The determinants of individual health care expenditures in prison: evidence from Switzerland.

Prison health systems are subject to increasing pressures given the specific health needs of a growing and aging prison population. Identifying the drivers of medical spending among incarcerated individuals is therefore key for health care governance in prisons. This study assesses the determinants of individual health care expenditures within the prisons of the canton of Vaud, a large region of Switzerland. We use a unique dataset linking demographic and prison stay characteristics as well as objective measures of morbidity to detailed medical invoice data. We adopt a multivariate regression approach to model total, somatic and psychiatric outpatient health care expenditures. We find that chronic infectious, musculoskeletal and skin diseases are strong predictors of total and somatic costs. Schizophrenia, neurotic and personality disorders as well as the abuse of illicit drugs and pharmaceuticals drive total and psychiatric costs. Furthermore, cumulating psychiatric and somatic comorbidities has an incremental effect on costs. By identifying the characteristics associated with health care expenditures in prison, this study constitutes a key step towards a more efficient use of medical resources in prison

Palliative care initiation in pediatric oncology patients: A systematic review

Palliative care (PC) aims to improve quality of life for patients and their families. The World Health Organization and American Academy of Pediatrics recommend that PC starts at diagnosis for children with cancer. This systematic review describes studies that reported PC timing in the pediatric oncology population. The following databases were searched: PubMed, Web of Science, CINAHL, and PsycInfo databases. Studies that reported time of PC initiation were independently screened and reviewed by 2 researchers. Studies describing pilot initiatives, published prior to 1998, not written in English, or providing no empirical time information on PC were excluded. Extracted data included sample characteristics and timing of PC discussion and initiation. Of 1120 identified citations, 16 articles met the inclusion criteria and comprised the study cohort. Overall, 54.5% of pediatric oncology patients received any palliative service prior to death. Data revealed PC discussion does not occur until late in the illness trajectory, and PC does not begin until close to time of death. Despite efforts to spur earlier initiation, many pediatric oncology patients do not receive any palliative care service, and those who do, predominantly receive it near the time of death. Delays occur both at first PC discussion and at PC initiation. Efforts for early PC integration must recognize the complex determinants of PC utilization across the illness timeline

Exploring differences in healthcare utilization of prisoners in the Canton of Vaud, Switzerland.

Prison healthcare is an important public health concern given the increasing healthcare needs of a growing and aging prison population, which accumulates vulnerability factors and suffers from higher disease prevalence than the general population. This study identifies the key factors associated with outpatient general practitioner (GP), nursing or psychiatric healthcare utilization (HCU) within prisons. Cross-sectional data systematically collected by the prison medical staff were obtained for a sample of 1664 adult prisoners of the Canton of Vaud, Switzerland, for the year 2011. They contain detailed information on demographics (predisposing factors), diagnosed chronic somatic and psychiatric disorders (needs factors), as well as prison stay characteristics (contextual factors). For GP, nurse and psychiatric care, two-part regressions are used to model separately the probability and the volume of HCU. Predisposing factors are generally not associated with the probability to use healthcare services after controlling for needs factors. However, female inmates use higher volumes of care, and the volume of GP consultations increases with age. Chronic somatic and psychiatric conditions are the most important predictors of the probability of HCU, but associations with volumes differ in their magnitude and significance across disease groups. Infectious, musculoskeletal, nervous and circulatory diseases actively mobilize GP and nursing staff. Schizophrenia, illicit drug and pharmaceuticals abuse are strongly positively associated with psychiatric and nurse HCU. The occupancy rate displays positive associations among contextual factors. Prison healthcare systems face increasingly complex organizational, budgetary and ethical challenges. This study provides relevant insights into the HCU patterns of a marginalized and understudied population

Research Ethics in the European Influenzanet Consortium: Scoping Review.

