Framing local conflict and justice in Bangladesh

The institutional landscape of local dispute resolution in Bangladesh is rich: it includes the traditional process of shalish, longstanding and impressive civil society efforts to improve on shalish, and a somewhat less-explored provision for gram adalat or village courts. Based on a nationally representative survey, qualitative evidence from focus groups, and a telephone survey of 40 Union Parishad chairpersons (a little less than 1 percent of the total Union Parishads), it provides both an empirical mapping of local conflict and justice and pointers to possible policy reforms. It suggests a number of opportunities for strengthening local justice and argues that the village courts may pose a useful bridge between Bangladesh's informal and formal justice institutions.Gender and Law,Judicial System Reform,Legal Institutions of the Market Economy,Legal Products,Public Sector Corruption&Anticorruption Measures

Design and implementation of an affordable, public sector electronic medical record in rural Nepal

IntroductionGlobally, electronic medical records are central to the infrastructure of modern healthcare systems. Yet the vast majority of electronic medical records have been designed for resource-rich environments and are not feasible in settings of poverty. Here we describe the design and implementation of an electronic medical record at a public sector district hospital in rural Nepal, and its subsequent expansion to an additional public sector facility.DevelopmentThe electronic medical record was designed to solve for the following elements of public sector healthcare delivery: 1) integration of the systems across inpatient, surgical, outpatient, emergency, laboratory, radiology, and pharmacy sites of care; 2) effective data extraction for impact evaluation and government regulation; 3) optimization for longitudinal care provision and patient tracking; and 4) effectiveness for quality improvement initiatives.ApplicationFor these purposes, we adapted Bahmni, a product built with open-source components for patient tracking, clinical protocols, pharmacy, laboratory, imaging, financial management, and supply logistics. In close partnership with government officials, we deployed the system in February of 2015, added on additional functionality, and iteratively improved the system over the following year. This experience enabled us then to deploy the system at an additional district-level hospital in a different part of the country in under four weeks. We discuss the implementation challenges and the strategies we pursued to build an electronic medical record for the public sector in rural Nepal.DiscussionOver the course of 18 months, we were able to develop, deploy and iterate upon the electronic medical record, and then deploy the refined product at an additional facility within only four weeks. Our experience suggests the feasibility of an integrated electronic medical record for public sector care delivery even in settings of rural poverty

Power and rights in the community: paralegals as leaders in women's legal empowerment in Tanzania

What can an analysis of power in local communities contribute to debates on women’s legal empowerment and the role of paralegals in Africa? Drawing upon theories of power and rights, and research on legal empowerment in African plural legal systems, this article explores the challenges for paralegals in facilitating women’s access to justice in Tanzania, which gave statutory recognition to paralegals in the Legal Aid Act 2017. Land conflicts represent the single-biggest source of local legal disputes in Tanzania and are often embedded in gendered land tenure relations. This article argues that paralegals can be effective actors in women’s legal empowerment where they are able to work as leaders, negotiating power relations and resisting the forms of violence that women encounter as obstacles to justice. Paralegals’ authority will be realised when their role is situated within community leadership structures, confirming their authority while preserving their independence

Finishing the euchromatic sequence of the human genome

The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers ∼99% of the euchromatic genome and is accurate to an error rate of ∼1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead

Between Law and Society: Paralegals and the Provision of Justice Services in Sierra Leone and Worldwide

Efforts to advance justice and improve the rule of law can be divided into two categories. One set of efforts-by far the better funded and more established of the two-focuses on state institutions, on improving the effectiveness and fairness of the courts, the legislature, the police, the health and education systems, etc. A second set of efforts, sometimes termed legal empowerment, focuses on directly assisting ordinary people, especially the poor, who face justice problems. There are two primary reasons for complementing state-centered reforms with this second type of undertaking. First and most simply, institutional reform is slow and difficult, and there is a need to tend to those wounded by broken systems not yet fixed. Second-and this reason conceives of the poor as agents rather than as victims-lasting institutional change depends on a more empowered polity

