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The policy advocacy of academics and researchers signify the public spending on education and health as the positive externalities and spillover effects in the society. It also promotes that social spending helps reducing income inequality and eventually reduce poverty. This study aims at analyzing the distributional effects of social spending on education and health by examining the pre and post income distribution in Thailand following the quantitative dataset of 2011. It follows calculation of benefit incidences, which is a method of computing distributional effects of public spending, based on different five income groups (poorest, poor, moderate, rich & riches). The study divulges that Thai education system seems to be pro-poor particularly for primary and secondary education whereas healthcare seems pro-rich. It is revealed that benefit of the poorest income group increased from 8.16 per cent to 9.51 per cent while it decreased from 41.48 per cent to 39.86 per cent for the richest group after government expenditure. The increase for poor and decrease for rich in income benefit after public expenditure is treated as positive for the society. The total public expenditure on these two sectors in Thailand denotes the decrease in inequality as the Gini coefficient went down to 0.2818 from 0.3056. The study suggests increasing expenditure for the rural and poor people to minimize the gap. A special stipend is suggested for the rural student to at tertiary level where richest has highest share and there is big gap in at this level. The study also recommends establishing more higher education institutes at the provincial level to benefit the poor and rural people living away from the capital. Study suggests government to impose tax on private healthcare, which is usually availed by affluent people. Likewise, government can spend more money for lower income group. Policy should also formulate to emphasize rural people than urban in order to provide benefit to the poor.

This article used qualitative research method to arrive at an in-depth understanding of the functionality of financial committees in schools as required by the Department of Education. Data was collected through semi-structured interviews and document analysis with principals, finance officers, chairpersons, and treasures. Content analysis was used to analyse the data. The findings revealed that there are no finance committees and financial policies in schools. In case where there is financial committee it was not operating as expected as members were working individually and not collectively. This was attributed to a lack of knowledge on policy and legislation for financial management. The study recommends that the school which does not have the finance committee should establish such a committee as matter of urgency because it is mandated by the policy. Circuit officials charged with school governance must enforce the policy and legislative mandates relating to financial management by helping the schools in the formulation of such committee. Members of finance committee must be thoroughly trained to execute their functions as it is evident that they are not performing their functions accordingly. The study further recommends that parent members serving on the finance committees must be paid a stipend as it was evident that some of them value their livelihood more than participating in the committee.

In this paper we offer a detailed analysis of the extent, direction and evolution of ministerial stipend cross subsidies at differing levels of granularity in the United Free Church of Scotland between 1909 and 1929; from the Church's establishment of a single Central Fund, to its union with the Church of Scotland. By focussing on aggregate flows of money in support of the Church's key employees, we throw new light not only on the question of the extent to which the United Free Church's national provision of the ordinances of religion was dependant on financial transfers, but also the wider challenge of bringing two culturally distinct ecclesiastical bodies together. 1

The study examined information and communication technologies usage among agricultural students of tertiary institution in Southwest of Nigeria. Multistage sampling procedure was used to select 300 agricultural students from tertiary institutions. Structured questionnaire was employed to elicit information on students’ socioeconomic characteristics, availability of ICTs, accessibility and purposes of ICTs usage. Data were subjected to percentage, chi-square, the Pearson Product Moment Correlation and the Analysis of variance at p=0.05. Findings revealed that the most available ICTs among students were internet and mobile phone (95.0%) respectivelywhile they had access to mobile phone (Weighted Mean (WM)=0.58) and radio (WM=0.51), they used ICTs for information (WM=0.77), academics (WM=0.70) and entertainment (WM=0.70) purposes; with high level of availability (71.0%), access (56.7%) and ICTs usage purpose (51.3%) respectively. There were significant relationships between respondents’ monthly stipend (r=0.200), state of institution (χ2=8.000), religion (χ2=222.660), marital status (χ2=211.680), category of students’ programme (χ2= 320.4608), type of institution (χ2=56.000) and their purposes for using ICTs but with a significant difference across the states (F=23.821; p=0.00). Students used ICTs for information, academic and entertainment purposes based on their age and type of their institutions. Since ICTs are used for beneficial purposes, it is recommended that ICTs should be adapted, applied and incorporated into tertiary institutions’ curricula across the nation. Keywords: ICTs usage, undergraduate students, entertainment purposes, mobile phone, tertiary institutions.

After years of decreasing public punitiveness and declining crime rates, politicians are seeking evidence-based crime policies to reduce mass incarceration without increasing crime. One such policy that has been implemented in several US cities is the Operation Peacemaker Fellowship (OPF), which incentivizes conformity and program participation by providing monetary stipends to individuals at risk of violent offending, thereby simultaneously reducing violence and incarceration. Yet, there is no evidence about public support for such policies. Using a nationally representative survey experiment, we examine public support for violence prevention stipends. We employ a referendum-style, contingent valuation design to measure the impact of tax increases versus tax savings on public opinion, and we randomize message framing that emphasizes the stipend program’s risky versus protective features. Both tax changes and risk framing matter. The public is willing to vote for stipends when they reduce taxes and are framed as a method to save lives. Most Republicans oppose stipends under all conditions. Reformers can increase public support for effective, nonpunitive policies that target violent offenders by emphasizing both their economic and social benefits. However, such policies are likely to face consistent opposition from certain portions of the public.

ObjectivesCommunity health workers (CHWs) played important roles in supplementing scarce healthcare workforce in Sierra Leone during the Ebola outbreak, causing the government to launch the National Community Health Worker Policy 2016–2020. This study evaluated this ambitious policy and examined CHWs’ sustainability through their job satisfaction and the underlying factors to inform new policy recommendations, especially the implication for COVID-19 containment.DesignA mixed-methods approach applying structured questionnaires and semistructured interviews.Setting and participants188 CHWs in Bombali District (key Ebola-stricken areas) of Sierra Leone, 184 of them participated in follow-up interviews.Primary and secondary outcome measuresQuantitative and qualitative elements were triangulated to improve robustness of investigation: job satisfaction was measured by the Minnesota Satisfaction Questionnaire (MSQ), and factors associated with job satisfaction were identified through thematic analysis and multivariable logistic regression.ResultsThe MSQ score of CHWs in Sierra Leone was 65.09, extremely low even among low-income and middle-income countries. Five themes (grouped from 16 subthemes) emerged through the semistructured interviews and were tested quantitatively. Payment was CHWs’ top concern. Low stipend and payment tardiness were significantly associated with dissatisfaction. Those with Ebola experience were 5.20 times (95% CI 1.51 to 17.95, p=0.009) more likely to be dissatisfied. This study also found that working conditions, medical material supplies and career development were far from what the CHW policy promised. CHWs’ commitment was the only ‘positive’ theme, and their intrinsic job satisfaction (mean=3.61) was much higher than the extrinsic job satisfaction (mean=2.72).ConclusionsSome critical components of the 2016 National Community Health Worker Policy, aiming to promote CHWs and strengthen primary healthcare, have severe shortfalls in practice. The Sierra Leone government should address the underlying factors that have impaired CHWs’ job satisfaction to ensure sustainability of its CHW network, especially during the combat against COVID-19.

