Dimagi (United States)

Large language models (LLMs) have significantly improved natural language processing, holding the potential to support health workers and their clients directly. Unfortunately, there is a substantial and variable drop in performance for low-resource languages. This paper presents an exploratory case study in Malawi, aiming to enhance the performance of LLMs in Chichewa through innovative prompt engineering techniques. By focusing on practical evaluations over traditional metrics, we assess the subjective utility of LLM outputs, prioritizing end-user satisfaction. Our findings suggest that tailored prompt engineering may improve LLM utility in underserved linguistic contexts, offering a promising avenue to bridge the language inclusivity gap in digital health interventions.

BackgroundThe unmet need for mental health care affects millions of Americans. A growing body of evidence in implementation science supports the effectiveness of task sharing in the delivery of brief psychosocial interventions. The digitization of training and processes supporting supervision can rapidly scale up task-shared interventions and enable frontline health workers (FLWs) to learn, master, and deliver interventions with quality and support.ObjectiveWe aimed to assess the perceived feasibility and acceptability of a novel mobile and web app designed and adapted to support the supervision, training, and quality assurance of FLWs delivering brief psychosocial interventions.MethodsWe followed human-centered design principles to adapt a prototype app for FLWs delivering brief psychosocial interventions for depression, drawing from an app previously designed for use in rural India. Using a multimethod approach, we conducted focus group sessions comprising usability testing and group interviews with FLWs recruited from a large health system in Texas to assess the feasibility and acceptability of the app. The positive System Usability Scale was used to determine the app’s overall usability. We also calculated the participants’ likelihood of recommending the app to others using ratings of 0 to 10 from least to most likely (net promoter score). Focus group transcripts were coded and analyzed thematically, and recommendations were summarized across 4 key domains.ResultsA total of 18 FLWs varying in role and experience with client care participated in the study. Participants found the app to be usable, with an average System Usability Scale score of 72.5 (SD 18.1), consistent with the industry benchmark of 68. Participants’ likelihood of recommending the app ranged from 5 to 10, yielding a net promoter score of 0, indicating medium acceptability. Overall impressions of the app from participants were positive. Most participants (15/18, 83%) found the app easy to access and navigate. The app was considered important to support FLWs in delivering high-quality mental health care services. Participants felt that the app could provide more structure to FLW training and supervision processes through the systematic collection and facilitation of performance-related feedback. Key concerns included privacy-related and time constraints regarding implementing a separate peer supervision mechanism that may add to FLWs’ workloads.ConclusionsWe designed, built, and tested a usable, functional mobile and web app prototype that supports FLW-delivered psychosocial interventions in the United States through a structured supervision mechanism and systematic collection and review of performance measures. The app has the potential to scale the work of FLWs tasked with delivering these interventions to the hardest-to-reach communities they serve. The results of this project will inform future work to evaluate the app’s use and efficacy in real-world settings to support task-shared mental health programs across the United States.

To the Editor-In January 2023, the Science and Security Board of the Bulletin of the Atomic Scientists moved the hands of the Doomsday Clock forward to 90 seconds before midnight, reflecting the growing risk of nuclear war [1] . In August 2022, the UN secretary general, António Guterres, warned that the world is now in "a time of nuclear danger not seen since the height of the Cold War" [2] . The danger has been underlined by growing tensions between many nuclear-armed states [1, 3] . As editors of health and medical journals worldwide, we call on health professionals to alert the public and our leaders to this major danger to public health and the essential life support systems of the planet-and urge action to prevent it. Current nuclear arms control and non-proliferation efforts are inadequate to protect the world's population against the threat of nuclear war by design, error, or miscalculation. The Treaty on the Non-Proliferation of Nuclear Weapons (NPT) commits each of the 190 participating nations "to pursue negotiations in good faith on effective measures relating to cessation of the nuclear arms race at an early date and to nuclear disarmament, and on a treaty on general and complete disarmament under strict and effective international control" [4]. Progress has been disappointingly slow, and the most recent treaty review conference in 2022 ended without an agreed statement [5] . There are many examples of near disasters that have exposed the risks of depending on nuclear deterrence for the indefinite future [6] . Modernization of nuclear arsenals could increase risks-for example, hypersonic missiles decrease the time available to distinguish between an attack and a false alarm, increasing the likelihood of rapid escalation. Any use of nuclear weapons would be catastrophic for humanity. Even a "limited" nuclear war involving only 250 of the 13,000 nuclear weapons in the world could kill 120 million people outright and cause global climate disruption leading to a nuclear famine, putting 2 billion people at risk [7, 8] . A large-scale nuclear war between the United States and Russia could kill 200 million people or more in the near term and potentially cause a global "nuclear winter" that could kill 5-6 billion people, threatening the survival of humanity [7, 8] . Once a nuclear weapon is detonated, escalation to all-out nuclear war could occur

