Binscombe Lane in Surrey is a recent project that included a new extension, which you can see to the right of the property, which increased the living space within the house.
The project also required roofing and replacement fascias and soffits and new windows completed the outward appearance of the house.
Internally, new french windows let in more light, giving the house a light and airy feel. The property was completely refurbished, with new kitchen and bathroom, new oak wooden floors and decorated throughout.
The house was complimented externally with a new driveway with brickwork at the front and at the rear a new patio with steps to the garden area.
Barham Road was another extension, this time to the back of the property.
The project involved some complex structural alterations and changes to foundations and drainage.
The extension was built in order to provide space for a new wet room and utility area. A new patio was laid to finish off the back of the house and make the job complete.
The initial stage of this project was ground clearance. An overgrown garden had to be cleared including the removal of trees and bushes.
One large bush had lifted a large area of concrete and this was broken out and removed. We cleared the garden and cut back remaining the trees and hedges to ensure the final result would be smart.
The original wall was built from rubble and was removed and replaced with a new brick wall.
The front of the property and the driveway were then tarmaced to provide a low maintenance area.
This work was followed up with the addition of double gates to the side of the property.
We are able to undertake any projects including tarmacing, brick and concrete structural repairs, brickwork pointing, built-in wardrobes, handmade furniture, concreting, flint and stonework, groundworks and demolition, handmade kitchens can be designed and fitted, external buildings and log cabins, partition walls, staircases and under pinning.
Make sure you visit our Checkatrade page to find out more.
D M Jones Contractors, David Jones, East Meon, Hampshire, GU32 1HL.


text:
The Department of Anthropology is located in the National Museum of Natural History in downtown Washington, DC, and at the Museum Support Center in Suitland, MD.
Inquiries: AnthroPublicInquiry@si.edu
Mailing via U.S. Postal Service
Attn: name of addressee
P.O. Box 37012, MRC 112
Mailing via Courier (UPS, FedEx)
Note: All photographs, cds and other media should be sent via courier (UPS or FedEx)
National Museum of Natural History, MRC 112
10th and Constitution Avenue NW
Appraisals / Authentifications
Staff of the Smithsonian Institution, as a matter of legal and ethical policy, do not authenticate or perform appraisals of any artifacts for the public. The Smithsonian's policy on appraisals and the Smithsonian's Museum Conservation Institute website both have more information and resources relating to appraisals.
Anthropology staff may be able to provide some assistance with basic identification of anthropological artifacts, and may also advise on resources for further research. Email photographs of your artifacts to anthropublicinquiry@si.edu, but please do not send or bring the artifacts themselves to the museum. If your object is archaeological (prehistoric or excavated), the state archaeologist of the state where it was found may also be of assistance to you.
Collections Sampling / Analysis
Contact Esther Rimer, after reviewing our sampling policies and procedures
Contact Allison Butler, Registration Specialist, after reviewing our loan policies and procedures
Donating Collections
Please contact our Collections Manager, David Rosenthal, and describe the object or collection you wish to donate. He will direct you to the appropriate curator, who will evaluate whether the collection is suitable for addition to the Smithsonian collections, and guide you through the accession process.

redpajama_set_name: RedPajamaCommonCrawl


Bengaluru-based dog food company 'Dogsee Chew' has raised Rs 2 crore in an angel round from Renu Balyan, a Delhi-based angel investor, and Jyotsna Bapat, an Associate Professor at IIIT Bangalore. The funding will be utilized to expand product portfolio and launch human grade dog biscuits. The company also plans to foray into global markets, including the APAC region and Europe.


text:
BBC News Updated every minute of every day
BBC News at Ten
Page last updated at 14:59 GMT, Thursday, 8 May 2008 15:59 UK
Boris Johnson removes LDA staff
The mayor's panel will look at allegations of corruption at the LDA
New London Mayor Boris Johnson is replacing two members of his predecessor Ken Livingstone's staff.
Mr Johnson has asked the chairwoman and chief executive of the London Development Agency (LDA), the mayor's business arm, to step down.
He has also set up a panel to look at the finances and running of the LDA and Greater London Authority (GLA).
Part of its remit will be to focus on allegations of mismanagement and corruption at the LDA.
Chairwoman Mary Reilly and Chief Executive Manny Lewis will be replaced by people recommended by Mr Johnson.
Recommendations discussed
The chair of the LDA is a direct mayoral appointment and is ratified by the London Assembly.
The board of the development agency is changed every four years and was due to be renewed in July.
The chief executive is appointed by the board, which will discuss the mayor's recommendations in due course.
Mr Johnson announced he was nominating former Westminster council chief executive Peter Rogers to replace Mr Lewis.
This is not a witch hunt
Businessman Harvey McGrath is nominee to chair the LDA. He is the chairman of business pressure group London First, and former chairman of hedge fund specialists the Man Group.
The panel examining finances will be headed up by Patience Wheatcroft, former editor of The Sunday Telegraph.
Police are investigating allegations of fraud in connection with six organisations which received funding from the LDA.
It follows allegations about money paid by the agency to a number of organisations.
Mr Johnson told BBC London: "This is not a witch hunt.
"But if there has been waste and maladministration there will be changes.
"I was elected on a promise to provide Londoners with better value for money from their taxes."
The panel will present a progress report to the mayor within 30 days and a final report within 60 days.
video and audio news
Manny Lewis and Mary Reilly, were Chief Executive and Chairperson of the London Development Agency.
BBC London
Sport, travel, weather, things to do, features and much more
Johnson bans drink on transport
07 May 08 | London
Further arrest in City Hall probe
18 Mar 08 | London
TOP LONDON STORIES
Teen murder 'witnessed by many'
Man denies double murder
Ambulance service under scrutiny
WATCHED/LISTENED
Indonesia's female 'devil wheel' riders
Widgets & Alerts


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We offer an extensive range of roofing services for domestic homeowners, from tile and slate to flat roofs, and everything in between.
a complete service focused on service and quality with continued support through preventative maintenance.
of commercial roofing systems including flat roofing, pitched roofing, tiling and slating.


The peas and broad beans are sautéed with sage in butter. With a bit of kneading, you can make your own potato gnocchi - which will delight your family or dinner guests.
Peel agria potatoes and cut into even-sized pieces. Cook in boiling, salted water for 15 to 20 minutes or until tender.
Drain and mash with butter, egg, salt and pepper. Add one cup of flour and knead to a soft, manageable dough.
Measure tablespoons of mixture and create the gnocchi shape using remaining flour to help form ovals.
Fill a large, deep-sided frying pan with salted water. Bring to the boil.
Add gnocchi to the pan in batches. Allow gnocchi to rise to the surface. Cook a further three minutes.
Remove with a slotted spoon to a warm serving dish.
Pour over sauté of peas, broad beans and sage and serve with shaved Parmesan.
Thaw frozen broad beans and remove skins. Mix with peas. Peel onion and chop finely. Melt butter in a saucepan.
Add onion and cook for one minute, stirring often.
Add beans, peas, chopped sundried tomatoes and sage leaves.
Cook covered over a gentle heat for five minutes. Add salt and pepper.


Online shopping is one of the fastest growing industries today. It is a multi-million industry that has continued to attract consumers because of the many benefits that it offers. While some consumers may still have some concern about some aspects of online shopping, a great number of them still choose to do their shopping from the hundreds of online stores that offer different kinds of products and services.
The noticeable growth of the online shopping industry can be attributed to a number of factors including the presence of various online stores that offer deals exclusive to online shoppers and the fact that customers can conveniently shop by using mobile electronic gadgets such as their mobile phones and tablets. Check out this infographic below from goodonlineshoppingsites.net.


text:
Ebersdorf is een dorp in de Duitse gemeente Saalburg-Ebersdorf in het Saale-Orla-Kreis in Thüringen. Het dorp wordt voor het eerst genoemd in een oorkonde uit 1401.  In 2003 fuseerde het met Saalburg tot de huidige gemeente.

Hernnhutters
Het dorp was van 1678 tot 1848 residentie van het geslacht Reuss-Ebersdorf. In 1722 trouwde Nikolaus von Zinzendorf met Erdmuthe Dorothea von Ebersdorf wat leidde tot een vestiging van meerdere leden van de Hernnhutters in het dorp. In 1746 werd het een zelfstandige Broedergemeente, hetgeen een grote, nog steeds merkbare invloed op het uiterlijk van het dorp had.

