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Firms in global markets often belong to business groups. We argue that this feature can have a profound influence on international asset pricing. In bad times, business groups may strategically reallocate risk across affiliated firms to protect core “central firms.” This strategic behavior induces co-movement among central firms, creating a new intertemporal risk factor. Based on a novel data set of worldwide ownership for 2002–2012, we find that central firms are better protected in bad times and that they earn relatively lower expected returns. Moreover, a centrality factor augments traditional models in explaining the cross section of international stock returns.

Background: Despite potential for community health workers (CHWs) to effectively reduce morbidity and mortality in sub-Saharan Africa, they still face multiple barriers including access to on-going and refresher training. Digital technology offers a potential solution to improve the provision of ongoing training for CHWs. Objectives: This report shares participant insights and experiences following the implementation of a mobile health (mHealth) assisted Integrated Community Case Management (iCCM) refresher training programme for CHWs in Mukono, Uganda. We seek to document benefits and challenges of such an approach. Methods: CHWs were trained to recognize, treat and prevent childhood pneumonia via locally made videos preloaded onto low cost, ruggedized Android tablets. Subsequent interviews were compiled with key stakeholders including CHWs, CHW leaders and programme supervisors to better understand the strengths, barriers and lessons learned following the interven- tion. Results: Success factors included the establishment of CHW leadership structures, the ability to use the tablets to learn on an “any pace, any place” basis and using the tablets to conduct community teaching and outreach. Barriers included appro- priate consideration of the implementation timeline and avoiding a “one size fits all” approach to digital literacy training. Conclusions: The strength of the program stemmed from a grassroots approach that prioritized stakeholder input at all stages. Leadership at a local level, a history of local engagement and trust built up over a period time were also integral. As organizations aim to scale up digitally enhanced training initiatives, it is paramount that attention is paid to these human factors which are key for program success. Keywords: Low-cost ruggedized Android tablets; in-service training; community health workers; Mukono.

Running is a popular activity practiced worldwide. It is important to understand how running affects joint health to provide recommendations to sports medicine practitioners and runners. Our aim was to summarize the influence of running on lower limb cartilage morphology and composition using quantitative magnetic resonance imaging (MRI). Prospective repeated-measures studies evaluating cartilage using MRI before and after running were included. Data sources included Pubmed, Embase, CINAHL, SportDiscus, Web of Science, and Cochrane Central Registry of Controlled Trials. Qualitative analyses considered the number and methodological quality ratings of studies based on the QualSyst tool, and recommendations were based on the strength of evidence (strong, moderate, limited, or very limited). Quantitative analysis involved meta-analyses, for which effect sizes were calculated as Hedge’s g standardized mean differences. We included 43 articles, assessing seven outcomes (lesions, volume, thickness, glycosaminoglycan content, and T1ρ, T2, and T2* relaxation times). Nineteen articles were rated as high quality, 24 were rated as moderate quality, and none were rated as low quality. Qualitative analyses suggest that running may cause an immediate reduction in knee cartilage volume, thickness, as well as T1ρ and T2 relaxation times immediately; however, these changes did not persist. Meta-analyses revealed a small and moderate decrease immediately following a single running bout in T2 relaxation time in the medial femur and tibia, respectively. Qualitative analyses indicated that the influence of repeated exposure to running on cartilage morphology and composition was limited. Despite conflicting evidence regarding pre-existing knee cartilage lesions, moderate evidence suggests that running does not lead to the formation of new lesions. Repeated running exposure did not cause changes to foot and ankle cartilage thickness or composition. Changes to lower limb cartilage following running are transient. Immediate changes to cartilage morphology and composition, which likely reflect natural fluid dynamics, do not persist and were generally not significant when pooled statistically. Results suggest that cartilage recovers well from a single running bout and adapts to repeated exposure. Given that moderate evidence indicates that running does not lead to new lesions, future trials should focus on clinical populations, such as those with osteoarthritis. Not applicable.

