The analytical frame revealed different emphases of information categories among the three program note writer groups, with a more sophisticated combination of categories used by the professional writers and composers. This has implications for the teaching of program note writing in tertiary performance institutions, encouraging diversity of student content without extinguishing personal insights.At classical music concerts, a program note is the usual medium for communicating information about the music to be heard and performed. Although there may be crossover of information, the program note is distinct from the CD cover note, from notes contained within a musical score note, and from a composer’s directions for performers. With a focus on contemporary classical works in the Australian context, the researchers’ aim in this study was to develop and test an analytical frame of informational categories with which to examine program note content. Three extant studies – one scientific, one phenomenological and one semiotic – informed the development of an initial theoretical framework for program note analysis. This was tested through the analysis of program notes ( At classical music concerts, a program note is the usual medium for communicating information about the music to be heard and performed. Despite this, there is almost no research on the role and impact of program notes; neither is there research on program note content or structure. With a focus on contemporary classical works in the Australian context, the study reported in this article aimed firstly to develop an analytical frame with informational categories with which to examine program note content; and secondly to trial the preliminary frame by analysing program note content written by students, composers and professional writers in relation to the informational categories, grammatical person, word count and program intent.Despite research that emphasizes the importance of the engaging with music audiences, there exists limited scholarly writing about the program note. And yet audience engagement and commitment is a long-held concern for live music scholars and practitioners . One of The first of only three studies to analyze the impact of program notes on listeners was conducted by Following on from Margulis’ work, In the third of three extant studies on the music program note, The first theme relates to the intended purpose of a program note, which can be to guide or to direct the listener. As such, program notes typically provide the titles and composers’ details for works within the concert program alongside information on poetics or aesthetic suggestions of the piece, the personal experience of the composer, and links with other music works or art works of other arts disciplines that informed the piece. A program note can also include performer notes which might be of interest to listeners: for example, an alternative tuning or tonguing technique.Blom, Bennett and Stevenson observe that a program note could be considered a vital inclusion for performances of abstract music, however, in line with Margulis’ observation they note that a program note for abstract music might mislead audiences by imposing an external framework. In general, an argument might be made that musical works shouldn’t require a program note to be effective and that reductive listening allows a focus on the sound itself, removed from anecdotal, referential preconceptions of the piece to allow listening which is free from prejudice. A program note might also present a work as overly complex or intellectual.The second theme is that the program note can seek to create “ideal listeners” by preventing modalities not in accord with the composer’s intentions. The program note can also guide listeners whilst not limiting interpretation or the listening experience; by retaining some ambiguity, it can inform and contextualize but not essentialize what the listener hears in the music. A program note can therefore provide a subtle track, leaving some mystery in the air and suggesting rather than imposing a framework for listener engagement.The third theme identified by Blom, Bennett and Stevenson is that a program note can help to shape the performer’s interpretation of a work. This might take the form of programmatic notes or descriptions of the sounds and timbres the composer would like to evoke.Fourth, a program note can inspire the listener to become absorbed in listening to the music, thereby adding a dimension which enables the listener to become more engaged or involved in the music. This can be a way to access the work, promote understanding, and reveal what the piece is trying to explore and achieve.The fifth and final theme is that the program note can be a collaborative tool between composer, performer and listener by sharing larger artistic concerns, giving additional insights and helping both performers and listeners navigate the piece. This generates dialogue between performer, listener and composer, communicates the composer’s intention through the performer to the listener, and encourages the listener to empathize with the composer’s intentions. Several roles for a program note emerge from the literature: restraining the listener, guiding the listener, scaffolding familiarity versus novelty in the repertoire, helping shape the performer’s interpretation, inspiring musical absorption, and acting as a collaborative tool.For Professional program note writer Leonard Scaife’s “well-balanced commentary” can contain three types of content information. The first of these is contextual information, which can inform listeners about of the personal experience of the composer or about other musical works or works of art that informed the piece . The comThe second type of information relates to descriptive and expressive aspects of the music. This information might relate to the poetics and aesthetics of the piece  or to thThe third type of information in a program note relates to technical details such as compositional structure and devices. However, most of the advice to program note writers warns against using “technical analysis that will make no sense to the majority of the audience” , p. 106 At the heart of a program note is analysis of the music. For composer and theorist … analyses of music are more likely to be valuable as consciousness-raising exercises – or as the tools for such exercises – than as renderings of the content of musical experiences. What they might help to raise consciousness about is what goes into a hearing, what there might be to listen for, that no one had thought to listen for (perhaps even while listening for it).Dubiel’s account is a fair description of the role of the program note as a consciousness-raising exercise for the listening audience.amount of interpretive guidance they preferred.Harries’ study into “attitudes toward program notes, and their influences on responses to music”  asked two participant groups, musicians and music novices, to rank the most and least interesting aspects using a list of five program note features. The musicians ranked historical background of music highest, followed by narrative details of music, composers’ backgrounds, compositional/structural analysis, and performers’ biographies. For the novices, narrative details of music was ranked first, then historical background of music, composers’ backgrounds, performers’ biographies and compositional/structural analysis. All participants believed that program notes “played a role in facilitating musical experience … [assisted] with directing attention and focus, provided insight into appropriate listener responses, or helped assess the quality or accuracy of a performance” . All participants also wished to be provided with a program when attending concerts; however, they expressed a range of views on the Harries’ study suggests that musicians are likely to prefer to form their own interpretative responses to music, whereas novice listeners welcome interpretative guidance; this finding mirrors that of Arguing the need for a “retooling” of technical descriptions of music within music analysis, … they (1) conceal the conceptual and ideological underpinnings of their accounts of what music does, (2) take an exclusionary approach to musical explanation, eliminating the historical and critical context that surrounds understanding, and (3) ignore the expressive, or “signifying,” features of musical meaning.Here, Lochhead is emphasizing the value of contextual information in providing access to a deeper appreciation of the music by a broad range of listeners. She also encourages a clearer engagement with the meanings linked to musical content which has been obscured by a focus on the techniques of composition. Lochhead (p. 6) recognizes the “current interest in music as experienced by listeners, listening-oriented criticism and explanation” as part of a broadening of music analysis, and she argues that “this ‘variant understanding of a world of music’ requires a retooling of the technique in order to reveal ‘precisely’ and ‘productively’ this dimension of the musical phenomenon.” She also reminds us (p. 5) hat… a technique-based account of music will likely not have a revelatory function for such listeners [to whom] … technical accounts of music at either a low- or high-level of explanation may seem like a “foreign language” … because they have no practical engagement with the technique.This is precisely the same view communicated by several writes about program note content, including that of professional program note writer Leonard War Jubilee Overture by Lindpaintner, writing: “tho’ not possessing any great depth as a musical composition, it is remarkable for the vigor and power of the instrumentation” (archives.nyphil.org). Such personal value comments can be categorized as descriptive comments.Our review of scholarly and gray literature revealed one further type of information, found in an program note written for the Sonata in E flat minor (1905) by Janáček, includes three types of information. There is historical contextual information in the first paragraph. The rest of the note comprises largely technical analysis with expressive descriptive adjectives and references to the poem Janacek wrote about a tragic event which formed the impetus for the sonata. Scaife’s program note example says (p. 13): “The second subject provides reflective calm in an otherwise tempestuous movement. It is likely that the composer was recalling the crowd scenes and events of the poem while writing this highly-charged music, which contains much anger and frustration.”Of the two examples of “good” program notes given by In summary, program notes are texts. As such, they can be viewed as “the product of interpretation and claim in social life and should be seen both as motivated , and as accounts ” , p. 5. SThe study was conducted in two phases. We began in phase 1 with a review of scholarly and gray literature. This led to the theoretical framework shown at For consistency, the program notes were focused on the Australian context: that is, program notes written about Australian contemporary classical works by professional program note writers, Australian composers, and higher education students. The programs written by professional writers and Australian composers were selected from programs of concerts given over the previous 10 years; each program featured a different musical work. The student program notes were drawn from students at a single higher education institution and were written over the previous 20 years period. The longer time frame was required as students are not required to perform Australian repertoire; hence, there were fewer examples.Drawing on aspects of Generally, analysis categories aligned to text of between one and ten sentences. In nearly all cases, codes were applied at sentence boundaries. Where compound-categories were identified, single