Plaats in Thüringen
Saalburg-Ebersdorf

redpajama_set_name: RedPajamaWikipedia


text:
Q: Stronger continuity of measure from below? If $(X,\mathcal F, \sigma)$ is any space with a measure and $\mathcal{A \subseteq F}$ is a countable chain then $\sigma(\bigcup \mathcal A)=\sup_{A \in \mathcal A} \sigma(A)$; this is well-known. Can there be a space $(X,\mathcal F, \sigma)$ where an uncountable chain $\mathcal {A \subseteq F}$ such that $\bigcup \mathcal A \in \mathcal F$ and $\sigma(\bigcup \mathcal A)\neq\sup_{A \in \mathcal A}\sigma(A)$ can be found?
I generally accept Axiom of Choice.

A: Consider $(\aleph_1, \mathcal P(\aleph_1), \sigma)$ where $\aleph_1$ is the smallest uncountable ordinal and $\sigma(E)=0$ if $E$ is countable, $\sigma(E)=\infty$ if $E$ is uncountable. Consider
$$
\mathcal A = \bigl\{ A_x=\{y\in\aleph_1:y\leq x\}: x\in\aleph_1 \bigr\}.
$$
Then each $A_x$ is countable therefore
$$
\sup_{A\in\mathcal A} \sigma(A) = 0 \neq \infty = \sigma\left(\bigcup\mathcal A\right) .
$$

redpajama_set_name: RedPajamaStackExchange


WW1 official historian. Bean was instrumental in the establishment of the Australian War Memorial and of the creation and popularisation of the ANZAC legend.
Worked at the Australian Museum from 1971-2000, head of anthropology. Much of his work focused on PNG and he was instrumental in the repatriation of cultural property by the museum.


text:
Ian Zook
Areas and Ensembles
World-Class Facilities
Contact Professor Zook
Visit Professor Zook's website
Associate Professor, Horn
Brass/Percussion Area Coordinator
Ian Zook is an active orchestral and solo performer and has appeared in concerts throughout the United States, Europe, and Asia. He joined the faculty of James Madison University in 2009 and performs frequently with the Madison Brass and Montpelier Winds, both faculty ensembles in-residence at James Madison University. As soloist he has performed with numerous ensembles including the JMU Brass Band at the Kennedy Center, the JMU Wind Symphony, Percussion Ensemble, Chorale and KOR, the Charlottesville & University Symphony Orchestra, the Virginia Baroque Consort, and the Chamber Orchestra of Charlottesville.
Mr. Zook's orchestral experience is extensive and has included positions with the Princeton and Haddonfield Symphony Orchestras, and frequent performances as a substitute musician with the Philadelphia Orchestra, the Pennsylvania Ballet and the Harrisburg, Richmond, Roanoke, Delaware, and Vermont Symphonies. He has performed under many of the world's premiere conductors including Valery Gergiev, Charles Dutoit, Neemi Järvi, Michael Tilson Thomas, Rafael Fruhbeck de Burgos, Osmo Vänskä, David Zinman, Leonard Slatkin, Zubin Mehta, and James Conlon.
He has also presented numerous solo performances and lectures at universities, including Penn State, University of Michigan, Central Michigan University, Western Michigan University, UNC-Greensboro, Western Carolina University, Virginia Commonwealth University, and UNC – Chapel Hill, as well as the annual South East and North East Horn Workshops and International Horn Symposium.
Mr. Zook holds degrees from the University of North Carolina - Chapel Hill and the University of Michigan and attended the Verbier and Pacific Music Festivals, the National Orchestral Institute, Sarasota Music Festival, Aspen Music Festival, and the American Institute of Musical Studies in Graz, Austria.
Brass Professors
Ian Zook, Horn
Associate Professor, Brass/Percussion Area Coordinator
zookir@jmu.edu
Chris Carrillo, Trumpet
carrilcj@jmu.edu
Andrew Lankford, Trombone
lankfoab@jmu.edu
Kevin J. Stees, Tuba and Euphonium
Professor, Conductor of the JMU Brass Band
steeskj@jmu.edu
wampledk@jmu.edu


Good thing the tarp is on.
I think Navy will have the advantage in those conditions.
Starting to look like Penn State 1973. Another "Victory at Sea" coming up???
"Sails set to the Sky…" That makes sense!
Bring on the brown water Navy!


text:
In Ohio, paper audit records are a mess
Study of Diebold machines used in Cleveland area finds 10% of paper receipts are compromised, 75% don't match electronic votes.
By ZDNet Editors for ZDNet Government | August 16, 2006 -- 09:58 GMT (02:58 PDT) | Topic: Developer
"Destroyed, blank, illegible, missing, taped together or otherwise compromised." That describes nearly 10 percent of the paper ballots produced by Diebold machines in Cuyahoga County, Ohio, where Cleveland is located, according to a review of the county's electronic voting system, the Cleveland Plain Dealer reports.
Even when the paper receipts were legible in the May 2 primary, more than three-quarters of them listed vote tallies that did not match the electronic record in the touch-screen machines.
"The election system, in its entirety, exhibits shortcomings with extremely serious consequences," says the study by the San Francisco-based Election Science Institute. "Especially in the event of a close election."
The report focuses on problems with the Diebold machines' paper records.
In more than 75 percent of the machines examined, the paper record did not match the votes recorded on the memory chips or the memory cards. In more than a third of the machines, the difference was greater than 25 votes.
The report said that the major problem was human error, resulting from poor training.
"Much of the problems we're finding are easy to resolve," said Steven Hertzberg, project director of Election Science Institute. The firm recommends big improvements in worker training and coming up with better systems for auditing the accuracy of the machines.
"I think there is fairly widespread agreement that the problems experienced in Cuyahoga County were procedural problems," a spokesman for the Ohio Secretary of State said. "If the Board of Elections properly trains its poll workers and the poll workers follow the instruction, these problems will be taken care of."
The county suffered horrendous problems in their May 2 election. Results were delayed for a week because absentee ballots had to be counted by hand. Optical scanning machines -- also purchased from Diebold -- were unable to read the absentee ballots because the county designed the ballots incorrectly.
Ironically, the lesson election officials are taking from all this is that voters should vote absentee, rather than trusting to the vagaries of electronic machines and polling place workers.
County Commissioner Jimmy Dimora said in the next election the absentee ballots will be correctly designed, and voters can avoid problems at polling places by casting absentee ballots early. "It's better to have a ballot that you have the ability to cross-check to look at the votes tabulated," he said.
Hardware Enterprise Software Open Source Mobile OS
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They are going to leave Facebook: A chat with social networkers Revolution Populi
Famed Yale professor David Gelernter and investment banker Rob Rosenthal field questions about Revolution Populi, their startup effort to build a blockchain-based alternative ...
Frustrated by programming language shortcomings, Guido van Rossum created Python. With the language now used by millions, Nick Heath talks to van Rossum about Python's past and ...
Firefox 68 is out: New dark reader view, better extensions, enterprise IT controls
Firefox 68 ushers in Mozilla's new recommended add-on program.


Description The Blackthorn Coven has been causing inordinate amounts of trouble for Adoulin with the traps they are setting. Trek to J-6 in Yorcia Weald to capture these mavens of mischief and set the sacred city at ease.
Speak to Zaffeld (J-8) in Eastern Adoulin near the Castle.
Head to the southwest corner of (J-6) in Yorcia Weald and click on the Occultist Footprints for a cutscene.
The closest waypoint is the Frontier Station.
Trade 1 Snapweed Secretion and 2 Snapweed Tendrils to the Occultist Footprints to trigger a cutscene and obtain your reward of 1,000 Bayld.
This page was last modified on 9 April 2017, at 16:42.


