Literatura académica sobre el tema "Basel Mission Hospital"

e23118 Background: Mission and vision statements (MVS) help convey an institution's identity and priorities. Missions describe objectives and responsibilities, while visions describe overarching directions for the future. Effectively communicating MVS is particularly important for cancer centers and hospitals seeking to inspire and reach patients and employees. We sought to assess the composition, readability, and topics addressed for MVS provided by NCI-designated cancer centers and their affiliated hospitals. Methods: We extracted MVS data from institutional websites for 65 NCI-designated cancer centers and 59 affiliated hospitals in 2023 (6 cancer centers did not have an affiliated hospital). We determined the composition of statements using word counts and time to read. We assessed the readability of statements using Flesch-Kincaid (FK) reading ease and grade level scores. We reviewed the MVS to determine the presence of four topics: equity, quality care, training, and research. We used descriptive statistics to compare these issues in MVS for cancer center versus the hospital. Results: Among the 65 cancer centers, we found mission statements for 93.9% (61/65) and vision statements for 63.1% (41/65). All affiliated hospitals provided a mission statement and 86.4% (51/59) had a vision statement. Data for composition, readability, and topics addressed for MVS are provided in the table. Overall, readability of MVS was difficult based on FK reading ease scores, with relatively high reading grade levels. Mission statements for cancer centers had a significantly lower reading ease and higher grade level compared with hospitals. In general, mission statements were slightly longer than vision statements, more frequently addressing the topics of quality care, training, and research. Compared with hospitals, cancer centers had a significantly lower frequency of mentioning the topic "training" in their MVS. Conclusions: We found that the majority of NCI-designated cancer centers report mission statements, but fewer provide vision statements. We demonstrated difficult readability for the MVS provided, highlighting a need to consider simpler diction and structure of language. Additionally, our work provides an overview of topics addressed for these statements including equity, quality care, training, and research. These topics underscore the values and priorities of an institution, and this review of MVS provides insights into the messaging that cancer centers communicate. [Table: see text]

ObjectiveTo describe characteristics and outcomes for patients where the Danish Helicopter Emergency Medical Service (HEMS) either transported the patient to hospital, treated the patient on scene but did not transport the patient or was dispatched but cancelled en route to the patient (aborted mission), and to assess the field triage by comparing these outcomes.DesignNational population-based study.Setting and participantsHEMS dispatches are undertaken from the five Danish emergency dispatch medical centres according to national guidelines. The study analysed all primary missions with helicopter take off where the patient was admitted to hospital between 1st October 2014 and 30th April 2018.Main outcome measuresMortality rates, admittance to an intensive care unit (ICU), need of mechanical ventilation and length of hospital stay (LOS).Results6931 patients were admitted to hospital; 3311 patients were air lifted, 164 patients were ground escorted by a HEMS physician, 1421 were assisted on scene by HEMS, but escorted by the ground units and 2035 missions were aborted. The mortality was highest among the airlifted and ground escorted patients, and lowest among the patients in the aborted mission group. Mortality for the airlifted patients increased from 8.2% (95% CI; 7.3 to 9.2) at day 1 to 19.5% (95% CI; 18.2 to 20.9) after 1 year. The airlifted and ground escorted patients were frequently admitted to ICU and subsequently mechanically ventilated and they also had an increased LOS compared with the patients only assisted on scene by HEMS and the patients in the aborted mission group.ConclusionPatients to whom HEMS are dispatched are often critically ill or injured and have a relatively high mortality. The patients airlifted or ground escorted to hospital by HEMS appear more critically ill or injured compared with the assisted patients and the patients in the aborted mission group. The on-scene triage seems appropriate.

Abstract Introduction Global health engagement missions are conducted to improve and protect the health of populations worldwide. Recognizing the strong link between health and security, the Armed Forces have increased the number of global health engagement missions over the last decade to support force health protection, medical readiness, enhance interoperability, improve host nation capacity building, combat global health threats (i.e., emerging infectious diseases), support humanitarian assistance and disaster relief efforts, as well as build trust and deepen professional medical relationships worldwide. These missions additionally support the US Global Health Security Agenda, US National Security Strategy, US National Defense Strategy and National Military Strategy. Although global health engagement missions are conducted by armed forces with numerous military units and geographical locations, military healthcare personnel assigned to US Naval hospital ships also perform a wide range of these missions. These missions comprise some of the largest global health engagement missions conducted, encompassing hundreds of subject matter expert exchanges, community health exchanges, medical symposiums, and side-by-side partnered healthcare in countries around the world. Military healthcare personnel who have completed past missions possess valuable knowledge related to ship-based global health engagement missions. Capturing and transferring this knowledge to future deployed personnel is important for future successful missions, but has remained a significant challenge. The purpose of this study was to capture and examine first-person accounts of experiential learning among active duty physicians, nurses, and hospital corpsmen who had participated in recent hospital ship-based global heath engagement missions. Materials and Methods We used the interpretive, ethnographic method of interviewing and data analysis described by Benner. Interviews elicited detailed, narrative examples of experiences from military health care personnel who had participated in previous global health engagement missions aboard hospital ships (N = 141). Our approach to gaining meaning from these narratives was guided by three central strategies: (1) identify paradigm cases, (2) identify themes within and across participant narratives of meaningful patterns, and (3) identify exemplars to represent common patterns of meaning and common situations. Additionally, we collected demographic information. Results Our findings provide firsthand descriptions of five essential elements to prepare military healthcare personnel for shipboard global health engagement missions. These essential elements are mission clarity, preparedness, experiential knowledge, lessons learned, and flexibility/adaptability. Conclusions Widespread dissemination of the lessons learned from military global health engagement missions is crucial to shaping forces that operate effectively in a rapidly changing global environment. Sharing lessons learned increases efficiency, adaptability, and agility, while decreasing variance in processes and the need to relearn mission-specific lessons.

