To send content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about sending content to .
To send content items to your Kindle, first ensure email@example.com
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about sending to your Kindle.
Note you can select to send to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
We assessed the role of home visits by Shasthya Shebika (SS) – female volunteer community health workers (CHWs) – in improving the distribution of micronutrient powder (MNP), and explored the independent effects of caregiver–provider interaction on coverage variables.
We used data from three cross-sectional surveys undertaken at baseline (n 1927), midline (n 1924) and endline (n 1540) as part of an evaluation of a home fortification programme. We defined an exposure group as one that had at least one SS visit to the caregiver’s household in the 12 months preceding the survey considering three outcome variables – message (ever heard), contact (ever used) and effective coverage (regular used) of MNP. We performed multiple logistic regressions to explore the determinants of coverage, employed an ‘interaction term’ and calculated an odds ratio (OR) to assess the modifying effect of SS’s home visits on coverage.
Sixty-eight sub-districts from ten districts of Bangladesh.
Children aged 6–59 months and their caregivers.
A home visit from an SS positively impacts message coverage at both midline (ratio of OR 1·70; 95 % CI 1·25, 2·32; P < 0·01) and endline (ratio of OR 3·58; 95 % CI 2·22, 5·78; P < 0·001), and contact coverage both at midline (ratio of OR 1·48; 95 % CI 1·06, 2·07; P = 0·021) and endline (ratio of OR 1·74; 95 % CI 1·23, 2·47; P = 0·002). There was no significant effect of a SS’s home visit on effective coverage.
The households visited by BRAC’s volunteer CHWs have better message and contact coverage among the children aged 6–59 months.
This paper focuses on the use of ‘concurrent evaluation’ to evaluate a nationally scaled-up programme in Bangladesh that was implemented by BRAC (an international development organisation) using Shasthya Shebika (SS) – volunteer community health workers – to promote home fortification with micronutrient powders (MNP) for children under-five.
We developed a programme impact pathway to conceptualise the implementation and evaluation strategy and developed a strategic partnership among the key programme stakeholders for better use of evaluation evidence. We developed a multi-method concurrent evaluation strategy to provide insights into the BRAC programme and created provision for course correction to the implementation plan while it was in operation.
One hundred sixty-four sub-districts and six urban slums in Bangladesh.
Caregivers of children 6–59 months, SS and BRAC’s staff members.
The evaluation identified low awareness about home fortification among caregivers, inadequate supply and frequent MNP stockouts, and inadequate skills of BRAC’s SS to promote MNP at the community level as hindrances to the achievement of programme goals. The partners regularly discussed evaluation results during and after implementation activities to assess progress in programme coverage and any needs for modification. BRAC initiated a series of corrections to the original implementation plan to address these challenges, which improved the design of the MNP programme; this resulted in enhanced programme outcomes.
Concurrent evaluation is an innovative approach to evaluate complex real-world programmes. Here it was utilised in implementing a large-scale nutrition programme to measure implementation process and effectiveness.
This study aimed to investigate the association between 25-hydroxyvitamin D (25(OH)D) level and low back pain (LBP) among adolescents while adjusting for potential confounders pertinent to this age group including the weight of school bags, BMI and physical activity. A cross-sectional study was conducted on 760 randomly selected adolescents in middle schools. Data on LBP and the risk factors for LBP were collected from parents by a self-administered questionnaire and from adolescents by face-to-face interview. Blood samples were tested in an accredited laboratory; and 25(OH)D was measured using liquid chromatography-tandem MS. The lifetime prevalence and the 6-month prevalence of LBP were 32·28 (95 % CI 28·97, 35·73) % and 21·26 (95 % CI 18·40, 24·33) %, respectively. There was no difference in the geometric mean of 25(OH)D between those with and without LBP in the past 6 months (28·50 nmol/l and 30·82 nmol/l, respectively; P = 0·122). There was no association between 25(OH)D and LBP in the univariable or multivariable analysis whether 25(OH)D fitted as a continuous or as a categorical variable. We found no association between vitamin D level and LBP in adolescents in an area with high prevalence of vitamin D deficiency. Although it is important to have sufficient vitamin D levels during adolescence for several other health benefits, we concluded that vitamin D is not a major determinant for LBP among adolescents in our setting.