categories were replaced with compound codes. Following initial coding of the 30 program notes, the three sets of analysis were tabulated and compared. Where differences were observed, detailed discussion led to consensus. During this final stage, minor adjustments were also made to the application of codes until all three researchers were satisfied that the existing code definitions had been applied consistently.Subsequent to coding the program notes, the following information was noted: the percentage coverage of each category of content information; grammatical person (whether first or third person writing was used); total word count for each program note; and categories or styles outside the expected. These were defined as cases “likely to upset your thinking” , p. 87, Coding was applied using the text formatting and word count features of Microsoft Word. Word count percentages, averages and standard deviations (STDEVP) were calculated using Microsoft Excel.To protect their anonymity, students program writers are identified as Student A to Student J and student composers are given pseudonyms. The notes written by professional writers and composers are in the public domain and these writers are identified in each case. For all writers, we include the year in which each note was written.From the literature review, three studies in particular – one scientific, one phenomenological and one semiotic – laid the foundation of a theoretical framework of informational categories with which to analyze program note content. This combination of studies suits analysis of a document containing musical and personal information – the program note. In her study of the effect of two different types of music description (or no description) on 16 people without formal musical training when listening to excerpts from Beethoven String Quartets, Počme Électronique five times. Ferrara concluded that the first stage of listening is a syntactical orientation in which people listen openly to “everything.” Listeners then begin to separate sounds for their individual and phonemic qualities before considering the meanings behind, or relationships between the sounds: the semantic meaning of the music. Next, listeners consider ontological meanings: the work in its entirety. This might include, for example, the historical life-world of the composer and the circumstances in which the work was written.In terms of five repeated hearings, Ferrara summarizes the process as follows:Mirroring We Never Come Here, Munro observes that “maniacal, irregular tapping puts teeth on edge. Slow pulsing summons a wall of sound. Each jump-cut is hard, unexpected, communicating uncertainty, agitation.” Here are three short sentences, each beginning with technical information and moving immediately to descriptive assertions. This can be thought of as category 4. Similarly, essentially expressive assertions are often supported by technical features. Rachel Campbell’s note for composer Michael Smetanin’s Swell (2008) links the work’s central structural concept with its title. This can be thought of as category 5.Although Margulis did not consider ontological or poietic language in her study, three basic categories are noted in the literature: technical ; descriptive (semantic); and contextual ; however, we contend that two further compound-categories emerge. In practice, categories 1 and 2 are often combined in program notes such that essentially technical descriptions lead to expressive assertions. For example, in Timothy Munro’s (2016b) note for composer Alexander Garsden’s The notion of a wavelike swelling motion … underlies … aspects of the work: certain wavelike gestures, and the way the clarinets expand out from a restricted, close set of pitches at the opening to a larger musical space as the first section progresses. Further expansion and support is then received from the gradual entries of the other instruments.In his book on semiological analysis, 1.The poietic dimension: aspects of the process of creation, deliberations (by the composer) on what must be done to produce the work, operations on materials, the production of the work;2.The neutral/trace dimension: an “objective” description of the properties of the work, its form/structure, etc.; and3.The esthesic dimension: assigning or constructing meaning from the work in the course of active perception.We also suggest that for simplicity of analysis, the contextual  and poietic categories, though different in emphasis, might be combined to refer to the imaginative, biographical, historical, contextual, practical and productive aspects of the composer’s work. The “personal value” comments of the anonymous program note writer of 1844 align with category 2 (descriptive). The thinking of Ferrara, Nattiez, Margulis, and other commentators discussed earlier in the paper, lead us the refined theoretical framework presented at contextual information: information which details influences from an historical context, the arts, aspects of the production or creation process, and/or relations to the life-world of the composer.As the standard deviation of population figures at contextual information (37%) with technical the second most used content style (27%). Technical-descriptive information was used for 18% of the total word count across all program notes; however, information leading with expressive content  was used least, at 11% and 8% respectively).Professional writers’ program notes favored Contextual information provided by professional writers for contemporary Australian works included references to the commissioning process often for specific performers or ensembles, or the venue in which the program was presented. For example, Timothy Munro’s description of Natasha Anderson’s Nowhere and Forever (2016a) introduced the café featured in a television drama which inspired the work, and then linked this to the venue in which sounds for the work were collected. Munro wrote:… like the cafe, Carriageworks [a Sydney performance venue with a rich railway yard history] itself is caught between past and present, a building haunted by memories, yet transformed for a new generation, an anachronism.oeuvre: for example, Michael Hooper, writing about David Lumsdaine’s A Tree Telling of Orpheus (1990), noted thatFor older works, links were made to the composer’s Hagoromo begins with the growth from a single pitch to changing harmony, a very similar gesture to that which begins A Tree Telling of Orpheus.many of Lumsdaine’s works begin simply. The orchestra piece technical content described specific musical features: for example,The professional writers’ use of The melodic material is conceived as simple contours  rather than specific pitches. ;Aria for Edward John Eyre – an hour-long tour de force for soprano, ensemble and electronics – also begins with a single pitch, then a chord, and then a melody. ;The supporting ensemble is a mellow and flexible combination of three woodwinds  and string trio, with the addition of a guitar to suggest Orpheus’ lyre .contextual (36%) and descriptive (33%) information with technical information making up 15% and Technical-Descriptive representing 14%. In line with the professional writers, some of the composers’ program notes included contextual information about the ensemble itself, its aims, ethos, aesthetic, which begins the individual notes for pieces.Composers’ program notes favored Descriptive information was used by composers to describe their musical intent and outcomes. Some composers included contextual comments about intimate events related to the writing of the piece. Clare Maclean captures the context of her work for viola and piano in two sentences.“In the sea paths” is a phrase from the Anglo-Saxon poem, the Seafarer. The poem’s imagery of sea paths as paths of life resonates with symbolism of the sea as the soul or the subconscious in literature and mythology.descriptive content is exemplified by composer Mary Finsterer writing about her piece Biographica .None of the content represented “personal value” comments, although composers often talked of their experiences when writing about their own work. The category of The composition aims to catch moments in the journey and demise of an eccentric, wondrous soul from the beginnings of our modern age. It’s like a visit to a great portrait gallery, full of different paintings – but all depicting the same person.Contextual content was the most prevalent at 53%, with technical (17%) and descriptive (17%) used less often. Some student program notes included a “personal value” comment about their composition or their performing concerns; these comments were only seen within the student writing. For example, student performer Student A reflects concerns about the difficulty of the performance: “I will aim to play what [the composer] has heard and written to the fullest degree.” This type of content was not found in the composer and professional writers’ notes as it is likely to create a strong effect on the reader. However, the comments do reflect the afore-mentioned 1844 program note writer who gave an authoritative, candid, negative “personal value” comment about a composer’s work.Student program note writers used a narrower range of content types. technical-descriptive (13%) and not descriptive-technical content. The following example begins with technical detail that links to evocative descriptive content:Within the student writing, some use was made of two content styles within a single sentence group; this was always The piece uses Western instrumentation to mimic a more traditional Japanese ensemble sound, consisting of sporadic percussion in free time that symbolize the first flickers of ember in the flame. (Program note by student D)technical-descriptive material with some use of the descriptive-technical, depending on which type of information was privileged within the sentence. In the following example, terms such as “absurd beatboxer” and “ubiquitous symbol” pushed technical material into the descriptive-technical category:Professional writers and composers often used sentence groups with compound-categories, in particular Composed especially for the Co-Artistic Director, Hi Hat and Me reduces the drum kit – the ubiquitous symbol of pop music’s beat – to a mere hi hat. With such limited resources on which to stake their virtuoso coordination, the percussionist instead turns to vocalizing like an absurd beatboxer. descriptive-contextual material: for example,Some sentence groups extended our categories to consider Anderson’s works are unsettling sonic mystery-boxes. This Australian composer, musician and installation artist aims to create “idiosyncratic” sounds that explore intense experiences, the abject and the uncanny. contextual information concerns the composer. It is written by someone other than the composer and yet seeks to represent the composer’s intentions in relation to expressive responses to the sounds.Here, the technical information in their program note content, composers had the highest use of descriptive information, and student program notes had the highest percentage of contextual information.In summary, shown at Other aspects of program note content considered in the study were word count, use of first and third person and program note intent.Program note word count was higher for professional writers than for program notes written by composers and students see .contextual information about the genesis of the work. In contrast, student composers and performers were more inclined to write about their own experience of developing the work for performance and their influences. This first person presentation style helps to account for the higher proportion of contextual information in student program notes.Analysis of grammatical person revealed that third person was used in the majority of the writing by composer and professional writers and first person was used by the majority