A tale of two cases - investigating reasoning in similar cases with different outcomes.

Why is it that some care order cases result in the child being removed from parental care, while in others she is not, despite the cases being similar? This paper investigates how decision-makers reason and justify different outcomes for similar cases, by an analysis of four pairs of judgments (from Norway, Estonia, and Finland) about care orders, using thematic analysis. The comparison is within the pairs and not across countries. I find that the variance in outcome and reasoning seems to be a result of discretionary evaluations: risk, cooperation of the parents, and the potential of services to alleviate the situation are interpreted differently in the cases and lead to different outcomes. This appears to be a legitimate use of the discretionary space available to the decision-makers. The decisions are justified with 'good reasons' mostly related to threshold, the least intrusive intervention principle, and the best interests of the child. Such justifications are suitable to provide accountability and legitimacy, but the reasoning is at times lacking transparency and thoroughness. The reasoning is longer in the non-removal cases, suggesting that more thorough reasoning is required when the decision-makers depart from the most common outcome.

Comparison of the rate of healthcare encounters for influenza from source-specific PM2.5 before and after tier 3 vehicle standards in New York state.

BACKGROUND: Influenza healthcare encounters in adults associated with specific sources of PM2.5 is an area of active research. OBJECTIVE: Following 2017 legislation requiring reductions in emissions from light-duty vehicles, we hypothesized a reduced rate of influenza healthcare encounters would be associated with concentrations of PM2.5 from traffic sources in the early implementation period of this regulation (2017-2019). METHODS: We used the Statewide Planning and Research Cooperative System (SPARCS) to study adult patients hospitalized (N = 5328) or treated in the emergency department (N = 18,247) for influenza in New York State. Using a modified case-crossover design, we estimated the excess rate (ER) of influenza hospitalizations and emergency department visits associated with interquartile range increases in source-specific PM2.5 concentrations (e.g., spark-ignition emissions [GAS], biomass burning [BB], diesel [DIE]) in lag day(s) 0, 0-3 and 0-6. We then evaluated whether ERs differed after Tier 3 implementation (2017-2019) compared to the period prior to implementation (2014-2016). RESULTS: Each interquartile range increase in DIE in lag days 0-6 was associated with a 21.3% increased rate of influenza hospitalization (95% CI: 6.9, 37.6) in the 2014-2016 period, and a 6.3% decreased rate (95% CI: -12.7, 0.5) in the 2017-2019 period. The GAS/influenza excess rates were larger in the 2017-2019 period than the 2014-2016 period for emergency department visits. We also observed a larger ER associated with increased BB in the 2017-2019 period compared to the 2014-2016 period. IMPACT STATEMENT: We present an accountability study on the impact of the early implementation period of the Tier 3 vehicle emission standards on the association between specific sources of PM2.5 air pollution on influenza healthcare encounters in New York State. We found that the association between gasoline emissions and influenza healthcare encounters did not lessen in magnitude between periods, possibly because the emissions standards were not yet fully implemented. The reduction in the rates of influenza healthcare encounters associated with diesel emissions may be reflective of past policies to reduce the toxicity of diesel emissions. Accountability studies can help policy makers and environmental scientists better understand the timing of pollution changes and associated health effects.

Stakeholder Perspectives on the Governance and Accountability of Nigeria's Basic Healthcare Provision Fund.

In recent decades, Nigeria has implemented a number of health financing reforms, yet progress toward Universal Health Coverage (UHC) has remained slow. In particular, the introduction of the Basic Health Care Provision Fund (BHCPF) through the National Health Act of 2014 sought to increase coverage of basic health services in Nigeria. However, recent studies have shown that health financing schemes like the BHCPF in Nigeria are suboptimal and have frequently attributed this to weak accountability and governance of the schemes. However, little is known about accountability and governance of health financing in Nigeria, particularly from the perspective of key actors within the system. This study explores perceptions around governance and accountability through qualitative, in-depth interviews with key BHCPF actors including high-level government officers, academics and Civil Society Organisations. Thematic analysis of the findings reveals broad views among respondents that financial processes are appropriately ring-fenced, and that financial mismanagement is not the most pressing accountability gap. Importantly, respondents report that accountability processes are unclear and weak in subnational service delivery, and cite low utilisation, implicit priority-setting, and poor quality as issues. To accelerate UHC progress, the accountability framework must be redesigned to include greater strategic participation and leadership from subnational governments.

Addressing Worker Safety and Health Through the Lens of Strategic Enforcement-Part One.

Ensuring the safety and health of workers in this country, who are employed at millions of workplaces that present a dizzying array of hazards, is daunting. Every day, workers are maimed or die from workplace injuries or occupational illnesses. Hence, government agencies must use all available means to ensure the laws intended to keep workers safe and healthy in their workplaces are maximally effective in accomplishing that purpose. This paper addresses this challenge through the lens of strategic enforcement. It examines how federal and state authority are designed to interact to ensure worker protection in this space, and focuses on what tools for deterring violations - many unrecognized or underutilized by worker safety agencies - are available to leverage the limited resources that inevitably constrain the agencies' reach. The forthcoming Part II will, among other things, showcase a number of noteworthy state and local initiatives that exceed the federal standard.

An evaluation of a multi-partner approach to increase routine immunization coverage in six northern Nigerian States.

