Legitimacy and Effectiveness of a Grassroots Truth and Reconciliation Commission

Williams describes the Truth and Reconciliation Commission (TRC) process that was put into place in Greensboro NC. That process was set up to address community hostilities that had been festering for more than twenty years, since the 1979 killings of black protesters by Ku Klux Klansmen and American Nazis. In that case a grassroots-initiated TRC was formed to address the community problems, but it was not backed by the local government and it lacked the ability to grant amnesty or to subpoena witnesses. Community members had very different views regarding the necessity and likely helpfulness of the TRC. She concludes that in that case, in which local community leaders did not play a central supporting and empowering role for the TRC process, truth was enhanced but reconciliation was not furthered. Without local government buy-in, institutional reform was not taken seriously and trust between racial groups was not enhanced

Digital Pathology in the Clinic: Training, Validation and Patient Safety

Digital pathology is a technology with the potential to transform the way in which histopathological diagnoses are made and cancer diagnostic services are delivered. Despite this, clinical deployment of digital slides has lagged behind research and educational uses. This thesis describes some of the key barriers to widespread clinical adoption, which largely relate to a lack of guidance and information for pathologists regarding validation, training and patient safety. The evidence base for patient safety was analysed in a novel way to provide the basis for a validation and training protocol which was trialled in real world clinical settings, and guidance documents were developed and disseminated to the clinical pathology community to help with the transition from glass slide to digital slide reporting. In Chapter 1, background information and an overview of the published literature regarding clinical use of digital pathology is provided. In the second chapter, the results of a national survey on access to and usage of digital pathology hardware, in addition to attitudes to digital pathology, is presented. One significant barrier preventing digital pathology adoption has been a lack of widespread acceptance of digital slides as a safe alternative to conventional glass slides. Historically, validation literature investigating the safety of digital pathology as an alternative to conventional light microscopy has focussed on concordance metrics of glass and digital diagnoses, when arguably, it is appreciation of discordant cases that provides the clinical pathologist with the best opportunity to evaluate the scope of safe digital practice in their specialty. Chapter 3 describes a novel study to analyse diagnostic accuracy of whole slide imaging and identify key training and educational targets for novice digital pathologists. Chapter 4 presents the validation and training protocol developed by the author for Leeds Teaching Hospitals NHS Trust, which was subsequently adopted by the Royal College of Pathologists as an example of best practise in digital pathology implementation.1 Chapter 5 describes the deployment of this protocol to train and validate the primary digital diagnosis of cohorts of breast and neuro- pathologists. Chapter 6 introduces modifications of the protocol for use for more niche reporting scenarios: frozen section diagnosis and immunohistochemistry assessment. Chapter 7 responds to concerns in the pathology community regarding accreditation of digital services, and the use of WSI for primary assessment of screening programme specimens. The body of work presented in this thesis has generated multiple peer reviewed publications which have influenced national and international digital pathology guidance. In this time period, enormous progress has been made in converting digital pathology from a niche technology for the early adopter to a mainstream topic at clinical digital pathology conferences, and the number of deployments and planned deployments in the National Health Service and beyond has risen dramatically. The use of digital slides in routine clinical practice represents a major departure from conventional light microscopy working practices, and the author hopes this work will help the pathology community maintain diagnostic quality in a time of change

The Efficient-Market Hypothesis During a Recession

The phrase, A Random Walk Down Wall Street may make a portfolio manager shudder. I first learned about this theory while reading a book of the same name by Burton G. Malkiel. I saw the last four years crashing down around me as I read about the competition I would be facing upon graduation–a blindfolded chimpanzee. The random walk theorizes that the stock market is so efficient that a blindfolded chimpanzee can throw darts at the Wall Street Journal to select a portfolio of stocks that will perform equally as well as those managed by the experts. Unfortunately for the experts, this theory has held up surprisingly well for over thirty years. The unmanaged S&P 500-Stock Index has produced a greater return than more than two-thirds of portfolios managed by professional portfolio managers. Still, studies have indicated that the market might not be as efficient as the chimpanzee would hope (Malkiel, 1999, p. 15)

Igniting an Interoperable Healthcare System: HCI|DC 2014 Healthcare Innovation day

Interoperability -- the ability of systems to exchange information and to use the information that has been exchanged -- can help solve the healthcare crisis. The West Health Institute's HCI-DC 2014, co-hosted by ONC, brought together experts from across the healthcare community to consider how interoperability can cut costs, improve efficiency, reduce errors, and improve health. Interoperability across systems and care settings can empower patients, help doctors make better decisions, and allowing all healthcare providers to spend more time with patients. It can accelerate innovation and free up technology resources in hospitals so that they can focus on improving care in the community.It is by implementing standards-based technology that we can achieve interoperability between systems. Standards can help by moving us away from proprietary solutions and toward open source solutions. Commonly adopted standards will eliminate the custom interfaces required today, lessening associated costs, risks and time. Interoperability supported by standards-based exchange and semantics will help us finally harness the power of information technologies to improve healthcare.The experts at HCI-DC 2014 considered what we must do to tap into the information technology revolution that has transformed other industries to solve some of healthcare's thorniest problems. Their deliberations have been consolidated into the Call to Action offered in this document. Their key message: All of us must work together now to ignite an interoperable system. It is a burning issue. Our patients are waiting

Barriers and solutions to addressing tobacco dependence in addiction treatment programs.

Despite the high prevalence of tobacco use among people with substance use disorders, tobacco dependence is often overlooked in addiction treatment programs. Several studies and a meta-analytic review have concluded that patients who receive tobacco dependence treatment during addiction treatment have better overall substance abuse treatment outcomes compared with those who do not. Barriers that contribute to the lack of attention given to this important problem include staff attitudes about and use of tobacco, lack of adequate staff training to address tobacco use, unfounded fears among treatment staff and administration regarding tobacco policies, and limited tobacco dependence treatment resources. Specific clinical-, program-, and system-level changes are recommended to fully address the problem of tobacco use among alcohol and other drug abuse patients