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Previous research has highlighted the negative impact of the COVID-19 pandemic on healthcare workers’ (HCWs) mental health, yet protective factors remain underexplored. Emerging studies emphasize the importance of trust in government and interpersonal relationships in reducing infections and fostering positive vaccine attitudes. This study investigates the relationship between HCWs’ trust in the workplace and government and depressive symptoms during the pandemic. The COVID-19 HEalth caRe wOrkErS study surveyed 32,410 HCWs from 22 countries, including clinical and nonclinical staff. Participants completed the Patient Health Questionnaire-9 and ad-hoc questions assessing trust in the workplace and government. Logistic regression and multilevel models examined associations between trust levels and depressive symptoms. High workplace trust (OR = 0.72 [0.68, 0.76]) and government trust (OR = 0.72 [0.69, 0.76]) were linked to lower odds of depressive symptoms, with significant between-country variation. Country-level analyses showed that workplace trust was more protective in more developed countries and under stricter COVID-19 restrictions. Despite cross-country variation, HCWs with higher trust in the workplace and government had ~28% lower odds of experiencing depressive symptoms compared to those with lower trust. Promoting trust may help mitigate the mental health impact of future crises on HCWs.
In the field of parafoil airdrop path planning, the inherent complexity and time-sensitive nature of mission requirements necessitate rapid path generation through low-order mathematical models that approximate the system’s true dynamics. This study presents a novel sparse identification framework for constructing a parafoil path planning approximate model. Leveraging high-fidelity 9-degree-of-freedom (9 DOF) dynamic simulation data as training inputs, our method identifies simple nonlinear relationships between 3D positional coordinates (for spatial targeting) and yaw angle (for directional control), which are critical path planning parameters. Compared to conventional 4 DOF models, experimental validation using field airdrop data reveals that the proposed sparse model achieves enhanced predictive accuracy while maintaining computational efficiency. Quantitative analysis demonstrates reductions in root mean square error (RMSE) by approximately 12.96% (horizontal position), 54.44% (height) and 37.96% (yaw angle). The efficacy is further confirmed through successful fixed-point homing across diverse initial deployment scenarios, underscoring its potential for parafoil path planning.
CBRN events can occur randomly or intentionally. Rapid and appropriate response to CBRN events can significantly mitigate the adverse effects on physical health and reduce mortality rates. The effectiveness of these responses largely depends on the preparedness of hospital emergency Clinical staff.
Methods
This study was a mixed-methods research aiming to develop and validate a psychometric research instrument in 2025. Based on the review of the literature regarding CBRN events, the items were extracted, rewritten, and validated. In the quantitative phase, the validity of the questionnaire was evaluated in terms of face, content, and construct validity, and its reliability was evaluated based on internal consistency and stability (Cronbach’s alpha and Interclass Correlation Coefficient [ICC]).
Results
The designed questionnaire included 6 dimensions and 65 items. The dimensions included (1) programs and guidelines, treatment of the injured; (2) exercise; (3) decontamination and waste management; (4) education and human resources; (5) prevention, coordination, and security; and (6) PPE. The content and face validity of the questionnaire were approved by the specialists and experts of hospital emergency and health in disasters and emergencies. The content validity ratio was >0.6 for all items. The content validity index was also approved for all items. The Cronbach’s alpha coefficient and ICC were respectively 0.977 and 0.972 for the total questionnaire.
Conclusion
Hospital Emergency Clinical Staff play a vital role in responding to CBRN events; therefore, policies, programs, coordination efforts, budgets, and other necessary measures are strongly recommended to increase ED clinical staff preparedness against CBRN events.
To explore adults’ perceptions towards obesity and factors influencing eating behaviour and physical activity in North Lebanon, using a variation of the Photovoice method.
Design:
This research is part of a broader qualitative study exploring factors influencing the rising levels of obesity and understanding the barriers and enablers for effective policy for obesity prevention using a socio-ecological model as a guiding framework. For this study, a variation of ‘Photovoice’ was used to collect photographs to explore participants’ perspectives of obesity and its causes in Lebanon, using these photographs to generate discussion in one-to-one face-to-face interviews. Inductive and deductive thematic analyses were used to analyse the transcribed interviews.
Setting:
Tripoli, North Governorate, Lebanon.
Participants:
Twenty Lebanese adults aged 20–64 years were recruited.
Results:
The participants (n 20) generated 257 photographs representing both positive and negative influences related to food choice and physical activity, and the various factors perceived to be associated with rising obesity in Lebanon: changes in the food and eating landscape, sedentary behaviours, food environments, eating out and food marketing on social media platforms. Several themes specific to Lebanon were also identified, including the perceptions towards obesity, the central role of women in Lebanese food preparation and the family and the sociocultural importance of food and social gatherings.
