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The World Professional Association for Transgender Health (WPATH) has prepared a consensus statement to inform the Diagnostic and Statistical Manual (DSM) 5th Edition Work Group on Sexual and Gender Identity Disorder as it redefines the transgender experience. As part of that initiative, the authors of this article (a designated WPATH work group) looked at options for changing (or not changing) the DSM 5 diagnoses related to gender identity, taking into consideration how each of those options might affect access to care for transgender persons. Drawing on a thorough review of the literature, the WPATH work group undertook to describe the current and possible future states of access to health care; “access” defined according to established human rights measures, the “transgender experience” defined according to current DSM and International Classification of Diseases (ICD) codes. The role of various parties that influence access was considered, including transgender persons, care providers, policy writers, and decision makers in government and industry. A change to the DSM 5 that supports a normative transgender identity with distressed states is recommended in the context of a continuing dialogue between stakeholders. [ABSTRACT FROM AUTHOR]

Inuit face worse cancer survival rates and outcomes than the general Canadian population. Persistent health disparities cannot be understood without examining the structural factors that create inequities and continue to impact the health and well-being of Inuit. This scoping review aims to synthesise the available published and grey literature on the structural factors that influence cancer care experienced by Inuit in Canada. Guided by Inuit input from Pauktuutit Inuit Women of Canada as well as the Joanna Briggs Institute scoping review methodology, a comprehensive electronic search along with hand-searching of grey literature and relevant journals was conducted. A total of 30 papers were included for analysis and assessment of relevance. Findings were organised into five categories as defined in the a priori framework related to colonisation, as well as health systems, social, economic, and political structures. The study results highlight interconnections between racism and colonialism, the lack of health service information on urban Inuit, as well as the need for system-wide efforts to address the structural barriers in cancer care. [ABSTRACT FROM AUTHOR]

Colonial administrations introduced various social infrastructures in Africa. This paper analyses and compares the development of colonial governments' health care provision and policies in Ghana and Côte d'Ivoire from circa 1900 to 1955. Using qualitative and quantitative information from colonial reports, a new dataset captures the development of four factors relevant to these aims: health care expenditures, health care facilities, medical staff, and patients. Deflated health care expenditures per capita were found to be higher in Ghana than in Côte d'Ivoire in almost all years. The number of health care facilities per capita was larger in Côte d'Ivoire than in Ghana, and facilities were more geographically dispersed. Ghana had a lower number of medical staff per capita than Côte d'Ivoire as of the 1920s. Medical staff from Côte d'Ivoire formed the majority of the staff base as early as the mid-1910s. Finally, the analysis shows that the number of patients treated in health care facilities in Ghana was low until the 1920s, and took off as more facilities became available during the 1940s. These findings provide evidence that even two countries that are relatively similar (apart from their colonial history) can have different colonial health care trajectories. [ABSTRACT FROM AUTHOR]

Ukraine has been improving the quality of health care by reforming the health care system. Evidence on healthcare users' perceptions of quality is important for future system changes. This paper aims to analyze the aspects of quality that outpatient care users find most important. Data from a longitudinal household survey 'Health Index. Ukraine' in 2016–2019 were used. The survey had a sample size of over 10,000 participants per wave. Data were analyzed using descriptive statistics as well as binary regression analysis. Our results showed the importance of quality attributes as 'effectiveness of treatment' and 'qualification of medical personnel' as well as changes in the perception of quality attributes connected with payment policies and general management of the facility (like working hours, setting and hygiene ensuring by medical personnel). Our study provides new insights into the importance of healthcare quality attributes for outpatient healthcare users in Ukraine, showing the need to develop in future a national policy on quality and a national quality strategy for health care that incorporates quality aspects important to patients to make the healthcare system more responsive to the needs and expectations of healthcare users. [ABSTRACT FROM AUTHOR]

Knowledge management is intended to achieve organisational goals through effective management of knowledge resources and performance. This paper presents a review of knowledge management effects and performance in health care. Six databases were searched, the searches employing Boolean operators and combinations of key words. In total, 16 articles fulfilled the criteria set for inclusion. Data were analysed using inductive content analysis. The review shows that in health care knowledge management effects and performance have been viewed from various perspectives: it has been linked to health care functions such as management, finance, patient care, quality and safety, IT, continued improvement of clinical operations, and organisational culture. However, the effects of knowledge management extend also to employees' work, job satisfaction, learning, knowledge distribution, and productivity. This review aims to summarise the recent research on knowledge management effects and performance in health care. Some of the effects are universal and some are context-specific. [ABSTRACT FROM AUTHOR]

In this paper, we draw on systems leadership, complexity and paradox theory to elucidate the tensions that organizational actors experience when practising multi-level leadership. We explore these issues through a study of the perceptions and experiences of stakeholders within an Integrated Care System (ICS) in England. Employing a collaborative inquiry approach, data were collected via 19 narrative interviews with participants in key leadership roles across ICS partners and nine co-creation workshops with a total of 86 participants from different parts of the ICS. Findings highlight that in developing multi-level leadership practice, leaders experience contradictory expectations and outcomes, including paradoxes of identity, place, purpose and change. We conclude by suggesting that leadership in multi-level contexts requires oscillating between competing polarities in a dynamic equilibrium with attention to localized interactions. MAD statement Integrated Care Systems were enacted across England in July 2022 to enhance the capacity for statutory, voluntary and community organizations to work in partnership to improve health outcomes across diverse populations. Multi-level systems leadership, however, poses significant challenges around navigating the inevitable tensions that arise when working with complexity. Through qualitative research in a vanguard ICS, this paper highlights a range of paradoxes faced by leaders and organizations and proposes implications for policy and practice in enabling dynamic equilibrium and working in contexts of uncertainty and change. [ABSTRACT FROM AUTHOR]