Community Health Worker (CHW) supervision is an under-researched area. This mixed-methods study engaged key stakeholders involved in CHW supervision in Mukono District, Uganda including CHWs (n = 1...

People living in low- and middle- income countries (LMICs) meet significant challenges in accessing ear and hearing care (EHC) services. We conducted a scoping review to identify and summarise such barriers, to recognise gaps in the literature, and to identify potential solutions. Reviewers independently screened titles, abstracts and full-text articles and charted data. We undertook thematic analysis of supply and demand side dimensions of access, and summarised findings mapped against the Levesque framework. Of 3048 articles screened, 62 met inclusion criteria for review. Across the five access dimensions, supply-side constraints were more frequently described, the most common being a shortage of EHC workforce or appropriate facilities, despite high demand. We identified a thin geographical spread of literature on barriers to accessing EHC services in LMICs, reflecting low availability of such services. LMICs face a diverse range of demand and supply side challenges including workforce, equipment and resource shortages, and challenges for the majority of the population to pay for such services. There is a need for many LMICs to develop health policy and programmes in EHC, including integration into primary care, scaling up the EHC workforce through increased training and education, and improving EHC literacy through public health measures.

It is estimated that Head and Neck Cancer (HNC) will cause over 500,000 deaths worldwide by 2030. This is coupled with a shortage of trained healthcare professionals to manage HNC. An alternative cadre of workers - community healthcare workers (CHWs) - could be deployed to address this shortage. A systematic scoping review was conducted. Seven major databases were searched from inception to 30 June 2021. Studies were included from across the globe and excluded if the focus was not on HNC or CHWs. We identified 13 studies for inclusion. Twelve were based in India. CHWs were deployed in education and awareness raising initiatives, community screening, and ensuring compliance with treatment and follow-up. CHWs were compared to specialists for effectiveness in four studies with one reporting sensitivity of 94·3% and specificity 99·3% for HNC screening. This review highlights ways in which CHWs can be deployed to meet the growing demand for HNC services. The existing evidence suggests that CHWs can have potential roles in screening for HNC, therefore facilitating an earlier diagnosis. It is important this screening is implemented where there is appropriate capacity to manage HNC. Further research needs to be carried out to explore barriers and facilitators to these programmes.

Sanitation is a major global challenge that is often addressed at national and international levels, while community opinions and beliefs are neglected. To promote water, sanitation and hygiene (WASH) we organized a cross-cultural knowledge exchange workshop to assess participatory methods for engaging local stakeholders. The workshop included 22 participants from all sectors of society. Practical solutions to sanitation challenges were identified and later shared with a local community. Qualitative and quantitative analyses were used to assess impact and showed participatory methods were highly valued to encourage information sharing among widely varied stakeholders, and that video was a particularly successful approach when engaging with local communities. An 8-month follow-up survey of village members revealed excellent information recall, positive behaviour changes and a desire for future visits. Our evidence suggests that community-based participation helped identify solutions to WASH issues affecting rural communities in resource-poor settings. Engaging in a multicultural knowledge-share was particularly valuable as it enabled participants to recognize they have common challenges and allowed them to share low-cost solutions from their different communities. Our use of video was widely viewed as an ideal means of circulating findings, as it communicated information to people with a wide variety of community roles and to all age groups. Its relevance was increased by adopting a culturally appropriate context by involving local communities in workshop activities. We recommend that research in low- and middle-income countries should be mindful of the environmental context in which WASH is implemented, and encourage acceptance by engaging with communities through the use of varied participatory methods.

