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This study explored the enablers and challenges influencing the performance of community health volunteers (CHVs) in Machakos County, Kenya, during the COVID-19 pandemic.
Background:
The COVID-19 pandemic disrupted healthcare systems globally, with particularly severe impacts in developing countries. Community health workers (CHWs) played a critical role in crisis communication, community engagement, case detection, referrals, and maintaining care continuity. However, limited evidence exists on the factors enabling and hindering their performance during the pandemic.
Methods:
This study employed a convergent mixed-methods design, integrating focus group discussions (FGDs), in-depth interviews (IDIs), and structured data extraction from the Kenya Health Information System (KHIS). Analysis of the data was guided by Agarwal et al.’s conceptual framework for measuring community health workforce performance with the quantitative data being analyzed using descriptive statistics, while qualitative data being analyzed through thematic analysis.
Findings:
CHVs effectively disseminated COVID-19 information, addressed vaccine hesitancy, and mobilized communities, supported by training, supervision, and community recognition. Their efforts led to significant improvements in healthcare services, including increased household visits, immunizations, and maternal health referrals. Despite their contributions, CHVs faced challenges such as delayed stipends, limited resources, and occasional community stigma, which hindered performance. Social support networks, community appreciation, and priority healthcare access emerged as key enablers, fostering resilience and motivation. Improved reporting mechanisms also highlighted CHVs’ expanded roles during the pandemic.
Conclusion:
This study underscores the critical role of CHVs in sustaining healthcare services during the COVID-19 pandemic, despite facing financial, logistical, and social barriers. Their resilience and adaptability led to significant improvements in key health services, supported by effective supervision and training. Strengthening systemic support, integrating CHVs into long-term strategies, and enhancing community recognition are essential to maximize their impact in future health challenges.
Illicit drug use may lead to dependence on those drugs, is associated with various psychiatric disorders, and can have hazardous, sometimes life-threatening, consequences. We investigated the genetic architecture underlying the lifetime use (LU) of several drugs, individually and in combination.
Methods
We conducted genome-wide association studies of LU of cocaine, methamphetamine, inhalants, illegal opioids, prescription opioids, and prescription stimulants in European (EUR), African (AFR), and Latin American (AMR)-ancestry subjects (cases ranging from n = 4,900–21,850 [EUR], n = 519–9,802 [AFR], and n = 899–5,012 [AMR]; controls from n = 93,763–110,658 [EUR], n = 37,261–46,509 [AFR], and n = 31,412–35,501 [AMR]). We also investigated the use of illicit drugs of any kind and the total count of drugs a person has ever used. Then, we assessed the global and local genetic correlations between substance LU (SubLU) traits and their genetic correlations with other traits.
Results
We found numerous genes that affect SubLU traits, with no overlap among the significant loci between traits, suggesting that unique genetic factors may differentially affect the use of different drugs. Nevertheless, the genetic correlations between SubLU traits were very strong; however, the phenotypic correlations were moderate. There were strong genetic correlations between various SubLU traits and psychiatric traits, most notably opioid use disorder, cannabis use disorder, problematic alcohol use, and suicidality.
Conclusions
Our findings provide insights into the genetic basis of substance use, identifying several novel genes associated with SubLU traits. This study can provide an improved understanding of the biology underlying SubLU and could potentially facilitate future risk assessments for the use of illicit and hazardous drugs.
Recent studies showed contradictory results with regard to the implementation of proactive language control during bilingual sentence production. To add novel evidence to this debate, the current study investigated the blocked language order effect, a measure of proactive language control that has previously only been examined in single-word production. More specifically, bilingual participants completed a network description task, using their L1 in Blocks 1 and 3 and their L2 in Block 2. Results showed increased language intrusions in Block 3 compared to Block 1. This pattern indicates that proactive language control can be implemented during bilingual sentence production.