text:
Cross-Country Rally / Silk Way Rally / Stage report
Silk Way Rally: Despres and Sotnikov at the gates of Xi'an
Stage13 - Alashan Youqi-Zhongwei: "Cathedrals in the dunes" – 690,31 km
Stéphane Peterhansel (Peugeot 3008DKR n°106) wins his 5th stage on the 2017 Silk Way Rally, on the penultimate leg between Alashan Youqi and Zhongwei.
Overall his team mate Cyril Despres (Peugeot 3008DKR n°100), second on the day, extends his lead and looks to be on the verge of his second consecutive Silk Way victory this Saturday in Xi'an.
In the truck class, Dmitry Sotnikov (Kamaz-Master n°303), winner of the stage seems to have taken the reins of power over his Kamaz team mates. Tomorrow, before the final podium held in the heart of the ancient capital of the Middle Empire, there remains a short but challenging special of just over 100 kilometres.
Click here to check out daily video reports on Motorsport.tv
Cars: 5 for Peterhansel
Sand and dunes as far as the eyes could see. Oasis lying at the bottom of cathedral dunes: the scenery for this 13th and penultimate Silk Way Rally stage was as beautiful as it was demanding, for both men and machines.
Divided into two distinct timed specials, the stage victory went to the Peugeot 3008DKR n°106 of Stéphane Peterhansel and Jean-Paul Cottret. Continuing their rapid assistance role for their team mates and overall leaders Cyril Despres and David Castera (Peugeot 3008DKR n°100), the winningest duo in the history of the sport take their 5th stage win, whilst at the same time watching over their team mates, who look almost certain to take a second Silk Way Rally win in a row.
Second on the stage and comfortable leaders overall, Despres and Castera have only a 100 km special to race before pulling off the feat this Saturday in Xi'an. If their performance was much anticipated, behind them the race was animated to say the least.
Fighting it out 'cat and mouse style' in the dunes of the Tenger Desert, Christian Lavieille (Baïcmotor n°108), took third place on the day, 19m41s behind the winner and in doing so 'pinched' the 2nd place overall from the Chinese driver Han Wei (Geeley SMG Buggy n°107).
The Minis had an even worse day. Yazeed Al Rajhi made it to the finish in 9th place after getting stuck in the sand, while his team mate Bryce Menzies, who was 4th overall this morning, got into even more difficulty in the soft dunes and isn't expected into the bivouac before nightfall…
Trucks: Sotnikov, finishes on top
While it was almost certain this morning that it would be a Kamaz that would take the final victory on the 2017 Silk Way Rally, it was still unclear who would be on the top step of the podium tomorrow in Xi'an.
With just a little over 3 minutes in the lead, Dmitry Sotnikov knew that his leadership was threatened by his young team mate Anton Shibalov. Attacking hard, Shibalov actually took the virtual overall lead at the end of the first special by just 2 seconds, but Sotnikov fought back in the second to actually increase his overall lead to 06:04. The last special tomorrow might be short but it isn't expected to be easy, so while it would be very unwise to declare Sotnikov the winner, after a shaky start earlier in the day, he is looking marginally more comfortable this evening than he was this morning. Mardeev, 3rd on the special, and overall, led in the Belorussians Viazovich (MAZ n°304) and Vasilevski (MAZ n°309) and the Kazakh Ardavicius.
Bad day on the other hand for his team mate Gerard De Rooy (Iveco Powerstar n°302), forced to drive to the bivouac at Zhongwei by tarmac, before the start of the second special, after running into steering problems.
Silk Way Rally: Lavieille and Mardeev surf, the leaders suffer
Despres seals Silk Way Rally victory for Peugeot
Series Cross-Country Rally
Event Silk Way Rally
Sub-event Stage 13
Drivers Stéphane Peterhansel , Cyril Despres , Anton Shibalov , Dmitry Sotnikov
Ula Neom Rally: Fernando Alonso shares his experience after stage 1
RDM: Leg 5 Highlights
Rallye du Maroc: Day 7 News
Alonso scores first podium finish in Dakar build-up event
Alonso "has pace to find" in Saudi Arabian desert rally
Alonso left with "bittersweet" feeling in Morocco
Morocco Rally: De Villiers wins, Alonso 27th
Morocco Rally: Sainz tops Stage 4, de Villiers takes lead


I wondered what on earth I could teach my girls about the Tower of Babel. I mean, they have read their Bible. And they are very familiar with the story. What else was there? It wasn't until I began digging a bit deeper, using the Mystery of History text as my starting point, that I realised just how much fun this could be.
But, alas, the paper cups had their own ideas!
Job done! The girls took photos and create a note page for their folders.
Charlotte took on card 2. We decided she had to attempt to get her point across using absolutely no speech, grunts or props 🙂 She hated this! Lol!
…which she did with remarkable ease and so quickly, I managed to get only one photo.
Possibly, I had more fun than the rest of them put together! Having created the game, I couldn't actually take part. So, I just sat back and giggled at everyone else. There was a lot of fodder for teasing. Just saying.
I was pleased by all we did. Next up, Gilgamesh!
If you would like a copy of any of the notepages shown in this post, click on the link below!
I love it! I love the activities you did, and the art study you added in, I'm going to have to add in his painting to my plans for next year.


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Alright, I'm fresh out of 3 days at my mentor's branch and 2 days at my own.
Still. In. Love. With. The. Job!
Really, I just enjoy what I'm doing. Yes, there is a degree of monotony to it, but it hasn't gotten to me yet. I get to use my brain, and really take time to enjoy my customers, and I love it. I really really love it!
I like almost every coworker I've met between the 3 locations. The one I don't like I've only met once and it very easily could have been an off day, so I'm not worried there. She very well could end up my favorite. You never know! Even then, 1 out of them all isn't bad!
When I left my mentor branch the manager made it very clear he thought I was doing well. They even joked about keeping me. Though they were serious when they said they'd be happy to have me back should they need a set of hands and my branch can spare me. And I'd be thrilled to go back!
So early into this and I already have this great confidence to my work that apparently shows! The few things I do have questions in, I have no problems asking and the whole team seems happy to help.
So really, things could not be going any better!
Starting this coming week, I'm finally settling down into my regular schedule which makes me happy. It's a better balance and spread, not that it was bad before. I just like my set schedule much better.