Background Although the community health workers’ (CHWs) / volunteer health teams’ (VHTs) work is widely appreciated, some households do resist their interventions, and figures of authority sometimes question their manner and ability. Despite critical shortage of health workers’ world-over, little has been done to explore whether community health workers satisfy the people they serve. To fill this VHT training and support gap, Omni Med Uganda, a local Non-Governmental Organization in Uganda, has been implementing an enhanced hybrid VHT program since 2008. This study aimed at assessing community satisfaction with the CHW activities involved the enhanced CHW program. Materials and methods A cross-sectional study was employed. Qualitative data was collected from 217 participants using semi-structured questionnaires. Descriptive statistics such as frequencies, proportions, and means were performed for socio-demographic characteristics, Community satisfaction, and CHW activities. Prevalence Ratios (PR) were used to determine association between Community satisfaction and enhanced CHW activities. Results Majority of the respondents 81.1% (176/217) reported that the performance of the CHWs was satisfactory to maintain their health and that of their families. CHW activities such as confirming sick persons (APR:1.26 :95%CI (1.01–1.44), mobilization for cook stove building, (APR: 1.18: 95%CI (1.04–1.34), and monthly visits at participant’s homes (APR: 1.17: 95%CI (1.01–1.35) were positively associated with community satisfaction. Conclusion Enhancement of CHW activities should be considered during CHW programs. However, CHW performance should also be considered because community satisfaction does not imply high performance by CHWs and adherence to health interventions by the community.

Background Despite the growth in mobile technologies (mHealth) to support Community Health Worker (CHW) supervision, the nature of mHealth-facilitated supervision remains underexplored. One strategy to support supervision at scale could be artificial intelligence (AI) modalities, including machine learning. We developed an open access, machine learning web application (CHWsupervisor) to predictively code instant messages exchanged between CHWs based on supervisory interaction codes. We document the development and validation of the web app and report its predictive accuracy. Methods CHWsupervisor was developed using 2187 instant messages exchanged between CHWs and their supervisors in Uganda. The app was then validated on 1242 instant messages from a separate digital CHW supervisory network in Kenya. All messages from the training and validation data sets were manually coded by two independent human coders. The predictive performance of CHWsupervisor was determined by comparing the primary supervisory codes assigned by the web app, against those assigned by the human coders and calculating observed percentage agreement and Cohen’s kappa coefficients. Results Human inter-coder reliability for the primary supervisory category of messages across the training and validation datasets was ‘substantial’ to ‘almost perfect’, as suggested by observed percentage agreements of 88–95% and Cohen’s kappa values of 0.7–0.91. In comparison to the human coders, the predictive accuracy of the CHWsupervisor web app was ‘moderate’, suggested by observed percentage agreements of 73–78% and Cohen’s kappa values of 0.51–0.56. Conclusions Augmenting human coding is challenging because of the complexity of supervisory exchanges, which often require nuanced interpretation. A realistic understanding of the potential of machine learning approaches should be kept in mind by practitioners, as although they hold promise, supportive supervision still requires a level of human expertise. Scaling-up digital CHW supervision may therefore prove challenging. Trial registration: This was not a clinical trial and was therefore not registered as such.

Training and supervision are paramount to well-functioning, adaptable Community Health Worker (CHW) programmes. Balancing theoretical and methodological research, lessons from health worker practice, and case studies, this volume has sought to provide a resource to practitioners, policymakers and academics striving to design equitable, participatory CHW programmes. Weaving together interdisciplinary and multiregional perspectives, this book has focussed on the design, implementation and evaluation of technology-based programmes for training and supervision of CHWs, particularly in low- and middle income countries. In doing so, it has set out a roadmap for future equitable, pedagogy-driven CHW programmes.

Training and supervision are core to the development of an effective CHW programme and have been recognized as so for many years. Their development and framing are important to understand from a historical perspective as this has ultimately helped to shape current approaches in the field. However, current CHWs face many related challenges, including determining their key benefits, whom they serve, and the mechanisms by which these benefits occur. This chapter directly addresses these issues by highlighting some of the key opportunities that could play a role in helping overcome some of these challenges, such as the role of mobile technologies. It is a starting point for developing the foundations for beginning to understand the complexities of this fragmented, contested, and important field of study and practice.

