Documenting Community Health Worker Compensation Schemes and Their Perceived Effectiveness in Seven sub-Saharan African Countries: A Qualitative Study.

INTRODUCTION: Community health worker (CHW) incentives and remuneration are core issues affecting the performance of CHWs and health programs. There is limited documentation on the implementation details of CHW financial compensation schemes used in sub-Saharan African countries, including their mechanisms of delivery and effectiveness. We aimed to document CHW financial compensation schemes and understand CHW, government, and other stakeholder perceptions of their effectiveness. METHODS: A total of 68 semistructured interviews were conducted with a range of purposefully selected key informants in 7 countries: Benin, Burkina Faso, Ghana, Malawi, Mali, Niger, and Zambia. Thematic analysis of coded interview data was conducted, and relevant country documentation was reviewed, including any documents referenced by key informants, to provide contextual background for qualitative interpretation. RESULTS: Key informants described compensation schemes as effective when payments are regular, distributions are consistent, and amounts are sufficient to support health worker performance and continuity of service delivery. CHW compensation schemes associated with an employed worker status and government payroll mechanisms were most often perceived as effective by stakeholders. Compensation schemes associated with a volunteer status were found to vary widely in their delivery mechanisms (e.g., cash or mobile phone distribution) and were perceived as less effective. Lessons learned in implementing CHW compensation schemes involved the need for government leadership, ministerial coordination, community engagement, partner harmonization, and realistic transitional financing plans. CONCLUSION: Policymakers should consider these findings in designing compensation schemes for CHWs engaged in routine, continuous health service delivery within the context of their country's health service delivery model. Systematic documentation of the tasks and time commitment of volunteer status CHWs could support more recognition of their health system contributions and better determination of commensurate compensation as recommended by the 2018 World Health Organization Guidelines on Health Policy and System Support to Optimize Community Health Worker Programs.

Identification of genetic and environmental factors influencing aerial root traits that support biological nitrogen fixation in sorghum.

Plant breeding and genetics play a major role in the adaptation of plants to meet human needs. The current requirement to make agriculture more sustainable can be partly met by a greater reliance on biological nitrogen fixation by symbiotic diazotrophic microorganisms that provide crop plants with ammonium. Select accessions of the cereal crop sorghum (Sorghum bicolor (L.) Moench) form mucilage-producing aerial roots that harbor nitrogen-fixing bacteria. Breeding programs aimed at developing sorghum varieties that support diazotrophs will benefit from a detailed understanding of the genetic and environmental factors contributing to aerial root formation. A genome-wide association study of the sorghum minicore, a collection of 242 landraces, and 30 accessions from the sorghum association panel was conducted in Florida and Wisconsin and under 2 fertilizer treatments to identify loci associated with the number of nodes with aerial roots and aerial root diameter. Sequence variation in genes encoding transcription factors that control phytohormone signaling and root system architecture showed significant associations with these traits. In addition, the location had a significant effect on the phenotypes. Concurrently, we developed F2 populations from crosses between bioenergy sorghums and a landrace that produced extensive aerial roots to evaluate the mode of inheritance of the loci identified by the genome-wide association study. Furthermore, the mucilage collected from aerial roots contained polysaccharides rich in galactose, arabinose, and fucose, whose composition displayed minimal variation among 10 genotypes and 2 fertilizer treatments. These combined results support the development of sorghums with the ability to acquire nitrogen via biological nitrogen fixation.

Disability terminology: the use of "disability," "disorder," and "illness" in academic writing.

