAF was conducted remotely by long-term care pharmacists; recommendations were provided to the prescriber via fax. The primary outcome was antibiotic days of therapy (DOT) per 1000 resident-days. Determinants to implementation were gathered from participating pharmacists and mapped to the Theoretical Domains Framework.
Results:
During the intervention, of 794 antibiotic assessments, 89 recommendations were made and 27 (30%) were accepted. Total antibiotic use measured in DOT per 1,000 resident days in intervention homes was similar before and after PAF (54.0 before vs. 57.9 after). Similarly, usage in the control group was relatively stable (49.0 before vs. 51.6 after) (DiD Analysis: +2.4 DOT/1,000 resident days, 95% CI −7.8, 12.3). Barriers to PAF implementation included communication challenges (communication via fax) and limited clinical information (lack of indication on prescription). Facilitators included organizational support and pharmacist motivation.
Conclusions:
While this pilot had limited uptake and was not associated with a change in antibiotic use, it highlighted important barriers and facilitators for AMS in retirement homes. This initiative strengthened local capabilities for antibiotic use surveillance to support future AMS interventions.
Artificial Intelligence (AI) systems are increasingly supporting targeting, intelligence analysis and operational planning across military domains, reshaping how commanders use force through human–machine teaming (HMT). HMT offers operational advantages, but risks such as automation bias, adversarial manipulation and degraded performance pose challenges for the ability of deployers to use AI systems in compliance with international humanitarian law (IHL). This article argues that adherence to IHL cannot be deferred until hostilities arise; system design, testing, governance and training must be structured in advance to establish the conditions under which AI-enabled human–machine teams can exercise appropriate human judgement consistent with IHL obligations. The paper proposes an HMT Assurance Card, a cross-disciplinary life-cycle instrument integrating IHL obligations, civilian harm pattern analysis and AI governance frameworks into measurable standards applicable across the AI system life cycle, defence institutions and coalition environments.
This article introduces the global Women’s Safety Index (WSI), outlining its rationale, purpose, and potential applications. The Index consist of three dimensions: Equity, Protection, and Resources, identified as foundational to women’s safety. Key indicators within each dimension are selected based on theoretical relevance and empirical evidence. We detail the statistical methodology and framework used to construct the Index and present validation analyses demonstrating its ability to capture changes in women’s safety, particularly in response to external disruptions. The WSI is available on an interactive digital platform, enabling users to explore, visualize, and compare women’s safety data across regions and over time.
Why are contemporary central banks – institutions designed to be narrow, technical, and apolitical – suddenly publishing extensively on non-monetary topics? This research essay explores how knowledge production has become central banks’ primary tool for managing a fundamental tension: expanding the scope of their interventions while maintaining technocratic legitimacy. By analysing their knowledge production across two key domains – climate change and digital currencies – we identify two axes of ‘scientisation’: boundary-pushing/keeping; and proactive/reactive. This suggests scientisation can be seen as a strategic response to mandate uncertainty, transforming expert knowledge into both a vehicle for negotiating central banks’ political mandate and a shield against democratic accountability. The implications of our findings extend beyond central banks, speaking to fundamental questions over technocratic power in an era of perpetual crisis.
We are concerned with the nonlinear modelling of three-dimensional internal gravity waves in the lower atmosphere. A simplified configuration of density stratification is adopted, assuming that the atmosphere consists of two layers of uniform density with a sharp interface between the two bulk fluids. A time-dependent topography is considered to model a non-uniform, time-varying background current over variable terrain. Based on the Ablowitz–Fokas–Musslimani formulation for irrotational flows, both fully and weakly nonlinear long-wave isotropic models are derived in the Benjamin–Ono regime, where the upper layer is set to be semi-infinite. Two atmospheric gravity wave phenomena, motivated by satellite observations, are simulated using two modified numerical schemes to showcase the newly developed nonlinear models: the internal wave wake in the downwind zone behind a local topographic high and concentric ring waves, which appear as arched cloud formations along wave crests.
It has been widely suggested in recent years that exposure to and use of multiple languages can affect cognitive performance, with bilinguals frequently being argued to demonstrate superior cognitive performance to their monolingual peers. The current study investigates whether there are any effects of minimal exposure to second-language (L2) Welsh on the cognitive skills of English-speaking emergent bilingual primary school children in Wales. Participants were divided into two language groups based on their school year, with performance between monolingual (N = 25) and emergent bilingual (N = 38) children compared on a variety of executive function (EF) tasks. Results revealed superior performance for the bilingual children in Reception and Year 1 on all EF tasks aside from the Forward digit recall compared to monolingual peers, with no differences between groups in Year 2. This suggests that the cognitive benefits of bilingualism emerge at very early stages of second-language exposure.
This study examines how late adolescent Mandarin-English heritage speakers (HSs) process different types of Mandarin pronouns in real time and how individual differences in cognitive and experiential factors modulate this process. Using a web-based visual world eye-tracking paradigm, we tested the interpretation of pronominals (ta), simplex reflexives (ziji), and complex reflexives (taziji), which differ in their reliance on narrow syntax versus syntax-discourse-semantic integration. At the group level, taziji was interpreted locally, while ziji and ta were interpreted as referring to long-distance (LD) antecedents. Working memory and inhibition modulated the processing of ziji and ta, whereas only current heritage language (HL) exposure influenced the processing of taziji. These findings indicate that domain-general cognitive resources are recruited during the resolution of pronouns involving LD and interface-level dependencies, while narrow syntactic structures are more sensitive to variation in language exposure. The results point to structural asymmetries in how cognitive and experiential factors affect real-time HL pronoun resolution.
