Artigos de revistas sobre o tema "Committee on Scholarships and Financial Aids"

With the student aid becoming more and more diversified, China has established an integrated financial aid system of scholarships, educational loans, aids, subsidies and reduction of tuitions. However, there still remain some problems to be resolved regarding the part-time jobs, such as focusing too much on economic aid, mismanagement of part-time positions and slow integration with innovation and entrepreneurship education. In order to achieve the dual goal of financial relief and integral education, we should expand and enrich the part-time positions, form new brands and ensure a sustainable development model. In this way, we can arouse students’ enthusiasm for innovation and entrepreneurship to the most extent and better incorporate education in students’ study, work and life so as to develop an omnibearing educational system.

This case aids the exploration of exploring the financial disclosure requirements proposed by the AICPA Special Committee on Financial Reporting (i.e., the Jenkins Committee). The premise of the Committees report was to propose a model for comprehensive business reporting that is closer in line with the needs of financial statement users. This case provides a reusable framework for investigating and report upon the availability of current information disclosures available for a given company and facilitates a comparison with those disclosures advocated by the Jenkins Committee. The re-usability feature is derived from the uniqueness that each company report will have based upon the information available for a given company at a given point in time. Hence, the case will differ for each student assignment in the same semester and will also differ from one semester to the next. Five primary objectives have been specifically addressed: (1) to raise students awareness of evolving issues I the accounting profession, (2) to facilitate students understanding of the real changes in current reporting that may evolve from the Jenkins Committee, (3) to understand the difficulties faced by financial statement users who currently must search for additional disclosures through multiple information sources of questionable reliability, (4) to provide a meaningful analysis of financial statement content and disclosures, and (5) to demonstrate how the Internet can be used as s tool for aggregating information when conducting business research and analysis.

The Catholic Bishops' Conference of India (CBCI) Chair at Indira Gandhi National Open University (IGNOU) was established with the signing of a Memorandum of Understanding (MoU) between CBCI and IGNOU on 29 February 2000 to plan, design, develop and launch socially relevant programmes of study in the areas of HIV/AIDS social work, philosophy, etc. The one-time endowment grant of US$125,000 facilitates the programme development process without any financial contribution from IGNOU. In the 13 years of its existence, the CBCI Chair has developed eight programmes – from Certificate to Doctoral programmes. Some of these programmes have been revised. Over 30,000 students have enrolled for these programmes, which are being offered in 12 countries. Although the chair follows all the prescribed procedures for programme development and launch, the nature, scope and financial viability being enjoyed by the Chair facilitates timely decision making and achievement of targets. The CBCI Chair is a success story in Open and Distance Learning (ODL) as it has helped in the establishment of the first School of Social Work in ODL, the Centre for Tibetan Studies and the Mother Teresa Chair. The Chair has been instrumental in providing scholarships and awards to several students. This paper examined the what, why and how of the CBCI Chair and the implications it has as a model towards targeted interventions in ODL systems, quality assurance, maintenance and sustainability.

The article examines the relations of the GDR and the ANC on the basis of archival documents of the ANC stored in the National Heritage and Culture Studies Centre at the University of Fort Hare (Alice, South Africa). The author shows, that the relations of the GDR with the ANC in the 1960s — 1980s were of the most diverse nature, gradually expanding and deepening. They were not limited to inter-party ties, the GDR Solidarity Committee played a big role in their development. With its participation, the ANC received direct financial assistance, as well as scholarships to train its activists in a wide range of specialties. The author introduces a whole layer of previously unknown archival materials and memoirs of ANC activists into scientific circulation. He concludes, that in terms of the level and volume of relations with the ANC, the GDR was the first of all the COMECON countries after the USSR. At the same time, unlike other COMECON countries, the struggle of the German socialist state for international recognition left a certain imprint on the relations of the GDR with the APK.

Gender equality is still an issue in business schools, since women in MBAs classrooms, in faculty and in management teams have low representation. Challenges caused by lack of financial aids, salaries gap and a very masculine model avoid a better gender balance in the business graduate schools, which, globally, should lead women personal and professional development. The main objective of this research is to analyse business schools communication priorities related to gender equality projects and policies in their sustainability reports, considering these as a fundamental tool for corporate legitimacy. Through a content analysis of the sustainable reports of the top 50 business schools of the world, we elaborate a “Codes Frequency Report” focusing on “Goal 4: quality of education” (in relation with scholarships and grants allocation) and “Goal 5: gender equality” and we explore the correlations with the schools’ ranking positions, the price of the MBA programmes, the percentage of female MBA students, of female faculty members and women in board of directors in the different geographical areas as Europe, US and Asia. Results show that gender equality related topics are a source of positive impact and legitimacy for top business schools.

Worldwide, the effectiveness of the government plays a significant role in fostering economic growth within a nation. This is because the government is responsible for nurturing a skilled workforce, creating a business-friendly regulatory and investment climate, and developing the necessary infrastructure for the flow of goods and information. In this context, the audit committee serves a vital function by overseeing and helping the board monitor an organization's responsibilities, making their role crucial in ensuring sound financial management. In Kenya like other developing countries, the public expectations and priorities are changing. Assessing the effectiveness and efficiency of the public sector through performance measurement has been widely acknowledged as essential. Despite a growing demand for public services, the prevailing financial limitations force numerous public organizations to accomplish their goals with fewer available resources. However, these can only be assured through effective auditing of the public sector. Recently, the government of Kenya has recommended the constitution of audit committees of all government ministries. The purpose of the research is to explore how audit committee qualities affect the IEBC's performance in Kenya. The specific objectives were to determine the effect of audit committee member qualifications, size, independence and gender diversity on the performance of the independent Electoral and Boundaries Commission in Kenya. The population of study was the management staff at the IEBC secretariat who total to 129. This consisted of 129 respondents. A sample of 65 respondents, constituting 50% of the target population, was randomly selected for this study. Primary data was collected utilizing self-administered semi-structured questionnaires. This analysis was helped by the employment of SPSS software. The findings were disseminated using various visual aids such as tables, charts, graphs, frequencies, and percentages. The research findings from this study offered an opportunity for individual parastatals and the public sector to assess their audit committee characteristics in comparison to other entities within the same sector in the country. This assessment enabled them to identify both the strengths and weaknesses in their audit committee practices.

The article highlights the measures taken and carried out to honor the memory of Solomon Mikhoels in 1948. This happened in the context of the Soviet leadership’s position of expectation regarding the liquidation of the Jewish Anti-Fascist Committee and the deployment of the struggle against «rootless cosmopolitanism». The basis of the research was the issues of the newspaper «Eynikayt», which were published throughout 1948 until the closing of the newspaper’s editorial office on November 20 (now copies of the newspaper are kept in particular in the funds of the Department of the Jewish Foundation of the Manuscript Institute of the National Library of Ukraine named after V. I. Vernadsky). It was found that the initiative for planning and implementing these events belonged to both the authorities and representatives of the Jewish public, who were connected to Solomon Mikhoels by friendly and professional ties. The latter’s motives should be explained by the desire to honor the memory of a loved one. Instead, it is suggested that the Soviet leadership could thus pursue the goal of dispelling possible suspicions of involvement in the man’s murder. The measures mentioned above included the payment of one-time financial support to the artist’s family members; granting the name of Mikhoels to the Moscow State Jewish Theater, a school that functioned at the theater and cultural center in the city of Birobidzhan; establishment of scholarships named after the deceased for students of the State Institute of Theater Arts named after A. V. Lunacharsky and the Moscow Jewish Theater School; a lengthy article by Itsik Fefer dedicated to the memory of Mikhoels; publication of a book in memory of the man; memorial evenings, «Mikhoels-lectures», the creation of a sculpture of an artist by a graduate of the Repin Institute of the Academy of Arts of the USSR. The article defines the open issue of the payment of the scholarships declared in the newspaper’s publications to the recipients of education at two educational institutions and the pension of Mikhoels’ daughter Nina as measures initiated by the authorities.

Objective: to assess the knowledge and practices of adolescent students in relation to HIV/AIDS and other STIs. Methods: this is a cross-sectional study, with a quantitative approach, which included twelve public schools from seven cities in Rio Grande do Norte, with a sample of 623 individuals. Two electronic and interactive questionnaires were used for data collection. Data processing was performed using SPSS 25.0® and Stata 14.0. For the analysis of associated factors, the Item Response Theory was used. The project of this study was approved by the Research Ethics Committee of the Federal University of Rio Grande do Norte, Protocol No. 99473118.2.0000.5292. Results: The participants who achieved the highest means of knowledge level were female (6.04 ± 4.47), with a partner (6.13 ± 4.49), white (6.10 ± 4.46) and received financial assistance from the government (6.72 ± 4.40). Most teenagers reported that they had already had their first sexual intercourse. Of those who continued to have sex in the last 6 months, only 31.3% used a condom. Final considerations: Adolescents have a considerable level of knowledge about the prevention of HIV/AIDS and other STIs, but their sexual practices do not follow the recommended preventive measures.

Background: As PLHIV now live longer, family caregivers play a crucial role in providing physical, emotional, and financial support. This study investigates the burden experienced by family caregivers of People Living with AIDS (PLHIV) in Kakinada District, Andhra Pradesh. Objectives: 1. To assess burden Among caregivers (family members) of PLHIV. 2. To Explore care giver perspective of caring experiences Methodology: Methodology: The study is a cross-sectional study. By using mixed-method approach both qualitative and quantitative data was collected by convenient sampling method in an ART Centre of Kakinada District. Prior approval was taken from Institutional Ethics Committee. A pretested semi-structured questionnaire for socio-demographic information and validated, standardized 22-item Zarit Burden Interview (ZBI) tool to assess the perceived caregiver burden. Quantitative analysis done by using SPSS and Qualitative Information gathered through in-depth interviews. These were recorded, transcribed, translated, and later coded for analysis following thematic approach. Results: Demographics revealed that Female were 54.8% and Male were 45.2%. The mean age group was 38.38±11.5. In this study revealed that 22.6% were under severe burden & 12.9 % were moderate to severe &38.7% were mild to moderate burden. Mean Zarit Burden score was 36.32±18.8. Caregivers faced a range of challenges, pertaining to physical, psychological, emotional, social, and financial burden. Challenges experienced by the them regarding stigma and discrimination are more common. Conclusion: Majority of caregivers having Burden. Caring for someone with HIV/AIDS brings both positive and tough experiences for caregivers. ongoing support is crucial for families in this situation. Simple, focused measures can make a real difference in the well-being for caregivers and Improve Care givers experience.

The effects of Covid-19 are not only in terms of health, but many things arise along with its existence. One of them is poverty. Due to this, Universiti Teknologi MARA(UiTM) has taken the initiative to offer several financial aids to the affected students. However, the students must fill in the application form to obtain the aid. They need to provide the supporting documents such as parents pay slip, information on family dependent and so on, which will be inspected, graded and selected by the committee to determine the qualification for the financial aids. Due to this, it will be a long process to select the rightful applicants, which involves a significant length of time as it consisted of hundreds of applicants. Hence, the aim of this study is to select and rank the most eligible candidates among UiTM Perlis students with fairness, fast and accurate manner. In this study, the Fuzzy Technique for Others Preference by Similarity to Ideal Solution (TOPSIS) method was used to solve the problem. The model was run using Microsoft Excel. The selection of UiTM Perlis students were based on a set of criteria that had been predetermined which includes family income, occupation and the number of dependent in the family. The findings of the study showed that from 35 samples of UiTM Perlis students, the highest-ranking was student 35 (S35) with 1.0000 relative closeness. Meanwhile, the lowest ranking was student 30 (S30) with 0.6478 relative closeness. It is also shown that all samples are qualified to receive financial aid due to sufficient allocation amount provided by UiTM Perlis. As a result, the mistakes during the selection process can be reduced by using this method compared to manual selection. Thus, making it easier and faster to channel the aid. All in all, it has been demonstrated that this method is very suitable to be used in this study.