In this paper, female sex workers tell stories of their interactions with health care providers (HCP) in four cities in the Republic of Ireland. While Irish society has made great progress in listening to the sexual stories of women that were historically silenced (e.g. stories of abortion, sexual abuse), sex workers have not benefited from this new climate. Regularly silenced by parliamentarians and non-governmental organisations who speak upon their behalf, sex workers are consigned within a narrative of victimhood and coercion. This paper draws from a participant action research study conducted in 2019–20 and explores women's motivations in whether to disclose their sex work, and the strategies deployed to conceal it while seeking access to sexual health care. These strategies included traveling beyond their own communities for health care and STI home testing. The paper identifies women, particularly, migrants who felt their precarious position made it impossible for them to be truthful about their sex work to health care providers, exposing them to greater health risk. The paper understands this marginality within a context of structural violence where sex worker health is shaped by institutional power relations creating unequal health outcomes but is also challenged by stories of solidarity. [ABSTRACT FROM AUTHOR]

Copyright of Public Money & Management is the property of Routledge and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Much has been written about the claim that the British National Health Service (NHS) is becoming more like the US health care system, something a number of commentators view as a form of “Americanization”. Yet, that term is imprecise and unhelpful for rigorous analysis of what has, and has not, happened. This paper uses the lens of policy transfer to explore this issue, which provides a sharper insight into policy development. The paper examines the relevance of the Dolowitz and Marsh framework for the study of policy transfer from the US to the British NHS from 1979 onwards. In terms of the framework’s main research questions, the discussion of the potential US influence on the NHS case stresses the role of policy entrepreneurs in policy transfer. In terms of policy success, however, commentators suggest a mix of uninformed, incomplete, or inappropriate transfer. We conclude that Dolowitz and Marsh do provide a useful framework that asks relevant questions about policy transfer, which provides a more nuanced account of policy transfer from the US to the NHS than the crude term “Americanization”. [ABSTRACT FROM AUTHOR]

Healthcare sector is emerging as a very dynamic and competitive sector where the service providers are in constant pursuit to differentiate and distinguish themselves from each other. Green and agile practices have been gaining importance over the years as an important aspect in the service sector. Although majority of the sectors were forerunners in green–agile implementation, the healthcare sector has been fast catching up, where agility and green practices show promises and lots of scope. There is a general absence of research focus involving the impact of green practices and agile practices in patient care delivery in the healthcare sector, let alone in Indian healthcare context. This paper aims at empirically investigating the antecedent consequence relationships between green and agile practices on patient satisfaction and aims at empirically validating the proposed linkages. The contribution of this paper lies in understanding whether green practices and agile practices' implementation in Indian hospitals has any implication on patient perception and their understanding of satisfaction. [ABSTRACT FROM AUTHOR]

Background: In psychiatric care, doctors depend on information from interactions with patients to arrive at the right diagnosis and appropriate therapy (Brisset C, Leanza Y, Rosenberg E, Vissandjée B, Kirmayer LJ, Muckle G, et al. language barriers in mental health care: a survey of primary care practitioners. J Immigr Minor Health. 2014;16(6):1238–46). This is a qualitative descriptive study which seeks to investigate language barriers faced by psychiatrists in their interactions with patients and the effectiveness of the strategies which are employed to deal with the barriers. Methods: Research questions are informed by Convergence (Giles H. Communication Accommodation Theory. In: Baxter LA, Braithewaite DO, editors. Engaging theories in interpersonal communication: multiple perspectives. Thousand Oaks (CA): Sage Publications; 2008. p. 161–73). Using semi-structured interviews, psychiatric doctors from the three state-owned psychiatric hospitals in Ghana report their experiences with convergence strategies they use, and offer suggestions that could inform future studies and policy formulation with regard to psychiatric care in Ghana. A qualitative conventional content analysis was applied whereby coding categories were derived straight from the text data. Results: The literature suggests that the study is novel with reference to Ghana. Similar studies (Lee E. Cross-cultural communication: therapeutic use of interpreters in mental health for professionals and clinicians. In: Lee E, editor. Working with Asian Americans: a guide for clinicians. New York (NY): The Guilford Press; 1997; Swartz L, Drennan G. Beyond Words: notes on the 'irrelevance' of language to mental health services in South Africa. Transcult Psychiatry. 2000;37(2):185–201; Jarvis GE, Ahmed R, Ryder A, Kirmayer LJ. Assessing language barriers to mental health services in a multiethnic population: preliminary findings. Presentation at Health care Access for Linguistic Minorities: Breaking the Barriers. Montreal, Quebec, Canada; 2014) corroborate this paper's findings that language barriers have the potential of causing misdiagnoses if psychiatrists do not employ effective communication strategies. Conclusions: The paper recommends areas for further research and improvement measures which carry policy implications. [ABSTRACT FROM AUTHOR]