Training and supervision have been cited as integral aspects to well-functioning community health worker (CHW) programmes. This chapter initially outlines the rationale for this book, discussing the global health equity gap, the roles of CHWs, the need for CHW training and supervision, and the role technology can play in these. The chapter then introduces the main sections of the book: Section One of the book focuses on training and supervision; Section Two explores the intersection of technology and education in the context of CHW training; Section Three investigates how methodological choice can contribute to social justice in CHW programmes and facilitate CHW training in an equitable way; and in Section Four, ethical issues arising from CHW training are discussed.

Introduction Globally 6% of the population suffers from disabling hearing loss and the majority resides in low- and middle-income countries, but diagnosis and treatment are hampered by poor availability of expert diagnosis. We compared the utility of tele-diagnosis, non-expert diagnosis, and prediction model diagnosis as a screening tool for common external and middle ear disorders. Method We recruited consecutive adult and paediatric patients presenting with ear or hearing symptoms to ENT outpatients at Children’s Surgical Centre, Cambodia. Each participant underwent sequential symptomatic and otoscopic assessment by a non-specialist and an ENT specialist. The non-specialist captured data using a novel automated symptom questionnaire loaded onto a smartphone otoscope. An ENT specialist in the UK subsequently reviewed these data. Results 138 ears were recruited. The prediction model performed poorly, but absence of otorrhoea was found to reliably exclude a diagnosis of chronic suppurative otitis media (negative predictive value=0.99). Both on-site non-expert and expert tele-diagnosis had high diagnostic specificity (90-99% and 86-99%), but low sensitivity ( Conclusions We report the first study to directly compare approaches for non-specialist diagnosis of disorders of the middle/external ear, which shows suboptimal but comparable performance using an automated questionnaire, on site non-expert diagnosis, or remote expert diagnosis

OBJECTIVES Community Health Workers are one way to address the shortage of ear and hearing care specialists in low-resource settings. However, there are few reports evaluating training and service delivery by Community Health Workers. DESIGN, SETTING AND PARTICIPANTS We trained 13 Community Health Workers in primary ear and hearing care in Mukono District, Uganda. Community Health Workers attended a two-day training workshop and received remote supervision thereafter during service delivery in the community. An ear camp was held at the local health centre every two months, where a local ENT specialist could assess referred cases. MAIN OUTCOME MEASURES Clinical and diagnostic skills and decision-making were assessed using an Objective Structured Clinical Examination, with scores recorded at baseline and six months. Service delivery was evaluated by analysing the following: (i) number of individuals evaluated; (ii) treatments delivered; (iii) cases referred for specialist opinion; (iv) proportion of appropriately referred cases; and (v) agreement between Community Health Worker and specialist diagnosis. RESULTS Observed Structured Clinical Examination scores were high and stable for six months. 312 individuals were screened in the community by the Community Health Workers, with 298 classified as having an abnormality. Care was delivered in the community to 167 of these, and the remaining 131 referred to the ear camp. Diagnostic agreement was 39%, but 98% of referrals were deemed "appropriate" by the ENT specialist. 27 individuals self-presented to the ear camp without prior assessment by a Community Health Worker, and 97% of these were deemed appropriate. CONCLUSION Trained Community Health Workers can play an important role in delivering ear and hearing services. Future work should look to explore this model in other contexts and/or compare it to other models of service delivery.

Components of balance sheet asset growth driven by earnings management contributed to the asset growth anomaly in the past. These components of balance sheet asset growth are no longer related to returns and this has contributed to the disappearance of the asset growth anomaly. I provide evidence that the Sarbanes-Oxley Act reduced earnings management induced mispricing which I relate to the asset growth anomaly. More broadly, these findings point towards changes in the regulatory environment as a novel driver of equity market anomalies.

