Enrollment Rates Research Articles

Enhancing College Access in Zimbabwe: Impact of Student Loans and Grants

This study explores how government interventions, grants, and loans influence college access in Zimbabwe, focusing on understanding the factors affecting college access and retention rates. The research aims to inform evidence-based decision-making regarding college access through a mixed research approach integrating qualitative and quantitative methods. Combining both qualitative and quantitative methods to ensure the validity and reliability of the findings. It analyses secondary data sources, such as literature, reports, and statistical datasets, to explore aspects like college access, enrollment trends, poverty rates, financial aid programs, and student loan systems in Zimbabwe. Triangulation techniques enhance the credibility of the study's findings by integrating evidence from various sources and employing diverse data collection and analysis methods, enriching perspectives and strengthening the validity and reliability of the study's conclusions. Key findings suggest that grants and loans significantly contribute to increasing college enrollment rates, particularly among economically disadvantaged groups. However, enrollment disparities persist, especially among marginalized populations like women. Despite a modest increase in government spending on education, concerns arise due to a slowdown in overall enrollment growth. Barriers to student loan uptake include complex application processes, concerns about debt burdens, and uncertainties regarding post-graduation employment prospects. The study emphasizes the importance of comprehensive policy interventions to simplify eligibility criteria, enhance financial literacy, and promote employment pathways. Using human capital and open systems theories, the research lays a groundwork for evidence-based decision-making to enhance access to higher education in Zimbabwe.

IMPROVING THE KNOWLEDGE, RISK STRATIFICATION AND OUTCOMES IN ADVANCED HEART FAILURE. THE ISMETT HEART FAILURE REGISTRY

Abstract Background Advanced heart failure (AdHF) accounts for approximately 10% of patients in HF clinics worldwide. Clinical management of patients with AdHF remains challenging and most of the available studies focus on chronic but not advanced HF. Registry studies may provide important insights into this specific population. Methods All consecutive patients referred to our centre for AdHF therapies candidacy (left ventricular assist device (LVAD), heart transplant (HTx)) are prospectively studied and enrolled in the registry. On the same day, all patients undergo a comprehensive clinical and instrumental examination, including electrocardiogram, echocardiography, extended laboratory tests and right heart catheterisation. Most patients also undergo a cardiopulmonary exercise test and, in the case of a non–ischaemic aetiology, cardiac magnetic resonance imaging and genetic testing, if not already performed. Echocardiography is also performed to assess advanced echocardiographic measures (biventricular and atrial strain, myocardial work, 3–D chambers assessment). Results Forty–five patients were enrolled from March 1, 2023 to December 22, 2023 (enrolment rate 4.5 patients/month). Mean age was 54 years and 2/3 were male. Median disease duration was 69 (28–165) months. Non–ischemic HF was the most common aetiology with a NYHA IV prevalence of 4% (all others were in NYHA III). 31% of patients had chronic kidney disease and overall liver function was preserved. 67% of patients were treated with sacubitril/valsartan, > 90% were taking beta–blockers (median dose 4.8 mg bisoprolol–equivalent dose) and 84% SGLT2 inhibitors. Both standard and advanced echocardiography showed features of advanced disease. Over a median follow–up of 4 (2 – 6) months 2 (4%) patients died, 5 (11%) underwent urgent HTx and 8 (18%) underwent LVAD implantation. For most variables, there was a trend showing that patients with events were sicker but, currently, the sample size limited the statistical power. Conclusions A systematic comprehensive evaluation of patients with AdHF evaluated for advanced HF therapies could help to reduce the knowledge gap for this high–risk HF population.