of student writers. In one case, the professional program note writer was also a member of the performing ensemble; in this case, the writer used first person to describe his relationship with the composer and his music, and third person to describe the music itself. In three cases, composers used first person to provide To examine intent, we drew on three of Blom et al.’s  five key themes of program note intent: “to guide or direct the listener or performer; to shape the performer’s interpretation; and as a tool for collaboration between the composer, performer, and listener.”contextual information provided historical context, sometimes linking the work to its presentation within the venue as in the Carriageworks example given earlier. Descriptive information encouraged interpretation and sought to guide or direct the listener.In professional writers’ program notes, contextual historical information, information about instruments, and descriptive information about influences on the work, were written with the intent of guiding and directing the listener, and drawing the listener into the music. Student program note writers gave contextual information on influences, descriptive information on personal challenges and technical information on compositional thinking, all with the intent of guiding and directing the listener. Both the composers and students designed the program note as a collaborative tool between the writer and the listener. Student performers sometimes made overt connections between the composer, the performer (themselves) and the listener: for example, “I haven’t had much experience with performing prepared piano at all, henceforth this piece being a challenge that I hope to interpret it supremely” (program note by Student A).In the composers’ program notes, descriptive writing about their aesthetic reasoning. For example, composer Mary Finsterer (2017) described her creative objectives thus: “In Biographica I’ve focused on capturing an essence of Renaissance music by filtering it through a contemporary lens”; and student H wrote, “This indeed is a challenge to perform and I would especially like to thank [the composer] for the hours he has spent helping me prepare for this performance.”No “personal value” comments regarding a writer’s like or dislike of a piece were encountered; however, both student and established composers used first person language in their technical-descriptive and descriptive-technical compound-categories were identified at descriptive-contextual category. This would have accounted for around 3% of the content of professional writers and 2% of the composer’s content. This type of writing, whereby two content styles are combined, might temper the potential for technical information alone to become dry and alienating (The new analytical frame provided a useful guide for the investigation of program note content. In terms of content coverage, the framework categories were generally shown to provide descriptive adequacy. Although ienating , and in Program note informational content included a range of categories, the role of which was to guide and direct listeners through information which is variously technical, descriptive and/or contextual. The program note is not a benign piece of writing; rather, it is a documentation or narrative of a musical work and the life from which it came .contextual information over the other content types.In this study, the three groups of program note writers adopted different content styles for their program notes and brought different perspectives to that writing. This perspective difference is perhaps of particular importance when the work is contemporary and the composer’s voice can be heard without being mediated through another writer. The distribution of content types within a single program note varied across the three cohorts of writers, but all three cohorts favored contextual and technical content than composers and student writers to guide and direct the listener. These content types are to be expected when the writer is not the composer or performer with inside knowledge of the work and is therefore writing for a concert audience with which there will be no direct engagement.Professional writers and composers were able to combine content styles in one or two sentences. Professional program note writers also included a higher proportion of Descriptive writing about a musical work received the highest use by composers. This aligns with descriptive style of information comes best from the composer. Although student program note writers used a narrower range of content styles in their program notes, they often offered a frank and personal view of their compositional or performance concerns. These personal views were refreshing to read, although the communication of specific worries and concerns could negatively impact the enjoyment of the listener.In the higher education performance environment, the program note can be an authentic assessment task for performance and composition students, enabling the development of professionally oriented writing skills and requiring deep thinking about repertoire, context, influences and compositional process. Some institutions offer advice on how to write these notes, yet the instructional texts largely fail to communicate that program notes are far from neutral documents and that their purpose and structure varies. The findings of this study offer an opportunity for students to learn how to shape program note content aimed to engage the audience in a variety of contexts, through a marriage of descriptive, technical and contextual information. This is a skill which can be taught, learned, and refined over time.Writing from the context of contemporary interest in the listener experience of music, Although the study did not examine different styles of program note format, such as a sidebar with key listening points , we noteProfessional program note writers wrote the longest program notes, although we note that length is usually determined by a publisher or, in the case of students, a teacher; there is also little time for reading program notes , so it iFinally, the findings suggest that writing a program note is always a collaborative relationship, a point raised by The datasets generated for this study are available on request to the first author.All authors made substantial contributions to the conception or design of the work and the acquisition, analysis, and interpretation of data for the work; drafted the work and revised it critically for important intellectual content; approved the final version to be published; and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


The 2019 Coronavirus disease (COVID-19) has been characterized as a pandemic, representing a serious global public health emergency. Serological tests have been proposed as reliable tools for detecting Coronavirus SARS-CoV-2 antibodies in infected patients, especially for surveillance or epidemiological purposes. The aim of this study is to evaluate the agreement between the IgM/IgG rapid assays, based on lateral flow immunochromatographic assay, and the fully automated 2019-nCoV IgM and IgG, based on chemiluminescence immunoassay.SARS-CoV-2 antibodies were measured with the BIOSYNEX COVID-19 BSS IgM/IgG test  and the MAGLUMI CLIA (IgM and IgG)  in 70 serum samples from patients with PCR-confirmed diagnosis. The strength of the agreement of the two methods was calculated by using the Cohen Kappa index.The results showed a good grade of concordance between the two immunoassays with a Cohen’s kappa coefficient of 0.71 (95%CI: 0.54-0.87) for IgG SARS-CoV-2 antibodies and 0.70 (95%CI: 0.53-0.87) for IgM SARS-CoV-2 antibodies. In addition, the rapid assays BIOSYNEX COVID-19 BSS for detecting SARS-CoV-2 antibodies showed a positive likelihood ratio (LR) of 10.63 (95%CI: 2.79-40.57) for IgG and a LR of 6.79 (95%CI: 2.93-15.69) for IgM.Our results suggest that the immunochromatographic rapid IgM/IgG test and the chemiluminescence IgM and IgG immunoassay have a good degree of concordance, suggesting that both could be considered as useful tools for epidemiologic surveillance. The 2019 Coronavirus (2019-nCoV or SARS-CoV-2) disease (COVID-19) has rapidly spread across China and to the other countries of the world  has stressed the need for research on To date, the diagnosis of COVID-19 must be confirmed by a molecular test using real-time reverse transcriptase-polymerase chain (RT-PCR) assay on the oropharyngeal or nasopharyngeal swabs for detecting 2019-nCoV genome  with the fully automated MAGLUMI 2019-nCoV IgM and IgG , which we have recently implemented in our laboratory. Given the increased demand for rapid serological tests, its comparison with serologically positive or negative results measured by CLIA may be helpful in evaluating the degree of agreement among available immunoassays.A total of 70 patients with PCR-confirmed COVID-19 diagnosis  years), from April to May 2020, were enrolled in this study. For each patient, the serum sample was obtained during the hospital stay, 7-10 days after nasopharyngeal and oropharyngeal swabs collection. The SARS-CoV-2 IgM and IgG measurement was performed at the Department of Laboratory Medicine, University Hospital “P. Giaccone”, Palermo, Italy. All samples were analysed anonymously. Demographical and clinical data were recorded at admission. All the clinical and biological assessments were carried out in accordance with the Declaration of Helsinki, and the study was approved by the local Ethics Committee. All participants gave written consent.The MAGLUMI 2019-nCoV IgG/IgM assay is a capture CLIA for the quantitative measurement of IgM and IgG antibodies against SARS-CoV-2 in human serum by using the fully automated MAGLUMI analyser . According to the manufacturer’s instructions, serum antibodies directed against both virus spike (CoV-S) and nucleocapsid (CoV-N) are detected by using magnetic microbeads coated with ABEI-labelled 2019-nCoV recombinant antigen. As declared by the manufacturer, a threshold of positivity of 1.00 AU/ml was established for both IgM and IgG, whilst the overall indicated reproducibility of assays ranges from 6.8% to 8.7%. Borderline data (≥ 0.95 to < 1.0) were considered reactive.The BIOSYNEX COVID-19 BSS assay  is a rapid, portable qualitative chromatographic assay. The test cassette consists of SARS-CoV-2 recombinant antigens  conjugated with colloidal gold; a nitrocellulose membrane strip containing an IgG line (G Line) coated with anti-human IgG, an IgM line (M Line) coated with anti-human IgM, and the control line (C Line) coated with goat-anti-rabbit IgG. It was performed on serum samples according to the manufacturer’s instructions. If a line was observed for IgM and/or IgG, the test was considered positive. If the control line did not appear, the test was invalidated and repeated. Weak signal for IgM and IgG, together or separate, was considered positive.Ten serum samples were randomly selected and tested six times in order to evaluate the assay repeatability. Two independent operators observed repeatability of 0.83. Both tests are CE (European Community) approved.https://www.medcalc.org; 2015). Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated. Results were considered significant for a P < 0.05. The Cohen Kappa index was calculated to determine the strength of the agreement of the two methods used. Results were interpreted according to the following kappa values: i) 0.01-0.20, slight agreement; ii) 0.21-0.40, fair agreement; iii) 0.41-0.60, moderate agreement; iv) 0.61-0.80, substantial agreement; and v) 0.81-1.00, perfect agreement  for IgG and 0.71 (95%CI: 0.54-0.87) for IgM.The comparison between MAGLUMI 2019-nCoV positive/negative et al. and Padoan et al. . Thus, it might be considered as an efficient additional tool for characterizing subjects who have had a prior infection and thus developed SARS-CoV-2 antibodies.


