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Does enhanced HIV prevention, diagnosis, and linkage to care reduce hospitalisation in high HIV-burden communities in Zambia and South Africa? Findings from the HPTN 071 (PopART) randomised trial
No full textThe objective of this study is to explore if a community-based HIV combination prevention intervention reduced inpatient hospitalisations in Zambia and South Africa by diagnosing HIV and TB in earlier stages of disease progression, thereby preventing severe disease and new infections. As part of the HIV Prevention Trials Network (HPTN) 071 trial, hospitalisation data from a cohort of 16 968 consenting randomly sampled adults aged 18–44 years were collected between 28 November 2013 and 16 November 2018 across 21 communities in Zambia and South Africa across three study arms. Arm A included annual visits by Community HIV-care Providers (CHiPs) and universal linkage to care for ART initiation for all PLWH (irrespective of CD4 count); arm B included annual CHiPs visits and ART per local guidelines; control arm C received the standard of care provided at government clinics, including HIV testing and ART offered according to local guidelines. For this study, we used a cluster-level two-stage analysis and adjusted for covariates that were unbalanced across intervention arms. Covariates included in the models were the cluster’s baseline HIV prevalence and hospitalisation rate and data on the respondent’s gender, age, educational attainment, and socio-economic status. Out of the pooled sample of 13 964 responses from the three post-baseline surveys, 439 (3.14%) reported hospitalisation in the past 12 months – 234 (1.68%) when excluding hospital admissions for births or injury. Comparing hospitalisations in the intervention and control arm clusters, the estimated adjusted risk ratio was 1.03 [0.64–1.66] for the full sample and 0.82 [0.39–1.74] for PLWH. We find no compelling evidence of impact of the HPTN071 (PopART) community-wide combination HIV prevention intervention on in-patient hospitalisation among a general population sample
Bridging barriers: how COVID-19 changed racial diversity in economics seminars
No full textIn this paper, new facts are documented on the racial distribution of seminar speakers in economics. From a sample of 270 institutions, I determined that before the COVID-19 pandemic, 82.5% of seminars were given by White speakers, 13.9% of seminars were given by Asian speakers, and 3.6% by speakers with a Hispanic-Latino or Black background. The racial distribution of speakers did not change globally. However, the share of speakers from underrepresented minorities in the United States almost doubled with the introduction of virtual seminars during the COVID-19 pandemic
Green and intelligent: the role of AI in the climate transition
No full textArtificial Intelligence (AI) can play a powerful role in supporting climate action while boosting sustainable and inclusive economic growth. However, limited research exists on the potential influence of AI on the low-carbon transition. Here we identify five areas through which AI can help build an effective response to climate threats. We estimate the potential for greenhouse gas (GHG) emissions reductions through AI applications in three key sectors—power, food, and mobility—which collectively contribute nearly half of global emissions. This is compared with the increase in data centre-related emissions generated by all AI-related activities
Hidden majoritarianism and women’s career progression in proportional representation systems
No full textThe share of women in politics is higher, on average, under closed-list proportional representation (PR) electoral systems compared to majoritarian systems. Yet, even in PR systems, progress toward gender parity has been slow and uneven. We argue that women’s representation and career progression under PR might be impeded when single-occupant positions, such as local mayor and list leader, serve as important stepping stones in political career paths. Using a century of detailed candidate-level data from Norway, we investigate (1) whether gaps in women’s representation emerge at these “majoritarian stepping stones” and (2) how access to these positions affects women’s progression into higher offices. Our empirical analysis reveals that gender gaps indeed emerge at majoritarian stepping stones. However, we also document how Norwegian parties have employed workarounds—promoting women occupants of these positions at higher rates than men—to mitigate the adverse effects of this hidden majoritarianism on women’s representation in higher offices
Invitation letters increase response rates in elite surveys: evidence from Germany and the United Kingdom
No full textA key challenge when surveying political elites is recruitment. Low response rates can lead to biased samples and underpowered designs, threatening the validity of descriptive and experimental scholarship. In a randomized control trial, we test the effects of sending postal invitations in a large survey of local elected officials. We find that German and UK local politicians are more likely to complete the survey if invited by postal mail, rather than simply by email. Recruitment mode does not impact the quality of responses but shapes the population of local officials recruited. Officials invited via postal letter were more likely to come from smaller municipalities and less likely to have a college degree. Costs per response are relatively high but can be reduced as we learn more about selection into elite surveys
Boiling point: short-term coping with heatwaves in the UK is not enough
