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Objective:The PULsE-AI trial sought to determine the effectiveness of a screening strategy that included a machine learning risk prediction algorithm in conjunction with diagnostic testing for identification of undiagnosed atrial fibrillation (AF) in primary care. This study aimed to evaluate the cost-effectiveness of implementing the screening strategy in a real-world setting. Methods:Data from the PULsE-AI trial – a prospective, randomized, controlled trial conducted across six general practices in England from June 2019 to February 2021 – were used to inform a cost-effectiveness analysis that included a hybrid screening decision tree and Markov AF disease progression model. Model outcomes were reported at both individual- and population-level (estimated UK population ≥30 years of age at high-risk of undiagnosed AF) and included number of patients screened, number of AF cases identified, mean total and incremental costs (screening, events, treatment), quality-adjusted-life-years (QALYs), and incremental cost-effectiveness ratio (ICER). Results:The screening strategy was estimated to result in 45,493 new diagnoses of AF across the high-risk population in the UK (3.3 million), and an estimated additional 14,004 lifetime diagnoses compared with routine care only. Per-patient costs for high-risk individuals who underwent the screening strategy were estimated at £1,985 (vs £1,888 for individuals receiving routine care only). At a population-level, the screening strategy was associated with a cost increase of approximately £322 million and an increase of 81,000 QALYs. The screening strategy demonstrated cost-effectiveness versus routine care only at an accepted ICER threshold of £20,000 per QALY-gained, with an ICER of £3,994/QALY. Conclusions:Compared with routine care only, it is cost-effective to target individuals at high risk of undiagnosed AF, through an AF risk prediction algorithm, who should then undergo diagnostic testing. This AF risk prediction algorithm can reduce the number of patients needed to be screened to identify undiagnosed AF, thus alleviating primary care burden.

INTRODUCTION During the second wave of Covid-19 in January 2021 in Lesotho, MSF carried out an exploratory assessment at hospitals providing care for Covid-19 patients. We observed healthcare teams were understaffed and overworked, with an absence of nurse aides or patient care assistants to provide basic care (helping patients to eat and drink, dress, toilet, changing bed linen). Hence nurses and medical doctors would prioritise skilled tasks, such as medication administration, over more basic care, normally performed by nurse aides. Such basic care is essential to patient experience. quality of care, and dignity. As part of Covid-19 care, training nurse aides on proning or repositioning oxygen masks of hypoxic patients could potentially reduce morbidity and mortality. To date, MSF has never implemented formal training for nurse aides, relying instead on on-the-job training, with significant variations in the delivery of training and what tasks are fulfilled. METHODS A pilot programme was implemented in Lesotho during February and March 2021. 16 nurse aides were trained and supervised by MSF. Further programmes were initiated during the third wave of Covid-19 in Zimbabwe (two hospitals) and South Africa (three hospitals) in 2021. Specific training materials and implementation tools were developed to support deployment of this innovative strategy. As part of programme monitoring, nurse aide and staff surveys covering satisfaction with the programme impact, the experience of staff and patients, and training received were carried out at the end of the interventions. At two sites, nurse aides and their supervisor recorded data for a sample of their daily tasks and the time spent performing each task. ETHICS This innovation project does involve human participants and their data. Permission was granted by the Medical Director of MSF Operational Centre Brussels. RESULTS 100% of medical staff surveyed (nurses, doctors, and nurse aides) from all six hospitals reported satisfaction with this programme for improving the provision of basic patient care during the waves of Covid-19. Qualitative data highlighted the programme helped support basic patient care, to reduce workloads of nurses and doctors for these tasks, and to improve patient dignity. Nurse aides reported overall satisfaction with their training, especially for bedside and practical sessions. A hands-on nursing supervisor was reported as crucial for success. Showing potential for handover, the Ministry of Health continued employing nurse aides at one hospital in South Africa, and a partner non-governmental organisation took over the group trained in Lesotho. CONCLUSION These short programmes supported the surge workload of Covid-19 waves. While the role of nurse aides exists within MSF projects, scope exists to develop formal training packages covering essential patient care. Training can be adapted to extend such roles in the context of other outbreak scenarios, such as cholera or Ebola virus disease, and to support provision of holistic patient care. There is interest in repeating the programme in the southern Africa region, and to share the model as a strategy to support medical human resources. CONFLICTS OF INTEREST None declared.

The goal of this literature review based bachelor’s thesis is to offer a deeper understanding of the concept of freedom in the educational context and the application of such idea in democratic schools. In order to conceptualize the idea of freedom in education, a philosophical approach is taken to introduce the topic. The study continues with discussion of the work of the main three authors that are object of this thesis: Rebeca Wild, A.S. Neill and Daniel Greenberg, who use the concept of freedom in the educational context in their work and their schools. Elements such as respect, autonomy, trust, existence of limits and democracy are common values in the understanding of freedom by these authors and are important components of their educational philosophies. After outlining the understanding of the concept of freedom in the educational context, the focus turns to defining democratic education and introducing the concept of democratic schools as educational initiatives that follow the principles of democratic education. In addition to having freedom, equality and respect as a driving force, democratic way of managing the school and self-directed learning are core values to this way of understanding education. A deeper understanding is offered by showing examples of real-life practices where the idea of freedom is applied in these schools. After examining of some of the characteristics of these schools, certain gaps are found and a main critique is raised. In this thesis I am proposing the use of the term freedom-based education as an alternative to the democratic education one. The reason behind this proposal is to open a discussion about the shape of the democratic model that is applied in this type of schools and which alternatives could be used. By proposing the term of freedom-based education I aim to collaborate on improving the concept of democratic education and making it more accessible to a greater number of people. Understanding the goal of this type of education as a transformative one makes it pose itself as an alternative to the mainstream educational model and offers a possible change in the educational paradigm.

Argues that changes in the industrial output of other nations, and the stridency of today's workers have made businessmen more aware of the need to find solutions to the problems facing them, and explores job enlargement, modified workweeks, and the psychology of responsiveness. (JM)

Einleitung: Die Ösophagektomie ist elementarer Bestandteil des multimodalen Therapiekonzeptes bei Patienten mit fortgeschrittenem Ösophaguskarzinom, ist aber mit einer signifikanten perioperativen Morbidität verbunden. Ziel dieser Studie ist die Herausarbeitung einer simplen Risikoskala[zum vollständigen Text gelangen Sie über die oben angegebene URL], 133. Kongress der Deutschen Gesellschaft für Chirurgie