During the first half of this decade, much new information about the acquired immunodeficiency syndrome (AIDS) became available, including landmark reports of the syndrome in children from Oleske et al, Rubinstein et al, and Scott et al; descriptions of AIDS in pregnancy by Wetli et al, Rawlinson et al, and Minkoff et al; and discovery of the agent that causes AIDS, the human immunodeficiency virus (HIV, formerly called HTLV-III/LAV). The first sets of health guidelines pertaining to HIV-infected children and adolescents in school, day-care and foster care settings were published by the American Academy of Pediatrics' Committee on Infectious Diseases in March 1986 and 1987. In 1987, the Surgeon General's Workshop on Children With HIV Infection and Their Families provided the first comprehensive set of recommendations relevant to the provision of pediatric and obstetrical care to infected mothers, infants, children, and adolescents. Most recently, during February 1988, the Secretary of Health and Human Services formed the Secretary's Work Group on Pediatric HIV Infection and Disease that consisted of members from each of the health and human services agencies, including the Social Security Administration and the Health Care Financing Administration. The broad mandate of this group was to make recommendations to facilitate the removal of barriers to care, treatment, and financial burdens of children and adolescents with HIV infection and their families. In contrast, HIV infection has not received sufficiently widespread attention from the obstetric, pediatric, or adolescent research communities. The uneven geographic distribution of the disease; its associated social, legal, and ethical complexities; and the lack of sufficient research monies all have contributed to this problem.

The primary purpose of auditing is to increase openness and accountability in both the public and private sectors. In Pakistan's public and private sector enterprises, the word "audit quality" is a contentious subject. It is critical to maintain audit quality since it aids in the reduction of agency problems in the public sector. When the interests of ministries conflict with those of the public and the government, an agency dilemma occurs. The agency problem, develops when management is unable to take responsibility for where monies have been allocated to achieve the desired results. As a result, audit committees have the ability to alter internal and external audit competence, which has an impact on audit quality. The purpose of this research was to see if there is a link between the efficacy of audit committees, internal audit functions, and external audit fees in Malaysian public companies. This study used a demand-side strategy to look into the relationship between audit committee expertise and internal audit function with external audit fees. With the help of SPSS software, other statistical methods such as descriptive frequencies (demographic analysis) and reliability were employed to determine the extent and direction of relationship between variables. For the purposes of the underlying study, these statistical tools have shown the descriptive and influential relationship between the major factors of Audit quality. The findings of the underlying study reveal that there is no impact of the selected predictor variables on the dependent variable of the study. Keywords: Performance Audit, Top Management Support, Autonomy to Implement Audit Techniques, Audit Quality.

Improving the quality of students’ life is an important task for every university and the educational system as a whole, which fits into the aims of the studies of the social dimension of students’ life. To solve this task, the study of students’ problems is a priority, while the second step can be the creation of university structures that would solve these problems effectively. The article presents an ideal model of the consulting center that can solve such problems. The authors conducted four focus groups in the RUDN University with students of different courses from different countries, and used projective techniques and group discussions to identify models of the consulting center, departments that it should consist of, and qualities of employees working in these departments. The general model of the consulting center includes an information department as its ‘core’ responsible for the distribution of students’ requests to necessary departments; IT department (site, corporate mail, etc.); department of social support (scholarships, financial support, etc.); residence department (registration, dormitory, etc.); department of science and education (grants, competitions, etc.); student committee (leisure). The students prefer to receive all necessary information online, by phone and also in person. The preferred social network for information is Facebook - for foreigners - and VK (Vkontakte) - for Russian students. The students also mentioned three main languages for distribution of information - Russian, English and Chinese. The focus-groups allowed to find out that although some necessary units designed to solve students’ problems already exist, they do not actually solve them due to bureaucratic or other reasons. Therefore, the proposed model of the consulting center can be an effective management solution ‘from the bottom’ that would help the university to communicate with students and to understand their real needs.

Berdasarkan laporan Association of Certified Fraud Examiners (ACFE) 2022, industri perbankan dan jasa keuangan mempunyai beban tertinggi dari seluruh kelompok industri yaitu sebesar 22,3%. Penting untuk memahami faktor-faktor apa saja yang mempengaruhi kecurangan laporan keuangan agar pemangku kepentingan dapat peduli untuk meningkatkan kualitas laporan keuangan. Penelitian ini bertujuan untuk menganalisis pengaruh fraud diamond terhadap kecurangan laporan keuangan. Fraud diamond terdiri dari elemen tekanan (pressure), kesempatan (opportunity), rasionalisasi (rationalization), dan kemampuan (capability). Penelitian ini penting untuk dilakukan agar diketahui faktor-faktor apa saja yang berpengaruh terhadap kecurangan laporan keuangan sehingga menjadi perhatian bagi stakeholders untuk peningkatan kualitas laporan keuangan. Teknik pengаmbilаn sаmpel dilаkukаn secаrа purposive sаmpling, Data yang digunakan dalam penelitian adalah data sekunder pada perusahaan Bank Umum Syariah yang Terdaftar di OJK 2016-2022, Analisa data menggunakan alat bantu statistik SPSS 23. Hasil penelitian menunjukkan bahwa secara parsial Tekanan dengan proksi rasio leverage, Tekanan dengan proksi rasio sales, Kesempatan dengan proksi porsi anggota independen dalam dewan komisaris, Kemampuan dengan proksi pergantian direksi tidak berpengaruh terhadap kecurangan laporan keuangan. Sedangkan Kesempatan dengan proksi porsi anggota independen dalam komite audit, Rasionalisasi dengan proksi total penghasilan akrual berpengaruh negatif terhadap kecurangan laporan keuangan. Based on the Association of Certified Fraud Examiners (ACFE) 2022 report, the banking and financial services industry has the highest burden of all industry groups at 22.3%. It is important to understand what factors influence financial statement fraud so that stakeholders can care about improving the quality of financial statements. This study aims to analyze the effect of fraud diamond on financial statement fraud. Fraud diamond consists of elements of pressure, opportunity, rationalization, and capability. This research is important to do so that it is known what factors affect financial statement fraud so that it becomes a concern for stakeholders to improve the quality of financial statements. The technique of selecting samples is carried out by purposive sampling, the data used in the study is secondary data on Islamic Commercial Bank companies registered with OJK 2016-2022, data analysis using SPSS 23 statistical aids. The results showed that partially Pressure with proxy leverage ratio, Pressure with proxy sales ratio, Opportunity with proxy portion of independent members in the board of commissioners, Ability with proxy change of directors has no effect on financial statement fraud. While Opportunity with the proxy of the portion of independent members on the audit committee, Rationalization with the proxy of total accrual income has a negative effect on fraudulent financial statements.

The financing of inclusive education in Ukraine and the procedure of using subsidies from the state budget to local budgets for providing state support to persons with special educational needs are the subject of research. The purpose of the article is to analyse the current process of financing inclusive education in Ukraine. The research methods were carried out in three years (2020, 2021, 2022). The methodology is based on modern provisions of economics, economic theory, financial law and reflects the interrelation of methodological approaches to the study of the concept of the process of financing inclusive education in general secondary educational institutions of Ukraine. The results of the study prove that the financing of inclusive education in Ukraine and the procedure of using subsidies from the state budget to local budgets for providing state support to persons with special educational needs is an urgent problem today. The procedure of using subsidies from the state budget to local budgets for providing state support to persons with special educational needs is highlighted. The formula for calculating the equalisation subsidy is constructed in such a way that a single standard of budgetary support per secondary school pupil is used for all general secondary schools. Funding programmes for inclusive education can be targeted at students and their families rather than at local authorities and schools. This can be financial assistance (e.g., scholarships), tuition fee waivers or other assistance such as school meals. The procedure and conditions for granting subsidies from the state budget to local budgets for the provision of state support for persons with special educational needs take into account the financing of resources for corrective and developmental classes. No more than 35% of the funds of the "integrative" subsidy are used for the purchase of corrective and developmental aids. The work of specialists hired on the basis of civil law contracts (for corrective and developmental classes) is also paid from this subsidy. The resolution also contains a list of corrective and developmental classes that may be conducted. Practical implications. The main source of funding from local budgets that can be used for inclusive education services is the equalisation grant. The government has a general policy of financing local authorities or schools. The method of financing regions, schools and pupils in secondary education in general and primary education in particular should be based more on equality in the redistribution of material resources. The Law of Ukraine "On General Secondary Education" (2020) states in paragraph 3 of Article 24 that for work in inclusive classes or groups there should be an additional payment of 20% to the tariff rate for all teaching staff. Special education teachers, rehabilitators and teacher's assistants receive an additional payment for hours worked in inclusive primary school classes. The research has shown that in 2020, the state will allocate 21.3 thousand UAH for each child who graduates from secondary school in various educational institutions in Ukraine.

Aims: The objectives of the study were: to determine suicide and substance abuse rate among college students within KMTC colleges in zone six; to establish psychosocial factors that influence mental and suicide distress among KMTC students in the mentioned zone; and to analyze the relationship between the psychosocial factors and suicide & substance rates among KMTC students in zone six. Methods: The study employed descriptive and inferential research design and collected both quantitative and qualitative data. The data collection instruments were interviews among students, focus group discussion and questionnaires. Study Sample: The study target population was at zone six colleges with population sample size of 289. Data Analysis: The collected data was analyzed by use of the Statistical Package for Social Science (SPSS) version 26.0. Data was presented in form of tables and figures. Institutional based cross-sectional study was conducted among students of Kenya Medical Training college, a structured self-administered questionnaire (SRQ 20) and suicidal ideation was assessed using semi structured yes/no question face to face interview. Stratified multistage sampling technique was used to select the study participants from respective campuses from a randomly selected zone. Ethical clearance was considered due to the sensitivity of the matter; clearance from respective authorities were obtained before actual data collection were done. Results: All of the respondents agreed to more than 50% on the factors that lead to suicide ideation. From the findings, 51.8% respondents agreed that the use Tobacco and its products (cigarette, chewing tobacco, cigars etc) affects their health, legal, social and cost financial problems weekly, 20.5 % once or twice 9.1% monthly 9.5% daily. Also 90.9% of the students agreed that Alcohol beverages (beer, wines, spirits etc) has caused health, legal, social and financial problems on a daily basis, 2.7% once or twice, 1.4% weekly and 15% never affected by alcohol. Conclusions and Recommendations: The study recommends that the government should develop an authority to handle suicide and mental health related issues. The authority should be seriously funded like case of HIV-AIDS. The authority should be able to establish adequate policy for the involvement of the society. Its policies should result in re-establishment of positive social norms, as currently norms seem to be dwindling slowly by slowly. This change in norms is likely to change society to prevent causes and effects of suicide, making the society view the phenomena differently and positively. The proposal was approved by the college research committee. Confidentiality of the participants was highly observed. In addition, the researcher-maintained anonymity of the respondents upon obtaining a written consent based on an elaborate explanation of the study.