Introduction: It is well documented fact that there are differences in the actual and perceived body image among both sexes. This study was aimed to assess the association of monthly allowance with body-mass index (BMI), and body image perception among university students. Methods: The design of this study was a cross sectional design A total of 152 students were registered from the International Islamic University Malaysia, Kuantan Campus.A questionnaire administered comprised of three sections i.e. socio-demographic, anthropometric and body image perception data using Figure Rating Scale (FRS) & Shape Questionnaire (BSQ). The collected data on the three aspects were compiled and statistically analyzed using descriptive analysis and Pearson correlation analysis. Results: The statistical analysis revealed that there was no association between the student students’ allowance and body image perception, however, still using considerable amount of their allowances for looking good. The FRS assessment shows that the respondents perceived degree of self-discrepancy between current and ideal body image. The body image perception assessed with BSQ showed the respondents are least concern about body shape. However, there was significant P

An important anti-poverty program for older Americans is facing a serious problem: The Senior Community Service Employment Program (SCSEP) was deemed “ineffective” by the Department of Labor. The department’s 2020 budget, in fact, proposes the program’s elimination. SCSEP, which places low-income adults aged 55 and older with multiple barriers to work in on-the-job training in nonprofit and public agencies while providing a modest stipend, has the goal of helping participants to transition into unsubsidized, gainful employment. Yet measures used to determine the program’s effectiveness focus solely on employment outcomes, ignoring important outcomes related to health and social engagement. This commentary advocates for the preservation of SCSEP by countering the view that it is purely an employment intervention for low-income older adults. We describe the complexity of the program and the people it serves and argue that using select measures that do not encompass the breadth of SCSEP’s benefits creates an inaccurate appearance of ineffectiveness. We conclude with recommendations for SCSEP administrators and grantees, social workers, and others to enhance the promise of this important program.

Student stipend programs are a significant strategy to build the child welfare workforce and encompass a set of specific obligations. This includes the student’s pledge to enter the child w...

Do politicians manipulate the enforcement of conditional welfare programs to influence electoral outcomes? We study the Bolsa Familia Program (BFP) in Brazil, which provides a monthly stipend to poor families conditional on school attendance. Repeated failure to comply with this requirement results in increasing penalties. First, we exploit random variation in the timing when beneficiaries learn about penalties for noncompliance around the 2008 municipal elections. We find that the vote share of candidates aligned with the president is lower in zip codes where more beneficiaries received penalties shortly before (as opposed to shortly after) the elections. Second, we show that politicians strategically manipulate enforcement. Using a regression discontinuity design, we find weaker enforcement before elections in municipalities where mayors from the presidential coalition can run for reelection. We provide evidence that manipulation occurs through misreporting school attendance, particularly in municipalities with a higher fraction of students in schools with politically connected principals.

Key Points Question Is the presence of a resident labor union associated with improved well-being at US surgical training programs? Findings In this cross-sectional survey study of 5701 residents, unionized programs were more likely to offer housing stipends and 4 weeks (instead of 2-3 weeks) of vacation time to residents; however, no difference in burnout, suicidality, job satisfaction, duty hour violations, mistreatment, salary, or the educational environment were found between residents at unionized and nonunionized programs. Meaning These findings suggest that resident labor unions do not appear to improve resident well-being., This survey study evaluates the association of resident physician unions with burnout, suicidality, job satisfaction, duty hour violations, mistreatment, educational environment, salary, and benefits among surgical residents in the US., Importance Labor unions are purported to improve working conditions; however, little evidence exists regarding the effect of resident physician unions. Objective To evaluate the association of resident unions with well-being, educational environment, salary, and benefits among surgical residents in the US. Design, Setting, and Participants This national cross-sectional survey study was based on a survey administered in January 2019 after the American Board of Surgery In-Training Examination (ABSITE). Clinically active residents at all nonmilitary US general surgery residency programs accredited by the American Council of Graduate Medical Education who completed the 2019 ABSITE were eligible for participation. Data were analyzed from December 5, 2020, to March 16, 2021. Exposures Presence of a general surgery resident labor union. Rates of labor union coverage among non–health care employees within a region were used as an instrumental variable (IV) for the presence of a labor union at a residency program. Main Outcomes and Measures The primary outcome was burnout, which was assessed using a modified version of the abbreviated Maslach Burnout Inventory and was defined as experiencing any symptom of depersonalization or emotional exhaustion at least weekly. Secondary outcomes included suicidality, measures of job satisfaction, duty hour violations, mistreatment, educational environment, salary, and benefits. Results A total of 5701 residents at 285 programs completed the pertinent survey questions (response rate, 85.6%), of whom 3219 (56.5%) were male, 3779 (66.3%) were White individuals, 449 (7.9%) were of Hispanic ethnicity, 4239 (74.4%) were married or in a relationship, and 1304 (22.9%) had or were expecting children. Among respondents, 690 residents were from 30 unionized programs (10.5% of programs). There was no difference in burnout for residents at unionized vs nonunionized programs (297 [43.0%] vs 2175 [43.4%]; odds ratio [OR], 0.92 [95% CI, 0.75-1.13]; IV difference in probability, 0.15 [95% CI, −0.11 to 0.42]). There were no significant differences in suicidality, job satisfaction, duty hour violations, mistreatment, educational environment, salary, or benefits except that unionized programs more frequently offered 4 weeks instead of 2 to 3 weeks of vacation (27 [93.1%] vs 52 [30.6%]; OR, 19.18 [95% CI, 3.92-93.81]; IV difference in probability, 0.77 [95% CI, 0.09-1.45]) and more frequently offered housing stipends (10 [38.5%] vs 9 [16.1%]; OR, 2.15 [95% CI, 0.58-7.95]; IV difference in probability, 0.62 [95% CI 0.04-1.20]). Conclusions and Relevance In this evaluation of surgical residency programs in the US, unionized programs offered improved vacation and housing stipend benefits, but resident unions were not associated with improved burnout, suicidality, job satisfaction, duty hour violations, mistreatment, educational environment, or salary.

“This is only temporary,” I told myself as I switched from pursuing my Ph.D. research to being a COVID-19 diagnostic technician. During the summer, I had been volunteering in a diagnostic laboratory, assaying samples for the presence of SARS-CoV-2. Now, the lab was offering to take over paying my stipend, tuition, and fees so I could commit more time to that work—and so my Ph.D. adviser wouldn't have to support me while I did so. My research progress and graduation were my priority. At the same time, I wanted to continue to do my part to protect my community from the pandemic, as well as help out the lab and ease my adviser's financial burden. I was torn between the needs of my community and my personal needs. > “I am grateful my skills were useful during the pandemic.” Prior to starting my Ph.D., I had spent several years working at state veterinary diagnostic laboratories. I enjoyed the diagnostic work, but I wanted to pursue Ph.D.-level research. Four years in, everything was going well as I learned how to combine the precision and speed from my diagnostic training with the flexible thinking and creativity needed for research. Then, of course, the pandemic hit. My research was mostly stalled as my lab was closed, and I was feeling helpless and frustrated at home. I was interested to learn about a public health effort to track the virus in our community, a collaboration between my university and the county health department—and that veterinary diagnostic labs were pitching in. I realized I had the knowledge and training to help with the project, called TRACE COVID-19. Despite having left diagnostics, now was not the time to focus on my personal career goals. I was done watching from the sidelines. Initially, I volunteered in the diagnostic lab 8 to 10 hours a day, a few times a week. It seemed like a rewarding use of my excess time. But my adviser didn't approve. He was paying me, after all, and didn't think I should be dedicating time to diagnostics. Still, I continued to volunteer through the summer months, using the time when I would otherwise be quarantining at home. When my research lab opened at limited capacity, volunteering did not hinder my research progress. But when the diagnostic laboratory offered to fund me, I faced a dilemma. I worried that if the diagnostic lab took over my funding, it might be logistically challenging to fully return to my Ph.D. research when the time came. At the same time, I didn't want to abandon my work with the diagnostic lab. My adviser also encouraged me to keep working for TRACE, saying it would augment my CV. So, I naively forged ahead, thinking I could work on my research in my spare time. Instead, TRACE consumed my life. The number of samples delivered daily was overwhelming, and in the evenings, I faced the onslaught alone. I skipped meals and neglected exercise, and my mental health suffered. But I kept telling myself it was only temporary. By the end of the fall term, I was burned out and ready to transition back to research. To my dismay, my adviser was running low on funding. My “temporary” decision was looking more and more permanent, and what had begun as rewarding work was becoming a ball and chain. Extricating myself took flexibility, creativity, and patience. I reached out to faculty members for advice and support, and everyone was willing to help—something I had forgotten during my isolation in the diagnostic lab. One of them encouraged me to apply for a position at a local biotech company. I was thrilled when the company offered me the job, as well as the funding I needed to complete my degree. My way forward was now clear. I don't regret my time with the TRACE project, despite the sacrifices to my research progress and mental health. I am grateful my skills were useful during the pandemic. And I've learned that, when I encounter detours and setbacks on my career path, I should look to the bigger picture and remind myself that it's only temporary.

