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Adolescent depression often presents with somatic complaints, and its clinical manifestation is strongly shaped by cultural context. In non-western districts, psychological distress is frequently expressed through physical symptoms; a tendency that, combined with mental health stigma and culturally influenced health beliefs, complicates accurate detection, diagnosis and treatment. Standardised diagnostic tools developed in Western populations may overlook culturally specific symptom patterns, contributing to under-recognition and inadequate care. Despite the global impact of adolescent depression, cross-cultural symptom-level studies remain limited, hindering the development of culturally responsive mental health strategies.
Aims
This study aims to compare somatic-depressive symptom networks in Chinese and Rwandan adolescents using symptom-level network analysis, to identify culturally distinct central and bridge symptoms, and to assess structural differences between symptom networks across groups.
Method
A cross-sectional sample of 3830 adolescents (China: n = 2017, mean age 15.35 ± 1.56; Rwanda: n = 1813, mean age 15.80 ± 1.90) completed culturally adapted versions of the Patient Health Questionnaires for somatic symptoms (PHQ-15) and depression (PHQ-9). Gaussian Graphical Models were estimated in R to construct symptom networks. Centrality measures (expected influence and bridge expected influence) were used to identify influential symptoms within each group. Network Comparison Tests were conducted to examine differences in global strength and network structure, and bootstrapping was employed to assess network stability.
Results
Depressive symptoms were more prevalent among Rwandan adolescents (54.6%) than among Chinese adolescents (29.2%), whereas somatic symptoms were more commonly reported by Chinese participants (71.0% v. 64.0%). Low energy and sleep problems emerged as key bridge symptoms in both groups. Cultural differences were observed in central symptoms: psychomotor impairment and chest pain were central symptoms in Rwanda, whereas dizziness and headaches were central in China. Network structure differed significantly between groups (S = 0.99, p < 0.05), with culturally specific symptom connections.
Conclusions
The findings revealed distinct central and bridge symptoms in Chinese and Rwandan adolescents, reflecting culturally patterned architectures of symptom expression and distress reporting. These results highlight the need for culturally adapted screening tools and symptom-level interventions that target culture-specific symptoms to improve adolescent mental health care globally.
Contemporary just war theory is increasingly remote from the grounded realities of warfare. This is problematic because it diminishes the utility of just war theory as an action-guiding framework. This article asks how just war theorists can better incorporate the lived experience of war into their analysis. The argument it develops places war writing front and center. Drawing inspiration from Martha Nussbaum’s argument that moral philosophers should use the literary works of writers such as Henry James to fill out and work through their own positions, it proposes that just war theorists should engage war memoirs in a similar manner. This argument is substantiated via a close reading of Frank Richards’s World War I memoir, Old Soldiers Never Die. By incorporating experience into their ethical frame, this article concludes, just war theorists will be better able to account for the ambiguity and messiness of combat—ambiguity and messiness that simply fall out of the frame when the ethical questions that war generates are examined from a detached perspective.
The plot of Richard E. Grant's 2005 autobiographical film Wah-Wah was detailed by the writer-director himself in his initial pitch to obtain backing for the project to his potential producer Hilary Heath at a lunch meeting at London's entertainment-industry watering hole, The Ivy, on October 14, 1999.
Matthew Paris was the literary heir of Roger of Wendover, whom he spent around a decade with at St Albans.1 Matthew inherited Roger's view of the vassalage, his use of parallels and contrasts, and his inclination towards exaggeration and the use of hyperbole. However, Matthew was far more than a mere successor and continuator. He extended the condemnation of the papacy and the English clergy well beyond Roger's scope. Matthew's condemnation of the nature of the Anglo-Papal relationship reached unprecedented heights, and his view of King Henry III bordered on the treasonous.