This paper addresses an immediate gap in knowledge about community reintegration of previously incarcerated older adults. It presents an exploratory case study of a community residential facility program in Ontario, Canada, focusing on the experiences and perspectives of older residents, staff members, and community stakeholders on the community reintegration of previously incarcerated older men. Findings provide insights into the aging-related reintegration issues such as the older men's ability to access health and medical services upon community reentry, the challenges and opportunities of the continuum of support (or lack thereof) to help ease the reintegration process, and stigma and other barriers the older men face as they attempt to access long-term care upon release from correctional institutions. Emergent questions for research, policy, and practice are highlighted and discussed to set an agenda for expanding the thread of inquiry into the community reintegration of previously incarcerated older adults. Future research calls for further investigation into the diversity of experiences (e.g., gender, race/ethnicity, geographical locale) to advance the field of study as it relates to aging and social policy. [ABSTRACT FROM AUTHOR]

The Internet of things (IoT) has been a controversial domain of inquiry in engineering applications since the term was first introduced in 2000. The emergence of IoT also promotes the advancement of health care monitoring from face-to-face consultation to telemedicine or eHealth system. This paper presents the prototyping of an embedded health care monitoring system based on the IoT paradigm. The proposed system architecture consists of three sensors for the measurement of three basic vital signs, i.e. body temperature, pulse rate, and blood pressure. The integrated sensors are interfaced with the Intel Edison platform, and the output readings are transferred to IBM Bluemix for cloud storage and display. Taking advantage of IoT, the condition of the physical body can be monitored remotely and diagnosed with anomalies by doctors. The paper also presents the health care analytical framework related to diabetes and kidney disease. The prediction results from the analytics show the potential of the classification model to be integrated into the proposed system to identify the potential risk of certain diseases at early stages of early treatment. In the preliminary investigation, the accuracy of the developed model to differentiate between a healthy person and patients with diabetes and kidney disease is 90.54% and 87.88%, respectively. Concerning the functionality of the proposed system architecture, the sensors' measurement accuracy is above 90% compared to conventional medical equipment. [ABSTRACT FROM AUTHOR]

Deep learning and transfer learning are being extensively adopted in biomedical, health and well-being related applications. As per worldwide agreement proclamation from the Fleischner Society, registered computer tomography is an applicable screening instrument owing to its higher efficiency in identifying early pneumonic changes since lung infection is a major manifestation of the covid 19 virus. Notwithstanding, doctors are still very involved battling COVID-19 in this period of overall emergency and new variants of the virus are emerging (delta, omicron) even after two years. Hence, it is urgent to speed up the advancement of AI consciousness indicative device to help doctors. Regardless of colossal endeavors, it remains extremely difficult to create a powerful model to aid the exact measurement appraisal of COVID-19 from the chest CT pictures. The idea of obscured limits, regulated division techniques generally experience the ill effects of explanation predispositions.Imagebased finding, it is envisaged will achieve significant improvements in more rapidly, effectively and accurately identifying Covid contamination in human beings. In this paper we have proposed CNN based multi-picture growth procedure for recognizing COVID-19 in CT scans of Covid speculated patients. We have proposed framework implements deep learning via multi-faceted CNN with high accuracy. [ABSTRACT FROM AUTHOR]

Contemporary "knowledge" relies increasingly on probabilistic data. A key example is the "evidence" for the effectiveness of health and social welfare interventions. Such claims to "knowing" require an epistemological underpinning. This paper explores the concept of probabilistic knowledge, evidence and "proof" which underpin claims for the effectiveness of social welfare interventions from the perspective of scholastic epistemology. It provides a framework based on contingent events, establishing different levels of certitude and ways of increasing it, thanks to intellectual virtues such as prudence and art. Knowing the value of the data that form the basis for making decisions in social processes, we can construct directions for social policies. Greater methodological precision (that philosophy in its various traditions might offer) may be of service to attempts in social work to conceptualize questions of effectiveness and measurement of outcomes, given their probabilistic nature. [ABSTRACT FROM AUTHOR]

The relationship between the Horthy era (1920–44) and the communist era shows continuities from a social historical perspective. The paper contributes to the reinterpretation of these relations by examining Hungarian health care in the 1930s and 1940s with a focus on the relationship between international transfers and path dependency in forging health care reforms. The author argues that the achievements communists regarded as inventions of socialism in health care and the welfare state had already been developed in the 1930s and 1940s. It was only because of the strict wartime budget of the early 1940s that these welfare reforms had not been realized. With the help of internal affairs documents, essays on health care, official statistics records in the National Archives of Hungary and the Semmelweis Library and Archives of Medical History as well as press material, Cora demonstrates that, even if communists depicted the interwar period as 'fascist and imperialist', the health care system of the so-called 'productive social policy' showed continuities. Moreover, social policy makers of the 1930s and early 1940s, such as Béla Johan, Ferenc Keresztes-Fischer and Béla Kovrig also designed welfare and health care reforms for the post-war period by both developing already existing Hungarian programmes and selectively adapting foreign welfare models (American management principles, the Alsace scheme and the Beveridge Plan). The study investigates Hungarian health care in view of the theory of path dependency and the macrohistorical convergence thesis developed by Tomka (on East–West convergence). It is within this framework that the paper addresses the issue of health care transfers to better understand the development of twentieth-century European health care systems by identifying similarities and differences in their development as well as to speculate on the trajectory of various political solutions to social challenges, including health care. [ABSTRACT FROM AUTHOR]