BackgroundCommunity health volunteers (CHVs) play crucial roles in enabling access to healthcare at the community levels. Although CHVs are considered volunteers, programmes provide financial and non-financial incentives. However, there is limited evidence on which bundle of financial and non-financial incentives are most effective for their improved performance.MethodsWe used a discrete choice experiment (DCE) to understand incentive preferences of CHVs with the aim to improve their motivation, performance and retention. Relevant incentive attributes were identified through qualitative interviews with CHVs and with their supervisors. We then deployed a nominal group technique to generate and rank preferred attributes among CHVs. We developed a DCE based on the five attributes and administered it to 211 CHVs in Kilifi and Bungoma counties in Kenya. We used mixed multinomial logit models to estimate the utility of each incentive attribute and calculated the trade-offs the CHWs were willing to make for a change in stipend.ResultsTransport was considered the incentive attribute with most relative importance followed by tools of trade then monthly stipend. CHVs preferred job incentives that offered higher monthly stipends even though it was not the most important. They had negative preference for job incentives that provided award mechanisms for the best performing CHVs as compared with jobs that provided recognition at the community level and preferred job incentives that provided more tools of trade compared with those that provided limited tools.ConclusionA bundled incentive of both financial and non-financial packages is necessary to provide a conducive working environment for CHVs. The menu of options relevant for CHVs in Kenya include transport, tools of trade and monthly stipend. Policy decisions should be contextualised to include these attributes to facilitate CHW satisfaction and performance.

Effective recruitment and retention strategies in clinical trials are essential to achieve the enrollment goals. We aimed to identify baseline characteristics predicting dropouts and analyze the effect of retention strategies within the MemAID elderly cohort. The trial consisted of 12 visits during 24 weeks of INI/placebo treatment and 24 weeks of follow-up. Retention strategies were implemented 2 years after the beginning of the study and included incentives (meals, stipend, transportation), revised eligibility criteria, and flexibility in scheduling. A total of 244 participants (122 female; 65.8 ± 9.1 years old, 115 diabetes (DM)) were randomized, and completed baseline (223), treatment (174), and follow-up (156). After randomization, 65 participants (27%, 30 DM [46%]) dropped out. Dropouts occurred earlier in the study (19.6% cumulative failure at 100 days) as compared to later (25.3% cumulative failure at 300 days). Cox models showed no risk of dropout with DM diagnosis, but increased risk (p Disclosure F. Khan: None. D. F. Isaza-pierotti: None. P. Novak: Other Relationship; Self; Dysimmune Foundation, Endonovo Therapeutics, Oxford Press. C. Mantzoros: Advisory Panel; Self; Amgen Inc., GENFIT, Intercept Pharmaceuticals, Inc., Novo Nordisk, Regeneron Pharmaceuticals Inc. L. H. Ngo: Consultant; Self; Five Islands Consulting, Other Relationship; Self; Radiological Society of America. V. Novak: Advisory Panel; Spouse/Partner; Endonovo Therapeutics, Inc., Consultant; Spouse/Partner; Dysimmune Foundtation, Other Relationship; Spouse/Partner; Oxford University Press. Funding National Institute of Diabetes and Digestive and Kidney Diseases (1R01DK103902); U.S. Food and Drug Administration (IND107690); Novo Nordisk (ISS-001063), Medtronic (NERP15-0310); World Health Organization (UTN-U111-1175-1588)

Background Community health workers (CHWs) play a critical role in supporting health systems, and in improving the availability and accessibility to health care. However, CHW programs globally continue to face challenges with poor performance and high levels of CHW attrition. CHW programs are often underfunded and poorly planned, which can lead to loss of motivation by CHWs. The study aims to determine preferences of CHWs for job incentives with the goal of furthering their motivation and success. Methods Relevant incentive attributes were identified through focus group discussions and in-depth interviews with CHWs, non-governmental organization CHWs, CHW supervisors, and policy-level stakeholders. Based on seven attributes (eg, training, workload, stipend) we developed a discrete choice experiment (DCE) that was administered to 399 CHWs across eight districts in Uganda. We used conditional and mixed multinomial logit models to estimate the utility of each job attribute. We calculated the marginal willingness to accept as the trade-off the CHWs were willing to make for a change in salary. Results CHWs preferred higher salaries, though salary was not the most important attribute. There was a preference for reliable transportation, such as a bicycle (β = 1.86, 95% CI = 1.06, 2.67), motorcycle (β = 1.81, 95% CI = 1.27, 2.34) or transport allowance (β = 1.37, 95% CI = 0.65, 2.10) to no transport. Formal identification including identity badges (β = 1.61, 95% CI = 0.72, 2.49), branded uniforms (β = 1.04, 95% CI = 0.45, 1.63) and protective branded gear (β = 0.76, 95% CI = 0.32, 1.21) were preferred compared to no identification. CHWs also preferred more regular refresher trainings, the use of mobile phones as job-aids and a lesser workload. The relative importance estimates suggested that transport was the most important attribute, followed by identification, refresher training, salary, workload, recognition, and availability of tools. CHWs were willing to accept a decrease in salary of USH 31 240 (US$8.5) for identity badges, and a decrease of USH85 300 (US$23) for branded uniforms to no identification. Conclusions This study utilized CHW and policymaker perspectives to identify realistic and pragmatic incentives to improve CHW working conditions, which is instrumental in improving their retention. Non-monetary incentives (eg, identification, transportation) are crucial motivators for CHWs and should be considered as part of the compensation package to facilitate improved performance of CHW programs.

Objective: To determine if the racial and ethnic compositions of the participants in Obstetrics and Gynecology randomized controlled trials (RCTs) conducted in the U.S. match that of the general U.S. population. Design: Retrospective analysis of U.S. RCTs. Setting: United States. Population: Women enrolled in U.S. RCTs. Methods: Racial and ethnic composition of RCT participants published in two premier US journals, Obstetrics and Gynecology and American Journal of Obstetrics and Gynecology, from January 2010 to April 2020 were collected and analyzed. Main outcome measures: Comparison of the racial and ethnic composition of the U.S. RCTs to U.S. General population. Results: Chi-square analysis showed significant deviations from the U.S. general population in both Obstetrics (p

Are subsidies to female education worth supporting to enhance socioeconomic and demographic changes? This paper examines whether or not the Female Secondary Stipend and Assistance Program (FSSAP) in Bangladesh matters. If it does, how much and in what way—on both observed short- and long- term outcomes associated with female education? How did FSSAP impact the education of children, and boys in particular? The paper also explores the impact on female labor force participation, as well as age at marriage, fertility, and other effects on society.

Climate change is generating both sustained trends in average temperatures and higher frequency and intensity of extreme events. This poses a serious threat to biodiversity, especially in vulnerable environments, like alpine systems. Phenotypic plasticity is considered to be an adaptive mechanism to cope with climate change in situ, yet studies of the plastic responses of alpine plants to high temperature stress are scarce. Future weather extremes will occur against a background of warmer temperatures, but we do not know whether acclimation to warmer average temperatures confers tolerance to extreme heatwaves. Nor do we know whether populations on an elevational gradient differ in their tolerance or plasticity in response to warming and heatwave events. We investigated the responses of a suite of functional traits of an endemic Australian alpine herb, Wahlenbergia ceracea, to combinations of predicted future (warmer) temperatures and (relative) heatwaves. We also tested whether responses differed between high- vs. low-elevation populations. When grown under warmer temperatures, W. ceracea plants showed signs of acclimation by means of higher thermal tolerance (Tcrit, T50, and Tmax). They also invested more in flower production, despite showing a concurrent reduction in photosynthetic efficiency (Fv/Fm) and suppression of seed production. Heatwaves reduced both photosynthetic efficiency and longevity. However, we found no evidence that acclimation to warmer temperatures conferred tolerance of the photosynthetic machinery to heatwaves. Instead, when exposed to heatwaves following warmer growth temperatures, plants had lower photosynthetic efficiency and underwent a severe reduction in seed production. High- and low-elevation populations and families exhibited limited genetic variation in trait means and plasticity in response to temperature. We conclude that W. ceracea shows some capacity to acclimate to warming conditions but there is no evidence that tolerance of warmer temperatures confers any resilience to heatwaves.