PURPOSE: The ways in which words are used to describe and discuss people with disabilities has long been an area of social concern. Previous research has demonstrated that language can overtly and subtly influence cognitions and perceptions of individuals, but there is less research on how language relates to perceptions of individuals with disabilities. MATERIALS AND METHODS: A content analysis of 236 peer-reviewed articles was performed to explore differences in the frequency of the use of "disability," "disorder," and "illness" in academic articles related to eight common conditions: deafness, blindness, multiple sclerosis, quadriplegia, anxiety, depression, schizophrenia, and addiction. RESULTS: Results indicated that there were differences in how disability language was used by academic writers. Specifically, "disability" appeared in the writing more frequently in articles related to physical disabilities, "disorder" appeared most frequently in articles related to anxiety and depression, and "illness" appeared most frequently in articles related to schizophrenia. CONCLUSIONS: This observed difference in frequency use could reflect differences in the context and meaning of the use of these conditions. Suggestions for future research are discussed.

The way individuals write and talk about conditions may indicate the way they think about the conditions.When compared to articles written about physical conditions, the term "disability" is used less by academic writers than when discussing mental conditions.This suggests that academic writers may view mental conditions as less "prototypical" disabilities (compared to physical conditions).Careful consideration should be given to the language used when discussing all types of disabilities.When writers, media professionals, policymakers, and the public are educated on the diverse range of conditions and the unique challenges they present to individuals, only then can rehabilitation be truly comprehensive and effective.

Effects of Campus Sexual Assault Prevention Programs on Attitudes and Behaviors Among American College Students: A Systematic Review and Meta-Analysis.

The US Campus Sexual Assault Violence Elimination (SaVE) Act of 2013 mandates that all higher education institutions receiving federal funds offer incoming students primary prevention and awareness programming addressing sexual violence. Yet, there is no thorough and up-to-date quantitative synthesis of the effects of campus sexual assault prevention programs on sexual assault attitudes/knowledge and behaviors. Thus, we conducted a systematic review of the literature and a meta-analysis of experimental and high-quality quasi-experimental research examining effects of college sexual assault prevention programs on sexual assault attitudes and behaviors. Our synthesis of 385 effect sizes from 80 eligible studies disseminated between 1991 and 2021 indicates campus sexual assault programs have a more pronounced effect on attitudes/knowledge than on violence. Effects on sexual assault victimization were significant but small (g = 0.15) and effects on sexual assault perpetration were nonsignificant. Moderator analyses indicate programs that use a risk reduction framework are associated with less favorable outcomes than programs that do not use a risk reduction framework. Considering the limited effect of campus sexual assault prevention programs on violence, we recommend programming efforts move beyond a focus on individuals and, instead, adopt an ecological perspective targeting individuals, social relationships, community factors, and societal factors.

Association Between Genetically Predicted Expression of TPMT and Azathioprine Adverse Events.

Polymorphisms thiopurine-S-methyltransferase (TPMT) and nudix hydrolase 15 (NUDT15) can increase the risk of azathioprine myelotoxicity, but little is known about other genetic factors that increase risk for azathioprine-associated side effects. PrediXcan is a gene-based association method that estimates the expression of individuals' genes and examines their correlation to specified phenotypes. As proof of concept for using PrediXcan as a tool to define the association between genetic factors and azathioprine side effects, we aimed to determine whether the genetically predicted expression of TPMT or NUDT15 was associated with leukopenia or other known side effects. In a retrospective cohort of 1364 new users of azathioprine with EHR-reported White race, we used PrediXcan to impute expression in liver tissue, tested its association with pre-specified phecodes representing known side effects (e.g., skin cancer), and completed chart review to confirm cases. Among confirmed cases, patients in the lowest tertile (i.e., lowest predicted) of TPMT expression had significantly higher odds of developing leukopenia (OR=3.30, 95%CI: 1.07-10.20, p=0.04) versus those in the highest tertile; no other side effects were significant. The results suggest that this methodology could be deployed on a larger scale to uncover associations between genetic factors and drug side effects for more personalized care.

Classification and analysis of asynchronous communication content between care team members involved in breast cancer treatment.