We investigated moral judgments about transgressions of social conventions and moral rules in two studies. In Experiment 1, we compared socially problematic juveniles from Youth Educational Centres (YEC, aged 14–18) with control juveniles from technical schools. Control juveniles judged moral transgressions as more severe than conventional transgressions, whereas YEC juveniles showed the opposite pattern. This reversal allowed for approximately 70% accurate classification of group membership. In Experiment 2, we tested whether the degree of moral-conventional differentiation predicted socialization outcomes in a general sample of secondary school students (N = 204). Students who more clearly differentiated moral transgressions from social convention violations on a goodness scale received higher teacher-assigned behavior grades. Reversal of normal moral-conventional differentiation predicts poor socialization in at-risk adolescents; within a general school sample, the strength of that differentiation predicts teacher-rated behavior.
In this paper, we propose using Learning from Answer Sets to approximate black-box models, such as Neural Networks (NN), in the specific case of learning user preferences. We specifically explore the use of ILASP (Inductive Learning of Answer Set Programs) to approximate preference learning systems through weak constraints. We have created a dataset on user preferences over a set of recipes, which is used to train the NNs that we aim to approximate with ILASP. Our experiments investigate ILASP both as a global and a local approximator of the NNs. These experiments address the challenge of approximating NNs working on increasingly high-dimensional feature spaces while achieving appropriate fidelity on the target model and limiting the increase in computational time. To handle this challenge, we propose a preprocessing step that exploits Principal Component Analysis to reduce the dataset’s dimensionality while keeping our explanations transparent.
Under consideration for publication in Theory and Practice of Logic Programming (TPLP).
Recent evidence suggests that oligarchs hold disproportionate influence over electoral representative institutions and limit people’s participation in both formal and informal spaces of democratic politics. Drawing on phenomenology, I develop the concept of oligarchic fatigue to describe the political exhaustion that arises when people’s attempts to engage in democratic practices are obstructed by oligarchic domination. Oligarchic fatigue materializes through two analytically distinct mechanisms: people experience fatigue either (1) when they actively participate within formal political spaces, but their options for participation are constrained due to oligarchic control over political institutions; or (2) when their political participation is deemed illegitimate and functionally denied by oligarchy. The corrective to oligarchic fatigue, I contend, is a renewed focus on political freedom as a constitutive element of democratic innovations and anti-oligarchic institutional design.
Timely detection of pathogen-related outbreaks in hospitals is important for preventing onward transmission and can be supported by automated outbreak detection systems (AODS). Many methods overlook in-hospital patient transfers and focus only on patient locations at the time of sampling. This study compares three approaches for incorporating patient transfers into AODS.
Design:
Two existing AODS frameworks, a local percentile-based system and a statistical modeling-based system were extended to include patient transfers: 1) grouping wards into communities based on frequent patient exchange, 2) including prior ward visits in the past 14 days, and 3) including both prior ward visits and time spent on wards. Alerts generated were reviewed for clinical relevance.
Setting:
Data from January 2014 to December 2021 from a University Medical Center in the Netherlands.
Results:
Using the percentile-based approach, the baseline scenario detected 99 possible outbreaks. Extension with ward community groupings, prior ward visits, and prior ward visits accounting for time spent in each ward increased this number with 16 (+15%), 42 (+42%), and 106 (+110%) possible outbreaks, respectively. Of the alerts generated by including individual patient transfer history, 35% were judged as requiring investigation. The trade-off between increased detection and relevance was less favorable for the other approaches. Similar findings were found for statistical modeling-based methods.
Conclusions:
Inclusion of patient transfer data in AODS improved sensitivity, at the cost of increasing the alert burden. Therefore, ongoing refinement should further optimize the balance between accurate outbreak detection and a manageable alert burden.
Effective soil nutrient management remains a critical determinant of agricultural profitability among smallholder farmers. This research evaluates the economic viability of fertilizer trials for teff and sorghum crops under different landscape positions in the dryland areas of northeastern Ethiopia. The study employed a randomized complete block design (RCBD) comprising nine treatments across three districts. Data from 855 experimental plots were analysed using a linear mixed-effects model (LMEM) across the slope gradients of foot slope, mid slopes, and hill slopes. Partial budget analysis, value-to-cost ratios (VCRs), and sensitivity analysis were employed to evaluate the economic feasibility of nutrients. The result from the LMEM revealed that fertilizer treatments, crop type, and slope position significantly affect net benefits. The results also showed that profitability declined progressively from the foot slope to the mid slope and further to the hill slope. The mixed model results indicated that the NP fertilizer has substantially increased net benefits relative to other treatments. Moreover, the partial budget, VCR, and sensitivity analyses also confirmed that NP fertilizer produced the highest economic return for both crops. A sensitivity analysis further confirmed the robustness of the NP fertilizer under the price fluctuation scenarios of inputs (fertilizer and both crops). Therefore, the NP is an economically viable fertilizer for both teff and sorghum producers. Strategic soil and nutrient management practices tailored to different landscape positions will further enhance farm profitability in the study areas.