Following [1], given cardinals $\kappa <\lambda $, we say $\kappa $ is a club $\lambda $-Berkeley cardinal if for every transitive set N of size $<\lambda $ such that $\kappa \subseteq N$, there is a club $C\subseteq \kappa $ with the property that for every $\eta \in C$, there is an elementary embedding $j: N\rightarrow N$ with $\mathrm {crit }(j)=\eta $. We say $\kappa $ is $\nu $-club $\lambda $-Berkeley if $C\subseteq \kappa $ as above is a $\nu $-club. We say $\kappa $ is $\lambda $-Berkeley if C is unbounded in $\kappa $. We show that under $\textsf {AD}^{+}$, (1) every regular Suslin cardinal is $\omega $-club $\Theta $-Berkeley (see Theorem 7.1), (2) $\omega _1$ is club $\Theta $-Berkeley (see Theorem 3.1 and Theorem 7.1), and (3) the ’s are $\Theta $-Berkeley – in particular, $\omega _2$ is $\Theta $-Berkeley (see Remark 7.5).
Along the way, we represent regular Suslin cardinals in direct limits as cutpoint cardinals (see Theorem 5.1). This topic has been studied in [31] and [4], albeit from a different point of view. We also show that, assuming $V=L({\mathbb {R}})+{\textsf {AD}}$, $\omega _1$ is not $\Theta ^+$-Berkeley, so the result stated in the title is optimal (see Theorem 9.14 and Theorem 9.19).
The present study relied on internet memes as a tool to possibly fight ageism and shape public views in a positive manner. Data collection took place between May and June 2024, recruiting 160 Israeli Arabs, aged 13 to 16, from 3 different schools. In total, 105 memes addressed ageism towards older people. Visual and written contents were described, followed by more interpretative analysis. The memes were classified into two main themes. The first concerned negative ageist stereotypes of older persons (n = 66). The second theme concerned attempts to combat ageism (n = 39). Even though students received explicit instructions to fight ageism via their meme production, most students produced memes which depicted older age and ageing in a negative stereotypical light. The study highlights the relatively high levels of ageism in this group of participants and points to areas needing further attention in future interventions to alleviate ageism. The present findings are important as they question the current thinking of the Arab population as characterized by familistic values of high levels of respect towards older persons.
Water demand continues to increase in the western U.S., straining existing (and forecasted future) supplies. Water transfers – through either the sale of water rights or contractual leases of bounded duration – are now a well-established means of reallocating water to the highest economic benefit. Water is not a typical commodity, however. Significant variability in price across different geographic locations reflects differences in hydrologic conditions, demand and supply, and infrastructure development. These differences will persist even in well-functioning markets due to high transportation costs and user interconnectivity.
While sufficient data now exist to describe market activity and price trends, no study has yet performed a rigorous analysis that fully accounts for contract type (whether water rights transfer or lease) and price endogeneity. We fill this gap by estimating a simultaneous system of demand equations for rights transfers and leases that accounts for supply drivers of price determination. As one might anticipate, the demand for leases is more elastic than the demand for water rights. Accounting for contract type and price endogeneity provides a more accurate estimation of water’s market value in different locations across the western U.S. Ignoring either issue leads to significant biases with policy implications.
Research focused on digital tools and the Global South has enhanced our understanding of electoral campaigning. Although big data and social media seem to be game-changers in contemporary politics, studies of data-driven campaigns highlight that the reality does not always match the potential. Moreover, research into campaigns in Africa, East Asia and Latin America has enriched our knowledge, underlining that digital campaign tools are at their most effective when combined with more traditional means of campaigning, when clicks are combined with mortar. Rallies, in particular, remain an important mode of campaigning given both the information conveyed by their physical location, and the popularity of the candidate or party indicated by the size of the crowd. Reviewing the advances in scholarship, however, highlights that despite changes in the modes of campaigning, the key ingredient of a campaign remains a clear and compelling message to mobilize and persuade the electorate.