Feasibility, acceptability, and perceived usefulness of a community-evidence-based harm reduction intervention for sexualized stimulant use among Mexican gay, bisexual, and other men who have sex with men

BackgroundThe use of stimulants and other substances with the purpose of enhancing, maintaining, and prolonging sexual activity is known as sexualized substance use. Also known as chemsex, this pattern of use has been mainly explored in high-income countries. The aim of this article was to assess the feasibility, acceptability, and usefulness of a community- evidence-based harm reduction intervention among Mexican gay, bisexual, and other men who have sex with men (gbMSM) adults who reported sexualized stimulant use in the past 6 months and who were not enrolled in any psychosocial treatment.MethodsThe in-person intervention was designed in partnership with gbMSM who used substances. It consisted of 39 harm reduction strategies before, during, and after episodes of use. The components of the intervention were health and self-care, safety, and psychopharmacology. The intervention was delivered at a university campus, a public recreational space, and an HIV public clinic. Feasibility to deliver the intervention was assessed based on enrolment and completion rates; acceptability through a 28-item, 5-point Likert scale (140 max.) constructed and validated for the Mexican population with good reliability coefficients; usefulness through a 5-point Likert scale (“not useful”-“very useful”) for each of the 39 strategies; and potential behavioral change by subtracting the likelihood of implementing each strategy minus the frequency of use of the technique before the intervention.ResultsParticipants (n = 19; recruitment rate = 35.2%; completion rate = 84.2%) rated the intervention as acceptable with a mean score of 121.6 (SD = 7.5). The highest potential for behavioral change was regarding the use of information about the half-life of stimulants, polysubstance use, and overdose prevention.ConclusionsThis intervention is feasible when provided within public health services where potential participants are already in contact. Harm reduction strategies need to surpass sexually transmitted infections prevention and HIV care and focus on substance use and mental health strategies.

대학 정량지표를 통해 본 대학혁신지원사업의 성과와 시사점

Objectives This study analyzed the performance of university innovation support projects through quantitative in-dicators of universities. Methods A paired t-test method and one-way analysis of variance were used as research methods. Results As a result of the analysis, the acquisition rate of full-time teachers and the recruitment rate of students were lower than before the university innovation support project, while the education cost reduction rate, the total number of courses per student, the appropriateness of the lecture size, the recruitment rate of new students, and the employment rate of graduates were higher than before the university innovation support project. The recruit-ment rate of enrolled students and the employment rate of graduates were higher in the metropolitan area than in the non-metropolitan area. According to the university size, there was no difference in the rate of change in all indicators except for the enrollment rate, and in the case of the enrollment rate, large universities performed better than those that did not. Conclusions This study is significant in that it has confirmed that the university innovation support project is ach-ieving quantitative as well as qualitative performance of various university innovations, and balances according to university regional conditions and size.

Secondary School Enrollment in Nigeria: The Role of Remittances from Abroad

Using the autoregressive distributed lag (ARDL) method, the study looked at how remittances affected secondary school enrollment in Nigeria. The research uses annual data from 1981 to 2022. Remittances from overseas, GDP per capita, gross fixed capital formation, inflation, and the ratio of tertiary school enrollment are the five channels that are taken into consideration. The findings show that the remittances coefficient indicates a one-unit increase in remittances leads to a -0.0168-unit decrease in the secondary school enrollment rate, although not statistically significant. This suggests that when remittances are used for basic needs like housing, healthcare, and daily expenses, there is less money available for schooling. Families may feel that the high fees are excessive and that income dynamics cannot support the costs of secondary education. The findings also show that the log of GDP per capita is associated with a 0.0626-unit increase in the log of secondary school enrollment rate. Tertiary school enrollment is associated with an increase in the current log of secondary school enrollment rates because higher secondary school enrollment rates are driven by increased education desires, tertiary opportunities, and better access. The study concludes that while remittances have the potential to impact educational decisions and outcomes in general, they had no effect on secondary school enrollment rates in Nigeria or during the study period, and it suggests that the government look into the challenges faced by families that rely on remittances for education. Pay careful attention to the outcomes of implemented policies and programmes so that you can assess their effectiveness and adjust as needed in response to community input.

Implementing a behavioral physical activity program in children and adolescent survivors of childhood cancer: a pilot randomized controlled trial.