Ficus deltoidea var. deltoidea Jack (FD) is a well-known plant used in Malay folklore medicine to lower blood glucose in diabetic patients. For further research of the antihyperglycemic mechanisms, the protein tyrosine phosphatase 1B (PTP1B)-inhibitory effect of FD was analysed both in vitro and in vivo. To optimise a method for FD extraction, water, 50, 70, 80, 90 and 95 % ethanol extracts were prepared and determined for their total phenolic and triterpene contents, and PTP1B-inhibition capacity. Among the tested extracts, 70 % ethanol FD extract showed a significant PTP1B inhibition (92·0 % inhibition at 200 µg/ml) and high phenolic and triterpene contents. A bioassay-guided fractionation of the 70 % ethanol extract led to the isolation of a new triterpene (3β,11β-dihydroxyolean-12-en-23-oic acid; F3) along with six known compounds. In vivo, 4 weeks’ administration of 70 % ethanol FD extract (125, 250 and 500 mg/kg/d) to streptozotocin–nicotinamide-induced type 2 diabetic rats reversed the abnormal changes of blood glucose, insulin, total Hb, GLUT2, lipid profile, and oxidative stress in liver and pancreas. Moreover, FD reduced the mRNA expression of the key gluconeogenic enzymes (phosphoenolpyruvate carboxykinase and glucose 6-phosphatase) and restored insulin receptor and GLUT2 encoding gene (Slc2a2) expression. In addition, FD significantly down-regulated the hepatic PTP1B gene expression. These results revealed that FD could potentially improve insulin sensitivity, suppress hepatic glucose output and enhance glucose uptake in type 2 diabetes mellitus through down-regulation of PTP1B. Together, our findings give scientific evidence for the traditional use of FD as an antidiabetic agent.
Southern Niger and northern Nigeria are the two main parts of the Central Sudan, an area of West Africa that extends roughly from the Mossi Plateau to Lake Chad, and in which populations share much in common in terms of culture, language, economic interactions, political history and social relations. Despite the national border cutting through it, separating Nigeriens from Nigerians, the Central Sudan remains a coherent unit in which networks of all manner of exchanges and contacts maintain, as of old, an apparently seamless web of human relationships. In a very tangible sense, as we will see in this chapter, southern Niger is only the northern fringe of northern Nigeria, especially owing to the dominance of Hausa language and culture, and of the Islamic religion. Given this general context, one would expect the current violent crisis in northern Nigeria to have a direct impact on southern Niger and indeed, to result in copycat actions there, since it is highly likely that radical ideas and sentiments originating in parts of northern Nigeria are broadcast throughout the Central Sudan. So far, however, and despite a small number of incidents, Niger remains largely unscathed. Even the incidents just mentioned occurred either in isolated areas in the far-eastern Diffa region, or in connection with the Malian and Libyan, rather than the northern Nigerian, crises. It is thus particularly interesting to study contexts in southern Niger that might illuminate the relative but very real calm experienced there. Why has religio-political radicalism been so muffled in southern Niger compared to northern Nigeria? What specificities in the Nigerien context would explain that ideas and sentiments that result in violence and mayhem in northern Nigeria seem to lose their teeth in Niger? To respond to these and related questions, I will focus on two Nigerien regions that share a border with Nigeria: Diffa and Maradi – creating a lens into the factors underpinning the contrast between the two countries.
Northern Nigeria is bordered by five of Niger's eight administrative regions, belonging to all four larger geopolitical sections of the country. These are, from west to east, Dosso (west), Tahoua (north), Maradi and Zinder (central), and Diffa (east). While also describing the overall Nigerien context, I have focused on Diffa and Maradi for a number of obvious reasons.
