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Objective: Urgent global action is required to combat climate change, with radiographers poised to play a significant role in reducing healthcare's environmental impact. This paper explores radiography-related activities and factors in resource-limited departments contributing to the carbon footprint and proposes strategies for mitigation. The rationale is to discuss the literature regarding these contributing factors and to raise awareness about how to promote sustainability activities in clinical radiography practice and education in resource-limited countries., Key Findings: The radiography-related activities and factors contributing to the carbon footprint in resource-limited countries include the use of old equipment and energy inefficiency, insufficient clean energy to power equipment, long-distance commuting for radiological examinations, high film usage and waste, inadequate training and research on sustainable practices, as well as limited policies to drive support for sustainability. Addressing these issues requires a multifaceted approach. Firstly, financial assistance and partnerships are needed to adopt eco-friendly technologies and clean energy sources to power equipment, thus tackling issues related to old equipment and energy inefficiency. Transitioning to digital radiography can mitigate the environmental impact of high film usage and waste, while collaboration between governments, healthcare organisations, and international stakeholders can improve access to radiological services, reducing long-distance commuting. Additionally, promoting education programmes and research efforts in sustainability will empower radiographers with the knowledge to practice sustainably, complemented by clear policies such as green imaging practices to guide and incentivise the adoption of sustainable practices. These integrated solutions can significantly reduce the carbon footprint of radiography activities in resource-limited settings while enhancing healthcare delivery., Conclusion: Radiography-related activities and factors in resource-limited departments contributing to the carbon footprint are multifaceted but can be addressed through concerted efforts., Implications for Practice: Addressing the challenges posed by old equipment, energy inefficiency, high film usage, and inadequate training through collaborative efforts and robust policy implementation is essential for promoting sustainable radiography practices in resource-limited countries. Radiographers in these countries need to be aware of these factors contributing to the carbon footprint and begin to work with the relevant stakeholders to mitigate them. Furthermore, there is a need for them to engage in education programmes and research efforts in sustainability to empower them with the right knowledge and understanding to practice sustainably., Competing Interests: Conflict of interest statement None., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Purpose: There are major gaps in our knowledge of hereditary ocular conditions in the Asia-Pacific population, which comprises approximately 60% of the world's population. Therefore, a concerted regional effort is urgently needed to close this critical knowledge gap and apply precision medicine technology to improve the quality of lives of these patients in the Asia-Pacific region., Design: Multi-national, multi-center collaborative network., Methods: The Research Standing Committee of the Asia-Pacific Academy of Ophthalmology and the Asia-Pacific Society of Eye Genetics fostered this research collaboration, which brings together renowned institutions and experts for inherited eye diseases in the Asia-Pacific region. The immediate priority of the network will be inherited retinal diseases (IRDs), where there is a lack of detailed characterization of these conditions and in the number of established registries., Results: The network comprises 55 members from 35 centers, spanning 12 countries and regions, including Australia, China, India, Indonesia, Japan, South Korea, Malaysia, Nepal, Philippines, Singapore, Taiwan, and Thailand. The steering committee comprises ophthalmologists with experience in consortia for eye diseases in the Asia-Pacific region, leading ophthalmologists and vision scientists in the field of IRDs internationally, and ophthalmic geneticists., Conclusions: The Asia Pacific Inherited Eye Disease (APIED) network aims to (1) improve genotyping capabilities and expertise to increase early and accurate genetic diagnosis of IRDs, (2) harmonise deep phenotyping practices and utilization of ontological terms, and (3) establish high-quality, multi-user, federated disease registries that will facilitate patient care, genetic counseling, and research of IRDs regionally and internationally., Competing Interests: Declaration of Competing Interest The authors have no conflicts of interest to disclose., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: The use of a standardized national chronic noncommunicable disease (CNCD) registry is of immense benefit in addressing the CNCD burden in Trinidad and Tobago (T&T). This study seeks to assess the outcomes of a paper-based CNCD registry implemented in the primary health-care centers in South Trinidad. Methods: At the South-West Regional Health Authority, a standardized paper-based registry was implemented in 2017, at the 33 public primary health-care clinics. Following this, a CNCD Registry Assessment Survey was administered cross-sectionally to 94 end-users to evaluate the implementation outcomes of the registry. The outcome domains – feasibility, penetration, acceptability, sustainability, fidelity, uptake, and costs were analyzed using summary statistics. Results: Fifty-five percent of end-users responded. Most responses came from the primary care physicians 1 (50.0%) of County Caroni. Most respondents were from County Caroni, 19 (36.5%) and St. Patrick, 19 (36.5%). Ninety-one percent of end-users thought that the CNCD registry was easily adopted. For 85.9% of end-users, the registry had fidelity (85.9%); 84.2% thought it was well accepted; feasible (82.7%); easily penetrated (82.7%), and appropriate (76.0%). Forty-two percent thought that the cost of implementation was high, while 30.8% were neutral. Seventy-one percent thought that the paper-based CNCD registry should be sustained, and 94.2% of end-users thought that an electronic CNCD registry should be implemented. Conclusion: It is possible and feasible to implement a standardized paper-based registry. Through this process, we were able to define the prevalence of five CNCDs and two risk factors of overweight/obesity and smoking for the chronic disease clinic population. Subsequently, we would like to implement a digitized CNCD registry.