Influenzanet was launched in several European countries to monitor influenza-like illness during flu seasons with the help of volunteering participants and Web-based technologies. As in the case of developing fields, ethical approaches are not well developed in the collection, processing, and analysis of participants' information. Existing controversies and varying national ethical regulations can, thus, hamper efficient cross-border research collaboration to the detriment of quality disease surveillance. This scoping review characterizes current practices on how ethical, legal, and social issues (ELSIs) pertinent to research ethics are handled by different Influenzanet country groups to analyze similarities and identify the need for further harmonization of ethical approaches. A literature search was carried out on PubMed, Web of Science, Global Digital Library on Ethics, and Bioethics Literature Database to identify ELSIs for Influenzanet country platforms. Only English-language papers were included with publication dates from 2003 to 2017. Publications were screened for the application of bioethics principles in the implementation of country platforms. Additional publications gathered from the Influenzanet Consortium website, reference screening, and conference proceeding were screened for ELSIs. We gathered 96 papers from our search methodology. In total, 28 papers that mentioned ELSIs were identified and included in this study. The Research Ethics Committee (REC) approvals were sought for recruiting participants and collecting their data in 8 of 11 country platforms and informed e-consent was sought from participants in 9 of 11 country platforms. Furthermore, personal data protection was ensured throughout the Consortium using data anonymization before processing and analysis and using aggregated data. Epidemics forecasting activities, such as Influenzanet, are beneficial; however, its benefits could be further increased through the harmonization of data gathering and ethical requirements. This objective is achievable by the Consortium. More transparency should be promoted concerning REC-approved research for Influenzanet-like systems. The validity of informed e-consent could also be increased through the provision of a user friendly and standard information sheet across the Consortium where participants agree to its terms, conditions, and privacy policies before being able to fill in the questionnaire. This will help to build trust in the general public while preventing any decline in participation

Static Test on Full Scale Rammed Earth Building with Mesh-Wrap Retrofitting Strategy

This paper reports the experimental campaign for static tests performed on unreinforced (URE) and mesh retrofitted (RRE) full scale rammed earth building. Amongst varying building patterns of traditional rammed earth houses found in Bhutan, a two-storied building with a full solid wall (small openings) on the first floor and larger opening in the front facade of the second floor was chosen. The proposed mesh–wrap retrofitting of the walls involved the use of standard mild steel welded mesh as the main mesh, M–Mesh (Ø 1.8 mm and 34 mm c/c spacing) and light and galvanized welded mesh as a lapping mesh, L–Mesh (Ø 1.45 mm and 28 mm c/c spacing) provided at the corners and along the height of the walls. The static test loading protocol involved the displacement controlled loading with drift-control over the building. Cracks and damage observations were made at the storey drift ratios of: 1/2000, 1/1000, 1/750, 1/500 for URE building. The same URE building was retrofitted afterward and retested as RRE to storey drift ratios of: 1/2000, 1/1000, 1/750, 1/500, 1/250, 1/150, 1/100 and 1/75. The mesh retrofitting is found effective in both damage control as well as strength enhancement over the unreinforced one. The URE specimen showed a clear opening of shear and vertical cracks in the in-plane loaded walls near the openings and Jugshing holes. For the RRE specimen, cracks dispersed over a large region of the in–plane loaded walls. No delamination of mesh–wrap was observed, showing the effectiveness of the proposed technique. The RRE specimen showed enhancement in base shear by 2.5 times, ductility 2.3 times, and energy absorption 12 times the URE counterpart

Bhutan: educational challenges in the land of the Thunder Dragon

The Himalayan Kingdom of Bhutan, where images of magical splendor obscure its challenges, provides a viewpoint from which to understand the contradictions that emerging economies face as they move towards mass education. Isolated from the outside world in every sense except for the mythologies that surround it, Bhutan is attempting to move from a basic agrarian societal framework as found in the feudal 1800s into the whirl of a technologically savvy twenty-first century. The demands for such a transition require educators and politicians at all levels to rethink the role of schooling and what it means to be educated in this country at this point in time. To provide guidance, the government set up a special task force, the Royal Education Council, to devise a curriculum and pedagogy that would equip young people with the skills to move into the future without forsaking their past. This ethnographic piece of research explores the challenges faced by teachers and principals in nine designated Beacon schools as they grapple within a historical context which views teachers as labourers, working under difficult conditions with minimal support. The work ends with the question of whether mass education might in fact move this country away from the traditional values that are perceived as making Bhutan special, if not unique. © 2013 Copyright Taylor and Francis Group, LLC