Purpose We aimed to document the acceptability (enrollment rate) and feasibility (phone call delivery rate) of implementing a behavioral PA intervention over 12 weeks, in addition to documenting its effects on patient-reported outcomes and physical functioning. This study also describes the costs of carrying out a behavioral PA intervention. A total of 40 participants were randomized in a 1:1 ratio. The tailored behavioral PA intervention was developed based on the most recent PA guidelines in pediatric oncology and on the COM-B framework to enact PA behavior changes. The prescription (frequency, intensity, time and type (FITT)) was adjusted each week during the weekly support calls. The control group did not receive the intervention. 26 males and 14 females (13.6 years old on average and 2.9 years post-cancer treatment on average) participated in our study. The acceptability rate was 90.9% and the feasibility rate was > 85%. We found that 85% improved PA frequency, 80% improved PA intensity, 100% improved PA time, and 50.0% achieved the recommended PA guidelines. No adverse events were reported over the duration of the intervention. Physical function improved with longer 6-minute walk distances in the intervention group (465.8 ± 74.5m) than in the control group (398.7 ± 92.9m) (p = 0.016). PROs scores for all participants were within the limits of the normal range. The estimated cost per participant of carrying out this intervention was USD $126.57. Our 12-week behavioral PA intervention, based on the COM-B framework, was found to be acceptable, feasible and safe in childhood cancer survivors. This study is an important step in the right direction to make exercise standard practice in pediatric oncology.

Feasibility of a Telemedicine-Based Principal Illness Navigation (PIN) Service for Complex Populations Following Hospital Discharge After Acute Stroke

Background Principal Illness Navigation (PIN) services may play an important role in helping patients through important transitions in care following acute hospitalization. We evaluated a novel PIN telemedicine approach to understand the feasibility of providing these services to diverse patient cohorts. Methods A single-arm, retrospective observational study of Kandu Health’s post-acute PIN service was conducted in patients experiencing ischemic or hemorrhagic stroke in California and New Jersey. The technology-enabled program offered remote healthcare support led by occupational therapists and licensed clinical social workers that was tailored to individual patient needs to facilitate transition to community settings post-discharge. Barriers to recovery were addressed through patient education, one-on-one guidance, and specialized referrals. Patient outcomes were assessed through in-app assessments and clinician-assessed modified Rankin Scores conducted via video consultation. Readmissions were monitored through both patient reporting and admission/discharge/transfer feeds from health information exchanges. Results A total of 111 patients were enrolled between June 22, 2022 and January 11, 2024. Patients were onboarded an average of 29 ± 40 days (median 18, IQR 8-32) after acute care hospital discharge and spent an average of 81 ± 21 days (median 90, IQR 75-90) in the program. During that time, the average enrollee spent 333 ± 156 minutes (median 350, IQR 205-435) of 1:1 time interacting with their dedicated navigator, and navigators spent an additional 113 ± 87 minutes (median 95, IQR 61-140) per patient on care coordination and curriculum curation. Patients with 5 or more social determinants of health (SDOH) needs required over 50% more navigator time than those without any SDOH needs. Within 6 weeks of hospital discharge, 8.5% experienced an inpatient hospital all-cause readmission that was not associated with race, ethnicity, or SDOH. Conclusions High rates of enrollment and extensive patient engagement in both navigator-facilitated and self-directed program elements can be achieved using the Kandu program. Our findings indicate that telemedicine facilitated, app-supported PIN is feasible to deliver following acute stroke discharge across diverse ages, races, ethnicities, functional status (mRS), and social needs.

