Artigos de revistas sobre o tema "Salaries and fringe benefits – united states"

While the European Court of Justice issues many important rulings with respect to competition, transportation, free movement of capital, and other policies, its contributions to tax policy sometimes get overlooked. Too many view taxation as just an issue of national import. However, the European Court of Justice has made some extraordinarily important contributions in the area of taxation. The recently discussed case of Astra Zeneca UK LTD v. HMRC (C-40/09, <curia.europa.eu>) proves this notion. The following discusses the facts, governing guidance, issues, resolutions, drawbacks, and future applications. On appeal from the VAT and Duties Tribunal of Manchester, United Kingdom, this case addresses whether UK tax law with regard to value-added taxes (VATs) is correct. The judgment considers whether VAT applies to fringe benefits beyond cash (retail vouchers) from an employer to an employee. For global context here, the US tax system’s treatment of fringe benefits can be considered. In the United States then, there is no VAT. However, for income tax purposes, fringe benefits result in the best possible treatment. As the employers deduct the fringe benefits provided, the employees exclude the fringe benefits from their gross income.

A Review of: Applegate, R. (2009). Who benefits? Unionization and academic libraries and librarians. The Library Quarterly, 79(4), 443-463. Abstract Objective – To investigate the quantitative benefits of unionization for libraries, librarians, and students at academic libraries in the United States. Design – Quantitative analysis of existing datasets. Setting – Academic libraries in the United States. Subjects – One thousand nine hundred four accredited colleges and universities in the United States. Methods – Institutions that provided data for both the National Center for Education Statistics (NCES) Academic Libraries Survey (ALS) and the NCES Integrated Postsecondary Education Data Service (IPEDS) survey series in 2004 were considered for inclusion in this study. Of these institutions, only those with student populations over 500 and employing more than one librarian were included. The study did not include specialized libraries at institutions where “most of their degrees were awarded in a single area” (p. 449). The institutions were categorized by type derived from data by Carnegie and the Association of Research Libraries. The final categories were: ARL, Doctoral Non-ARL, Masters, Baccalaureate, and Associates. Governance was determined by using information from IPEDS that classified the institutions as public, private not-for-profit, and private for-profit. Unionization status was derived from the Directory of Faculty Contracts and Bargaining Agents in Institutions of Higher Education. After private not-for-profit and private for-profit classifications were collapsed into one category, governance and unionization information were combined to create the final governance categories of: private, public nonunionized, and public unionized. The study analyzed the following characteristics in terms of institution type, governance, and institution type and governance interaction: ratio of students to librarians, ratio of library expenditures to institutional budget expenditures, average librarian salary, percentage of staff who were librarians, librarian salaries as a percentage of staff salaries, and percentage of the library budget spent on staff salaries. Main Results – Analysis revealed statistically significant differences (p< .05) between governance and student-librarian ratio and between governance and percentage of library budget spent on staff salaries. No consistently beneficial relationship between governance and student-librarian ratio was determined. A consistently positive relationship was found between governance and percent of the library budget spent on librarian salaries; all public unionized institution types had higher percentages of the library budget devoted to librarian salaries than private and public nonunionized institutions. All five dependent variables showed statistically significant differences (p< .05) when analyzed by institution type. Analysis by institution type and governance interaction found statistically significant differences (p< .05) for student-librarian ratios, librarian salary, and percentage of library budget devoted to staff salaries. Strong R2 values were determined for the dependent variables of: staff salaries as a proportion of library budget (.51) and student-librarian ratio (.34). Conclusion – Based on the results, the author stated that unionization appears to have positive or neutral benefits for the library, librarians, and students, regardless of institutional type. Further quantitative and qualitative research is needed to analyze the effects of unionization on library quality.

The research purpose is to determine the study of the fringe benefits important of employees. Fringe benefits are additions to compensation that companies give their employees. This research project is on Fringe Benefits and Employees productivity in public sector. This research work is generally about the Benefits and Employees productivity Public Sector. The project has undertook the general introduction into the research work led to the review of various literature that relates to the major variables involved in the research work especially employees productivity. The purpose of employee benefits is to increase the economic security of staff members, and in doing so, improve worker retention across the organization. As such, it is one component of reward management. In any case, employers use fringe benefits to help them recruit, motivate, and keep high-quality people. According to Mathis and John (2003), productivity is a measure of the quantity and quality of work done, considering the cost of the resources used. The more productive an organization, the better its competitive advantage, because the costs to produce its goods and services are lower. Employee benefits in Canada usually refer to employer sponsored life, disability, health, and dental plans. Employee benefits in the United States include relocation assistance; medical, prescription, vision and dental plans; health and dependent care flexible spending accounts; retirement benefit plans (pension, 401(k), 403(b). fringe benefits refers to the regular review of an employee’s job performance and overall contribution to a company. The objective is to know the effect of fringe benefits on employee motivation. The reveals that fringe benefits lead to improved employees’ performance. This results from increased productivity in the organization. The majorities of the employees are motivated of the organization through feedback and increased productivity.

Abstract Direct support professionals (DSPs) and frontline supervisors (FLSs) play an integral role in the lives of people with intellectual and developmental disabilities (IDD) and are often the individuals directly responsible for assisting people with IDD to live and fully participate in their communities. These two groups of workers have typically been employed at lower wages with limited access to fringe benefits, contributing to high rates of turnover compared to a similarly skilled worker in the United States. This article summarizes findings and is the first investigation in several years to systematically examine the wages, fringe benefits, and stability of the DSP and FLS workforces supporting individuals with IDD. Findings suggest that a typical DSP may expect to earn about $11.25 per hour, while FLSs may expect wages of about $15.45 hourly. Of concern, however, is that fringe benefit provision was quite limited in this sample. Implications, including relation to past reports of DSP workforce development, are discussed.

In the United States, academic advising is among the highest turnover professions in the university system. Academic advisors, who work at the intersection of academics and student life, bear the brunt of increased pressures and decreased resources. Yet, primary-role advisors often do not experience high salaries or opportunities for advancement. Despite a high turnover in advising, some advisors have intentionally chosen to remain in advising. Framed by the social cognitive model of career self-management, this phenomenological study examined the workplace career management of female primary-role advisors at public institutions in the midwestern region of the United States. Through holistic coding, three primary factors emerged from the data: students, supportive environments, and balance and benefits. We offer implications for practice.

Abstract Women show greater and greater activity on the job market, they obtain better positions, salaries, etc. However, the statistics concerning their professional activity differ from those of men. We should take into consideration the fact that women are the ones who give birth to children and, in majority, take care of their upbringing, especially in the first years of child’s life. Policies of particular states are different in terms of the amount and availability of family benefits, and that can be reflected in women’s willingness to return to work.

Analyses of the corporatization of U.S. health care typically focus on the political struggle between corporations and traditional health care providers, e.g., physicians. A neglected area of study is the struggle between corporations and their employees over the employment-based health insurance system. Yet, since this system is currently the primary mechanism for financing health care in the United States, an analysis of its historical development is critical to any understanding of the corporatization of U.S. health care. It is argued here that the employment-based health insurance system was a part of a political compromise between capital and labor that emerged after World War II. In exchange for control over production and increased worker productivity, corporations agreed to provide workers with steady wage increases and an expanded system of fringe benefits, or “corporate welfare.” But, by the late 1970s, rising health care costs created a corporate health care financing crisis that has prompted corporations to cut back employee health insurance coverage. The relative inability of workers to resist such cutbacks reveals the extent to which, by linking health care to wage labor, the “corporate welfare” system has made the U.S. working class more vulnerable to corporate power.

Established group practices in Ontario were surveyed to determine their structure, characteristics and attitudes toward government assistance in the development of group practice. The degree of organization of the groups surveyed was related to size and less than that reported in surveys of United States group practices. Group size and years of operation were strongly associated. Night, weekend and vacation coverage, the use of a unit patient record and the employment of non-physician administrators were reported frequently, and were more common in older and larger groups. As well, fringe benefits, except for professional organization dues, were not commonly provided.

Since the second half of the twentieth century, in the liberal world economy, the idea has emerged that the benefit of entrepreneurs must be harmonized with environmental protection, safety and health measures for workers and the provision of extra-wage earnings. This 'fad' - underpinned by the philosophy of human rights and the ideology of sustainable development - is called 'corporate social responsibility' (CSR). Initially developed as an economic practice in the United States, corporate social responsibility has become a general hallmark of economic activities across the globe. In Romania, the most popular CSR measures are: meal vouchers, medical fringe benefits, training programmes and covering the costs of professional certifications, flexible working hours or working from home, access to gyms and lifestyle benefits, bonuses and bonuses, company car, holiday vouchers, mobile phones and high-performance laptops.

AbstractAdequate income is a social determinant of health. In the United States, only Social Security beneficiaries receive inflation-protected guaranteed income. Social Security needs another 1983 compromise in which stakeholders accepted “shared pain” to avoid insolvency. We propose indexing the benefit using the chained consumer price index (CPI) for all urban consumers and providing a one-time bonus of 8% to 10% for beneficiaries in their mid-80s, when needs become greater. The chained CPI has little impact when beneficiaries start receiving benefits, but older beneficiaries need protection. The estimated 75-year savings from this restructured benefit amount to 14.2% to 18% of Social Security deficits. Modest increases in payroll taxes and maximum earnings taxed should make up most of the shortfall. Including unearned income with wages and salaries subject to the 6.2% individual tax would produce much more revenue. The discussion explores the proposal’s political feasibility, grounding in current policy and political science literature, and the role of income as a social determinant of health.

e19381 Background: Although cancer is a leading cause of illness in the United States, its true impact on productivity is poorly understood. Traditional approaches to capturing health-related productivity loss—e.g., the human capital method—focus on patients’ foregone wages, overlooking fringe benefits and the impacts incurred by caregivers and co-workers. Thus, the value of lost productivity is often underestimated. We sought to comprehensively estimate productivity loss incurred by working-age cancer patients and unpaid caregivers in the United States. Methods: We conducted a cross-sectional survey study of (i) non-small cell lung cancer (NSCLC) and breast cancer (BC) patients, and (ii) unpaid caregivers. To measure loss associated with absenteeism and presenteeism, participants reported pre- and post-cancer diagnosis income, hours worked, and time to complete tasks. The “multiplier effect” method was used to measure productivity loss incurred by co-workers due to patient or caregiver absenteeism and/or presenteeism. Exploratory multivariable analyses controlled for cancer type, stage, age, time since diagnosis, oncogene mutation status, and industry sector. Results: A total of 404 participants (104 BC, 100 NSCLC patients; 100 BC, 100 NSCLC caregivers) completed the surveys. Of these, 319 participants (162 BC, 157 NSCLC) who worked ≥40 weeks in the year pre-diagnosis and who did not transition from part- to full-time work after diagnosis were included in the analysis. Over a third of the NSCLC (33%) and BC (43%) patients left the workforce after diagnosis. For patients, estimated mean annual productivity loss equaled $123,792 (144% of mean income pre-diagnosis) for NSCLC and $123,502 (209% of mean income pre-diagnosis) for BC. For caregivers, the estimated mean annual productivity loss was $90,421 (108% of mean income pre-diagnosis) for NSCLC and $143,839 (190% of mean income pre-diagnosis) for BC. Exploratory analyses also found that patient age and stage at diagnosis were positively correlated with a greater absenteeism effect. Conclusions: This study found that traditional approaches, such as the human capital method, significantly underestimate productivity loss in cancer patients and caregivers. Holistic approaches that include lost wages, fringe benefits, and teamwork effects, are better approaches to understanding the amplified impact cancer can have for patients, caregivers, and co-workers.

