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Chapter 6 analyzes racial inequity in health care assessments and treatment leading to further inequity in Social Security Act disability decision-making, by examining the practice by medical and health care professionals, including the Social Security Act’s internal and retained physicians, of “race-norming” or “race correction.” This involves the insertion of race into medical clinical-decision support tools and diagnostic algorithms that adjust or correct their outputs on the basis of a patient’s race or ethnicity predicated on fallacious principles of biological race. Race-normed or corrected outputs often understate the severity of Black and other minority patients’ conditions or require greater demonstration of illness to receive treatment for a range of severe and sometimes life-threatening conditions. As a result, they also inequitably, illegally, and unconstitutionally raise the bar on the demonstration of disabling impairment severity for Black claimants and other claimants of color subject to race-norming. This chapter ends with recommendations for eradicating race-norming in Social Security Act adjudication including strengthening a recent, albeit insufficient, 2022 internal Social Security Act guideline precluding use of a race-normed kidney function (eGFR) clinical-decision support-tool in disability adjudications and expanding that guideline to commonly race-normed tools in other areas, such as pulmonary function tests, and all other race-normed tools and algorithms.
Chapter 2 presents the theoretical approach of the book. Images are conceptualized as cultural artefacts that are both signs open for meaning making and tools open for social action. They are also dialogical and political artefacts that take part in knowledge production and circulation.
Assessing hospital preparedness for nuclear and radiological threats is one of the most effective methods for evaluating the condition of hospitals in relation to such incidents. This study aimed to review the tools used to assess hospital preparedness for nuclear and radiological threats and to analyze the strengths and weaknesses of these instruments.
Materials and Methods
In this systematic review, the full texts of 98 studies identified through database searches and 7 studies identified through manual searches were reviewed. Data were extracted from studies that addressed the measurement tools for assessing hospital preparedness for nuclear and radiological threats from 2000 to 2024, following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The content quality of the tools was evaluated based on the World Health Organization (WHO) preparedness criteria, and the psychometric properties of the tools were examined using the COSMIN (Consensus-based Standards for the selection of health Measurement Instruments) study criteria.
Results
Among the studies reviewed, only 21 met the inclusion criteria, within which 9 tools for assessing hospital preparedness were identified. Eight tools directly assessed vulnerability in terms of physical space, related equipment, and hospital personnel, while one tool used a different criterion as an indicator of hospital preparedness for nuclear and radiological threats. The findings showed that most of the tools focused solely on evaluating a hospital’s vulnerability in terms of physical space, equipment, and personnel, with insufficient attention given to other critical aspects such as protocols, triage, and other important issues.
Conclusion
Given the limitations of existing tools in terms of psychometric evaluation, the lack of theoretical models, the reliance on empirical findings for tool design, and considering the critical importance of measuring and assessing hospital preparedness for nuclear and radiological threats, there is a pressing need in the health sector for the development of scientific tools based on the experiences of process owners and hospital specialists. These tools should adhere to rigorous processes of instrument development and validation.
MTVE is an open-source software tool (citeware) that can be applied in laboratory and online experiments to implement video communication. The tool enables researchers to gather video data from these experiments in a way that these videos can be later used for automatic analysis through machine learning techniques. The browser-based tool comes with an easy user interface and can be easily integrated into z-Tree, oTree (and other experimental or survey tools). It provides the experimenters control over several communication parameters (e.g., number of participants, resolution), produces high-quality video data, and circumvents the Cocktail Party Problem (i.e., the problem of separating speakers solely based on audio input) by producing separate files. Using some of the recommended Voice-to-Text AI, the experimenters can transcribe individual files. MTVE can merge these individual transcriptions into one conversation.
Local governments have an important role to play in creating healthy, equitable and environmentally sustainable food systems. This study aimed to develop and pilot a tool and process for local governments in Australia to benchmark their policies for creating healthy, equitable and environmentally sustainable food systems.
Design:
The Healthy Food Environment Policy Index (Food-EPI), developed in 2013 for national governments, was tailored to develop the Local Food Systems Policy Index (Local Food-EPI+) tool for local governments. To incorporate environmental sustainability and the local government context, this process involved a literature review and collaboration with an international and domestic expert advisory committee (n 35) and local government officials.
Setting:
Local governments.
Results:
The tool consists of sixty-one indicators across ten food policy domains (weighted based on relative importance): leadership; governance; funding and resources; monitoring and intelligence; food production and supply chain; food promotion; food provision and retail in public facilities and spaces; supermarkets and food sources in the community; food waste reuse, redistribution and reduction; and support for communities. Pilot implementation of the tool in one local government demonstrated that the assessment process was feasible and likely to be helpful in guiding policy implementation.