The most effective corticosteroid dose in the treatment of glenohumeral osteoarthritis: Feasibility pilot and protocol for double blinded randomized controlled trial

ObjectiveOsteoarthritis affects over 5.4 million people in the United States. A common treatment is to perform intra-articular corticosteroid injections. However, the ideal steroid dose is unknown. This study aimed to pilot a corticosteroid injection protocol for primary glenohumeral OA. MethodsWe conducted a double blinded randomized feasibility pilot study. Patients with primary osteoarthritis of the glenohumeral joint were recruited and randomized to receive 20 ​mg, 40 ​mg, or 80 ​mg of triamcinolone. The primary outcome was the feasibility of the protocol and change in the Shoulder Pain and Disability Index (SPADI) 6 months following injection. Results300 patients were screened for participation with 78 meeting inclusion criteria. 19 subjects completed the study. The most common reason for not participating was concern they would receive a smaller dose than previous injections. There was a 26% dropout rate, with 2 patients undergoing a total shoulder arthroplasty. There was no clinically significant difference (p ​= ​0.090) between the groups at 6-months for the SPADI although all treatment groups showed a reduction of SPADI from baseline at 6 months. There was one adverse event in the 20 ​mg group, with a patient experiencing facial flushing after the injection. ConclusionWe were successful in developing a feasible protocol. In the future excluding those who have received previous injections would be helpful for a higher enrollment rate. This patient concern highlights the need to complete clinical trials to guide medical decisions surrounding corticosteroid administration. NCT03586687.

Remote monitoring of cardiac implantable electronic devices using smart device interface versus radiofrequency‐based interface: A systematic review

AbstractBackgroundGuidelines recommended remote monitoring (RM) in managing patients with Cardiac Implantable Electronic Devices. In recent years, smart device (phone or tablet) monitoring‐based RM (SM‐RM) was introduced. This study aims to systematically review SM‐RM versus bedside monitor RM (BM‐RM) using radiofrequency in terms of compliance, connectivity, and episode transmission time.MethodsWe conducted a systematic review, searching three international databases from inception until July 2023 for studies comparing SM‐RM (intervention group) versus BM‐RM (control group).ResultsTwo matched studies (21 978 patients) were retrieved (SM‐RM arm: 9642 patients, BM‐RM arm: 12 336 patients). There is significantly higher compliance among SM‐RM patients compared with BM‐RM patients in both pacemaker and defibrillator patients. Manyam et al. found that more SM‐RM patients than BM‐RM patients transmitted at least once (98.1% vs. 94.3%, p < .001), and Tarakji et al. showed that SM‐RM patients have higher success rates of scheduled transmissions than traditional BM‐RM methods (SM‐RM: 94.6%, pacemaker manual: 56.3%, pacemaker wireless: 77.0%, defibrillator wireless: 87.1%). There were higher enrolment rates, completed scheduled and patient‐initiated transmissions, shorter episode transmission time, and higher connectivity among SM‐RM patients compared to BM‐RM patients. Younger patients (aged <75) had more patient‐initiated transmissions, and a higher proportion had ≥10 transmissions compared with older patients (aged ≥75) in both SM‐RM and BM‐RM groups.ConclusionSM‐RM is a step in the right direction, with good compliance, connectivity, and shorter episode transmission time, empowering patients to be in control of their health. Further research on cost‐effectiveness and long‐term clinical outcomes can be carried out.

The Negative Effects of Cultural Identity on Preschool Girls in Bong, Lofa, and Nimba Counties of Liberia

This paper probes into the multifaceted issues surrounding violence against women and challenges to girls' education in Liberia. Coomaraswamy's 2002 research underscored the role of cultural behaviors in family structures contributing significantly to violence against women. King and Winthrop's 2015 study explored factors such as poverty, gender norms, and cultural expectations, contributing to discussions on fair educational opportunities. Cunningham et al.'s 2023 research delved into gender disparities across economic, educational, healthcare, and political spheres, employing a women's empowerment perspective. Theoretical frameworks rooted in gender and social norm theories were employed to understand the impact of cultural identity on preschool girls' education in Liberia. The study focused on evaluating negative effects on preschool girls in Bong, Lofa, and Nimba counties, emphasizing the need for targeted interventions to create a supportive environment. Coomaraswamy's 2002 insistence on rejecting the use of cultural considerations to justify violence against girls resonates globally. The study also highlighted disparities in girls' primary school enrollment rates in the region compared to the global average, emphasizing the urgency of addressing educational inequalities. Overall, this paper contributes valuable insights for policymakers, educators, and communities, advocating for positive change in Liberia's educational landscape and women's empowerment.