As a fast growing specialty, medical telephone triage lines (nurse lines) play an important role in providing advice and recommendations to help ensure that medical care is delivered at the appropriate level. In this paper, we discuss the operations of these nurse lines, based on studies in the literature and interviews with nurse line researchers and practitioners. This leads us to identify issues relevant for the design and management of such lines, challenges that operations research (OR)/operations management (OM) can help address. We demonstrate that a classical call center modelling approach, focusing exclusively on congestion, will be insufficient in addressing these challenges. Thus, we motivate research on an integrated framework in which both congestion and decision-making accuracy are coupled. We summarise the limited extant research in OR/OM that is applicable to the unique challenges posed by nurse lines, highlighting these models’ contributions, as well as the questions they leave unanswered. These questions provide significant opportunities for future research. [ABSTRACT FROM PUBLISHER]

Some emerging countries have made significant progress in developing local pharmaceutical and biotechnology but had less success in building medical device industries (MDIs). This paper explores the weak development of local MDIs by analysing the contrasting evolutionary trajectories of Indian healthcare technology sectors. The Indian pharmaceutical and biotechnological industries have emerged as leading global suppliers of generic drugs and vaccines, in marked contrast to the medical devices industry. This paper reveals that existence of a weak collaborative linkage between medical device manufacturers and the Indian health system, which largely lacks a systemic and cross-sectoral linkages, and weak communication between industry and government policy-makers have become a huge barrier to the development of the Indian MDI in the contemporary neo-liberal environment. The weak connection between technology and industrial policy and healthcare policy objectives has severely hampered both development of national technological capabilities and the creation of affordable health care. [ABSTRACT FROM AUTHOR]

This paper provides an overview of our 10-year research on the application of stochastic and dynamic programming techniques to address health care operational deficiencies in a demand-driven way. We first describe the main operational deficiencies motivating our research in the capacity allocation and scheduling of diagnostic equipment and operating rooms. We then present main findings of extensive field studies to show current practices and key features of the problems under consideration. Applications of stochastic and dynamic programming to these problems are discussed by giving key assumptions, mathematical models, properties of the optimal solution, solution approaches and main numerical findings. The relaxation of the key assumptions is shown to lead to various future research directions that have drawn significant interests of the operations research and industrial engineering communities. We conclude by identifying barriers and potential solutions on the path from theories to applications. [ABSTRACT FROM AUTHOR]

Existing scholarship on federalism seeks to gauge the extent of centralization and decentralization by examining the role of federal and subnational governments in policymaking in a range of federal countries. Most of these studies are focused on debates about self-rule and subnational representation in the legislative branch. This paper explores the role of subnational governments in health care decisions made at the national level in Brazil. Some researchers argue that health care policymaking in Brazil is heavily centralized. This article aims to deepen our understanding of how subnational governments influence decisions in the health care equalization system. The existing scholarship shows that the effective power of states and municipalities in national decision making remains limited, yet this paper argues that other players, who support changes towards increased centralization, influence health policy decisions. [ABSTRACT FROM AUTHOR]

This paper proposes a new scheduling problem for patient visits with two objectives: minimizing patient waiting time and travel time. It also presents a novel encoding method for Genetic Algorithms (GA) that is well-suited for this problem. Experiments demonstrate that the proposed encoding method reduces optimization iterations by 17% compared to conventional methods, and the GA can decrease waiting time by up to 58.2% and travel time by up to 89.3% for specific examples. The novel scheduling problem and the encoding method are two main contributions of this work. [ABSTRACT FROM AUTHOR]

The link between social inequality and health has been widely recognized, as there are systematic differences in health between people from lower and higher social classes. Furthermore, the complexity and multidimensionality of health and social problems has resulted in primary health care services that are increasingly integrating the approach of interprofessional collaboration between medical professionals and social workers. Despite this current focus, there is a lack of empirical insights into patients' experience of the quality of care resulting from these collaborations. This paper aims to contribute to knowledge by adopting a research approach that captures the narratives of patients in vulnerable situations from a primary care center by conducting semi-structured interviews. Through content analysis, data was analyzed according to five themes: (1) availability, (2) accessibility, (3) affordability, (4) comprehensibility, and (5) usefulness. The results suggest a positive role for interprofessional collaboration between medical professionals and social workers within a primary health care setting. This includes the opportunity for giving greater attention to social rights and collaboration within the local community. [ABSTRACT FROM AUTHOR]

For years now, the Indian healthcare system has been viewed through the lens of heteronormativity, sidelining sexual and gender minorities. Despite the lack of established data, an estimated 45.4 million people in India belong to the LGBTQ community and these individuals face increased risk of various physical and mental health disorders. Given the rapidly changing sexual demographic of the country, along with the changes of legislation and other factors that mold it, this paper systemically reviews LGBTQ individuals vulnerabilities toward various communicable and non-communicable diseases along with the lacunae in the primary healthcare system and the need for their inclusion in it. [ABSTRACT FROM AUTHOR]