The Baby-Friendly Hospital Initiative (BFHI) has been shown to increase breastfeeding rates, improving maternal and child health and driving down healthcare costs via the benefits of breastfeeding. Despite its clear public health and economic benefits, one key challenge of implementing the BFHI is procuring funding to sustain the program. To address this need and help healthcare stakeholders advocate for funds, we developed a structured method to estimate the first-year cost of implementing BFHI staff training, using the United States (US) and Mexico as case studies. The method used a hospital system-wide costing approach, rather than costing an individual hospital, to estimate the average per birth BFHI staff training costs in US and Mexican hospitals with greater than 500 annual births. It was designed to utilize publicly available data. Therefore, we used the 2014 American Hospital Association dataset (n = 1401 hospitals) and the 2018 Mexican Social Security Institute dataset (n = 154 hospitals). Based on our review of the literature, we identified three key training costs and modelled scenarios via an econometric approach to assess the sensitivity of the estimates based on hospital size, level of obstetric care, and training duration and intensity. Our results indicated that BFHI staff training costs ranged from USD 7.27–125.39 per birth in the US and from PPP 2.68–6.14 per birth in Mexico, depending on hospital size and technological capacity. Estimates differed between countries because the US had more hospital staff per birth and higher staff salaries than Mexico. Future studies should examine whether similar, publicly available data exists in other countries to test if our method can be replicated or adapted for use in additional settings. Healthcare stakeholders can better advocate for the funding to implement the entire BFHI program if they are able to generate informed cost estimates for training as we did here.

Across the United States, there has been a growing interest in local food production, which provides an alternative way to increase self-sufficiency and support greater well-being and food security at the community level. This study focused on the Northern Panhandle region of Idaho, where opportunities derived from the local food movement have emerged in several resort and college towns. This research integrated spatial analysis and modeling in a geographic information system (GIS) environment and a linear-programming (LP) optimization approach to identify, quantify, and map these potential opportunities. The obtained results show that existing local food producers are located in the urban fringe and on productive cropland. The foodshed model further suggests that Northern Idaho has enough farmland to feed its whole population within an average distance of 49 km or 31 miles. An alternative land use scenario was explored that involves removing marginal cropland with high soil erodibility from commodity cropping to improve the ecological benefits of local food production. The results of the study, including nuanced evidence of growing demand for local-food products, the existence of enough cropland capacity to meet demand, and potential environmental benefits, are quite encouraging to local food advocates in Northern Idaho and other areas and demonstrate the utility of land-based foodshed analysis.

This Article explores some of the legal initiatives and reforms that opponents of same-sex marriage in Canada and the United States have pushed forward. Despite being animated by a desire to dilute the protections for same-sex couples, these reforms resulted in “queering” family law, in the sense that they functionalized the notion of family. Consequently, two cohabiting relatives or friends would be eligible for legal recognition, along with all the public and private benefits of such recognition. I term these kinds of “unions” and other nonnormative relationships to be “new families.” The central claim of this Article is thus that new families should build alliances with conservative fringe groups and capitalize on their common interest in creating legal alternatives to marriage. Section I of the Article will provide a primer on the legal remedies available to non-normative relationships. Section II will engage in a comparative analysis of conservative reforms in the United States and Canada that ended up extending eligibility requirements to new families, or that, although currently restricted to conjugal couples, could constitute a viable model for protecting all new families, if their eligibility requirements were amended. Section III tries to operationalize legal recognition by analyzing the potential paths to gain it. I will first anticipate and respond to criticism surrounding recognition of new families, and then will lay the foundation for rethinking queer activists’ political action. I will then offer some recommendations (a) on the best model for implementation and (b) on forming alliances with conservative groups.

Precarious work in the United States is defined by economic and temporal dimensions. A large literature documents the extent of low wages and limited fringe benefits, but research has only recently examined the prevalence and consequences of unstable and unpredictable work schedules. Yet practices such as on-call shifts, last minute cancellations, and insufficient work hours are common in the retail and food-service sectors. Little research has examined racial/ethnic inequality in this temporal dimension of job quality, yet precarious scheduling practices may be a significant, if mostly hidden, site for racial/ethnic inequality, because scheduling practices differ significantly between firms and because front-line managers have substantial discretion in scheduling. We draw on innovative matched employer-employee data from The Shift Project to estimate racial/ethnic gaps in these temporal dimensions of job quality and to examine the contribution of firm-level sorting and intra-organizational dynamics to these gaps. We find significant racial/ethnic gaps in exposure to precarious scheduling that disadvantage non-white workers. We provide novel evidence that both firm segregation and racial discordance between workers and managers play significant roles in explaining racial/ethnic gaps in job quality. Notably, we find that racial/ethnic gaps are larger for women than for men.

The United States does more than just talk; it invests a lot of money in public education. While students are the major focus of concern, teachers are a mainstay in the enterprise. In 2002, the U.S. invested $192 billion in teacher pay and benefits. More than 50% of all dollars allocated by the government for education is paid in salaries for teachers, yet there is little research to guide decisions as whom to hire, retain, and promote (Rice, 2003). However, the general consensus is that under good teachers, students get a good education, and under poor teachers, students get a poor education. The difference between the two makes a world of difference. The U. S. cannot afford to trust its most valuable asset students - to the tutelage of poor teachers. Doing so would be to run the risk of needlessly suffering from medical conditions, financial woes, and a quality of life not befitting a highly advanced nation. This manuscript provides a functional framework for the student and faculty, a review of related literature, and a detailed description of an individual effort at implementing promising practices to prepare quality teacher educators. The expectation is that information and preliminary findings that are provided will, in some way, further thinking and effort at producing effective teachers to staff our schools.

Background. Previous estimates of administrative costs in U.S. hospitals have been based on figures in California, and nationwide extrapolation has been controversial. If the costs of bureaucracy are high, major policy reforms may yield substantial savings. Methods. We obtained detailed data on hospital expenses for fiscal year 1990 from reports submitted to Medicare by 6400 hospitals. We calculated each hospital's administrative costs by summing expenses in the following Medicare cost-accounting categories: administrative and general, nursing administration, central services and supply (excluding the purchase cost of supplies), medical records and library, utilization review, and the salary costs of the employee benefits department. We classified costs in most other categories as clinical. Some small categories of expenses (e.g., gift shop) were excluded from both our clinical and administrative groupings, and for others (e.g., plant operations), a proportional share was allocated between the two groupings. Results. Nationwide, administration accounted for an average of 24.8 percent of each hospital's spending in fiscal 1990. Average hospital administrative costs ranged from 20.5 percent in Minnesota to 30.6 percent in Hawaii. Administrative salaries accounted for 22.4 percent of the average hospital's salary costs. Administrative costs were similar in states with high and low rates of enrollment in health maintenance organizations (HMOs). Conclusions. Hospital administrative costs in the United States are higher than previous estimates and more than twice as high as those in Canada. Greater enrollment in HMOs, with more competitive bidding by hospitals for managedcare contracts, an important element of proposed managed-competition health care reforms, does not seem to lower hospital administrative costs. N Engl J Med. 1993;329:400-3.

The fortieth anniversary of Sartre’s death, on April 15 of this year, found much of the world in lockdown in response to a new virus, Covid-19, which has changed humanity’s situation on this planet in ways we will be struggling to elucidate for years to come. In these unprecedented circumstances, Sartre’s thought has been an obvious resource to help us understand the impact and ramifications of this pandemic. The virus has been an unsparing indicator in itself of social injustice, unmasking the pious platitudes of our advanced, modern democracies. In the United States in particular, the reality is truly ugly. Covid-19 has shed pitiless light on the disparity between affluent white communities, able to “shelter in place” and avoid putting their members at risk of infection, and less affluent black and brown districts, where workers on subsistence salaries, often without health-care benefits, have been forced to work in unsafe conditions, with terrible consequences for them and their families. Living in the “richest” country on earth, we can imagine only too easily Sartre’s vitriolic assessment of America in its present crisis. And it is just as easy to imagine the fervor with which he would have embraced the Black Lives Matter protests that erupted all over the world, provoked by the 8 minute 46 second video clip that showed the matter-of-fact murder by asphyxiation of George Floyd by white police officers in Minneapolis.

Introduction: Substantial growth in the field of transplantation in recent years has increased the need for transplant coordinators. The growing need for these highly skilled clinicians warrants a review of characteristics that increase job satisfaction, an important consideration for transplant centers. Research question: The study described transplant coordinators’ perceptions of job satisfaction in their current positions. Design: This study evaluated transplant coordinator job satisfaction conducted on 3 separate occasions at US geographically diverse sites. Two instruments, the Vermont Nurses: Job Analysis and Retention Survey and an investigator-designed role and demographic survey, were used to capture study participants’ attitudes regarding elements of job satisfaction, design, and involvement. Results: Demographic characteristics of study participants (N = 133) reveal a largely female population (n = 113, 85%) employed full time (n = 124, 93%) in a hospital setting (n = 106, 80%). Scores for items related to job satisfaction, design, and involvement were generally positive. Participants reported being less satisfied for characteristics including promotion opportunities, fringe benefits, and attention to career development provided by employers. Conclusion: As annual rates of transplants continue to increase across the United States, the need for growing and retaining talented staff in transplant care settings is even more critical. Results of the study suggest that while transplant coordinators remain largely satisfied with the challenges and personal fulfillment associated with their positions, opportunities for professional development may improve retention and recruitment. Specifically, supporting career development and providing formalized evaluation and supervision were identified as areas of improvement within this specialized group of clinicians.

Introduction: Addressing nurse turnover is a challenge for both health service leaders and human resources researchers. Researchers continue to highlight the importance of job satisfaction in nurses’ turnover intention, which appears to be more important than other determinants such as age, night shift, and career advancement. Aim: The purpose of this research study was to investigate the job satisfaction of the nursing staff of the 251 Air Force General Hospital (251AGH) and their intention to leave the profession in the next five years. Material and Method: A cross-sectional study was conducted during the summer season of 2022 involving nurses and licensed practical nurses working in 251 GNA. Data were collected via structured anonymous questionnaire with closed-ended questions, consisting of three thematic sections: the first section included the Job Satisfaction Survey – JSS tool of the Professor of Psychology at the University of South Florida, United States of America, Paul Spector-, the second section presented questions about the healthcare professionals’ intention to leave their job and the organization and the third part demonstrated the demographic characteristics of the study sample. Results: The sample of our study consisted of 205 nurses and licensed practical nurses, of whom 63 (30%) were men and 142 (69%) were women. The participants reported dissatisfaction with salary, promotion, fringe benefits, contingent rewards, and working conditions. They felt ambivalent about partners, the nature of work and communication, but satisfied with the supervision. Finally, in terms of overall job satisfaction, they felt dissatisfied. Regarding the intention of leaving nursing profession, seems to be moderately to quite likely for the next five years. Conclusions: Job satisfaction as a whole and subsequently satisfaction with potential rewards and salary are significantly and negatively related to intention to leave AGH. Post-secondary graduates are less likely to drop out of nursing than college/university and postgraduate professionals. Finally, it was mentioned a strong positive correlation between age and years of service with their intention to leave their job.

Background/Context Charter schools are commonly discussed as being more effective at matching student and family interests with school mission, ensuring family choice of educational products and improving education quality and the efficiency of resource use as a result of the competitive dynamics they are assumed to generate between themselves and public schools. The rhetoric around charter schools in general puts little attention on teacher management and resource acquisition, and the literature on charter schools has tended to focus on outcomes such as student achievement. The prevalence of charter schools within and outside the United States underscores the need to understand what role such issues as teacher management and resourcing play in this increasingly popular education reform. Focus of Study The purpose of this article is to uncover and present the strategies that charter schools employ for managing teachers and acquiring resources, and with what implications. Research Design Through a qualitative case study of a charter school program in Bogotá, Colombia, that began in 1999, we investigated (a) the regulations that governed the hiring, firing, and compensation of charter school teachers, in addition to (b) how charters respond to those regulations in contracting teachers, and (c) the overall approach of charter principals and the charter management organizations (CMOs) that oversee them when it comes to teacher engagement, collaboration, supervision, and professional development. In terms of resource acquisition, the focus was on understanding (d) the extent of government-provided resources to charter schools, (e) the perceptions of charter principals and CMO directors of the resources provided by the government, (f) the ways in which these actors have sought to complement these resources, and (g) the kinds of additional resources that have been obtained. Data in the form of documents, archives, literature and evaluations, and qualitative interviews were collected over eight months. Conclusions Findings indicate that charter school teachers in Bogotá feel that many aspects of their work environment are positive, though they also report tradeoffs in terms of job security and financial compensation. Charter schools use the flexibility afforded to them around employment to spend half as much on teachers by hiring nonunionized teachers, contracting them for periods of a year or less, assigning teachers to lower compensation categories, and offering significantly lower salaries, despite teachers working over 12 hours more each week than their public school counterparts. Findings with regard to resource acquisition address differences between public and charter schools, perceptions of school leaders, and the routes to resource acquisition used by charter schools, namely budget prioritization, donations, volunteers, partnerships, and alumni networks. Implications for future research are discussed, including the need for studies to distinguish among types of charter schools. The article concludes that, when addressing the costs and benefits of charter schools, we need to ask: Costs in what sense? Benefits for whom? And at whose expense?