This study was designed to evaluate the effectiveness of mentorship program in improving the academic performance of 1st MBBS students. Mentoring is a natural process, which blossoms from the desire of experienced veterans to give and the thirst of inexperienced novices to grow.Formal faculty mentoring could help the 1 148 first MBBS students of Al Azhar medical college, who were admitted for 2017-18 academic year, were included for this interventional study. Mentorship program was started in our college since January 2018 after first internal exam, wherein the students were equally divided among 6 mentors. At the end of 6 months, to assess the effectiveness of mentorship program, a post-exam was conducted and the marks were compared with the pre-program performance. Paired t test was used to compare the marks before and after the program. Furthermore, the perception of mentees on mentorship program was also assessed by a valid questionnaire (score of 1-4).  The mean score of students in the exam conducted after mentorship program was significantly higher (p<0.001) than that conducted before commencing mentorship program. This increment in performance is appreciated more in girls rather than the boys. Furthermore, the mentorship program significantly (p<0.001) helped to boost the academic performance in below average students who had scored < 50% marks in pre-program assessment. The effectiveness of the mentorship program was further supported by the students’ feedback. 40.5% of the students agreed and 56.8% of them strongly agreed that mentorship program was effective and beneficial to them. The mentorship program obviously improves the academic performance of students, especially below average performers who need extra care and guidance. Mentorship program is a process whereby an experienced, highly regarded, empathetic person (the mentor) guides another  individual (the mentee) in the development and re-examination of their own ideas, learning, and personal and professional development  . It bloFirst year MBBS students are exposed to lot of obstacles, which may prevent them from excelling in academics. They have to face a new environment and new challenges in medical course, which force them to seek for an extra care and guidance, so that they can cope up with the difficulties faced in a new environment. Formal faculty mentoring could help the students to thrive on the complicated situations they face in the initial stages and excel in their career.Though mentorship programs were developed in the USA in the 1970s, formal mentoring programs for medical students and doctors, however, were not developed until the late 1990s  . There Apart from students, the teachers, institute & society are also benefitted from this program  . It proThis single group experimental study was conducted in the Department of Medical Education, Al - Azhar Medical College, Kerala. Excluding two students who were absent for first or last internal exam, we enrolled the remaining 148 first year students admitted in the academic year 2017-2018 for this study. The mentorship program started in the college in January, 2018 after the first mid-semester exam. The students were divided among 6 faculty members who were sensitised to the guidelines and procedure of mentorship program before commencement of the program. The students were divided according to their roll numbers and they were also sensitised regarding their role as mentees. During the mentorship program, each student was spending a minimum of half an hour per week with the assigned mentor. At the end of 6 months, after obtaining approval from IRB, the exam was conducted and the marks were compared with pre-program performance. Furthermore, the perception of mentees on mentorship program was also assessed by a questionnaire in a scale of 1-5. After obtaining data, the mean marks of the students before and after the program were compared using paired t test. Chi-square test was used to find association between two variables. A p value≤0.05 was considered as statistically significant. SPSS 20.0 software was used for all statistical analyses.The students scored significantly (p< 0.001) higher marks in the exam conducted after the mentorship program comparedto those before commencing the program. This increment in performance is appreciated more in the girls rather thanin the boys. Furthermore, the mentorship program significantly (p<0.001) helped to boost the academic performancein below average students who had scored < 50% marks in pre-programme assessment.The effeMentoring is defined as an insightful process in which the mentor's wisdom is acquired and modified as needed by the mentee, as well as a process that is supportive and often protective  . MentorWith similar objectives, mentorship program was introduced in our institute for the first MBBS students. The faculty members were sensitised to the guidelines and procedures of mentorship program and they were elaborated on their role and importance of delivering effective feedback before commencement of the program. Likewise, the mentees were also made aware of their role and what is expected of them. Protected time was dedicated to mentoring activities to encourage interaction and engagement between the mentors and the mentees. Among 150 students, two students who were absent for internal exams, were excluded from this study. For the remaining 148 students, mentorship program proved to maximise their academic performance and its effectiveness was more evident among the below average students. In concordance with our present study, various research works provided evidence to showcase the effectiveness of mentorship program. According to Levinson W, et al. mentorship program enhances the productivity, career advancement and career satisfaction  . ApplegApart from these benefits, V Devi, et al. in their work, found that mentorship program had the ability to inculcate research skills in students and encourage the development of positive attitude and knowledge about scientific research  . In ourMore than academic performance, it is emotional quotient, which is directly influenced by mentorship program. The influence of mentorship program on emotional stability of students might be taken into considerations.The mentorship program obviously improved the academic performance of students especially in below average performers, who needed extra care and support. The benefits of mentorship program are not only limited to academic performance but also to emotional and personal aspects including career development, improved relationships with faculty, greater interest in research, aspirations toward academic careers, improved self-esteem and reduced stress. In future, the study can be extrapolated to assess the other benefits, too.


Primary V1 trigeminal neuralgia is a common refractory neuralgia in clinical practice, lacking effective treatments. Radiofrequency therapy has certain treatment efficacy, but its long-term efficacy remained poor and the disease might relapse.  To compare the effects of different types of supraorbital foramen variations on the treatment efficacy of radiofrequency therapy for V1 trigeminal neuralgia.  Data of 54 patients with V1 trigeminal neuralgia who underwent treatment in the First Hospital of Jiaxing, Zhejiang, were retrospectively analyzed. All these patients received CT-guided radiofrequency thermocoagulation of supraorbital nerve. According to the CT images, the supraorbital foramen of the patients was categorized as holes (hole group) or notches (notch group). The patient characteristics, including Numerical Rating Scale (NRS) score and effective treatment rates before and 1 d, 0.5 y, 1 y, and 2 y after operation, and numbness degree at day 1 and 2 y after the operation were compared. The short- and long-term complications during postoperative follow-up period were also recorded. P < 0.05). The numbness and numbness degree after operation showed no significant differences between the two groups. The numbness degree at 2 y after operation was significantly lower than 1 d after operation (P < 0.05). The numbness and numbness degree after operation showed no significant differences between the two groups. The numbness degree at 2 y after operation was significantly lower than 1 d after operation (P < 0.05). The numbness and numbness degree after operation showed no significant differences between the two groups. The numbness degree at 2 y after operation was significantly lower than 1 d after operation ( Among the 54 patients, 25 patients were grouped into the hole group and 29 into the notch group. The NRS scores before and at 1 d, 0.5 y, 1 y, and 2 y after operation showed no significant differences between the two groups. However, the NRS scores at the remaining time points after operation were significantly decreased when compared with scores before operation ( The short- and long-term effective rates of radiofrequency therapy during V1 trigeminal neuralgia treatment are relatively high in patients with different types of supraorbital foramen variations. However, the effective rate is even higher in patients with hole-type supraorbital foramen. No other severe complications, except numbness, were found, and the acceptability rate remained high in patients. The primary trigeminal neuralgia is mainly manifested as paroxysmal shock-like intense pain, restricting the areas innervated by the trigeminal nerve . The paiRadiofrequency treatment for trigeminal neuralgia has shown definitive treatment efficacies . HoweverAlthough the peripheral supraorbital nerve resection is done at high-temperature radiofrequency, relapse still occurred in some patients. To increase the duration of trans-supraorbital foramen radiofrequency therapy on primary trigeminal neuralgia and reduce the relapse rate effectively, this study retrospectively analyzed the data of 54 patients with primary V1 trigeminal neuralgia who underwent treatment between November 2011 and June 2017 to provide evidence. After the analysis of long-term follow-up data, as well as the imaging findings during the operation, the findings revealed that different shapes of supraorbital foramina could affect the destruction of the nerves by radiofrequency therapy, as well as the velocity of nerve regeneration after operation. This study aimed to compare the influences of different supraorbital foramen variations on the treatment efficacies of radiofrequency therapy in patients with primary V1 trigeminal neuralgia.Fifty-four patients with primary V1 trigeminal neuralgia who received CT-guided radiofrequency thermocoagulation through the supraorbital foramen in the First Hospital of Jiaxing, Zhejiang, between November 2011 and June 2017 were included. All patients included in this study met the diagnostic criteria of primary trigeminal neuralgia as described in the International Classification of Headache Disorders (3rd edition) . The incThe patients were placed in the supine position on the table for undergoing CT treatment, with the head fixed by the tape. The site and route of puncture were designed by CT software to measure the depth of punctuation. The puncture site was then marked on the body surface. After local anesthesia was induced by 1% lidocaine, a 22 G radiofrequency puncture needle with a bare segment length of 2 mm was used for puncturing at the predefined site and predefined depth. The needle was then adjusted according to the CT scanning results until the needle point reaches the supraorbital foramen . After tThe characteristics of the patients, including age, gender, disease course, times of CT scanning, NRS  score, and effective rate (NRS ≤1 was considered effective) before and on day 1, at 0.5 y, 1 y, and 2 y after operation, as well as the numbness degree  on day 1 and at 2 y after the operation, and the shapes of the supraorbital foramen were obtained through the hospital information systems (HIS) medical record system or telephone call. The