This paper uses empirical data collected from 117 female sex workers living in informal settlements in Nairobi and 15 healthcare providers to highlight specific effects of COVID-19 and related restrictions on healthcare access for the sex workers. We highlight the existing gender and health inequalities that have now been reinforced by the initial outbreak of the COVID-19 pandemic. Specifically, we focus on the most concerning healthcare needs for the sex workers including HIV prevention, care and treatment and sexual and reproductive healthcare. Our study findings reveal that the various restrictions imposed by the government to help curb the spread of COVID-19 to a large extent made it difficult for the sex workers to access their healthcare needs. The paper discusses the challenges of healthcare service delivery reflecting on some innovative and pioneering responses from health care providers to address the emergency situation. [ABSTRACT FROM AUTHOR]

The persistent binary between the state and civil society has been recently challenged by conceptualizations that represent the state as an effect of discursive and mundane socio-spatial practices of government. This article approaches the historically contingent relationship between the state and its citizenry by connecting the prosaic aspects of the construction of the territorial state with biopolitical governmentality through an inquiry into health care as a statist social practice of constituting a governable category of the ‘mundane health’ of a national population. Applying Foucault’s concept of dispositif as a methodological tool, the paper focuses on the ways in which the territorial state, in this context Finland, becomes involved in a population’s everyday social life through statist knowledge production on population health and associated governmental technologies. The paper suggests that dispositif analysis provides a fruitful method for examining the ways in which national population is constituted as an object of government and brought together with spaces of scientific knowledge production by statist technologies of health. [ABSTRACT FROM AUTHOR]

An important source of health information is word of mouth (WOM). Nevertheless, a model describing WOM in the health care sector does not exist. The aim of this paper is to contribute to research by providing concrete suggestions for a model of word of mouth in the health care sector. A conceptual framework comprising the theory of cognitive dissonance, the theory of the strength of weak ties, and the theory of perceived risk are used as a theoretical anchor. In order to gain a more precise knowledge of WOM in the health care sector, a literature review of leading health care journals is conducted. The findings are summarized in the form of a model proposal describing the creation, spread, and impact of WOM in the health care sector. As the model summarizes the current WOM literature, it seems to be a good starting point for further research by scholars. The paper also helps practitioners to better understand WOM and integrate the WOM aspects described into their daily work. [ABSTRACT FROM PUBLISHER]

This paper provides a review of the marketing literature on elderly consumers' health choices and risk perceptions, in order to summarize the state of the art and provide a comparison term for future studies. The research was carried out on scientific articles published from 1970 up to 2019, in a selection of 100 thematic journals. The results confirmed the significance of health choices and risk perceptions as two essential points of marketing research concerning older consumers, and demonstrated that the growing needs and purchasing power of older consumers are accompanied by psychological, biological and relational conditions that can impact decision-making. [ABSTRACT FROM AUTHOR]

Addressing spiritual needs of patients in healthcare settings improves patient experiences and clinical outcomes; however, non-chaplain providers typically assess spiritual needs differently (quantitative psychometric) than healthcare chaplains (long form narrative) and thus there is little shared language or cross-disciplinary evaluation frameworks across disciplines. This discrepancy impedes the provision of both team-based and patient-centered care. This paper used scoping review methodology to illustrate the overlap between narrative and psychometric assessment tools, comparing four narrative tools against eight psychometric tools. The SpNQ-120 and Brief RCOPE demonstrated consistent domain coverage across the four chaplain narrative tools. This work provides preliminary resources to aid clinicians and researchers in choosing an appropriate tool. Additionally, for those who do not work closely with chaplains, it provides a sense of what domains chaplains prioritize, from their professional and lived experience, in assessing the spiritual life of the patient. This improves interdisciplinary communication, and therefore, patient care. [ABSTRACT FROM AUTHOR]

Copyright of Australian Journal of Political Science is the property of Routledge and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Trust provides the foundation for the successful implementation and operation of a virtual community (VC). Trust is an especially relevant success factor in online health-care communities. A look at existing communities leads to the conclusion that many VCs fail to meet requirements upon which trust is established. Based on the findings in the literature and the researchers' experience, this paper describes how trust-enabling functionalities can be systematically designed and implemented in a VC for cancer patients. Consequently, the outcomes of these design measures are evaluated. The evaluation results show that supporting trust can be achieved following a two-step model. The presented components support the perceived competence and perceived goodwill of the operators and the other members. Perceived goodwill and competence then support the process of creating and sustaining trust between members as well as between members and the operators of the VC and contribute to the successful implementation and maintenance of the community. The paper concludes with a discussion on further trust-supporting components yet to be implemented and gives recommendations for further research in this area. [ABSTRACT FROM AUTHOR]

The aim of this paper is to describe a solution suitable for the automation of standard pollen information service (EN 16868:2019). We are describing the RealForAll integrated information system developed for automatic airborne pollen detection and real-time data delivery to end-users. This solution is based on the measurements from the Rapid-E airborne particle monitor. The system incorporates an AI-enabled subsystem based on a convolutional neural network that continuously retrieves raw data from Rapid-E and performs the classification of airborne pollen. The main advantages of this system reflect in real-time data delivery and independence of aerobiology experts during the pollen season. [ABSTRACT FROM AUTHOR]