Abstract Context.—The Veterans Health Administration (VA) operates the largest integrated laboratory network in the United States. Objective.—To assess whether the unique characteristics of VA laboratories impact efficiency of operations, we compared the productivity of VA and non-VA facilities. Design.—Financial and activity data were prospectively collected from 124 VA and 131 non-VA laboratories enrolled in the College of American Pathologists Laboratory Management Index Program (LMIP) during 2002. In addition, secular trends in 5 productivity ratios were calculated for VA and non-VA laboratories enrolled in LMIP from 1997 through 2002. Results.—Veterans Health Administration and non-VA facilities did not differ significantly in size. Inpatients accounted for a lower percentage of testing at VA facilities than non-VA facilities (21.7% vs 37.3%; P &lt; .001). Technical staff at the median VA facility were paid more than at non-VA facilities ($28.11/h vs $22.60/h, salaries plus benefits; P &lt; .001), VA laboratories employed a smaller percentage of nontechnical staff (30.0% vs 41.9%; P &lt; .001), and workers at VA laboratories worked less time per hour paid (85.5% vs 88.5%; P &lt; .001). However, labor productivity was significantly higher at VA than at non-VA facilities (30 448 test results/total full-time equivalent (FTE)/y vs 19 260 results/total FTE; P &lt; .001), resulting in lower labor expense per on-site test at VA sites than at non-VA sites ($1.79/result vs $2.08/result; P &lt; .001). Veterans Health Administration laboratories paid less per test for consumables (P = .003), depreciation, and maintenance than their non-VA counterparts (all P &lt; .001), resulting in lower overall cost per on-site test result ($2.64 vs $3.40; P &lt; .001). Cost per referred (sent-out) test did not differ significantly between the 2 groups. Analysis of 6-year trends showed significant increases in both VA (P &lt; .001) and non-VA (P = .02) labor productivity (on-site tests/total FTE). Expenses at VA laboratories for labor per test, consumables per test, overall expense per test, and overall laboratory expense per discharge decreased significantly during the 6-year period (P &lt; .001), while in non-VA facilities the corresponding ratios showed no significant change. Conclusions.—Overall productivity of VA laboratories is superior to that of non-VA facilities enrolled in LMIP. The principal advantages enjoyed by the VA are higher-than-average labor productivity (tests/FTE) and lower-than-average consumable expenses.

Objectives: To estimate years of potential life lost (YPLL) and present value of future lost productivity (PVFLP) associated with premature mortality due to HPV-attributable cancers, specifically those targeted by nonavalent HPV (9vHPV) vaccination, in the United States (US) before vaccine use.Methods: YPLL was estimated from the reported number of deaths in 2017 due to HPV-related cancers, the proportion attributable to 9vHPV-targeted types, and age- and sex-specific US life expectancy. PVFLP was estimated as the product of YPLL by age- and sex-specific probability of labor force participation, annual wage, value of non-market labor, and fringe benefits markup factor.Results: An estimated 7,085 HPV-attributable cancer deaths occurred in 2017 accounting for 154,954 YPLL, with 6,482 deaths (91%) and 141,019 YPLL (91%) attributable to 9vHPV-targeted types. The estimated PVFLP was $3.8 billion for cancer deaths attributable to 9vHPV-targeted types (84% from women). The highest productivity burden was associated with cervical cancer in women and anal and oropharyngeal cancers in men.Conclusions: HPV-attributable cancer deaths are associated with a substantial economic burden in the US, much of which could be vaccine preventable.

AbstractStates have turned to novel Medicaid financing to pay for community health worker (CHW) programs, often through fee-for-service or capitated payments. We sought to estimate Medicaid payment rates to ensure CHW program sustainability. A microsimulation model was constructed to estimate CHW salaries, equipment, transportation, space, and benefits costs across the U.S. Fee-for-service rates per 30-min CHW visit (code 98960) and capitated rates were calculated for financial sustainability. The mean CHW hourly wage was $23.51, varying from $15.90 in Puerto Rico to $31.61 in Rhode Island. Overhead per work hour averaged $43.65 nationwide, and was highest for transportation among other overhead categories (65.1% of overhead). The minimum fee-for-service rate for a 30-min visit was $53.24 (95% CI $24.80, $91.11), varying from $40.44 in South Dakota to $70.89 in Washington D.C. The minimum capitated rate was $140.18 per member per month (95% CI $105.94, $260.90), varying from $113.55 in South Dakota to $176.58 in Washington D.C. Rates varied minimally by metro status but more by panel size. Higher Medicaid fee-for-service and capitated rates than currently used may be needed to support financial viability of CHW programs. A revised payment estimation approach may help state officials, health systems and plans discussing CHW program sustainability.

Austerity has been hotly debated as either an elixir or a poison for tough economic times. But what is austerity? Real austerity means that the government and its employees have less money at their disposal. For the economists at the International Monetary Fund, «austerity» may mean spending cuts, but it also means increasing taxes on the beleaguered public in order to, at all costs, repay the government’s corrupt creditors. Keynesian economists reject all forms of austerity. They promote the «borrow and spend» approach that is supposedly scientific and is gentle on the people: paycheck insurance for the unemployed, bailouts for failing businesses, and stimulus packages for everyone else. Austrian School economists reject both the Keynesian stimulus approach and the IMF-style high-tax, pro-bankster «Austerian» approach. Although «Austrians» are often lumped in with «Auste-rians,» Austrian School economists support real austerity. This involves cutting government budgets, salaries, employee benefits, retirement benefits, and taxes. It also involves selling government assets and even repudiating government debt. Despite all the hoopla in countries like Greece, there is no real austerity except in the countries of eastern Europe. For example, Latvia is Europe’s most austere country and also has its fastest growing economy. Estonia implemented an austerity policy that depended largely on cuts in government salaries. There simply is no austerity in most of western Europe or the U.S. As Professor Philipp Bagus explains, «the problem of Europe (and the United States) is not too much but too little austerity—or its complete absence.»

As a prospective university student, student loans will probably account for a significant portion of one's financial obligations throughout higher education. Its primary objective is to enable students to focus exclusively on their studies without having to work part-time to cover living costs, tuition, books, or other needs necessary to sustain a modest lifestyle. Tuition (annual fees), particularly for universities, has been increasing globally, most notably in developed countries, with a statistical estimate of a 1.6-times increase in actual monetary value (Digest of education, 2006), owing to the fact that university personnel salaries and benefits typically increase faster than inflation ('Baumol's cost disease'). As a result, education plays a critical part in society's functioning. It allows individuals with the ability to nurture new members of the labor force to tolerate higher prices with the aim of financing a solid education investment. With postsecondary education playing such an essential role in many people's lives, it's unsurprising that many students take out loans without giving it much thought. Student loans impact nearly 44.7 million debtors in the United States alone, with a total outstanding debt of over USD 1.71 trillion.

Many urban districts in the United States have difficulty attracting and retaining quality teachers, yet they are often the most in need of them. In response, U.S. states and districts are experimenting with financial incentives to attract and retain high-quality teachers in high-need, low-achieving, or hard-to-staff urban schools. However, relatively little is known about how effective financial incentives are to recruit new teachers to high-need urban schools. This research explores factors that are important to the job choices of teachers in training. Focus groups were held with students at three universities, and a policy-capturing study was done using 64 job scenarios representing various levels of pay and working conditions. Focus group results suggested that: a) many pre-service teachers, even relatively late in their preparation, are not committed to a particular district and are willing to consider many possibilities, including high need schools; b) although pay and benefits were attractive to the students, loan forgiveness and subsidies for further education were also attractive; and c) small increments of additional salary did not appear as important or attractive as other job characteristics. The policy-capturing study showed that working conditions factors, especially principal support, had more influence on simulated job choice than pay level, implying that money might be better spent to attract, retain, or train better principals than to provide higher beginning salaries to teachers in schools with high-poverty or a high proportion of students of color.

While two editorials have raised concerns about the decline in Australian academic psychiatry, for a genuine rejuvenation to ever occur, we will need to re-examine how women can be better included in this important endeavour. While attainment of fellowship has reached gender parity, academic psychiatry has disappointingly lagged, with 80% of its senior leadership roles across Australia and New Zealand still held by men, with a similar situation in the United Kingdom and the United States as well as many other countries. Encouraging women into academic psychiatry is not only critical to progress as a profession but also will help address the current blindness to sex differences in biological psychiatry, as well the social impact of restrictive gender norms and the effects of gender-based violence on mental health. This potentially creates opportunities for significant gains and insights into mental disorders. However, addressing the barriers for women in academia requires tackling the entrenched disparities across salaries, grant funding, publications, teaching responsibilities, keynote invitations and academic promotions alongside the gender-based microaggressions, harassment and tokenism reported by many of our female academics. Many women must grapple with not just a ‘second shift’ but a ‘third shift’, making the burden of an academic career unreasonable and burnout more likely. Addressing this is no easy task. The varied research in academic medicine reveals no quick fixes, although promoting gender equity brings significant potential benefits. Areas such as academic psychiatry need to recognise our community’s growing discomfort with workplaces that choose to maintain status quo. Gender equity must be a critical part of any quest to revive this important area of practice for our profession.

Barrier islands and their backbarrier saltmarshes have a reciprocal relationship: aeolian and storm processes transport sediment from the beaches and dunes to create and build marshes along the landward fringe of the island. In turn, these marshes exert a stabilizing influence on the barrier by widening the barrier system and forming a platform onto which the island migrates, consequently slowing landward barrier migration and inhibiting storm breaching. Here, we present a novel framework for applying these natural interdependencies to managing coastal systems and enhancing barrier-island resilience. Further, we detail application of these principles through a case study of the design of a marsh creation project that showcases the interdisciplinary engagement of scientists, engineers, stakeholders, and policymakers. Specifically, we describe: (1) the ecologic, sedimentologic, stratigraphic, and morphologic data obtained from the southern 4 km of Cedar Island (Virginia, United States) and nearby backbarrier tidal channels, tidal flats, and flood-tidal deltas, and (2) the use of those data to develop an engineering and design plan for the construction of a high (46 ha) and low (42 ha) fringing marsh platform located behind the island, proximal to a former ephemeral inlet. Additionally, we chronicle the process used to narrow five initial alternative designs to the optimal final plan. This process involved balancing best-available existing science and models, considering design and financial constraints, identifying stakeholder preferences, and maximizing restoration benefits of habitat provision and shoreline protection. Construction of this marsh would: (1) provide additional habitat and ecosystem benefits, (2) slow the rapid migration (up to 15 m/yr at present) of the barrier island, and (3) hinder island breaching. Ultimately, this project – presently at the final design and permitting stage – may enhance the storm and sea-level rise resilience of the island, backbarrier marshes and lagoons, and the mainland town community; and provide an example of a novel science-based approach to coastal resilience that could be applied to other global barrier settings.