In Brazil’s democratic history, two corruption scandals have exposed political parties and politicians to the public opinion and law-enforcement like no others. The first, Mensalao, roughly meaning “big monthly stipend” was coined to describe clandestine payments made by the Workers’ Party (PT) to congressional allies in return of support for its legislative agenda and occurred during the first term of president Luiz Inacio Lula da Silva’s presidency. The second, Petrolao, alluding to Brazil’s state-controlled oil giant, Petrobras, started in 2014 and unveiled a web of illegal payments connecting public contractors, civil servants and politicians channeling money from deals into secret slush funds.

The positive coexistence of humans and AI is possible and needs to be designed as a system that provides for all members of society, but one that also uses the wealth generated by AI to build a society that is more compassionate, loving, and ultimately human. It is incumbent on us to use the economic abundance of the AI age to foster the values of volunteers who devote their time and energy toward making their communities more caring. As a practical measure, to protect against AI/robotics’ labor saving and job displacement effects, a “social investment stipend” should be explored. The stipend would be given to those who invest their time and energy in those activities that promote a kind, compassionate, and creative society, i.e., care work, community service, and education. It would put the economic bounty generated by AI to work in building a better society, rather than just numbing the pain of AI-induced job losses.

There is strong scientific evidence that muscle-strengthening exercise (i.e. use of weight machines, push-ups, sit-ups) is independently associated with a reduced risk of multiple chronic diseases (e.g. diabetes, hypertension, cardiovascular disease). However, prevalence rates for meeting the muscle-strengthening exercise guideline (≥2 times/week) are significantly lower (~20%) than those reported to meet the aerobic physical activity guideline (e.g. walking, jogging, cycling) (~50%). It is therefore important to understand public health surveillance approaches to assess muscle-strengthening exercise. The aim of this review was to describe muscle-strengthening exercise assessment in public health surveillance. Informed by the PRISMA guidelines, an extensive keyword search was undertaken across 7 electronic data bases. We identified 86,672 possible articles and following screening (n = 1140 in full-text) against specific inclusion criteria (adults aged ≥18 years, English, studies containing1000 participants), extracted data from 156 manuscripts. Fifty-eight different survey systems were identified across 17 countries. Muscle-strengthening exercise frequency (85.3%), duration (23.7%) and intensity (1.3%) were recorded. Muscle-strengthening exercise questions varied significantly, with some (11.5%) requiring a singular 'yes' vs 'no' response, while others (7.7%) sought specific details (e.g. muscle groups targeted). Assessments of duration and intensity were inconsistent. Very few studies measured the validity (0.6%) and reliability (1.3%) of muscle-strengthening exercise questions. Discrepancy exists within the current assessment systems/surveys used to assess muscle-strengthening exercise in public health surveillance. This is likely to impede efforts to identify at risk groups and trends within physical activity surveillance, and to accurately assess associations between muscle-strengthening exercise and health-related outcomes.

To explore the satisfaction and well-being experienced by anaesthesia residents during their training, and to investigate factors that may have influenced their experiences.Cross-sectional online anonymous voluntary survey.A total of 150 (of approximately 600 canvassed) former veterinary anaesthesia residents.Participants were invited to complete an internet-based survey regarding the satisfaction and well-being experienced during their residency. Multiple choice, categorical, dichotomous, Likert-type rating scales and slider questions were used to investigate five domains (demographic, working conditions, educational environment, training satisfaction, well-being). Sampling adequacy, questionnaire reliability and participant responses were investigated by Kaiser-Meyer-Olkin (KMO) indices, Cronbach's α and standard statistical techniques, respectively (p0.05).The questionnaire demonstrated good sampling adequacy (median KMO index 0.74; range 0.51-0.89) and high item 'reliability' (α = 0.82-0.94). Of the 150 responders, (25% participation rate) 62% were satisfied, 14% were neutral and 24% were dissatisfied with their residency training; 60.6% would do the residency again, 39.3% would not or were unsure. Sex and age did not correlate with training satisfaction (p0.05). Salary/stipend was considered inadequate by 70% of responders; 66% received no on-call supplement. Greater supervisory input, a good working environment and extra income when on-call were positively correlated with training satisfaction (p0.01). The majority (94.6%) of trainees suffered from at least one medical condition during their residency, with fatigue, sleep disturbance or anxiety reported by62%.Although a quarter of responders were dissatisfied with their residency, several modifiable factors were identified, particularly with respect to supervisors' input, working environment and pay, which could inform improvements for future residency programmes. Most trainees experienced negative health impacts; however, this parallels the general situation in both the medical and veterinary professions, which requires greater attention from the supervisors, trainees and colleges.

Introduction There is ongoing controversy concerning the potential influence of industry and financial conflict of interest (FCOI) in the development of clinical practice guidelines (CPG). The influence of industry in renal guideline development has been discussed in the past with emphasis on the National Kidney foundation (NKF) and Kidney and Dialysis Outcomes Quality Initiative guidelines. In this study we evaluate the self-reported FCOI among guideline panel members in Kidney Disease: Improving Global Outcomes (KDIGO) CPGs. Methods We examined 10 of the most recent KDIGO CPGs developed between 2009 and 2018. Using disclosure lists, we catalogued FCOIs for panelists for each individual CPG. The categories were Advisor/Consultant, Honoraria, Travel Stipend, Grant/Research Support, Speaker, Equity Interest, Employee, Board of Trustees, Royalties, Advisory Board, Employment, Ownership, Data Monitoring Committee, Expert Testimony, and Development of Education Materials. We also reviewed FCOIs for members of evidence review team (ERT). We also catalogued the company involved in each disclosure. One conflict describes 1 instance of participation of an individual in 1 category in each guideline. “Company” describes a commercial, industry, or institute affiliation reported in each episode. Results One hundred two (66.4%) of the total 151 panelists reported FCOI. A total of 662 conflicts were disclosed. Being a consultant or advisor was the most common category. One hundred fifty-one companies were associated with FCOI disclosure. One company was most frequently reported, involving 60 (9%) of 662 conflicts. Of the 52 members in the ERT, there was 1 instance of FCOI. Conclusion FCOI is prevalent in KDIGO guidelines with almost two thirds of the panelists self-reporting FCOI. The evidence review team had only 1 instance of FCOI., Graphical abstract

Summary Community health volunteers (CHVs) act as vital links between communities and health facilities, bridging the health service delivery gap common in low- and middle-income countries. In 2013, changes in funding in western Kenya left most CHVs without their individual monthly stipend. In this article, we explore how the implementation of a pooled incentive model had an impact on the lives of CHVs from two counties in western Kenya. Participation in this form of table banking was meant to allow CHVs to pool their resources together and invest in income-generating activities to offset the costs of unpaid health work. A pre-post qualitative study, consisting of focus group discussions and in-depth interviews explored CHV compensation, motivations and challenges experienced in 2013 and 2015, prior to and after the implementation of this pooled incentive model. Following withdrawal of the monthly stipend, we found that CHVs continued to take on roles and responsibilities of paid health workers, motivated by shared social identities and connections to their communities. However, replacing the stipend with a pooled-group incentive model seemingly exacerbated the financial burden already experienced by this vulnerable population. This study brings into question the sustainability and viability of a volunteer community health worker programme and highlights the need to address the financial burden associated with the CHV role in western Kenya.