Forecasting of armed conflicts is a critical area of research with the potential to save lives and mitigate suffering. While existing forecasting models offer valuable point predictions, they often lack individual-level uncertainty estimates, limiting their usefulness for decision-making. Several approaches exist to estimate uncertainty, such as parametric and Bayesian prediction intervals, bootstrapping, quantile regression, but these methods often rely on restrictive assumptions, struggle to provide well-calibrated intervals across the full range of outcomes, or are computationally intensive. Conformal prediction offers a model-agnostic alternative that guarantees a user-specified level of coverage but typically provides only marginal coverage, potentially resulting in non-uniform coverage across different regions of the outcome space. In this article, we introduce a novel extension called bin-conditional conformal prediction (BCCP), which enhances standard conformal prediction (SCP) by ensuring consistent coverage rates across user-defined subsets (bins) of the outcome variable. We apply BCCP to simulated data as well as the forecasting of fatalities from armed conflicts, and demonstrate that it provides well-calibrated uncertainty estimates across various ranges of the outcome. Compared to SCP, BCCP offers improved local coverage, though this comes at the cost of slightly wider prediction intervals.
Occupational shoulder exoskeletons can relieve workers during strenuous overhead work. Passive solutions are lightweight, robust, and cost-effective, but they can also restrict user movement, have limited support, and cannot dynamically adapt to different working conditions. Semi-active and active systems are still mostly the subject of research, and existing systems are heavy or have limited performance and support. Here, we present a lightweight semi-active exoskeleton for shoulder support that incorporates a novel motorized torque adjustment mechanism that varies the effective lever arm with which a spring applies force to the supporting joint. The mechanism is integrated into lateral structures and can be actuated via Bowden cables with motors located on the user’s back. The technical performance of the system was experimentally characterized in terms of its dynamic support torque profiles at six different support levels. Furthermore, adjustment times and energy consumption were investigated. The system showed plateau-like support torque profiles in the intended working range and could be adjusted from nearly 0 Nm up to 12 Nm of maximum support per arm. Adjustment times varied between 0.5 s for the adjustment of 20% of the total adjustment range and 1.0 s for a full activation/deactivation. Adjustments consumed between 0.1 As and 1.9 As of battery charge, allowing long operating times of up to one working day, using only a small 2 Ah battery. As a result, the exoskeleton provides high performance by combining comparatively high support, rapid motorized support adjustment, and low energy consumption in a lightweight design.
Although Adolphe Sax’s serpentine invention hailed from Belgium, and then France, saxophones today are widely perceived as symbols of United States-led popular modernity. This image’s strength occludes a largely unknown antipodean precursor: the instrument debuted in British colonial Australia before being first heard across the Atlantic. This article foregrounds the goldrush-era Australian introduction of an instrument otherwise known as a ‘turkophone’, by enigmatic French musician Charles Jean-Baptiste Soualle, known in his orientalist stage persona as ‘Ali Ben Sou Alle’, from December 1852 to July 1855.
This article establishes the European origins of Soualle’s act and examines its effusive Australian reception through a historical musicology lens, before discussing the cultural dynamics key to this episode’s geographic context. While a Saidian, Orientalism-inspired critique sheds some light on the appeal of ‘Ali Ben Sou Alle’ to Australian audiences, Soualle’s local success was perhaps most notably underwritten by geopolitical events. For example, the 1853 outbreak of the Crimean War, which pitted the allied imperial French, British, and Ottoman powers against Tsarist Russia, challenged a nascent Australia’s sense of itself and place in the world, and provided Soualle an opportune, sympathetic platform from which to compose and perform. Remarkably, given characterizations the instrument signified in the Jazz Age decades hence, Soualle’s saxophone also embodied notions of freedom for its mid-nineteenth-century Australian audiences.
This episode, and its thematic resonances, offers insights into histories of touring musicians, understandings of music and coloniality, musical globalism, and the saxophone’s symbolic malleability prior to its rise to worldwide prominence.