Background and Objective: High-quality clinical practice guidelines (CPGs) are needed to guide practitioners, policy makers, and other stakeholders to provide optimal health care. This study aims to appraise the CPGs developed in the Philippines using the AGREE II instrument., Methods: Ninety-one CPGs were appraised independently by two health-care professionals. CPGs were considered acceptable if they garnered an overall mean score of at least 75.0% for all 6 domains and a domain score of at least 75.0% for rigor of development. A mean score of <75.0% on either of the criteria implied that the CPG needed revision., Results: Overall mean scores of the CPGs ranged from 8.4% to 79.2%, with a mean of 43.9% (standard deviation = 13.4%). In general, CPGs scored better for the domains of clarity of presentation, scope and purpose, and stakeholder involvement. Lowest scores were obtained for the domains of rigor of development, applicability, and editorial independence. Only 1 (1.1%) CPG qualified as acceptable., Conclusion: AGREE II is a practical and useful guide in appraising the quality of CPGs. Strengthening technical capacity in various medical fields is essential to improve the quality of CPGs. Rigor of development, applicability issues, and editorial independence should be emphasized in CPG capacity-building activities., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Objectives: The Chilean health system mandates providers to ensure assistance under a guaranteed system, the Explicit Guarantees in Healthcare (EGH) program. The Health Ministry has developed clinical practice guidelines (CPGs), but independent assessment of their quality is lacking., Study Design and Setting: We assessed all CPGs of the EGH program using Appraisal of Guidelines for Research & Evaluation II (AGREE II) tool for appraising quality, validity period, and last update., Results: Eighty-six CPGs were published between 2005 and 2016. Only 15 (17.4%) were updated. The overall mean raw score was 4.18 (±0.98). The scaled scores for each domain were: Scope and objectives 79.7%, Stakeholder involvement 46.2%, Rigor of development 36.3%, Clarity of presentation 82.8%, Applicability 23.5%, and Editorial independence 39.2%. The highest items were: overall objectives described, population described, options for management clearly presented, and key recommendations easily identifiable. The worst evaluated items were: views and preferences of the target population, strengths and limitations of the body of evidence, methods for formulating the recommendations, external review by experts, and description of facilitators and barriers to application., Conclusion: Most Chilean CPGs included in the EGH program are outdated and show items that should be improved, mainly through a more rigorous methodology, the inclusion of patients in its development, and appropriate consideration of its applicability., (Copyright © 2020 Elsevier Inc. All rights reserved.)