AbstractIntroductionOperational stress describes individual behavior in response to the occupational demands and tempo of a mission. The stress response of military personnel involved in combat and peace-keeping missions has been well-described. The spectrum of effect on medical professionals and support staff providing humanitarian assistance, however, is less well delineated. Research to date concentrates mainly on shore-based humanitarian missions.ProblemThe goal of the current study was to document the pattern of operational stress, describe factors responsible for it, and the extent to which these factors impact job performance in military and civilian participants of Continuing Promise 2011 (CP11), a ship-based humanitarian medical mission.MethodsThis was a retrospective study of Disease Non-Battle Injury (DNBI) data from the medical sick-call clinic and from weekly self-report questionnaires for approximately 900 US military and civilian mission participants aboard the USNS COMFORT (T-AH 20). The incidence rates and job performance impact of reported Operational Stress/Mental Health (OS/MH) issues and predictors (age, rank, occupation, service branch) of OS/MH issues (depression, anxiety) were analyzed over a 22-week deployment period.ResultsIncidence rates of OS/MH complaints from the sick-call clinic were 3.7% (4.5/1,000 persons) and 12.0% (53/1,000 persons) from the self-report questionnaire. The rate of operational stress increased as the mission progressed and fluctuated during the mission according to ship movement. Approximately 57% of the responders reported no impact on job performance. Younger individuals (enlisted ranks E4-6, officer ranks O1-3), especially Air Force service members, those who had spent only one day off ship, and those who were members of specific directorates, reported the highest rates of operational stress.ConclusionThe overall incidence of OS/MH complaints was low in participants of CP11 but was under-estimated by clinic-based reporting. The OS/MH complaints increased as the mission progressed, were more prevalent in certain groups, and appeared to be related to ship’s movement. These findings document the pattern of operational stress in a ship-based medical humanitarian mission and confirm unique ship-based stressors. This information may be used by planners of similar missions to develop mitigation strategies for known stressors and by preventive medicine, behavioral health specialists, and mission leaders to develop sensitive surveillance tools to better detect and manage operational stress while on mission.ScoutenWT, MehalickML, YoderE, McCoyA, BrannockT, RiddleMS. The epidemiology of operation stress during Continuing Promise 2011: a humanitarian response and disaster relief mission aboard a US Navy hospital ship. Prehosp Disaster Med. 2017;32(4):393–402.

Missions have played numerous developmental roles towards the achievement of economic and social advancement including the provision of healthcare. From their entry into Africa, they have employed numerous methods in order to introduce their Christian faith. The construction of schools and hospitals, engagement in public health campaigns, provision of relevant services for the poor, and spearheading the provision of formal education, among others, have been the most effective mechanisms. The activities of missionaries have taken different dimensions as their scope continues to change over time. Nevertheless, existing literature shows little data on the changing landscape of mission medicine and hospitals in Africa. Using a systematic literature review approach, the current study discusses the changing landscape of mission medicine and hospitals in Sub-Saharan Africa. This contribution dwells partly on the missionary theory of medical practice to define most of the services of these faith-based organization (FBOs) in Africa. Findings from the study have revealed that mission hospitals have established schools and training schemes that allow them to train medical personnel to complement the limited number of health personnel on the continent. In the twenty-first century, they have contributed to achieving the targets of the Millennium Development Goals (MDGs) and the Sustainable Development Goals (SDGs), especially aspects that focus on health. It is evident that while the focus, methods, and partnerships have changed, missions in healthcare have not diverted their attention from sharing the gospel of Jesus Christ.

Neonatal period is sensitive due to the physiological adaptations newborns make to adapt to extra uterine environment. High percentage of mortality during infancy occur during this period especially in developing countries. Nigeria neonatal mortality record is among the worst in the world.This study examined morbidity and mortality pattern of neonates admitted to Our Lady of Apostles (OLA) Catholic hospital, Okeofa Ibadan. This hospital-based retrospective study was carried out among admitted neonates at OLA Catholic hospital Oluyoro Ibadan, for a period of 1 year from May, 2017 to June 2018. Overall, 360 complete case notes were reviewed. A 5-sectioned structured checklist containing 39 items designed by the researchers was used for data collection. Data was analyzed using descriptive statistics and chi-square test.Among 360 neonatal case notes that were studied, 310 (86.1%) were admitted within the first and 7th day of life with the mean day of admission being 4 ± 5.5 days. 248 (68.9%) of the neonates had normal birth weight, 59 (16.4%) had low birth weight and 53 (14.7%) were macrosomic babies with the mean weight being 3 ± 0.6 kg. The two main causes of admission were neonatal sepsis 113 (31.4%) and birth asphyxia 94 (26.1%).A total of 248 (68.9%) neonates survived and were discharged home, 79 (21.9%) were discharged against medical advice, 25 (6.9%) were referred to a higher centre and 8 (2.2%) died. There is a significant association between neonates’ gender (P0.025), birth weight (P0.013) and neonatal outcome.Sepsis and birth asphyxia were the leading causes of neonatal morbidity and mortality. Efforts should be intensified to improve the care provided to women and their newborns during labor and immediate postpartum period respectively.

In 1695, Jan Teofil Plater and his wife Aleksandra founded a hospital for six impoverished nobles in Vilnius. Situated near the newly built church of the Ascension and the convent of the Congregation of Mission in the Subocz suburb beyond the city walls, this hospital was the first and, until the end of the eighteenth century, the only charitable institution providing care for individuals of particular social status. The article, based on the hospital’s registry book and other sources, examines the quantitative, as well as qualitative characteristics of the institution’s clientele, such as its fluctuations in size, its social composition, and the causes of its inmates’ impoverishment. The research revealed that, despite the demand for care, the overseers managed to maintain a stable number of inmates, rarely admitting more than one or two persons every year, and thus ensuring a steady operation of the hospital (see table 1). However, in contrast with other charitable institutions in Vilnius, the clientele of the Congregation of Mission hospital changed frequently because of expulsions (39.6 percent of all cases) and inmates leaving the hospital on their own initiative (20.1 percent) already in the first year of their stay. The mortality of inmates (27.8 percent) affected the size and turnover of the clientele to a much lesser extent than observed in other hospitals. Although there are no reliable data on the inmates’ age and health, such statistics show that they probably were younger and healthier than the clients of other charitable institutions in Vilnius. Moreover, the Congregation of Mission hospital’s inmates differed from the clients of other institutions in respect of social composition. Impoverished petty nobles, originating mainly from the districts of Lida and Oszmiana, constituted the majority (56.25 percent) of the hospital’s inmates whose social status is noted in the registry book (62.5 percent). The nobles became clients of the Congregation of Mission hospital either because of old age, disability, as well as other accidental causes, or because of increased social vulnerability outside mutual aid networks, comprised of family members, kin or neighbours. The article argues that the foundation of a hospital designated to provide care primarily for impoverished nobles shows that the poverty of nobles was recognized by contemporaries as a social problem that should be tackled. Keywords: poverty, charity, hospital, the Congregation of Mission, Vilnius, nobles, eighteenth century.