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text:
Working as frontline health facilitators, service providers, program supporters, and social health activists in Indian hilly terrain areas: A qualitative study of accredited social health activists' experiences before and during the COVID-19 pandemic
Manisha Gore1, Anand Kawade2, Pam Smith3, Hilary Pinnock4, Sanjay Juvekar2, RESPIRE Collaboration
1 Symbiosis Community Outreach Programme and Extension, Faculty of Health Sciences, Symbiosis International (Deemed) University, Lavale, Pune, India
2 KEM Hospital Research Centre, Vadu Rural Health Program, Rasta Peth, Pune, India
3 Nursing Studies, School of Health in Social Science, NIHR Global Health Research Unit on Respiratory Health, University of Edinburgh, Edinburgh, United Kingdom
4 NIHR Global Health Research Unit on Respiratory Health, Usher Institute, University of Edinburgh, Doorway 3, Medical School, Edinburgh, United Kingdom
Community health workers (CHW) contribute to achieving health targets of the Sustainable Development Goals (SDG) and Universal Health Care (UHC) in low- and middle-income countries (LMICs). In India, accredited social health activists (ASHAs) function as health facilitators, service providers, and programme supporters for rural and tribal communities and are at the frontline during the COVID-19 pandemic. We aimed to describe the ASHAs' work roles both before and during the COVID-19 pandemic, explore the tasks ASHAs performed throughout the pandemic, and understand its effects on the evolving role of ASHAs.
We used qualitative data from a pre-COVID-19 study conducted in 2018-2019 including face-to-face interviews with purposively sampled ASHAs and their health care supervisors (n = 18) from rural Maharashtra state (India), and a follow-up study during the COVID-19 pandemic using telephonic interviews with a subset of participants from the pre-COVID-study (n = 8). Data were analysed thematically using MAXQDA v11.00.
The primary theme in the pre-COVID-19 study was ASHAs' role as described above, except as social health activists, linking beneficiaries to the local maternal and child health care services, distributing medicines for common illnesses, access to government schemes, and engaging in multiple health surveys. During the pandemic, raising awareness, screening of at-risk populations, arranging referrals, providing treatment and follow-up to COVID-19 patients, and supporting their family members. These activities increased the workload and health risks to ASHAs and their family, causing stress and tension among them. However, they had effectively carried out the new duties. ASHAs have improved their status, earning praise from families, society, and the government. They were honoured with the Global Health Leaders Award at the 75th World Health Assembly.
ASHAs' contribution to the health system improved the indicators related to maternal and child health during the pre-COVID-19 pandemic. Additionally, they maintained frontline health care during the COVID-19 pandemic, demonstrating resilience despite the challenges of increased workload and stress. However, the COVID-19 pandemic highlights the need to respond to and understand the implications of ASHAs' evolving roles.
Although the community health workers (CHWs) programme started in China in 1930, the concept has been expanded to help achieve health targets of Sustainable Development Goals and Universal Health Care in low- and middle-income countries (LMICs) [1–4]. While Bangladesh, Brazil, and Nepal succeeded in reducing under-five mortality through robust CHW programmes [5], those in Pakistan, Ethiopia, and Malawi were focused on family planning and maternal and child health [1]. Additionally, in India, they contribute to the prevention, identification, and treatment of non-communicable diseases (NCDs) [6,7], including chronic obstructive pulmonary disorders (COPD) and asthma, like initiatives in Uganda, Kyrgyzstan, and Malaysia [8]. India introduced CHWs in the early 1970s through small projects in specific areas of the country [9]. Such projects showed that CHWs could be an asset for India's public health system through the Mandwa Project in Maharashtra [10], the over-five-decade-old Vadu Rural Health Program (VRHP) [11], the Society for Education, Welfare and Action (SEWA) Rural project in Gujrat [12], and the Mitanin CHW Program of Orissa [1]. Nationwide CHWs were introduced after the declaration of Alma Ata as community health volunteers (CHVs) and (more recently) as accredited social health activists (ASHAs) (ie, village women selected and trained to work as ASHAs); providing health care services to underprivileged, poorly literate, culturally diverse, and hard-to-reach rural/tribal Indian communities [1,8,9]. Their roles and responsibilities, mandated by operational guidelines [8], have evolved over time. ASHAs work as health educators and promoters, linking workers (between population and government health care services) and service providers [8], raising health awareness (nutrition, sanitation) to address barriers to health care, and participating in surveillance [13].
The COVID-19 pandemic affected CHWs' roles in many LMICs [14–17]. In Kenya, Mali, Malawi, and Uganda, CHWs were supported to maintain the pace and scope of community-delivered care during the pandemic [15]. CHWs in Nigeria (and even in high-income countries like Texas) reported exhaustion due to increased workload [14–16].
We previously explored the ASHA role in a rural area of Maharashtra state, India [18], concluding that ASHAs perceived themselves as voluntary community health workers rather than health activists. During the COVID-19 pandemic, they were given multiple additional responsibilities of screening, identifying high-risk populations, referring patients to treatment centres, monitoring isolated patients, and supporting families of people with COVID-19 [13]. There was limited training before taking on these new roles, and despite the increased workload, there were no systems for timely remuneration. [13]. The lack of personal protective equipment meant that ASHA and their families were contracting COVID-19. We thus investigated ASHAs' activities as front-line health workers during the pandemic and returned to our earlier work to better understand the impact of the pandemic on evolving roles of ASHA compared to their pre-COVID roles as health facilitators, service providers, programme supporters, and social health activists.
We synthesized data from two sources. The first source was a mixed-methods pre-COVID-19 study, conducted between September 2018 and March 2019 [18]. Following the start of the COVID-19 pandemic (July to September 2021), we contacted all 18 participants from the qualitative pre-COVID-19 study and requested a follow-up qualitative interview exploring the pandemic's impact on ASHA roles. The most common reason for non-participation was being too busy with pandemic duties (eg, conducting immunization sessions).
Two researchers (a qualitative researcher and an epidemiologist/health scientist) conducted in-depth face-to-face interviews in the pre-COVID-19 study. The interviews undertaken during the COVID-19 pandemic were conducted and audio-recorded over the telephone (to comply with social distancing regulations) [19] by MG, a female anthropologist who analysed the data for both studies. The interviews took place in the evenings, when the participants could dedicate sufficient time and were not constrained by work obligations, and lasted from 60 to 90 minutes. No ethical issues arose. Interview guides had questions on roles and responsibilities during the pandemic, risk perception, the experience of tension and stress, coping mechanisms, and the pandemic's effect on their roles and responsibilities. Interviews were conducted in Marathi, transcribed verbatim manually, and translated into English by MG.
MG and SJ (using MAXQDA v11.00) (re)analysed the pre-COVID-19 study and the study conducted during the pandemic to determine the specifics of the roles and the challenges experienced in fulfilling them. They repeatedly examined the transcripts using an inductive approach to uncover frequently reported patterns connected to objectives with similarities and differences. We coded the data from both studies, formed categories, and identified themes. We then compared the data related to the four defined ASHA roles (health care facilitator, service provider, health activist, and programme supporter) between the two studies to identify changes in the perceived role influenced by the pandemic.
Interviewee characteristics
The eight ASHAs (all female) interviewed in the pre-COVID-19 study had eight to 10 years of work experience and two had >10 years of experience. Six of the ASHA (three each from rural and tribal areas) were recruited to the study conducted during the pandemic. Of the four block facilitators (BFF), two (one each from rural and tribal areas; all female), were interviewed in the pandemic-period study. The auxiliary nurse midwives (ANMs) were more senior with one having over 25 years of experience (Table 1). We present our findings in thematic maps (Figure 1 and Figure 2) and a framework (Figure 3) to answer the three study objectives. Table 2 explains the local terms used by the participants and Table 3 shows the examples of verbatim to showcase accredited social health activists' experiences during the pre-COVID-19 and COVID-19 phases.
Table 1. Demographic information of study participants
School (standard)
COVID-19 time study
A01 30-39 08.lis 08.lis AFU05
A02 40-49 11.pro 08.lis None
A06 30-39 08.lis 08.lis None
A07 40-49 08.lis >10 AFU03
Key informants
BFF01 30-39 >12 <8 BFFFU01
BFF02 30-39 11.pro 08.lis None
BFF03 30-39 >12 <8 None
BFF04 30-39 11.pro 08.lis BFFFU02
ANM01 50-55 08.lis >25 None
ANM02 30-39 11.pro <11 None
ANM03 40-49 >12 <11 None
ANM04 50-59 08.lis 01.svi None
MO01 30-39 >15 01.svi None
MO02 40-49 >15 <10 None
ASHA – accredited social health activist, BFF – block facilitator, ANM – auxiliary nurse midwife, MO – medical officer
Figure 1. Roles of ASHA.
Figure 2. Barriers to providing the services. *108, Dial-108, or one-zero-eight is a toll-free telephone number for emergency services in India. It is currently operational in 18 states. The 108 Emergency Response Service is a free emergency service providing integrated medical services.
Figure 3. Effect of COVID-19 pandemic on the workload of ASHAs.
Table 2. Explanation of local terms in Indian context
1 GP is village self-government. It is a democratic framework at the grass-root level, a political organization that serves as village cabinet. www.nrega.nic.in
2 Sarpanch, also known as "Gram Pradhan" or "Mukhiya", is a decision-maker, elected by the Gram Sabha (village-level constitutional body) of GP. Gramsevak is GP's secretary, responsible for GP's functioning, accounts, and records. www.pria.org
3 Two-wheeler riders: Villagers use two-wheeler vehicles to facilitate routine commuting. ASHA frequently accompanies such persons for household visits in hilly locations to make travel easier. Not applicable
4 Aadhaar card with a 12-digit random number, issued by Unique Identification Authority of India UIDAI (Authority) to Indian residents after satisfying verification process laid down by Authority. Any individual, irrespective of age and gender, who is a resident of India, may voluntarily enrol to obtain Aadhaar card. Pan Card – Permanent Account Number is a ten-character alphanumeric identifier, issued in the form of a laminated "PAN card", by Indian Income Tax Department, to a "person" who applies for it or to whom the department allots the number without an application. It can also be obtained as PDF file. www.uidai.gov.in, www.incometaxindia.gov.in
5 Pradhan Mantri Matru Vandana Yojana (PMMVY) is a government-sponsored direct benefit transfer scheme with a cash incentive of ₹5000provided directly in the bank/post office account of Pregnant Women and Lactating Mothers. www.wcd.nic.in
6 Janani Suraksha Yojana is a government-sponsored scheme which integrates cash assistance for mothers with delivery and post-delivery care. www.nhm.gov.in
7 Shardagram Arogya Sanjeevani Program- medicines and nutrition supplements are provided to ANC. www.nhm.gov.in
GP – Gram Panchayat, ASHA – accredited social health activist, ANC – antenatal care
Table 3. Examples of verbatim to showcase accredited social health activists' experiences during the pre-COVID-19 and COVID-19 phases
1 Role of ASHA as Healthcare facilitator "One night, a woman from a remote hamlet went into labor. She experienced pains all night, and the next morning, I received a message from her family stating that she would deliver at any time. I rushed to her house and delivered her baby. I was new at that time and had little experience, yet I had the courage to perform" (ASHA-X; tribal).
"I took a woman requiring antenatal care to hospital and returned at midnight as I had to send my children (to school) early next morning" (ASHA-X; rural).
2 Barriers to performing the role of a service provider "I have spent out-of-pocket to take the patient to PHC for a surgery because he was unable to afford the transportation though managed to get the PHC vehicle while returning" (ASHA-X; rural).
3 Villagers' non-cooperation "Even if I visit 1-2 times, I develop rapport with the community, ASHA lacks these skills and that is one reason why ASHA fails to fulfil duties". "It's not just the villagers but people living on farms that need to be visited and who often are missed by ASHA" "Such instances increase non-cooperation from the villagers" (ASHA-X; rural).
4 Experiences during generating awareness in the community during COVID-19 "At first, people did not open their doors for us but as they became aware of the situation through WhatsApp etc., they cooperated" (ASHA-X; rural).
"I was scared very much to do the household visits, but soon after ANM talked to me, I realized that this is the best opportunity to prove ourselves" (ASHA-X; tribal).
ASHA – accredited social health activist, ANM – auxiliary nurse midwife
Accredited social health activists' role during the pre-COVID-19 study
Healthcare facilitator
ASHAs serve as link workers, ensuring that women receive antenatal (ANC) and intrapartum care. This entails making regular home visits to young couples, registering newlyweds, and identifying and registering pregnant women for ANC. ASHAs provide health education, dispense iron and folic acid tablets, and escort pregnant women to the primary health centre (PHC) for antenatal checks. They usually accompany women in labour to a government health facility for a safe birth and stay with her when necessary. The participants perceived this as fulfilling work; however, it requires great mental focus. ASHAs visit new mothers on alternate days to support new-born care, disseminate family planning information, and assist auxiliary nurse midwives (ANMs) with post-natal care (recording blood pressure and arranging investigations). They perform the dual responsibilities of educators and link workers in identifying and bringing eligible children to immunization camps, while also working on mobilizing the villagers and escorting them to the PHCs for health-related issues.
Service provider: First point of health care
As the first contact for health care in the villages, ASHAs are trained to treat minor illnesses and perform other tasks (for example, monitor blood pressure). They provide directly observed therapy (DOTS) to tuberculosis (TB) patients and hold stocks of medicines (for example, oral rehydration solutions, iron and folic acid, chloroquine) which they dispense as required. Being residents of the same village, they can deliver accessible, timely, and cost-effective health services in remote places with limited communication/transport facilities and to a population with high illiteracy rates. The MO and BFF considered that ASHAs considerably reduced the health system's workload, as they manage minor ailments and bring patients to the local health facility. A BFF corroborated this opinion, stating that ASHAs in tribal regions "do a great job", serving fewer beneficiaries than their rural colleagues.
Barriers to performing the service provider role
Barriers (Figure 2) included problematic systems, difficult geographical reach, and delayed and non-lucrative honorariums.
Problematic systems
There were serious problems with public transport. Delay in attendance of the free health care emergency ambulance ("108") was a major concern. ASHAs cited instances when delayed transport had resulted in home delivery. A vehicle is stationed at each PHC but is often not available during an emergency due to a driver not being available, a lack of fuel, or because the single vehicle was already attending to a patient in another village. A few ASHAs mentioned how they organized vehicles by paying "out-of-pocket".
Difficult to reach
Limited transport for reaching distant villages/hamlets hampered the ASHAs' work and could adversely affect services. Pregnant women living in hilly areas must trek down dangerously steep slopes for ANC. If ASHAs could not be accompanied by two-wheeler riders to remote locations, they restricted visits to houses within walking distance. ANM understood the challenges if pregnant women in remote villages were not visited. An ASHA's region constitutes a wadi (hamlet) consisting of 15-30 houses (preferably the village they live in). Therefore, they have demanded that bicycles should be provided to ASHAs travelling more than three kilometres a day to help with transport.
Villagers' non-cooperation in certain situations
Several examples were given of situations where villagers mistrusted or did not cooperate with ASHA services. People with TB often refused to attend follow-up visits. The Kathkari tribal community did not respect ASHAs, believing that (unlike doctors) they lacked knowledge. The villagers were suspicious when ASHAs asked for their bank details for the transfer of scheme funds. They did not disclose the information, and as a result, ASHAs were not eligible for the incentives. Additionally, language could be a barrier if ASHAs did not belong to the same community, especially in Thakar tribes, though some ASHAs had learned the dialect.
Social health activist role
ASHAs did not describe themselves as "health activists" because they thought of themselves as "health workers". They addressed health-related issues but had no voice against the socio-cultural barriers that prevent communities from accessing health care services. They were unhappy that they were ignored by MO and ANMs during discussions on strategies to improve the health status of the villagers.
Program supporter
ASHAs supported health programmes by conducting multiple surveys, including family planning, welfare, leprosy, TB, cancer, oral health, dengue, malaria, domestic water storage practices, and identification of people with disabilities. They facilitate government schemes (such as Pradhan Mantri Matru Vandana Yojana benefits) available to the community. ASHAs reported how they opened bank accounts for villagers, which could be a long process if the necessary documentation was lacking.
Accredited social health activists' role during the COVID-19 pandemic-period study
ASHAs were trained online two to three times by the MOs during the first wave of the pandemic, followed by face-to-face training in small groups at the PHCs. However, some ASHAs initially felt "completely ignorant" about (for example) the use of a pulse-oximeter and thermometer, which caused some confusion until they received guidance from ANMs.
Generating awareness
During the first wave of the COVID-19 pandemic, ASHAs played a crucial role in raising awareness among the villagers by undertaking surveys and facilitating contact with hard-to-reach and remote populations. Use of social media platforms such as WhatsApp groups helped disseminate information. Disease prevention communication materials were displayed in public places (bus stops, schools, temples, Gram Panchayat offices). For tribal communities, information pamphlets were read out. Rickshaws/other vehicles with speakers disseminated vital information. The Gram Panchayat raised funds to pay for these intensive awareness campaigns and preventative measures such as disinfecting villages twice a week and distributing hygiene kits containing soap, sanitizers, and masks. Initially, ASHAs were apprehensive about making the visits but agreed to complete duties after discussion with BFF and/or ANM. When ASHAs visited a residence to undertake the survey, a few reluctant villagers asked many questions, refused admittance out of fear of infection, insulted them, or behaved badly. A quote from an ASHA in a rural area speaks a thousand words (Table 3 ).
Screening the population to identify COVID-19 patients