We first present a way to formulate the equations of motion for a nonholonomic system with nonlinear constraints with respect to the velocities. The formulation is based on the Cetaev condition which aims to extend the practical method of virtual displacements from the holonomic case to the nonlinear nonholonomic one. The condition may appear in a certain sense artificial and motivated only to coherently generalize that concerning the holonomic case. In the second part we show that for a specific category of nonholonomic constraints (homogeneous functions with respect to the generalized velocities) the Cetaev condition reveals the same physical meaning that emerges in systems with holonomic constraints. In particular the aspect of the mechanical energy associable to the system is analysed.

Abstract A signal mixer made of a transistor or a diode facilitates rich computation, which has been the building block of modern telecommunications. The mixing produces new signals at the sum and difference frequencies of the input, thereby enabling powerful operations such as frequency conversion (aka heterodyning), phase detection, and multiplexing. Here, we report that a neural cell is also a signal mixer. We found throughex-vivoandin-vivowhole-cell measurements that neurons mix exogenous (controlled) and endogenous (spontaneous) subthreshold membrane potential oscillations, producing new oscillation frequencies. We show, using pharmacological manipulation, that the neural mixing originates in the voltage-gated ion channels. Furthermore, we demonstrate that the neural mixing dynamic is evident in human brain activity and is associated with cognitive functions. We found that the human electroencephalogram (EEG) displays distinct clusters of local and inter-region mixing interactions. By quantifying the strength of these interactions before a task, we show that converting the salient posterior alpha-beta oscillations into gamma-band oscillations regulates the visual attention state. Neural circuit oscillations have been observed in nearly every cognitive domain and species, and abnormal spectra of neural oscillations have been found in almost all brain disorders. Signal mixing enables individual neurons to actively sculpt the spectrum of their circuit oscillations and utilize them for computational operations, which have only been seen in modern telecommunication until now.

To understand how the San Francisco (SF) COVID-19 case investigation and contact tracing (CICT) workforce documented sexual orientation and gender identity (SOGI) data, as well as a qualitative assessment of the workforce's capacity to successfully collect that data. This mixed-methods project analyzed data from 2 sources: SOGI item completeness among adult completed/partially completed interviews in the SF digital CICT COVID-19 database, and a secondary data analysis of qualitative data from 16 semistructured 90-minute virtual interviews with the SF CICT workforce, between November 14, 2020, and April 14, 2021. Among 15 416 COVID-19 cases and 7836 close contacts, sexual orientation data are missing from 20% of cases and 17% of contacts. The proportion of transgender/nonbinary individuals was 0.32% and 0.5%, respectively. The SF CICTs participants discussed challenges in collecting SOGI data, not understanding SOGI measure rationale, and feeling uncomfortable asking the questions. Qualitative interviews with the COVID-19 CICT workforce and quantitative data on SOGI parameters in COVID-19 surveillance suggest that these data may have been underreported. Our results strongly suggest that comprehensive training is crucial in the collection of SOGI data among COVID-19 cases and their close contacts. If SOGI data are not collected accurately, the true impact of COVID-19 among lesbian, gay, bisexual, transgender, and queer populations remains unknown, preventing data-driven allocation of COVID-19 funds to lesbian, gay, bisexual, transgender, and queer communities.

When trying to make sense of the twentieth century—civil rights, feminism, religion, literature, law, sexuality, and more—all roads lead to Pauli Murray. Her pathbreaking role in multiple movements for social change has made her an attractive subject for biographers and historians, most recently Rosalind Rosenberg, Patricia Bell-Scott, and Glenda Gilmore. Troy R. Saxby enters this historiographical terrain by staking out his own claim: to look at the “complicated personality behind the achievements” and “to describe as fully as possible her lived experience” (p. xiv). Wary of imposing a coherent narrative, triumphant or otherwise, on her often messy and complicated life, he aims to give as much attention to what she felt as to what she did. Of course, this juggling act between the personal and the political is central to the biographer's craft. What is special or distinctive about Saxby's intervention? The events in Murray's life do not change in...