All this came to the forefront as Matthew reported on the reception of Legate Otto de Tonengo, cardinal-deacon of S. Nicola in Carcere. Otto arrived in England in the summer of 1237, and did not depart until January 1241. Matthew viewed the mere anticipation of Otto's arrival as a catalyst for the kingdom becoming ‘divided and dismantled’ (‘divisum et dissipatum’). However, Matthew did not only blame the papacy for this rupture; forces within England shared in the blame.
Matthew viewed the reception of the legate from the point of view of the English dissidents – those who declined to welcome the legate and to acknowledge his authority. This, as will be seen below, was likely an illusion, in the sense that Matthew employed the dissident perspective to engineer a division within the English community that did not exist or only existed on the fringes of the English polity. This dissident perspective facilitated his attack on the king and the English prelates, whose acceptance of the legate he regarded as a voluntary act of unnatural submission.
IT IS OFTEN said that the Ring was written backwards and composed forwards. This is not far from the truth, but the reality is, as always, more complicated than the quip. It is true that Wagner originally wrote the text for a single opera, Siegfrieds Tod, the first version of what would ultimately become Götterdämmerung. He then realized that Siegfrieds Tod could not stand alone, so he wrote a prequel, Der junge Siegfried, which in its final form became Siegfried. That did not solve the problem, either. Audiences would still have needed a good deal of background information to make sense of what was going on, and imparting this verbally was apt to be confusing or tedious and would carry too little emotional weight; as Wagner wrote to Liszt, “a work of art … can only make its rightful impression if the poetic intent is fully presented to the senses in every one of its important moments.”1 Events conveyed through narrative would not work well with Wagner's evolving language of musicaldramatic motifs and their development, either, as Carl Dahlhaus explains:
Anything that had no foundation in the action was suspect to Wagner. … In order to be understood beyond all shadow of doubt … a musical idea—a “melodic element”—had to be introduced in association with both words and an event on the stage, and it was the latter that was of crucial importance. … It is only when a musical motive has been explicitly associated with something on the stage, with the gold, the ring, Valhalla or the restraints placed on Wotan by his contracts and obligations … that it can become a motive of remembrance or a leitmotiv: a means, that is, of linking what is seen and spoken with what is not seen and not spoken.
As a consequence of setting itself up as a bountiful smuggling warehouse, the Isle of Man, by association, was embroiled in another questionable trade, that of slavery. Both these contentious enterprises needed to be fully addressed before the Island could move towards a more befitting future. As a result, by the end of the eighteenth century and the beginning of the nineteenth it had been through major reforms and restructuring. It was at a crossroads in its economic history. With changes being needed, there were new and welcome monetary benefits coming from two different but innovative revenue drivers – new residents and summer visitors – which would give a considerable boost to the local commerce and the British government's exchequer.
Throughout this time any attempts for fiscal or political reforms from the Manx citizens’ perspective were firmly rejected. Constitutional issues inevitably went hand in hand with financial ones, and Britain was concerned that any alteration to the establishment of the self-elected House of Keys would lead to requests for local control of public finances as well. Indeed, the Keys themselves were not prepared to alter their ancient self-elected status. And there was always the fear of possible total annexation by Britain which acted as a restraint on any agitation for revolutionary modifications. But there were emerging demands for financial protection and political remodelling. Through the well-co-ordinated work of two very different sets of activists there would be the beginnings of a conservative determination to protect the pockets of consumers of taxed luxury goods taking place alongside a radical determination to bring about the greatly needed reform of the House of Keys.