The primary task for ASHAs throughout the pandemic was screening villagers for COVID-19 symptoms. ASHAs visited every household and enquired about any family member suffering from symptoms of cold, cough, fever, headache, or body pain. People showing mild symptoms were checked for fever (using thermometers) and oxygen saturation (using pulse oximeters). Anyone suspected of having COVID-19 was referred for testing, and if positive, treated at COVID-19 care centres. ASHAs undertook stringent tracing of the positive person's contacts in the last 10 days, checking for patterns of movement, travel history, and so on. Family members were tested, as well, with those testing positive joining the patient in COVID-19 care centres, and those who were negative being confined to home and instructed not to visit any public place for the next 14 days. ASHAs monitored family members for COVID-19 symptoms, checked temperature and oxygen saturations, counselled families about preventive measures, and provided basic medicines (paracetamol, multivitamins). They also supported the families by delivering essentials during quarantine, leaving bags of groceries and vegetables outside the houses for family members to pick up.
The ASHAs' target was screening 100-150 people every day. Walking/traveling to distant houses took additional time, so the target could not always be achieved. Some ASHAs devoted four to six hours daily to this survey, visiting flexibly as per villagers' availability. The workload increased for ASHAs who had higher numbers of COVID-19 patients in their respective villages. A few monitored more than 100 patients, along with patients' family members. ASHAs with fewer COVID-19 patients and ANM/BFF were deputed to assist them. If people had to go outside the house or to any public place, people reported this to ASHAs. A team of ANM/MO/Sarpanch/Gram Sevak made surveillance visits to the homes of people under quarantine and sprayed disinfectants in the surrounding areas. ASHAs reported working eight to 12 hours a day during the first pandemic wave (February to November 2020) as they managed frequent enquiries, monitored people with mild symptoms, or quarantined and screened people in high-risk groups (such as people with hypertension, diabetes, and the elderly and small children). The workload was further increased by their routine tasks.
Continued work despite perceived high-risk of contracting COVID-19
Despite apprehension about engaging in the screening survey, after discussions with the BFF and ANM, ASHAs accepted that it was their role as a frontline health worker. Fear of infection, trepidation, and uncertainty were initial emotions, but they later gained confidence in making field visits. The families of a few ASHAs were hesitant about letting them undertake the screening, but the BFF intervened to explain the gravity of the situation and the importance of the work. Four ASHAs ignored their family opposition to continue work during the pandemic, but one left the role. ASHAs over 50 years were exempt from work, but all preferred working. The fear reduced gradually, especially after vaccination. ASHAs believed that they were serving people and would be protected by God. They followed precautionary measures, asking information from a safe distance and phoning (instead of visiting) houses with children. Preventive methods included wearing N95 masks, scarves, and gloves, using sanitizer after touching surfaces, and bathing with hot water after returning home. Some isolated themselves in different rooms before entering home after returning from work. ASHAs limited the time spent in homes, but when residents had questions or concerns, they were given appropriate attention. Despite taking preventive measures, one ASHA contracted COVID-19.
Impact of COVID-19 on accredited social health activists' roles
The pandemic changed the health situation in rural and tribal areas and affected ASHAs' roles and responsibilities (Figure 1). The routine work stopped, as they focused on pandemic-related activities. The health care facilitator role, involving extensive pandemic-related work, dominated their other three roles (see above). ASHAs, ANMs, and MOs unanimously reported that routine ASHA responsibilities, such as antenatal services, child immunization, and family planning work, were hampered. Pandemic restrictions meant that women could not travel to health care facilities to access pregnancy services. Family planning camps were cancelled and put on hold for a year. Child immunization was maintained, but poorly attended. Many women started bringing children when the restrictions eased which delayed doses but avoided omissions. At times, people hesitated to approach ASHAs, considering them to be at high risk of COVID-19 because of their work. Depending on their socioeconomic level, some people approached private physicians, while others approached government hospitals. During this time, the PHCs were open and provided treatment.
Stress and tension because of the pandemic situation and change in the roles
ASHAs were stressed during the pandemic for various reasons, including the substantial increase in work hours and shift in work patterns (as the pre-pandemic routine work was replaced with new, unpredictable COVID-19 related tasks) and the perceived high risk of contracting COVID-19 and transmitting it to family members (Figure 1). The cessation of routine work affected the ASHAs' incentives and created financial tension, until the government authorized payments without monitoring routine work, which helped relieve the stress. Even then, some ASHAs complained they did not receive the honorarium for four to five months. Insufficient remuneration, delayed payment, unemployment of family members, lockdown, and inflation forced ASHAs to engage in other income-generating activities, including farming and daily waged work. Initially, Anganwadi sevika and schoolteachers assisted; later, ASHAs shouldered the tasks alone. BFFs helped ASHAs by providing precise instructions regarding their tasks, accompanying them on visits, and assisting in counselling resistant people, which helped relieve stress.
Recognition, acknowledgement, and appreciation
ASHAs' image improved positively as people witnessed their exhaustive efforts and proactive approach to solving challenges and extending selfless support to COVID-19 patients. They received love and acknowledgement for their diligent follow-up when the movements were restricted. People expressed their concern about ASHAs' health, advising them to "take good care".
Summary of the key findings
This paper synthesizes the findings of two studies conducted before and during the COVID-19 pandemic. Before COVID-19, ASHA performed in three of their four defined roles: as "Health facilitators", "Service providers", and "Programme supporters". They were task-driven and not enabled to take on the role of "Health activist". The COVID-19 pandemic resulted in a dramatic shift in their responsibilities as the "Health care provider and facilitator" role took over all other tasks. There was an increase in workload, experiences of stress and anxiety, and a backlog of routine tasks, but they received widespread appreciation for their frontline activities.
In the pre-COVID-19 study, the multi-stakeholder perspective (ie, interviews with ASHAs, ANMs, BFFs, and MOs) enabled a comprehensive understanding of ASHA work and roles. Data collection was iterative, as participants' views, opinions, and experiences informed subsequent interviews. Telephone interviews with ASHAs in the COVID-19 study were scheduled in the evenings when ASHAs were at home, leaving time to explore their experiences in detail. Researchers experienced connectivity issues with remotely located ASHAs, which disrupted and extended interviews. Interviews were conducted in Marathi, the language used by ASHAs in rural and tribal areas. Prolonged engagement (six of eight ASHA in the pre-COVID-19 study [17] participated in the COVID-19 study) and a feedback meeting after the pre-COVID-19 study improved trustworthiness,[20], though pandemic workload precluded MOs and ANMs from being involved in the COVID-19 study, which could have led to possible bias. Interpretation by a multi-disciplinary research team enhanced credibility. We maintained reflexivity throughout the study, as detailed notes and researchers' biases were documented and discussed within the team [21].
Discussion in relation to other literature
Pre-COVID-19 roles and barriers in performing the service provider duties
During the pre-COVID-19 study, our findings on the four defined ASHA roles echo those of other studies. The role of the "Health facilitator" is confirmed in studies in Karnataka and Manipur [22,23], and ASHAs in Udipi were highly aware of this role [24]. The tasks of frontline "Service providers" (treating minor illnesses or monitoring blood pressure) were well documented in studies from rural Manipur [23], though were less commonly provided in Karnataka [22]. The role of "Programme supporters" was also described in Karnataka, where the ASHA role was perceived as predominantly that of a link-worker/facilitator [23]. The lack of the "Health activist" role that we observed in our pre-COVID-19 study is reflected in other studies across India [18,23]. The reasons for this warrant further research, but may include a health system's lack of awareness and (consequently) failure to prepare ASHAs for an "activist" role. Barriers influencing ASHAs' performance included delayed and scanty honorariums, health care system flaws regarding the operation of the "108" emergency vehicle, ASHAs' training for the "Activist" role, geographical remoteness, and time spent travelling. Several studies have reported that ASHAs are unhappy with the present incentive-based honorariums and are seeking permanent jobs with salaries [22,24]. Non-availability of transport has been described in other studies [19,25], for example, emergency "108" vehicles were often delayed in Orissa [25]).
Impact of the COVID-19 pandemic on ASHA roles and well-being
Our finding that the pandemic resulted in an unforeseen shift in roles is supported by studies from other LMICs, summarised in a review article [26]. In many countries, CHWs were engaged in COVID-19-related tasks, including raising awareness about the disease, implementing precautionary measures, contact tracing, coordinating patient care, providing support, and helping overcome stigma at the community level [26,27]. As in our study, this disrupted their routine work.
Stress and tension amongst CHWs due to COVID-19 restrictions and fear of contracting COVID-19 have been reported (for example, among CHWs engaged in door-to-door surveys in Texas, USA) [22,27], but our study extends these findings with an in-depth exploration of ASHAs' experience of the changed responsibilities and increased workload [27]. There is evidence of stress in frontline health care professionals, including clinicians, nurses, and paramedical employees, but a few include CHWs [28].
Understanding the evolving roles through the lens of theories
Role identity theory has been used to examine CHWs' perceptions, experiences, and identities as they undertook new roles (eg, in rural South Africa [29]). This theory, [30] describes the process through which individuals assign meaning to themselves in the context of their professional roles. A complex mix of community "insider," "outsider", and "broker" identities were assumed by CHWs in response to the diversity of requirements and expectations from their role; each identity offering a distinctive way for the CHW to place themselves in the community. During the pandemic, ASHA perceived both "insider" and "outsider" role identities, as they provided services to their own community as an "insider", but were considered "outsiders" when people were suspicious of them as government health care personnel. Similarly, ethnographic accounts of CHWs in 21st-century Africa, Latin America, and Asia reflect their involvement in significant social, political, and economic developments, as well as in pursuing improvements in their local community [31].
Current CHW roles are aimed at community management of disease/health, technical functions, and reporting to authorities, and typically underplay the activist role [18,31]. In a study from South Africa, CHWs performed diverse health and social care professional roles and felt as if they contributed to the health system [32], finding purpose in their jobs from the community's positive response and associations with team leaders. Learning from this approach might support the Indian government to adapt and strengthen ASHAs' roles and responsibilities. To understand the nuanced changes in the CHWs' roles both nationally and internationally, future research in this area is crucial.
Health services globally were disrupted by the COVID-19 pandemic, including in India [18], as limited resources were diverted to the management of the pandemic [13] and the population avoided accessing routine health care because of fear of infection. During this time, India's resilient ASHAs maintained frontline health care, despite increased workload and stress. Their award as Global Health Leaders [13] formally acknowledges their contribution at the highest levels. ASHAs' long-term role in improving health indicators (especially related to maternity and child health [33]) is well recognized, but the pandemic has highlighted the need to understand evolving ASHA roles and address the persistent challenges. The foremost practical requirements are to ensure their financial security, a robust system for regular payment of honorariums, provision of adequate resources, continuous supervision with training and capacity building in areas of public health. The pandemic has highlighted the potential for strengthening the "Social activist" role. These strategies could secure the sustained and multidimensional role of ASHAs, enabling their ongoing impact on the health of vulnerable populations of India.
We gratefully acknowledge all study participants for their participation. We acknowledge Field Research Assistants of Vadu HDSS for data collection and Ms Pallavi Lele for supervision of data collection in pre-COVID-19 study and health system stakeholders for their active participation in the study.
Ethics statement: Both studies were approved by the King Edward Memorial Hospital Research Centre Ethics Committee, Pune, India (pre-COVID-study: Ref No KEMHRC/MHS/EC/134 and COVID-time-study: KEMHRC/RVM/EC/915). In pre-COVID-study, written Informed consent was obtained from all participants prior to data collection whereas verbal consent was taken for telephone interviews during the COVID study
Data availability: The data that support our study findings are available from the corresponding author upon reasonable request.
[1] Funding: This research was funded by UK National Institute for Health Research (NIHR) (Global Health Research Unit on Respiratory Health (RESPIRE); 16/136/109) using UK aid from the UK Government to support global health research. The views expressed in this publication are those of author(s) and not necessarily those of NIHR or of UK Government" or of KEMHRC. "RESPIRE collaboration comprises UK Grant holders, Partners, and research teams as listed on RESPIRE website (www.ed.ac.uk/usher/respire).
[2] Authorship contributions: MG, SJ, AK conceived this study. MG and SJ led the writing of the paper. AK, HP, and PS reviewed and edited the final manuscript. All authors had full access to all the data. All authors contributed to drafting the paper and revised the manuscript for important intellectual content. All authors had final responsibility for the decision to submit for publication.
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[14] Maternal & Child Health Training Program at the University of Texas at Houston Health School of Public Health & The Community Health Worker Core Consensus Project at Texas Tech Health Science Centre El Paso Paul L. Foster School of Medicine & Texas Tech Health Science Centre School of Biomedical Sciences, Community Health Worker COVID-19 Impact Study2021, https://sph.uth.edu/research/centers/dell/resources/the%20final%20report%20of%20the%20community%20health%20worker.pdf
[15] Z Olateju, T Olufunlayo, C MacArthur, C Leung, and B Taylor. Community health workers experiences and perceptions of working during the COVID-19 pandemic in Lagos, Nigeria—A qualitative study. PLoS One. 2022;17:e0265092. DOI: 10.1371/journal.pone.0265092. [PMID:35259204]
[16] M Ballard, A Johnson, I Mwanza, H Ngwira, J Schechter, and M Odera. Community Health Workers in Pandemics: Evidence and Investment Implications. Global Health: Science and Practice. Johns Hopkins School Bloomberg School of Public Health Center for Communication Programs. 2022;10:e2100648.
[17] P Kardas, JFM van Boven, H Pinnock, E Menditto, B Wettermark, and I Tsiligianni. Disparities in European healthcare system approaches to maintaining continuity of medication for non-communicable diseases during the COVID-19 outbreak. The Lancet Regional Health. 2021;4:100099. DOI: 10.1016/j.lanepe.2021.100099. [PMID:33875981]
[18] A Kawade, M Gore, P Lele, U Chavan, H Pinnock, and P Smith. Interplaying role of healthcare activist and homemaker: a mixed-methods exploration of the workload of community health workers (Accredited Social Health Activists) in India. Hum Resour Health. 2021;19:7 DOI: 10.1186/s12960-020-00546-z. [PMID:33407518]
[19] B Self. Conducting Interviews during the COVID-19 Pandemic and Beyond. Federal Center of Theoretical and Applied Sociology of the Russian Academy of Sciences. 2021;13:9-27. DOI: 10.19181/inter.2021.13.4.1
[20] Liamputtong P, Ezzy D. Qualitative research methods. Second. Melbourne: Oxford university press; 2005.
[21] JE Dodgson. Reflexivity in Qualitative Research. J Hum Lact. 2019;35:220-2. DOI: 10.1177/0890334419830990. [PMID:30849272]
[22] FN Fathima, M Raju, KS Varadharajan, A Krishnamurthy, SR Ananthkumar, and PK Mony. Assessment of 'accredited social health activists'—a national community health volunteer scheme in Karnataka State, India. J Health Popul Nutr. 2015;33:137 [PMID:25995730]
[23] L Saprii, E Richards, P Kokho, and S Theobald. Community health workers in rural India: analysing the opportunities and challenges Accredited Social Health Activists (ASHAs) face in realising their multiple roles. Hum Resour Health. 2015;13:95 DOI: 10.1186/s12960-015-0094-3. [PMID:26646109]
[24] S Shet, K Sumit, and S Phadnis. A study on assessment of ASHA's work profile in the context of Udupi Taluk, Karnataka, India. Clin Epidemiol Glob Health. 2018;6:143-7. DOI: 10.1016/j.cegh.2017.08.004
[25] M Panda, S Nanda, and RC Giri. A study on the work profile of ASHA workers in a district of Odisha in eastern India International Journal of Community Medicine and Public Health. 2019;6:675 DOI: 10.18203/2394-6040.ijcmph20190190
[26] S Bhaumik, S Moola, J Tyagi, D Nambiar, and M Kakoti. Community health workers for pandemic response: a rapid evidence synthesis. BMJ Glob Health. 2020;5:e002769. [PMID:32522738]
[27] C Byrd-Williams, M Ewing, EL Rosenthal, JA St. John, P Menking, and F Redondo. Training Needs of Community Health Workers Facing the COVID-19 Pandemic in Texas: A Cross-Sectional Study. Front Public Health. 2021;9:689946. DOI: 10.3389/fpubh.2021.689946. [PMID:34195172]
[28] MS Spoorthy, SK Pratapa, and S Mahant. Mental health problems faced by healthcare workers due to the COVID-19 pandemic–A review. Asian J Psychiatr. 2020;51:102119. DOI: 10.1016/j.ajp.2020.102119. [PMID:32339895]
[29] L Mlotshwa, B Harris, H Schneider, and M Moshabela. Exploring the perceptions and experiences of community health workers using role identity theory. Global Health Action. 2015;8:28045 DOI: 10.3402/gha.v8.28045. [PMID:26387505]
[30] SM Farmer, P Tierney, and K Kung-Mcintyre. Employee Creativity in Taiwan: An Application of Role Identity Theory. Academy of Management Journal[Internet] Acad Manage J. 2003;46:618-30. DOI: 10.2307/30040653
[31] K Maes. Community health workers and social change Ann Anthropol Pract. 2015;39:1-15. DOI: 10.1111/napa.12060
[32] MM Ramukumba. Exploration of Community Health Workers' views about in their role and support in Primary Health Care in Northern Cape, South Africa. J Community Health. 2020;45:55-62. DOI: 10.1007/s10900-019-00711-z. [PMID:31392601]
[33] S Agarwal, SL Curtis, G Angeles, IS Speizer, K Singh, and JC Thomas. The impact of India's accredited social health activist (ASHA) program on the utilization of maternity services: a nationally representative longitudinal modelling study. Hum Resour Health. 2019;17:68 DOI: 10.1186/s12960-019-0402-4. [PMID:31426801]
Dr Anand Kawade
King Edward Memorial Hospital Research Centre,
Sardar Moodliar Road, Rasta Peth, Pune – 41101, Maharashtra