OBJECTIVE: A growing research literature has highlighted the work of managing and triaging clinical messages as a major contributor to professional exhaustion and burnout. The goal of this study was to discover and quantify the distribution of message content sent among care team members treating patients with breast cancer. MATERIALS AND METHODS: We analyzed nearly two years of communication data from the electronic health record (EHR) between care team members at Vanderbilt University Medical Center. We applied natural language processing to perform sentence-level annotation into one of five information types: clinical, medical logistics, nonmedical logistics, social, and other. We combined sentence-level annotations for each respective message. We evaluated message content by team member role and clinic activity. RESULTS: Our dataset included 81 857 messages containing 613 877 sentences. Across all roles, 63.4% and 21.8% of messages contained logistical information and clinical information, respectively. Individuals in administrative or clinical staff roles sent 81% of all messages containing logistical information. There were 33.2% of messages sent by physicians containing clinical information-the most of any role. DISCUSSION AND CONCLUSION: Our results demonstrate that EHR-based asynchronous communication is integral to coordinate care for patients with breast cancer. By understanding the content of messages sent by care team members, we can devise informatics initiatives to improve physicians' clerical burden and reduce unnecessary interruptions.

Does attentional focus during balance training in people with Parkinson's disease affect outcome? A randomised controlled clinical trial.

OBJECTIVE: To compare the effects of attentional focus to augment balance outcomes in individuals with Parkinson's disease. DESIGN: Randomised controlled clinical trial. SETTING: University gait and balance research laboratory. PARTICIPANTS: Forty-nine individuals with idiopathic Parkinson's disease. INTERVENTIONS: Participants were randomly assigned into one of four groups (three balance intervention groups and one control). The three intervention groups all received the same 4-week balance training program augmented with either external, internal, or no focus instructions. The control group did not receive any balance training. MAIN MEASURES: Outcomes were measured at baseline, post intervention, 2-weeks post intervention, and 8-weeks post intervention and included: Sensory Organization Test, Berg Balance Scale, Self-Selected Gait Velocity, Dynamic Gait Index, Activities-Specific Balance Confidence Scale, and obstacle course completion time. RESULTS: There were no differences among the groups in trajectory over the course of the trial for all outcomes (ps ⩾ .135). All groups improved from baseline to post intervention and from baseline to 2-weeks post intervention for all outcomes (ps ⩽ .003), except Self-Selected Gait Velocity, which did not change over the course of the trial (P = .121). CONCLUSIONS: Attentional focus instructions to augment a 4-week balance training program did not result in any change over and above a control group in measures of gait and balance in individuals with Parkinson's disease. Additionally, while all four groups improved, there was no difference among the groups, including the control, suggesting that the 4-week balance training program in this trial was not effective.

Pig oocyte activation using a Zn²âº chelator, TPEN.

Artificial oocyte activation is a critical step during SCNT. Most current activation protocols focus on inducing an increase in the intracellular free Ca(2+) concentration of the oocyte. Here, we have used a zinc chelator, TPEN, to enhance the efficiency of oocyte activation during SCNT. TPEN treatment of matured pig oocytes resulted in the reduction of available Zn(2+) in pig oocytes; however, the cytosolic Ca(2+) concentration in the oocytes was not affected by the TPEN treatment. When various concentrations (100-250 µM) and incubation durations (45 minutes-2.5 hours) of TPEN were used to activate oocytes, the efficiency of oocyte activation was not different from conventional activation methods. When oocytes that were activated by conventional activation methods were incubated with a lower concentration of TPEN (5-10 µM), a significant increase in embryos developing to the blastocyst stage was observed. In addition, when oocytes receiving a small Ca(2+) stimulus were further activated by higher concentration of TPEN (100-200 µM), a significant increase in the frequency of blastocyst formation was observed, compared to a conventional activation method. This result indicated that TPEN can be a main reagent in oocyte activation. No increase in the cytosolic Ca(2+) level was detected when oocytes were exposed to various concentrations of TPEN, indicating the ability of TPEN to induce oocyte activation is independent of an intracellular Ca(2+) increase. We were able to produce clones through SCNT by using the TPEN-assisted activation procedure, and the piglets produced through the process did not show any signs of abnormality. In this study, we have developed an efficient way to use TPEN to increase the developmental potential of cloned embryos.