AbstractBackgroundUnited States foreign policy is tied extensively to health initiatives, many related to the use of military assets. Despite substantial resource investment by the US Department of Defense (DoD) in hospital ship humanitarian assistance and disaster response missions, the impact of this investment is unclear.MethodsA systematic literature review of both peer-reviewed and grey literature using eight databases representing the international community and multiple sectors was conducted. Data on the characteristics of missions directly related to US Navy hospital ship humanitarian assistance and disaster response from 2004-2012 were extracted and documented.ResultsOf the 1445 sources reviewed, a total of 43 publications met criteria for review. Six (13.9%) met empirical documentation criteria and 37 (86.0%) were considered nonempirical expert opinions and anecdotal accounts that were primarily descriptive in nature. Overall, disaster response accounted for 67.4% (29/43) and humanitarian assistance 25.6% (11/43). Public and private sector participants produced 79.0% (34/43) and 20.9% (9/43) of the publications respectively. Of private sector publications, 88.9% (8/9) focused on disaster response compared to 61.8% (21/34) from the public sector. Of all publications meeting inclusion criteria, 81.4% (35/43) focused on medical care, 9.3% (4/43) discussed partnerships, 4.7% (2/43) training, and 4.7% (2/43) medical ethics and strategic utilization. No primary author publications from the diplomatic, development, or participating host nations were identified. One (2.3%) of the 43 publications was from a partner nation participant.DiscussionWithout rigorous research methods yielding valid and reliable data-based information pertaining to Navy hospital ship mission impact, policy makers are left with anecdotal reports to influence their decision-making processes. This is inadequate considering the frequency of hospital ship deployments used as a foreign policy tool and the considerable funding that is involved in each mission. Future research efforts should study empirically the short- and long-term impacts of hospital ship missions in building regional and civil-military partnerships while meeting the humanitarian and disaster response needs of host nation populations.LicinaD. Hospital ships adrift? Part 1: a systematic literature review characterizing US Navy hospital ship humanitarian and disaster response, 2004-2012. Prehosp Disaster Med.2013;28(3):1–10..

Background: Reported coverage estimates for vaccine have the inherent problem of missing private entity data, to circumvent this, the National Health Mission, Ernakulam, designed and implemented an Immunization Information System (IIS) to collect routine vaccination reports from the private sector. This study attempted to identify the barriers to reporting by the private sector. Methodology: The study was conducted in Kerala's Ernakulam district. The design of the study was cross-sectional. The end–users, who are from the private sector, were the participants of 28 in-depth interviews in the study. Results: The new reporting system has increased private sector involvement in information exchange, all 78 private hospitals (100%) were reporting to NHM Ernakulam. But the completeness of reporting was not uniform. Major barriers identified were the lack of IIS interoperability with the hospital information system (HIS) being used by the private hospitals, variance because of lack of training of staff entering the data, and the unavailability of dedicated staff for reporting data. Conclusion: Addressing these barriers could improve the reporting of routine vaccination data from the private sector.

AbstractIn the year 1966, the first government hospital, Oshakati hospital, was inaugurated in northern South-West Africa. It was constructed by the apartheid regime of South Africa which was occupying the territory. Prior to this inauguration, Finnish missionaries had, for 65 years, provided healthcare to the indigenous people in a number of healthcare facilities of which Onandjokwe hospital was the most important. This article discusses these two agents’ ideological standpoints. The same year, the war between the South-West African guerrillas and the South African state started, and continued up to 1988. The two hospitals became involved in the war; Oshakati hospital as a part of the South African war machinery, and Onandjokwe hospital as a ‘terrorist hospital’ in the eyes of the South Africans. The missionary Onandjokwe hospital was linked to the Lutheran church in South-West Africa, which became one of the main critics of the apartheid system early in the liberation war. Warfare and healthcare became intertwined with apartheid policies and aggression, materialised by healthcare provision based on strategic rationales rather than the people’s healthcare needs. When the Namibian state took over a ruined healthcare system in 1990, the two hospitals were hubs in a healthcare landscape shaped by missionary ambitions, war and apartheid logic.

In Religion and Medicine, Dr. Jeff Levin, distinguished Baylor University epidemiologist, outlines the longstanding history of multifaceted interconnections between the institutions of religion and medicine. He traces the history of the encounter between these two institutions from antiquity through to the present day, highlighting a myriad of contemporary alliances between the faith-based and medical sectors. Religion and Medicine tells the story of: religious healers and religiously branded hospitals and healthcare institutions; pastoral professionals involved in medical missions, healthcare chaplaincy, and psychological counseling; congregational health promotion and disease prevention programs and global health initiatives; research studies on the impact of religious and spiritual beliefs and practices on physical and mental health, well-being, and healing; programs and centers for medical research and education within major universities and academic institutions; religiously informed bioethics and clinical decision-making; and faith-based health policy initiatives and advocacy for healthcare reform. Religion and Medicine is the first book to cover the full breadth of this subject. It documents religion-medicine alliances across religious traditions, throughout the world, and over the course of history. It summarizes a wide range of material of relevance to historians, medical professionals, pastors and theologians, bioethicists, scientists, public health educators, and policymakers. The product of decades of rigorous and focused research, Dr. Levin has produced the most comprehensive history of these developments and the finest introduction to this emerging field of scholarship.