Effects of higher education subsidies on equity and efficiency across developmental stages

This study investigates the impact of taxes and subsidies for higher education on equity–efficiency trade-offs under various phases of higher education development. A scholarship program emerges as the most effective subsidy for higher education across all developmental stages. During both early and later phases, a universal grant proves more effective than a scholarship grant in reducing inequality. At the later stages of higher education development, the enrollment rate increases for universal grants but decreases for other policies, implying that the recent shift away from universal grant schemes in the UK could lead the enrollment rate to decline.

Asymmetric effects of long-term war on human resource development in Af…ghanistan: evidence from NARDL approach

This study explores the effects of war on human resource development in Afghanistan using non-linear autoregressive distributed lags (NARDL) and asymmetric causality analysis. The results of the NARDL bound test support an asymmetric long-run relationship between predictors. It reveals that positive and negative shocks from the per capita cost of war, child mortality rate, and population growth rate asymmetrically affect the school enrollment rate in both the short and long runs. Furthermore, it shows that positive shocks from per capita GDP and per capita government expenditures on education increase the school enrollment rate, while their negative shocks have adverse effects, in both the short and long runs. This implies that school enrollment is highly sensitive to changes in the per capita cost of war and reacts swiftly. Moreover, the results reveal significant causality from both the positive and negative components of the per capita cost of war, per capita GDP, per capita government expenditures on education, and population growth to both the positive and negative components of the school enrollment rate. However, there is only a causal nexus from the negative component of the child mortality rate to the school enrollment rate. Based on these findings, relevant policy implications are discussed.

Feasibility and Acceptability of a Meditation Mobile App Intervention for Adolescent and Young Adult Survivors of Childhood Cancer.

Adolescent and young adult (AYA) survivors of childhood cancer are increasingly recognized as a vulnerable group with unique emotional, social, and practical needs due to the intersection of cancer survivorship and normal developmental processes. Mindfulness meditation has shown early efficacy in improving psychological distress among cancer patients. However, the overall scientific study of app-based mindfulness-based interventions is still in its early stages. The goal of this study was to evaluate the feasibility and acceptability of a commercially available mindfulness mobile app intervention "Ten Percent Happier" among AYA survivors of childhood cancer. We conducted a single-arm pilot intervention with 25 AYA survivors of childhood cancer ages 18-29 years. A total of 108 potentially eligible individuals were initially identified for screening. Of the 45 individuals reached (contact rate = 41.67%), 20 declined to participate; 25 were enrolled in the study and completed the baseline survey (enrollment rate = 55.56%). Twenty-one participants completed the study (retention rate = 84%). Changes in several outcomes were promising, with medium to large effect sizes: Mindfulness (d = 0.74), Negative Emotion (d = 0.48), Perceived Stress (d = 0.52), and Mental Health (d = 0.45). Furthermore, results suggested that participants with consistent app usage showed greater improvement in reported outcomes than those who stopped their usage (e.g., Mindfulness: d = 0.74, Perceived Stress: d = 0.83, Mental Health: d = 0.51; Meaning and Purpose: d = 0.84; and Sleep Disturbance: d = 0.81). Qualitative feedback indicated high satisfaction, but participants suggested adding group or individual peer support to improve their experience with the app. AYA survivors can be difficult to reach, but a mindfulness app was feasible and acceptable to this group. In particular, the robust retention rate and high satisfaction ratings indicate that the meditation mobile app was well received. Preliminary results suggest positive changes in health-related quality of life outcomes, warranting a larger efficacy trial.