The main mechanism that causes resistance to carbapenem, one of the most potent antibiotic available, in Enterobacterales bacterial isolates, is due to Klebsiella pneumoniae carbapenemase (KPC) production by the bacterium. KPC is spread worldwide, requiring laboratories to be capable of identifying this enzyme, however some methods can be expensive for small laboratories, especially in developing countries. Therefore, the development of methods with low cost of reagents for the detection of KPC enzyme is necessary. The objective of this study was to evaluate the detection of KPC enzyme by MALDI-TOF MS from inactivated bacteria impregnated in filter paper. A total of 129 Enterobacterales isolates were impregnated in filter paper, and after 7 days at room temperature, they were subjected to a protein extraction protocol and spectra acquisition, in triplicates, by MALDI-TOF MS. The spectra were evaluated and KPC was identified according to the presence of a peak of 28,712.62 ± 27.80 m / z. Considering the presence of the KPC peak in at least one spectrum of the triplicates, this method presented 60.8% sensitivity and 96.4% specificity. However, considering the presence of KPC peak in at least two spectra of the triplicate, a specificity of 100% was achieved. The detection of KPC enzyme from inactivated bacteria impregnated in filter paper can be used as a method to confirm the presence of KPC, which could be very significant for small laboratories with limited resources. • Detection of KPC by MALDI-TOF MS can be performed from bacteria in filter-paper. • Detection of KPC from filter-paper by MALDI-TOF MS can be a confirmatory method. • The impregnation of inactivated bacteria in filter-paper is simple and inexpensive. [ABSTRACT FROM AUTHOR]

Microfluidic paper-based analytical devices (microPADs) are a new class of point-of-care diagnostic devices that are inexpensive, easy to use, and designed specifically for use in developing countries. (To listen to a podcast about this feature, please go to the Analytical Chemistry multimedia page at pubs.acs.org/page/ancham/audio/index.html.).

Pediatric radiotherapy is a critical part of pediatric oncology protocols and the quality of the radiotherapy may determine the future quality of life for long-term survivors. Multidisciplinary team decision making provides the basis for high-quality care. However, delivery of high-quality radiotherapy is dependent on resources. This article provides guidelines for delivery of good quality radiation therapy in resource-limited countries based on rational procurement and maintenance planning, protocol development, three-dimensional planning, quality assurance, and adequate staff numbers and training., (© 2017 Wiley Periodicals, Inc.)

Objective: To explore the development of family medicine postgraduate training in countries with varying levels of resources at different stages of development of the discipline., Composition of the Committee: Since 2012, the College of Family Physicians of Canada has hosted the Besrour Conferences to reflect on its role in advancing the discipline of family medicine globally. The Besrour Narrative Working Group was conceived in 2012 at the first Besrour Conference. Their mandate was to use narrative and appreciative inquiry to gather stories of family medicine worldwide. The working group comprised members of various academic departments of family medicine in Canada and abroad who attended the conferences., Methods: A consultation process with our partners from lower-middle-income countries was undertaken from 2012 to 2014. Stories were sought from each global partner institute with ties to Canadian family medicine departments. An appreciative inquiry approach was chosen to elicit narratives. Thematic analysis was used to search for common threads and important elements of success that could serve to inform other initiatives in other nations and, in turn, offer hope for greater effect., Report: Sixteen narrative stories have been collected so far. These stories highlight insightful solutions, foresight, perseverance, and ultimately a steadfast belief that family medicine will improve the health system and the care provided to the citizens of each nation. Seventeen themes were elucidated by 3 independent Canadian readers. At a subsequent workshop, these themes were validated by Besrour Centre members from Canada and elsewhere. The linkage between the thematic analysis and the experiences of various schools helps to illustrate both the robustness and the usefulness of the narratives in exploring generalizable observations and the features supporting success in each institute., Conclusion: If we are to understand, and contribute to, the development of family medicine throughout the world (a key objective of the Besrour Centre), we must begin to hear each others' stories and search for ways in which our collective story can advance the discipline., (Copyright© the College of Family Physicians of Canada.)