Efforts to combat the large global burden of ear and hearing disorders are hampered by poor availability of expert diagnosis We report the first study to directly compare prediction model, non-expert and tele-diagnosis of middle and external ear disorders. A prediction model based upon a novel automated otological symptom questionnaire performed poorly, but absence of otorrhoea was found to reliably exclude a diagnosis of chronic suppurative otitis media. Both on-site non-expert and expert tele-diagnosis had high diagnostic specificity, but low sensitivity. Future work could explore how the validity of these diagnostic methods may be improved.

Background Cesarean rates have increased significantly over the past decade. The reasons for this are both complex and context specific, and have significant consequences for health resources. The aim of this systematic review was to assess published, peer-reviewed, and gray qualitative literature on the reasons behind cesarean delivery on maternal request (CDMR). Methods A systematic search of MEDLINE, EMBASE, CINAHL, LILACS, and PsycINFO databases was performed for all relevant articles published between January 2006 and June 2016. Reference lists of all included studies were also searched in addition to select web-based sources. Studies were included if they qualitatively evaluated women's preferences for CDMR, with no geographic restriction. Findings from the studies were narratively and thematically synthesized. Results Sixteen studies were included in this review. Three themes were identified as to why women choose CDMR, which were: social norms, emotional experiences, and personal experiences. A woman's decision was often shaped by various influences including family, friends, and the media. In addition, previous experience of childbirth and interactions with health care professionals contributed to a strong preference for CDMR. CDMR provided women with a sense of control over the birth and diminished feelings of fear. Conclusions The reasons behind CDMR are multifactorial and complex. Situation-specific cultural factors, fear of pain during childbirth, previous experience, and interactions with health care professionals are likely to have led to the increase in CDMR. Multifaceted, context-specific approaches are required if there is to be a reduction in CDMR rates.

Understanding the experiences of community health workers (CHWs) through the use of participatory visual methods (PVMs) has been relatively underexplored. One such PVM is photovoice, which involves the capture of photographic images related to issues of social importance. In this study, we explore challenges faced by eight CHWs in Mukono District, Uganda through the use of photovoice. Over a six-week period, CHWs captured 62 relevant photographs. Subsequent individual interviews and group discussions were held with the CHWs regarding the content of the photographs. Using traditional content analysis, a range of themes related to perceived challenges faced by the CHWs were highlighted, including poor infrastructure, insufficient on-going training and supervision, relationships with other health professionals and equipment supplies. Suggestions were raised as to why such challenges existed and how they could be addressed; mainly through increased roles of the government and supporting NGOs. Overall, photovoice was generally a feasible method to highlight the challenges faced by CHWs, however community acceptability regarding image capture and consent taking may prove challenging, given past historical experiences. The use of photovoice in this study highlighted the need to address the multiple and complex challenges faced by CHWs in order to help them fulfil their roles.

Background Hearing loss is a prevalent but neglected disease, especially in low- or middle-income countries. The role of Community Health Workers (CHWs) to deliver primary ear and hearing care has been explored in several studies from a technical standpoint, but understanding perceptions, barriers, and enablers of such an approach from the perspective of CHWs themselves through a health equity lens has been less well documented. Methods This qualitative study used photovoice to explore the views and experiences of CHWs in the Seeta Nazigo Parish of Mukono District in the delivery of ear and hearing care in the community. CHWs were trained in ear and hearing care, and provided with digital cameras to capture photographs related to their work in the community over the following 3 months. Individual interviews regarding the photographs were held at the end of each month, in addition to one focus group discussion. A community workshop was convened at the end of the study to display the photos. Thematic analysis of photographs was conducted using Braune and Clarkes six-step framework. We also used the data to explore potential roles for key stakeholders in primary ear and hearing care, and how photovoice may facilitate their engagement. Results 13 CHWs participated in the study. Several themes were generated from analysis. CHWs perceived a high burden of ear and hearing disorders in their community and recognised the role they could play in tackling that burden. Potential barriers identified included a lack of equipment, training, and supervision of CHWs; logistical, financial, or psychological barriers to community participation; and the widespread use of traditional medicine. CHWs identified roles for the government and NGO bodies to enable and support delivery of ear and hearing care in the community. The community workshop was a useful method to engage key stakeholders in this topic. Conclusions Photovoice is a powerful method to capture issues affecting CHWs. Here it was used to identify a number of perceptions, barriers and enablers to the delivery of ear and hearing care. Our results may inform future strategy in the field of ear and hearing care, and the potential use of photovoice to enact sociocultural change.