Conclusions:
This study highlights how influences across the five levels of the socio-ecological model shaped the participants’ food choices and physical activity levels. Collaborative initiatives and public policies are necessary to address the identified barriers and curb the increasing prevalence of obesity in Lebanon.
To evaluate research exploring food policy, practice and provision in early childhood education and care (ECEC) settings, using the socio-ecological model (SEM).
Design:
A scoping review was conducted in accordance with the Joanna Briggs Institute (JBI) Methodology for scoping reviews and the Preferred Reporting Items for Systematic Reviews and Meta-analysis for Scoping Reviews (PRISMA-ScR). Five databases were systematically searched. Eligible studies were retrieved after full-text screening. Data were extracted and synthesised based on food policy, practice and provision concepts and grouped according to SEM level. Results were presented using a narrative summary.
Results:
Twenty-four studies were included, the majority had qualitative (n 13, 54 %) or cross-sectional study designs (n 11, 46 %) and presented findings at the organisational SEM level. Nursery settings were most represented (n 16, 67 %), followed by childminders (n 5, 21 %), then preschools (n 3, 13 %). Studies were conducted in England (n 20, 83 %) and Scotland (n 2, 8 %); however, no studies were undertaken in Wales or Northern Ireland. Studies reported poor adherence to food policies in ECEC. Recommended practices were frequently adhered to; however, food provided did not consistently meet nutritional recommendations. Common barriers to implementing healthy food practices and provision were cost, staff shortages, lack of training and awareness of available guidance.
Conclusions:
This review identified a need for research that targets a range of SEM levels and is conducted in Scotland, Wales and Northern Ireland. Our findings support the need for increased governmental support for ECEC, through food standards, free meal provision for ECEC and more accessible nutrition training.
One of the most incredible aspects of the Mexican Baja Peninsula is the immense wealth of plant and animal diversity it holds. The human communities living alongside this richness have boundless intimate knowledge of its natural history, potentially with novel insights into the ecological and evolutionary processes shaping the diversity of plants and animals. These same human communities have likely also witnessed changes to these natural environments over their lifetimes, particularly as the effects of global change are being felt by similar rural communities around the world. However, because the area is so remote, they often have little access to scientific data or current information about the causes or effects of the changes they observe. Using a thematic analysis of recorded conversations, this project seeks to connect remote rural ranches in Mexico with scientists, to gather data on the issues that matter most to the community members, and work to find collaborative solutions. Through thematic analysis of recorded conversations, our research reveals that unpredictable climate variability, including droughts, hurricanes, and shifting seasonal patterns, poses significant challenges to ranching livelihoods. Ranchers’ deep ecological knowledge provides critical insights into the stresses of changing and increasingly unpredictable environmental trends. By integrating local perspectives with scientific approaches, this study highlights the potential for collaborative biodiversity research.
The atomic bombings of Hiroshima and Nagasaki reshaped international politics and the field of International Relations. But one question—“How should the atomic bomb be used?”—has been largely overlooked in political science. This article recovers American deliberations on alternative nuclear use options before August 1945, including the “noncombat demonstration,” targeting military installations, giving advance warning, and striking more symbolically valuable cities. We develop theoretical insights on the value of staging violent spectacles and the emotive power of visible destruction. We then use a wide range of sources to show that U.S. leaders selected an ostentatiously lethal means of atomic debut due to concerns about conventional military inferiority vis-à-vis the Soviet Union, the desire to instill a widespread view of the bomb’s revolutionary character, and the imperative of shaping the postwar international order. This study advances our understanding of the post-1945 international order and the performative dimensions of political violence.
The vast presence of populism in contemporary political discourse has introduced a narrative steeped in nostalgia, evoking images of a revered national past and delineating a stark division between the ‘authentic us’ and the ‘alien them’. While these messages resonate with a substantial portion of citizens, they concurrently foster identity-driven animosity and derogation. In a pre-registered experiment in the Netherlands (with data collected between January and March 2023), we distinguish the influence of nostalgic narratives and scapegoating on societal sentiments, revealing their pivotal role in exacerbating current levels of polarization. Our findings underscore the potential of nostalgic narratives to shape affective sentiments towards ideological and social in-groups, while also influencing sentiments towards out-groups. Messages featuring scapegoats were found to intensify positive sentiment towards in-groups, while simultaneously diminishing positive sentiment towards out-groups. This research underscores a crucial mechanism underpinning the ebb and flow of identity-based sentiments. The results indicate that nostalgic discourse, particularly when intertwined with scapegoating, can serve as a catalyst for the intensification of in-group affinity and the exacerbation of out-group aversion. In essence, our study underscores the far-reaching implications of nostalgic narratives in perpetuating societal animosity and polarization and sheds light on a critical facet of contemporary political discourse.