Current political developments worldwide illustrate that research on democratic backsliding is as important as ever. A recent exchange in Political Science & Politics (February 2024) highlighted again that the measurement of democracy remains a challenge. With many democracy indicators consisting of subjective assessments rather than factual observations, trends in democracy over time could be due to human biases in the coding of these indicators rather than empirical facts. This article leverages two cutting-edge Large Language Models (LLMs) for the coding of democracy indicators from the V-Dem project. With access to huge amounts of information, these models may be able to rate the many “soft” characteristics of regimes at substantially lower costs. Whereas LLM-generated codings largely align with expert coders for many countries, we show that when these models deviate from human assessments, they do so in different but consistent ways. Some LLMs are too pessimistic and others consistently overestimate the democratic quality of these countries. Although the combination of the two LLM codings can alleviate this concern, we conclude that it is difficult to replace human coders with LLMs because the extent and direction of these attitudes is not known a priori.
Efficient coordination is a major source of efficiency gains. We study in an experimental coordination game with 727 children and teenagers, aged 9 to 18 years, the strategies played in pre-adulthood. In our one-shot, experimental coordination game, we vary the incentives for reaching the more efficient equilibrium and the number of subjects within a group. Looking at strategy choices dependent on age, we do not find robust age effects in the aggregate. Yet, we see that smaller group sizes and larger incentives increase the likelihood of choosing the efficient strategy. The larger strategic uncertainty in larger groups is obviously harmful for overall efficiency. Regarding incentives, we find that increasing the profits in the efficient equilibrium seems to work better than providing a cushion in case of miscoordination. Beliefs play an important role as well, as subjects are more likely to play the efficient strategy when they expect others to do so as well. Our results are robust to controlling for individual risk-, time-, and social preferences.
William Labov carried out literacy research throughout his career from the 1960s to 2010s. This developed in tandem with his linguistic documentation of African American Vernacular English. Both began in 1965, when Labov received funding for a three-year fieldwork project on Black youths’ language and schooling in Harlem, New York. Literacy was an important political issue in the 1960s, with substantial funding to raise basic education levels, as part of socioeconomic development agendas. In the US, this coincided with civil rights movements, shifting race relations, and a period of social unrest. In this article, Labov’s first phase of literacy research is traced through this historical moment, from the late 1960s to early 1970s. Also charted is the development of one deficit theory Labov contested during this period—cultural deprivation theory. Three parts are described: foundational conferences in 1964, research and reports from 1965–1968, and centers of contestation from 1969–1972. (Sociolinguistics, ethnography, literacy, reading, cultural deprivation theory)*
Mental health is a global priority, fundamental to the health and development of all nations. The contribution of mental disorders to the global burden of disease is widely recognized; however, a significant care gap exists, particularly in the context of low-and middle-income countries. In India, for instance, there are 0.3 psychiatrists per 1,00,000 population. To address this severe shortage of mental health professionals and resources globally, the World Health Organization has suggested the adoption of a community-based mental health care approach, where the locus of services shifts from institutional care to local communities. Over the last five decades in India, diverse approaches to mental health care have emerged because of the interaction of dominant discourses on community-based mental health care with various socio-cultural contexts. In addition to the government-run mental health program and programs run by medical colleges, civil society organizations have increasingly contributed to this space. Although studies have assessed individual interventions, there exists a need to map these interventions and synthesize the approaches for service delivery to inform public health practice in India and in low-and middle-income countries at large. This narrative review attempts to map and synthesize insights from community-based mental health interventions in India implemented across diverse contexts. We searched peer-reviewed journal articles and book chapters published in the English language between 2010 and 2023. We present the synthesis of approaches used in 41 community-based mental health interventions, where we unpack key intervention components and processes adopted for primary prevention and promotion; identification and case detection; treatment and care, and rehabilitation in the community. This review presents key recommendations for practitioners about the role of community, the diversity and commonalities in various approaches across contexts, the roles of various actors in service delivery, and the shared values guiding the conceptualization and implementation of community-based mental health interventions in India.