IntroductionCommunity-based screening for cervical cancer and task sharing to community health workers (CHWs) have been suggested as a potential way to increase screening coverage in low- and middle-income countries (LMICs). The aims of the scoping review were to understand the following: (i) where and how CHWs are currently deployed in screening in LMIC settings; (ii) the methods used to train and support CHWs in screening, and (iii) The evidence on the cost-effectiveness of using CHWs to assist in screening.MethodsA scoping literature search of 11 major databases and the grey literature was performed between 1978 and 2018. We included comprehensive search terms for ‘CHWs’ and ‘Cervical Cancer’, and used the World Bank criteria to define LMICs.ResultsOf the 420 articles screened, 15 met the inclusion criteria for review. Studies were located in Africa (n=5), Asia (n=5), and South and Central America (n=5). CHWs played a role in community education and raising awareness (n=14), conducting or assisting in cervical screening (n=5), or follow-up (n=1). 11 studies described CHW training activities. Only one study provided a formal cost analysis.ConclusionThe roles of CHWs in cervical cancer screening in LMICs have largely to date focused on education, outreach, and awareness programmes. Community-based approaches to cervical cancer screening are feasible, although the sociocultural context plays an important role in the acceptability of these interventions. Further in-depth contextually grounded studies exploring the acceptability of such interventions are required, as well as studies exploring the cost-effectiveness of involving CHWs in cervical cancer screening activities.

ObjectivesUnderstanding the current landscape of ongoing training for community health workers (CHWs) in low-income and middle-income countries (LMICs) is important both for organisations responsible for their training, as well as researchers and policy makers. This scoping review explores this under-researched area by mapping the current delivery implementation and evaluation of ongoing training provision for CHWs in LMICs. DesignSystematic scoping review. Data sourcesMEDLINE, Embase, AMED, Global Health, Web of Science, Scopus, ASSIA, LILACS, BEI and ERIC. Study selectionOriginal studies focusing on the provision of ongoing training for CHWs working in a country defined as low income and middle income according to World Bank Group 2012 classification of economies. ResultsThe scoping review found 35 original studies that met the inclusion criteria. Ongoing training activities for CHWs were described as supervision (n=19), inservice or refresher training (n=13) or a mixture of both (n=3). Although the majority of studies emphasised the importance of providing ongoing training, several studies reported no impact of ongoing training on performance indicators. The majority of ongoing training was delivered inperson; however, four studies reported the use of mobile technologies to support training delivery. The outcomes from ongoing training activities were measured and reported in different ways, including changes in behaviour, attitudes and practice measured in a quantitative manner (n=16), knowledge and skills (n=6), qualitative assessments (n=5) or a mixed methods approach combining one of the aforementioned modalities (n=8). ConclusionsThis scoping review highlights the diverse range of ongoing training for CHWs in LMICs. Given the expansion of CHW programmes globally, more attention should be given to the design, delivery, monitoring and sustainability of ongoing training from a health systems strengthening perspective.