Background: The private healthcare sector has become an essential component of healthcare systems globally. This interest has increased with the universal health coverage agenda. However, in most low- and middle-income countries, few classificatory studies of the private hospital sector were carried out., Methods: This study describes the private hospital sector in a developing country setup and propose a typology that could facilitate the identification of its categories and the understanding of its organizational and strategic characteristics., Results: All private hospitals in Morocco as of December 31, 2021 including 397 facilities are included. Most hospitals are for-profit, poly-disciplinary, independent, commercial societies, have fewer than 30 beds or between 30 and 99 beds and are located in urban areas. Private hospitals have a median turnover of 9.8 million MAD and a median capital value of 2 million MAD. The clustering method identifies three main categories of private hospitals: for-profit hospitals with medium size and turnover, spread across the country but with a high concentration in large regions; not-for-profit hospitals, with medium to large size, high turnover, located in large regions and including university hospitals; and small for-profit hospitals with low turnover, independent ownership and wide distribution over the country. Three criteria have the most significant discriminatory power: ownership, size (beds, turnover) and mode of governance., Conclusions: Private hospitals in Morocco are organized into three types according to three similarity criteria including ownership, size and governance. These criteria might be used as the basis for a common typology of private hospitals in Morocco and possibly in other low- and middle-income countries with similar contexts., (© 2024. The Author(s).)

The promotion of inclusive green growth is one of the most debated topics in international forums and is considered a major concern by all countries in the world. Although the existing literature has examined several determinants of inclusive green growth, the impact of environmental taxation on inclusive green growth is relatively little explored. This study is therefore the first attempt to examine the impact of the environmental tax on inclusive green growth for developing countries from 2000 to 2021. To do this, we apply the system generalised method of moments (GMM) that controls unobserved heterogeneity, heteroskedasticity, simultaneity, reverse causality and endogeneity. The empirical results show that environmental tax promotes inclusive green growth. In addition, our results indicate that the control of corruption, government efficiency, the quality of regulation and the rule of law interact with the environmental tax to promote inclusive green growth. Furthermore, this study reveals interestingly that the environmental tax has a positive impact on the two components of inclusive growth and green growth, but the institutional factors that accentuate the impact of the environmental tax are somewhat nuanced. The results of the study have important policy implications for decision-makers in developing countries in promoting inclusive and environmentally friendly growth., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: Technological advancements, improved surgical access, and heightened demand for surgery have fueled unprecedented device and supply turnover impelling wealthy hospitals to upgrade continually and sell, donate, recycle, or dispose of used, expired, antiquated, or surplus goods. This paper reviews the issues related to device and supply lifecycles and discusses the opportunities and challenges they present for sustainable surgical growth in low- and middle-income (LMICs) countries., Observations: This review found, in LMICs countries, regulatory disparities persist that limit effective harmonization secondary to highly variable national policies and a lack of prioritized enforcement. Heterogeneity in the regulatory landscape, specifically in the classification, nomenclature, and identification of medical devices, encumbers effective regulation and distribution. Once devices are sold, donated, or reused in LMICs countries, complexities arise in regulatory compliance, maintenance, and appropriate use of these technologies. At the end of the lifecycle, waste management poses significant obstacles with limited resources hindering the implementation of best practices., Conclusion: There are major disparities in access to quality surgical equipment and supplies around the world. Improved communication between relevant stakeholders and harmonization of manufacture and disposal regulations will be needed to ensure adequate and appropriate responses to these challenges., Trial Registration Number: Not applicable., (© 2024 The Authors. World Journal of Surgery published by John Wiley & Sons Ltd on behalf of International Society of Surgery/Société Internationale de Chirurgie (ISS/SIC).)

The RAD-AID Conference on International Radiology for Developing Countries is a yearly forum addressing global shortages of radiology that contribute to health care disparity. In this paper, the authors present key issues and consensus positions related to the planning, analyzing, implementing, and monitoring of radiology in limited-resource areas on the basis of presentations at the 2012 RAD-AID conference, to advocate for (1) economic development to build health care capacity, (2) multidisciplinary educational strategies, (3) innovative epidemiologic and infrastructural solutions tailored to community needs, (4) advanced technical solutions leveraging the widespread use of wireless telecommunications and phone-based portable devices, and (5) improved dialog across radiology and public health institutions for coordinating global health strategies., (Published by Elsevier Inc.)