Purpose The purpose of this paper is to report the training of college librarians, academic and management staff, IT managers and students on how to organise, manage and use a user-friendly library. In Uganda, as in many countries, the problem is that school and/or college libraries are managed by librarians who may have good cataloguing and management skills, but who do not have the pedagogic skills and knowledge of the school curricula that are necessary for librarians to be able to guide and mentor both teachers and students or organise curriculum-related activities or facilitate research. The development of user-friendly libraries contributes in improving education quality through nurturing the interest of students and teachers in literacy activities and active search for knowledge. Under the stewardship of the Belgium Technical Cooperation and the Ministry of Education in Uganda, library stakeholders were trained on how to put users – rather than themselves – in the centre of the library’s operations and introduced to active teaching and learning methodologies and activities with emphasis on getting engaged in transforming spaces, services, outreach to users and collections. Several measures, short and long term were taken to address the gaps limiting the performance of the librarians. Given the disparities in the trainees’ education level and work experience, the training was delivered in seven modules divided into three units for over eight months in 2015. By the end of the training, trainees developed unique library strategic plan, library policies and procedures, capacity to use library systems, physical design and maintenance systems, partnerships, library structure and staff job descriptions. Design/methodology/approach To effectively engage the participants each topic was conducted using active teaching and learning (ATL) methodologies, including: lecture with slides and hands-on practice – each topic was introduced in a lecture form with slides and hands-on exercises. The main goal was to introduce the participants to the concepts discussed, offer opportunities to explore alternative approaches, as well define boundaries for discussion through brainstorming. The question-answer approach kept the participants alert and to start thinking critically on the topic discussed – brainstorming sessions allowed thinking beyond the presentation room, drawing from personal experiences to provide alternatives to anticipated challenges. The goal here was for the participants to provide individual choices and approaches for real life problems; group discussions: case study/ scenario and participant presentations – participants were provided with a scenario and asked to provide alternative approaches that could solve the problem based on their personal experience at their colleges. By the end of the group discussion, participants presented a draft of the deliverable as per the topic under discussion. More so, group discussions were an excellent approach to test participant’s teamwork skills and ability to compromise, as well as respecting team decisions. It was an opportunity to see how librarians will work with the library committees. Group discussions further initiated and cemented the much-needed librarian–academic staff – college management relationship. During the group discussion, librarians, teaching staff, ICT staff and college management staff, specifically the Principals and Deputy Principals interacted freely thus starting and cultivating a new era of work relationship between them. Individual presentation: prior to the workshop, participants were sent instructions to prepare a presentation on a topic. For example, participants were asked to provide their views of what a “user-friendly library” would look like or what would constitute a “user-friendly library”; the college library of HTC-Mulago was asked to talk about their experience working with book reserves, challenges faced and plans they have to address the challenges, while the college librarian from NTC-Kaliro was asked to describe a situation where they were able to assist a patron, the limitations they faced and how they addressed them. Doing so did not only assist to emotionally prepare the participants for the training but also helped to make them start thinking about the training in relation to their libraries and work. Take-home assignment: at the end of each session, participants were given home assignments to not only revise the training material but also prepare for the next day training. Further the take-home assignments provided time for the participants to discuss with their colleagues outside of the training room so as to have a common ground/ understanding on some of the very sensitive issues. Most interesting assignment was when participants were asked to review an article and to make a presentation in relation to their library experiences. Participant reports: participant reports resulted from the take-home assignments and participants were asked to make submission on a given topic. For example, participants were asked to review IFLA section on library management and write a two-page report on how such information provided supported their own work, as well as a participant report came from their own observation after a library visit. Invited talks with library expert: two invited talks by library experts from Consortium of Uganda University Libraries and Uganda Library and Information Science Association with the goal to share their experience, motivate the participants to strive higher and achieve great things for their libraries. Library visitation: there were two library visits conducted on three separate days – International Hospital Kampala (IHK) Library, Makerere University Library and Aga Khan University Hospital Library. Each of these library visits provided unique opportunities for the participants to explore best practices and implement similar practices in their libraries. Visual aids – videos, building plans and still photos: these were visual learning aids to supplement text during the lectures because they carried lot of information while initiating different thoughts best on the participants’ past experience and expertise. The training advocated for the use of ATL methodologies and likewise similar methodologies were used to encourage participants do so in their classrooms. Findings Addressing Key Concerns: Several measures, both long and short term, were taken to address the gaps limiting the performance of the librarians. The measures taken included: selected representative sample of participants including all college stakeholders as discussed above; active teaching and learning methodologies applied in the training and blended in the content of the training materials; initiated and formulated approaches to collaborations, networks and partnerships; visited different libraries to benchmark library practices and encourage future job shadowing opportunities; and encouraged participants to relate freely, understand and value each other’s work to change their mindsets. College librarians were encouraged to ensure library priorities remain on the agenda through advocacy campaigns. Short-term measures: The UFL training was designed as a practical and hands-on training blended with individual and group tasks, discussions, take-home assignments and presentations by participants. This allowed participates to engage with the material and take responsibility for their own work. Further, the training material was prepared with a view that librarians support the academic life of teaching staff and students. Participants were tasked to develop and later fine-tune materials designed to support their work. For example, developing a subject bibliography and posting it on the library website designed using open source tools such as Google website, Wikis, blogs. The developed library manual includes user-friendly policies and procedures referred to as “dos and don’ts in the library” that promote equitable open access to information; drafting book selection memos; new book arrivals lists; subscribing to open access journals; current awareness services and selective dissemination of information service displays and electronic bulletins. Based on their library needs and semester calendar, participants developed action points and timelines to implement tasks in their libraries at the end of each unit training. Librarians were encouraged to share their experiences through library websites, Facebook page, group e-mail/listserv and Instagram; however, they were challenged with intimate internet access. College libraries were rewarded for their extraordinary job. Given their pivotal role in the management and administration of financial and material resources, on top of librarians, the participants in this training were college administrators/ management, teaching and ICT staff, researchers and student leadership. Participants were selected to address the current and future needs of the college library. These are individuals that are perceived to have a great impact towards furthering the college library agenda. The practical nature of this training warranted conducting the workshops from developed but similar library spaces, for example, Aga Khan University Library and Kampala Capital City, Makerere University Library, International Hospital Kampala Library and Uganda Christian University Library. Participants observed orientation sessions, reference desk management and interviews, collection management practices, preservation and conservation, secretarial bureau management, etc. Long-term measures: Changing the mindset of librarians, college administrators and teaching staff is a long-term commitment which continues to demand for innovative interventions. For example: job shadowing allowed college librarian short-term attachments to Makerere University Library, Uganda Christian University Library, Aga Khan Hospital University Library and International Hospital Kampala Library – these libraries were selected because of their comparable practices and size. The mentorship programme lasted between two-three weeks; on-spot supervision and follow-up visits to assess progress with the action plan by the librarians and college administration and college library committee; ensuring that all library documents – library strategic plan, library manual, library organogram, etc are approved by the College Governing Council and are part of the college wide governing documents; and establishing the library committee with a job description for each member – this has strengthened the library most especially as an advocacy tool, planning and budgeting mechanism, awareness channel for library practices, while bringing the library to the agenda – reemphasizing the library’s agenda. To bridge the widened gap between librarians and the rest of the stakeholders, i.e. teaching staff, ICT staff, college administration and students, a college library committee structure and its mandate were established comprising: Library Committee Chairperson – member of the teaching staff; Library Committee Secretary – College Librarian; Student Representative – must be a member of the student Guild with library work experience; and Representative from each college academic department. A library consortium was formed involving all the four project supported colleges to participate in resource sharing practices, shared work practices like shared cataloguing, information literacy training, reference interview and referral services as well a platform for sharing experiences. A library consortium further demanded for automating library functions to facilitate collaboration and shared work. Plans are in place to install Koha integrated library system that will cultivate a strong working relationship between librarians and students, academic staff, college administration and IT managers. This was achieved by ensuring that librarians innovatively implement library practices and skills acquired from the workshop as well as show their relevance to the academic life of the academic staff. Cultivating relationships takes a great deal of time, thus college librarians were coached on: creating inclusive library committees, timely response to user needs, design library programmes that address user needs, keeping with changing technology to suite changing user needs, seeking customer feedback and collecting user statistics to support their requests, strengthening the library’s financial based by starting a secretarial bureau and conducting user surveys to understand users’ information-seeking behaviour. To improve the awareness of new developments in the library world, college librarians were introduced to library networks at national, regional and international levels, as a result they participated in conferences, workshops, seminars at local, regional and international level. For example, for the first time and with funding from Belgium Technical Cooperation, college librarians attended 81st IFLA World Library and Information Congress in South African in 2015. College libraries are now members of the Consortium of Uganda University Libraries and Uganda Library and Information Science Association and have attended meetings of these two very important library organisations in Uganda’s LIS profession. The college librarians have attended meetings and workshops organized by these two organisations. Originality/value At the end of the three units training, participants were able to develop: a strategic plan for their libraries; an organogram with staffing needs and job description matching staff functions; a Library Committee for each library and with a structure unifying all the four project-support Colleges; a library action plan with due dates including deliverables and responsibilities for implementation; workflow plan and organisation of key sections of the library such as reserved and public spaces; furniture and equipment inventory (assets); a library manual and collection development policy; partnerships with KCCA Library and Consortium of Uganda University Libraries; skills to use Koha ILMS for performing library functions including: cataloguing, circulation, acquisitions, serials management, reporting and statistics; skills in searching library databases and information literacy skills; skills in designing simple and intuitive websites using Google Sites tools; and improved working relationship between the stakeholders was visible. To further the user-friendly libraries principle of putting users in the centre of the library’s operations, support ATL methodologies and activities with emphasis on getting engaged in transforming spaces, services, outreach to users and collections the following initiatives are currently implemented in the colleges: getting approval of all library policy documents by College Governing Council, initiating job shadowing opportunities, conducting on-spot supervision, guide libraries to set up college library committees and their job description, design library websites, develop dissemination sessions for all library policies, incorporate user-friendly language in all library documents, initiate income generation activities for libraries, set terms of reference for library staff and staffing as per college organogram, procurement of library tools like DDC and library of congress subject headings (LCSH), encourage attendance to webinars and space planning for the new libraries.