The COVID-19 pandemic has shed light on the growing need for home care workers, who support their elderly and disabled clients in their homes with activities of daily living, and on the challenges of recruiting and retaining workers in the industry. This brief describes the state of the home care sector and its connection to the economy. It looks at home care as a rapidly growing industry facing significant challenges and at home care’s role in enabling working-aged family members to participate in the labor force,i which supports the Federal Reserve’s maximum employment mandate There is an expanding need for home care in the United States, as the proportion of the population aged 65 and over rises.ii Home care is projected to add the largest number of jobs of any occupation over the next 10 years.iii At the same time, home care workers earn low wages and face challenging working conditions, factors that may be contributing to high turnover in the industryiv and a rising home care worker shortage.v Although low wages pose challenges to home care worker recruitment and retention, long-term care is unaffordable for many families. Medicaid pays for the majority of home care costs in the United States; however, many states have Medicaid waitlists for long-term care, and Medicaid eligibility requires individuals to have limited assets or to spend down the countable assets they have.vi To fill the long-term care affordability gap, many family members—disproportionately women—provide unpaid care, often reducing work hours or dropping out of the labor force entirely.vii Studies estimating the economic impacts of increased public funding for home care find that such investments have economic implications, such as reductions in worker turnover and in reliance on social safety net programs, increases in tax revenues and consumer spending due to wage increases, and higher salaries of those who would otherwise reduce their work hours or drop out of the labor force to provide unpaid family care.viii Improving home care worker wages, benefits, and working conditions and expanding access to subsidized home care has significant equity implications as well. The home care workforce is composed disproportionately of women of color and immigrant women.ix Unpaid family caregivers are also disproportionately women, many of whom reduce their own work hours or leave the labor force when they lack sufficient access to affordable, professional home care.x In 2020, many states used pandemic subsidies to expand eligibility for Medicaid-funded home care services and to give home care workers retainer payments.xi However, with those subsidies expiring, industry researchers have noted that many home care agencies have reduced the worker recruitment and retention incentives they offered in 2020; thus, low wages persist, and worker turnover rates remain high.xii Improving pay, recruitment, and retention in this rapidly growing and disproportionately women of color workforce could not only support this sector, but also enable labor force participation and contribute to a more equitable economy.xiii

The article is devoted to modern tendencies of change of strategies in formation of corporate culture in the crisis caused by the coronavirus. In modern business, corporate culture is an important condition for the successful work of a company, the foundation of its dynamic growth, striving to improve efficiency. Regardless of how the culture of an organization is formed, whether it is created deliberately or develops over time, it is always unique for each production (gender, age, professional and qualification structure of personnel, industry, specifics, etc.). CEOs are much more likely to think through the type of corporate culture of their company as it grows than in a possible crisis situation. The purpose of this study is to analyze the ways of transformation of key elements of corporate culture on the basis of sociological research in the form of surveys of employees of top corporations in the world. The coronavirus pandemic has shaken the entire global economy. First its paralyzed part of production in China, then stopped hundreds of enterprises in Europe, Asia and the United States. The authorities of different countries go to great lengths to help the business: salaries for the state account, parental benefits, cheap loans and tax deferral. However, in the context of the work of each enterprise, significant responsibilities lie with the management and the team. The negative consequences of the coronavirus pandemic are affecting and will exacerbate the work of both large state-owned enterprises and small businesses for a long time to come. According to the forecast of the International Labor Organization, due to the coronavirus pandemic, about 20 million people may lose their jobs. Operating under these stressful circumstances negatively impacts interpersonal relationships and business. In the article forms of manifestation of corporate culture in the context of a pandemic are considered. The data of surveys of employees and heads of organizations of such countries as the USA, Great Britain, Germany, Australia, Ukraine are analyzed. The significance and priority of supporting the team along with the elimination of financial risks and economic recovery was assessed.

Although globally the artisan sectora is the second largest employer in many emerging economies, and is valued at more than $750 billion dollars1, most artisansb are underemployed and socially marginalized.2 Traditional artisans in these countries primarily occupy lower income levels, indigenous communities are often at the margins of contemporary consumer-producer society, and overall digital and literacy divides create a dependence on intermediaries (individuals and organizations who command higher salaries) to support production, quality control, shipping, and baking; amongst other fundamental aspects of running a craft-based business. This article critically examines the roles that artisan sector brandc founders and designersd have played in maintaining this inequitable status quo, and suggests how their contributions may be reimagined in the service of social, political, and economic justice and in ways that can help artisans around the world realize grater benefit(s). This position paper has been co-authored by a founder of an accessories brand which has actively engaged in co-creation with indigenous artisans in Colombia, a designer who works as a creative consultant across the Colombian artisan sector, and a design educator and social activist who has conducted primary and secondary research about the global artisan sector. It summarizes a common design process used in commerce-based engagements between designers and artisans, and suggests that the "solutions" these yield are extractive and even recolonizing.e Additionally, this piece examines and interrogates how designers and their work on behalf of well-branded clients (such as Macy's3, Levi's4, IKEA5, and Kate Spade6, to name but a few examples) that utilize intermediaries such as brokers, buyers, and exporters to source craft goods produced by artisans the world over contributes to their economic marginalization. The authors' 25+ years of combined project-based experience in design is informed by a diverse set of perspectives, which span a spectrum of working within the academy and working on behalf of a variety of non-for-profit and for-profit businesses. The work we have undertaken with artisan communities of weavers, beaders, and quiltmakers in Colombia, Guatemala, and the United States confirms that intermediaries are complicit in maintaining a well-established status quo among artisans that tends to result in their being impoverished and exploited. If designers and the founders of artisan brands are in fact committed to improving the livelihoods of the artisans with whom they work, they must decide to either initiate and then sustain a radical shift in how they engage with artisan communities or stop seeking goods from them altogether. To support this idea, we are calling for designers to radically change how they engage with artisans as they collaborate on the making and marketing of products in ways that prioritize sustainable futures for themselves and their children. We also invite designers to consider how much artisan communities (especially indigenous groups) can teach us about planning and engaging in more sustainable ways of working that are centered around processes that yield mutual benefits and that foster more equitable collaborations. Our goal is to promote sustainability and decolonization, and, parallel with this, to guide and fuel socio-cultural, political, and economic justice and a fairer and more equitable future for artisans working and living around the world.