Conclusion:
The Local Food-EPI+ tool and assessment process offer a comprehensive mechanism to assist local governments in benchmarking their actions to improve the healthiness, equity and environmental sustainability of food systems and prioritise action areas. Broad use of this tool will identify and promote leading practices, increase accountability for action and build capacity and collaborations.
Are robots a tool mindlessly following their programming, or an actor with agency? Are robots inevitable to the extent that we should just accept them, or does regulation have a role to play? And how do we understand our understanding, that is, how do we arrive at concepts to understand human–robot interaction that adequately incorporate different disciplines? These questions suggest that to understand robots and our place in the legal world with them, we must consider subject matter beyond substantive law and procedure. The narrative chapters in this Part of the book provide additional ways to identify the questions raised by human–robot interaction and propose how to begin answering them.
The present study aimed to describe the experience of district nurses (DNs) in using a clinical decision support system (CDSS) and the safe medication assessment (SMA) tool during patient visits to elderly care units at primary health care centres.
Background:
In Swedish primary health care, general practitioners (GPs) prescribe and have the responsibility to regularly review older adults’ medications, while DN (nurses specialised in primary health care) play an important role in assessing older adults’ ability to manage their medications, detecting potential drug-related problems and communicating with patients and GPs about such problems. In a previous feasibility study, we found that DNs who use a combination of a CDSS and the SMA tool identified numerous potentially harmful or dangerous factors and took a number of nursing care actions to improve the safety and quality of patients’ medication use. In telephone interviews, patients indicated that they were positive towards the assessment and interventions.
Methods:
Individual interviews with seven DNs who worked at six different primary health care centres in Region Stockholm were carried out in 2018. In 2019, an additional group interview was conducted with two of the seven DNs so they could discuss and comment on preliminary findings. Qualitative content analysis was used to analyse the interview transcripts.
Findings: Using the tools, the DNs could have a natural conversation about medication use with older adults. They could get a clear picture of the older adults’ medication use and thus obtain information that could facilitate collaboration with GPs about this important component of health care for older adults. However, for the tools to be used in clinical practice, some barriers would have to be overcome, such as the time-consuming nature of using the tools and the lack of established routines for interprofessional collaboration regarding medication discussions.
In 2009, the Robert Koch Institute (RKI) and the 16 German federal state public health authorities (PHAs) established a weekly epidemiological teleconference (EpiLag) to discuss infectious disease (ID) events and foster horizontal and vertical information exchange. We present the procedure, discussed ID topics and evaluation results of EpiLag after 10 years. We analysed attendance, duration of EpiLag and the frequency of reported events. Participants (RKI and state PHA) were surveyed regarding their satisfaction with logistics, contents and usefulness of EpiLag (Likert scales). Between 2009 and 2018, RKI hosted 484 EpiLag conferences with a mean duration of 25 min (range: 4–60) and high participation (range: 9–16; mean: 15 PHAs). Overall, 2975 ID events (39% international, 9% national and 52% subnational) were presented (mean: 6.1 per EpiLag), most frequently on measles (18%), salmonellosis (8%) and influenza (5%). All responding participants (14/16 PHAs and 9/9 at RKI) were satisfied with the EpiLag's organization and minutes and deemed EpiLag useful for an overview and information distribution on ID events relevant to Germany. EpiLag is time efficient, easily applicable and useful for a low-threshold event communication. It supports PHAs in crises and strengthens the network of surveillance stakeholders. We recommend its implementation to other countries or sectors.
Culture allows humans to adapt to a diversity of contexts. Participatory experience in technical activities and activity with artefacts provide the basis for learning traditional technical skills. Some populations of non-human animals use tools. The ways in which artefacts influence the development of a traditional skill in non-human species can provide insight into essential supports for technical traditions in humans and shared learning processes across species. In wild bearded capuchins, nut cracking leaves edible pieces of nuts, nut shells and stones used as hammers at anvil sites. We addressed how mastery of cracking nuts by young monkeys is associated with interactions with these objects. We studied monkeys’ reuse of nuts, hammers and anvils and the outcome of attempts to crack nuts, and from these data derived their behavioural variability and proficiency in nut cracking. Behavioural variability was the most robust predictor of whether a monkey collects pieces of nuts cracked by others or reuses stones and nuts, and was a stronger predictor of proficiency than age. Young monkeys were increasingly likely to reuse the stone used by another after the other monkey had left the anvil as they increasingly focused their behaviour on actions relevant to cracking nuts.