As the Boko Haram insurgency heads into its second decade, it seems no quick end is in sight. What are the possible scenarios for the future trajectory of Boko Haram, and in particular what is its endgame? While predicting the future is a very hazardous business, plausible endgame scenarios can be envisioned based on reflection on the metamorphoses of Boko Haram, careful analysis of the dynamics of its current situation, and prognosis of its emergent trends. The formal declaration of the Boko Haram Caliphate and its territorial control over much of Borno State are no more. Yet the ‘technical military defeat’ proclaimed by President Muhammad Buhari in 2015 has not prevented Boko Haram from carrying out attacks not only in rural areas, but in big towns and even military bases, often killing Nigerian soldiers – as many as 100 soldiers in one attack. Negotiations leading to the release of Boko Haram captives in exchange for freeing incarcerated leaders of the insurgency came about more than a year after the proclamation of the technical defeat. It seems that decisive defeat leading to complete surrender and total cessation of hostilities is not on the immediate horizon. Yet what scenario is likely to unfold?
This chapter explores this question by drawing insights from the literature on the growth, decline, and end of past insurgent insurgencies and civil wars. Theoretically, one may argue that there are only a few possible outcomes to an insurgency: the government may defeat the insurgents; the insurgents may defeat the government; both parties may reach a negotiated settlement; there may be a stalemate; or the insurgency may transform into something else, such as organized crime. We suggest that rather than one distinct ending, Boko Haram is likely to continue its previous patterns of transformations and factionalization, precluding decisive outcomes. Unless distinctively different approaches are taken by the state, likely endgames include a negotiated settlement with some factions, the further entrenchment of the war economy with its continuous menacing of rural areas by others, and some elements potentially becoming absorbed into the global terrorist networks of the Islamic State.
The robotic intervention has great potential in the rehabilitation of post-stroke patients to regain their lost mobility. In this paper, firstly, we present a design of a novel, 7 degree-of-freedom (DOF) upper limb robotic exoskeleton (u-Rob) that features shoulder scapulohumeral rhythm with a wide range of motions (ROM) compared to other existing exoskeletons. An ergonomic shoulder mechanism with two passive DOF was included in the proposed exoskeleton to provide scapulohumeral motion with corresponding full ROM. Also, the joints of u-Rob have more range of motions compared to its existing counterparts. Secondly, we propose a fractional sliding mode control (FSMC) to control u-Rob. Applying the Lyapunov theory to the proposed control algorithm, we showed the stability of it. To control u-Rob, FSMC has shown effectiveness to handle unmodeled dynamics (e.g. friction, disturbance, etc.) in terms of better tracking and chatter compared to traditional SMC.
Current approaches for early identification of individuals at high risk for autism spectrum disorder (ASD) in the general population are limited, and most ASD patients are not identified until after the age of 4. This is despite substantial evidence suggesting that early diagnosis and intervention improves developmental course and outcome. The aim of the current study was to test the ability of machine learning (ML) models applied to electronic medical records (EMRs) to predict ASD early in life, in a general population sample.
We used EMR data from a single Israeli Health Maintenance Organization, including EMR information for parents of 1,397 ASD children (ICD-9/10) and 94,741 non-ASD children born between January 1st, 1997 and December 31st, 2008. Routinely available parental sociodemographic information, parental medical histories, and prescribed medications data were used to generate features to train various ML algorithms, including multivariate logistic regression, artificial neural networks, and random forest. Prediction performance was evaluated with 10-fold cross-validation by computing the area under the receiver operating characteristic curve (AUC; C-statistic), sensitivity, specificity, accuracy, false positive rate, and precision (positive predictive value [PPV]).
All ML models tested had similar performance. The average performance across all models had C-statistic of 0.709, sensitivity of 29.93%, specificity of 98.18%, accuracy of 95.62%, false positive rate of 1.81%, and PPV of 43.35% for predicting ASD in this dataset.
We conclude that ML algorithms combined with EMR capture early life ASD risk as well as reveal previously unknown features to be associated with ASD-risk. Such approaches may be able to enhance the ability for accurate and efficient early detection of ASD in large populations of children.