Photo by National Cancer Institute on Unsplash ABSTRACT The COVID-19 pandemic has brought about the advent of many new telehealth technologies as providers have been forced to shift their practice from the clinic to the cloud. Perhaps, none of these fields has been as widely advertised and expanded as telemental health. While many have lauded this change, it is important to question whether this method of practice is truly beneficial for patients, and further whether it benefits all patients. This paper critically examines the current structure of telemental health interventions and compares them to more traditional in-person interactions, reflecting on the unique benefits and challenges of each method, and ultimately concluding that telemental health is the wrong modality for certain patients and modalities. INTRODUCTION As the e-health revolution rapidly progresses, scientists, healthcare professionals, and technology experts are attempting to determine which areas of medical practice will best adapt to changing dynamics. Two key professions that are ripe for this kind of disruption are psychiatry and psychology. The American Psychiatric Association, along with its partners in the American Telemedicine Association, states that “telemental health in the form of interactive videoconferencing has become a critical tool in the delivery of mental health care. It has demonstrated its ability to increase access and quality of care, and, in some settings, to do so more effectively than treatment delivered in-person.”[1] This claim, though appearing bombastic, is also reflected, though with more nuance, by the American Psychological Association. For its part, the American Psychological Association states that “the expanding role of technology and the continuous development of new technologies that may be useful in the practice of psychology present unique opportunities, considerations, and challenges to practice.”[2] Thus, the point of this paper will be to examine whether the rapidly expanding system of telemental health is ethical based on its adherence to accepted standards of care, privacy concerns, and concerns about the boundaries of the patient-provider relationship. l. Standard of Care Concerns One of the most considerable objections to the broader implementation of telemental health services is the speculation that it is less effective than in-person treatment. It would follow that a system that is broadly implemented would not only fail to be beneficent, but it would also fail to be non-maleficent. Providers would be knowingly providing an ineffective treatment. Some may argue that such a system would also violate the principle of justice. It would create an unequal system of care in which those patients who could afford to see their therapist in person would benefit more than those who could not. However, data from a wide variety of sources at first glance, would seem to contradict these fears.[3] A review of the literature regarding the implementation of telemental health in geriatric patients, for example, showed that telemental health was as good as in-patient psychiatric care in several areas, including the diagnosis of dementia, nursing home consultations, and in conducting psychotherapy for geriatric patients and their caregivers.[4] On the other end of the age spectrum, a review of nineteen randomized controlled trials and one clinical trial demonstrated high comparative effectiveness between telemental health interventions in children and adolescents.[5] Hailey et al. found that telemental health interventions were effective in over half of the 65 studies reviewed. These studies encompassed a diverse and wide-ranging number of psychiatric disciplines, including child psychiatry, post-traumatic stress disorder, dementia, cognitive decline, smoking cessation, and eating disorders. Methods included phone- and web-based interventions.[6] Indeed, the data is not just limited to outpatient settings. For example, Reinhardt et al. conducted a literature review of studies about telemental health visits for psychiatric emergencies and crises. They found that no studies reported a significant statistical difference in diagnosis or disposition among psychiatric patients who presented to the Emergency Department. In addition, their review demonstrated a reduction in length of stay, reduction in time to care, and decreased costs among these patients. The authors also reviewed literature pertaining to crisis response teams and patients with severe mental illness. Both studies demonstrated that telemental health visits for these patients were similar, if not better, than face-to-face visits. In addition, both patients and practitioners showed high satisfaction with these services.[7] Thus, the implementation of telemental health is limited to out-patient settings and could feasibly be implemented in the in-patient and emergency settings. There is, however, one particularly glaring gap in telemental health services: group therapy. Perhaps the most famous example of group therapy is Alcoholics Anonymous, but group therapy has expanded to include many different modalities. Group therapy is a common intervention for many mental illnesses and can be incredibly effective in treating diseases ranging from PTSD to borderline personality disorder.[8] In a pilot study comparing a video teleconference based Dialectical Behavioral Therapy (DBT) group to an in-person DBT group, Lopez et al. found that while patients had similar levels of cohesion with the facilitator, participants in the video teleconference group saw less group cohesion than their peers in the in-person group. Further, while many patients in the video teleconference group believed that the convenience offset the adverse effects, many also wished for an in-person group. Attendance was also significantly higher in the video teleconference group.[9] Thus, while the video teleconference group did report some positives, some significant differences raise ethical questions. How well does a group do without cohesion? For example, if a person needing to be consoled breaks down and cries in front of the group, the in-person response may be different from the video conference. In the in-person group, other group members may place a gentle hand on the shoulder of the grieving person or maybe even hug them. The group facilitator or group members in the video conference group could say the same words of consolation as those in the in-person group. However, there still seems to be some missing action. The idea of physical touch, in this way, can mean a lot more than just a small action. Van Wynsberghe and Gastmans argue that this kind of deprivation may lead to feelings of depersonalization.[10] And, to an extent, their supposition is supported by the data presented by Lopez et.al. The low level of group cohesion in the video conference group could suggest that other group members seem unimportant to the participants. They are simply things on a screen, not real people. Dr. Thomas Insel, former National Institute of Mental Health Director writes that while technology may hold the key to improving mental health on the population level, there is a human-sized piece of the puzzle missing from these interventions. The solution, he asserts, lies somewhere in the integration of these two types of experiences, one that he terms “high-tech and high-touch.”[11] The lack of touch and physical presence is an obstacle for both patients and providers. At best this may lead to a slightly poorer provider-patient relationship and at worst may result in poorer quality care. ll. Privacy & Confidentiality Concerns Privacy and confidentiality are among the most serious concerns for practitioners and patients, made more complex by the advent of e-health. Major news outlets provide plenty of examples of breaches of confidentiality of people’s electronic records. Even significant systems, often thought to be secure, used to facilitate direct contact between people in the wake of COVID-19, like Zoom, have been breached. Not too long ago, "Zoom Bombing” was a national phenomenon, appearing in online classrooms, often sharing explicit or politically motivated content. Psychiatric patients are susceptible to issues surrounding privacy and confidentiality, and they may even come from communities that ostracize and stigmatize mental illness. These concerns must be taken seriously. Of course, both the American Psychiatric Association and the American Psychological Association address privacy concerns. Both organizations note in their guidelines that relevant HIPAA regulations apply to telehealth and doctors must use apps and videoconferencing tools with the highest levels of security.[12] Interestingly, the American Psychiatric Association takes these instructions one step further. It requires providers to be in a private room during telehealth videoconferences or calls and that people seeking care also have a private space so that any conversations are not overheard. This not only prevents violations of privacy but reassures the therapeutic relationship between provider and patient.[13] While providers can take these steps to ensure their patients’ privacy, an internet connection may not guarantee privacy. Many privacy issues are more easily mitigated in a clinical space. For example, walls and doors can be soundproofed, or white noise can be played in the waiting room to ensure that therapeutic conversations are not overheard. And while the American Psychiatric Association asks providers to mitigate these risks as they would in their respective clinics, there is another layer to online privacy. Providers should be concerned about telecommunications providers, how they collect information, and what types of information they collect.[14] If, for example, the patient must navigate to the practitioner’s webpage to enter into the therapy portal, that information might be tracked and used to generate personalized ads for the patient. If a person suffering from severe paranoia started receiving ads for psychiatric medication, they may react negatively to the invasion of privacy. That type of targeted advertising could even exacerbate a mental health condition. The scandals surrounding the National Security Administration (NSA) in recent years have added another layer of complexity to the issue of privacy. Whistleblowers like Edward Snowden, revealed that the government was collecting metadata from text messages, videos, and social media. Government surveillance is an added risk of mental health videoconferencing.[15] The government would not be bound by the rules that require privacy with few exceptions like the Tarasoff law, which could require disclosure to stop a violent act as a clinical care provider. The government might judge someone a risk-based on ill-gotten surveillance data, wrongly add a person to a watch list, or engage in further surveillance of a patient whom non-clinicians working in government assess to be a potential danger. Protection from government surveillance is a fundamental ethical endeavor. Yet government as a collector of data without a warrant or with easily attained FISA and other warrants is problematic. Scenarios may seem far-fetched but are within the realm of possibility. Secondly, the provider must envision how this might hinder care. For example, patients aware of the possibility of government surveillance may be reluctant to show up to online meetings if they show up at all. Perhaps they are so sensitive to these issues that they stop checking with their therapist altogether. It is easy to see how a person who has schizophrenia and shows signs of paranoia may avoid telehealth for fear of being tracked. Of course, one could also have privacy concerns about a therapist’s office. Perhaps patients are nervous about being seen in the office or parking lot. They might worry about being overheard. These concerns, however, can be mitigated fairly simply, for example, patients could find anonymous means of transportation and practitioners can soundproof their offices. Thus, in both the office and the videoconference, concerns can be mitigated easily and tangibly, but not eliminated entirely. Mental health providers should use the highest quality communication services with end-to-end encryption to bolster online privacy. lll. Boundary Issues and Professionalism The boundaries here are philosophical, not physical. Both the American Psychiatric Association and the American Psychological Association work to ensure that the patient-professional boundaries are kept as close to normal as possible. Both organizations expect practitioners to maintain the highest levels of professionalism when dealing with patients using telemental health services.[16] Practitioners are responsible for enforcing boundaries through informing their patients about appropriate behavior so that patients are discouraged from calling at inappropriate times absent an emergency. Videoconferencing systems and multi-layered protections like passwords and gatekeeping would prevent patients from logging into another patient’s appointment. These boundaries exist for a good reason. A 2017 report demonstrated that there is an escalating shortage of psychiatrists.[17] Nearly 1 in 5 people in the US has a mental health condition.[18] Mental health providers are nearly overwhelmed, therefore inappropriate, frequent, and unnecessary contact adds another level of complexity to treating patients. Mental health providers need to be stewards of the resource they provide. They must concentrate on the patient they are with. They also must guard themselves against burnout, because dealing with patients too often, even though technology allows for it, will lead to them being less effective for the rest of their patients. While these professional boundaries must be policed carefully, practitioners should also be careful of having boundaries that are too high. Thus, providers must balance between too much intimacy and too little.[19] Presence and physical touch have symbolic meaning. Being with a person reaffirms their personhood, and both provider and patient can feel that. Humans are relational beings, and a physical relationship often comforts people. It may also legitimize and reinforce the patient through sensation and perception. There may be something inherently missing from the practice of telemental health, as exemplified by the group members’ inability to console others in group therapy sessions over teleconference.[20] The screen may also be an agent of depersonalization. It may make the patient’s complaints seem less real. Or perhaps the patient may feel as though they are not being heard. Although the evidence of telemedicine’s successes above may seem to contradict this, none of the studies that extoll the benefits of telemental health have follow-up periods greater than one year. And while many studies show that patients are highly satisfied with telemental health, measurements of satisfaction are not standardized. It remains unclear whether patients benefit enough from their telemental sessions or whether they require more regular sessions to stay as satisfied as they were with in-person mental health care. Perhaps as time goes on, patients become more frustrated with telemental health. The research must answer these questions, but currently, it does not sufficiently address metaphysical arguments against telemental health. CONCLUSION Privacy is a key practical issue that remains. Although providers try to combat issues of privacy by using high-level conferencing software, which has end-to-end encryption,[21] surveillance and breaches may occur. While not suitable for all kinds of patients, telemental health services prove to be effective for groups of people that otherwise may not have been able to receive care over the past two years. There are some settings, such as group therapies, that are best suited for in-person meetings. Although online sessions encourage individuals to show up regularly, their downsides are not yet known. There is incredible power in the idea of presence, and humans are inherently relational beings. For some, a lack of contact is unwelcomed and makes therapy less satisfying. Opportunities to use in-person clinical care remain a priority for some patients, and healthcare providers should further investigate prioritizing in-person care for those who want it. Telemental health could be beneficial for emergencies, natural disasters, vulnerable groups, or when patients cannot get to their provider's office. However, for now, telemental health should not take a leading role in providing mental health treatment. - [1] Chiauzzi E, Clayton A, Huh-Yoo J. Videoconferencing-Based Telemental Health: Important Questions for the COVID-19 Era from Clinical and Patient-Centered Perspectives. JMIR Ment Health, 2020. doi:10.2196/24021 [2] Joint Task Force for the Development of Telepsychology Guidelines for Psychologists. Guidelines for the practice of telepsychology. American Psychologist, 2020. 791–800. doi.org/10.1037/a0035001 [3] Gentry MT, Lapid MI, Rummans TA. Geriatric Telepsychiatry: Systematic Review and Policy Considerations. Am J Geriatr Psychiatry. 2019 doi: 10.1016/j.jagp.2018.10.009; Campbell R, O'Gorman J, Cernovsky ZZ. Reactions of Psychiatric Patients to Telepsychiatry. Ment Illn. 2015;7(2):6101, 2015. doi:10.4081/mi.2015.6101; Malhotra S, Chakrabarti S, Shah R. Telepsychiatry: Promise, potential, and challenges. Indian J Psychiatry, 2013. doi: 10.4103/0019-5545.105499; Reinhardt I, Gouzoulis-Mayfrank E, Zielasek J. Use of Telepsychiatry in Emergency and Crisis Intervention: Current Evidence. Curr Psychiatry Rep, 2019. doi: 10.1007/s11920-019-1054-8 [4] Gentry, Lapid, and Rummans, Geriatric Telepsychiatry [5] Abuwalla, Zach & Clark, Maureen & Burke, Brendan & Tannenbaum, Viktorya & Patel, Sarvanand & Mitacek, Ryan & Gladstone, Tracy & Voorhees, Benjamin. Long-term Telemental health prevention interventions for youth: A rapid review, 2017. Internet Interventions. Doi.11. 10.1016/j.invent.2017.11.006. [6]Hailey D, Roine R, Ohinmaa A. The effectiveness of telemental health applications: a review, 2008. Can J Psychiatry. doi:10.1177/070674370805301109. [7] Reinhardt, Gouzoulis-Mayfrank, and Zielasek, Use of Telepsychiatry in Emergency and Crisis Intervention [8] Kealy, David & Piper, William & Ogrodniczuk, John & Joyce, Anthony & Weideman, Rene. Individual goal achievement in group psychotherapy: The roles of psychological mindedness and group process in interpretive and supportive therapy for complicated grief, 2018. Clinical Psychology & Psychotherapy. doi:10.1002/cpp.2346. Schwartze D, Barkowski S, Strauss B, Knaevelsrud C, Rosendahl J. Efficacy of group psychotherapy for posttraumatic stress disorder: Systematic review and meta-analysis of randomized controlled trials. Psychother Res, 2019. doi: 10.1080/10503307.2017.1405168; Wetzelaer P, Farrell J, Evers SM, Jacob GA, Lee CW, Brand O, van Breukelen G, Fassbinder E, Fretwell H, Harper RP, Lavender A, Lockwood G, Malogiannis IA, Schweiger U, Startup H, Stevenson T, Zarbock G, Arntz A. Design of an international multicentre RCT on group schema therapy for borderline personality disorder. BMC Psychiatry, 2014. doi: 10.1186/s12888-014-0319-3 [9] Lopez, Amy et al. “Therapeutic groups via video teleconferencing and the impact on group cohesion.” mHealth, 2020. doi:10.21037/mhealth.2019.11.04 [10] Van Wynsberghe A, Gastmans C. Telepsychiatry and the meaning of in-person contact: a preliminary ethical appraisal. Med Health Care Philos, 2009. doi: 10.1007/s11019-009-9214-y. [11]Thomas Insel, “Tech Can Help Solve Our Mental Health Crisis. But We Can’t Forget The Human Element.,” Substack newsletter, Big Technology (blog), January 27, 2022, https://bigtechnology.substack.com/p/tech-can-help-solve-our-mental-health. [12] Armstrong, C. M., Ciulla, R. P., Edwards-Stewart, A., Hoyt, T., & Bush, N. Best practices of mobile health in clinical care: The development and evaluation of a competency-based provider training program, 2018. Professional Psychology: Research and Practice. doi.org/10.1037/pro0000194 [13] Armstrong, C. M., Ciulla, R. P., Edwards-Stewart, A., Hoyt, T., & Bush, N. Best practices of mobile health in clinical care: The development and evaluation of a competency-based provider training program [14] Sabin JE, Skimming K. A framework of ethics for telepsychiatry practice. Int Rev Psychiatry, 2015. doi:10.3109/09540261.2015.1094034 [15] Lustgarten, S. D., & Colbow, A. J. Ethical concerns for telemental health therapy amidst governmental surveillance, 2017. American Psychologist. doi.org/10.1037/a0040321 [16] Armstrong, C. M., Ciulla, R. P., Edwards-Stewart, A., Hoyt, T., & Bush, N. Best practices of mobile health in clinical care: The development and evaluation of a competency-based provider training program [17] Merritt Hawkins. An Overview of the Salaries, Bonuses, and Other Incentives Customarily Used to Recruit Physicians, Physician Assistants and Nurse Practitioners, 2018. http://physicianresourcecenter.com/wp-content/uploads/2018/09/Merritt-Hawkins-2018-Review-of-Physician-and-Advanced-Practitioner-Incentives.pdf [18] Bose, J., Hedden, S., Lipari, R., Park-Lee, E. Key Substance Use and Mental Health Indicators in the United States: Results from the 2015 National Survey on Drug Use and Health, 2015. https://www.samhsa.gov/data/sites/default/files/NSDUH-FFR1-2015/NSDUH-FFR1-2015/NSDUH-FFR1-2015.pdf [19] Sabin and Skimming. A Framework of Ethics for Telepsychiatry Practice [20] Van Wynsberghe and Gastmans, Telepsychiatry and the Meaning of In-Person Contact [21] Lustgarten and Colbow, Ethical Concerns for Telemental Health Therapy amidst Governmental Surveillance