In colonial Africa, coffee was generally a smallholder crop, grown by peasant households on communally owned or, sometimes, privatized land. Angola was among the few African countries where coffee became a settler crop grown on medium and large estates. The reasons for smallholder dominance were fundamentally economic. Coffee production on estates involved expensive overheads and salary costs but offered few economies of scale. Meanwhile, smallholders required very little capital, as they had access to land at little or no cost, could rely on unpaid family labour, and used cheap hand tools to grow and process coffee (see Chapter 2). In many African regions, settlers played a role in the early development of coffee cultivation, often experimenting with imported arabica cultivars. But for political, environmental, or economic reasons they often withdrew from coffee growing before African production became globally significant. As William Clarence-Smith has explained, settlers were typically ‘opportunistic producers, most likely to turn away from coffee when expenditure was especially high’, as happened when coffee prices fell or when colonial governments banned compulsory labour, forcing planters to pay market-rate wages to plantation workers. However, in settler-elite economies like Angola, the Belgian Congo, and Kenya, colonial governments proved willing to intervene in African land and labour markets to ensure the survival of a foreign planter class.
Tis chapter analyses the twentieth-century transition from smallholding to settler agriculture in northern Angola, where the share of European estates in coffee production jumped from at best one-quarter in 1900 to approximately two-thirds in 1958.
Children with cyanotic CHD experience chronic hypoxaemia and recurrent medical interventions that may adversely affect health-related quality of life.
Aims:
To compare health-related quality of life between children with cyanotic CHD and healthy peers in Sulaimani, Iraq.
Methods:
A hospital-based case–control study was conducted between October 2023 and April 2024, including 200 children with cyanotic CHD and 200 age- and sex-comparable healthy controls aged 3–13 years. Quality of life was assessed using the Pediatric Quality of Life Inventory (PedsQL™), including the Generic Core Scale Version 4.0 and the Cardiac Module Version 3.0, through parent-reported interviews. Group differences were examined using independent-samples t-tests and analysis of covariance, adjusting for age, sex, peripheral oxygen saturation (SpO2), and educational level.
Results:
Children with cyanotic CHD had significantly lower health-related quality-of-life scores across all domains compared with healthy children (all p-values < 0.001). After adjustment, the largest differences were observed in physical functioning and total quality of life, with large effect sizes (partial η2 = 0.50 and 0.63, respectively). Mean SpO2 levels were also significantly lower among children with cyanotic CHD (p < 0.001).
Conclusions:
Cyanotic CHD was independently associated with substantial impairment in quality of life across physical and psychosocial domains. Lower peripheral oxygen saturation (SpO2) was independently associated with poorer health-related quality of life. These findings support integrating health-related quality-of-life assessment and multidisciplinary care into the routine management of children with cyanotic CHD.
This volume forms the second element of the fourth volume of the new history of the Isle of Man, produced under the auspices of the Centre for Manx Studies at the University of Liverpool. It covers the period from the early fifteenth century to 1830 and is focused on social and economic aspects of the Island's history. Companion volumes covering the evolution of the natural landscape (edited by Richard Chiverrell and Geoffrey Thomas), the medieval period (edited by Seán Duffy and Harold Mytum), and the modern period (edited by John Belchem) have previously been published by Liverpool University Press.
As will immediately be clear, this volume and its companion are a collaborative effort involving a large group of scholars from the Island and beyond. In some cases, their contributions are worthy of particular note as we record with sadness that they did not live to enjoy the publication of their work: William Cain, Ulla Corkill, Nigel Crowe, Jennifer Platten, J.R. Roscow, R.L. Thomson and Nigel Yates. This preface also allows for recognition to be given to those who have helped coordinate the efforts of the contributors, especially amongst the editorial team: Professor Harold Mytum has deftly maintained the momentum of the project overall; Dr Mike Hoy has taken particular trouble to support the development of the Island-based contributions and played a pivotal role in coordinating support for the project there, including working with Charles Guard (formerly Administrator of the Manx Heritage Foundation, now Culture Vannin, whose generosity and commitment to the project is also acknowledged) on the identification of the extensive range of illustrations which support the text and ensuring the necessary permissions were secured;
It has been suggested that the year 1660 marked the beginning of a period during which the Manx people were ‘almost constantly in collision with their Stanley rulers’. According to A.W. Moore, a principal cause of this conflict was the Stanley policy of attempting to convert the customary tenure of the Island into leasehold.1 This is, however, something of an oversimplification of the history of the later years of the Stanley lordship, in which the problem of land tenure in the Island and its eventual resolution at the beginning of the eighteenth century in the Act of Settlement were important elements, though only one part of a more complex picture. The early years of the restored Stanley regime under Charles, eighth earl of Derby, were dominated by the earl's determination to bring to justice the leader of the rebellion against the authority of Earl James and Countess Charlotte in 1651. Like the events of the 1640s, the trial of William Christian had considerable, long-term repercussions for the Island and its lord. Perhaps few were more significant than the apparent growth in the influence of the Keys in the course of the seventeenth century, partly in response to these incidents and no doubt partly encouraged by contemporary events in England and elsewhere. The reaction of the governor and other officers to an evident change in the dynamics of politics within the Island was equally crucial in shaping the future development of the Island's government. In addition, changing trading patterns and restrictive practices outside the Isle of Man had a fundamental impact on the Island's economy after the 1680s.