Abstract PO4-09-12: Academic-community partnership bridges disparities in African American patient representation in accelerated partial breast irradiation clinical trials

Abstract Purpose/Objectives: Clinical outcomes in African American (AA) patients diagnosed with breast cancer continue to lag behind other racial groups. Thus, AA women are 41% more likely to die from breast cancer than White women despite lower incidence of breast cancer in AA women. Some of these disparities are related to barriers in access to standard-of-care treatments such as radiation therapy (RT). The prolonged nature of radiation treatments confers disproportionate higher burden (due to lost wages, transportation costs etc.) on economically disadvantaged groups such as AA women. Accelerated partial breast irradiation (ABPI), which dramatically reduces treatment time in appropriately selected patients, has the potential to mitigate financial toxicity, and improve access and treatment compliance for AA. However, underrepresentation of AA patients in APBI trials may pose a barrier to wide adoption of APBI treatments in this patient population. At our institution, we have established a unique partnership between our University Hospital and a county hospital that serves as a safety-net hospital for many economically disadvantaged groups and treats a large proportion of AA patients. The goal of this study is to determine if our unique academic-community partnership improves disparities in representation of AA patients in APBI trials. Methods: We performed a PUBMED search to identify 197 clinical trials involving ABPI. After excluding international trials and multiple reports from the same trials, we identified 80 unique studies that were based in the United States. A total of 20 studies investigating APBI provided demographics data, comprising 1735 total patients. AA enrollment rate in these trials was compared to APBI trials completed at our institution in partnership with our county hospital partner. Results: Out of 1785 patients enrolled in APBI trials in the United States where demographic information was available, 1488 patients were White (85.7%), 124 were Black (7.1%), 67 were Hispanic (3.9%), and 46 were Asian (2.7%), and 10 patients were classified as multiple or unknown (0.6%). We compared these results to two APBI trials conducted at our institution investigating 5-fraction and single fraction APBI regimens. Out of a total of 104 patients treated, 17 patients (16.3%) were Black. This difference in proportion of AA patient enrollment between our institution (16.3%) versus those reported in APBI trials across the United States (7.1%) was statistically significant (p < 0.05). Conclusion: Reporting and representation of AA patients in APBI trials remains low, which may lead to lower adoption of APBI treatments in AA patients. This may lead to underutilization of APBI, a convenient treatment with lower financial toxicity, among AA patients. Our study shows that effective academic-community partnerships can bridge such disparities in AA patient representation in APBI trials. Expansion of such academic-community partnerships across the country may bridge systemic disparities in AA patient representation in oncology clinical trials. Future studies are needed to determine if improved access to novel and convenient treatments such APBI will bridge existing disparities in clinical outcomes in patients diagnosed with breast cancer. Citation Format: Ev Kakadiaris, Brian Lue, Young Suk Kwon, Prasanna Alluri, D Nathan Kim, Ann Sprangler, Mona Arbab, Robert Timmerman, Asal Rahimi. Academic-community partnership bridges disparities in African American patient representation in accelerated partial breast irradiation clinical trials [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO4-09-12.

Evaluating the real-world implementation of the Family Nurse Partnership in England: a data linkage study.