Introduction The study of online conspiracy theory communities presents unique methodological challenges. Online conspiracy theorists often adhere to an individualistic knowledge culture of “doing one’s own research” (Fenster 158). This results in a decentralised landscape of theories, narratives and communities that challenges conventional top-down approaches to analysis. Moreover, conspiracy theories tend to be discussed on the fringes of the online ecosystem, in chat groups, small subcultural Web forums and away from mainstream social media platforms such as Facebook and Twitter (Frenkel; see also De Zeeuw et al.). In this context, the messaging app Telegram has developed into a particularly prominent space (Rogers, “Deplatforming”; Urman and Katz). On the one hand, this platform is not quite part of the same mainstream as Facebook or Twitter, owing in part to its emphasis on security, “social privacy”, and lack of central moderation (Rogers, “Deplatforming”). But it is also not quite an “alternative social medium” (Gehl), as it does not position itself in opposition to mainstream platforms per se, nor does its business model centered around investor funding and advertisements present a break from the “dominant political economy” (ibid.). This ambiguous position might account for Telegram’s wide adoption, as well as its status as a relatively safe haven for communities deplatformed elsewhere – including a lively ecosystem of conspiracy theory communities (La Morgia et al.). Because Telegram communities are distributed over a wide range of channels and chat groups, they cannot always be investigated using existing analytical approaches for social media research. Confronting this challenge, we propose and discuss a method for studying Telegram communities that repurposes the “methods of the medium” (Rogers, Digital Methods). Specifically, our method appropriates Telegram’s feature of forwarding messages from one group to another to discover interlinked distributed communities, collect data from these communities for close reading, and map their information sharing practices. In this article, we will first present this approach and illustrate the types of analyses the collected data might afford in relation to a brief case study on Dutch-speaking conspiracy theories. In this short illustration, we map the convergence of right-wing and conspiratorial communities, both structurally and discursively. As Vieten discusses, “digital pandemic populism during lockdown might have pushed further the mobilisation of the far right, also on the streets”. In the Dutch context there has been a demonstrated connection between the two. Because of this connection, we were drawn to the questions of what these entanglements might look like in a relatively unmoderated Telegram environment. We then proceed to discuss some strengths and limitations, identify avenues for future research, and conclude with some ethical, methodological and epistemological reflections. Overview of Method Our method first combines expert knowledge, and the affordances of the Telegram app’s ‘search’ function to retrieve a set of channels mentioning specific politicians or political parties, as well as other marked terms that might point towards far-right or conspiratorial content. This includes wakker (awakened), variations of batavier and geus (nationalist demonyms), names of known far right politicians (such as The Netherlands’ Thierry Baudet and Flanders’ Dries Van Langenhove) and conspiracy theory activists, and volk (a term meaning roughly “our people”). As this approach precludes discovery of related groups that do not match the queries exactly, this initial curated list is then supplemented with channels advertised elsewhere, such as those featured on the Websites of far-right politicians and organisations, as well as channels covered in mainstream news media. This yields an initial expert list of channels, in our sample case of Dutch-speaking right-wing and conspiracist actors comprising 50 items. One might stop here, and collect data for this manually curated list of groups, as in Nikkhah et al.’s study of Telegram use among the Iranian diaspora in the United States, or Davey and Weinberg’s analysis of far-right groups used in the US military. But this would exclude any groups not known by the researchers; and groups are not always easy to naively discover on Telegram. Because of this, in a subsequent step, we expanded the initial set of relevant Telegram channels by crawling posts in these channels that were forwarded from other channels, constituting links between these channels. We used a custom crawler based on the open source library Selenium, which allows one to control a browser programmatically. The browser was then made to scroll through the Web-based view of the selected channels (e.g. https://t.me/s/durov). In principle, all messages ever posted in a channel are available in this view. We then follow those links, and store the names of the linked channels. Overall, this method thus presumes that if a channel forwards a message from another channel there will be some overlap in terms of topic of discussion between both, making the newly discovered channel similarly relevant to the analysis. This results in a network-like representation of connections between channels. In the context of our case study, this process expands our initial seed list to a list of over 215 relevant public channels, after discarding groups that are not germane to the case study, i.e. those that were not related to far-right or conspiracy theory-related communities. To verify this, channels were inductively coded by a team of four researchers after capture. We then repeat the data collection for this new list of channels, retrieving forwarded messages from over 370,000 total messages spanning the period 2017-2021. This dataset then serves as a starting point for structural analysis of the wider context of the community, aspects of which will be illustrated in the next section. Illustration Emphasising the value of a “quali-quanti” (Venturini and Latour) approach we offer a tentative analysis of the decentralised Dutch-speaking conspiracist narratives and communities on Telegram, and in a broader sense observe what such a distributed community may look like on the platform. This then suggests the various affordances which a dataset collected with this method can offer. Fig. 1: Network visualisation of collected channels (depth: 1) including channels forwarded from (4354 nodes). Nodes are sized and coloured by degree (amount of connections to other channels). A first observation that can be made concerns the topology of the network of channels we found (see fig. 1). A network analysis is a suitable distant reading approach for this kind of data, because it “maps and measures formal and informal relationships … viz., who knows whom, and who shares what information and knowledge with whom” (Serrat 40). It is a type of analysis that can reveal the relevance and positioning of actors and narratives within the data. In our network visualisation, we use the ForceAtlas2 algorithm (Jacomy et al.) to position the nodes. This algorithm makes more connected nodes “gravitate” towards each other; the more central a node is, the more connected it is to the rest of the network, roughly speaking (Figure 1). Highlighting the channels representing political parties shows, for example, that while the Dutch far right party FvD (FVDNL) is quite central (connected), this is not the case for the Flemish far right politician Dries Van Langenhove (kiesdries). This suggests that compared to a similar Flemish politician, the Dutch FvD is a more prominent part of the general conspiracist discussion – which is then perhaps more overtly politicised in the Dutch context. We can additionally discern channels that we might label “content aggregators”, which forward large numbers of messages from other channels but post comparatively little original content, occupying a relatively central place in the wider network. These content aggregators play an important structural role in the network, as other channels might forward messages from these collections on a “pick and choose” basis. More abstractly, they also serve to confirm thematic similarity between the channels messages are forwarded from, with the owners of the aggregator channels playing the role of a curator that collects interesting content about a certain topic of interest. Furthermore, our data reveal that the network is highly dynamic. As forwarded messages are timestamped, we can plot the graph at different moments in time. When comparing changes over a year, we can observe a significant growth in the number of channels that connect to the network particularly between 2020 and 2021 (see fig. 2). This growth, and the associated diversity of the network, can be attributed to Telegram’s role as a haven for actors that were deplatformed (or present themselves as targets of deplatforming and censorship) from other social media; a “platform of last resort”. Previous research has for instance indicated that a number of alt-right fringe actors moved to Telegram after being deplatformed from Facebook or Twitter (Rogers, “Deplatforming”). It can be hypothesised that events such as Donald Trump’s removal from Twitter around the time of the January 2021 Capitol riots might similarly have inspired other actors to move to Telegram in response to the platform policies of mainstream social media. Fig. 2: The channel network based on messages sent before June 2020 (334 nodes). Same layout and parameters as in Figure 1 (not to scale). Nodes also appearing in Figure 1 are highlighted. The structure of the network (in fig. 1) can also be used to discern ‘sub-communities’, which forward messages mutually but have relatively few links to the broader network. These can then be analysed qualitatively. This may then reveal that Flemish groups that oppose COVID-19 policies are less connected with the far right, whereas such groups that can be identified as Dutch seem to merge more easily with far-right channels. As discussed, this is also suggested by the position of FVDNL, the Dutch far-right political party Forum voor democratie (FvD) which is central in the network. On this level, this suggests that structurally, Dutch far-right parties are more explicitly affiliating themselves with conspiracy-related channels than Flemish parties. Actual textual analyses of the channels’ posts and images, however, could offer a more nuanced picture, whereby structurally unconnected channels might still share common harmful narratives, spanning anti-progressive discourse, anti-mainstream sentiments, anti-government discourse, and evocations of prominent conspiracy theories such as QAnon and The Great Reset. These structural analyses then present a number of possibilities for further content analysis, where one might for example “zoom in” on Dutch far-right groups in particular, and qualitatively study images posted therein to identify salient narratives and positions. Discussion Methodological Gains Variations of the proposed approach have been used in other work (e.g. Hashemi and Chahooki; La Morgia et al.). Most prominently, the Pushshift Telegram Dataset (Baumgartner et al.) comprises a large dataset of channel metadata, author metadata and messages. This dataset was collected by discovering new channels from an initial seed list of approximately 300 channels using forwarded messages, and then collecting messages from these channels. While there is great archival value in the resulting datasets, our approach differs from these earlier approaches in a number of instructive ways. Like other work we appropriate an affordance of Telegram – forwarded messages – for our own research purposes, but we purposely limit the extent of “following” these forwarded messages. Though one could keep following links indefinitely, not every link is a link that is structural to the distributed community of users that is of interest here. Though more extensive crawling might reveal ever more channels and associated data, these are also increasingly unlikely to be related to the initial topic of interest, and are in any case further removed from the users of the initial seed groups. For this reason, we use a relatively shallow crawl depth and only retain links up to two “hops” away from the initial seed channels. This trades a higher number of crawled channels for a higher likelihood that the captured channels are indeed relevant to the case study. The suitable crawl depth would differ from case to case. In our case, it was established empirically through pilot crawls, which were stopped once collected groups appeared to no longer be strongly connected to the initial seed groups by topic. Datasets of this type are often also difficult to reproduce or qualify. For example for the datasets compiled by La Morgia et al. as well as for Baumgartner et al., the original seed list is not provided. Because of this, it is impossible to see where the network of found groups originates and how it might be biased one way or another. We suggest that where possible, this seed list is documented and shared. In our case, this would be particularly important as the seeds represent an intentional and explicit bias; that is, Dutch-speaking conspiracy-themed and far-right groups. If the starting point of the crawl is documented, one could potentially re-collect the data later from the same starting points and compare results to those found initially, allowing for longitudinal analyses of the topology of these communities. Ethics The method described here does not deal with personally identifiable information (PII) per se; one can map the channel network on a structural level without collecting user data or analysing specific messages, when purely tracing the origin of forwarded messages. It should be noted, however, that in the process of collecting these structural data, one can potentially go further. For example, it is possible to scrape the full content of messages. When also including chat groups, user details including (user-provided) full names are also available. Their inclusion in (public) datasets should be subject to closer scrutiny than that of public channels, as the former may represent conversations had under the assumption that this conversation was more or less off the record; while the latter are explicitly intended for information broadcast. Even if many of these chat groups are technically public, we should consider that "even if users are aware of being observed by others, they do not consider the possibility that their actions and interactions may be documented and analysed in detail at a later occasion" (Sveningsson Elm 77). In many cases, a (structural) analysis of only channels strikes a good balance between collecting representative data and respecting the privacy of those who produce the collected data. Avenues for Future Research The method may be expanded in a number of ways. One could, as discussed, increase the amount of crawl iterations, which would expand the network at the potential cost of case-specificity. A larger seed list could also increase the quantity of the data, though the effect of this can often be limited, as a relatively limited amount of channels forward messages from other channels. Links between channels could be collected not only from forwarded messages, as we do here, but also via other repurposed Telegram features such as channel invitation links or simple hyperlinks to other channels found in message content. The latter would require more fine-grained parsing of the message texts through natural language processing, for example, as a hyperlink can suggest a wider range of connections than an intentionally forwarded message. Additionally, and as previously mentioned, one could include not only public channels but also public chat groups, which are often linked to these channels and offer a space for people to discuss the content posted in them. While this can be an attractive way of acquiring extra data, we forego this in our example. As discussed, there are ethical trade-offs to consider when deciding to work with data from groups; but, it can be argued that Telegram channels represent an explicit “broadcast” style of communication (Shehabat et al.). Because the channel owner(s) decide what is worthy of sharing, one can reasonably assume that if one “follows the medium” here, all content retrieved from a channel will be somewhat relevant to the channel's purported theme. Conversely, discourse in chat groups might be expected to meander into a variety of directions and can easily include many (forwarded) messages only tangentially related to the case study of interest. Conclusion In this article we have sought to present one methodological approach to studying communities on Telegram. Rather than presenting a thorough case study or a definitive analysis of the Telegram-based community we discuss, our goal was to demonstrate the method's benefits but also its potential shortcomings, avenues of further development, and what types of analysis data collected with it might afford. A cursory analysis of the fringe community we studied here shows how with such data one can map a given community or set of communities on a structural level, which may then be used to demarcate areas of interest for further content analysis. The observations presented in this article are far from a complete picture of the data collected, but can serve as suggestions for analytical avenues one might venture down in a more substantive analysis. Beyond these observations, our repurposing of “the methods of the medium” (Rogers, Digital Methods) through forwarded messages allows us to contribute an empirically informed reflection on the possibilities and limitations of studying conspiracist information sharing practices on Telegram. Our method for instance highlights tensions between public and private knowledge, whereby we only consider information from public channels, and for technical and ethical reasons omit Telegram’s closed-off, private chat groups from our analysis. Our method of sourcing channels through forwarded messages does not preclude the existence of isolated channels or clusters of channels that, for a lack of forwarded messages from channels that were already identified, elude the scope of such snowballing efforts. Along the same lines, one could imagine that a deeper, more far-reaching crawl would reveal some strange bedfellows for the initial seed that were not part of our a priori understanding and hypotheses concerning the communities of interest. All of these considerations represent choices that may be taken differently depending on the case study at hand. Statement on Data and Ethics The analysis on offer in this article is limited to names of public channels on Telegram and we purposely refrain from citing channel names or analysing specific messages so they cannot be traced back to single persons. Our analysis does not comprise live subjects or PII, and thus did not require ERB clearance from our respective institutions. The anonymised dataset described above is available upon request via Zenodo at https://doi.org/10.5281/zenodo.6344795. Acknowledgements We would like to thank Nathalie van Raemdonck (Vrije Universiteit Brussel) and Jasmin Seijbel (Erasmus Universiteit Rotterdam) for their contributions to the empirical work underlying this article. References Baumgartner, Jason, et al. “The Pushshift Telegram Dataset.” Proceedings of the International AAAI Conference on Web and Social Media 14 (2020): 840–847. Blondel, Vincent D., et al. “Fast Unfolding of Communities in Large Networks.” Journal of Statistical Mechanics: Theory and Experiment 2008.10 (2008): P10008. Davey, Jacob, and Dana Weinberg. Influence: Discussions of the US Military in Extreme Right-Wing Telegram Channels. ISD Global, 2021. De Zeeuw, Daniel et al. “Tracing Normiefication: A Cross-Platform Analysis of the QAnon Conspiracy Theory.” First Monday 25.1 (2020). Fenster, Mark. Conspiracy Theories. Minneapolis: U of Minnesota P, 2008. Frenkel, Sheera. “Facebook Amps Up Its Crackdown on QAnon.” The New York Times 6 Oct. 2020, sec. Technology. <https://www.nytimes.com/2020/10/06/technology/facebook-qanon-crackdown.html>. Gehl, Robert W. “The Case for Alternative Social Media.” Social Media + Society 1.2 (2015). Hashemi, Ali, and Mohammad Ali Zare Chahooki. “Telegram Group Quality Measurement by User Behavior Analysis.” Social Network Analysis and Mining 9.1 (2019): 33. Jacomy, Mathieu, et al. “ForceAtlas2, a Continuous Graph Layout Algorithm for Handy Network Visualization Designed for the Gephi Software.” PLOS ONE 9.6 (2014): e98679. La Morgia, Massimo et al. “Uncovering the Dark Side of Telegram: Fakes, Clones, Scams, and Conspiracy Movements.” arXiv:2111.13530 [cs] (2021). <http://arxiv.org/abs/2111.13530>. Nikkhah, Sarah, et al. “Coming to America: Iranians’ Use of Telegram for Immigration Information Seeking.” Aslib Journal of Information Management 72.4 (2020): 561–585. Rogers, Richard. “Deplatforming: Following Extreme Internet Celebrities to Telegram and Alternative Social Media.” European Journal of Communication 35.3 (2020): 213–229. ———. Digital Methods. Cambridge: MIT P, 2013. Serrat, Olivier. “Social Network Analysis.” In Knowledge Solutions: Tools, Methods, and Approaches to Drive Organizational Performance. Ed. Olivier Serrat. Singapore: Springer, 2017. 39–43. <https://doi.org/10.1007/978-981-10-0983-9_9>. Shehabat, Ahmad, Teodor Mitew, and Yahia Alzoubi. “Encrypted Jihad: Investigating the Role of Telegram App in Lone Wolf Attacks in the West.” Journal of Strategic Security 10.3 (2017): 27–53. Sveningsson Elm, Malin. “How Do Various Notions of Privacy Influence Decisions in Qualitative Internet Research?” In Internet Inquiry: Conversations about Method. Eds. Annette Markham and Nancy Baym. SAGE, 2009. 69–97. Urman, Aleksandra, and Stefan Katz. “What They Do in the Shadows: Examining the Far-Right Networks on Telegram.” Information, Communication & Society (2020). Venturini, Tommaso, and Bruno Latour. “The Social Fabric: Digital Footprints and Quali-quantitative Methods.” In Proceedings of Futur en Seine 2009: The Digital Future of the City. Festival for Digital Life and Creativity, 2010. 87-101. Vieten, Ulrike M. “The ‘New Normal’ and ‘Pandemic Populism’: The COVID-19 Crisis and Anti-Hygienic Mobilisation of the Far-Right.” Social Sciences 9.9 [165] (2020).