Background:Interventions directed to individuals by health and social care systems should increase health and welfare of patients and customers. Aims:This paper aims to present and define a new concept Clinical Impact Research (CIR) and suggest which study design, either randomized controlled trial (RCT) (experimental) or benchmarking controlled trial (BCT) (observational) is recommendable and to consider the feasibility, validity, and generalizability issues in CIR. Methods:The new concept is based on a narrative review of the literature and on author’s idea that in intervention studies, there is a need to cover comprehensively all the main impact categories and their respective outcomes. The considerations on how to choose the most appropriate study design (RCT or BCT) were based on previous methodological studies on RCTs and BCTs and on author’s previous work on the concepts benchmarking controlled trial and system impact research (SIR). Results:The CIR covers all studies aiming to assess the impact for health and welfare of any health (and integrated social) care or public health intervention directed to an individual. The impact categories are accessibility, quality, equality, effectiveness, safety, and efficiency. Impact is the main concept, and within each impact category, both generic- and context-specific outcome measures are needed. CIR uses RCTs and BCTs. Conclusions:CIR should be given a high priority in medical, health care, and health economic research. Clinicians and leaders at all levels of health care can exploit the evidence from CIR.Key messagesThe new concept of Clinical Impact Research (CIR) is defined as a research field aiming to assess what are the impacts of healthcare and public health interventions targeted to patients or individuals.The term impact refers to all effects caused by the interventions, with particular emphasis on accessibility, quality, equality, effectiveness, safety, and efficiency. CIR uses two study designs: randomized controlled trials (RCTs) (experimental) and benchmarking controlled trials (BCTs) (observational). Suggestions on how to choose between RCT and BCT as the most suitable study design are presented.Simple way of determining the study question in CIR based on the PICO (patient, intervention, control intervention, outcome) framework is presented.CIR creates the scientific basis for clinical decisions. Clinicians and leaders at all levels of health care and those working for public health can use the evidence from CIR for the benefit of patients and the population. [ABSTRACT FROM PUBLISHER]

Based on two empirical studies on education in health and elderly care, this paper reflects on the possible role of ‘old ideas’ involved in creative innovation. Most researchers agree that creativity and innovation are the results of a combination of what is new and valuable. What tends to be paid less attention, however, is the fact that many creative activities and everyday innovations in modern-day organisations actually build upon what is already there. Creative products and processes are often the result of some kind of learning from or even re-creation of existing processes and materials. The paper argues that there is excessive enthusiasm towards the novelty aspects of creativity and innovation, which overshadow the potential of old ideas and past experience as drivers of change. [ABSTRACT FROM AUTHOR]

This paper focuses on performance changes stemming from a series of lean interventions in a medical laboratory. This research is one of the first to link a series of lean interventions and performance over time. In a mixed-method case study, six years of patient-related throughput data, retrieved from a laboratory computer database, are analysed. Three distinct periods with significant differences in throughput time performance can be distinguished. Semi-structured interviews were held to investigate the lean interventions preceding the performance changes. Given the long-term nature of the study, the event history calendar method was applied to enhance the respondents’ recall and reliability. A single lean intervention, among the hundreds that took place, was supposed to cause the main reduction in throughput times. It concentrated on improving process flow through the removal of batching, a source of artificial variability. A later major intervention, the introduction of flow-focused machinery, had mixed effects and initial performance gains were not sustained. The results show that ongoing series of interventions do not always lead to ongoing performance improvements in terms of throughput times but support theories emphasising the importance of variability reduction. [ABSTRACT FROM PUBLISHER]

In this paper, we present the findings of a qualitative study aimed at conceptualizing the service needs of aging gay men living with HIV (GMLH). Our analysis is based on interview data from 16 gay-identified men living with HIV, ages 50 and over. Drawing on a framework of intersectionality, which theoretically accounts for interlocking expressions of marginalization in groups affected by multiple systems of oppression, we highlight the practical, social, and mental health needs of this population, as well as services that could be designed or adapted to address these concerns. We also emphasize the relevance of specialized training for caring professionals serving older GMLH, and articulate the need for initiatives that more fully engage gay men aging with HIV in the development and delivery of services intended for their use. [ABSTRACT FROM AUTHOR]

The literature on welfare and social policy regimes often assumes that countries perform consistently across policy sectors. Is this assumption correct, particularly in the global South? Do countries that do well in a given policy sector do also well in others? This article examines the matter by contrasting pensions with health care in Latin America, clustering countries based on their degree of segmentation in policy outputs. As a region, Latin America is an interesting case to study because of its comparatively high levels of social spending, long history of welfare systems, significant policy transformation in the first decade of the twenty-first century and extensive body of research. Findings show that while some countries do consistently well or poorly across sectors, others report an uneven performance. Questioning overarching generalizations based on the notion of the regime, the paper calls for further comparative analysis on the political economy behind the sectoral change. [ABSTRACT FROM AUTHOR]

The principal idea of this paper is that human resource management (HRM) and quality management (QM) ideas require contextualization when used to change organizations. Here, contextualization stands for the process that leads to a shared meaning, i.e. the majority of the co-workers in an organization understand and define a concept or change in terms that are shared and accepted. In the present paper, we study a strategic change project, based on HRM and QM ideas, conducted at the County Council of Värmland (CCV), the public healthcare authority in the County of Värmland in Sweden, where the focus was on everybody's involvement. Our interpretation of the project shows that a shared meaning of the concept of everybody's involvement was not reached in this particular case, i.e. contextualization did not occur. One important result of the study is that contextualization is a prerequisite for realizing HRM and QM thoughts. The paper also stresses how important it is that general and 'non-contextualized' HRM and QM ideas are adapted to local practices when used to direct organizational change. [ABSTRACT FROM AUTHOR]