Lesbian, gay, bisexual, transgender, queer and related community (LGBTQ+) individuals have significantly increased risk for mental health problems. However, research on inequalities in LGBTQ+ mental healthcare is limited because LGBTQ+ status is usually only contained in unstructured, free-text sections of electronic health records.
Aims
This study investigated whether natural language processing (NLP), specifically the large language model, Bi-directional Encoder Representations from Transformers (BERT), can identify LGBTQ+ status from this unstructured text in mental health records.
Method
Using electronic health records from a large mental healthcare provider in south London, UK, relevant search terms were identified and a random sample of 10 000 strings extracted. Each string contained 100 characters either side of a search term. A BERT model was trained to classify LGBTQ+ status.
Results
Among 10 000 annotations, 14% (1449) confirmed LGBTQ+ status while 86% (8551) did not. These other categories included LGBTQ+ negative status, irrelevant annotations and unclear cases. The final BERT model, tested on 2000 annotations, achieved a precision of 0.95 (95% CI 0.93–0.98), a recall of 0.93 (95% CI 0.91–0.96) and an F1 score of 0.94 (95% CI 0.92–0.97).
Conclusion
LGBTQ+ status can be determined using this NLP application with a high success rate. The NLP application produced through this work has opened up mental health records to a variety of research questions involving LGBTQ+ status, and should be explored further. Additional work should aim to extend what has been done here by developing an application that can distinguish between different LGBTQ+ groups to examine inequalities between these groups.
Gas-phase turbulence in a bubbling gas–solid fluidised bed is modelled using the data from particle-resolved direct numerical simulations. The subgrid particle-induced turbulent kinetic energy (TKE) is modelled as a function of filter width, filtered solid volume fraction, particle Reynolds number and filtered gas-phase strain rate tensor. Within the volume-filtered framework, we demonstrate that the fluid Reynolds stress models originally developed for a homogeneous system remain applicable to the inhomogeneous fluidised bed, provided that the inhomogeneous drag and particle-induced TKE models are used for the dissipation rate interfacial term. An algebraic model for the anisotropy of gas-phase velocity variance is developed by simplifying the proposed Reynolds stress equation model, which incorporates the effects from both filtered slip velocity and filtered fluid strain rate. The new models are shown to agree well with the direct numerical simulation data of clustered particle settling systems, indicating good applicability of our models for various clustered particle-laden flows.
Loneliness is associated with several physical and mental health problems, yet its costs to the healthcare system remain unclear.
Aims
The current study aimed to review literature on the health and social care impacts of loneliness, and review economic evaluations of loneliness interventions.
Method
We conducted a systematic review of studies published from 2008 to April 2025 by searching five bibliographic databases, grey literature and reference lists of systematic reviews. Studies estimating health and social care cost/expenditure, and on health resource utilisation, were included to assess the impact of loneliness on the health system. Return on investment, social return on investment and cost-effectiveness evaluations were included to assess the economic impact of loneliness interventions. We conducted quality appraisal and narrative synthesis of results.
Results
We included 53 studies. Eight estimated the healthcare cost/expenditure of loneliness, 33 reported healthcare resource use and 19 were economic evaluations of interventions. Findings relating to the cost/expenditure of loneliness and service use were inconsistent: some studies reported excess costs/expenditure and service use, whereas others found lower costs/expenditure and service use. Economic evaluation studies indicated that loneliness interventions can be cost-effective, but were not consistently cost-saving or effective in reducing loneliness.
Conclusions
Findings on the impact of loneliness on the healthcare system and economic evaluations of loneliness interventions were varied. Therefore, we cannot derive confident conclusions from this review. To address evidence gaps, future research relating to social care, younger populations, direct healthcare costs of loneliness and randomised controlled trials with long-term follow-ups should be prioritised.