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Since 2008, Sushi Studio Arts has led the greater Los Angeles and Orange County area in Japanese Cuisine catering and event planning. With our innovative designs and wide range of styles, we can help you plan the event of your dreams and offer you a memorable experience. We specialize in creative, custom catering menus and wait service as an added option. Whatever your event, we can make it the most special - small or large, casual or elegant - whatever your dreams, we will make your occasion unforgettable. We provide the highest level of service, freshly made cuisine, and delicious dishes. You tell us what you want and we'll make it happen for you and your guests. We accommodate all sizes, no menu is too small or large. Whatever your taste, our chef staff will design the menu you're looking for.


Days of Joy. Acts of Kindness.
Days of Joy. Acts of Blessing.
For many, the Christmas season is a painful reminder of how life isn't. Christmas shopping and cookie baking and light touring are done with an ache of deep loss.
I remember our first Christmas without Dan. I was so desperate for some measure of joy in our family, some indication that our toppled world would be righted again one day. That Christmas, and for the Christmases since, I needed to intentionally turn life inside out and pursue joy.
And so we started Days of Joy. During December and leading up to Christmas, we decided to look for ways to bless others. It wasn't an everyday thing. With days already brimming full, we could not have handled another self-imposed must-do. But sprinkled throughout the month, as we saw a need or found a way to bless or serve, we did.
Toys for a local charity and a free Chick-Fil-A sandwich!
When you're going through difficulty or grief, there is so much energy focused on self. Processing all of the thoughts and emotions is necessary, but I grew to really dislike the self-absorption. I didn't want to ignore my sadness and I needed to battle the thoughts that overwhelmed me, but I sure was ready to look outside of myself and minister to others.
Getting eyes off self and seeing the needs of others is one of the best ways I know to turn deep pain inside out and work toward healing. It's an intentional march toward full healing and seeing joy again.
We'll be doing Days of Joy again this year. It's become one of my favorite things leading up to Christmas.
How does your family spread joy at Christmas? I know many of you are so creative! It's so inspiring to hear how about how others are intentionally blessing during the Christmas season.
If you would like to know when new posts are up, please leave your e-mail address at the top of the page and posts will be delivered right to your inbox. Thank you and Merry Christmas!
I felt compelled to pay for the groceries of the firefighter who was in line in front of me at the grocery store the other day. I was blessed WAY more than he was! The lady in line behind me quietly said, "Thank you so much for doing that. I'm the mom of a firefighter and a police officer, and that's appreciated so much." What an unexpected surprise that SHE would be blessed, too!
That's so sweet! I learned from a good friend to stop and thank service men and women for serving. It's really neat to see their responses.
I know! They are always so humble.
I can't believe I haven't seen this sign up opportunity before. I would have followed from day 1. Thank goodness I have you on Facebook and have been moved by many. Blessings!
Thanks for sharing this very personal part of your life. I hope you find joy this year and share it with others and encourage them in Jesus. I am next to you over at Women Living Well.
Thank you Judith. I'll head over and look!
Wow! What a great idea. I hope you will share with us what you and your family do this year. What a blessings you are to others. Wishing you continued healing!
Thank you Laura! We're doing a few new things this year, like writing to wounded soldiers spending Christmas at Walter Reed.
Hi Lisa, Its my first time here. I really love your blog. you speak with passion for the ministry. God Bless you and your family.
Thank you for visiting! Have a great Christmas.
Thanks for sharing your ideas and inspiring…I try to do kind things for people as God leads…it may be to bring baked goods…it may be to donate…praying for your family today….for God's continued comfort and joy for you and your kids.
Thank you Dolly for visiting and thank you for your prayers.