Constant demand for new naval and commercial vessels has created special conditions for the Government-owned Soviet shipbuilding industry, which practically has not been affected by the world shipbuilding crisis. On the other hand, such chronic diseases of the centralized economy as lack of incentive, material shortage and poor workmanship cause specific problems for ship construction. Being technically and financially unable to rapidly improve the overall technology level and performance of the entire industry, the Soviets concentrate their efforts on certain important areas and have achieved significant results, especially in welding and cutting titanium and aluminum alloys, modular production methods, standardization, etc. All productivity improvement efforts are supported by an army of highly educated engineers and scientists at shipyards, in multiple scientific, research and design institutions. Discussion Edwin J. Petersen, Todd Pacific Shipyards Three years ago I addressed the Ship Production Symposium as chairman of the Ship Production Committee and outlined some major factors which had contributed to the U.S. shipbuilding industry's remarkable achievements in building and maintaining the world's largest naval and merchant fleets during the five-year period starting just before World War II. The factors were as follows:There was a national commitment to get the job done. The shipbuilding industry was recognized as a needed national resource. There was a dependable workload. Standardization was extensively and effectively utilized. Shipbuilding work was effectively organized. Although these lessons appear to have been lost by our Government since World War II, the paper indicates that the Soviet Union has picked up these principles and has applied them very well to its current shipbuilding program. The paper also gives testimony to the observation that the Soviet Government recognizes the strategic and economic importance of a strong merchant fleet as well as a powerful naval fleet. In reviewing the paper, I found great similarity between the Soviet shipbuilding productivity improvement efforts and our own efforts or goals under the National Shipbuilding Research Program in the following areas:welding technology, flexible automation (robotics), application of group technology, standardization, facilities development, and education and training. In some areas, the Soviet Union appears to be well ahead of the United States in improving the shipbuilding process. Most noteworthy among these is the stable long-and medium-range planning that is possible by virtue of the use and adherence to the "Table of Vessel Classes." It will be obvious to most who hear and read these comments what a vast and significant improvement in shipbuilding costs and schedules could be achieved with a relatively dependable 15year master ship procurement plan for the U.S. naval and merchant fleets. Another area where the Soviet Union appears to lead the United States is in the integration of ship component suppliers into the shipbuilding process. This has been recognized as a vital step by the National Shipbuilding Research Program, but so far we have not made significant progress. A necessary prerequisite for this "supplier integration" is extensive standardization of ship components, yet another area in which the Soviets have achieved significantly greater progress than we have. Additional areas of Soviet advantage are the presence of a multilevel research and development infrastructure well supported by highly educated scientists, engineering and technical personnel; and better integration of formally educated engineering and technical personnel into the ship production process. In his conclusion, the author lists a number of problems facing the Soviet economy that adversely affect shipbuilding productivity. Perhaps behind this listing we can delve out some potential U.S. shipbuilding advantages. First, production systems in U.S. shipyards (with the possible exception of naval shipyards) are probably more flexible and adjustable to meet new circumstances as a consequence of not being constrained by a burdensome centralized bureaucracy, as is the case with Soviet shipyards. Next, such initiatives as the Ship Production Committee's "Human Resources Innovation" projects stand a better chance of achieving product-oriented "production team" relationship among labor, management, and technical personnel than the more rigid Soviet system, especially in view of the ability of U.S. shipyard management to offer meaningful financial incentives without the kind of bureaucratic constraints imposed in the Soviet system. Finally, the current U.S. Navy/shipbuilding industry cooperative effort to develop a common engineering database should lead to a highly integrated and disciplined ship design, construction, operation, and maintenance system for naval ships (and subsequently for commercial ships) that will ultimately restore the U.S. shipbuilding process to a leadership position in the world marketplace (additional references [16] and [17]).On that tentatively positive note, it seems fitting to close this discussion with a question: Is the author aware of any similar Soviet effort to develop an integrated computer-aided design, production and logistics support system? The author is to be congratulated on an excellent, comprehensive insight into the Soviet shipbuilding process and productivity improvement efforts that should give us all adequate cause not to be complacent in our own efforts. Peter M. Palermo, Naval Sea Systems Command The author presents an interesting paper that unfortunately leaves this reader with a number of unanswered questions. The paper is a paradox. It depicts a system consisting of a highly educated work force, advanced fabrication processes including the use of standardized hull modules, sophisticated materials and welding processes, and yet in the author's words they suffer from "low productivity, poor product quality, . . . and the rigid production systems which resists the introduction of new ideas." Is it possible that incentive, motivation, and morale play an equally significant role in achieving quality and producibility advances? Can the author discuss underlying reasons for quality problems in particular—or can we assume that the learning curves of Figs. 5 and Fig. 6 are representative of quality improvement curves? It has been my general impression that quality will improve with application of high-tech fabrication procedures, enclosed fabrication ways, availability of highly educated welding engineers on the building ways, and that productivity would improve with the implementation of modular or zone outfitting techniques coupled with the quality improvements. Can the author give his impressions of the impact of these innovations in the U.S. shipbuilding industry vis-a-vis the Soviet industry? Many of the welding processes cited in the paper are also familiar to the free world, with certain notable exceptions concerning application in Navy shipbuilding. For example, (1) electroslag welding is generally confined to single-pass welding of heavy plates; application to thinner plates—l1/4 in. and less when certified—would permit its use in more applications than heretofore. (2) Electron beam welding is generally restricted to high-technology machinery parts; vacuum chamber size restricts its use for larger components (thus it must be assumed that the Soviets have solved the vacuum chamber problem or have much larger chambers). (3) Likewise, laser welding has had limited use in U.S. shipbuilding. An interesting theme that runs throughout the paper, but is not explicitly addressed, is the quality of Soviet ship fitting. The use of high-tech welding processes and the mention of "remote controlled tooling for welding and X-ray testing the butt, and for following painting" imply significant ship fitting capabilities for fitting and positioning. This is particularly true if modules are built in one facility, outfitted and assembled elsewhere depending on the type of ship required. Any comments concerning Soviet ship fitting capabilities would be appreciated. The discussion on modular construction seems to indicate that the Soviets have a "standard hull module" that is used for different types of vessels, and if the use of these hull modules permit increasing hull length without changes to the fore and aft ends, it can be assumed that they are based on a standard structural design. That being the case, the midship structure will be overdesigned for many applications and optimally designed for very few. Recognizing that the initial additional cost for such a piece of hull structure is relatively minimal, it cannot be forgotten that the lifecycle costs for transporting unnecessary hull weight around can have significant fuel cost impacts. If I perceived the modular construction approach correctly, then I am truly intrigued concerning the methods for handling the distributive systems. In particular, during conversion when the ship is lengthened, how are the electrical, fluid, communications, and other distributive systems broken down, reassembled and tested? "Quick connect couplings" for these type systems at the module breaks is one particular area where economies can be achieved when zone construction methods become the order of the day in U.S. Navy ships. The author's comments in this regard would be most welcome. The design process as presented is somewhat different than U.S. Navy practice. In U.S. practice, Preliminary and Contract design are developed by the Navy. Detail design, the development of the working drawings, is conducted by the lead shipbuilder. While the detail design drawings can be used by follow shipbuilders, flexibility is permitted to facilitate unique shipbuilding or outfitting procedures. Even the contract drawings supplied by the Navy can be modified— upon Navy approval—to permit application of unique shipbuilder capabilities. The large number of college-trained personnel entering the Soviet shipbuilding and allied fields annually is mind-boggling. According to the author's estimation, a minimum of about 6500 college graduates—5000 of which have M.S. degrees—enter these fields each year. It would be most interesting to see a breakdown of these figures—in particular, how many naval architects and welding engineers are included in these figures? These are disciplines with relatively few personnel entering the Navy design and shipbuilding field today. For example, in 1985 in all U.S. colleges and universities, there were only 928 graduates (B.S., M.S. and Ph.D.) in marine, naval architecture and ocean engineering and only 1872 graduates in materials and metallurgy. The number of these graduates that entered the U.S. shipbuilding field is unknown. Again, the author is to be congratulated for providing a very thought-provoking paper. Frank J. Long, Win/Win Strategies This paper serves not only as a chronicle of some of the productivity improvement efforts in Soviet shipbuilding but also as an important reminder of the fruits of those efforts. While most Americans have an appreciation of the strengths of the Russian Navy, this paper serves to bring into clearer focus the Russians' entire maritime might in its naval, commercial, and fishing fleets. Indeed, no other nation on earth has a greater maritime capability. It is generally acknowledged that the Soviet Navy is the largest in the world. When considering the fact that the commercial and fishing fleets are, in many military respects, arms of the naval fleet, we can more fully appreciate how awesome Soviet maritime power truly is. The expansion of its maritime capabilities is simply another but highly significant aspect of Soviet worldwide ambitions. The development and updating of "Setka Typov Su dov" (Table of Vessel Classes), which the author describes is a classic example of the Soviet planning process. As the author states, "A mighty fishing and commercial fleet was built in accordance with a 'Setka' which was originally developed in the 1960's. And an even more impressive example is the rapid expansion of the Soviet Navy." In my opinion it is not mere coincidence that the Russians embarked on this course in the 1960's. That was the beginning of the coldest of cold war periods—Francis Gary Power's U-2 plane was downed by the Russians on May 1, 1960; the mid-May 1960 Four Power Geneva Summit was a bust; the Berlin Wall was erected in 1961 and, in 1962, we had the Cuban Missile Crisis. The United States maritime embargo capability in that crisis undoubtedly influenced the Soviet's planning process. It is a natural and normal function of a state-controlled economy with its state-controlled industries to act to bring about the controlled productivity improvement developments in exactly the key areas discussed in the author's paper. As the author states, "All innovations at Soviet shipyards have originated at two main sources:domestic development andadaptation of new ideas introduced by leading foreign yards, or most likely a combination of both. Soviet shipbuilders are very fast learners; moreover, their own experience is quite substantial." The Ship Production Committee of SNAME has organized its panels to conduct research in many of these same areas for productivity improvement purposes. For example, addressing the areas of technology and equipment are Panels SP-1 and 3, Shipbuilding Facilities and Environmental Effects, and Panel SP-7, Shipbuilding Welding. Shipbuilding methods are the province of SP-2; outfitting and production aids and engineering and scientific support are the province of SP-4, Design Production Integration. As I read through the descriptions of the processes that led to the productivity improvements, I was hoping to learn more about the organizational structure of Soviet shipyards, the managerial hierarchy and how work is organized by function or by craft in the shipyard. (I would assume that for all intents and purposes, all Russian yards are organized in the same way.) American shipyard management is wedded to the notion that American shipbuilding suffers immeasurably from a productivity standpoint because of limitations on management's ability to assign workers across craft lines. It is unlikely that this limitation exists in Soviet shipyards. If it does not, how is the unfettered right of assignment optimized? What are the tangible, measurable results? I believe it would have been helpful, also, for the author to have dedicated some of the paper to one of the most important factors in improvement in the labor-intensive shipbuilding industry—the shipyard worker. There are several references to worker problems—absenteeism, labor shortage, poor workmanship, and labor discipline. The reader is left with the impression that the Russians believe that either those are unsolvable problems or have a priority ranking significantly inferior to the organizational, technical, and design efforts discussed. As a case in point, the author devotes a complete section to engineering education and professional training but makes no mention of education or training programs for blue-collar workers. It would seem that a paper on productivity improvement efforts in Soviet shipbuilding would address this most important element. My guess is that the Russians have considerable such efforts underway and it would be beneficial for us to learn of them.

This study aims at describing principles of fairness education examined from intellectual and financial aspects of sociology in the social perspectives. Relying on the quantitative approach, this study collected data using survey, observation, in depth interview, and documentary analysis. Area sampling techniques were used in this study involving one countries and one cities in the Makasar provinces. The number of respondents and their areas were 2 persons from Education Department Office, 12 principals, 12 school-teachers, 12 student-parents, 3 members of School Committee, and 24 students. Data of this study were analyzed using tabulation techniques focusing on the frequency and rate percentage. Three findings were revealed in this study. First, schools that have conducted principles of fairness education included schools that opened acceleration classes, superior classes, SNBI classes, bilingual classes, and inclusive or integrated classes. Second, schools that implemented principles of fairness education emphasizing on financial aspects were schools that gave scholarships and cross-subsidy. Third, schools that accommodated principles of fairness education based on the intellectual aspect put strong emphasis on the quality of input students. In addition, financial aspects in the implementation of principles of fairness education included economy status of students’ parents, school budget condition, support from local government, support from school committee, and support from stakeholders.

The Scholarships in Science, Technology, Engineering, and Mathematics (S-STEM) Program in the Department of Computer Science, Mathematics, and Engineering at Shepherd (grant number: DUE - 1259713) has been funded by NSF since June 2013. The overall goal of the program is to increase the number of STEM graduates by providing financial, academic, and social supports, which enables qualified students to overcome certain barriers that prevent them from meeting their educational and career goals. In fall 2015, 64 applications were received; the selection committee interviewed qualified applicants and selected 16 new awardees. In this poster, major activities for supported students are presented. Survey and report results from the last academic year, along with initiatives that increase, retain, and support students in STEM fields such as Computer Information Science, Computer Information Technology, Computer Engineering, and Mathematics, are discussed.

This article discusses the impact of COVID-19 on a cohort of international students studying at one Australian university and the efforts made by social work academics to assist these students through a challenging and distressing time between December 2019 and July 2020. International social work students usually rely on scholarships and casual employment to support themselves while studying. Nonetheless, the Australian government made no financial provisions for international students when the COVID-19 pandemic struck leaving many students without any means of support. Students from all parts of the world attend Griffith University, located in south-east Queensland, Australia, including students from Wuhan, China, where the first known outbreak of COVID-19 was identified. Shame, anxiety, racism and concerns related to the wellbeing of families overseas were superimposed onto their own health concerns and day-to-day survival while still seeking to maintain academic progress. Material and emotional support were provided through the establishment of a food bank and the development of a case management model to address the needs of students. A COVID-19 Alternative Placement course and a field education student hub supported academic success during the health emergency. These interventions developed independently as a crisis response and were merged into a multi-pronged, coordinated approach that included collaborations with other sections of the university and the community. A School working committee was established to co-ordinate interventions to address individual student need that included crisis intervention, referrals to internal and external resources, and developing communities of support. The journey traveled by students and academics and the lessons learned from this experience are described, all of which are relevant to future health emergencies including the value of involving social work in university preparedness planning. The article concludes that intensive support can enhance resilience while supporting students’ own survival strategies, and, importantly, how such efforts can minimize, as far as possible, disruption to academic progress.

Local Governments (LGs) plays a vital role in Sustainable Development (SD) at the grassroots. Despite the enormous powers and responsibilities vested in LGs, they failed to function efficiently and effectively due to the failure and unethical nature of LGs budgeting. LGs budgeting process suffer from inappropriate planning leading to misallocation of public funds. This call for better understanding of Budgeting Techniques (BT), Budgetary Control (BC), and instruments for effective BT and BC in LGs. Based on this, the study examined BT and BC with Participatory Budgeting (PB) as a critical instrument for SD in LGs. The study adopts exploratory research design. The study concluded that budget process and its implementation should be fair, equitable and transparent in the allocation of scarce resources in order to avert corruption, wastages and inefficiency in service delivery. Furthermore, adoption of PB technique will aid transparency, accountability, and probity in the distribution of public resources. It also aids in communicating government policies, programs, and political direction among the citizens, thereby entrenched democratic system. The study recommends that stakeholders should be fully involved in budget preparation while LG should installed sound internal control mechanism and effective budget monitoring and implementation strategies for performance appraisal and decision making. LG should also ensure strict compliance to due process and laid down rules on budgeting to safeguard fraud and financial recklessness on procurement of goods and services. In addition, Public Account Committee of the legislative house should be alert to their responsibilities.