The objective is to analyze the implications of ICT in the digital economy and the labor market, in addition to its effects on digital skills for the labor market. The method is qualitative under the modular research model by transformation object, with argumentative and conceptual design, of descriptive type. The results highlight that the impact of technological change in the labor market lies in changing the work schemes and the characteristics of the labor market, where digital factors are determinants in work activities that go beyond the production process, by directly influencing areas of the professional and personal life of workers; as well as in the structure of the labor market. The main findings reveal that above a better salary stipend, currently there are strategies with greater labor flexibility for the development of workers, which suggests that ICT in general and the Internet in particular, they are central factors of technological change and the new context of the labor economy. In conclusion, ICTs lead to a change in the profile of workers, which implies that they are in constant training, through connectivity strategies that allow them to develop digital skills and immaterial work.

The need of subspecialty training has been acutely felt in Nepal now with the rapid advancement in the field of medical sciences, the changing burden of diseases, the acute shortage of highly specialized health professionals, the evolving concept of learning and medical education and the ever-increasing focus on right and safety of patients.Fellowship Training is obtained in a specific specialty or subspecialty. Fully academic 3-year Fellowship programsin Pulmonary and Critical Care Medicine, Hepatopancreatobiliary Surgery and Cardiologyhavebeen initiated for certification of the training for the first time in Nepal at Chitwan Medical College (CMC) and all three are recognized by the Nepal Medical Council.The three Fellowship training programs, run in affiliation with Lincoln University, at the CMC have all the training criteria of DM/MCh included along with extra requirement of one more paper publication and the trainees are paid adequate stipend without any tuition fee or bond. The high volume of cases and procedures in CMC, exposes the FCMC Fellows to an increased chance of appropriate skill development along with appropriate postings in various other institutions for adequate experience of hands on training.Fellowship programs are the cornerstone of providing super specialized patient care.The need today is to focus on the basic training concepts and criteria, rather than on various names like diploma, MD, MS, DM/MCh of training.Nepal should focus onthe prerequisites, infrastructure and human resource for expanding the quality Fellowship trainingprograms in the country and thereby enhancing the standard of patient care.Keywords: Cardiology; DM; FCMC; fellowship; hepatopancreatobiliary surgery; MCh; PCCM.

Background The American Society of Echocardiography Committee on Pediatric Echocardiography Laboratory Productivity was formed in 2011 to study institutional factors that could influence the clinical productivity of physicians and sonographers in academic pediatric echocardiography laboratories. In the previous two surveys, staff clinical productivity remained stable while total echocardiography volumes increased. This third survey was designed to assess how clinical productivity is associated with laboratory infrastructure elements such as training, administrative tasks, quality improvement, research, and use of focused cardiac ultrasound (FCU). Methods Survey questions were sent by e-mail to North American laboratories. The aims were to assess (1) educational and training obligations, (2) academic productivity and research, (3) laboratory medical director satisfaction, (4) quality improvement, (5) laboratory leadership roles, and (6) impact and use of FCU. Survey responses were compared with clinical productivity metrics defined in the first two surveys. Results There were 38 responses. Academic productivity was higher at institutions with more dedicated imaging personnel, personnel with dedicated protected academic time, and advanced imaging fellows. Academic productivity did not correlate with clinical productivity and was not significantly affected by the presence of dedicated research sonographers. The satisfaction level of laboratory medical directors was related to dedicated administrative time and an administrative stipend. The majority of administrative roles were tasked to the laboratory medical director with support of the technical director. FCU was listed as a hospital privilege at four institutions (13%). Twenty-two (58%) were training FCU providers in one or more subspecialties. FCU was not associated with clinical or academic productivity. Conclusion This third survey gathered supplemental data to complement the clinical productivity data collected from the first two surveys. Together, the results of these surveys further describe the range of factors that can affect North American academic pediatric echocardiography laboratories.

Background To examine the current trends in trauma call coverage of pediatric orthopaedic surgeons in North America and to identify predictors of surgeon on-call satisfaction. Methods In 2015, ∼1200 active members of the Pediatric Orthopaedic Society of North America (POSNA) were surveyed regarding emergency room on-call practices. In total, 410 members completed the survey with a response rate of 35%. Information collected included call frequency, practice setting and satisfaction with call. This information was analyzed and compared with the 2006 and 2010 trauma call surveys of Pediatric Orthopaedic Society of North America membership using 2 sample difference in proportion, χ tests for trend and the Fisher exact tests. Logistic regression analyses were used to identify predictors of call satisfaction among pediatric orthopaedic surgeons. Results In total, 47% of pediatric orthopaedic surgeons had access to a designated trauma operating room in 2015, up from 39% in 2010 and 24% in 2006. In total, 43% of pediatric orthopaedic surgeons currently receive a stipend for taking call, up from 35% in 2010 and 28% in 2006. Although 83% of pediatric orthopaedic surgeons believe that trauma call is an integral part of their practice, only 53% are satisfied with their call experience. Controlling for covariates, believing that call is integral to one's practice doubles odds of call satisfaction. Having resident or fellow support and being financially compensated for orthopaedic trauma call also increases one's odds of satisfaction. The odds of being satisfied with call decrease by 7% for each year of increase in age of the surgeon. Conclusions Access to a designated trauma operating room and financial compensation for call coverage have steadily increased over the past decade. A sizable majority of respondents continue to believe that trauma care is an integral part of being a pediatric orthopedist. Despite this, 47% of respondents remain dissatisfied with their trauma call arrangements. The age and attitude of the individual surgeon and extent of hospital support predict satisfaction of surgeons providing trauma coverage. Level of evidence Level V-economic and decision analysis.

Childhood obesity remains a public health problem requiring mobilization across diverse social and political sectors. The faith-based sector can contribute to obesity prevention advocacy when existing resources are supported and leveraged. This article describes an advocacy resource assessment conducted in six Chicago faith organizations. Key administrators and congregation members were surveyed to identify organizational resources that could be mobilized for childhood obesity prevention advocacy. Survey data were analyzed using SPSS and Excel. Descriptive statistics were calculated for each organization and for all combined. Organizational resources for advocacy were identified, with varying degrees of resources within organizations. Congregation members and faith leaders expressed interest in advocacy training and activities but acknowledged competing organizational priorities. Participating organizations received a stipend to pursue recommended action items based on their assessment. Faith organizations have unique resources and human capital and can be key partners in childhood obesity prevention. Conducting an assessment prior to planning interventions and advocacy approaches can strengthen partnerships, leverage assets among partners, and ensure efforts are relevant and beneficial for faith organizations. It may also be strategic to incorporate funding in grant budgets in order to empower faith organizations to act on findings from the assessment process.

This paper examines the effects of female education on marriage outcomes by exploiting the exogenous variation generated by the Female Secondary School Stipend Program in Bangladesh, which made secondary education free for rural girls. Our findings show that an additional year of female education leads to an increase in 0.72 years of husband’s education and that better educated women pair with spouses who have better occupations and are closer in age to their own, suggesting assortative mating. Those educated women appear to experience greater autonomy in making decisions on receiving their own health care and visiting their family. Furthermore, educated women have lower fertility and use more maternal health care, and their children have better health outcomes than those of less educated women. Overall, our results suggest that the marriage market is one of the channels through which women’s education affects their life outcomes.