Alkali-borosilicate glasses (ABS) are used as host immobilization matrices for different radioactive waste streams and are characterized by their ability to incorporate a wide variety of metal oxides with respectively high waste loadings. The vitreous wasteform is also characterized by very good physical and chemical durability. The durability of three ABS compositions were analyzed by investigating their leaching behavior using the MCC1 test protocol and these data were used to investigate the waste components retention in the altered layer and the evolution of the interfacial water composition during the test. The results indicated that the Mg species evolution is exceptional with respect to other alkaline elements and dependent on glass matrix composition and leaching progress, while transition elements speciation is fairly constant throughout leaching process and independent on glass compositions. Si and B species are changing during leaching process and are affected by waste composition. For modified wasteform sample, evolution of Mg, Si and B species is respectively constant, whereas at highest waste loading, these elements have fairly constant speciation evolution within the first 2 weeks of leaching.
Drought and high temperature each damage rice (Oryza sativa L.) crops. Their effect during seed development and maturation on subsequent seed quality development was investigated in Japonica (cv. Gleva) and Indica (cv. Aeron 1) plants grown in controlled environments subjected to drought (irrigation ended) and/or brief high temperature (HT; 3 days at 40/30°C). Ending irrigation early in cv. Gleva (7 or 14 days after anthesis, DAA) resulted in earlier plant senescence, more rapid decline in seed moisture content, more rapid seed quality development initially, but substantial decline later in planta in the ability of seeds to germinate normally. Subsequent seed storage longevity amongst later harvests was greatest with no drought because with drought it declined from 16 or 22 DAA onwards in planta, 9 or 8 days after irrigation ended, respectively. Later drought (14 or 28 DAA) also reduced seed longevity at harvest maturity (42 DAA). Well-irrigated plants provided poorer longevity the earlier during seed development they were exposed to HT (greatest at anthesis and histodifferentiation; no effect during seed maturation). Combining drought and HT damaged seed quality more than each stress alone, and more so in the Japonica cv. Gleva than the Indica cv. Aeron 1. Overall, the earlier plant drought occurred the greater the damage to subsequent seed quality; seed quality was most vulnerable to damage from plant drought and HT at anthesis and histodifferentiation; and seed quality of the Indica rice was more resilient to damage from these stresses than the Japonica.
In this paper, a reduced-size dielectric resonator antenna with switchable diversity patterns is proposed. Ring- and linear-shaped slots are etched in the ground plane of the antenna so as to generate two modes
at a center frequency of 19 GHz. Moreover, two groups of PIN diodes are integrated into these slots to short one group of slots, and let the other group generates the required mode. Thus, the antenna is able to generate two switchable patterns with an envelope correlation coefficient of 0.4. Furthermore, the antenna size is reduced to half of its original size by placing a copper sheet over certain plane of the antenna structure. The antenna achieves wide bandwidths of 17.6–20.9 GHz (17.1
) and 18.3–21.6 GHz (13.8
) in cases of exciting
modes, respectively. The antenna also attainsa high gain of 7.1 and 3.2 dB at the center frequency.
Child undernutrition is a major public health problem throughout the world, particularly in developing countries. The main objective of this study was to identify the risk factors for acute undernutrition among under-5 children in Bangladesh. Data were taken from the nationally representative Bangladesh Demographic Health and Survey conducted in 2014. The study sample comprised 7131 under-5 children. Of these, 4.6% were found to be severely wasted (Z-score < −3.0), 11.1% moderately wasted (−3.0≤Z-score < −2.0) and 84.3% adequately nourished (Z-score ≥−2.0). Chi-squared analysis was used to investigate the association between child nutrition status and selected covariates. Multinomial logistic regression was applied to identify the risk factors for acute undernutrition. The selected factors division, place of residence, sex of child, place of delivery, child age, respiratory illness, size at birth, measles vaccination, fever, diarrhoea, maternal BMI, maternal education, paternal occupation, wealth index and household toilet facilities were found to be highly significant (p < 0.05) in the analysis. Multinomial regression analysis revealed that residence in Barisal and Chittagong divisions, a smaller than average size at birth and low maternal BMI (≤18.50 kg/m2) were significant determinants of both moderate and severe acute undernutrition among under-5 children in Bangladesh.