We use the data leak of the Panama Papers on April 3, 2016 to study whether and how the use of secret offshore vehicles affects firm value around the world. The data provide insights into the operations of more than 214,000 shell companies incorporated in tax havens by Panama-based law firm Mossack Fonseca. Using event study techniques, we find that the data leak erases US$135 billion in market capitalization among 397 public firms with direct exposure to the revelations of the Panama Papers, reflecting 0.7 percent of their market value. Tax aggressive firms and firms with exposure to perceptively corrupt countries are more adversely affected. This is consistent with the leak (i) reducing firms’ ability to avoid taxes and finance corruption, or (ii) increasing regulatory fines for past tax evasion and violations of anti-corruption regulations. Taken together, secret offshore vehicles are used for value-enhancing but potentially illegal activities that go beyond tax avoidance. Offshore intermediaries facilitate such activities.

With the need to design and evaluate Community Health Worker (CHW) programmes from a more human-centred perspective, researchers and programme managers are exploring the role of participatory visual methodologies (PVMs). This review identifies, maps, and assesses the quality of current literature that describes the use of PVMs with CHWs. It includes material from the grey literature and 10 major databases between 1978-2018. A Critical Appraisal Skills Programme (CASP) Qualitative checklist was used to assess the overall quality of the included studies. 12 original studies met the inclusion criteria. The studies were located in North America (n = 9) or sub-Saharan Africa (n = 3), with photovoice (n = 6) and digital storytelling (n = 5) being the most commonly used forms of PVMs. The overall quality of the evidence described in these articles was high, but it was notable that seven studies did not fully report the ethical considerations of their work. The studies revealed that PVMs can help assist CHWs’ reflective practice and understanding of complex health issues, as well as identifying key issues in the community to potentially leverage social action.

Since 2012, The World Health Organization and UNICEF have advocated for community health workers (CHWs) to be trained in Integrated Community Case Management (iCCM) of common childhood illnesses, such as pneumonia. Despite the effectiveness of iCCM, CHWs face many barriers to accessing training. This pilot study compares traditional training with using locally made videos loaded onto low-cost Android tablets to train CHWs on the pneumonia component of iCCM.We conducted a pilot randomised controlled trial with CHWs in the Mukono District of Uganda. The unit of randomisation was the sub-county level, and the unit of analysis was at the level of the individual CHW. Eligible CHWs had completed basic iCCM training but had not received any refresher training on the pneumonia component of iCCM in the preceding 2 years. CHWs in the control group received training in the recognition, treatment, and prevention of pneumonia as it is currently delivered, through a 1-day, in-person workshop. CHWs allocated to the intervention group received training via locally made educational videos hosted on low-cost Android tablets. The primary outcome was change in knowledge acquisition, assessed through a multiple choice questionnaire before and after training, and a post-training clinical assessment. The secondary outcome was a qualitative evaluation of CHW experiences of using the tablet platform.In the study, 129 CHWs were enrolled, 66 and 63 in the control and intervention groups respectively. CHWs in both groups demonstrated an improvement in multiple choice question test scores before and after training; however, there was no statistically significant difference in the improvement between groups (t = 1.15, p = 0.254). There was a statistically significant positive correlation (Pearson's r = 0.26, p = 0.03) linking years of education to improvement in test scores in the control group, which was not present in the intervention group. The majority of CHWs expressed satisfaction with the use of tablets as a training tool; however, some reported technical issues (n = 9).Tablet-based training is comparable to traditional training in terms of knowledge acquisition. It also proved to be feasible and a satisfactory means of delivering training to CHWs. Further research is required to understand the impacts of scaling such an intervention.Registered on 23/11/2016 at clinicaltrials.gov ( NCT02971449 ).