Home visits for pregnancy and postnatal care were endorsed by the WHO and partners as a complementary strategy to facility-based care to reduce newborn and maternal mortality. This article aims to synthesise findings and implications from the economic analyses of community-based maternal and newborn care (CBMNC) evaluations in seven countries. The evaluations included five cluster randomized trials (Ethiopia, Ghana, South Africa, Tanzania, Uganda) and programmatic before/after assessments (Bolivia, Malawi). The economic analyses were undertaken using a standardized, comparable methodology the 'Cost of Integrated Newborn Care' Tool, developed by the South African Medical Research Council, with Saving Newborn Lives and a network of African economists. The main driver of costs is the number of community health workers (CHWs), determined by their time availability, as fixed costs per CHW (equipment, training, salary/stipend, supervision and management), independent from the level of activity (number of mothers visited) represented over 96% of economic and financial costs in five of the countries. Unpaid volunteers are not necessarily a cheap option. An integrated programme with multi-purpose paid workers usually has lower costs per visit but requires innovative management, including supervision to ensure that coverage, or quality of care are not compromised since these workers have many other responsibilities apart from maternal and newborn health. If CHWs reach 95% of pregnant women in a standardized 100 000 population, the additional financial cost in all cases would be under USD1 per capita. In five of the six countries, the programme would be highly cost-effective (cost per DALY averted

Using an ethnographic approach, this article examines the role of racialization in health-disease-care processes specifically within the realm of maternal health. It considers the experiences of health care administrators and providers, indigenous midwives and mothers, and recipients of conditional cash transfers through the Oportunidades program in Mexico. By detailing the delivery of trainings of the Mexican Social Security Institute (IMSS) [Instituto Mexicano del Seguro Social] for indigenous midwives and Oportunidades workshops to indigenous stipend recipients, the article critiques the deployment of "interculturality" in ways that inadvertently re-inscribe inequality. The concept of racial i(nter)dentification is offered as a way of understanding processes of racialization that reinforce discrimination without explicitly referencing race. Racial i(nter)dentification is a tool for analyzing the multiple variables contributing to the immediate mental calculus that occurs during quotidian encounters of difference, which in turn structures how individuals interact during medical encounters. The article demonstrates how unequal sociohistorical and political conditions and differential access to economic resources become determinants of health.Desde un abordaje etnográfico, este artículo examina el papel de la racialización en los procesos de salud-enfermedad-atención-cuidado, específicamente dentro del ámbito de la salud materna, a partir de las experiencias de los proveedores y administradores de salud, parteras y madres indígenas y las receptoras de transferencias monetarias condicionadas a través del programa Oportunidades. Al analizar las capacitaciones del Instituto Mexicano del Seguro Social (IMSS) a parteras indígenas y de los talleres del programa Oportunidades para personas indígenas, este artículo critica la utilización de la “interculturalidad” a través de formas que reafirman inadvertidamente la desigualdad. El concepto de i(nter)dentificación racial se ofrece como una manera para entender los procesos de racialización que refuerzan la discriminación sin hacer referencia explícita a la raza. La i(nter)dentificación racial es una herramienta para el análisis de variables múltiples que contribuyen al análisis interno inmediato que ocurre durante encuentros cotidianos con la diferencia, lo cual también estructura cómo los individuos interactúan durante los encuentros médicos. Este artículo muestra cómo las condiciones sociohistóricas y políticas desiguales y el acceso diferencial a los recursos económicos se convierten en determinantes de la salud.

Rural health care leaders are increasingly tasked with the responsibility of providing health access to 21% of the national population with only 10% of the provider workforce. Provider recruitment strategies offering loan repayment have had some success in the short term but are less impactful at creating a long-term retention rate, unless the providers have an existing connection to either the community in which they are working or rural health care. Responding to these data, a demonstration project and study has been underway in Colorado to test a rural focused "grow your own" advanced practice registered nurse (APRN) model. Phase 1 is designed to measure recruitment of RNs from inside rural communities to return to school and become primary care providers within those communities. Phase 2 will measure completion of education and phase 3 will measure retention rates in those communities. This article reports on phase 1 of the project, which is recruitment. The project offers stipend support with assistance in the school application process, educational support, clinical and job placement assistance, and monthly coaching. In addition, communities were asked to provide matching funds to support the APRN students with a goal of creating a self-sustaining model that will build a continuous pipeline of APRN providers. This strategy avoids the costly need to recruit and relocate providers who have no ties to the community. Thirty-four of 36 nurses (94%) responded to the study survey. Survey results suggested that the combination of financial, community, and employer support utilized in this model could serve to create a new and sustainable strategy for building a rural APRN provider workforce pipeline. The ultimate outcome has the potential to ensure that all people in rural areas have access to a high-quality, well-educated primary care provider.

Social scientists have increasingly invested in understanding how to improve data quality and measurement of sensitive topics in household surveys. We utilize the technique of list randomization to collect measures of physical intimate partner violence in an experimental impact evaluation of the Government of Zambia’s Child Grant Program. The Child Grant Program is an unconditional cash transfer, which targeted female caregivers of children under the age of five in rural areas to receive the equivalent of $24 USD as a bi-monthly stipend. The implementation results show that the list randomization methodology functioned as planned, with approximately 15% of the sample identifying 12-month prevalence of physical intimate partner violence. According to this measure, after four years, the program had no measurable effect on partner violence. List randomization is a promising approach to incorporate sensitive measures into multi-topic evaluations, however more research is needed to improve upon methodology for application to measurement of violence.

In 2015, India had an estimated 69.2 million people with diabetes and a national prevalence of 8.7%. Evidence is mounting for the benefits of telemedicine in diabetes care, but remains limited on mobile-health (m-Health) interventions.This study assessed the impact of an m-Health diabetes platform on clinical outcomes, patient-reported outcomes, patient and provider satisfaction, and app usage.This open-label, two-arm parallel study enrolled 91 people at 3 sites in India, aged 18-65, with type 2 diabetes, and an A1c between 7.5% and 12.5% (58-113 mmol/mol). Participants were randomly assigned 1:1 to m-Health or usual care and observed for 6 months. All received free visits, laboratory tests, transportation fees, and strips and lancets. Intervention participants received the m-Health app and a mobile phone data stipend.A1c change was previously reported as statistically significant. Significantly more participants in intervention than control had improved medication adherence (39.0% vs. 12.8%; p = 0.03) and increased frequency of blood glucose (BG) self-testing (39.0% vs. 10.3%; p = 0.01) at 6 months from baseline. No other outcomes were significantly different. Among m-Health users, 75% of participants actively used the app at week 24. Participants entered 29,668 medications and 2,575 BG readings, sent 497 messages, and received 890 messages. Most participants (80%) were satisfied with all aspects of the app and all seven providers rated the software very acceptable.Participants assigned to m-Health had increased medication adherence and frequency of BG testing compared with usual care participants.This tool could be an effective way to expand access to quality chronic disease care and improve outcomes.

The number of graduates of U.S. dental schools enrolled in U.S. postdoctoral programs in periodontics has been decreasing. The aims of this study were to determine the perspectives of periodontics department chairs regarding 1) features of a school's predoctoral curriculum that promote student interest in advanced periodontal education and 2) characteristics of a periodontal residency program that make it more attractive to dental students over other specialty programs. In 2015, a 14-question survey was designed and sent to chairs of periodontics departments at all 65 U.S. dental schools at the time. Questions addressed number of instructional hours; specialty clinic rotations; elective courses; number of applicants to periodontal residency; existence of a residency program; length of the residency program; and externships, fellowships, and financial stipends offered. The survey response rate was 73.8%. The results showed that departments offering more than seven clinical credit hours in periodontics to predoctoral students had the greatest number of residency applicants. Most of the applicants were from institutions that offered specialty clinic rotations, elective courses, and residency programs in periodontics. The number of applicants did not change significantly if a stipend or fellowship was offered. However, the availability of an externship was significantly associated with a greater number of applicants (p=0.042). These results suggest that offering periodontal clinical rotations, elective courses, and especially externships in periodontics during predoctoral education may encourage more graduating students to pursue postdoctoral periodontal education.

The national move toward integrated mental health and substance abuse service delivery has a significant impact on social work education and necessitates changes in how we train students. To address this need, the Global Leaders of Behavioral Health Education (GLOBE) training project was developed. GLOBE is a student training and stipend program that prepares students for clinical behavioral health practice in integrated care. This teaching note describes GLOBE, reports challenges encountered in its implementation, and provides strategies for overcoming them. The challenges include assigning students to grant-compliant field placements, engaging other health care professionals in the educational efforts, and implementing curriculum changes. Suggestions for social work program administrators interested in integrated care training are provided.