The Family Nurse Partnership is an intensive home visiting programme for adolescent mothers. We aimed to evaluate the effectiveness of the Family Nurse Partnership on outcomes up to age 7 using national administrative data. We created a linked cohort of all mothers aged 13-19 using data from health, educational and children's social care and defined mothers enrolled in the Family Nurse Partnership or not using Family Nurse Partnership system data. Propensity scores were used to create matched groups for analysis. One hundred and thirty-six local authorities in England with active Family Nurse Partnership sites between 2010 and 2017. Mothers aged 13-19 at last menstrual period with live births between April 2010 and March 2019, living in a Family Nurse Partnership catchment area and their firstborn child(ren). The Family Nurse Partnership includes up to 64 home visits by a family nurse from early pregnancy until the child's second birthday and is combined with usual health and social care. Controls received usual health and social care. Indicators of child maltreatment (hospital admissions for injury/maltreatment, referral to social care services); child health and development (hospital utilisation and education) outcomes and maternal hospital utilisation and educational outcomes up to 7 years following birth. Family Nurse Partnership Information System, Hospital Episode Statistics, National Pupil Database. Of 110,520 eligible mothers, 25,680 (23.2%) were enrolled in the Family Nurse Partnership. Enrolment rates varied across 122 sites (range: 11-68%). Areas with more eligible mothers had lower enrolment rates. Enrolment was higher among mothers aged 13-15 (52%), than 18-19 year-olds (21%). Indicators of child maltreatment: we found no evidence of an association between the Family Nurse Partnership and indicators of child maltreatment, except for an increased rate of unplanned admissions for maltreatment/injury-related diagnoses up to age 2 for children born to Family Nurse Partnership mothers (6.6% vs. 5.7%, relative risk 1.15; 95% confidence interval 1.07 to 1.24). Child health and developmental outcomes: there was weak evidence that children born to Family Nurse Partnership mothers were more likely to achieve a Good Level of Development at age 5 (57.5% vs. 55.4%, relative risk 1.05; 95% confidence interval 1.00 to 1.09). Maternal outcomes: There was some evidence that Family Nurse Partnership mothers were less likely to have a subsequent delivery within 18 months of the index birth (8.4% vs. 9.3%, relative risk 0.92; 95% confidence interval 0.88 to 0.97). Younger and more vulnerable mothers received higher numbers of visits and were more likely to achieve fidelity targets. Meeting the fidelity targets was associated with some outcomes. Bias by indication and variation in the intervention and usual care over time and between areas may have limited our ability to detect effects. Multiple testing may have led to spurious, significant results. This study supports findings from evaluations of the Family Nurse Partnership showing no evidence of benefit for maltreatment outcomes measured in administrative data. Amongst all the outcomes measured, we found weak evidence that the Family Nurse Partnership was associated with improvements in child development at school entry, a reduction in rapid repeat pregnancies and evidence of increased healthcare-seeking in the mother and child. Future evaluations should capture better measures of Family Nurse Partnership interventions and usual care, more information on maternal risk factors and additional outcomes relating to maternal well-being. The study is registered as NIHR CRN Portfolio (42900). This award was funded by the National Institute of Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: 17/99/19) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 11. See the NIHR Funding and Awards website for further award information.

Undermining the Translational Potential of Clinical Research With Adolescents and Young Adults: Differential Enrollment in Randomized Clinical Trials During COVID-19.

COVID-19 stay-at-home orders and research restrictions halted recruitment and follow-up of clinical research patients. Although clinical research has resumed, it is an open question whether research participation has returned to levels similar to those before COVID-19. We used data from the TECH-PN (NCT No. NCT03828994) study, a single-center randomized controlled trial enrolling 13- to 25-year-olds with mild-moderate pelvic inflammatory disease (PID) receiving ambulatory care. We examined enrollment patterns before COVID-19 and during/after COVID-19 among those assessed for eligibility by estimating the average rate of recruitment visits for each period. We focused on this monthly rate by pandemic status, the length of stay (LOS) by pandemic status, as well as the relationship between the LOS and patient demographics. Descriptive analyses were conducted, including Student t test to compare rates between time periods and a χ2 test to compare the proportion refusing enrollment. The monthly enrollment rate during/after the pandemic was significantly lower than before COVID-19 (4.8 per month compared with 7.4 per month, P < 0.001). However, eligible participants' age, race, and insurance type were similar before and during/after the pandemic. Among eligible patients, LOS for receiving PID care was slightly increased, from a median of 5.4 to 6.4 hours ( P = 0.650), and the rate of refusal to participate among those eligible was similar (23% vs. 27%, P = 0.362). There were a similar number of ineligible patients because of inpatient admissions during both periods. COVID-19 pandemic restrictions negatively impacted recruitment into this randomized controlled trial. Enrollment differences may reflect ongoing perceptions of restrictions in care access or a hesitancy to use health services. More research is needed to stabilize access to ambulatory sexually transmitted infection/PID care and access to clinical trials.