In the 1880s, Sievers proposed that in Old English words such as *feorhes, the loss of the post-consonantal *h caused compensatory lengthening of the vowel: fēores. Since there are no unambiguous traces of this sound change in later English, widespread analogical restitution of the short vowels was assumed (e.g. from feorh). The evidence for this lengthening is largely metrical. I argue that while Sievers is correct that words like <feores> often need to scan with a heavy initial syllable, this need not be explained by a general lengthening in the language at large. Indeed, the distribution of where heavy scansions are required in verse is typical for metrical archaisms: late prehistoric metrical values of words preserved for poetic convenience. Just as wundor ‘marvel’ can continue to be scanned as monosyllabic *wundr, or contracted hēan can scan as disyllabic *hēahan, so can light-syllabled feores continue to scan as heavy *feorhes. The same sets of poems that prefer non-epenthesized or non-contracted forms also prefer the heavy scansions of feores-type words. If heavy scansions of feores-words are seen as a matter of poetic convention, then the hypothesis of compensatory lengthening in the language generally is left without evidence and should be rejected.
How do state actors interpret and share information? Theories of the state have long recognized the role of legibility – the modes and practices by which states render society and nature knowable through intervention and information collection – in constructing and maintaining state power. Yet, research has only begun to explore the processes by which information is created and diffused within state administrations. Drawing upon theories of agency relations in states, this article explores how administrators’ communicative practices shape knowledge and legibility. Through examining memos, legislative studies, and draft legislation for decrees recognizing water rights in the French Protectorate in Morocco, I identify a set of common patterns in the construction of bureaucratic information as it moves from street-level administrators to central officials. In analyzing these patterns, I demonstrate how administrators’ obligations and their understandings of the state’s political projects determined not only how French officials collected information, but what they communicated to others. As information moved across administrative levels, officials iteratively changed information. Joining critiques and extensions of legibility theory that emphasize the role of non-state actors in the construction of state knowledge, I argue that we must also attend to intra-state dynamics. In tracing communication and information, I demonstrate that information is iteratively constructed by state agents according to their administrative position and transformed by its particular bureaucratic routes. Modeling legibility and the development of state knowledge requires attending to administrators’ agency, their relationships with each other, and their understanding of the state’s goals.
Although women leaders assume prominent national offices in the United States (and the world), one of the well-established specializations in political science and psychology (i.e., leadership studies) is inundated with male-centric benchmarks. This research often relies on a reference group to develop leaders’ profiles in comparison to other elites. They are predominantly populated, however, with male leaders. This article suggests a remedy and introduces a women leaders reference group for operational code analysis, which is a quantitative approach measuring leaders’ beliefs about politics. We gathered American women leaders’ speeches from the Iowa State University Archives of Women’s Political Communication. Using an automated content analysis, we developed a norming group exclusively for American female politicians in national politics. Whereas our findings indicate noticeable differences and suggest similarities with existing reference groups, we aspire to initiate a conversation and hope that more data will follow and shed more light on women leaders. This reference group can serve as a crucial tool in providing contextualized political-personality profiles of American women leaders and also provide an illustrative example to bridge leadership and gender studies in advancing the study of women leaders in the United States (and beyond).
Fourier analysis is the standard tool of choice for quantifying the distribution of kinetic energy amongst the eddies in a turbulent flow. The resulting spectral energy-density function is the well-known energy spectrum. And yet, because eddies are distinct from waves, alternative approaches to finding energy-density functions have long been sought. Townsend (1976) outlined a promising approach to finding a spatial energy-density function, $V\!(r)$, where $r$ is the eddy size. Notably, this approach led to two distinct and mutually inconsistent formulations of $V\!(r)$ in homogeneous, isotropic turbulence. We revisit Townsend’s proposal and derive the corresponding three-dimensional $V\!(r)$ as well as introduce its one-dimensional variants (which, to our knowledge, have not been explicitly discussed before). By training our focus on the associated dimensionality of the function, we resolve the discrepancies between the previous formulations. Additionally, we generalise our analysis to include anisotropic flows. Finally, by means of concrete examples, we illustrate how one-dimensional spatial energy-density functions are useful for analysing empirical data. Some notable findings include new insights into the $k_1^{-1}$ scaling (where $k_1$ is the streamwise wavenumber) and a possible resolution of the enigmatic sizes of organised motions at large scales.