short- and long-term complications after the operation were also recorded by telephone follow-up.t-test was used for comparisons between groups, while the paired t-test was used for comparisons between different batches. Qualitative data were described with frequencies and percentages (%) and compared with chi-square (χ2) test. P < 0.05 was considered to be statistically significant.SPSS 24.0 software was used for statistical analysis. The quantitative data that are normally distributed were described as means ± standard divisions . However, comparison of NRS scores before operation and at the remaining time points showed a significant decrease in both groups . However, the numbness degree at 2 y after the operation was significantly lower than at day 1 after the operation in both groups . However, the effective rate was significantly lower in the notch group than the hole group at 2 y after operation (P < 0.05, When compared with the hole group, the effective rates at day 1, 0.5 y, and 1 y after the operation showed no significant differences (Different degrees of swallowing at the puncture site were found in both groups after the operation, which disappeared spontaneously at 1–3 d without specific treatments. No other short- or long-term complications were found.In 54 patients with primary V1 trigeminal neuralgia, the supraorbital foramen showed great variations. The supraorbital foramina were mainly categorized into two types, namely, the hole type and the notch type. When compared with patients with the hole-type supraorbital foramen, the numbness degree was generally comparable in the notch group shortly after operation after the same treatments were conducted; however, the recovery of numbness was faster during long-term treatment, and the relapse rate was higher in the notch group. The differences in the effects of this specific anatomic structure on treatment efficacy could be due to several other reasons. For instance, the supraorbital nerve travels through the supraorbital foramen, while the route of travelling was generally unchanged. For patients with hole-type supraorbital foramen, the supraorbital nerve travels through the supraorbital foramen, and thus puncturing at this site for radiofrequency therapy could completely destruct the nerve. While for the patients with notch type supraorbital foramen, the supraorbital nerve may not travel through the supraorbital foramen. But travelling of supraorbital nerve might show some inner or outer deviation. Therefore, such anatomic variations could lead to deviations between the target puncturing site for radiofrequency therapy and actual site of the nerve, consequently leading to a relatively higher relapse rate, and in turn, affecting clinical efficacy . The holRadiofrequency therapy has been widely applied in clinical practice for the treatment of trigeminal neuralgia . AlthougCompared with Gasserian ganglion, the target for radiofrequency therapy for primary V1 trigeminal neuralgia through supraorbital foramen is closer to the surrounding tissues. Thus, the effect on the branches of some small nerves could be insufficient, and so a part of neuralgia might be missed. The Gasserian ganglion could not be completely destroyed by high-temperature radiofrequency, which might be due to severe complications induced by adjacent nerve damage. More studies are needed to identify new targets and parameters of radiofrequency therapy that are close to the central but cannot easily damage the normal nerves.In summary, the short- and long-term effective rates of radiofrequency therapy for treating V1 trigeminal neuralgia are relatively high in patients with different types of supraorbital foramen variations; however, the effective rate is even higher in patients with hole-type supraorbital foramen. No other severe complications, except numbness, were found, and the acceptability remained high in these patients. The sample size with primary V1 trigeminal neuralgia included in this study was relatively small, as this is a single-center study. Our future study should increase the sample size to explore the efficacy of different operation methods in patients with different types of anatomic variations of supraorbital foramen, thus helping to improve the treatment efficacy. We speculated that the use of transverse puncture to increase the destruction area by radiofrequency thermocoagulation might result in better treatment efficacy in patients with notch-type supraorbital foramen than conventional vertical puncture.


Empirical evidence suggests that the uptake of maternal and child health (MCH) services is still low in poor rural areas of China. There is concern that this low uptake may detrimentally affect child health outcomes. Previous studies have not yet identified the exact nature of the impact that a conditional cash transfer (CCT) has on the uptake of MCH services and, ultimately, on child health outcomes. The objective of this study is to examine the relationship between CCT, uptake of MCH services, and health outcomes among children in poor rural areas of western China.We designated two different sets of villages and households that were used as comparisons against which outcomes of the treated households could be assessed. In 2014, we conducted a large-scale survey of 1522 households in 75 villages (including 25 treatment and 50 comparison) from nine nationally designated poverty counties in two provinces of China. In each village, 21 households were selected based on their eligibility status for the CCT program. Difference-in-difference analyses were used to assess the impact of CCT on outcomes in terms of both intention-to-treat (ITT) and average-treatment-effects-on-the-treated (ATT).Overall, the uptake of MCH services in the sample households were low, especially in terms of postpartum care visits, early breastfeeding, exclusive breastfeeding, and physical examination of the baby. The uptake of the seven types of MCH services in the CCT treatment villages were significantly higher than that in the comparison villages. The results from both the ITT and ATT analyses showed that the CCT program had a positive, although small, impact on the uptake of MCH services and the knowledge of mothers of MCH health issues. Nonetheless, the CCT program had no noticeable effect on child health outcomes.The CCT program generated modest improvements in the uptake of MCH services and mothers’ knowledge of MCH services in poor rural areas of Western China. These improvements, however, did not translate into substantial improvements in child health outcomes for two potential reasons: poor CCT implementation and the low quality of rural health facilities. Improving maternal and child health (MCH) is one of the targets of the United Nation’s Sustainable Development Goals . The ChiAlthough one reason for the low uptake of MCH services in these areas may be supply-side challenges, such as poor health service quality and the attitudes of doctors , 11, a lConditional cash transfer (CCT) programs are an increasingly popular method of improving participation in education and health services in high-, middle-, and low-income countries –18. In tPrevious research conducted within China suggests that CCT programs may be effective in improving MCH uptake in rural areas in China. As stated above, CCT provides cash payments as a way to incentivize certain socially responsible behaviors. From our previous studies, it seems that this cash incentive should be highly effective; when “women’s representatives,” officials charged with managing MCH in villages, were asked about the biggest obstacle to the increased uptake of MCH services by rural women in our sample areas, the most common answer was that costs were too high. In addition, all surveyed village women’s representatives believed that paying women to uptake MCH services—most likely through a CCT program—would be an effective way to increase uptake . A CCT pCCTs (conducted by researchers) have been previously used to reduce dropout rates among poor junior high school students in China, and this CCT program was found to significantly reduce dropout by 60% in these areas . In the With the goal of improving the uptake of MCH services in poor rural areas, China’s government, with support from the United Nations International Children’s Emergency Fund (UNICEF), launched a CCT pilot program in 2013 in which pregnant women and mothers with infants were incentivized with cash payments to utilize government-provided MCH services. To the best of our knowledge, this program is the first CCT initiative in the health field in China, and, thus, there has not yet been a rigorous impact evaluation of the effectiveness of a CCT program in China’s health field. Our overall goal is to measure the effects of China’s first CCT program on three sets of outcomes: MCH service utilization, mother’s knowledge of MCH issues, and child health outcomes among the poor western rural population in China.The MCH CCT project office, supported by the government of China, launched the MCH CCT pilot program in late spring 2013 in 40 townships (CCT townships) in three provinces: 11 in Gansu, 17 in Sichuan, and 14 in Yunnan. All villages within each CCT township were offered CCT services. It is important to note, however, that not all townships in these three provinces were CCT townships. The purpose of the CCT program was to encourage eligible pregnant women and mothers to use MCH services. This was expected to lead to better knowledge of MCH and better child health outcomes. All households from targeted towns with pregnant women or neonates during the implementation of the CCT program were eligible.The premise of the CCT intervention is simple. In a series of group meetings between eligible participants in a selected number of project villages in designated project townships, pregnant women were advised that, if they undertook any one of a set of seven MCH services—of which five are free—then they would receive not only the benefits of the service that was provided but also a cash payment of a certain amount. The program was designed to make payments to the participants shortly after completion of each visit to the MCH service provider.The list of services and the payment schedule were displayed prominently in all treatment townships. Eligible women were told that they would receive a separate payment each time they (a) underwent a prenatal examination; (b) delivered their baby in a hospital; (c) underwent a maternal postpartum examination; (d) engaged in early breastfeeding, that is, began breastfeeding within one hour after delivery; (e) breastfed exclusively for 6 months; (f) gave their child all required vaccinations; and (g) took their child to a child health examination. If a mother in a CCT project township completed all CCT activities, she would receive about 1000 Chinese yuan . This is a relatively large sum of money in the study area, given that the average annual income in 2013 was approximately 1500 yuan per capita .Our study is not, strictly speaking, a cluster randomized control design but, instead, uses a quasi-experimental design to make a comparison between those who received the treatment and those who did not receive the treatment in two dimensions. One dimension of the comparison is between village, and the other is within village.For the between-village comparison, we received access to 25 CCT townships, including nine townships from four counties in Gansu and 16 townships from five counties in Sichuan, an average of about three townships per county. One treatment village was randomly selected in each treatment township to generate a total set of 25 treatment villages. The corresponding 50 comparison villages were selected from 50 comparison townships that had similar ethnic, social, economic, and infrastructural characteristics to the treatment towns. A series of control variables were used to select comparison villages, including ethnicity (as measured