Recent international communicable disease crises have highlighted the need for countries to assure their preparedness to respond effectively to public health emergencies. The objective of this study was to critically review existing tools to support a country’s assessment of its health emergency preparedness. We developed a framework to analyze the expected effectiveness and utility of these tools. Through mixed search strategies, we identified 12 tools with relevance to public health emergencies. There was considerable consensus concerning the critical preparedness system elements to be assessed, although their relative emphasis and means of assessment and measurement varied considerably. Several tools identified appeared to have reporting requirements as their primary aim, rather than primary utility for system self-assessment of the countries and states using the tool. Few tools attempted to give an account of their underlying evidence base. Only some tools were available in a user-friendly electronic modality or included quantitative measures to support the monitoring of system preparedness over time. We conclude there is still a need for improvement in tools available for assessment of country preparedness for public health emergencies, and for applied research to increase identification of system measures that are valid indicators of system response capability.
The purpose of this study was to identify the self-report physical activity (PA) tool best suited for assessment of PA in community-dwelling older adults with multiple chronic conditions (MCC). PA can positively influence physical and psychological health in this population. Although self-report PA tools exist, little is known about the psychometric properties and feasibility of using these tools in older adults with MCC. A systematic literature review from 2000 to 2018 was conducted of studies reporting on the psychometric properties and feasibility of 18 self-report PA tools for community-dwelling older adults (≥ 65 years) to determine the suitability of these tools for use in older adults with MCC. Based on an assessment of the available evidence for the psychometric properties and feasibility of 18 different self-report PA tools, the Physical Activity Assessment Scale for the Elderly (PASE) is recommended as the best-suited self-report PA tool for older adults with MCC.
Mass-casualty incidents involving radiation are rare but potentially devastating events. Even incidents with a small number of casualties are challenging due to the specific nature of the information and decisions required, and the rate of decay of knowledge about radiation. A package of specific forms and guidelines could assist emergency department (ED) physicians with this process.
Methods:
A seven-page tool was developed as part of a project (METER 2008) funded by the Canadian Chemical, Biological, Radiological, and Nuclear Research and Training Initiative (CRTI) to facilitate the ED management of radiation casualties. These forms cover triage, the history and physical examination, diagrams to mark areas of contamination, standing orders, and a means of estimating Acute Radiation Syndrome severity. The tool was piloted at a workshop in Quebec City in November 2007. Later, a questionnaire was distributed to participants to assess the usefulness. The tool will be further tested at other workshops across Canada during the winter.
Results:
Participants found the tool to be useful, Their comments and improvements will be presented.
Conclusions:
The tool demonstrated in this presentation can be used to assist ED staff with the triage and management of casualties with exposure to radiation.
The central objective of the present author's research is to develop a system supporting the design of a technological process (a computer-aided process planning system) that functions similarly to a human expert in the field in question. The use of neural networks makes the creation of such a system possible. The proposed method uses a system of three blocks of neural networks, and involves the creation of neural networks to be used for the selection of machines, tools, and machining parameters. These networks are built for each process operation separately; that is, a set of neural networks is created for each selection. For the construction of models, different types of neural networks (multilayer networks with error backpropagation, radial basis function, and Kohonen) with different structures were employed, and the networks that made the best selections were identified. A method was also developed for the elimination of defects occurring during the production process. When a defect comes to light, this method suggests changes to the technological process, thus improving the quality of that process. Guidelines for the elimination of defects are produced in the form of decision rules. Such a computer-aided process planning system will be especially useful for process engineers who do not yet have sufficient experience in the design of technological processes, or who have only recently joined a particular manufacturing enterprise and are not fully familiar with its machines and other means of production (tools and instrumentation). It should be emphasized that such a system performs an advisory role, and it is always the process engineer who makes the final decision. The neural network models were tested on real data from an enterprise. A computer-aided process planning system based on rules and neural network models enables the intelligent design of technological processes.
In events such as earthquakes or terrorist attacks, hospitals may be victims of disasters. They may need to transfer patients to outside facilities rather than continue to provide on-site care. Following the Northridge earthquake, eight hospitals in the damaged area were the foci of a United States National Science Foundation study that examined the status of the hospitals' pre-event planning, post-event evacuationdecision-making, and internal and external evacuation processes. Building on this experience, this paper offers a standardized data collection tool, which will enable researchers to record hospital evacuation information in a systematic manner so that comparable data can be accumulated, evacuation research methods can be improved, and consensus on methods can be reached. The study's principal subjects include: (1) hospital demographics; (2) description of existing disaster response plans; (3) an event's impacts on hospital operations; (4) decision-making and incident command; (5) movement of patients within the facility; (6) movement of patients to off-site institutions; and (7) hospital recovery.