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We use variation in historical state centralization to examine the long-term impact of institutions on cultural norms. The Kuba Kingdom, established in Central Africa in the early 17th century by King Shyaam, had more developed state institutions than the other independent villages and chieftaincies in the region. It had an unwritten constitution, separation of political powers, a judicial system with courts and juries, a police force, a military, taxation, and significant public goods provision. Comparing individuals from the Kuba Kingdom to those from just outside the Kingdom, we find that centralized formal institutions are associated with weaker norms of rule following and a greater propensity to cheat for material gain. This finding is consistent with recent models where endogenous investments to inculcate values in children decline when there is an increase in the effectiveness of formal institutions that enforce socially desirable behavior. Consistent with such a mechanism, we find that Kuba parents believe it is less important to teach children values related to rule-following behaviors.

This paper investigates the trade-offs between local elites and state agents as tax collectors in low-capacity states. We study a randomized policy experiment assigning neighborhoods of a large Congolese city to property tax collection by city chiefs or state agents. Chief collection raised tax compliance by 3.2 percentage points, increasing revenue by 44 percent. Chiefs collected more bribes but did not undermine tax morale or trust in government. Results from a hybrid treatment arm in which state agents consulted with chiefs before collection suggest that chief collectors achieved higher compliance by using local information to more efficiently target households with high payment propensities, rather than by being more effective at persuading households to pay conditional on having visited them.

The emergence of large-scale cooperation during the Holocene remains a central problem in the evolutionary literature. One hypothesis points to culturally evolved beliefs in punishing, interventionist gods that facilitate the extension of cooperative behaviour toward geographically distant co-religionists. Furthermore, another hypothesis points to such mechanisms being constrained to the religious ingroup, possibly at the expense of religious outgroups. To test these hypotheses, we administered two behavioural experiments and a set of interviews to a sample of 2228 participants from 15 diverse populations. These populations included foragers, pastoralists, horticulturalists, and wage labourers, practicing Buddhism, Christianity, and Hinduism, but also forms of animism and ancestor worship. Using the Random Allocation Game (RAG) and the Dictator Game (DG) in which individuals allocated money between themselves, local and geographically distant co-religionists, and religious outgroups, we found that higher ratings of gods as monitoring and punishing predicted decreased local favouritism (RAGs) and increased resource-sharing with distant co-religionists (DGs). The effects of punishing and monitoring gods on outgroup allocations revealed between-site variability, suggesting that in the absence of intergroup hostility, moralizing gods may be implicated in cooperative behaviour toward outgroups. These results provide support for the hypothesis that beliefs in monitoring and punitive gods help expand the circle of sustainable social interaction, and open questions about the treatment of religious outgroups.

Introduction: Mastering microsurgery requires advanced fine motor skills, hand–eye coordination, and precision, making it challenging for novices. Robot-assisted microsurgery offers benefits, such as eliminating physiological tremors and enhancing precision through motion scaling, which may potentially make learning microsurgical skills easier. Materials and Methods: Sixteen medical students without prior microsurgical experience performed 160 anastomoses in a synthetic model. The students were randomly assigned into two cohorts, one starting with the conventional technique (HR group) and one with robotic assistance (RH group) using the Symani surgical system. Results: Both cohorts showed a reduction in procedural time and improvement in SAMS scores over successive attempts, with robotic anastomoses demonstrating a 48.2% decrease in time and a 54.6% increase in SAMS scores. The decreases were significantly larger than the RH group (p < 0.05). The quality of the final anastomoses was comparable in both groups (p > 0.05). Discussion: This study demonstrated a steep preclinical learning curve for robot-assisted microsurgery (RAMS) among novices in a synthetic, preclinical model. No significant differences in SAMS scores between robotic and manual techniques after ten anastomoses. Robot-assisted microsurgery required more time per anastomosis, but the results suggest that experience with RAMS may aid in manual skill acquisition. The study indicates that further exploration into the sequencing of robotic and manual training could be valuable, especially in designing structured microsurgical curricula.

Few phenomena have had as profound or long-lasting consequences in human history as the emergence of large-scale centralized states in the place of smaller scale and more local societies. This study examines a fundamental, and yet unexplored, consequence of state formation: its genetic legacy. We studied the genetic impact of state centralization during the formation of the eminent precolonial Kuba Kingdom of the Democratic Republic of the Congo (DRC) in the 17th century. We analyzed genome-wide data from over 690 individuals sampled from 27 different ethnic groups from the Kasai Central Province of the DRC. By comparing genetic patterns in the present-day Kuba, whose ancestors were part of the Kuba Kingdom, with those in neighboring non-Kuba groups, we show that the Kuba today are more genetically diverse and more similar to other groups in the region than expected, consistent with the historical unification of distinct subgroups during state centralization. We also found evidence of genetic mixing dating to the time of the Kingdom at its most prominent. Using this unique dataset, we characterize the genetic history of the Kasai Central Province and describe the historic late wave of migrations into the region that contributed to a Bantu-like ancestry component found across large parts of Africa today. Taken together, we show the power of genetics to evidence events of sociopolitical importance and highlight how DNA can be used to better understand the behaviors of both people and institutions in the past.