Esta obra se debruça sobre diálogos entre políticas públicas e direito, trazendo artigos científicos de diversos autores brasileiros acerca da participação e da sua efetividade na sociedade contemporânea. O livro apresenta um olhar interdisciplinar, sendo composto por capítulos escritos por pesquisadores não só da área jurídica, como também de Psicologia, Biologia, Odontologia e Pedagogia. A divisão dos capítulos parte de temas mais relacionados à participação política por diferentes vias, passando pelas demandas por efetivação dos direitos humanos, sem retrocesso social. Em seguida, transita por violações específicas no âmbito dos direitos a educação, igualdade racial e de gênero, moradia, dignidade física, psíquica e sexual, segurança pública e saúde. O primeiro capítulo discute em que medida foi eficaz a participação popular na tramitação da reforma política na Câmara dos Deputados do Brasil. Descreve as vias de participação popular nesse âmbito e discute seus efeitos na tramitação da referida reforma, a partir dos procedimentos metodológicos de revisão bibliográfica, análise de documentos, estudo de caso e process tracing com elite interviewing, em abordagem qualitativa. Os resultados indicam que, embora tenha havido aumento da participação popular institucional no período sob enfoque, o parlamento aplicou não decisões em relação à reforma política intencionada pelas entidades da sociedade civil que organizaram as provocações ao Poder Legislativo. Em seguida, o segundo capítulo tem como principal objetivo a análise acerca do Portal e-Democracia e o seu papel para uma maior democracia participativa de, principalmente, inclusão das minorias sociais. Estuda a relação entre a democracia brasileira e a participação popular, investiga o porquê do Portal e-Democracia ser tão necessário para a defesa dos direitos das minorias sociais, bem como explica a importância da participação popular legislativa das minorias sociais. Esta pesquisa parte de fontes bibliográficas primárias e secundárias, com revisão bibliográfica e análise do próprio portal em estudo. O estudo conclui que é essencial a criação de políticas públicas para a participação política das minorias sociais, sendo uma delas o mencionado portal eletrônico, porém esta medida isolada não resolve a presente questão, sendo necessárias políticas públicas de fácil acesso a todos e todas. O terceiro capítulo aborda as relações que conectam o princípio da vedação ao retrocesso social com as manifestações que apoiam o movimento de retorno da ditadura militar no Brasil no século XXI. Para tanto, no primeiro momento, os autores elucidam os conceitos de vedação ao retrocesso social, bem como o significado do chamado efeito cliquet, o qual corrobora com os ditames fixados do respectivo princípio, haja vista que, no alpinismo, significa que quando atingida uma determinada altura, não se pode mais voltar. Contextualizam, ademais, as heranças e as consequências da ditadura militar no Brasil, além de analisarem as manifestações que têm ocorrido na atualidade em prol de um retrocesso ao período ditatorial. O trabalho comprova que a volta da ditadura militar seria uma afronta ao princípio da vedação ao retrocesso social, uma vez que extinguiria e revogaria direitos fundamentais já consolidados no ordenamento jurídico brasileiro e regressaria a um período autoritário, que não se coaduna com o Estado Democrático de Direito. Conectando-se à discussão acerca de retrocessos e inefetividade de direitos, o quarto capítulo mergulha no debate democrático acerca da expansão da educação superior brasileira e das políticas de acesso que promoveram um significativo acréscimo de ingressantes nos cursos de graduação no Brasil. O trabalho atende a pesquisa bibliográfica e fundamenta-se na revisão de literatura com o suporte teórico de autores e legislações da área afim, refletindo sobre o processo de evolução e inclusão mediante a implementação de programas e ações afirmativas para a educação superior que corroboraram para dirimir o caráter elitista impregnado no perfil deste nível de ensino. Embora distante de reparar as injustiças sociais no Brasil, tais políticas geraram um número maior de ingressantes das camadas menos favorecidas da sociedade e, com isso, a representatividade dos grupos denominados de minorias aumentou, ainda que de modo tímido, mas refletindo na redução do déficit de acesso ao ensino superior. Ainda sobre desigualdades na educação no país, no quinto capítulo as autoras investigam como a discussão sobre o mito da democracia racial no Brasil impulsionou práticas racistas ao longo do tempo e como, a partir de um viés multiculturalista, se assentam as políticas afirmativas, com destaque para a política de cotas para ingresso de negros e pardos nas Universidades, implementadas a partir de 2012. Apontam, para tanto, que a construção deste mito não se coaduna com questões mais modernas e de relevo econômico e social que pautaram a promoção de políticas afirmativas no Brasil. Nesta senda, as políticas sociais afirmativas de cotas são medidas tomadas pelo Estado, de cunho temporário ou especial, com o objetivo de assegurar igualdade de oportunidades e que foram negadas historicamente para a população afro. Para embasar este artigo, foi utilizada a metodologia de revisão bibliográfica e a análise documental das políticas afirmativas de cotas. O capítulo seguinte aventa que as relações sociais são produtos da vida em sociedade e caracterizam-se, essencialmente, pela interação que há entre seus componentes considerando territórios, culturas, identidade e ideias. Contudo, é da natureza dessa dinâmica social que alguns grupos sociais se sobressaiam sobre os demais e imponham seus interesses pessoais acima dos interesses públicos, prejudicando, assim, a concretização de interesses gerais. Dessa maneira, com o intuito de explicar como essas relações de poder e de domínio influenciam na concretização de políticas públicas, o trabalho se propôs a analisar qual o protagonismo que os agentes sociais têm nessa fase. Como exemplo prático dessa discussão acadêmica, analisa-se como a elite governante brasileira busca conciliar seus interesses com a efetivação de políticas públicas habitacionais. Em outro aspecto de violação de direitos através de deficiências de políticas públicas, o sétimo capítulo analisa a evolução da taxa de homicídios no Brasil, verificando grande heterogeneidade entre os estados. Isso constitui uma deficiência estrutural grave, que compromete as bases do desenvolvimento no país. Assim, o propõe-se o entendimento da correlação das taxas de homicídios no Brasil em um período de 10 anos, verificando que os estados do Rio Grande do Norte, Goiás, Maranhão e Piauí se correlacionaram positivamente, apresentando um aumento na taxa de homicídios, enquanto Espírito Santo e Paraíba obtiveram redução. Diante dos resultados, destaca-se a atenção às políticas de segurança pública e conclui-se que é possível identificar padrões estruturais das distintas dinâmicas de homicídios contribuindo para e informações relevantes que possam subsidiar a implantação e efetividade das políticas públicas no país. Na seara das violências, o oitavo capítulo destaca aquelas cometidas contra mulheres no ambiente doméstico no bairro de Narandiba, em Salvador-BA. O artigo tem como objetivo geral analisar a possibilidade ou não de ampliação no atendimento às mulheres que sofrem violência doméstica através da unidade do Centro Judiciário de Solução Consensual de Conflitos (CEJUSC), órgão vinculado ao Tribunal de Justiça da Bahia, localizado no bairro de Narandiba, em Salvador. Como primeiro objetivo específico, examina se o acolhimento dessas vítimas estaria em conformidade com o regulamento e a missão que fundamenta o trabalho do CEJUSC. Como segundo objetivo específico, reflete sobre a demanda de mulheres, vítimas de agressão doméstica, que passam pela unidade de Narandiba em busca de um apoio ou uma orientação jurídica. Em termos metodológicos, o artigo é qualitativo e analisa o tema proposto utilizando a revisão bibliográfica, a análise de documentos e a observação da autora durante o período de janeiro a outubro de 2019. As violências domésticas atingem, não raro, a dignidade sexual de crianças e adolescentes. Assim, a conexão para o nono capítulo apresenta as etapas da perícia psicológica nos casos de suspeita de abuso sexual, tendo como enfoque os instrumentos e testes psicológicos mais utilizados nestas avaliações. Os objetivos específicos englobam conceituar avaliação psicológica e abuso sexual, bem como trazer técnicas da Psicologia que melhor respaldem o psicólogo nesse processo de avaliação. O método deste estudo foi realizado por meio de pesquisa bibliográfica. A avaliação psicológica pericial difere de outros tipos de avaliação psicológica em função de sua meta final onde atua subsidiando decisões legais quando estas dependem de um entendimento de funcionamento psicológico do(s) envolvidos(s) nos casos de suspeita de abuso sexual de crianças e adolescentes. Abuso sexual é qualquer contato ou interação entre uma criança ou adolescente e alguém em estágio psicossexual mais avançado do desenvolvimento, na qual a criança ou adolescente estiver sendo usado para estimulação sexual do perpetrador. As avaliações psicológicas têm sido requisitadas em todas as fases de encaminhamento dos casos, da notificação ao processo judicial. Desde a fase inicial ou investigativa, a criança pode passar por inúmeras intervenções (entrevistas, aplicação de testes psicológicos, etc), inclusive de psicólogos que não atuam diretamente com a justiça, mas que acabam colaborando no processo quanto à veracidade da situação de abuso. Não obstante possam ser vítimas de diversas violações de direitos, por vezes crianças e adolescentes entram em conflito com a lei. Nesse contexto, o décimo capítulo investiga a contribuição da aplicabilidade da entrevista terapêutica no processo de avaliação psicológica de adolescentes em conflito com a lei, descrevendo as características de adolescentes, explicando a função da Psicologia e elucidando entrevista terapêutica como ferramenta diferencial na avaliação psicológica desses adolescentes. Como metodologia foi realizada uma revisão bibliográfica, com base em livros e artigos científicos, com tratamento particular de publicações da área de Psicologia e da legislação específica sobre os direitos do adolescente. Como resultados, os adolescentes em conflitos com a lei apresentam características que se fundamentam em aspectos históricos, sociais e culturais e a entrevista terapêutica mostrou-se como importante na contribuição da avaliação psicológica desses adolescentes, uma vez que se dispõe como uma técnica de analise aberta, capaz de se ajustar a diferentes situações clínicas, com possibilidades de descobrir as subjetividades, conhecer comportamentos, indicar encaminhamentos ou fazer intervenções. Diante de uma realidade vivencial complexa e aprisionadora, a avalição psicológica é uma prática relacional, que visa com alteridade contribuir para incluir socialmente os adolescentes. É certo que a mudança comportamental dos adolescentes infratores requer apoio familiar e um trabalho multidisciplinar, que não comporta apenas o papel do Psicólogo, mas, o envolvimento do Estado e da sociedade como um todo em ações conjuntas, para efetivamente produzir transformações. Conclui-se que o estudo produziu uma discussão importante, por dispor conhecimentos para área da Psicologia, profissionais que atuam e para a sociedade, que podem melhor conhecer os espaços de intervenção, meios de atuação e a importância da psicologia neste contexto. Nessa linha de discussão que abarca questões relacionadas à saúde, o capítulo seguinte analisa a judicialização do direito à saúde. Esse direito, conforme o artigo 196 da Constituição Federal, pertence a todos e é dever do Estado fornecê-lo por meio de políticas públicas. Entretanto, a possibilidade de exercício por todos do referido direito fica limitada aos recursos disponíveis e por ações judiciais no âmbito do Sistema Único de Saúde (SUS). O objetivo geral, portanto, é analisar se a judicialização da saúde é a solução mais adequada para se obter uma vaga de leito de UTI no SUS. Assim, o trabalho descreve como o SUS regula a distribuição de leitos e reflete sobre o fenômeno da judicialização e o seu potencial ou não de efetivar esse direito com isonomia. Para a sustentação metodológica, o estudo utilizou de uma pesquisa qualitativa, com método fundamentado em análise de documentos e revisão bibliográfica a respeito do tema. Os resultados mostram que, embora o SUS estabeleça a quantidade de leitos de UTIs, alguns hospitais carecem de mais ofertas de leitos. Desta forma, é relevante ter um políticas públicas que efetivem o direito à saúde, em cumprimento às previsões legais. Nesse contexto de inefetividade do direito à saúde, o capítulo seguinte descreve o perfil das demandas judiciais referentes a medicamentos no município de Cuiabá – Mato Grosso, realizado na Defensoria Pública, em 2013, utilizando indicadores de Pepe. Foram analisadas 135 ações judiciais relativas às solicitações de medicamentos e 166 medicamentos requeridos nas mesmas. Em quatro dimensões (sócio demográficas do autor da ação judicial; processuais das ações judiciais; médico sanitárias das ações judiciais; político-administrativas das ações judiciais). As informações obtidas e delineadas no capítulo expõem o cenário da saúde frente a judicialização de medicamentos e as características dos indivíduos que abriram demandas contra o Estado ou o Município. Em preocupação com a saúde e a segurança alimentar dos brasileiros, o décimo terceiro capítulo discute o cabimento de arguição de descumprimento de preceito fundamental (ADPF) contra a nova política brasileira de agrotóxicos. A evolução clássica da política brasileira de agrotóxicos foi marcada pela ótica da proteção. Todavia, novos desafios, hoje, contrariam a política até então vigente e faz surgir um movimento, cada vez mais forte, pela flexibilização de normas. Nesse cenário, percebe-se o surgimento de uma nova política sobre tema, mas desta vez, tendo o agronegócio como protagonista. Desse modo, os efeitos desta nova política já são tangíveis, o que nos leva a discutir a constitucionalidade de tais ações. Posto isso, este trabalho tem como objetivo promover um debate acerca da existência de uma nova política brasileira sobre agrotóxicos em suas principais questões. Para realizar este trabalho, foram utilizados os tipos de pesquisa bibliográfica e documental, através da abordagem qualitativa. Conclui-se que a nova política de agrotóxicos é inconstitucional e, por consequência, atacável por meio da ADPF. Avançando na busca de efetivação de direitos humanos através de políticas públicas, o último capítulo investiga a necessidade de ressignificação das bases da teoria da execução para efetivar ações civis públicas em que se discutem tais políticas. Para tanto, utiliza-se de procedimento monográfico e bibliográfico. O estudo expõe as razões que levaram à judicialização da política, bem como traça diretrizes gerais sobre o atual panorama da execução. Aborda, ainda, a crise de efetividade da execução, que insiste em se valer de multas pelo descumprimento – que vêm sendo inefetivas para o cumprimento. Após essa discussão, o trabalho traz instrumentos jurídicos hábeis a colaborar com a concretização dos direitos. Espera-se que esta seleção de artigos científicos contribua, como obra coletiva, para avanços no conhecimento sobre políticas públicas como efetivadoras de direitos humanos, bem como sobre as múltiplas formas de participação popular na luta por tais direitos na sociedade contemporânea.