Eradication of hunger is one of the sustainable development goals listed by the United Nations. By 2050 the expected world population would be 10 billion and to provide food for all, we need to prioritize food security. A robust food security ecosystem will help to ensure that hygienic, nutritious food is available to the general population of a country. A decrease in the production of nutritious and safe food or limited purchasing power of consumers leads to food insecurity. Individuals facing financial constraints are affected the most because of food insecurity and hence are at a high risk of hunger and malnutrition. A deficiency, excess or imbalance of certain nutrients in the diet leads to malnutrition. Malnutrition is often used synonymously with undernutrition, which can be because of a deficiency of protein and/or micronutrients in the diet. Among the micronutrients, iron, zinc, and folic acid deficiency is very prevalent and the leading cause of undernutrition. Protein-energy malnutrition leads to conditions like Marasmus and Kwashiorkor. The common infectious diseases associated with undernutrition are pneumonia, diarrhoea, malaria, measles, and AIDS. Thus, food insecurity poses challenges not only to addressing public health but also affects the overall economic growth and socio-political stability of any nation. Hence at the global level, several programmes have been envisioned by the World Health Organization and United Nations Standing Committee on Nutrition. In context to the Indian population, the Government of India has started implementing various initiatives to establish food security. However, issues such as climate change, drought, floods, demographic changes, wars, increasing global population and pandemics need to be constantly addressed to achieve sustainable developmental goals. In this review, we have discussed what food security is and how in its absence, malnutrition predominates in a sizable population, especially children. The consequences of nutrient deficiency and their relationship with immunity and infection are highlighted and finally, the efforts that are being taken to tackle food security at a global level and in context to Indian issues are discussed.

Abstract Background The global critical shortage of health workers prevents expansion of healthcare services and universal health coverage. Like most countries in sub-Saharan Africa, Kenya’s healthcare workforce density of 13.8 health workers per 10,000 population falls below the World Health Organization (WHO) recommendation of at least 44.5 doctors, nurses, and midwives per 10,000 population. In response to the health worker shortage, the WHO recommends task sharing, a strategy that can increase access to quality health services. To improve the utilization of human and financial health resources in Kenya for HIV and other essential health services, the Kenya Ministry of Health (MOH) in collaboration with various institutions developed national task sharing policy and guidelines (TSP). To advance task sharing, this article describes the process of developing, adopting, and implementing the Kenya TSP. Case presentation The development and approval of Kenya’s TSP occurred from February 2015 to May 2017. The U.S. Centers for Disease Control and Prevention (CDC) allocated funding to Emory University through the United States President’s Emergency Plan for AIDS Relief (PEPFAR) Advancing Children’s Treatment initiative. After obtaining support from leadership in Kenya’s MOH and health professional institutions, the TSP team conducted a desk review of policies, guidelines, scopes of practice, task analyses, grey literature, and peer-reviewed research. Subsequently, a Policy Advisory Committee was established to guide the process and worked collaboratively to form technical working groups that arrived at consensus and drafted the policy. The collaborative, multidisciplinary process led to the identification of gaps in service delivery resulting from health workforce shortages. This facilitated the development of the Kenya TSP, which provides a general orientation of task sharing in Kenya. The guidelines list priority tasks for sharing by various cadres as informed by evidence, such as HIV testing and counseling tasks. The TSP documents were disseminated to all county healthcare facilities in Kenya, yet implementation was stopped by order of the judiciary in 2019 after a legal challenge from an association of medical laboratorians. Conclusions Task sharing may increase access to healthcare services in resource-limited settings. To advance task sharing, TSP and clinical practice could be harmonized, and necessary adjustments made to other policies that regulate practice (e.g., scopes of practice). Revisions to pre-service training curricula could be conducted to ensure health professionals have the requisite competencies to perform shared tasks. Monitoring and evaluation can help ensure that task sharing is implemented appropriately to ensure quality outcomes.

Objectives: GLOBAL AIM: Increase license portability across state lines for all US medical professionals. SPECIFIC AIM: Increase the ability to provide medical care nationwide for all US sports medicine physicians (who have a CAQ for their specialty) across state lines and set a precedent for other licensed healthcare professionals by 2026. The aim is to extend the portability of medical licensure across state lines to all sports medicine professionals (not just those who care for professional teams) and use this as a precedent eventually for all types of healthcare workers. Currently sports medicine physicians for professional teams are allowed to provide care across state lines which is legislated by “The Sports Medicine Licensure Clarity Act” (SMLCA) in 2018. As July 22, 2022, licensure is allowed for at least telemedicine across state lines for 23 states and has been extended by the HHS as part of Covid healthcare measures that were implemented in 2020. Methods: Review of current policies, barriers and facilitators has been performed using various search strategies and qualitative techniques. Current state and national laws were reviewed and will be presented. California has a large population where there is no reciprocity for other medical professionals, therefore meetings have been set with the Business Professions Committee with a plan to submit a bill sponsored by a state assemblyman to expand access to licensure across state lines in 2023. Results: One barrier is the loss of states’ autonomy as well as the individual authority and stature a medical professional may gain from being on a licensing board. Most US states have no reciprocity and not all have the licensure process standardized. Some states have a non-transparent process and others do not wish to participate in regional compacts such as California. Even more concerning, some states are found to more-likely censure doctors of color and perform sham peer review. This is an example of bias in medical credentialing that can impede diversity and inclusion efforts. The European Union allows medical licensure across national borders. Doctors need to pass a language proficiency test for the country they wish to practice in, regardless of which European country they received their medical training. Given that English is the only language of instruction in the US, proficiency can be easily evaluated. Language should not be a barrier to license portability, especially if one is already licensed in one US state even for foreign medical graduates. The Covid pandemic showed licensure is obtainable in a relatively rapid fashion across state lines. In addition, federal health care facilities such as the VA system already allow practitioners licensed in one state to practice in another without a license to that specific state. Portability across state-lines aids practitioners who practice on state borders in both rural and urban areas, such as the NH and VT border(rural), and NY and DC metro areas (urban) as well as telehealth for both an immobile and mobile populations, enhancing equitable healthcare access. This also removes financial barriers of cost for licensing fees for practitioners and staff resources to process licenses. Conclusions: The US has one of the most restrictive medical licensures of all developed countries, making mobilization of healthcare workers extremely difficult. Removing this barrier will be beneficial when medical staff is needed across state lines for pandemics, natural disasters, intake of refugees/immigrants, and global sporting events held in the US such as the World Cup in 2026, and Olympics in 2028. This could also extend access for the general US population to healthcare providers via “tele-medicine” (virtual/video visits), to essentially all populations (socio-economically disadvantaged, immigrants, those with mobility and transportation barriers, rural locations etc). This will ensure higher quality care, better follow-up along with more timely and equitable healthcare, which are all currently limited by restricting portability and requiring licenses for each individual state.