When religion and politics become entangled with each other, which one has the upper hand? Do politicians simply instrumentalize religion for their own purposes? Or does involvement with religion constrain what politicians can get away with? If it does, is that because of the content of religious doctrine? Or is it simply because religious movements, like any other coordinated movements of citizens, have political weight?
Henry Sharpe's journal was begun in 1830, the last year of the reign of George IV, when Henry was twenty-seven and living with his sister Catharine in New Ormond Street. In ‘a spirit of youthful enthusiasm and resolution, a young man takes stock of himself and considers his prospects’. He had just started his own business in the City of London, H & D Sharpe, in partnership with his youngest brother Dan, as merchants trading with Portugal from their office at Pinners’ Hall, Broad Street. We are gradually introduced to his family and their circle of friends who reappear in the journal over the years. However, his initial enthusiasm for the journal petered out after a few months and it was not until 1840 that he returned to it, by then married with a growing family, living “over the shop” in a house in Broad Street Buildings. This time he maintained the journal until 1847.
The journal covers a period of only nine years, but the text is rich with observations about national and international events, the great political and social concerns of the time, and commentary on life in London. In the ten years between Henry's first entry in 1830 and his resumption in 1840 there had been momentous developments: parliamentary reform, the abolition of slavery, the destruction by fire of both the Palace of Westminster and the Royal Exchange, and of course Queen Victoria began her reign. The Brunels and the Stephensons were at the height of their powers, providing the machinery that continued to power the Industrial Revolution; the new railways, steamboats, waterworks, gasworks, and the Thames Tunnel, provide the backdrop to Henry's world in the 1840s.
5 January. Sunday. I have not been able to begin my year till today, but I ought to begin by dating it Hampstead, where we have now been living for three years and a half and every day more pleased with our move here. The four children, Ellen, Harry, Kate and Sutton, are all in excellent health, each a picture in his way; and Eliza too is stronger than she has been for a long time. I am much pleased too, at our having succeeded in getting to some extent out of the narrow Presbyterian set, which we started in life amongst; very worthy people, but very limited and bigoted in their self-lauding liberality. Our great friend of all is King, the Puseyite curate who is in and out of the house at all hours of the day; Cockerell the Royal Academician, most accomplished and amiable gentleman; Evans the surgeon, a high churchman, and well informed man; the Kilburns where the young men are very agreeable; and just now the Wings have called on Eliza, but we hardly know them yet. Altogether a very pleasant change from the former Hampstead tea parties, the very essence of dullness. My own health is most excellent, the riding outside in all weathers agrees capitally with me; and every winter I have less of the rheumatism which troubled me so the last winter in Broad Street.
Our business continues to flourish … not exactly at this moment when it is dull, but comparing one year with another, the increase is very perceptible; and I hope Dan's present visit to Portugal and Spain will do us good. Our office has increased to 6 clerks working hard and costing us four hundred a year.