Indigenous Mountain People’s Risk Perception to Environmental Hazards in Border Conflict Areas

This study aims to understand community risk perception to environmental hazards in a border conflict zone context in high-mountain areas. Participatory rural appraisal (PRA) tools were applied by the social science team. The results were validated with a hazard map prepared by a separate team comprised of geologists. Turtuk, the northernmost village in Ladakh, India located near the line of control with Pakistan was undertaken as a case study. Turtuk represents a high mountain indigenous rural community which has experienced several major disasters (flash flooding and landslides in 2010, 2014, and 2015) and territorial conflicts (wars in 1971 and 1999 with Pakistan) in recent times. The villagers were able to identify various environmental hazards and associated risk zones through participatory timeline, hazard and dream mapping exercises. The PRA maps matched the geological hazard map of Turtuk, demonstrating that community people are highly aware of surrounding hazards regardless of differences in age, sex, education, occupation, and religion. They apply indigenous knowledge to deal with the adverse climate and calamities. The technique, of analysing community vulnerability in the context of conflict and disasters by applying qualitative PRA tools and validating the mapping results, as piloted in this study is novel and replicable in similar settings

Participatory Disease Surveillance Systems: Ethical Framework.

Advances in information technology are changing public health at an unprecedented rate. Participatory surveillance systems are contributing to public health by actively engaging digital (eg, Web-based) communities of volunteer citizens to report symptoms and other pertinent information on public health threats and also by empowering individuals to promptly respond to them. However, this digital model raises ethical issues on top of those inherent in traditional forms of public health surveillance. Research ethics are undergoing significant changes in the digital era where not only participants' physical and psychological well-being but also the protection of their sensitive data have to be considered. In this paper, the digital platform of Influenzanet is used as a case study to illustrate those ethical challenges posed to participatory surveillance systems using digital platforms and mobile apps. These ethical challenges include the implementation of electronic consent, the protection of participants' privacy, the promotion of justice, and the need for interdisciplinary capacity building of research ethics committees. On the basis of our analysis, we propose a framework to regulate and strengthen ethical approaches in the field of digital public health surveillance

Carbon neutral policy in action: the case of Bhutan

Climate policy across the world is proceeding at a highly variable pace, with some places very committed to decarbonizing their economies and others just beginning. Emerging nations are generally just starting along this journey. However, among the few nation states that have pledged to achieve carbon neutrality, is Bhutan, a least developed country. Carbon neutrality is an ambitious climate policy that is increasingly being recognized as necessary in order to stabilize global temperature rise at 1.5°C. However, Bhutan is likely to face significant challenges in maintaining this status as the country balances its desire to grow in economic opportunities (GDP) and in human happiness (GNH). Little research has been conducted inside the policy processes to better understand how Bhutan will maintain carbon neutrality. Through open-ended, semi-structured interviews with key stakeholders, this study provides an inside view on the current situation and future challenges that Bhutan may face, along with the complexities associated with implementing and maintaining an ambitious carbon neutral policy. The paper highlights Bhutan's story and how it could be useful for policy learning and knowledge sharing, especially in the context of emerging nations’ climate governance

Deformation analysis of a metropolis from C- to X-band PSI: proof-of-concept with Cosmo-Skymed over Rome, Italy

Stability of monuments and subsidence of residential quarters in Rome (Italy) are depicted based on geospatial analysis of more than 310,000 Persistent Scatterers (PS) obtained from Stanford Method for Persistent Scatterers (StaMPS) processing of 32 COSMO-SkyMed 3m-resolution HH StripMap ascending mode scenes acquired between 21 March 2011 and 10 June 2013. COSMO-SkyMed PS densities and associated displacement velocities are compared with almost 20 years of historical C-band ERS- 1/2, ENVISAT and RADARSAT-1/2 imagery. Accounting for differences in image processing algorithms and satellite acquisition geometries, we assess the feasibility of ground motion monitoring in big cities and metropolitan areas by coupling newly acquired and legacy SAR in full time series. Limitations and operational benefits of the transition from medium resolution C-band to high resolution X-band PS data are discussed, alongside the potential impact on the management of expanding urban environments