The objective of this paper is to develop a prescriptive model for the inter-country allocation of aid for COVID-19 support. Aid allocations are increasing functions of three dimensions of need: (i) hazard and exposure to COVID-19; (ii) vulnerability to COVID-19 impacts; and (iii) the capacity to cope, subject to an aid budget constraint. COVID-19 support from official donors to all ODA eligible countries is modeled. Aid allocations for COVID-19 support prescribed by the model are compared to actual allocations in 2020. Findings from the main model suggest that low-income countries are over-represented among the countries that should have received a greater share of the aid for COVID-19 support. Middle-income countries tended to receive more donor support for COVID-19 than amounts suggested by the model. The choice of weights assigned to the dimensions of need is arbitrary but findings are broadly consistent with respect to the use of different weights, alternative measures of support and changes to other parameters of the model. It is recommended that the donor community commit to a transparent needs-based funding formula when addressing a global pandemic., (© 2023 The Authors. Health Economics published by John Wiley & Sons Ltd.)

Health systems strengthening (HSS) is being increasingly recognized as a strategic cross-cutting issue in all World Health Organization (WHO) work. Health systems comprise six building blocks: service delivery; medical products, vaccines and technologies; health workforce; health systems financing; health information system; and leadership and governance. Public-private mix (PPM) approaches or partnerships consist of initiatives aimed at increasing collaboration and improving the relationships between public-public, public-private and private-private health providers. An important component of PPM is the clear distribution of tasks between the different providers involved in the provision of health care. In practice, most PPM initiatives are disease-specific and are often related to the health service delivery block mentioned above. Although there is widespread consensus that PPM initiatives are typically of an HSS nature, efforts to make explicit the links between PPM and health systems building blocks are rather uncommon. The present paper aims to identify - in order to facilitate operationalization - potential aspects linking PPM to health systems building blocks, using a few experiences from tuberculosis control and beyond. The paper targets policymakers, donors and health systems scientists and ends with a call for more aware and innovative leadership, for increased support of PPM initiatives covering various building blocks, and for more operational research.

Livestock contributes significantly to the world economy. However, animal diseases and food safety are still major constraints on livestock-sector productivity, economic growth, the reduction of poverty and food security. Efficient and effective governance of Veterinary Services throughout the world is a fundamental requirement for addressing the global animal health and related public health threats. Recent work by the World Organisation for Animal Health (OIE) through the application of the Tool for the Evaluation of Performance of Veterinary Services (PVS Tool) and related Gap Analysis (both of which form part of the PVS Pathway) has indicated that a significant proportion of the national Veterinary Services worldwide do not meet the essential requirements for good governance. This shortcoming poses a significant risk for many developing countries and their trading partners when considered in the context of the growing trade in animal-source foods, and the burgeoning global livestock population. Well-managed, transparent and credible Veterinary Services, in both the public and private sector, are essential for mitigating animal disease risks and ensuring sustainable incomes for vulnerable producers. They are also vital for limiting the public health risks posed by zoonotic diseases. This paper is intended to highlight the impact of governance on the delivery of veterinary services in a development context and the benefits generated by improving veterinary governance. It recognises 'global public good' elements embedded in the good governance of Veterinary Services, and it could also provide an operational development investment roadmap that builds on the OIE PVS Pathway, and innovative financing options based on government commitments supported by donor programmes.

The 2011 RAD-AID Conference on International Radiology for Developing Countries discussed data, experiences, and models pertaining to radiology in the developing world, where widespread shortages of imaging services significantly reduce health care quality and increase health care disparities. This white paper from the 2011 RAD-AID conference represents consensus advocacy of multidisciplinary strategies to improve the planning, accessibility, and quality of imaging services in the developing world. Conference presenters and participants discussed numerous solutions to imaging and health care disparities, including (1) economic development for radiologic service planning, (2) public health mechanisms to address disease and prevention at the population and community levels, (3) comparative clinical models to implement various clinical and workflow strategies adapted to unique developing world community contexts, (4) education to improve training and optimize service quality, and (5) technology innovation to bring new technical capabilities to limited-resource regions., (Published by Elsevier Inc.)