The accommodation of religious personal law systems is an issue that has arisen in many countries with significant Muslim minorities. The types of accommodations can range from direct incorporation into the state legal system to mere recognition of religious tribunals as private organs. Different forms of accommodation raise different types of legal, social, and political issues. Focusing on the case of Singapore, I examine one form of accommodation which entails the direct incorporation of this law regulating marriage, divorce, and inheritance for Muslims into the state system. Administered by the Administration of the Muslim Law Act, 1966, the Muslim law binds Muslims unless they abjure Islam. The resulting pluralistic legal system is deemed necessary to realize the aspirations of and give respect to the Muslim minority community, the majority of whom are constitutionally acknowledged as indigenous to the country. This Article examines the ramifications of this arrangement on the rights and well-being of members of this community in the context of change. It argues that, while giving autonomy to the community to determine its personal law and advancing group accommodation, the arrangement denies individuals the right to their choice of law, a problem exacerbated by traditionalism and the lack of democratic process in this domain. Consequently, the Muslim law pales in comparison to the civil law for non-Muslims. The rise of religious resurgence since the 1970s has but compounded the problem. How the system can accommodate the Muslim personal law without compromising the rights of individual Muslims is also discussed.
Bangladesh, like many emerging economies of South-East Asia, has started to experience a double burden of continuing high rates of undernutrition and increasing rates of overweight and obesity. A lack of assessment of the nutritional shift leaves a gap in current policies: the growing overweight and obesity is yet to be addressed. The present paper investigates the change in nutritional status, particularly the shift in BMI, of Bangladeshi women of reproductive age (15–49 years) and characterizes the vulnerable households for both underweight and overweight status during a period of 10 years (2004–2014).
Generalized linear mixed-effect models were fitted for both urban and rural residents to assess underweight and overweight status.
Bangladesh Demographic and Health Surveys.
Women aged 15–49 years (n 53 077).
The proportion of overweight increased during 2004–2014 from 10·7 to 25·1 % and the proportion of underweight decreased from 32·6 to 18·2 %. Prevalence of underweight status remained high in rural areas and prevalence of overweight increased rapidly in both rural and urban areas, creating a double burden. The significant contributors to this double burden were the change in women’s level of education, increased household wealth, divisional location and rapid urbanization.
The findings indicate that specific cohort- or area-based intervention policy studies in line with the UN Decade of Action on Nutrition are required to address the nutritional double burden in Bangladesh.
In that conventional approaches to governance reform, particularly legalistic reforms to the administrative process and the rise of the modern civic tech field, have tended to focus on a “good governance” framework that does relatively little to address deeper disparities of power and inequality. Yet we also saw that there is a different tradition of governance reform that takes the problems of power seriously. From mid-century experiments with institutionalized countervailing power to battles over participation in the War on Poverty, these alternative approaches to governance reform sought to remake bureaucracies and public policies alike to redress power imbalances, creating genuine democratic agency for individuals and communities. Chapters 6 and 7 explore what this power-shifting approach to governance reform looks like in the context of today’s battles over democracy, inequality, and governance.
There is a paradox at the heart of the recent anxieties regarding democratic failure in America. As noted in , there is a pervasive sense that trust in democracy is eroding and American democracy may be collapsing. Yet there has been no shortage of democratic energy and mass-movement mobilization in recent years; it has been present in the Occupy movement, the Tea Party, the Movement for Black Lives, and more recently the Women’s March, the March for Our Lives, Families Belong Together, and in the overall upsurge of protest activity since the election of 2016. At the same time, these instances of progressive mobilization under the rubric of popular “resistance” to the inequalities of the current moment feel very much outgunned by a parallel and terrifying upsurge of mobilization by white supremacists, the rise of “alt-right,” the continued policy influence of big business, and the forces of “exclusionary populism” activated by Donald Trump’s presidency.
On a frigid January evening in 2008, Barack Obama, then merely a junior senator from Illinois, shocked the political establishment by winning the Iowa Caucus. At the boisterous celebration rally, Obama delivered what would become one of the signature speeches of his political career, defining many of the central themes of his campaign and his presidency. “[T]he time has come,” Obama declared, “to tell the lobbyists who think their money and their influence speak louder than our voices that they don’t own this government – we do. And we are here to take it back!” If there was a central message in Obama’s 2008 campaign for the White House, it was this faith in a revival of American democracy – the belief “that in the face of impossible odds, people who love this country can change it.”