Photo by Renè Müller on Unsplash INTRODUCTION Forced sterilization of women around the globe is a human rights violation and bioethical concern. In the past, countries enacted laws to forcibly sterilize women deemed unfit to procreate. Although many of these laws have been retracted, the practice persists under the guise of public health. More recently, women living with HIV have been targets of nonconsensual sterilization. Consent is frequently obtained while under duress or threat or not obtained at all. Nonconsensual sterilization has been documented in Chile, the Dominican Republic, Mexico, Namibia, South Africa, and Venezuela.[1] In 2015, three women who were sterilized without consent sued the Supreme Court of Namibia, which did not find evidence that the doctors engaged in discrimination by performing or recommending the procedures due to the patient's HIV status.[2] l. What is Forced and Coerced Sterilization? Forced sterilization is any sterilization that takes place without a patient’s informed consent. In healthcare settings, it occurs when women seeking sexual and reproductive health care are sterilized without their knowledge or the opportunity to provide informed consent. The practice is used as a means of permanent contraception. Surgery is the most common sterilization method. Women may unknowingly have a hysterectomy, the blocking and severing of fallopian tubes, or they may be administered a medication that causes the fallopian tubes to seal, thus preventing fertilization. Nonconsensual sterilization may result from misinformation, financial incentives, or intimidation tactics obliging women to approve of the procedure.[3] ll. Namibia: A Case Study Namibia presents a crucial bioethical injustice despite its perceived legislative success in curbing forced sterilization. In 2008, the International Community of Women Living with HIV/AIDS (ICW) and the Namibian Women’s Health Network (NWHN) documented mass violations of sexual and reproductive health rights. The report recorded breaches of informed consent when testing for HIV, denial of information to women with HIV, and divulging or risking confidential patient information.[4] Between 2005 and 2007, three women were coerced into bilateral tubal ligation when seeking reproductive health care. In 2012, the women filed a suit against the Namibian Government for constitutional violations.[5] Their claims included infringements of their rights to dignity, liberty, and to make decisions about starting a family. In addition, the women claimed the procedures were discriminatory due to the women’s HIV status. In 2015, the Namibian High Court ruled in the women’s favor and rendered the sterilizations unlawful. However, the Court failed to conclude that the acts were discriminatory. [6] lll. Autonomy In the traditional Western view of bioethics, autonomy is defined as self-rule, freedom from the control and limitations of others. Autonomy requires informed consent and the absence of coercion. If a person’s choice is based on manipulation, coercion, or compulsion, consent is not truly voluntary, and if it is based on misinformation, it is not informed, violating autonomy.[7] Eight hours into labor, a nurse informed one of the plaintiffs that she must undergo a hysterectomy. The plaintiff was presented with official documentation to consent to the procedure, which was not explained to her. The documentation referred only to the sterilization procedure using an abbreviation. She was dependent on the clinician’s assistance in the birthing procedure. She was not aware of the nature of the procedure because she did not understand the options and consequences in the consent document. The healthcare workers made no effort to inform the woman of her right to abstain from the procedure, which she did not understand was a sterilization procedure. She did not learn that she was sterile until returning to the clinic to obtain retroviral medication for her child.[8] The consent was neither voluntary nor informed, undermining autonomy. lV. Beneficence The principle of beneficence consists of the moral obligation to do good and has been described as requiring one to act for another’s benefit or to further a patient’s interests. What constitutes the patient’s good is related to both the patient’s view of her good and what allows her to pursue her own conceptualization of “good.” Beneficence from a physician’s viewpoint might also concern what the physician thinks is good or best for the patient. Studies asking women, “have there been any positive or good changes in your life ever since you found out that you were sterilized,” report no positive outcomes.[9] By ignoring the interests of patients, beneficence is abandoned. By performing forced sterilizations, healthcare workers deprive women of the right to bear children in the future. This directly violates the notion of prioritizing a patient’s interests. In Namibia, patriarchal cultural values about reproduction, marriage, and child-rearing instill expectations on women to bear and rear children.[10] Forcibly sterilizing women ignores heightened cultural pressures and the psychosocial outcomes for women who cannot become pregnant. Sterilization risks discrimination against women with HIV. In addition, a woman who is forcibly sterilized may suffer abuse from a spouse who was excluded from the decision, leading to compounding adverse effects on physical and psychological well-being. Beneficence also calls for ending discrimination. Coerced sterilization is partly based on mistaken beliefs about vertical HIV transmission.[11] Although proper medication can prevent mother-to-child transmission, clinicians who are ill-informed about transmission resort to sterilization. Women subjected to forced sterilization suffer immense physical harm at clinicians' hands. Consequential physical health problems include heavy menstrual bleeding, severe abdominal pain, and lower limb weakness. These physical health problems increase financial difficulties and the need for health services, placing additional financial, physical, and emotional stress on patients. Clinicians’ disregard for the socio-cultural consequences is non-beneficent and a bioethical lapse. The sterilizations come under the backdrop of pervasive victimization of women, discrimination, and gender-based violence, made worse in the aftermath of sterilization.[12] Among women forcibly sterilized in Latin American countries, pregnant women with HIV are six times more likely to be forcibly sterilized than pregnant women with HIV whose diagnosis was unknown to themselves and their physicians.[13] Equivalent findings have been documented in Southern Africa.[14] By perpetuating HIV-discriminatory beliefs that deem women unworthy of reproduction, clinicians subject patients to harmful discrimination and freely discount the principle of justice. V. Through a Human Rights Lens Nonconsensual sterilization is recognized as an “act of torture, and cruel, inhumane, and degrading treatment” by the United Nations Human Rights Committee. Torture is defined as intentionally inflicted suffering on a person for an improper purpose or if that purpose is based on discrimination. [15] The United Nations has condemned forced sterilization as a violation of the rights to health, bodily integrity, freedom from violence, freedom from torture, freedom from discrimination, and to decide the number and spacing of their children. The right to health is guaranteed under the International Covenant on Economic, Social, and Cultural Rights (ICESCR). The right to information is guaranteed under The International Covenant on Civil and Political Rights (ICCPR).[16] There is also a long recognized right to informed consent under which healthcare practitioners provide the information necessary for people to make an informed choice. Practitioners must disclose the risks and benefits of a procedure. In the actions leading to the 2015 lawsuit in Namibia, the women were unaware that they had been made sterile until they returned to a healthcare facility. They had not been given a choice. The doctors told them they ‘must’ undergo the procedure. The clinicians failed to provide clear and comprehensible information and did not confirm that the patients understood the consequences of the process. Using the patient care framework (HRPC), healthcare facilities and governments can reduce stigma and discrimination. HRPC acknowledges the systematic nature of forced and coerced sterilization and calls for seeking out and trying to eliminate involuntary and coerced sterilization. To comply with the HRPC, countries must investigate and abolish all instances of coerced sterilization in an effective and just manner. In the courts, better human rights argumentation and the ability to challenge legal deficiencies would improve plaintiffs’ ability to win cases. CONCLUSION The bioethics community should take action to end coerced sterilizations as they violate the four principles of bioethics set forth by Beauchamp and Childress. In Namibia, the case of the three plaintiffs demonstrates the need for more bioethical attention, as the disregard for autonomy, beneficence, nonmaleficence, and justice were clear. Employing a human rights framework emphasizes the structural origins of the practice and calls for governments to seek out and end coerced sterilization. If coerced sterilization does occur, courts that prosecute it can be a deterrent and can work toward righting the wrong through the justice system. - [1] Open Society Foundations, “Against Her Will: Forced and Coerced Sterilization of Women Worldwide.”, (2011): 2-10 (accessed August). [2] Nyasha Chingore-Munazvo, Katherine Furman, Annabel Raw and Mariette Slabbert, “Chronicles of communication and power: informed consent to sterilisation in the Namibian Supreme Court’s LM judgment of 2015,” Theoretical Med Bioethics 38 (April 2017): 145-162, https://doi.org/10.1007/s11017-017-9405-0 [3] Mindy Jane Roseman, Aziza Ahmed, and Jennifer Gatsi-Mallet, “At the Hospital There Are No Human Rights’: Reproductive and Sexual Rights Violations of Women Living with HIV in Namibia,” no. 128-130 (July 2012), http://dx.doi.org/10.2139/ssrn.2220800. [4] Roseman, Ahmed, and Gatsi-Mallet, “At the Hospital,” 4. [5] LM and Others v. Government of the Republic of Namibia (I 1603/2008, I 3518/2008, I 3007/2008) at 4. The judgment notes the plaintiffs’ claims that the unlawful conduct violated the plaintiff’s rights guaranteed under the Constitution of the Republic of Namibia, in particular, her right to life (Article 7) , her right to human dignity (Article 8), and her right to found a family (Article 14). (2012) NAHC 211, https://namiblii.org/na/judgment/high-court/2012/211. [6] Chingore-Munazvo, Furman, Raw and Slabbert, “Chronicles of communication and power,” 146. [7] Jukka Varelius, “The value of autonomy in medical ethics,” Med, Health Care Philos 9 (October 2006): 377-388, https://doi.org/10.1007/s11019-006-9000-z. [8] Chingore-Munazvo, Furman, Raw and Slabbert, “Chronicles of communication and power,” 142-147. [9] Kudzai Bakare & Shelene Gentz, “Experiences of forced sterilisation and coercion to sterilise among women living with HIV (WLHIV) in Namibia: an analysis of the psychological and socio-cultural effects,” Sexual and Reproductive Health Matters, 28 no.1, https://doi.org/10.1080/26410397.2020.1758439. [10] Bakare & Gentz, “Experiences of forced sterilization.” [11] Open Society Foundations, “Against Her Will.” [12] Tamil Kendall and Claire Albert, “Experiences of coercion to sterilize and forced sterilization among women living with HIV in Latin America,” Wiley Online Library 18, no. 1 (March 2015), https://doi.org/10.7448/IAS.18.1.19462. [13] Kendall and Albert, “Experiences of coercion.” [14] Chingore-Munazvo, Furman, Raw and Slabbert, “Chronicles of communication and power.” [15] Open Society Foundations, “Against Her Will.” [16] Priti Patel, “Forced sterilization of women as discrimination,” Public Health Reviews 38, no. 15 (July 2017), https://doi.org/10.1186/s40985-017-0060-9.