In India, marginalised people with serious or chronic illness face particular challenges to finding sustainable treatment, and often experience financial devastation. One state welfare scheme (the EWS hospital bed quotas) holds the promise of treatment for those in Delhi's margins, through partnerships with corporate hospitals. Yet, the process of gaining access to treatment via the scheme is very frustrating. This ethnography illustrates the ways in which low-income patients' attempts to lay claim to state services often bring them into play with a mode of the state that is, in anthropologists' conceptions, opaque, arbitrary and erratic. In response to the 'illegible' modes of access to the scheme, patients and their families are compelled to construct and reproduce their eligibility to access treatment, through a repertoire of intricate and entwined practices, namely: the attainment of credible low-income documentation, the use of big men to leverage resources, and different kinds of performance. The burden of enacting these practices is further compounded and troubled by the state scheme's blurry entanglement with the private sector, in which roles and responsibilities for a 'duty of care' to citizens with illness are elusive. This paper therefore aims to be an original contribution to the social sciences, in interpreting health-seekers' experiences of state-private schemes in Delhi within anthropological understandings of the state and marginalised people's meaning-making of illegible state processes. [ABSTRACT FROM AUTHOR]

Transgender individuals will seek medical intervention for transition-related services as well as medical treatment for general health needs similar to cisgender individuals. However, people in the transgender community face unique barriers to treatment such as the lack of knowledge among health-care professionals, insurance coverage, and legal protections. This paper reviews barriers, major legal cases, and federal policy related to the health needs for transgender and gender expansive individuals. The authors call for a social work response at the macro and micro level. Advocacy for health care access for transgender individuals is a social justice issue social workers are uniquely positioned to work toward. At the micro level, social workers must help educate and advocate for their clients to bring transgender-sensitive practices to the health care system. [ABSTRACT FROM AUTHOR]

Drawing on findings from a study of two social generations of gender and sexuality diverse Australians, this paper offers a critical analysis of expectations and experiences of inclusive health care for LGBTQ+ youth. Data were collected by means of individual and focus group interviews with people from two different social generations who grew up in regional or urban Australia: those born in the 1970s (n = 50) and those born in the 1990s (n = 71). Data were analysed inductively to develop insights into what inclusive health care meant, and what this revealed about the potential for fostering belonging in healthcare settings. Findings raise critical questions about how inclusiveness of care might best be understood in encounters between gender and sexual minorities and health professionals. In particular, forms of 'inclusivity labour' were observed across the social generations, both in terms of the work involved in seeking to locate supportive services, and in assessing the performance of clinicians in healthcare settings, with implications for the continued engagement of LGBTQ+ young people with essential forms of care. Mobilising contemporary forms of inclusivity labour, including attention to the affective dimensions of healthcare engagement, has the potential to promote both better health and more meaningful experiences of belonging for gender and sexual minorities. [ABSTRACT FROM AUTHOR]

This short paper is a Reply to ‘Medical altruism in mainstream health economics: theoretical and political paradoxes. COMMENTS’. [ABSTRACT FROM PUBLISHER]

This paper explores design students’ proposals for a redesign of the interior of a room of silence at the SUS hospital in Malmö. Reflection and existential meaning-making are discussed in relation to the material culture of design, and more specifically in relation to four different themes found among the students’ proposals: nature as common symbolic framework and salutary force; lighting creating a visual and spatial ambience for retreat; interactive objects allowing ritualised activities; and the presence and absence of religious symbols. In this paper, we argue that architecture and design more profoundly could support people with varying existential viewpoints when it comes to providing religiously and culturally shared public spaces for dealing with existentially crucial moments. We also argue for an interdisciplinary research approach to healing environments, where existential meaning-making is included in the overall discussion of the design of health care architecture. [ABSTRACT FROM PUBLISHER]

Germany's traditional health resorts and spas have undergone far reaching transformation processes, triggered mainly by health care system reforms that started in the 1990s and resulted in significant cuts to the public funding of traditional restorative 'Kur' treatments in these destinations. Consequently, there has been a significant shift towards Germany's so-called 'second health care market', which captures all privately funded health-related products and services. This paper provides an insight into these highly complex transformation processes using three Bavarian health resorts and spas (Bad Birnbach, Bad Füssing and Bad Griesbach) as case examples. Semi-structured interviews with experts from the three destinations offer insight into the structural transition towards the second health care market, including its manifold challenges and opportunities in an emerging health-leisure nexus. [ABSTRACT FROM AUTHOR]

While Electronic Medical Records (EMRs) are an important mechanism used to document patient information and service provision, most interfaces prioritize collection of information required for medical billing purposes, rather than complexities of behavioral and social service needs. An emphasis on encounter data renders it challenging for social workers (SWs) to communicate statistically compelling explanations of contributions to team-based care and overall value to the health system. This paper reports outcomes of feasibility, acceptability, and appropriateness of integrating a validated psychosocial acuity metric into standardized social work (SW) documentation at a large, pediatric quaternary hospital in the northeastern United States. Approximately 20% (N = 42) of departmental SWs participated in an open pilot trial wherein participants were first trained in scale administration, utilized it for a circumscribed period following training, and evaluated implementation outcomes. Across five unique practice settings, results showed that the metric was feasible, acceptable and appropriate for use; 78% of participants were in favor of integrating it into the EMR interface as a required component of SW documentation. Assessing psychosocial acuity in every documented patient encounter facilitates intermittent review of psychosocial acuity at individual, setting, and programmatic levels and opportunities to evaluate how SW interventions address psychosocial acuity. [ABSTRACT FROM AUTHOR]