Framing Local Conflict and Justice in Bangladesh

The institutional landscape of local dispute resolution in Bangladesh is rich: it includes the traditional process of shalish, longstanding and impressive civil society efforts to improve on shalish, and a somewhat less-explored provision for gram adalat or village courts. Based on a nationally representative survey, qualitative evidence from focus groups, and a telephone survey of 40 Union Parishad chairpersons (a little less than 1 percent of the total Union Parishads), it provides both an empirical mapping of local conflict and justice and pointers to possible policy reforms. It suggests a number of opportunities for strengthening local justice and argues that the village courts may pose a useful bridge between Bangladesh's informal and formal justice institutions

Federated Learning for the Internet-of-Medical-Things: A Survey

Recently, in healthcare organizations, real-time data have been collected from connected or implantable sensors, layered protocol stacks, lightweight communication frameworks, and end devices, named the Internet-of-Medical-Things (IoMT) ecosystems. IoMT is vital in driving healthcare analytics (HA) toward extracting meaningful data-driven insights. Recently, concerns have been raised over data sharing over IoMT, and stored electronic health records (EHRs) forms due to privacy regulations. Thus, with less data, the analytics model is deemed inaccurate. Thus, a transformative shift has started in HA from centralized learning paradigms towards distributed or edge-learning paradigms. In distributed learning, federated learning (FL) allows for training on local data without explicit data-sharing requirements. However, FL suffers from a high degree of statistical heterogeneity of learning models, level of data partitions, and fragmentation, which jeopardizes its accuracy during the learning and updating process. Recent surveys of FL in healthcare have yet to discuss the challenges of massive distributed datasets, sparsification, and scalability concerns. Because of this gap, the survey highlights the potential integration of FL in IoMT, the FL aggregation policies, reference architecture, and the use of distributed learning models to support FL in IoMT ecosystems. A case study of a trusted cross-cluster-based FL, named Cross-FL, is presented, highlighting the gradient aggregation policy over remotely connected and networked hospitals. Performance analysis is conducted regarding system latency, model accuracy, and the trust of consensus mechanism. The distributed FL outperforms the centralized FL approaches by a potential margin, which makes it viable for real-IoMT prototypes. As potential outcomes, the proposed survey addresses key solutions and the potential of FL in IoMT to support distributed networked healthcare organizations

Radiomics predicts clinical outcome in primary gastroesophageal junction adenocarcinoma treated by chemo/radiotherapy and surgery

Purpose: Radiomics has shown great promise to use quantifiable imaging characteristics to predict the behavior and prognosis of neoplasms. This is the first study to evaluate whether radiomic texture analysis can predict outcomes in gastroesophageal junction adenocarcinoma (GEJAC) treated with neoadjuvant chemoradiotherapy (CRT). Materials and Methods: Pretreatment contrast-enhanced CT images of 146 patients with stage II-III GEJAC were reviewed (2009–2011), and randomly split into training and validation groups at a 1:1 ratio stratified with baseline clinical characteristics. Whole-tumor texture was assessed using quantitative image features based on intensity, shape, and gray-level co-occurrence matrix. The relevant pretreatment texture features, in addition to the significant baseline clinical features to predict survival, were identified using multivariate Cox proportional hazard regression model with stepwise variable selection in the training sample and verified in the validation sample, to facilitate the proposal of a multi-point index for standard patient pre-treatment risk classification. Results: Of the factors identified in the training cohort independently associated with OS, only shape compactness (p = 0.04) and pathologic grade differentiation (PDG) (p = 0.02) were confirmed in the validation sample. Using both parameters, we created a 3-point risk classification index: low-risk (well-moderate PDG and high compactness), medium-risk (poor PDG or low compactness), and high-risk (poor PDG and low compactness). The risk index showed a strong negative association with postoperative pathologic complete response (pCR) (p = 0.04). Median OS for the high-, medium-, and low-risk groups were 23, 51, and ≥72 months, respectively (p < 0.01). Similar results were seen with progression-free survival (respective 5-year rates of 15%, 30%, and 63%). Conclusion: Radiomic texture analysis can be used to stratify patients with GEJAC receiving trimodality therapy based on prognosis. The risk scoring system based on shape compactness and PDG shows a great potential for pre-treatment risk classification to guide surgical resection in locally advanced disease. Though in need of greater validation, these hypothesis-generating data could provide a unique platform of personalized oncologic care. Keywords: Radiomics, Gastroesophageal junction adenocarcinoma, Survival, Pathologic complete response, Prognostic model, Texture analysis, Radiolog