This book has examined the commodification of hospital care in the United States. It has looked at PubliCare Hospital, HolyCare Hospital, and GroupCare Hospital to highlight the contradictions between the mission of hospital care and the market for it. If PubliCare is reminiscent of the hospital's past, and HolyCare is indicative of health care's present, then GroupCare seems to anticipate health care's future. This concluding chapter considers some of the changes in the U.S. health care market and cites the impact of the Patient Protection and Affordable Care Act (PPACA, 2010). For example, the law imposes important new regulations on the insurance industry and promotes and incentivizes “evidence-based” medicine. The chapter argues that while PPACA certainly changes the market for hospital care, it does not resolve the market's contradictions. It also reflects on future prospects for hospitals and hospital care.

The structure, clinical processes, and measurement of outcomes of specialized palliative and hospice services, organized as hospital-based palliative care (HBPC) programs, have grown in sophistication in response to documented, poor end-of-life care; growth of the elderly and advanced, chronic illness populations; and documented successes of pilot and maturing clinical palliative care programs. Standards, guidelines, and other resources are now available to assist health systems to develop, sustain, or expand palliative care services for persons of all ages and stages of illness, along the entire care continuum. All hospitals and healthcare systems should develop palliative care services that are consistent with these standards and the mission, size, and scope of the health system.

This chapter will provide a strategic approach and firsthand insight into the best practices for Nyack Hospital’s User Community “Gateway to NH Medical Library Resources” Virtual Library 24/7 service. In an effort to maximize Library and Information Services (LIS) while minimizing the department’s planned budget and licensing fees, the author will share current practices of the knowledge-based information needs of the Hospital: Nyack Hospital and LIS Mission/Goals/Objectives, US Federal Government Mandates for Electronic Medical Records (EMR), Nyack’s McKesson Paragon Hospital Information System, Coordination of Knowledge Management – eResources (Web-version) and the function of hard copy, Acquisition, Annual Licensing Agreement (Institutional), Dissemination, and Preservation of Information Resources, Coordination with Southeastern New York Library Research Council (SENYLRC) and Hospital Library Program Services (HLSP), Extensive Literature Search and Document Delivery Services thru NLM/DOCLINE and ILL, End-User Orientation and Training, Continuing Medical Education (CME) Services. The author will present the current status of the state-of-the-art Med Lib Research Info Center and conclude with the future direction of the Research Learning Center.