In 2016, a conditional cash transfer programme that had been assisting targeted poor children since the 1990s was reformed to reach all children attending government schools in Bangladesh. Since the reforms, the cash has been disbursed through mobile money technology and a digital database. It is unchanged in key respects: it is still routed through students’ mothers, and its aims still include improving the attendance and performance of students in public schools. Based on research into the political interests and actors behind the reform of the scheme and involved in its implementation, this paper examines how the state’s capacity to achieve its aims in society through the stipend scheme (or its ‘infrastructural power’) interacted with local politics in the implementation of the reformed programme. The research found that the expansionary reform of the Primary Education Stipend Project (PESP) was motivated by the growing dominance of the ruling party in the political settlement, and how that increased its need for popular legitimacy and channels through which to reach citizens. The government and ruling party value the PESP not because it protects people from poverty or crisis, but because it enables the government to reach 10 million mothers with messages as well as money, while also raising educational standards. However, the research found no evidence that the growing dominance of the ruling party had strengthened its capacity to discipline its agents to enforce its policies. Instead, the government had responded to criticisms of the contention and alleged corruption in the programme by redesigning it to minimise the role of local actors. The research was undertaken a year and a half after the reform was implemented, and so it is likely that it picked up some of the teething problems likely to afflict any new or redesigned programme. However, now that the funds are transferred directly from Dhaka to mothers’ mobile phones, the teachers, bureaucrats, and local elites who previously provided information or a conduit for complaints no longer have such a role in the system. The scheme connects government directly to the people, but lacks the infrastructure for information flows, monitoring, and grievance redressal through which citizens may hold government accountable.

Background Compensating participants of biomedical research is a common practice. However, its proximity with ethical concerns of coercion, undue influence, and exploitation, demand that participant compensation be regulated. The objective of this paper is to discuss the current regulations for compensation of research participants in Malawi and how they can be improved in relation to ethical concerns of coercion, undue influence, and exploitation. Main text In Malawi, national regulations recommend that research subjects be compensated with a stipend of US$10 per study visit. However, no guidance is provided on how this figure was determined and how it should be implemented. While necessary to prevent exploitation, the stipend may expose the very poor to undue influence. The stipend may also raise the cost of doing research disadvantaging local researchers and may have implications on studies where income stipend is the intervention under investigation. We recommend that development and implementation of guidelines of this importance involve interested parties such as the research community and patient groups. Conclusion Compensating human research subjects is important but can also act as a barrier to voluntary participation and good research efforts. Deliberate measures need to be put in place to ensure fair compensation of research participants, avoid their exploitation and level the field for locally funded research.

Introduction Drinking water instead of sugar-sweetened beverages may reduce obesity and dental caries. Tap water is more affordable and sustainable than bottled water and more likely to contain fluoride, which prevents caries. To address inequities in access to safe tap water, cross-sector partners established the Agua4All safe drinking-water program in 2 rural San Joaquin Valley, California, communities. The program’s objective was to examine Agua4All’s feasibility, acceptability, and effect on water intake. Methods We provided bottle-filling stations dispensing safe water at 12 sites in 2 communities and provided limited promotional support. To compare the effect of different levels of promotion, sites in 1 community also received a promotions toolkit, a stipend, and assistance in developing and conducting their own promotional activities (site-led promotion). Beverage intake at sites was observed at baseline (pre-installation), at time 1 (post-installation), and at times 2 and 3 (post-promotion). Flowmeters tracked water dispensings. Staff interviews examined implementation barriers and facilitators. Results From baseline to time 3, a nonsignificant increase (21.16%) occurred in the proportion of people drinking water at sites with water stations and site-led promotion compared with sites with water stations and limited promotion (5.13%) (P = .14). Mean daily gallons of water taken from stations per site was 3.61 (standard deviation, 3.84). Most staff members (77%) at the sites preferred water stations to traditional drinking fountains. Conclusion Bottle-filling stations with safe water and site-led promotion are a promising strategy for increasing water intake in communities without safe tap water. Larger studies should examine the effects of such stations on intake of sugar-sweetened beverages and on overall health.

Background Nepal has a critical shortage of health workers for achieving its projected sustainable development goals pertaining to its health sector. Methods To counteract this crisis and reduce the morbidity and mortality associated with untreated brain injuries secondary to inadequate access, it is pivotal to generate solutions through the establishment of improved educational and training objectives. Objectives must align themselves with achieving equitable access to neurologic health. To that end, the cadre of health professionals able to treat neurologic disease should be sharply skilled and increased in number. We outline potential sustainable solutions at the training level to address this public health problem. Results Demanding and limitless working hours, burnout, social stressors, and minimal monthly stipend likely contribute to limited applications for neurosurgery residency programs. Measures should be taken to improve participation and access to extracurricular nonwork activities so as to improve resident well-being and avoid burnout. Moreover, gender inequality has also become a matter of concern as there were no females among 31 new specialist registrations in neurosurgery in 2017 and only 5 female neurosurgeons in practice to date in Nepal as per the NMC registration. Conclusions Every effort should be directed toward honing the “value of neurosurgeon” among residents and promoting and nurturing their capabilities thereby maximizing sustainability in our health care system.

Background and Objectives The goal of this study is to create data-driven guidelines and tools for caregivers and health care professionals that will enable caregivers to be prepared for future caregiving-related challenges and decrease their levels of stress. Research Design and Methods A total of 60 spousal caregivers of individuals with Alzheimer’s disease (AD) living in Poland were recruited for this study. The participants were assigned to two different groups. The intervention group was provided with a five-session training focused on teaching coping strategies for managing difficult behaviors and provided with a stipend for a period of 6 months (a financial aid program recently launched by the local agency). A control group was not provided with any of the interventions but asked to complete the questionnaires. The effectiveness of each intervention was assessed at a baseline and 6 months after baseline evaluation. Results Caregivers who received financial and educational training reported significantly decreased levels of depression and caregiver burden in comparison to the control group. The majority of caregivers emphasized that caregiving created financial problems and that their work has been underestimated by the government. Discussion and Implications This project addresses several issues of central importance to the success of building research foundation for the interventions. The results have the potential of generating more efficient and personalized interventions that address the needs of the caregiver as they occur, leading to increased knowledge of AD and decreased levels of depression and caregiver burden.

Although Kenya has a high burden of tuberculosis (TB), only 46% of cases were diagnosed in 2016.To identify strategies for increasing attendance at community-based mobile screening units.We analysed operational data from a cluster-randomised trial, which included community-based mobile screening implemented during February 2015-April 2016. Community health volunteers (CHVs) recruited individuals with symptoms from the community, who were offered testing for human immunodeficiency virus (HIV) and sputum collection for XpertA total of 1424 adults with symptoms were screened at 25 mobile unit sites. The median total attendance among sites was 54 (range 6-134, interquartile range [IQR] 24-84). The median yields of TB diagnoses and new HIV diagnoses were respectively 2.4% (range 0.0-16.7, IQR 0.0-5.3) and 2.5% (range 0.0-33.3, IQR 1.2-4.2). Attendance at urban sites was variable; attendance at rural sites where CHVs were paid a daily minimum wage was significantly higher than at rural sites where CHVs were paid a nominal monthly stipend (Mobile units were most effective and efficient when implemented as a single event with community health workers who are paid a daily wage.Bien que le Kenya soit lourdement affecté par la tuberculose (TB), seulement 46% des cas ont été diagnostiqués en 2016.Identifier les stratégies visant à augmenter la fréquentation des unités mobiles de dépistage en communauté.Nous avons analysé les données opérationnelles d'un essai randomisé en grappes, qui a inclus les unités mobiles de dépistage dans les communautés mises en œuvre entre février 2015 et avril 2016. Les travailleurs de santé communautaire (CHV) ont recruté des individus symptomatiques de la communauté, à qui ont été proposés un test de virus de l'immunodéficience humaine (VIH) et un recueil de crachats pour un test XpertAu total, 1424 adultes symptomatiques ont été dépistés dans 25 sites d'unités mobiles. La fréquentation médiane totale dans les sites a été de 54 (fourchette : 6–134; intervalle interquartile [IQR]: 24–84). Le rendement médian de diagnostic de TB et de nouveaux diagnostics de VIH a été de 2,4% (fourchette 0,0–16,7 ; IQR 0,0–5,3) et de 2,5% (fourchette 0,0–33,3 ; IQR 1,2–4,2), respectivement. La fréquentation dans les sites urbains a été variable ; la fréquentation dans les sites ruraux où les CHV ont reçu un salaire minimum journalier a été significativement plus élevée que dans les sites ruraux où les CHV ont reçu une compensation mensuelle modeste (Les unités mobiles ont été les plus efficaces et rentables quand elles ont été mises en œuvre sous forme d'un évènement unique avec les CHV qui sont payés chaque jour.A pesar de que Kenya tenga una carga de morbilidad por tuberculosis (TB) alta, en el 2016 solo se diagnosticaron 46% de los casos.Definir estrategias que aumenten la asistencia a las unidades móviles comunitarias de detección sistemática.Se analizaron los datos operativos de un ensayo clínico aleatorizado en conglomerados, que incluyó unidades móviles comunitarias de detección activa de la TB de febrero del 2015 a abril del 2016. Los agentes de salud comunitarios voluntarios (CHV) incorporaron a las personas sintomáticas de la comunidad, a quienes se ofreció la prueba diagnóstica del virus de la inmunodeficiencia humana (VIH) y el examen de muestras de esputo con la prueba XpertSe examinaron 1424 adultos sintomáticos en 25 puestos de unidades móviles. La mediana de la asistencia global en todos los puestos fue 54 (entre 6 y 134; amplitud intercuartil [IQR] 24–84). La mediana del rendimiento diagnóstico de TB fue 2,4% (entre 0,0 y 16,7; IQR 0,0–5,3) y la de diagnósticos nuevos de infección por el VIH fue 2,5% (entre 0,0 y 33,3; IQR 1,2–4,2). La asistencia a los puestos urbanos fue variable; en los puestos rurales, donde los CHV recibían un salario mínimo diario, la asistencia fue significativamente más alta que en los puestos donde los voluntarios recibían una remuneración nominal mensual (Las unidades móviles fueron más eficaces y eficientes cuando los CHV operaban en un evento único, con remuneración diaria.