National responses to COVID-19 depend in part on national health care financing arrangements. Yet the pandemic itself has not only strained system capacity, it has – through subsequent economic shocks – strained revenue sources that prop up these arrangements. In federal countries, fiscal pressures are particularly pronounced. As this paper argues, however, federal health financing regimes differ in ways that are shaping the agenda for post-pandemic reforms. The analysis, which focuses on health care financing in three federal countries (Canada, the United States, and Mexico), explores the current and potential future impact of COVID-19 on existing policy legacies. [ABSTRACT FROM AUTHOR]

Health Lean Management (HLM) is usually implemented to enhance the operational performance in health care; nevertheless, scant attention is devoted to visual control and daily accountability processes. This paper aims at investigating how to adopt a visual management system to: plan and control patient journey in health care operations and perform a continuous improvement process. Conducting in-depth interviews and observations, participating in meetings and collecting documentation, the patient journey board and daily briefings of an Intensive Care Unit were studied and improved. In the patient journey board, the Plan, Do and Check phases were reported, distinguishing between actual and planned actions for the patient care. The daily meetings were organised and a continuous improvement board was also developed to solve specific issues (Act phase), by creating ad-hoc teams, involving the staff and reporting transparently on the board. Operational and sociotechnical performance, before and after the adoption of HLM, were assessed demonstrating the effectiveness and efficiency of visual management tools. [ABSTRACT FROM AUTHOR]

The 2010 Affordable Care Act (ACA) increased healthcare access for many Americans. But, its exclusion of most noncitizens and imperfect state-level implementation stratified coverage by documentation status, place, income level, race, and ethnicity across the U.S.A. Drawing from the sociological literature on boundaries, this paper argues that these demographic boundaries facilitate de jure and de facto stratification for immigrants and low-income Americans of various ethnoracial backgrounds. Using existing survey research regarding national ACA implementation and a qualitative study of ACA implementation in Boston, MA, this paper shows how such stratification may worsen existing disparities in healthcare coverage and access among the U.S. population. Implications regarding President Donald Trump and conservative lawmakers’ plans to repeal the ACA are also discussed. The paper contributes to researchers’ understanding of how public policies produce boundaries by place, documentation status, race, ethnicity, and income that facilitate inequality. [ABSTRACT FROM AUTHOR]

The aim of this paper is to demonstrate that the large audience ofFormula AS– mostly due to its comprehensive health column making available cheap and feasible remedies which allow readers to avoid expensive hospital treatments – reflects increasing social and economic vulnerability for the majority of people as a result of the destruction of industries and the privatization of health care. Written from the view of social philosophy, the paper highlights the striking role of media messages in this process. [ABSTRACT FROM AUTHOR]

This paper analyzes U.S. budget debates in the context of the G-20's turn toward austerity at the 2010 Toronto Summit. It begins by looking at claims by Reinhart and Rogoff and the International Monetary Fund that rising ratios of government debt/gross domestic product pose serious threats to economic growth. Then the paper considers Alesina and Ardagna's contention that deep cuts in deficits somehow stimulate economies. The paper shows that none of these arguments is empirically well founded, especially for major reserve currency countries like the United States, which cannot depreciate without crushing the rest of the world.The paper analyzes competing accounts of how to measure the deficit over time and draw special attention to the Congressional Budget Office's unheralded acknowledgment in August 2010 that financial assets held by the government should be netted out of U.S. debt calculations. The paper argues that not entitlement spending or Social Security but the excessive costs of oligopoly in health care, defense spending, and another possible financial crisis are the major threats to the budgetary position. In an era of unbridled money politics, concentrated interests in the military, financial, and medical industries pose much more significant dangers to U.S. public finances than broad-based popular programs like Social Security, which is itself in good shape for as many years as one can make credible forecasts.The paper compares several different simulations and concludes that the risk to U.S. public finances, as measured by the debt/GDP ratio in 2020, is much greater on a trajectory of austerity than from any risks incurred by the very low public cost of borrowing to spur investment in infrastructure, education, and science that would generate large social and private gains in productivity. [ABSTRACT FROM AUTHOR]

Despite the apparently unrealistic assumption of infinite resources, infinite-server queueing models have played a central role in the development of queueing theory and its applications. Healthcare modelling applications have certainly benefited from these models, where arguably their greatest importance has been to provide the basis for the analysis of "offered load" in systems with single or multiple nodes with multiple servers and time-varying arrivals. In this paper, we provide a review of major healthcare applications to date, identifying and consolidating the underpinning theoretical results and commenting on the nature of the applications. We conclude by identifying potential further healthcare applications, their relationships to existing theory and methods, and the need for new theory and methods, including the use of infinite-server models alongside other modelling methodologies. [ABSTRACT FROM AUTHOR]