No full textIn July 2022, a national emergency was declared in the United Kingdom (UK) following the Met Office’s first-ever red extreme heat warning. As temperatures reached 40.3 °C, thousands of excess deaths were recorded. Based on 38 expert interviews and 4 focus groups with key decision-makers and stakeholders working on the frontline of the 2022 UK heatwaves, we found that the country is not prepared for extreme heat because: (1) policies and planning prioritise coping over resilience; (2) insufficient preventative actions were taken; and (3) a range of barriers hinder effective short and longer-term measures. We argue that whilst the UK coped with the heatwaves in 2022, it lacks the resilience needed to deal with persistent and prolonged heat events
Comparing the evolving dynamics of the mandatory-voluntary financing mix in OECD countries: a composite measure
No full textUniversal Health Coverage in OECD countries is achieved through a mix of government-based schemes and private health insurance markets (PHI). In response to global challenges, similar reform waves were implemented across countries with different health systems. Similar reforms might lead to a similar and increasingly complex health system financing structure over time. Equity and efficiency issues might arise at the interaction between government schemes and PHI. We outline the theoretical and methodological steps to construct a composite measure of the health system financing mix in 12 OECD countries between 1995 and 2022. Using OECD data, we employed principal component analysis to reduce the dimensionality of seven financing and coverage indicators that explain the maximum variance in healthcare financing. The resulting composite measure is the weighted sum of two components, defined as mandatory contributory government schemes and voluntary private health insurance market, accounting for 37% and 22% respectively of the explained variance among the seven indicators. In 2022, the composite measure scores between a minimum value of 1.3 and a maximum value of 8.2. The Phillips and Sul (Econometrica, 75(6), 1771-1855, 2007) convergence test and club clustering analyses reveal a common long-term convergence trend in the health system financing mix across OECD countries. This is mainly driven by a reduction in the reliance on voluntary PHI in countries with social health insurance. This descriptive measure offers a tool to systematically compare the evolving organization of health system financing across countries over time. Understanding the long-term dynamics of the health system financing mix might offer cross-country lessons to inform future reforms
Closing the gap between vocational and general education? Evidence from University Technical Colleges in England
No full textVocational education delivery is widely debated, with ongoing efforts to improve its effectiveness. In 2010, England introduced University Technical Colleges (UTCs), hybrid institutions combining general and vocational education. Using an instrumental variable approach, this paper examines the impact of UTC attendance on academic and vocational achievement, university enrolment, and labour market outcomes. For students entering UTCs at the unconventional age 14, enrolment significantly lowers academic achievement at age 16. However, for those entering at the conventional age 16, UTCs enhance vocational achievement, boost enrolment in STEM degrees, and improve labour market outcomes. The findings highlight the risks of early specialisation and the benefits of aligning education with students' interests at a more suitable stage
Deemphasizing nuclear weapons in nuclear deterrence: the case for conventional counterforce
No full textThis article advances a strategic theory on the benefits of integrated deterrence for the US alliance network in East Asia. After assessing the role of nuclear weapons in the region and tracing the evolution of US strategic thought on nuclear policy in East Asia, we evaluate the emerging risks and challenges of contemporary regional nuclear policy. We argue that over-reliance on nuclear weapons may exacerbate Sino-American tensions and pose difficulties for ally reassurance, especially against the backdrop of growing partisan politics in the United States. We outline and evaluate an alternative theory of integrated deterrence, which would prioritize the development of conventional counterforce capabilities and de-center nuclear weapons in the deterrence of nuclear threats. We assess this approach in relation to the escalation and entrapment risks posed by the current theory of regional nuclear deterrence. Finally, we reflect on the implications of US nuclear strategy in a changing regional nuclear environment
Cultural capture among regulators: a systematic review
No full textIn established democracies, the threat of regulatory capture—often implicated in major crises—is usually less about financial mechanisms like bribery and more about the subtle social processes of cultural capture. But how exactly is cultural capture defined, theorized, and assessed, and what are its underlying mechanisms, manifestations, and impact? This article presents a systematic review (n = 39) of cultural capture, identifying 7 descriptions and 10 mechanisms. We consolidate these into five underlying concepts (CHAIN): Closeness; Homogeneity; Avoidance; Identities; and Networks. We introduce a parsimonious definition of cultural capture: social and psychological processes that bias regulators' beliefs and behaviors, aligning them with those of the regulatees and marginalizing alternative viewpoints. A key contribution of this article is developing a set of 33 novel behavioral indicators to examine these five concepts empirically and clarify their relationship to regulatory capture. Finally, the review highlights theoretical and methodological issues to address for the field to advance