Mobile health (mHealth) approaches for medical education in developing countries may be particularly useful given the number of mobile phone subscription rates and the challenges faced by medical educators. The evidence to support its effectiveness has not been critically reviewed. The electronic databases PubMed, Scopus and MEDLINE were searched to retrieve English language articles published in international academic journals between January 2007 and September 2014. Two reviewers independently reviewed citations using predetermined inclusion and exclusion criteria. Only articles addressing the use of mobile or tablet technologies and that met a prespecified keyword strategy were selected for review. The original search returned 583 results, of which only seven pertained to medical education in developing countries and had full text available. There was significant variation between the studies reviewed, in terms of intended audience, intervention design, assessment method and outcome. Three studies assessed the integration of mHealth solutions into the training of allied healthcare professionals, three assessed resident doctors, and another assessed undergraduate medical students. Six of the seven studies used mobile phones as the intervention tool. The majority of studies pointed towards mHealth as a promising tool for education and training of healthcare professionals, yet due to the limited size of the studies definite conclusions were limited. The results of this review suggest that more studies with larger sample sizes and more quantitative methods of evaluation are needed in order to demonstrate that mHealth holds more than mere potential.

Objectives: To assess the feasibility and impact of using low-cost Android tablets to deliver video tutorials and remote online peer-tutoring for clinical skills between two countries.Methods: Nine...

Background:Dementia with Lewy bodies (DLB) and Alzheimer's disease (AD) are common forms of dementia, yet diagnosis is often difficult. Diffusion tensor imaging (DTI) is an MR technique used to assess neuronal microstructural integrity that may help develop a better understanding of the differences between the conditions.Methods:We recruited subjects with DLB (n = 35), AD (n = 36), and similar aged healthy controls (n = 35). T1 weighted anatomical and diffusion MR images were acquired at 3 Tesla. Region of interest (ROI) analysis was used to measure fractional anisotropy (FA) and mean diffusivity (MD) in five structures: precuneus, thalamus, pons, midbrain, and amygdala. Where appropriate diffusivity measures (FA, MD) were correlated with selected clinical measures.Results:Compared to controls, DLB subjects were characterized by reduced FA (p = 0.016) and increased MD (p = 0.007) in the precuneus. Amygdala diffusivity was positively correlated with UPDRS-III score in DLB (p = 0.003). In AD, reduced FA in the precuneus was also observed compared to controls (p = 0.026), and was associated with impaired global cognition (MMSE score) (p = 0.03).Conclusions:Our findings highlight the potential importance of the precuneus in the pathogenesis of DLB as well as AD. Diffusion tensor MRI may shed new light on the different neurobiological changes underpinning the key clinical features of DLB and AD.

Objectives To assess the feasibility and impact of using a low-cost Android tablet to deliver clinical skills training to third-year medical students in Kenya. Design A prospective study using a low cost tablet called ‘connecTAB’, which was designed and manufactured specifically for areas with low bandwidth. Instructional video tutorials demonstrating techniques of cardiovascular and abdominal clinical examinations were pre-loaded onto the tablet. Setting Maseno University School of Medicine, Western Kenya. Participants Fifty-one third-year medical students from Maseno University School of Medicine were subjects in the study. Twenty-five students were assigned to the intervention group and 26 to the control group. Main outcome measures At the start of the study, students from both groups completed an Observed Structured Clinical Examination (OSCE) of the cardiovascular and abdominal evaluations. Students who were allocated to the intervention group then received the connecTAB, whereas students in the control group did not. After a period of three weeks, students from both groups completed a post-study OSCE for both the cardiovascular and abdominal evaluations. Results There were significantly higher improvements in the scores for both cardiovascular and abdominal examinations ( p Conclusion The study suggests that access to connecTAB improves clinical education and efficacy and holds promise for international training in both medical and allied healthcare professional spheres in resource-limited settings.

SummaryAlzheimer's disease (AD) is the commonest form of dementia, estimated to affect 37 million people worldwide. Currently there is nothing to halt the progression of AD – treatment focuses largely on slowing the development of symptoms. More recently disease-modifying interventions, such as immunotherapy, have been investigated as their aim is to halt or even reverse symptoms by removing β-amyloid (Aβ) pathology. This paper assesses the developments made in this particular field, offers critical appraisal of important papers and assesses the viability of this potential form of treatment.