by the share of Han ethnicity in villages), total village population, nature of the local township road (as measured by the presence of a paved road from the township to the village), share of families who were receiving income support or welfare, and average travel time from the village office to the township health center. Thus, in the study, there were two comparison villages (and sets of respondents) for every treatment village.For the within-village comparison, we adopted three groups to present the status of the eligibility of CCT programs: a fully eligible group (women who were pregnant during the CCT implementation), a partially eligible group (women with newborns during the CCT implementation), and a non-eligible group (women who had delivered their babies before the CCT implementation). We thus can compare the differences among these three groups within a village.The sample villages were selected  in fall 2014, 18 months after the launch of the CCT program (as indicated above in spring 2013). Figure Our sampling frame worked as follows. First, we went to the nine CCT project counties from the Sichuan and Gansu provinces. From the five counties in Sichuan, we went to 16 townships that were offering the CCT program (treatment townships) and 32 that were not (comparison townships). From the four counties in Gansu, we went to nine CCT towns and 18 non-CCT towns.To choose the sample villages and households, we followed a pre-specified protocol that consisted of four steps. The first step was to take a between-village matching strategy. To do so, we randomly chose a set of treatment villages from among the 25 treatment townships that would contain households eligible to participate in the CCT program. After the treatment villages were randomly chosen, the second step involved choosing a set of comparison villages from among the 50 comparison townships. To improve the probability of having a good match, we chose two comparison villages for each treatment village. The assumption of our sampling strategy was that the two comparison villages, by nature of their proximity to the treatment villages, were likely to be close matches.To select the comparison villages, we used secondary township-level and village-level statistics. Utilizing all available variables noted above for each village in each township, we identified one village from within each of the two comparison townships that were similar to our treatment villages. No significant differences were found between the comparison and the treatment villages Table . This meThe sample included 25 treatment villages and 50 comparison villages, for a total of 75 study villages. The sample villages were selected, and the overall sampling protocol was implemented in fall 2014. The timing of the sample selection was carried out 18 months after the launch of the CCT program, which was spring 2013.For the third step of the sample selection protocol, we chose study households in the treatment and comparison villages. The goal was to choose three different types of households. The first type was termed Fully Eligible (FE) households, meaning that the mother became pregnant after the implementation of the CCT program in the treatment villages. This means that she would have been able to take advantage of all services offered by the program. The second type was termed Partially Eligible (PE) households, wherein the mother became pregnant prior to the launch of the CCT program but did not deliver her child until after its launch in the treatment villages. This means she would have been able to access some, but not all, program services. The third type was termed Ineligible (IE) households, meaning that the mother became pregnant and delivered her child prior to the launch of the CCT program. This would have barred her from being able to access its services even though she was in a CCT treatment village.To select these households, we went to each village and consulted the roster of all babies from the village doctor or the women’s representative. We grouped babies into three types based on their dates of birth. Within each type of household, we randomly selected seven babies and their mothers to become our sample households. As such, we selected 21 households per village. At the time of the final evaluation survey, FE households had babies who were between 3 and 12 months old; PE households had babies between 13 and 18 months old; and IE households had babies aged 19 to 24 months. Thus, at the time of the launch of the CCT program, IE households had babies who were between 1 and 6 months of age, whereas PE and FE households had mothers who were either pregnant or not pregnant yet, respectively. For clarity of exposition, we further classify households from treatment villages as FE treatment households, PE treatment households, and IE treatment households. Likewise, households from comparison villages are classified as FE comparison (or control) households, PE comparison households, and IE comparison households, matched by the same age period in the fourth step of our analysis.In summary, the sample included 21 households  in each of the 25 treatment villages and 21 households  in each of the 50 comparison villages. In total, the sample included 25 treatment villages and 50 comparison villages, for a total of 75 study villages. In addition, 21 households in each target village were selected based on their eligibility status for the CCT program. The assessment profile of this CCT program is depicted in Fig. The research team conducted the survey in October 2014 in Sichuan Province and November 2014 in Gansu Province. The survey comprised five modules that were designed to meet our objectives of measuring the impact of the CCT program on the outcomes of interest: uptake of MCH services, knowledge of the mother about MCH issues, health outcomes of the child, participation in and receipt of the CCT payments in the CCT eligible households in the treatment villages, and information on individual and family characteristics that we used as control variables in the analysis.The first module involved the collection of information needed to assess the uptake of MCH services. This included asking whether the caregiver of the child had participated in antenatal check-ups, in-hospital delivery, postpartum checkups, child physical checkups, or child vaccinations. Using our data, we constructed seven measures of MCH service uptake: any antenatal care visit made ; baby delivered in hospital ; any postpartum care visit made ; early breastfeeding (defined as a practice of a woman who begins to breastfeed within one hour after delivery) ; exclusive breastfeeding  ; compliance rate of child physical examinations (%); and compliance rate of child vaccinations (%). The compliance rates of child physical examinations and vaccinations were calculated based on the requirements of the national standards of basic public health services, which has a required schedule of physical examinations and vaccinations that a child should receive from birth to 6 years old. Therefore, the compliance rate is the actual frequency of physical examinations and vaccinations divided by the frequency of the national standards.The second module concerned the assessment of the mother’s knowledge of the MCH services that she was asked to take her child to as well as knowledge of infant nutrition. In this knowledge scale, there was a total of 22 items, scored by giving the respondent one point for each correct answer; thus, a mother with complete knowledge would score 22 points. Appendix A1 provides an English translation of the knowledge test [see Appendix Table A1 in the Additional file Z-scores (LAZ) and weight-for-length Z-scores (WLZ), based on international standards [In the third module, each sample child in the treatment and comparison groups received physical examinations. Trained nurses, as part of the survey team, collected data on three indicators of health outcomes for each child. The three measures included hemoglobin concentrations, height, and weight. Hemoglobin levels were measured using HemoCue Hb 201+ systems . Following international standards for our sample age group, we defined anemia as a hemoglobin count of less than 110 g per liter . Height tandards . Using oAlthough all other modules were administered to all sample households, regardless of their eligibility status, the fourth was not. For households in the treatment groups, namely, FE and PE treatment households, we had one extra module in which enumerators asked detailed information about their participation in the CCT program. Specifically, enumerators asked whether the mother registered for the program. Mothers were also asked to report the amount of cash that they had received for participating in the CCT MCH activities.controls that might directly or indirectly affect the uptake of MCH services or health outcomes. The survey contained items for mothers about their child’s age, gender, ethnicity, gestational age, and pregnancy order. Enumerators also quizzed mothers about their own characteristics, including age, education, ethnicity, and occupation. A final set of items concerned overall household characteristics, including distance from home to the township health center in terms of kilometers and travel time, and the nature of each household’s durable assets.The fifth module of the survey was designed for the collection of information on various factors, statistically, A power analysis was conducted based on one of the main outcomes: the rates of hospital delivery. With the power of 0.8 to detect a difference in hospital delivery rates between the treatment and control groups in a cluster controlled trial, a suitable sample size depends on the number of children per village, number of villages, and probability of hospital delivery in treatment villages and controlled villages at a 95% plausible interval. According to our study design, with one CCT village and two control villages, the total number of villages was 75. Based on previous studies , we assup-values below 0.05 were considered statistically significant. We reported coefficients and 95% confidence intervals (CIs) for all main variables of interest. Comparisons between the treatment and comparison groups for all outcomes by subgroup populations were assessed using t-tests or chi-square tests.All statistical analyses were performed using STATA 12.0 ; To examine the effect of the CCT program on the uptake and knowledge of MCH services as well as on child health status, the evaluation used two dimensions of variation, i.e., between-village analysis  and within-village analysis . The first is cross-sectional and comes from a comparison of households with the same eligibility but from villages with different treatment status, namely, CCT treatment villages versus non-CCT comparison villages, utilizing Evaluation Strategy 1. Under Strategy 1, we estimated the impact of the CCT program, using the following least squares regressions model:Yi is the outcome of interest for household i, including uptake of MCH services, knowledge of MCH services, and health status of children; CCTi is a dummy variable that indicates whether a household comes from a CCT village, which makes β the parameter of interest; and Xi is a vector of covariates that are included to capture the characteristics of children, mothers, and households. In all cases, we adjusted standard errors for clustering at the township level, using a cluster-corrected estimator.The second dimension of variation is temporal and comes from comparing households that are fully or partially eligible (FE/PE households) against those households that are ineligible (IE households) for this CCT program under Evaluation Strategy 2. In this evaluation strategy, we estimated the impact of the CCT program, using the following least squares regression model:CCTi with the dummy variable Eligibilityi, indicating whether a household is fully or partially