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Does channeling government-to-person (G2P) payments through bank accounts encourage financial inclusion and use? This paper explores the factors that have driven the adoption of digital payments in India by beneficiaries of PMGKY, the large-scale COVID-19 relief program launched in May 2020. India's 2013 move to pay social benefits through direct transfers into bank accounts significantly increased account ownership, but uptake of digital payments has been slower, although it has accelerated more recently through smartphone-based apps. Recipient survey data shows that personal and household attributes influence the likelihood of adopting digital payments. Smartphone ownership and digital literacy improve the odds while being a woman reduces them. The strength of the local digital payments ecosystem also exerts significant influence on household adoption;favorable personal and ecosystem factors are needed for widespread use. The historical progression shows that G2P transfers create an entry point but that widespread access to low-cost mobile telecommunications, interoperability, and the entry of new players offering convenient payments interfaces have been vital to the growth of digital payments.
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Background. Universities are interactive communities where frequent contacts between individuals occur, increasing the risk of outbreaks of COVID-19. We embarked upon a real-time wastewater (WW) monitoring program across the University of Calgary (UofC) campus measuring WW SARS-CoV-2 burden relative to levels of disease in the broader surrounding community. Figure 1 The colour scheme shows 6 sewer sub-catchments at the University of Calgary. Auto samplers were deployed at 4 sampling nodes within sub-catchments CR and YA (both residence halls), and UCE and UCS (catchments that include several campus buildings). Figure 2 Log10-transformed abundance (i.e., copies per mL) of nucleocapsid gene (i.e., N1) for SARS-CoV-2 for each sampling location during October 2021 - April 2022. Locations denoted by the same letters (A, B, or C) show no statistical difference (p > 0.05) according to the Wilcoxon rank-sum test. The WWTP sample corresponds to a catchment area covering most of Calgary including the university campus, for which sampling locations CR, UCE, UCS, and UCW are defined in Fig. 1. Methods. From October 2021 - April 2022, WW was collected thrice weekly across UofC campus through 4 individual sewer sampling nodes (Fig. 1) using autosamplers (C.E.C. Analytics, CA). Results from these 4 nodes were compared with community monitoring at Calgary's largest WW treatment plant (WWTP), which received WW from surrounding neighborhoods, and also from UofC. Nucleic acid was extracted from WW for RTqPCR quantification of the N1 nucleocapside gene from SARS-CoV-2 genomic RNA. Qualitative (positive samples defined if cycle threshold < 40) and quantitative statistical analyses were performed using R. Results. Levels of SARS-CoV-2 in WW were significantly lower at all campus monitoring sites relative to the WWTP (Wilcoxon rank-sum test p < 0.05;Fig. 2). The proportion of WW samples that were positive for SARS-CoV-2 was significantly higher for WWTP than at least two campus locations (p < 0.05 for Crowsnest Hall and UCE - University way and campus drive) according to Fischer's exact 2-sided test. The proportion of WW samples with positive WW signals were still higher for WWTP than the other two locations, but statistically not significant (p = 0.216). Among campus locations, the buildings in UCE catchment showed much lower N1 signals than other catchments, likely owing to buildings in this catchment primarily being administration and classroom environments, with lower human-to-human contact and less defecation compared to the other 3 catchments, which include residence hall, a dining area, and/or laboratory spaces. Conclusion. Our results show that SARS-CoV-2 RNA shedding in WW at the U of C is significantly lower than the city-wide signal associated with surrounding neighborhoods. Furthermore, we demonstrate that WW testing at well-defined nodes is a sampling strategy for potentially locating specific places where high transmission of infectious disease occurs.
ABSTRACT
Content: Background: Intravenous Immunoglobulin (IVIg) replacement therapy in patients with secondary hypogammaglobulinaemia, history of infections and low serum IgG levels leads to a significant reduction in clinically significant infections. However current practice is mainly driven by clinical experience and data from IVIg use in primary immunodeficiencies. The emergence of the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) had a significant impact on the management of haematology patients. Aim: To review the management of lymphoma and chronic lymphocytic leukaemia (CLL) patients receiving IVIg at University Hospital of Wales, Cardiff. Methods: An immunoglobulin link nurse was appointed to manage patients receiving IVIg. Serum Immunoglobulin levels were collected at different time points to help guide dosing and frequency of IVIg replacement. Results: 41 patients with the diagnosis of lymphoproliferative disorder were receiving IVIg. Patients' characteristics are listed in the table provided. During the first COVID-19 national lockdown, high risk patients (i.e. history of recurrent infections) were switched to Subcutaneous Immunoglobulin replacement (SCIg) (9/41), (3/41) patients had IVIg administered at home under the care of the immunology department. The rest of the patients had their IVIg infusions postponed and were provided with antibiotics prophylaxis. The majority of patients resumed IVIg infusions after an average of 12 weeks apart from 5 patients: 2 opted to stay on (SCIg), 2 had an average IgG level of 7.3 g/L and one patient opted to continue on prophylactic antibiotics. No infections were reported by any of the patients. The average trough IgG level before restarting IVIg was 4.8 g/L. Trough levels were monitored regularly, average trough IgG levels following 3 doses of IvIg infusions was 9.4 g/l. 10/41 patients had consistently high IgG levels above 10 g/L with no history of infections. As a result, 2/41 patients had their IVIg doses reduced and 8/41 patients had their dose interval changed. Unfortunately due to the significant increase in COVID-19 infections in Wales, further modifications to IVIg delivery had to be reintroduced including postponing IVIg infusions. Virology screen was performed in all patients, 2 patients had positive Hepatitis core antibodies detected, however further investigations revealed the likely passive transfer of antibodies. The majority of patients found (SCIg) to be poorly tolerated and opted to switch back to IVIg replacement. Conclusions: The appointment of an IVIg link nurse helped to provide high quality care to patients receiving IVIg. Our data showed low IgG levels off treatment in the majority of patients indicating the need to continue IVIg replacement. The continuous monitoring of trough IgG levels showed most patients are having an adequate IVIg replacement with no breakthrough infections. It also allowed dose adjustments for patients with high IgG levels. This will likely have a positive impact on patients' quality of life, nurses staffing levels and a favourable financial impact in the long term. The current department of health clinical guidelines on IVIg replacement recommends reasonable attempts should be made to reduce the dose, by increasing the dosing interval or by using reduced dose, or both. However, there are no available practical guidelines to assist in decision making. Characteristics Of Lymphoma and Chronic Lymphocytic Leukaemia Patients On Long Term Intravenous Immunoglobulin Replacement Therapy.