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« Nazarbayev : EXPO-2017 Astana deve trasformare una nazione in transizione in una…
Inaugurato il Consolato onorario della Repubblica del Kazakhstan a Venezia »
Kazakhstan's attractive and ambitious pharmaceuticals sector
Pubblicato 23 gennaio 2013 | Da admin
FT _ More and more multinationals are entering the pharmaceuticals sector in Kazakhstan, drawn by steadily growing demand. The government wants to accelerate the process and officials are busy negotiating with foreign companies, urging them to come. But its target of boosting domestic pharmaceutical production to 50 per cent of consumption by 2014 still looks over-ambitious.
Several new pharmaceutical deals were signed off in the final months of 2012, bringing yet more multinationals to a market where three of the top five companies are now controlled by foreign investors.
Prague-based Favea Europe signed an agreement with Romat, one of Kazakhstan's largest drug makers, on October 24 during a visit to the Czech Republic by President Nursultan Nazarbayev. Romat plans to build two new pharmaceutical factories in the northern towns of Pavlodar and Semey at a total cost €37m. Also in late 2012, Alma Pharma and Turkey's Abdi Ibrahim Global Pharm announced plans to build a $60m factory in the country.
The most significant deal to date was struck in September 2011, when Poland's Polpharma acquired Chimpharm, Kazakhstan's largest pharmaceuticals company, and announced plans to invest $85m in the Shymkent-based company including the construction of a new factory. Chimpharm and Nobel, an offshoot of the Turkish company that set up production in Almaty in 2004, are two of Kazakhstan's top six drug companies, and together account for up to 90 per cent of all pharmaceuticals produced in the country.
Kazakhstan has seen several other international drug giants open offices, including GlaxoSmithKline, which in June last year signed a cooperation agreement with the government that will involve the local production of GSK's vaccines and drugs.
A steep increase in demand for pharmaceuticals, driven by Kazakhstan's growing middle class and its increasingly sophisticated medical system, has caused a corresponding rise in imports. In 2011 it imported medicines worth around 142bn tenge ($940m), around 86 per cent of total consumption, according to IHS Global Insight. The remainder – almost entirely generic medicines – was produced by local companies.
Astana has responded by launching a new strategy for the sector aimed at increasing domestic production to supply 50 per cent of the drugs consumed within Kazakhstan by 2014. This is part of a broader government policy of diversifying the economy. But it is also intended to prevent state healthcare costs from spiraling, since the state accounts for around 45 per cent of pharmaceutical purchases.
There has already been some success in increasing both the quality and the quantity of domestic pharmaceuticals. Polpharma is bringing Chimpharm's manufacturing into line with international Good Manufacturing Practice (GMP) standards; the factory Abdi and Alma are building will also comply with the standard. "Both of the two largest domestic producers are in the process of implementing GMP standards, with the state planning to rely on seven domestic companies to drive forward domestic industry growth via different investment programmes," says Kavita Rainova, an analyst at IHS.
The government's plan has, however, been criticised for being over-ambitious and unrealistic. There are various obstacles to competition in Kazakhstan's pharmaceutical and medical markets, according to research from Kazakhstan's agency for competition protection, released in December . The agency is now drawing up proposals for removing barriers to entry in the pharmaceuticals and related sectors.
As of late 2012, "domestic production in Kazakhstan is estimated to account for around 15 per cent of the market in value terms. This is considerably below the 50 per cent domestic share target by 2014, which may potentially lead the government to consider revising the timeframe," Rainova says.
Market dynamics are also set to change when Kazakhstan, co-founder of a customs union with Belarus and Russia, enters the World Trade Organisation (WTO). "While the customs union is expected to be beneficial to the domestic pharmaceutical industry, Kazakhstan has secured a five-year transition period before fully implementing the customs union requirements," says Rainova. "One angle of Kazakhstan's entry to the WTO which would be positive for the foreign originator companies is the enforcing of TRIPs [Trade-Related aspects of Intellectual Property rights] and data exclusivity."
WTO director general Pascal Lamy told journalists in Moscow on January 17 that Kazakhstan's entry to the WTO "could be doable this year".
Pubblicato in Eventi, News, Politica Economia