Research protocol and recruitment redesign of a study of pregnant women and their infants during the COVID-19 pandemic: Childhood Allergy and the NeOnatal Environment (CANOE)

BackgroundRecruitment for research studies is a challenging endeavor that was further complicated by the COVID-19 pandemic. We launched a new NIH-supported multi-center birth cohort, “Childhood Allergy and the NeOnatal Environment” (CANOE) in January 2020 across four sites. While the pandemic temporarily halted clinical research, we restructured the study and instituted novel recruitment methods that we hypothesized would enable brisk enrollment when research activities resumed. ObjectiveDevelop protocol modifications and recruitment methods that promote successful recruitment of diverse populations in clinical research despite a global pandemic. MethodsWhile study activities were suspended, we modified recruitment strategies to limit in-person contact, shifting toward alternative HIPAA-compliant methods like clinician referrals, institutional social media, and telemedicine screening and consent procedures. Protocol changes included reducing the frequency of in-person visits, leveraging clinical care visits to collect biospecimens, expanded self-collection of samples at home, and making study materials available online. ResultsRemote methods, including targeted social media posts, mailed letters, and email, combined with in-clinic recruitment with modifications for social distancing led to successful recruitment at all sites. Rates of consent have been similar across recruitment sites, with the highest rates of enrollment of mother-infant dyads realized by sites that implemented multiple recruitment strategies. ConclusionsStudy procedures that prioritize health and safety measures such as social distancing, study participant convenience, and diverse recruitment strategies enable successful enrollment of pregnant women and their newborns into clinical research while adhering to public health restrictions during a global pandemic.

Legislature size and welfare: Evidence from Brazil

AbstractHow does legislature size impact public service provision? Despite the importance of institutional design for democratic governance, the effect of legislative features on citizen welfare remains little understood. In this article, we use a formal model to show that increasing legislature size improves public goods delivery. We argue that changes in bargaining costs depend on whether additional legislators share the executive's party affiliation: More opposition members reduce the equilibrium public goods provision, while more government‐aligned members increase it. We test this theory by exploiting sharp discontinuities in city‐council size in Brazil. We show that an additional city councilor has a 91% chance of belonging to the mayoral coalition, and this significantly improves primary school enrollment and infant mortality rates. To explore possible mechanisms, we surveyed 174 former city councilors and analyzed 346,553 bills proposed between 2005 and 2008. This article has implications for the design of representative institutions.

ESTABLISH THE RELATIONSHIP BETWEEN ECONOMIC GROWTH AND TELECOM GROWTH

Although India's cities and metro areas are densely populated, they only account for 30% of the nation's total population. Data from 2012 indicates that India's overall tele-density reached 76.66%. Urban areas boasted a tele-density of 167.46%, while rural regions lagged behind at 32.52%. Trends in both developed and emerging countries reveal that younger generations are more frequent internet users compared to older ones. In emerging economies, 30% of individuals under 25 use the internet, compared to 23% of those aged 25 and above. There also lies a significant opportunity for developing nations to connect schools and increase enrollment rates, considering that 70% of the under-25 population amounting to 1.9 billion people have yet to transition to internet usage. Evaluations concerning whether mergers lower prices, influence competition, improve opportunities in rural areas, as well as long-term versus immediate development, have been examined. The results indicated that service providers shared similar perceptions about the telecom sector's impact on rural areas.

Kemiskinan Pedesaan dan Angka Partisipasi Sekolah di Indonesia

This study analyzes the influence of rural poverty on school enrollment rates in Indonesia. Using time series data for the period 1998-2021, the analysis model used is simple linear regression. The study revealed that school enrollment rates and rural poverty levels in Indonesia fluctuate throughout the year. The estimation results indicate that rural poverty has a negative effect on school enrollment rates at both elementary school, middle school and high school levels. Therefore, efforts to increase school participation in Indonesia must be in line with efforts to reduce rural poverty levels.