Background: Various machine learning (ML) models have been developed for the prediction of clinical outcomes, but there is missing evidence on their performance in clinical routine and external validation. Objectives: Our aim was to deploy and prospectively evaluate an already developed delirium prediction software in clinical routine of an external hospital. Methods: We compared updated ML models of the software and models re-trained with the external hospital’s data. The best models were deployed in clinical routine for one month, and risk predictions for all admitted patients were compared to the risk ratings of a senior physician. After using the software, clinicians completed a questionnaire assessing technology acceptance. Results: Re-trained models achieved a high discriminative performance (AUROC > 0.92). Compared to clinical risk ratings, the software achieved a sensitivity of 100.0% and a specificity of 90.6%. Usefulness, ease of use and output quality were rated positively by the users. Conclusion: A ML based delirium prediction software achieved a high discriminative performance and high technology acceptance at an external hospital using re-trained ML models.

This chapter examines a paradox of GroupCare Hospital's palliative care program. On the one hand, GroupCare created a space for intimacy, honesty, and personal connection that has become exceedingly rare in the U.S. medical system. On the other hand, GroupCare considered the palliative care program to be consistent with its goal of “appropriate utilization” and likely would not have invested such resources in the program had it not been seen as economically efficient. This chapter shows that the staff at GroupCare tended to believe that through evidence-based medicine, technical savvy, and systems integration, it could make the mission of health care and the market for health care consistent with and supportive of one another. It also considers how GroupCare seemed to have succeeded in taming the market for hospital care and aligning the health of its membership with the economic interests of the organization and the practitioners within it.

Over the past ten years, there has been significant growth in the number of hospitals offering integrative therapies. A strong clinical and business case is emerging that is fueled by consumer demand and the expanding evidence base that demonstrates positive outcomes. Two exemplars of hospitals are highlighted where integrative nursing principles and concepts are deeply woven into the care model. In both institutions highlighted, aligning integrative health with organizational vision, mission and priorities was critical to success. Nurses are well positioned to provide leadership in advancing integrative health and nursing within acute care settings.

Mobile communication for healthcare workers is a critical part of hospitals infrastructure. Many of these systems do not work well together, leading to difficulties regarding multiple communication devices with different usage area, unavailable or missing equipment, and alarm fatigue. Physicians and nurses often need information fast, and any delay between the decision and the action taken could cause medical errors. One suggested solution for this problem is to implement wireless phone systems. However, psychological theory and empirical evidence, both suggest that wireless phones have the potential of creating additional problems related to interruptions. The fact that hospital workers prefer interruptive communication methods before non-interruptive methods, amplifies the risk of overloading staff. The key is how to handle the balance between increased availability and increased interruptions. In this chapter, the authors present solutions and possibilities based on context aware communication systems that aim to reduce interruptions and thereby also alarm fatigue.

A number of international studies have reported that HIV+ mothers under ART on average deliver babies that have low birth weight (LBW), are smaller (LBH) and are more often premature [1,2,3,4,5,6,7,8,9]. These 3 elements are well known risk factors for neonatal mortality. In our study we wanted to assess the actual status of such supposed HIV and ART related neonatal mortality risks in Burundi by taking advantage of the country’s large scale EMR implementation. A total of 64,682 birth records were extracted from EMRs in 17 hospitals for the period between January 1, 2018 and October 31, 2022. After quality control for missing or impossible data, 54,180 records were retained for the study. This study demonstrated that the use of ART during HIV+ pregnancies has no statistically significant impact on risk factors for neonatal mortality in Burundi. The study also indicates that the HIV prevalence among pregnant women in Burundi who give birth in a hospital is more than twice as high as expected based on the official figures. It was also demonstrated that an explanation for this finding cannot be found in a possible concentration of HIV+ deliveries in the hospital environment. The availability of large-scale implementation of structured electronic health records brings numerous new possibilities for population research based on routinely registered health data in a low-resource country like Burundi.

Abstract Ronald Barnes is a 12-year-old boy who was born with a severely deformed left ear. As a young child, Ronald had reconstructive surgery on the ear that produced a satisfactory functional result, but the ear remained quite small and misshapen. As Ronald grew older, he was frequently teased by his schoolmates, and he suffered poor school performance as a result. As he neared adolescence, the impact on his life of his “ugly “ ear escalated. In an attempt to alleviate mounting psychological problems, and with the recommendation of their pediatrician, Ronald’s parents took him to see Dr. Schmidt, a plastic surgeon. Dr. Schmidt told them that, through new surgical techniques, she could restore the ear to a nearly normal appearance. Ronald and his family were ecstatic, and Dr. Schmidt requested preauthorization for the revision from the family’s HMO, Ultima Care. Two weeks later the Barnes family received a brief letter from Ultima Care saying that coverage for treatment would be denied because it was a cosmetic procedure and therefore not “medically necessary. “ Confused and angry, Ronald’s parents didn’t know what they should do next. Dr. Steven Bernstein is the senior medical director for Ultima Care HMO, based in Massachusetts. One morning Dr. Bernstein received a call about a 20-year old man, Henry Larson, an Ultima member, who had been hospitalized for a month after a serious car accident left him quadriplegic. As the time approached when he was to be moved from the hospital to a nearby rehabilitation facility, the patient’s sister had called to request a benefit exception that would cover a transfer of Henry’s care to the Shepherd Rehabilitation Center in Atlanta, Georgia, the rehabilitation center where the wellknown actor Christopher Reeve received care after his injury.

The purpose of this chapter is to present a mission planning approach for a service robot, which is moving and manipulating objects in semi-structured and partly known indoor environments such as stores, hospitals, and libraries. The recent advances and trends in motion planning and scheduling of mobile robots carrying manipulators are presented. This chapter adds to the existing body of knowledge of motion planning for Service Robots (SRs), an approach that is based on the Bump-Surface concept. The Bump-Surface concept is used to represent the entire robot’s environment through a single mathematical entity. Criteria and constraints for the mission planning are adapted to the service robots. Simulation examples are presented to show the effectiveness of the presented approach.

As the role of modern naval non-combatants evolves to include multi-mission ships increasing their exposure to asymmetric threats and as damage can also occur accidentally outside of an intentional weapon impact, the assessment of survivability of non-combatant ships becomes necessary to ensure fleet-wide mission capability. A survivability enhancement case study was performed by modifying and applying traditional combatant survivability methodology to the 145m non-combatant naval training and hospital vessel shown above. Thousands of tests were conducted with each test randomly varying threat parameters and hit locations in order to capture the chaotic nature of random unknowns, thus providing a probabilistically determined assessment of occurrences similar to real world threat events. Structural, Mobility, Damage Control, and Self Defense mission areas with limited inherent survivability are identified and expert recommendations proposed based on analysis of initial damage in addition to “through time” performance results and from expert design review. In cases where design recommendations are not feasible or difficult to implement, then the recommendations made focus in improving operational survivability through crew actions and training.