Photo by Nathan Dumlao on Unsplash ABSTRACT The demographic of physicians in the United States has failed to include a proportionate population of Latinos in the United States. In what follows, I shall argue that the medical school admission process places an undue burden on low-income Latino applicants. Hence, the underrepresentation of Latinos in medical schools is an injustice. This injustice relates to the poor community health of the Latino community. Health disparities such as diabetes, HIV infection, and cancer mortality are higher amongst the Latino community. The current representation of Latino medical students is not representative of those in the United States. INTRODUCTION The demographic of physicians in the United States has failed to include a proportionate number of Latinos, meaning people of Latin American origin. Medical schools serve as the gatekeepers to the medical field, and they can alter the profession based on whom they admit. With over 60 million Latinos in the United States, people of Latin American origin comprise the largest minority group in the nation.[1] In 2020-2021, only 6.7 percent of total US medical school enrollees and only 4 percent of medical school leadership identified as Latino.[2] Latino physicians can connect to a historically marginalized community that faces barriers including language, customs, income, socioeconomic status, and health literacy. I argue that the medical school admissions process places an undue burden on low-income Latino applicants. This paper explores the underrepresentation of Latinos in medical schools as an injustice. A further injustice occurs as the barriers to medical education result in fewer Latino doctors to effectively deliver health care and preventive health advice to their communities in a culturally competent way. I. Latino Community Health Data The terms Latino and Hispanic have largely been considered interchangeable. US government departments, such as the US Census Bureau and the Centers for Disease Control and Prevention (CDC), define Hispanic people as those with originating familial ties to native Spanish-speaking countries, most of whom are from Latin America. The term Latino is more inclusive because it refers to all of those with strong originating ties to countries in Latin America, including those coming from countries such as Brazil and Belize who are not native Spanish speakers. Throughout this work, I refer to the term Latino because it is more inclusive, although the data retrieved from US government departments may refer to the population as Hispanic. “Low-income” refers to the qualifying economic criteria for the AAMC’s Fee Assistance Program Poverty Guidelines.[3] The AAMC Fee Assistance Program is designed to help individuals who do not have the financial means to pay the total costs of applying to medical school. For this paper, low-income refers to those who qualify for this program. The US government gathers data about Latino community health and its health risks. The Latino community has a higher poverty rate than the non-Hispanic white community.[4] Latino community health has long trailed that of white people collectively. For example, the Latino community experiences higher levels of preventable diseases, including hypertension, diabetes, and hepatitis, than the non-Hispanic white community does.[5] The CDC collects data about Latino community health and provides statistics to the public. Latinos in the United States trail only non-Hispanic blacks in prevalence of obesity. The Latino adult obesity rates are 45.7 percent for males and 43.7 percent for females.[6] Of the 1.2 million people infected with HIV in the United States, 294,200 are Latino.[7] The infection rate of chlamydia is 392.6 per 100,000 ― 1.9 times the rate in the non-Hispanic white population.[8] The tuberculosis incidence rate is eight times higher than that of non-Hispanic white people at 4.4 per 100,000.[9] Furthermore, Latinos have the third highest death rate for hepatitis C among all races and ethnic groups.[10] The prevalence of total diabetes, diagnosed and undiagnosed, among adults aged 18 and older also remains higher than that of non-Hispanic whites at 14.7 percent compared to 11.9 percent.[11] The high disease rate evidences the poor health of the community. Furthermore, 19 percent of Latinos in the United States remain uninsured.[12] Almost a quarter of the Latino population in the United States lives in poverty.[13] The high incidence of disease, lack of insurance, and high poverty rate create a frail health status for the Latino community in the United States. The medical conditions seen are largely preventable, and the incident rates can be lowered with greater investments in Latino community health. Considering the health disparities between Latino and non-Hispanic White people, there is an ethical imperative to provide better medical care and guidance to the Latino community. II. Ethical and Practical Importance of Increasing the Number of Latino Physicians Minorities respond more positively to patient-physician interactions and are more willing to undergo preventative healthcare when matched with a physician of their racial or ethnic background.[14] Latino medical doctors may lead to an improvement in overall community health through improved communication and trusting relationships. Patient-physician racial concordance leads to greater patient satisfaction with their physicians.[15] Identifying with the ethnicity of a physician may lead to greater confidence in the physician-patient relationship, resulting in more engagement on the patient’s behalf. A randomized study regarding African American men and the race of their attending physician found an increase in requests for preventative care when assigned to a black doctor.[16] Although the subjects were African American men, the study has implications applicable to other minority racial and ethnic groups. The application process is unjust for low-income Latinos. The low matriculation of Latinos in medical schools represents a missed opportunity to alleviate the poor community health of the Latino population in the United States. Medical school also would create an opportunity to address health issues that plague the Latino community. Becoming a physician allows low-income Latinos to climb the social ladder and enter the spaces in health care that have traditionally been closed off to them. Nonwhite physicians significantly serve underserved communities.[17] Increasing the number of Latino doctors can boost their presence, potentially improving care for underserved individuals. Teaching physicians cultural competence is not enough to address the health disparities the Latino community faces. Latino physicians are best equipped to understand the healthcare needs of low-income Latinos. I contend that reforming the application process represents the most straightforward method to augment the number of Latino physicians who wish to work in predominantly Latino or diverse communities, thereby improving healthcare for the Latino community. III. Cultural Tenets Affecting Healthcare Interactions “Poor cultural competence can lead to decreased patient satisfaction, which may cause the patient not to attend future appointments or seek further care.”[18] Latino community health is negatively affected when medical professionals misinterpret cultural beliefs. Cultural tenets like a reservation towards medication, a deep sense of respect for the physician, and an obligation to support the family financially and through advocacy affect how Latinos seek and use the healthcare system.[19] First, the Latino population's negative cultural beliefs about medication add a barrier to patient compliance. It is highlighted that fear of dependence upon medicine leads to trouble with medication regimens.[20] The fear stems from the negative perception of addiction in the Latino community. Taking as little medication as possible avoids the chance of addiction occurring, which is why many take the prescribed medicine only until they feel healthier, regardless of the prescribing regimen. Some would rather not take any medication because of the deep-rooted fear. Physicians must address this concern by communicating the importance of patient compliance to remedy the health issue. Explaining that proper use of the medication as prescribed will ensure the best route to alleviate the condition and minimize the occurrence of dependence. Extra time spent addressing concerns and checking for comprehension may combat the negative perception of medication. Second, the theme of respeto, or respect, seems completely harmless to most people. After all, how can being respectful lead to bad health? This occurs when respect is understood as paternalism. Some patients may relinquish their decision-making to the physician. The physician might not act with beneficence, in this instance, because of the cultural dissonance in the physician-patient relationship that may lead to medical misinterpretation. A well-meaning physician might not realize that the patient is unlikely to speak up about their goals of care and will follow the physician’s recommendations without challenging them. That proves costly because a key aspect of the medical usefulness of a patient’s family history is obtaining it through dialogue. The Latino patient may refrain from relaying health concerns because of the misconceived belief that it’s the doctor’s job to know what to ask. Asking the physician questions may be considered a sign of disrespect, even if it applies to signs, symptoms, feelings, or medical procedures the patient may not understand.[21] Respeto is dangerous because it restricts the patients from playing an active role in their health. Physicians cannot derive what medical information may be relevant to the patient without their cooperation. And physicians without adequate cultural competency may not know they need to ask more specific questions. Cultural competency may help, but a like-minded physician raised similarly would be a more natural fit. “A key component of physician-patient communication is the ability of patients to articulate concerns, reservations, and lack of understanding through questions.”[22] As a patient, engaging with a physician of one’s cultural background fortifies a strong physician-patient relationship. Latino physicians are in the position to explain to the patients that respeto is not lost during a physician-patient dialogue. In turn, the physician can express that out of their value of respeto, and the profession compels them to place the patient’s best interest above all. This entails physicians advocating on behalf of the patients to ask questions and check for comprehension, as is required to obtain informed consent. Latino physicians may not have a cultural barrier and may already organically understand this aspect of their patient’s traditional relationship with physicians. The common ground of respeto can be used to improve the health of the Latino community just as it can serve as a barrier for someone from a different background. Third, in some Latino cultures, there is an expectation to contribute to the family financially or in other ways and, above all, advocate on the family’s behalf. Familial obligations entail more than simply translating or accompanying family members to their appointments. They include actively advocating for just treatment in terms of services. Navigating institutions, such as hospitals, in a foreign landscape proves difficult for underrepresented minorities like Latinos who are new to the United States. These difficulties can sometimes lead to them being taken advantage of, as they might not fully understand their rights, the available resources, or the standard procedures within these institutions. The language barrier and unfamiliar institutional policies may misinterpret patients’ needs or requests. Furthermore, acting outside of said institution’s policy norms may be erroneously interpreted as actions of an uncooperative patient leading to negative interactions between the medical staff and the Latino patient. The expectation of familial contribution is later revisited as it serves as a constraint to the low-income Latino medical school applicant. Time is factored out to meet these expectations, and a moral dilemma to financially contribute to the family dynamic rather than delay the contribution to pursue medical school discourages Latinos from applying. IV. How the Medical School Admission Process is Creating an Undue Burden for Low-Income Latino Applicants Applying a bioethics framework to the application process highlights its flaws. Justice is a central bioethical tenet relevant to the analysis of the MD admissions process. The year-long medical school application process begins with the primary application. The student enters information about the courses taken, completes short answer questions and essays, and uploads information about recommenders. Secondary applications are awarded to some medical students depending on the institutions’ policies. Some schools ask all applicants for secondary applications, while others select which applicants to send secondary requests. Finally, interviews are conducted after a review of both primary and secondary applications. This is the last step before receiving an admissions decision. The medical school application process creates undue restrictions against underserved communities. It is understood that matriculating into medical school and becoming a doctor should be difficult. The responsibilities of a physician are immense, and the consequences of actions or inactions may put the patients’ lives in jeopardy. Medical schools should hold high standards because of the responsibility and expertise required to provide optimal healthcare. However, I argue that the application process places an undue burden on low-income Latino applicants that is not beneficial to optimal health care. The burden placed on low-income Latino applicants through the application process is excessive and not necessary to forge qualified medical students. The financial aspect of the medical school application has made the profession virtually inaccessible to the working class. The medical school application proves costly because of the various expenses, including primary applications, secondary applications, and interview logistics. There is financial aid for applications, but navigating some aid to undertake test prep, the Medical College Admission Test (MCAT), and the travel for interviews proves more difficult. Although not mandatory, prep courses give people a competitive edge.[23] The MCAT is one of the key elements of an application, and many medical schools will not consider applications that do not reach their score threshold. This practically makes the preparatory courses mandatory for a competitive score. The preparatory courses themselves cost in the thousands of dollars. There has been talk about adjusting the standardized test score requirements for applicants from medically underserved backgrounds. I believe the practice of holding strict cutoffs for MCAT scores is detrimental to low-income Latino applicants, especially considering the average MCAT scores for Latinos trail that of white people. The American Association of Medical Colleges’ recent data for the matriculating class of 2021 illustrates the wide gap in MCAT scores: Latino applicants average 500.2, and Latino matriculants average 506.6, compared to white applicants, who average 507.5 and white matriculants, who average 512.7.[24] This discrepancy suggests that considerations beyond scores do play some role in medical school matriculation. However, the MCAT scores remain a predominant factor, and there is room to value other factors more and limit the weight given to scores. The practice of screening out applicants based solely on MCAT scores impedes low-income Latino applicants from matriculating into medical school. Valuing the MCAT above all other admissions criteria limits the opportunities for those from underserved communities, who tend to score lower on the exam. One indicator of a potentially great physician may be overcoming obstacles or engaging in scientific or clinical experiences. There are aspects of the application where the applicant can expand on their experiences, and the personal statement allows them to showcase their passion for medicine. These should hold as much weight as the MCAT. The final indicator of a good candidate should not solely rest on standardized tests. There is a cost per medical school that is sent to the primary application. The average medical school matriculant applies to about 16 universities, which drives up the cost of sending the applications.[25] According to the American Association of Medical Colleges, the application fee for the first school is $170, and each additional school is an additional $42. Sending secondary applications after the initial application is an additional cost that ranges by university. The American Medical College Application Service (AMCAS), the primary application portal for Medical Doctorate schools in the United States and Canada, offers the Fee Assistance Program (FAP) to aid low-income medical school applicants. The program reduces the cost of the MCAT from $325 to $130, includes a complimentary Medical School Admission Requirements (MSAR) subscription, and fee waivers for one AMCAS application covering up to 20 schools.[26] The program is an important aid for low-income Latino students who would otherwise not be able to afford to send multiple applications. Although the aid is a great resource, there are other expenses of the application process that the program cannot cover. For a low-income applicant, the burden of the application cost is felt intensely. A study analyzing the American Medical College Application Service (AMCAS) data for applicants and matriculants from 2014 to 2019 revealed an association between income and acceptance into medical school. They state, “Combining all years, the likelihood of acceptance into an MD program increased stepwise by income. The adjusted rate of acceptance was 24.32 percent for applicants with income less than $50 000, 27.57 percent for $50 000 - $74 999, 29.90 percent for $75 000 - $124 999, 33.27 percent for $125 000 - $199 999, and 36.91 percent for $200,000 or greater.”[27] It becomes a discouraging factor when it is difficult to obtain the necessary funds. The interview process for medical schools may prove costly because of travel, lodging, and time. In-person interviews may require applicants to travel from their residence to other cities or states. The applicant must find their own transportation and housing during the interview process, ranging from a single day to multiple days. Being granted multiple interviews becomes bittersweet for low-income applicants because they are morally distraught, knowing the universities are interested yet understanding the high financial cost of the interviews. The expense of multiple interviews can impede an applicant from progressing in the application process. Medical schools do not typically cover travel expenses for the interview process. Only 4 percent of medical school faculty identify as Latino.[28] The medical school admission board members reviewing the application lack Latino representation.[29] Because of this, it is extremely difficult for a low-income Latino applicant to portray hardships that the board members would understand. Furthermore, the section to discuss any hardships only allows for 200 words. This limited space makes it extremely difficult to explain the nuances of navigating higher education as a low-income Latino. Explaining those difficulties is then restricted to the interview process. However, that comes late in the application process when most applicants have been filtered out of consideration. The lack of diversity among the board members, combined with the minimal space to explain hardships or burdens, impedes a connection to be formed between the Latino applicants and the board members. It is not equitable that this population cannot relate to their admissions reviewers because of cultural barriers. Gatekeeping clinical experience inadvertently favors higher socioeconomic status applicants. Most medical schools require physician shadowing or clinical work, which can be difficult to obtain with no personal connections to the field. Using clinical experience on the application is another way that Latinos are disadvantaged compared to people who have more professional connections or doctors in the family and social circles. The already competitive market for clinical care opportunities is reduced by nepotism, which does not work in favor of Latino applicants. Yet some programs are designed to help low-income students find opportunities, such as Johns Hopkins’ Careers in Science and Medicine Summer Internship Program, which provides clinical experience and health professions mentoring.[30] Without social and professional ties to health care professionals, they are forced to enter a competitive job and volunteer market in clinical care and apply to these tailored programs not offered at all academic institutions. While it is not unique to Latinos, the time commitment of the application process is especially harsh on low-income students because they have financial burdens that can determine their survival. Some students help their families pay for food, rent, and utilities, making devoting time to the application process more problematic. As noted earlier, Latino applicants may also have to set aside time to advocate for their families. Because the applicants tend to be more in tune with the dominant American culture, they are often assigned the family advocate role. They must actively advocate for their family members' well-being. The role of a family advocate, with both its financial and other supportive roles ascribed to low-income Latino applicants, is an added strain that complicates the medical school application. As a member of a historically marginalized community, one must be proactive to ensure that ethical treatment is received. Ordinary tasks such as attending a doctor's appointment or meeting with a bank account manager may require diligent oversight. Applicants must ensure the standard of service is applied uniformly to their family as it is to the rest of the population. This applies to business services and healthcare. It can be discouraging to approach a field that does not have many people from your background. The lack of representation emphasizes the applicant's isolation going through the process. There is not a large group of Latinos in medicine to look to for guidance.