Much has been written about the measurement of socio-economic position (SEP) in high-income countries (HIC). Less has been written for an epidemiology, health systems and public health audience about the measurement of SEP in low- and middle-income countries (LMIC). The social stratification processes in many LMIC-and therefore the appropriate measurement tools-differ considerably from those in HIC. Many measures of SEP have been utilized in epidemiological studies; the aspects of SEP captured by these measures and the pathways through which they may affect health are likely to be slightly different but overlapping. No single measure of SEP will be ideal for all studies and contexts; the strengths and limitations of a given indicator are likely to vary according to the specific research question. Understanding the general properties of different indicators, however, is essential for all those involved in the design or interpretation of epidemiological studies. In this article, we describe the measures of SEP used in LMIC. We concentrate on measures of individual or household-level SEP rather than area-based or ecological measures such as gross domestic product. We describe each indicator in terms of its theoretical basis, interpretation, measurement, strengths and limitations. We also provide brief comparisons between LMIC and HIC for each measure.

The 2010 RAD-AID Conference on International Radiology for Developing Countries was a multidisciplinary meeting to discuss data, experiences, and models pertaining to radiology in the developing world, where widespread shortages of imaging services reduce health care quality. The theme of this year's conference was sustainability, with a focus on establishing and maintaining imaging services in resource-limited regions. Conference presenters and participants identified 4 important components of sustainability: (1) sustainable financing models for radiology development, (2) integration of radiology and public health, (3) sustainable clinical models and technology solutions for resource-limited regions, and (4) education and training of both developing and developed world health care personnel., (Copyright © 2011 American College of Radiology. All rights reserved.)

Is a published research paper an important indicator of successful operational research at programme level in low-income countries? In academia, publishing in peer-reviewed scientific journals is highly encouraged and strongly pursued for academic recognition and career progression. In contrast, for those who engage in operational research at programme level, there is often no necessity or reward for publishing the results of research studies; it may even be criticized as being an unnecessary detraction from programme-related work. We present arguments to support publishing operational research from low-income countries; we highlight some of the main reasons for failure of publication at programme level and suggest ways forward.

A review of global epidemiological studies of traumatic spinal cord injury (TSCI) within 2 decades was undertaken to compare the incidence, mortality rate, patients' age, gender, causes, and severity of injury between developed countries and developing countries. The incidence rates varied greatly, and there was also a 2-fold difference between the highest mortality rate in developing countries and that in developed countries. Male sex and age from 30 to 50 years are strong risk factors in both these groups. Traffic accidents are the leading cause of injury in developed countries, whereas falls are the leading cause in developing countries. To clarify regional differences, future studies should contain long-term data about TSCI characteristics in a region-based population.

Objective: The medical specialty of physical medicine and rehabilitation (PM&R) has had a proven impact on persons with disability and on health care systems. Documents such as The White Book on Physical and Rehabilitation Medicine in Europe have been important in defining the scope of practice within various regions. However, on some continents, the practice has not been well defined., Design: To explore the practice of PM&R in subSaharan Africa and Antarctica., Methods: Medline searches, membership data searches, fax survey of medical schools, Internet searches, and interviews with experts., Results: The continents are dissimilar in terms of climate and government. However both Antarctica and subSaharan Africa have no PM&R training programs, no professional organizations, no specialty board requirements, and no practicing physicians in the field. Because there are no known disabled children on Antarctica and adults are airlifted to world-class health care, the consequences of this deficit are minimal there. However, the 788,000,000 permanent residents of subSaharan Africa, including approximately 78 million persons with disability, are left unserved., Conclusions: Antarctica is doing fine. Africa is in a crisis. Local medical schools, hospitals doctors, and persons with disability; along with foreign volunteers, aid groups, and policymakers can impact the crisis. However government-specifically national ministries of health-is ultimately responsible for the health and wellbeing of citizens.