Introduction: Bubbles and Sport The ephemeral materiality of bubbles – beautiful, spectacular, and distracting but ultimately fragile – when applied to protect or conserve in the interests of sport-media profit, creates conditions that exacerbate existing inequalities in sport and society. Bubbles are usually something to watch, admire, and chase after in their brief yet shiny lives. There is supposed to be, technically, nothing inside them other than one or more gasses, and yet we constantly refer to people and objects being inside bubbles. The metaphor of the bubble has been used to describe the life of celebrities, politicians in purpose-built capital cities like Canberra, and even leftist, environmentally activist urban dwellers. The metaphorical and material qualities of bubbles are aligned—they cannot be easily captured and are liable to change at any time. In this article we address the metaphorical sporting bubble, which is often evoked in describing life in professional sport. This is a vernacular term used to capture and condemn the conditions of life of elite sportspeople (usually men), most commonly after there has been a sport-related scandal, especially of a sexual nature (Rowe). It is frequently paired with connotatively loaded adjectives like pampered and indulged. The sporting bubble is rarely interrogated in academic literature, the concept largely being left to the media and moral entrepreneurs. It is represented as involving a highly privileged but also pressurised life for those who live inside it. A sporting bubble is a world constructed for its most prized inhabitants that enables them to be protected from insurgents and to set the terms of their encounters with others, especially sport fans and disciplinary agents of the state. The Covid-19 pandemic both reinforced and reconfigured the operational concept of the bubble, re-arranging tensions between safety (protecting athletes) and fragility (short careers, risks of injury, etc.) for those within, while safeguarding those without from bubble contagion. Privilege and Precarity Bubble-induced social isolation, critics argue, encourages a loss of perspective among those under its protection, an entitled disconnection from the usual rules and responsibilities of everyday life. For this reason, the denizens of the sporting bubble are seen as being at risk to themselves and, more troublingly, to those allowed temporarily to penetrate it, especially young women who are first exploited by and then ejected from it (Benedict). There are many well-documented cases of professional male athletes “behaving badly” and trying to rely on institutional status and various versions of the sporting bubble for shelter (Flood and Dyson; Reel and Crouch; Wade). In the age of mobile and social media, it is increasingly difficult to keep misbehaviour in-house, resulting in a slew of media stories about, for example, drunkenness and sexual misconduct, such as when then-Sydney Roosters co-captain Mitchell Pearce was suspended and fined in 2016 after being filmed trying to force an unwanted kiss on a woman and then simulating a lewd act with her dog while drunk. There is contestation between those who condemn such behaviour as aberrant and those who regard it as the conventional expression of youthful masculinity as part of the familiar “boys will be boys” dictum. The latter naturalise an inequitable gender order, frequently treating sportsmen as victims of predatory women, and ignoring asymmetries of power between men and women, especially in homosocial environments (Toffoletti). For those in the sporting bubble (predominantly elite sportsmen and highly paid executives, also mostly men, with an array of service staff of both sexes moving in and out of it), life is reflected for those being protected via an array of screens (small screens in homes and indoor places of entertainment, and even smaller screens on theirs and others’ phones, as well as huge screens at sport events). These male sport stars are paid handsomely to use their skill and strength to perform for the sporting codes, their every facial expression and bodily action watched by the media and relayed to audiences. This is often a precarious existence, the usually brief career of an athlete worker being dependent on health, luck, age, successful competition with rivals, networks, and club and coach preferences. There is a large, aspirational reserve army of athletes vying to play at the elite level, despite risks of injury and invasive, life-changing medical interventions. Responsibility for avoiding performance and image enhancing drugs (PIEDs) also weighs heavily on their shoulders (Connor). Professional sportspeople, in their more reflective moments, know that their time in the limelight will soon be up, meaning that getting a ticket to the sporting bubble, even for a short time, can make all the difference to their post-sport lives and those of their families. The most vulnerable of the small minority of participants in sport who make a good, short-term living from it are those for whom, in the absence of quality education and prior social status, it is their sole likely means of upward social mobility (Spaaij). Elite sport performers are surrounded by minders, doctors, fitness instructors, therapists, coaches, advisors and other service personnel, all supporting athletes to stay focussed on and maximise performance quality to satisfy co-present crowds, broadcasters, sponsors, sports bodies and mass media audiences. The shield offered by the sporting bubble supports the teleological win-at-all-costs mentality of professional sport. The stakes are high, with athlete and executive salaries, sponsorships and broadcasting deals entangled in a complex web of investments in keeping the “talent” pivotal to the “attention economy” (Davenport and Beck)—the players that provide the content for sale—in top form. Yet, the bubble cannot be entirely secured and poor behaviour or performance can have devastating effects, including permanent injury or disability, mental illness and loss of reputation (Rowe, “Scandals and Sport”). Given this fragile materiality of the sporting bubble, it is striking that, in response to the sudden shutdown following the economic and health crisis caused by the 2020 global pandemic, the leaders of professional sport decided to create more of them and seek to seal the metaphorical and material space with unprecedented efficiency. The outcome was a multi-sided tale of mobility, confinement, capital, labour, and the gendering of sport and society. The Covid-19 Gilded Cage Sociologists such as Zygmunt Bauman and John Urry have analysed the socio-politics of mobilities, whereby some people in the world, such as tourists, can traverse the globe at their leisure, while others remain fixed in geographical space because they lack the means to be mobile or, in contrast, are involuntarily displaced by war, so-called “ethnic cleansing”, famine, poverty or environmental degradation. The Covid-19 global pandemic re-framed these matters of mobilities (Rowe, “Subjecting Pandemic Sport”), with conventional moving around—between houses, businesses, cities, regions and countries—suddenly subjected to the imperative to be static and, in perniciously unreflective technocratic discourse, “socially distanced” (when what was actually meant was to be “physically distanced”). The late-twentieth century analysis of the “risk society” by Ulrich Beck, in which the mysterious consequences of humans’ predation on their environment are visited upon them with terrifying force, was dramatically realised with the coming of Covid-19. In another iteration of the metaphor, it burst the bubble of twenty-first century global sport. What we today call sport was formed through the process of sportisation (Maguire), whereby hyper-local, folk physical play was reconfigured as multi-spatial industrialised sport in modernity, becoming increasingly reliant on individual athletes and teams travelling across the landscape and well over the horizon. Co-present crowds were, in turn, overshadowed in the sport economy when sport events were taken to much larger, dispersed audiences via the media, especially in broadcast mode (Nicholson, Kerr, and Sherwood). This lucrative mediation of professional sport, though, came with an unforgiving obligation to generate an uninterrupted supply of spectacular live sport content. The pandemic closed down most sports events and those that did take place lacked the crucial participation of the co-present crowd to provide the requisite event atmosphere demanded by those viewers accustomed to a sense of occasion. Instead, they received a strange spectacle of sport performers operating in empty “cathedrals”, often with a “faked” crowd presence. The mediated sport spectacle under the pandemic involved cardboard cut-out and sex doll spectators, Zoom images of fans on large screens, and sampled sounds of the crowd recycled from sport video games. Confected co-presence produced simulacra of the “real” as Baudrillardian visions came to life. The sporting bubble had become even more remote. For elite sportspeople routinely isolated from the “common people”, the live sport encounter offered some sensory experience of the social – the sounds, sights and even smells of the crowd. Now the sporting bubble closed in on an already insulated and insular existence. It exposed the irony of the bubble as a sign of both privileged mobility and incarcerated athlete work, both refuge and prison. Its logic of contagion also turned a structure intended to protect those inside from those outside into, as already observed, a mechanism to manage the threat of insiders to outsiders. In Australia, as in many other countries, the populace was enjoined by governments and health authorities to help prevent the spread of Covid-19 through isolation and immobility. There were various exceptions, principally those classified as essential workers, a heterogeneous cohort ranging from supermarket shelf stackers to pharmacists. People in the cultural, leisure and sports industries, including musicians, actors, and athletes, were not counted among this crucial labour force. Indeed, the performing arts (including dance, theatre and music) were put on ice with quite devastating effects on the livelihoods and wellbeing of those involved. So, with all major sports shut down (the exception being horse racing, which received the benefit both of government subsidies and expanding online gambling revenue), sport organisations began to represent themselves as essential services that could help sustain collective mental and even spiritual wellbeing. This case was made most aggressively by Australian Rugby League Commission Chairman, Peter V’landys, in contending that “an Australia without rugby league is not Australia”. In similar vein, prominent sport and media figure Phil Gould insisted, when describing rugby league fans in Western Sydney’s Penrith, “they’re lost, because the football’s not on … . It holds their families together. People don’t understand that … . Their life begins in the second week of March, and it ends in October”. Despite misgivings about public safety and equality before the pandemic regime, sporting bubbles were allowed to form, re-form and circulate. The indefinite shutdown of the National Rugby League (NRL) on 23 March 2020 was followed after negotiation between multiple entities by its reopening on 28 May 2020. The competition included a team from