Hey! I'm Mateo Santiago and a freshman here at Bob Jones. I run Cross Country and Track for a sport. I'm interested in cybersecurity and plan to go to UAH for college. I listen to music in my free time and sleep.


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Q: How to Display data from the database in didRangeBeaconsInRegion? I want to display data to the textview from the database when the beacon is detected in specific distance .... the problem is it does not work or does not display anything here's my code ...
    public void didRangeBeaconsInRegion(Collection<Beacon> beacons, Region region) {

        if (beacons.size() > 0) {
        for (Beacon beacon: beacons) {
            if(beacon.getDistance() < 0.5){
              ddb();
            //Call Display data from database
            }

Does it has something to do with ranging every second?
Is it possible to display data from the database using didRangeBeaconsInRegion?

A: Try adding log lines to troubleshoot like this:
for (Beacon beacon: beacons) {
   Log.d(TAG, "saw beacon:"+beacon+"  with dist "+beacon.getDistance() );
   if(beacon.getDistance() < 0.5) {
      Log.d(TAG, " calling ddb");
      ddb();
      //Call Display data from database
   }
}

Check to see that you see the first log line, and verify that if the distance is less than 0.5 the second log line is shown.


These are some of the standards you should expect from us (please tell us if and where we don't match up to them).
On the day of your appointment you should be seen within a reasonable time.
Please ask at reception for an estimate if you think the clinic is running late.


text:
NGC 3157 is een balkspiraalstelsel in het sterrenbeeld Luchtpomp. Het hemelobject werd op 28 januari 1835 ontdekt door de Britse astronoom John Herschel.

Synoniemen
 IC 2555
 ESO 435-51
 MCG -5-24-26
 IRAS10094-3123
 PGC 29691

Zie ook
Lijst van NGC-objecten

Externe links
  NASA/IPAC Extragalactic Database
  SIMBAD Astronomical Database
  SEDS

NGC-object in Luchtpomp
Sterrenstelsel in Luchtpomp