eligible (FE/PE households). The rest of the variables are the same as described in eq. (Note that the only difference between eqs.  and 2)  2) is thd in eq. . TogetheA within-village difference for the first-stage difference and between-village but within-township difference for the second stage allows us to apply the difference-in-difference strategy to evaluate the effect of CCT on utilization of maternal health services and health outcomes. The baseline values for the difference-in-difference analysis were generated with the data of households that were ineligible for the CCT program.We supplemented our intention-to-treat (ITT) multivariable analysis described above by examining the average-treatment-effects-on-the-treated  to measure the impact on outcomes among the subpopulation of households that had heard about the CCT program. This allowed us to control for any confounding due to non-compliance, which we define as use of MCH services without receiving a monetary transfer. For the ATT analysis, we utilized an instrumental variable (IV) approach , in whicA total of 1522 households (mother-baby pairs) were enrolled in our study. In total, there were 503 households in the 25 treatment villages. Of these, 349 were treatment households , and 154 were comparison households (IE households). Likewise, there were 1019 households in the 50 comparison villages (non-CCT villages). Of these, 353 were FE households, 339 were PE households, and 327 were IE households.Table p-values were above 0.05. Below, we present the comparisons between CCT and non-CCT villages, including uptake of MCH services, impacts on mother’s knowledge, and impacts on health outcomes.For the integrity of the evaluation, the observable characteristics across treatment and comparison households are balanced (Columns 2 to 10). In the case of all of the individual variables, the p-values were less than 0.05). Specifically, more women in the FE households in the CCT villages made at least one prenatal care visit (85%) than did those in the comparison villages (78%). Although the differences were significant (p = 0.04), the magnitude of the difference was modest (7%). Mothers in FE households in CCT villages also took their children for post-natal physical examinations at a higher rate (33%) than did those in the comparison villages (23%). As in the case of prenatal visits, although the difference was significant (p = 0.01), the size of the difference was relatively small (10%). In the case of the other program healthcare activities—delivery in hospital, postpartum care visits, early breastfeeding, exclusive breastfeeding, and compliance with child vaccinations—there were no statistically significant differences in the rates of participation between the treatment and comparison villages.A comparison of FE households in the CCT and non-CCT villages showed that two out of the seven uptake measures were significant . The findings indicated that 56.6% of mothers in the CCT villages attended postpartum care visits, but only 39.2% of those in the non-CCT villages attended (p < 0.001). Similar to FE household comparisons, there were also statistical differences in the compliance rate of child physical examinations between PE households . The descriptive data showed that two out of the seven uptake measures were significant  and to take their children to more health checkups  . The measured differences in magnitudes for all of the other analyses were even smaller. Second, for the ITT analysis, which held equal the characteristics of the child, mother, and family, most of the measured impacts of the CCT intervention on either FE or PE women became insignificant.There was almost no effect on incidences of low birth weight, anemia, stunted growth, or wasting. The descriptive analysis, using Evaluation Strategy 1, found no improvement on any of the outcome measures between either the FE children or PE children in the treatment and comparison villages , only 55.8% reported that they had heard about the CCT program. Out of the 175 sample PE households in CCT villages, only 62.3% reported that they had heard about the program. In total, 59.0% of the women (both FE and PE women) in CCT villages said that they had been informed about the CCT program. Of the women who knew about the CCT program, the proportion who used MCH services and received a monetary transfer is even lower. The overall compliance rate of the CCT program was only 49.9%. Specifically, only 51.1% of the women from FE households received at least one type of MCH services and received a cash transfer. In the PE households, only 48.6% of the women complied.The results of the ATT analysis  mirrored the results of the ITT analyses. The CCT intervention had only a small impact on the uptake of MCH services and on improving mother’s knowledge. There was even a smaller  impact on improving child health outcomes Table .Table 6In this paper, we utilized rigorous impact evaluation approaches on a large sample of women who participated (or did not participate) in a pilot CCT program that sought to incentivize new mothers in two poor regions in Western China to improve their utilization of MCH services, enhance their knowledge, and, ultimately, improve health outcomes. In these areas, the utilization of MCH services and mother’s knowledge are poor overall. Health outcomes of children also are fairly poor. The purpose of the program was to increase the benefit of utilizing MCH services, and this was expected to lead to better knowledge about child health and better child health outcomes.The data, however, showed that this pilot program had a limited impact. Regardless of the evaluation strategy or the nature of the treatment and control groups, the rate of participation in MCH services did not rise systematically. Mother’s knowledge improved only marginally. Further, health outcomes did not show any sign of improvement. Indeed, throughout the results, from both the descriptive and multivariable analyses, there were instances in which there were significant differences between the treatment of mothers/children in CCT villages and the control mothers/children in non-CCT villages. Nevertheless, in a large proportion of the statistically significant results, the magnitudes of the shifts in outcomes  were small. That is, the CCT program technically worked, but the effects were so small that they could not be considered meaningful.In this respect, this pilot project’s relatively minor outcomes differ from those of similar programs implemented in other countries. In other middle- or low-income countries in which CCT programs have been used to help poor women overcome barriers to MCH services, many programs have been shown to improve health. For example, CCT programs have been shown to improve birth weight , decreasConsistent with the results of this study, however, there also have been CCT programs that did not work. An assessment of a CCT program in Honduras found no effect of such programs on child outcomes . In the In reflecting on the literature, we questioned why the experience with the CCT program in China more resembles that of the CCT programs of the Honduras and Kenya (which did not have an impact) rather than that of successful programs elsewhere—in other words, why was this CCT program so ineffective? Although identifying the precise reason is, unfortunately, beyond the scope of this study, we suspect a number of potential explanations.One possibility is that the CCT cash transfers might not have been large enough, which would lead to low uptake. Given the way this intervention was designed, however, we doubt this is the case. If a mother had taken advantage of all of the incentivized activities, she would have earned more than 1000 yuan. In these very poor communities, this is a sizeable amount, given that the average annual income in 2013 was approximately 1500 yuan per capita . Thus, tAnother possibility is that travel distances from villages to township health centers may have been prohibitively far. This does not seem likely, however, as only a small share—less than 15%—of target households were more than one hour away from the township health centers. Thus, at least for most mothers, this was unlikely to be a constraint. Likewise, our heterogeneous analysis identified no impacts of travel time from their household to the township health center [see Appendix Table A2 in the Additional file We also found that mother’s ethnicity and education were associated with the uptake of MCH services and knowledge [see Appendix Table A3 in the Additional file However, these demand-side factors were the exact barriers to MCH service uptake that the CCT program was supposed to overcome. Thus, there must be other factors that influence the effectiveness of the CCT program and explain low levels of improvement that we found. We suspect that problems with the CCT program’s implementation, similar to those encountered in the Honduras study , may proAnother potential reason for this lack of CCT participation may be due to low medical quality and consequent absence of trust in the Chinese medical system. There is a growing body of literature that documents the low quality of health care in rural China –45. BecaThis study has several limitations. First, due to the implementation schedule of the CCT program, we were unable to collect baseline data on either the treatment or control individuals/villages. The one-year implementation time may not be long enough to track changes in children’s outcomes. As our study focuses primarily on MCH service uptake (which is mostly those services used by the family during the child’s first year of life), however, we believe that the tracking of such outcomes does provide sufficient information to be able to evaluate the impact of this CCT program on the uptake of MCH services. Future research, of course, should continue following children for longer periods of time. Second, in part due to the absence of baseline data, our evaluation design was not a randomized control trial, and CCT villages were not randomly assigned. To do our best to decrease evaluation bias and increase evaluation power, we used a two-pronged evaluation strategy: a between-village matching strategy and a within-village difference-in-difference strategy. These strategies let us compare the changes not only after the CCT program was launched between CCT treatment villages and control villages but also before and after the CCT program was launched within villages.Another fundamental limitation of this paper is that we are not able to provide a full, empirically based prescription on how policymakers should focus their efforts to try to improve access to MCH services and improve health outcomes. In this paper, we can show only that uptake and knowledge of MCH services are poor and that the pilot CCT program really did not solve the problem. We did spend a lot of time in addressing the potential reasons for this, including poor implementation of the program, an absence of trust in the system, and poor quality health care in general . The current study, however, does not provide an empirical basis for conclusive findings on what to do in the future. Future research that includes both quantitative and qualitative methods is needed to identify and address a number of these other potential constraints in accessing MCH services and implementing CCT programs.The CCT program had a limited number of positive impacts on MCH service utilization and the knowledge of mothers; it also had almost no effect on child health outcomes. More research needs to be done to create an effective CCT system, and more emphasis on the quality of the health system should be considered in future efforts.To ensure the accuracy of the information, enumerators also checked children’s birth certificate  as well as their vaccination record booklet  on the spot.Additional file 1: Appendix A1. English translation of the knowledge test. Appendix Table A2. Heterogeneous analysis result by time factor. Appendix Table A3. Intention-to-treat (ITT) analysis for the ethnicity and education effects on using MCH services, mother’s knowledge, and child health outcomes. Appendix Table A4. Details of the regression specification for Table