another nation-state (the Warriors from Aotearoa/New Zealand) in creating an international sporting bubble on the Central Coast of New South Wales, separating them from their families and friends across the Tasman Sea. Appeals to the mental health of fans and the importance of the NRL to myths of “Australianness” notwithstanding, the league had not prudently maintained a financial reserve and so could not afford to shut down for long. Significant gambling revenue for leagues like the NRL and Australian Football League (AFL) also influenced the push to return to sport business as usual. Sport contests were needed in order to exploit the gambling opportunities – especially online and mobile – stimulated by home “confinement”. During the coronavirus lockdowns, Australians’ weekly spending on gambling went up by 142 per cent, and the NRL earned significantly more than usual from gambling revenue—potentially $10 million above forecasts for 2020. Despite the clear financial imperative at play, including heavy reliance on gambling, sporting bubble-making involved special licence. The state of Queensland, which had pursued a hard-line approach by closing its borders for most of those wishing to cross them for biographical landmark events like family funerals and even for medical treatment in border communities, became “the nation's sporting hub”. Queensland became the home of most teams of the men’s AFL (notably the women’s AFLW season having been cancelled) following a large Covid-19 second wave in Melbourne. The women’s National Netball League was based exclusively in Queensland. This state, which for the first time hosted the AFL Grand Final, deployed sport as a tool in both national sports tourism marketing and internal pre-election politics, sponsoring a documentary, The Sporting Bubble 2020, via its Tourism and Events arm. While Queensland became the larger bubble incorporating many other sporting bubbles, both the AFL and the NRL had versions of the “fly in, fly out” labour rhythms conventionally associated with the mining industry in remote and regional areas. In this instance, though, the bubble experience did not involve long stays in miners’ camps or even the one-night hotel stopovers familiar to the popular music and sport industries. Here, the bubble moved, usually by plane, to fulfil the requirements of a live sport “gig”, whereupon it was immediately returned to its more solid bubble hub or to domestic self-isolation. In the space created between disciplined expectation and deplored non-compliance, the sporting bubble inevitably became the scrutinised object and subject of scandal. Sporting Bubble Scandals While people with a very low risk of spreading Covid-19 (coming from areas with no active cases) were denied entry to Queensland for even the most serious of reasons (for example, the death of a child), images of AFL players and their families socialising and enjoying swimming at the Royal Pines Resort sporting bubble crossed our screens. Yet, despite their (players’, officials’ and families’) relative privilege and freedom of movement under the AFL Covid-Safe Plan, some players and others inside the bubble were involved in “scandals”. Most notable was the case of a drunken brawl outside a Gold Coast strip club which led to two Richmond players being “banished”, suspended for 10 matches, and the club fined $100,000. But it was not only players who breached Covid-19 bubble protocols: Collingwood coaches Nathan Buckley and Brenton Sanderson paid the $50,000 fine imposed on the club for playing tennis in Perth outside their bubble, while Richmond was fined $45,000 after Brooke Cotchin, wife of team captain Trent, posted an image to Instagram of a Gold Coast day spa that she had visited outside the “hub” (the institutionally preferred term for bubble). She was subsequently distressed after being trolled. Also of concern was the lack of physical distancing, and the range of people allowed into the sporting bubble, including babysitters, grandparents, and swimming coaches (for children). There were other cases of players being caught leaving the bubble to attend parties and sharing videos of their “antics” on social media. Biosecurity breaches of bubbles by players occurred relatively frequently, with stern words from both the AFL and NRL leaders (and their clubs) and fines accumulating in the thousands of dollars. Some people were also caught sneaking into bubbles, with Lekahni Pearce, the girlfriend of Swans player Elijah Taylor, stating that it was easy in Perth, “no security, I didn’t see a security guard” (in Barron, Stevens, and Zaczek) (a month later, outside the bubble, they had broken up and he pled guilty to unlawfully assaulting her; Ramsey). Flouting the rules, despite stern threats from government, did not lead to any bubble being popped. The sport-media machine powering sporting bubbles continued to run, the attendant emotional or health risks accepted in the name of national cultural therapy, while sponsorship, advertising and gambling revenue continued to accumulate mostly for the benefit of men. Gendering Sporting Bubbles Designed as biosecurity structures to maintain the supply of media-sport content, keep players and other vital cogs of the machine running smoothly, and to exclude Covid-19, sporting bubbles were, in their most advanced form, exclusive luxury camps that illuminated the elevated socio-cultural status of sportsmen. The ongoing inequalities between men’s and women’s sport in Australia and around the world were clearly in evidence, as well as the politics of gender whereby women are obliged to “care” and men are enabled to be “careless” – or at least to manage carefully their “duty of care”. In Australia, the only sport for women that continued during the height of the Covid-19 lockdown was netball, which operated in a bubble that was one of sacrifice rather than privilege. With minimum salaries of only $30,000 – significantly less than the lowest-paid “rookies” in the AFL – and some being mothers of small children and/or with professional jobs juggled alongside their netball careers, these elite sportswomen wanted to continue to play despite the personal inconvenience or cost (Pavlidis). Not one breach of the netballers out of the bubble was reported, indicating that they took their responsibilities with appropriate seriousness and, perhaps, were subjected to less scrutiny than the sportsmen accustomed to attracting front-page headlines. National Netball League (also known after its Queensland-based naming rights sponsor as Suncorp Super Netball) players could be regarded as fortunate to have the opportunity to be in a bubble and to participate in their competition. The NRL Women’s (NRLW) Premiership season was also completed, but only involved four teams subject to fly in, fly out and bubble arrangements, and being played in so-called curtain-raiser games for the NRL. As noted earlier, the AFLW season was truncated, despite all the prior training and sacrifice required of its players. Similarly, because of their resource advantages, the UK men’s and boy’s top six tiers of association football were allowed to continue during lockdown, compared to only two for women and girls. In the United States, inequalities between men’s and women’s sports were clearly demonstrated by the conditions afforded to those elite sportswomen inside the Women’s National Basketball Association (WNBA) sport bubble in the IMG Academy in Florida. Players shared photos of rodent traps in their rooms, insect traps under their mattresses, inedible food and blocked plumbing in their bubble accommodation. These conditions were a far cry from the luxury usually afforded elite sportsmen, including in Florida’s Walt Disney World for the men’s NBA, and is just one of the many instances of how gendered inequality was both reproduced and exacerbated by Covid-19. Bursting the Bubble As we have seen, governments and corporate leaders in sport were able to create material and metaphorical bubbles during the Covid-19 lockdown in order to transmit stadium sport contests into home spaces. The rationale was the importance of sport to national identity, belonging and the routines and rhythms of life. But for whom? Many women, who still carry the major responsibilities of “care”, found that Covid-19 intensified the affective relations and gendered inequities of “home” as a leisure site (Fullagar and Pavlidis). Rates of domestic violence surged, and many women experienced significant anxiety and depression related to the stress of home confinement and home schooling. During the pandemic, women were also more likely to experience the stress and trauma of being first responders, witnessing virus-related sickness and death as the majority of nurses and care workers. They also bore the brunt of much of the economic and employment loss during this time. Also, as noted above, livelihoods in the arts and cultural sector did not receive the benefits of the “bubble”, despite having a comparable claim to sport in contributing significantly to societal wellbeing. This sector’s workforce is substantially female, although men dominate its senior roles. Despite these inequalities, after the late March to May hiatus, many elite male sportsmen – and some sportswomen - operated in a bubble. Moving in and out of them was not easy. Life inside could be mentally stressful (especially in long stays of up to 150 days in sports like cricket), and tabloid and social media troll punishment awaited those who were caught going “over the fence”. But, life in the sporting bubble was generally preferable to the daily realities of those afflicted by the trauma arising from forced home confinement, and for whom watching moving sports images was scant compensation for compulsory immobility. The ethical foundation of the sparkly, ephemeral fantasy of the sporting bubble is questionable when it is placed in the service of a voracious “media sports cultural complex” (Rowe, Global Media Sport) that consumes sport labour power and rolls back progress in gender relations as a default response to a global pandemic. Covid-19 dramatically highlighted social inequalities in many areas of life, including medical care, work, and sport. For the small minority of people involved in sport who are elite professionals, the only thing worse than being in a sporting bubble during the pandemic was not being in one, as being outside precluded their participation. Being inside the bubble was a privilege, albeit a dubious one. But, as in wider society, not all sporting bubbles are created equal. Some are more opulent than others, and the experiences of the supporting and the supported can be very different. The surface of the sporting bubble may be impermanent, but when its interior is opened up to scrutiny, it reveals some very durable structures of inequality. Bubbles are made to burst. They are, by nature, temporary, translucent structures created as spectacles. As a form of luminosity, bubbles “allow a thing or object to exist only as a flash, sparkle or shimmer” (Deleuze, 52). In echoing Deleuze, Angela McRobbie (54) argues that luminosity “softens and disguises the regulative dynamics of neoliberal society”. The sporting bubble was designed to discharge that function for those millions rendered immobile by home confinement legislation in Australia and around the world, who were having to deal with the associated trauma, risk and disadvantage. 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