This study compares turbulent channel flows over elastic walls with those over rough walls, to explore the role of the dynamic change of shape of the wall in turbulence. The comparison is made meaningful by generating rough walls from instantaneous configurations of elastic cases. The aim of this comparison is to individually understand the role of fluid–structure interaction effects and the role of wall shape/undulations in determining the overall physics of flow near elastic walls. With an increase in the compliance of the wall, qualitatively similar trends for many of the effects produced by a rough wall are also seen in the elastic wall. However, specific features can be observed for the elastic-wall cases only, arising from the mutual interaction between the solid and fluid, leading to a further increase in drag. To understand them, we look at the turbulent structures, which exhibit clear differences across the various configurations: roughness induces only a slight reduction of streamwise coherency, resulting in a situation qualitatively similar to what is found in classical turbulent channel flows, whereas elasticity causes the emergence of a novel dominant spanwise coherency. Additionally, we explored the effect of vertical disturbances on elastic-wall dynamics by comparing with permeable walls having similar (average) wall-normal velocity fluctuations at the interface. The permeable walls were found to have minimal similarities to elastic walls. Overall, we can state that the wall motion caused by the complex fluid–structure interaction contributes significantly to the flow and must be considered when modelling it. In particular, we highlight the emergence of strong wall-normal fluctuations near the wall, which result in strong ejection events, an attribute not observed for rigid walls.
There is growing consensus on essential components of care for hospital-presenting self-harm and suicidal ideation, yet these are often inconsistently implemented. This qualitative study aimed to explore the implementation of components of care across hospitals. Interviews were conducted with health professionals providing care for self-harm and suicidal ideation in hospital emergency departments. Participants (N = 30) represented 15 hospitals and various professional roles. A framework analysis was used, where factors affecting each care component were mapped by hospital and hospital grouping.
Results
A timely, compassionate response was facilitated by collaboration between liaison psychiatry and emergency-department staff and the availability of designated space. Other factors affecting the implementation of care components included patient preferences for, and staff encouragement of, family involvement, time taken to complete written care plans and handover and availability of next care impacting follow-up of patients.
Clinical implications
The findings suggest a need for further integration of all clinical professionals on the liaison psychiatry team in implementing care for self-harm; improved systems of handover; further training and awareness on the benefits and optimal processes of family involvement; as well as enhanced access to aftercare.
It is widely believed that high inflation reduces the popularity of incumbents, and contributed to poor incumbent performance in recent elections in the United States and elsewhere. Existing research shows that voters’ inflation perceptions are associated with their evaluations of incumbent parties, but these observational studies cannot eliminate the possibility that the causal relationship runs the other way, where opposition to incumbent governments causes individuals to report higher price increases. To help overcome this inferential challenge, this study draws on a pre-registered experiment embedded in a nationally representative survey fielded just days before the 2024 US Presidential election. We find that priming Americans to think about inflation reduced support for the incumbent party. This effect is most pronounced among Independents and Democrats. These findings suggest that inflation likely contributed to the Democrats’ 2024 electoral defeat, and provide novel evidence that inflation has a causal effect on support for incumbent parties.
The locomotion of microorganisms in complex fluids at low Reynolds numbers has been widely studied by ignoring fluid inertia. Here, we combine the asymptotic analysis and numerical simulations to explore the effect of fluid inertia on the dynamic mechanism of microorganisms swimming through viscoelastic fluids using Taylor’s swimming sheet model, undergoing small-amplitude undulations. Surprisingly, fluid inertia can enhance the speed and efficiency of the infinite-length sheet in viscoelastic fluids at finite Reynolds numbers, in stark contrast to the previous results found in Newtonian fluids. Moreover, speed and efficiency slightly exceed those Newtonian values at the small Weissenberg number due to a passive inertial response of the sheet. We associate this with the magnitude of the hydrodynamic force increasing at finite Reynolds numbers. These insights contribute to a deeper understanding of the inertial effect on the locomotion of microorganisms through complex fluids.
Twin children are more likely to die than singletons. This is an additional burden in sub-Saharan African (SSA) countries, as child mortality levels are already higher than anywhere else. This article provides estimates of under-5 mortality rates (U5MRs) for twins and singletons in SSA from 1986 to 2016. It describes the geographical variations and changes over time. It also describes the variation of twins’ excess mortality according to age from 0 to 5 years. Additionally, it analyzes the factors associated with twins’ excess mortality. We used data from 156 national surveys from 42 countries. We estimated U5MRs for twins and single children and built a Cox model to analyze factors associated with excess mortality among twins. Although child mortality has declined on the continent, twins’ excess mortality remains very high. U5MRs are, on average, 3 times higher among twins than singletons. The Cox model shows that all other things being equal, the adjusted hazard ratio of under-5 mortality (U5M) is 3.2 (2.9−3.3; p < .001) times higher among twins than singletons. The main factors associated with excess mortality risks among twins are biomedical and nutritional features, such as low birth weight, non-use of cesarean section delivery, and lack of breastfeeding. Health policy makers in SSA should be aware of the vulnerability of twins, and interventions to prevent their early deaths should be considered.