Following the intervention, the participants belonging to the intervention group displayed significantly lower levels of stereotypes, perception of dangerousness, and global score toward people with schizophrenia (p < 0.001). In addition, participants presented lower levels of dangerousness-fear, avoidance, coercion, lack of solidarity, and global score (p < 0.001). The control group displayed no statistically significant differences in the level of stigma before and after the evaluation, for all of the items assessed. Finally, the overall assessment of each of the components of the program was highly positive. In conclusion, the study shows that online programs can contribute to reducing stigma toward mental disorders. The program assessed in this study had a positive impact on all the dimensions of stigma and all of the components of the program itself were positively evaluated by the participants.Stigma toward mental disorders is one of today's most pressing global issues. The Covid-19 pandemic has exacerbated the barriers to social inclusion faced by individuals with mental disorders. Concurrently, stigma reduction interventions, especially those aimed at university students, have been more difficult to implement given social distancing and campus closures. As a result, alternative delivery for programs contributing to stigma reduction is required, such as online implementation. This paper reports the results of a controlled study focused on an online multi-component program on reducing stigma toward mental illness that included project-based learning, clinical simulations with standardized patients and E-Contact with real patients. A total of 40 undergraduate students from the Universidad del Desarrollo in Santiago, Chile, participated in the study. They were randomly divided between an intervention and control group. The intervention group participated in the online multi-component program, while the control group participated in an online educational program on cardiovascular health. We assessed the impact of the program by using the validated Spanish-language versions of the Attribution Questionnaire AQ-27 and the Questionnaire on Student Attitudes toward Schizophrenia with both groups, before and after the intervention. In addition, an  Stigma toward mental disorders is one of today's most pressing global issues. , with imMental health professionals and medical students have been found to stigmatize psychiatric patients , 8, and At the international level, several strategies have been implemented within the general population, as well as medical students, to reduce stigma toward mental disorders , and theWhile these strategies have been implemented in different countries –30 and hIn the context of the SARS-CoV−2 pandemic, lockdowns and physical distancing recommendations, stigmatization and instances of discrimination against individuals with mental disorders have increased and have negatively impacted their well-being and quality of life . AdditioAmong such alternatives, for university students, active and interdisciplinary project-based learning, where students lead and develop a final project, has been proven useful , 44, as In addition to project-based learning, the use of standardized patients has shown different benefits for skill training and e-learning in the field of education in psychiatry and mental health . IncludiFinally, E-contact, defined as “computer-mediated real-time interactions where members of different groups interact online” , has beeThe objective of this study is to demonstrate the effectiveness of a multi-component online intervention incorporating E-contact with mental healthcare patients, standardized patients, and a project-based learning program.The participants were recruited within the Universidad del Desarrollo in Santiago, Chile, during “Innovation Week,” an event organized by the university, where students belonging to the first 3 years of undergraduate studies in different disciplines work on different innovative responses to local social issues.The sample consisted of 40 university students in their first, second or third year, 32 of which studied health science degrees and the remaining 8 studied social science degrees. Eighty percent of the participants were women and 20% were men, all aged between 18 and 23 years old . None of the participants had been trained in psychiatry.p > 0.05).The intervention group and control group were each made of 20 randomly allocated participants, with equal proportion of men and women, area of study, and no statistically significant difference with regards to age  of the students assessed at the top level the usefulness of the program in understanding the recovery process and promoting social inclusion of patients with severe mental disorder, while 100% (n = 20) of them rated at the top level the promotion of empathy. Additionally, 95% (n = 19) stated they would recommend this program to a peer. There was no statistically significant differences between the three interventions and their integration. Finally, positive and uniform comments were presented, also in conjunction with the following representative verbatim quotes: “The activities we carried out, helped me to have a better view of mental illness, and the use of simulated patients was useful in the experience and learning”; “I really liked the simulations and the E-Contact, it makes it much more didactic to learn and understand about mental illness” and “was a wonderful experience, it would be a huge challenge to do it on-site.”The assessment given by the participants on the intervention was measured with a Likert scale ranging from 0 to 5 points. As Stigma toward mental disorders is a pressing issue, considering, on the one hand, its impact on the wellbeing and quality of life of individuals with mental disorders –19, and At present, and to the best of our knowledge, there is no multi-component program focused on stigma toward mental disorders entirely carried out online. For this reason, as well as the lockdowns and social distancing measures implemented as a result of the SARS-CoV−2 pandemic, this study focuses on the implementation of an online program.The results show that the intervention had a positive impact on the reduction of stigma among the intervention group. These results may be explained by the intensity of the program, the integration of multiple components, the focus given to the recovery process and the implementation of direct E-contact between mental health patients and students, all of which have been demonstrated to be key points for the implementation of a successful stigma-reduction program , 73–77. Considering that the intervention was intensive, taking into account the number of activities carried out in a short amount of time, further qualitative studies will explore the experience of the participants and the lessons learned from the implementation of the key components, in order to adapt and adjust the program and make it easier to replicate.It is important to emphasize that the assessment that the students made of the program was positive with respect to online implementation for each of its components, and the components focused on the promotion of empathy, social inclusion and understanding of the recovery process of severe mental disorders scored the highest, especially when integrated together. This suggests that the participants enjoyed the experience, would recommend it to peers, bringing evidence on the advantages of interventions that take into account the motivation of university students toward learning and goal-achievement, which is in turn one of the main challenges of digital education , 80.In that sense, the educational intervention methods used in the current study are supported by robust theoretical and empirical evidence, and are especially adequate for online implementation, which is key in the context of the SARS-CoV-2 pandemic and the restriction of on-site interventions , 53–56. In conclusion, the design and implementation of this type of interventions and educational spaces focused on diminishing stigma toward psychiatric patients contribute to normalizing these experiences among the population, by openly sharing challenges around mental health and promoting effective help-seeking and the delivery of adequate treatment to those who need it , 84. TheHowever, the study presents several limitations. First, the sample is relatively small, comes from one specific institution and is not representative of the general population, which may undermine the generalization of the results and limit the interpretation of the effect size. Second, the phases of the intervention were not experimentally evaluated in an independent way and the measure of stigma was only evaluated for schizophrenia, making it necessary to include other prevalent mental disorders in future research. Third, specific characteristics of the participants and possible confounding factors, which may influence the results, such as their socio-cultural background and their level of knowledge, desire to work in psychiatry and closeness to mental disorders were not evaluated. Finally, the long duration of the program may limit its replication, presenting several logistical challenges in its implementation through virtual platforms, specifically when considering factors such as student motivation and the exhaustion experienced in this regard.https://data.mendeley.com/datasets/p5d39f3kp6/1.The datasets presented in this study can be found in online repositories. This data can be found here: The studies involving human participants were reviewed and approved by Ethics Committee of Universidad del Desarrollo, Santiago de Chile (protocol number: 2020–142). The patients/participants provided their written informed consent to participate in this study.MR-R, AJC, and DF-O contributed to the conception, coordination, and design of the work. MR-R and DF-O contributed to the implementation of the program. MR-R and AJC performed the statistical analysis. All authors contributed to the article and approved the submitted version.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


New Mexico now has the 32nd highest adult obesity rate; approximately one-third are Latinos. Obesity rates in NM for children aged 2-11 years range from 11 – 14%. Mentoring as a health promotion or intervention strategy has become widespread. However, few programs have focused on several generations reciprocally influencing each other in healthy behaviors. Project I’M HIP ’s goals included: Providing an innovative, multigenerational educational program to promote greater maternal, child, and grandparent well-being, healthier lifestyle behaviors, and support continued healthy home environments by empowering the families with knowledge. Three cohorts of 30 families  were recruited for Program I’M HIP. This Program utilized culturally sensitive Evidence-Based Programs (EBPs). Monthly educational sessions focused on physical activity and adapting meals to be healthy. Project outcomes included exercise frequency, Body Mass Index (BMI), and a knowledge quiz assessing healthy meal facts, exercise knowledge via a 10-item quiz; all assessments pre- and post-program. Program outcomes included: 100% of the parents shared at least 1 fact on nutrition or exercise with other relatives, thus affecting another household; paired t-test analyses revealed significant changes in knowledge quiz total scores , increased exercise frequency ; no significant change in BMI from pre- to post-assessments; and children corrected their parents on proper diet; all demonstrating the reciprocal mentoring effects of parent, child, and other relative on health behaviors.