Introduction: In May 2010, the Caregivers and Veterans Omnibus Health Services Act of 2010, was signed into law in the United States, establishing the Program of Comprehensive Assistance for Family Caregivers (PCAFC) provided through the VA Caregiver Support Program (CSP). Prior to this program, over half of family caregivers reported being untrained for the tasks they needed to provide. The training through PCAFC represents the largest effort to train family caregivers in the U.S., and the features of the program, specifically a monthly stipend to caregivers and access to a Caregiver Support Coordinator at each VA medical center nationally, make it the most comprehensive caregiver support program ever enacted in the U.S. Methods: The purpose of this study is to examine the association between PCAFC participation and caregiver well-being following enrollment, comparing participating PCAFC caregivers to caregivers who applied to but were not approved for PCAFC participation (non-participants). Well-being is defined using three diverse but related outcomes: depressive symptoms, perceived financial strain, and perceived quality of the Veteran's health care. Additional well-being measures also examined include the Zarit Burden Inventory and positive aspects of caregiving. Results: The survey sample comprised of 92 caregivers approved for PCAFC and 66 caregivers not approved. The mean age of responding caregivers was 45; over 90% of caregivers were female; and over 80% of caregivers were married in both groups. We find promising trends in well-being associated with PCAFC participation. First, the perception of financial strain declined among participants compared to non-participants. Second, while depressive symptoms did not improve for the PCAFC caregivers, depressive symptoms increased among non-participants. Third, perceived quality of the Veteran's VA healthcare was no different between participants and non-participants. However, the 158 returned surveys reflect only a 5% response rate; hence this evidence is preliminary. Conclusion: Despite cautioning that results be interpreted as preliminary, this study provides unique descriptive information about young caregivers of U.S. post-9/11 Veterans, and offers a first step in filling the evidence gap about how comprehensive caregiver support in the U.S. may affect caregiver well-being. These preliminary findings should be explored and validated in a larger sample.

Purpose The decision by prosthodontic residency program directors to employ the Match process highlights the need to understand applicant priorities that influence their choice of which programs to rank highly. The purpose of this study is to determine the factors that were most important to residents when choosing from among nonmilitary based prosthodontics dental residency programs in the United States. Materials and Methods Following completion of a pilot study, all currently enrolled prosthodontic residents at nonmilitary residency programs were invited to participate via the internet. The study consisted of a survey instrument asking residents to rank 26 possible factors that might impact an applicant's choice of residency program. In addition, the instrument collected other possible influencing variables including gender and debt load. Mean rank scores were compared to determine the most and least important factors. Kruskal-Wallis test was used to compare specific factors between the possible influencing variables. Results Two hundred and thirty residents completed the survey instrument, representing a 54.1% response rate of possible participants. With regard to factors influencing program choice, reputation of the residency program was the factor ranked the highest by participants, followed in descending order by the program director's personality, curriculum content, access to use of the latest digital technology, and opportunities for dental implant placement. Quality of schools for children, community outreach opportunities, and the ability to moonlight were ranked as the least important factors. Male and female residents ranked factors such as tuition/stipend, curriculum content, and community outreach opportunities significantly differently. Depending on debt load, residents ranked the factors tuition/stipend, ability to moonlight, curriculum content, and safety of the area where the program is differently. Conclusions Current prosthodontic residents valued the reputation of the program as the most important factor when applying to residency. Participant gender and debt load influence the factors chosen by residents as more or less important. These data will assist prosthodontic educators position their programs in the best possible light to attract applicants to their programs.

Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS) is a major burden disease in South Africa. The pandemic characterises the need for increased counselling and testing due to the availability of antiretroviral therapy (ART). This study describes the experiences of lay counsellors regarding care and support for HIV and AIDS. A qualitative approach was used during focus group interviews at four Tshwane clinics. The purposive sampling method was used to select participants from each facility. Data were collected and data analysis conducted using Tesch’s method. The results highlight that lay counsellors are not recognised as part of the health workers and multidisciplinary team by the Department of Health. It was recommended that the lay counsellors be retained as stipend earning government workers with clearly stipulated and revised conditions of service. On-going support, managerial support and supervision are necessary to improve care and support of HIV and AIDS.

In the modern advertising agency selection contest, each participating agency specifies not only its proposed creative campaign but also the budget required to purchase the agreed-on media. The advertiser selects the agency that offers the best combination of creative quality and media cost, similar to conducting a score auction. To participate in the contest, each agency needs to incur an up-front bid-preparation cost to cover the development of a customized creative campaign. Agency industry literature has called for the advertiser to fully reimburse such costs to all agencies that enter the contest. The authors analyze the optimal stipend policy of an advertiser facing agencies with asymmetric bid-preparation costs, such that the incumbent agency faces a lower bid-preparation cost than a competitor agency entering the contest. The authors show that reimbursing bid-preparation costs in full is never optimal, nor is reimbursing any part of the incumbent's bid-preparation cost. However, a stipend that is strictly lower than the competitor's bid-preparation cost can benefit the advertiser under certain conditions. The authors provide a sufficient condition (in terms of the distribution of agency values to the advertiser) for such a new-business stipend to benefit the advertiser.

In 2010, the Institute of Medicine made a recommendation in The Future of Nursing Report to diversify the student population of the health care professions in order to provide increasing minority providers to meet the culturally competent needs of the growing multicultural populations of the United States (Institute of Medicine, 2010). The Nursing Network and Careers and Technology Nurse Mentoring Program provides a nursing mentor to underrepresented ethnic minority and educationally disadvantaged students and a significant scholarship and stipend for tuition and monthly living expenses. Ethnically diverse and rural students have lifelong familial and geographical educational barriers that prevent them from succeeding. There are a plethora of major environmental and familial factors that need to be addressed by society for these students to be successful. These factors include improvement of county schools by financial support, improving the home environment through social supportive services, and implementing improved parent-child bonding with nurse family partnerships. Nursing faculty must embrace new approaches for increasing the number of ethnically diverse nursing providers through novel admission criteria and collaborative cohort peer-mentoring programs.