[31] The group cohesiveness that many communities experience through a rigorous process is not established among low-income Latino applicants. They may feel like outsiders to the profession. Encountering medical professionals of similar backgrounds gives people the confidence to pursue the medical profession. V. Medical School Admission Data This section will rely on the most recent MD medical school students, the 2020-2021 class. The data includes demographic information such as income and ethnicity. The statistics used in this section were retrieved from scholarly peer-reviewed articles and the Medical School Admission Requirement (MSAR) database. Both sources of data are discussed in more detail throughout the section. The data reveals that only 6.7 percent of medical students for the 2020-2021 school year identify as Latino.[32] The number of Latino students in medical school is not proportional to the Latino community in the United States. While Latinos comprise almost 20 percent of the US population (62.1 million), they comprise only 6.7 percent of the medical student population.[33] Below are three case studies of medical schools in cities with a high Latino population. VI. Medical School Application Process Case Studies a) New York University Grossman School of Medicine is situated in Manhattan, where a diverse population of Latinos reside. The population of the borough of Manhattan is approximately 1,629,153, with 26 percent of the population identifying as Latino.[34] As many medical schools do, Grossman School of Medicine advertises an MD Student Diversity Recruitment program. The program, entitled Prospective MD Student Liaison Program, is aimed such that “students from backgrounds that are underrepresented in medicine are welcomed and supported throughout their academic careers.”[35] The program intervenes with underrepresented students during the interview process of the medical school application. All students invited to interviews can participate in the Prospective MD Student Liaison Program. They just need to ask to be part of it. That entails being matched with a current medical student in either the Black and Latinx Student Association (BALSA) or LGBTQMed who will share their experiences navigating medical school. Apart from the liaison program, NYU participates in the Science Technology Entry Program (STEP), which provides academic guidance to middle and high school students who are underrepresented minorities.[36] With the set programs in place, one would expect to find a significantly larger proportion of Latino medical students in the university. The Medical School Admission Requirement (MSAR) database compiled extensive data about participants in the medical school; the data range from tuition to student body demographics. Of the admitted medical students in 2021, only 16 out of 108 identified as Latino, despite the much larger Latino population of New York.[37] Furthermore, only 4 percent of the admitted students classify themselves as being from a disadvantaged status.[38] The current efforts to increase medical school diversity are not producing adequate results at NYU. Although the Latino representation in this medical school may be higher than that in others, it does not reflect the number of Latinos in Manhattan. The Prospective MD Student Liaison Program intervenes at a late stage of the medical school application process. It would be more beneficial for a program to cover the entire application process. The lack of Latino medical students makes it difficult for prospective students to seek advice from Latino students. Introducing low-income Latino applicants to enrolled Latino medical students would serve as a guiding tool throughout the application process. An early introduction could encourage the applicants to apply and provide a resourceful ally in the application process when, in many circumstances, there would be none. Latino medical students can share their experiences of overcoming cultural and social barriers to enter medical school. b) The Latino population in Philadelphia is over 250,000, constituting about 15 percent of the 1.6 million inhabitants.[39] According to MSAR, the cohort of students starting at Drexel University College of Medicine, located in Philadelphia, in 2021 was only 7.6 percent Latino.[40] 18 percent of matriculated students identify as having disadvantaged status, while 21 percent identify as coming from a medically underserved community.[41] Drexel University College of Medicine claims that “Students who attend racially and ethnically diverse medical schools are better prepared to care for patients in a diverse society.”[42] They promote diversity with various student organizations within the college, including the following: Student National Medical Association (SNMA), Latino Medical Student Association (LMSA), Drexel Black Doctors Network, LGBT Medical Student Group, and Drexel Mentoring and Pipeline Program (DMAPP). The Student Center for Diversity and Inclusion of the College of Medicine offers support groups for underrepresented medical students. The support offered at Drexel occurs at the point of matriculation, not for prospective students. The one program that does seem to be a guide for prospective students is the Drexel Pathway to Medical School program. Drexel Pathway to Medical School is a one-year master’s program with early assurance into the College of Medicine and may serve as a gateway for prospective Latino Students.[43] The graduate program is tailored for students who are considered medically underserved or socioeconomically disadvantaged and have done well in the traditional pre-medical school coursework. It is a competitive program that receives between 500 and 700 applicants for the 65 available seats. The assurance of entry into medical school makes the Drexel Pathway to Medical School a beneficial program in aiding Latino representation in medicine. Drexel sets forth minimum requirements for the program that show the school is willing to consider students without the elite scores and grades required of many schools. MCAT scores must be in the 25th percentile or higher, and the overall or science GPA must be at least 2.9.[44] The appealing factor of this program is its mission to attract medically underserved students. This is a tool to increase diversity in medical school. Prospective low-income Latino students can view this as a graduate program tailored to communities like theirs. However, this one-year program is not tuition-free. It may be tempting to assume that patients prefer doctors with exceptional academic records. There's an argument against admitting individuals with lower test scores into medical schools, rooted in the belief that this approach does not necessarily serve the best interests of health care. The argument asserts that the immense responsibility of practicing medicine should be entrusted to the most qualified candidates. Programs like the Drexel Pathway to Medical School are designed to address the lower academic achievements often seen in underrepresented communities. Their purpose is not to admit underqualified individuals into medical school but to bridge the educational gap, helping these individuals take the necessary steps to become qualified physicians. c) The University of California San Francisco School of Medicine reports that 23 percent of its first-year class identifies as Latino, while 34 percent consider themselves disadvantaged.[45] The Office of Diversity and Outreach is concerned with increasing the number of matriculants from underserved communities. UCSF has instilled moral commitments and conducts pipeline and outreach programs to increase the diversity of its medical school student body. The Differences Matter Initiative that the university has undertaken is a complex years-long restructuring of the medical school aimed at making the medical system equitable, diverse, and inclusive.[46] The five-phase commitment includes restructuring the leadership of the medical school, establishing anti-oppression and anti-racism competencies, and critically analyzing the role race, ethnicity, gender, and sexual orientation play in medicine. UCSF offers a post-baccalaureate program specifically tailored to disadvantaged and underserved students. The program’s curriculum includes MCAT preparation, skills workshops, science courses, and medical school application workshops.[47] The MCAT preparation and medical school application workshops serve as a great tool for prospective Latino applicants. UCSF seems to do better than most medical schools regarding Latino medical students. San Francisco has a population of 873,965, of which 15.2 percent are Latino.[48] The large population of Latino medical students indicates that the school’s efforts to increase diversity are working. The 23 percent Latino matriculating class of 2021 better represents the number of Latinos in the United States, which makes up about a fifth of the population. With this current data, it is important to closely dissect the efforts UCSF has taken to increase diversity in its medical school. Their Differences Matter initiative instills a commitment to diversifying their medical school. As mentioned, the school's leadership has been restructuring to include a diverse administrative body. This allows low-income Latino applicants to relate to the admissions committee reviewing their application. With a hopeful outlook, the high percentage of Latino applicants may reflect comprehension of the application process and the anticipated medical school atmosphere and rigor among Latino applicants and demonstrate that the admissions committee understands the applicants. However, there are still uncertainties about the demographics of the Latino student population in the medical school. Although it is a relatively high percentage, it is necessary to decipher which proportion of those students are low-income Latino Americans. UCSF School of Medicine can serve as a model to uplift the Latino community in a historically unattainable profession. VII. Proposed Reform for Current Medical School Application One reform would be toward the reviewing admissions committee, which has the power to change the class composition. By increasing the diversity of the admissions committee itself, schools can give minority applicants a greater opportunity to connect to someone with a similar background through their application. It would address low-income Latino applicants feeling they cannot “get personal” in their application. These actions are necessary because it is not just to have a representative administration for only a portion of the public. Of the three medical schools examined, the University of California San Francisco has the highest percentage of Latino applicants in their entering class. They express an initiative to increase diversity within their medical school leadership via the Differences Matter initiative. This active role in increasing diversity within the medical school leadership may play a role in UCSF’s high percentage of Latino matriculants. That serves as an important step in creating an equitable application process for Latino applicants. An important consideration is whether the medical school administration at UCSF mirrors the Latino population in the United States. The importance of whether the medical school administration at UCSF mirrors the Latino population in the United States lies in its potential to foster diversity, inclusivity, and cultural competence in medical education, as well as to positively impact the healthcare outcomes and experiences of the Latino community. A diverse administration can serve as role models for students and aspiring professionals from underrepresented backgrounds. It can inspire individuals who might otherwise feel excluded or underrepresented in their career pursuits, including aspiring Latino medical students. Furthermore, a diverse leadership can help develop curricula, policies, and practices that are culturally sensitive and relevant, which is essential for addressing health disparities and providing equitable healthcare. It is also important to have transparency so the public knows the number of low-income Latino individuals in medical school. The Latino statistics from the medical school generally include international students. That speaks to diversity but misses the important aspect of uplifting the low-income Latino population of the United States. Passing off wealthy international students from Latin America to claim a culturally diverse class is misleading as it does not reflect income diversity. Doing so gives the incorrect perception that the medical school is accurately representing the Latino population of the United States. There must be a change in how the application process introduces interviews. It needs to be introduced earlier so the admissions committee can form early, well-rounded inferences about an applicant. The interview allows for personal connections with committee members that otherwise would not be established through the primary application. The current framework has the interviews as one of the last aspects of the application process before admissions decisions are reached. At this point in the application process, many low-income Latinos may have been screened out. I understand this is not an easy feat to accomplish. This will lead to an increase in interviews to be managed by the admissions committee. The burden can be strategically minimized by first conducting video interviews with applicants the admission committee is interested in moving forward and those that they are unsure about because of a weakness in a certain area of the application. The video interview provides a more formal connection between the applicants and admission committee reviewers. It allows the applicant to provide a narrative through spoken words and can come off as a more intimate window into their characteristics. It would also allow for an opportunity to explain hardships and what is unique. From this larger pool of video-interviewed applicants, the admission committee can narrow down to traditional in-person interviews. A form of these video interviews may be already in place in some medical school application process. I believe making this practice widespread throughout medical schools will provide an opportunity to increase the diversity of medical school students. There must be an increase in the number of programs dedicated to serving as a gateway to clinical experience for low-income Latino applicants. These programs provide the necessary networking environment needed to get clinical experience. It is important to consider that networking with clinical professionals is an admissions factor that detrimentally affects the low-income Latino population. One of the organizations that aids underserved communities, not limited to Latinos, in clinical exposure is the Summer Clinical Oncology Research Experience (SCORE) program.[49] The SCORE program, conducted by Memorial Sloan Kettering Cancer Center, provides its participants with mentorship opportunities in medicine and science. In doing so, strong connections are made in clinical environments. Low-income Latinos seek these opportunities as they have limited exposure to such an environment. I argue that it is in the medical school’s best interest to develop programs of this nature to construct a more diverse applicant pool. These programs are in the best interest of medical schools because they are culturing a well-prepared applicant pool. It should not be left to the goodwill of a handful of organizations to cultivate clinically experienced individuals from minority communities. Medical schools have an ethical obligation to produce well-suited physicians from all backgrounds. Justice is not upheld when low-income Latinos are disproportionally represented in medical schools. Programs tailored for low-income Latinos supplement the networking this population lacks, which is fundamental to obtaining clinical experience. These programs help alleviate the burden of an applicant’s low socioeconomic status in attaining clinical exposure. VIII. Additional Considerations Affecting the Medical School Application Process and Latino Community Health A commitment to practicing medicine in low-income Latino communities can be established to improve Latino community health.[50] Programs, such as the National Health Service Corps, encourage clinicians to practice in underserved areas by forgiving academic loans for years of work.[51] Increasing the number of clinicians in underserved communities can lead to a positive correlation with better health. It would be ideal to have programs for low-income Latino medical students that incentivize practicing in areas with a high population of underserved Latinos. This would provide the Latino community with physicians of a similar cultural background to attend to them, creating a deeper physician-patient relationship that has been missing in this community. Outreach for prospective Latino applicants by Latino medical students and physicians could encourage an increased applicant turnout. This effort can guide low-income Latinos who do not see much representation in the medical field. It would serve as a motivating factor and an opportunity to network within the medical field. Since there are few Latino physicians and medical students, a large effort must be made to make their presence known. IX. Further Investigation Required It is important to investigate the causes of medical school rejections of low-income Latinos. Understanding this piece of information would provide insight into the specific difficulties this population has with the medical school application. From there, the requirements can be subjected to bioethical analysis to determine whether those unfulfilled requirements serve as undue restrictions. The aspect of legacy students, children of former alumni, proves to be a difficult subject to find data on and merits further research. Legacy students are often given preferred admission into universities.[52] It is necessary to understand how this affects the medical school admissions process and whether it comes at a cost to students that are not legacy. It does not seem like these preferences are something universities are willing to disclose. The aspect of legacy preferences in admissions decisions could be detrimental to low-income Latino applicants if their parents are not college-educated in the United States, which often is the case. It would be beneficial to note how many Latinos in medical school are low-income. The MSAR report denotes the number of Latino-identified students per medical school class at an institution and the number of students who identify as coming from low resources. They do not specify which of the Latino students come from low-income families. This information would be useful to decipher how many people from the low-income Latino community are matriculating into medical schools. CONCLUSION It is an injustice that low-income Latinos are grossly underrepresented in medical school. It would remain an injustice even if the health of the Latino community in the United States were good. The current operation of medical school admission is based on a guild-like mentality, which perpetuates through barriers to admissions. It remains an exclusive club with processes that favor the wealthy over those who cannot devote money and time to the prerequisites such as test preparation courses and clinical internships. This has come at the expense of the Latino community in the United States in the form of both fewer Latino doctors and fewer current medical students. It is reasonable to hope that addressing the injustice of the underrepresentation of low-income Latinos in the medical field would improve Latino community health. With such a large demographic, the lack of representation in the medical field is astonishing. The Latino population faces cultural barriers when seeking healthcare, and the best way to combat that is with a familiar face. An increase in Latino medical students would lead to more physicians that not only can culturally relate to the Latino community, but that are a part of it. This opens the door for a comprehensive understanding between the patient and physician. As described in my thesis, Latino physicians can bridge cultural gaps that have proven detrimental to that patient population. That may help patients make informed decisions, exercising their full autonomy. The lack of representation of low-income Latinos in medicine is a long-known issue. Here, I have connected how the physician-patient relationship can be positively improved with an increase in low-income Latino physicians through various reforms in the admissions process. My hope is to have analyzed the problem of under-representation in a way that points toward further research and thoughtful reforms that can truly contribute to the process of remedying this issue. - [1] Passel, J. S., Lopez, M. H., & Cohn, D. (2022, February 3). U.S. Hispanic population continued its geographic spread in the 2010s. Pew Research Center. https://www.pewresearch.org/fact-tank/2022/02/03/u-s-hispanic-population-continued-its-geographic-spread-in-the-2010s/ [2] Ramirez, A. G., Lepe, R., & Cigarroa, F. 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