Knowledge of medical-related terminology and communication skills are essential for multinational partners participating in a wide variety of missions - combat, stabilization, humanitarian support and natural disaster relief. In case of injures and sickness they need to know basic medical terminology in English to evaluate the situation, arrange for MEDEVAC or coordinate health services. Although the First aid and MEDEVAC topics are included into many language training programs, participants are unable to use health-related vocabulary in challenging situations due to the lack of language practice and limited training time. The purpose of the study was to identify specific needs of the multinational partners in medical terminology, explore a range of technology-enhanced language learning strategies for vocabulary extension and refreshing, and suggest a framework for medical terminology assistance based on mobile learning. The study started with needs analysis to reveal specific language gaps and challenges in use of common medical terminology that may be addressed by individual mobile learning. It was intended to identify typical communication situations and vocabulary that should be addressed. Native and non-native English speakers from 14 NATO and partner countries (officers and civilians) who had participated in stability operations and other missions around the world were interviewed and answered questionnaire. Additionally, 5 instructors who teach medical and health-related English to future mission participants were interviewed. As a result, three main areas of vocabulary were identified: parts of body, injuries and other health issues (feelings, symptoms), and medical assets/devices used for first aid and healthcare prescriptions. Most typical communication situations were related to car accidents, MEDEVAC calls, taking a person to the hospital, and writing a report about the accident. To identify the best way of exploiting mobile learning for language assistance to the multinational partners we focused on clarifying differences between e-learning and m-learning and identifying specific features of m-learning that may be beneficial and even unique in supporting terminology acquisition for the multinational audience. Early research in m-learning emphasized limitations of the mobile devices, such as size of the display, reduced input, small memory, abridged or specific OS version, and lack of standards, which positioned m-learning as a specific case of e-learning. However, rapid evolution of mobile technologies, their recent features, including efficient and reliable tactile display, automated adjustment of the resolution and the like, put m-learning on an equal footing with e-learning. Moreover, as distribution of mobile devices significantly exceeds the number of personal computers, and “digital native” generation uses these devices extensively not only for communication but also for accessing information on the web, mobile access to e-learning content may increase several times in the near future. M-learning is perceived to be more flexible, more personalized, more interactive, and more engaging. Due to smaller portions of content and shorter learning session times, m-learning becomes a natural activity during transfer or waiting periods. Moreover, continuous use of the personal mobile device appeals to personalization of learning content through contextual and learning history relevancy. Integrating learning, communication, information exchange and assistance, mobile device became a natural enhancer/extender of the individuals’ capabilities. Extensive study of the literature on vocabulary learning strategies and their computer-based implementation suggested a range of learning activities useful for vocabulary acquisition. However, not all of them promise to be efficient in this specific case, as they do not address individual difficulties and initial vocabulary, short intervals of time that may be devoted to learning, limited attention to language learning due to other priorities, lack of translation to mother language. Moreover, most of the widely used vocabulary extension activities are reading-based, whereas video and audio samples are not properly tagged for share and reuse in vocabulary refreshing. Game-based and context-driven vocabulary acquisition strategies raise learning motivation but their efficiency comparing to memorization-based approach has not been measured. In the final part of the study, requirements to the mobile learning environment for medical terminology support are formulated and examples of language learning activities for mobile devices are described.

Indonesia plans to build the first nuclear power plant (NPP) to solve the country’s energy problems. It needs full skilled human resources in the field of nuclear technology. Department of Engineering Physics, Gadjah Mada University is the only university in Indonesia offering a nuclear engineering curriculum which is established since 1977. The main obstacle of nuclear engineering education development is the unclear government policy. The government postpones its plan several times since the first nuclear research reactor was established in Bandung (1972) due to the presence of anti-nuclear groups, especially after Fukushima accident. This paper would like to describe our experiences in order to response the challenge mentioned above. As an education institution, Gadjah Mada University has a mission to develop science and technology for leveraging the nation competitiveness. According to that goal, the nuclear engineering development has to be independent to the presence of NPP in Indonesia, since many NPP is establishing in the world. As addition, according to the Nuclear Energy Regulatory Agency (BAPETEN), there are 2,825 institutions, including medical institutions, which are currently utilizing radioactive materials in Indonesia. As addition, Indonesia now is playing important role in the radio-pharmacy production, particularly in Asia. So, there are several opportunities as basis for developing the new nuclear engineering curriculum. In the new nuclear engineering curriculum at Gadjah Mada University, student is offered two concentrations named Nuclear Energy System and Medical Physics Technology. The first one is oriented to support the nuclear reactor system development including G4 NPP, research reactor and radioisotopes production reactors. They study how to plan, to operate and to develop from cradle to grove of a nuclear reactor system that means from front-end to back-end. In the other hand, the second one is developed to graduate competence human resources who could apply their knowledge in medical field. They would be a partner of radio-oncologist in hospitals. Besides the hard skills, student’s character has to be educated in order to create their competitive excellences based on safety culture, global and national vision. We believe that the above mentioned hard and soft skills will assist student to survive in today’s global competition, especially in nuclear technology utilization.

Global population aging is one of the most critical factors in the coming decades (Eurostat, 2019). In Italy, international trends are confirmed: the average age of residents, which was 32 in 1952, increased to 46.2 years at the beginning of 2022 (Istat, 2022). The overall effects of aging on the health and welfare system are considerable. Indeed, with ageing is associated with an increase in chronic pathological conditions, co-morbidities, or the inability to perform basic daily activities independently, and this leads to an increase in the care and assistance needs of the elderly. The European health interview survey (2019) finds that there in Italy there are about 4.6 million elderly people with severe or moderate difficulties in ADLs (Activities of Daily Living) and IADLs (Instrumental Activities of Daily Living), such that they need help and support to carry them out. However, the need for help is not always fully met: more than 2 million people over 65 with impaired independence do not feel adequately helped (Istat, 2022b).A distinctive factor of the new generation of elders is their approach to technologies, a factor that can greatly expand the possibilities of access to care and assistance, communication and information services (Istat, 2019). To provide, as far as possible, the continuity of care and assistance people need, telemedicine services can ensure safe and efficient care pathways while maintaining a strong patient-physician relationship. For example, in Italy before the health emergency caused by the Covid-19 virus, the use of telemedicine services was very limited. The pandemic emergency accelerated the diffusion of telemedicine applications and services, especially aimed at bridging the difficulties of performing health care services in person and minimizing hospital admissions when unnecessary. Before that time, home-based telemedicine services were used for the management of asthma, hypertension, pulmonary disease, and congestive heart failure (Chan et al., 2003; Benatar et al., 2003; Maiolo et al., 2003; Hersh et al., 2006; Panicacci et al., 2021).Digital technologies are thus a resource to support care and assistance at home. Design, and in particular the Human-Centred Design approach, can have a crucial role both in understanding the elderly population's needs and in translating these needs into digital products that are more suitable and relevant to their purpose.This article presents the first results of the research conducted by the Laboratory of Ergonomics & Design (LED) of the University of Florence as part of Spoke 3 of the project "THE - Tuscany Health Ecosystem" of the PNRR (National Recovery and Resilience Plan), funded by the Italian government with Next Generation EU funds - Mission 4 (Education and Research) - Component 2 "From Research to Enterprise". The THE project involves the participation of 22 partners including universities, research centers and companies in the Tuscany Region, organized in 10 Spokes. The goal is to develop guidelines for the design of interfaces and products for telemedicine services in digital diagnosis and therapy for neurodegenerative diseases.This article will discuss the research questions, applied research methodology, results and future developments.