Here, for the first time, is a collection of short speeches by the charismatic doctor and social activist Paul Farmer. One of the most passionate and influential voices for global health equity and social justice, Farmer encourages young people to tackle the greatest challenges of our times. Engaging, often humorous, and always inspiring, these speeches bring to light the brilliance and force of Farmer's vision in a single, accessible volume. A must-read for graduates, students, and everyone seeking to help bend the arc of history toward justice, To Repair the World: • Challenges readers to counter failures of imagination that keep billions of people without access to health care, safe drinking water, decent schools, and other basic human rights; • Champions the power of partnership against global poverty, climate change, and other pressing problems today; • Overturns common assumptions about health disparities around the globe by considering the large-scale social forces that determine who gets sick and who has access to health care; • Discusses how hope, solidarity, faith, and hardbitten analysis have animated Farmer's service to the poor in Haiti, Peru, Rwanda, Russia, and elsewhere; • Leaves the reader with an uplifting vision: that with creativity, passion, teamwork, and determination, the next generations can make the world a safer and more humane place.

Rwanda’s approach to delivering healthcare in a setting of post-conflict poverty offers lessons for other poor countries, say Paul Farmer and colleagues

Psychological and cultural evolutionary accounts of human sociality propose that beliefs in punitive and monitoring gods that care about moral norms facilitate cooperation. While there is some evidence to suggest that belief in supernatural punishment and monitoring generally induce cooperative behaviour, the effect of a deity's explicitly postulated moral concerns on cooperation remains unclear. Here, we report a pre-registered set of analyses to assess whether perceiving a locally relevant deity as moralistic predicts cooperative play in two permutations of two economic games using data from up to 15 diverse field sites. Across games, results suggest that gods’ moral concerns do not play a direct, cross-culturally reliable role in motivating cooperative behaviour. The study contributes substantially to the current literature by testing a central hypothesis in the evolutionary and cognitive science of religion with a large and culturally diverse dataset using behavioural and ethnographically rich methods.

We use a variant of the Implicit Association Test (IAT) to examine individuals' implicit attitudes towards various ethnic groups. Using a population from the Democratic Republic of Congo, we find that the IAT measures show evidence of an implicit bias in favor of one's own ethnicity. Individuals have implicit views of their own ethnic group that are more positive than their implicit views of other ethnic groups. We find this implicit bias to be quantitatively smaller than the (explicit) bias one finds when using self-reported attitudes about different ethnic groups.

Background/Objectives: Robot-assisted microsurgery (RAMS) has been introduced into the field of plastic surgery in recent years. It potentially offers enhanced precision and control compared to traditional methods, which is crucial for complex microvascular tasks in free flap reconstructions. We aim to analyze our experiences with robotic-assisted microsurgery in the field of upper extremity free flap reconstruction. Methods: This prospective study evaluated the efficacy and safety of the Symani Surgical System for free flap reconstructions in 16 patients with upper extremity defects at our institution from February 2023 to March 2024. Operating times were compared to a matched, historical cohort. We collected data on surgical outcomes, operative times, and complication rates, following strict adherence to the Declaration of Helsinki. Results: Our cohort primarily involved male patients (81%) with defects mostly located on the hand (81%). The anterolateral thigh flap was the most commonly used free flap (14/16, 88%). The average operative time was 368 ± 89 min (range: 216–550 min). No complete or partial flap losses were observed, but one flap required revision surgery due to arterial thrombosis. Major complications occurred in 13% of the cases. The average anastomosis time was 31 ± 12 min (range: 20–35 min) for arterial end-to-end anastomoses and 33 ± 13 min (range: 20–60 min) for arterial end-to-side anastomoses. Venous anastomoses required, on average, 20 ± 6 min. Operating times were not significantly longer when compared to the historical cohort (p = 0.67). Conclusions: We were able to show comparable outcomes to conventional microsurgery, while requiring more time for the microsurgical anastomoses. The study highlights the need for larger, controlled trials to better understand the benefits and limitations of robotic assistance in microsurgical reconstruction of the upper extremity.