During the process of medical interpretation and diagnosis in medical image, doctors’ attention allocations are various depending on individuals and cases. The process of diagnosing in the medical image involves complex interplay between visual perception and effective information acquisition strategies coupled with medical knowledge. It is difficult for doctors to explicitly explain their strategies because the process is often implicit. To date, precisely what attention allocation patterns and cognitive strategies in medical image reading, remains unknown.This study aims to uncover the doctor’s attention allocation and transition patterns in reading chest X-ray image, elicit diagnostic strategies based on doctor’s eye movements and interviews, and find the differences of diagnostic strategies between expert and novice doctors. Finally, prospective suggestions for leading novice doctors to an effective diagnostic strategy in reading X-ray image can be presented.We simulate the scenario of annual medical checkup using four patients’ cases, and recruit participants with diverse medical experiences and specialties in Tokyo Medical and Dental University Hospital to compare the differences of attention allocations between doctors. Doctors are asked to identify the lesion and give diagnostic decision to four cases. Their eye movements are recorded in the whole process by eye tracker. After completing all four cases, participants are asked to attend an interview session in which their eye movements are used as cues to elicit their diagnostic strategies. And two questionnaires are answered at last. Fixation duration, the number of fixations in each are of interest (AOI) are used to visualize doctors’ attention allocation and fixation transition patterns. Both qualitative and quantitative analysis are used to describe doctors’ diagnostic strategies and compare the differences between expert and novice doctors. Each doctor has personal characteristics when diagnosing. Doctors have a significant preference to read to current image. Doctors tend to pay more attention to areas where physiological structures overlap and where doctors think suspicious. As for diagnostic strategies, four typical patterns of change of diagnostic strategies in timeline are found. Furthermore, the differences are found between expert and novice doctors in attention allocation and the use of historical image.The effective diagnostic strategy is that performing the inspection routine of the current image separate with comparison with the historical image to avoid distracting and missing information. The comparison should focus on important areas and suspicious areas rather than the whole image. The suggested important areas are the lung apex, mediastinum, heart, left lung hilar and the lower lung field. The proposed effective strategies could be included in the medical education and new doctor training to improve novice doctors’ ability to diagnose by multiple images.

INTRODUCTION In locations where few people have received Covid-19 vaccines, health systems remain vulnerable to spikes in SARS-CoV-2 infections. Triage tools, which could include biomarkers, to identify patients with moderate Covid-19 infection suitable for community-based management would be useful in the event of surges. In consultation with FIND (Geneva, Switzerland) we shortlisted seven biomarkers for evaluation, all measurable using point-of-care tests, and either currently available or in late-stage development. METHODS We prospectively recruited unvaccinated adults with laboratory-confirmed Covid-19 presenting to two hospitals in India with moderate symptoms, in order to develop and validate a clinical prediction model to rule-out progression to supplemental oxygen requirement. Moderate disease was defined as oxygen saturation (SpO2) ≥ 94% and respiratory rate < 30 breaths per minute (bpm), in the context of systemic symptoms (breathlessness or fever and chest pain, abdominal pain, diarrhoea, or severe myalgia). All patients had clinical observations and blood collected at presentation, and were followed up for 14 days for the primary outcome, defined as any of the following: SpO2 < 94%; respiratory rate > 30 bpm; SpO2/fraction of inspired oxygen (FiO2) < 400; or death. We specified a priori that each model would contain three easily ascertained clinical parameters (age, sex, and SpO2) and one of the seven biomarkers (C-reactive protein (CRP), D-dimer, interleukin-6 (IL-6), neutrophil-to-lymphocyte ratio (NLR), procalcitonin (PCT), soluble triggering receptor expressed on myeloid cells-1 (sTREM-1), or soluble urokinase plasminogen activator receptor (suPAR)), to ensure the models would be implementable in high patient-throughput, low-resource settings. We evaluated the models’ discrimination, calibration, and clinical utility in a held-out external temporal validation cohort. ETHICS Ethical approval was given by the ethics committees of AIIMS and CMC, India, the Oxford Tropical Research Ethics Committee, UK; and by the MSF Ethics Review Board. ClinicalTrials.gov number, NCT04441372. RESULTS 426 participants were recruited, of which 89 (21.0%) met the primary outcome. 257 participants comprised the development, and 166 the validation, cohorts. The three models containing NLR, suPAR, or IL-6 demonstrated promising discrimination (c-statistics: 0.72 to 0.74) and calibration (calibration slopes: 1.01 to 1.05) in the held-out validation cohort. Furthermore, they provided greater utility than a model containing the clinical parameters alone (c-statistic = 0.66; calibration slope = 0.68). The inclusion of either NLR or suPAR improved predictive performance such that the ratio of correctly to incorrectly discharged patients increased from 10:1 to 23:1 or 25:1 respectively. Including IL-6 resulted in a similar proportion (~21%) of correctly discharged patients as the clinical model, but without missing any patients requiring supplemental oxygen. CONCLUSION We present three clinical prediction models that could help clinicians identify patients with moderate Covid-19 suitable for community-based management. These models are readily implementable and, if validated, could be of particular relevance for resource-limited settings. CONFLICTS OF INTEREST None declared.

This report presents the results of an investigation by Greo Evidence Insights into how Canadian mental health (MH) costs could be estimated. It begins by conducting a review of studies estimating the costs of MH in Canada since 2010 and examines the various approaches employed. Based on this analysis the next section makes recommendations regarding cost types to include, the granularity of the estimates, and the approach to missing/ incomplete data. The report then recommends a phased approach to estimating the cost of mental health: Phase I describes in detail the data sources and methods to estimate public, direct health care costs associated with general and psychiatric MH-related hospitalizations and emergency room visits and non-hospital-based interventions (i.e., physician costs, pharmaceutical costs, community MH services). Phase II describes methods for estimating social and income support payments and indirect costs. Finally, Phase III describes data sources and methods for estimating private health and lost productivity costs.