BACKGROUND: Global health partnerships are increasingly being used to improve coordination, strengthen health systems, and incentivize government commitment for public health programs. From 2012 to 2022, the Bill & Melinda Gates Foundation (BMGF) and Aliko Dangote Foundation (ADF) forged Memorandum of Understanding (MoU) partnership agreements with six northern state governments to strengthen routine immunization (RI) systems and sustainably increase immunization coverage. This mixed methods evaluation describes the RI MoUs contribution to improving program performance, strengthening capacity and government financial commitment as well as towards increasing immunization coverage. METHODS: Drawing from stakeholder interviews and a desk review, we describe the MoU inputs and processes and adherence to design. We assess the extent to which the program achieved its objectives as well as the benefits and challenges by drawing from a health facility assessment, client exit interview and qualitative interviews with service providers, community leaders and program participants. Finally, we assess the overall impact of the MoU by evaluating trends in immunization coverage rates. RESULTS: We found the RI MoUs across the six states to be mostly successful in strengthening health systems, improving accountability and coordination, and increasing the utilization of services and financing for RI. Across all six states, pentavalent 3 vaccine coverage increased from 2011 to 2021 and in some states, the gains were substantial. For example, in Yobe, vaccination coverage increased from 10% in 2011 to nearly 60% in 2021. However, in Sokoto, the change was minimal increasing from only 4% in 2011 to nearly 8% in 2021. However, evaluation findings indicate that issues pertaining to human resources for health, insecurity that inhibits supportive supervision and vaccine logistics as well as harmful socio-cultural norms remain a persistent challenge in the states. There is also a need for a rigorous monitoring and evaluation plan with well-defined measures collected prior to and throughout implementation. CONCLUSION: Introducing a multi-partner approach grounded in a MoU agreement provides a promising approach to addressing health system challenges that confront RI programs.

Google Trends-Assisted Analysis of the Readability, Accountability, and Accessibility of Online Patient Education Materials for the Treatment of AMD After US FDA Approval of Pegcetacoplan.

Purpose: To evaluate the readability, accountability, accessibility, and source of online patient education materials for treatment of age-related macular degeneration (AMD) and to quantify public interest in Syfovre and geographic atrophy after US Food and Drug Administration (FDA) approval. Methods: Websites were classified into 4 categories by information source. Readability was assessed using 5 validated readability indices. Accountability was assessed using 4 benchmarks of the Journal of the American Medical Association (JAMA). Accessibility was evaluated using 3 established criteria. The Google Trends tool was used to evaluate temporal trends in public interest in "Syfovre" and "geographic atrophy" in the months after FDA approval. Results: Of 100 websites analyzed, 22% were written below the recommended sixth-grade reading level. The mean (±SD) grade level of analyzed articles was 9.76 ± 3.35. Websites averaged 1.40 ± 1.39 (of 4) JAMA accountability metrics. The majority of articles (67%) were from private practice/independent organizations. A significant increase in the public interest in the terms "Syfovre" and "geographic atrophy" after FDA approval was found with the Google Trends tool (P < .001). Conclusions: Patient education materials related to AMD treatment are often written at inappropriate reading levels and lack established accountability and accessibility metrics. Articles from national organizations ranked highest on accessibility metrics but were less visible on a Google search, suggesting the need for visibility-enhancing measures. Patient education materials related to the term "Syfovre" had the highest average reading level and low accountability, suggesting the need to modify resources to best address the needs of an increasingly curious public.

Transformative justice to support truth and reconciliation within nurse-midwifery education.

Nursing education holds a history framed in white supremacy and whiteness. Efforts to employ antiracist strategies have been hindered, largely due to an inability for faculty to acknowledge and hold accountability for racialized harms that occur within nursing educational structures. A nurse-midwifery program in the Pacific Northwest United States uncovered harm that impacted students and identified a need to respond and hold accountability. Guided by the framework of Transformative Justice, a truth and reconciliation process was implemented as a first step to better address racism within nursing and nurse-midwifery education. This paper describes the process to support other institutions in their work to address harms within nursing education.

How to mitigate the risks of deployment of artificial intelligence in medicine?

The aim of this study is to examine the risks associated with the use of artificial intelligence (AI) in medicine and to offer policy suggestions to reduce these risks and optimize the benefits of AI technology. AI is a multifaceted technology. If harnessed effectively, it has the capacity to significantly impact the future of humanity in the field of health, as well as in several other areas. However, the rapid spread of this technology also raises significant ethical, legal, and social issues. This study examines the potential dangers of AI integration in medicine by reviewing current scientific work and exploring strategies to mitigate these risks. Biases in data sets for AI systems can lead to inequities in health care. Educational data that is narrowly represented based on a demographic group can lead to biased results from AI systems for those who do not belong to that group. In addition, the concepts of explainability and accountability in AI systems could create challenges for healthcare professionals in understanding and evaluating AI-generated diagnoses or treatment recommendations. This could jeopardize patient safety and lead to the selection of inappropriate treatments. Ensuring the security of personal health information will be critical as AI systems become more widespread. Therefore, improving patient privacy and security protocols for AI systems is imperative. The report offers suggestions for reducing the risks associated with the increasing use of AI systems in the medical sector. These include increasing AI literacy, implementing a participatory society-in-the-loop management strategy, and creating ongoing education and auditing systems. Integrating ethical principles and cultural values into the design of AI systems can help reduce healthcare disparities and improve patient care. Implementing these recommendations will ensure the efficient and equitable use of AI systems in medicine, improve the quality of healthcare services, and ensure patient safety.

Legislation for advancing women's leadership in the health sector in India and Kenya: a 'law cube' approach to identify ways to strengthen legal environments for gender equality.

OBJECTIVES: This paper examines the availability of legal provisions, or the lack thereof, that support women to progress equitably into leadership positions within the health workforce in India and Kenya. METHODS: We adapted the World Bank's Women, Business and Law framework of legal domains relevant to gender equality in the workplace and applied a 'law cube' to analyse the comprehensiveness, accountability and equity and human rights considerations of 27 relevant statutes in India and 11 in Kenya that apply to people in formal employment within the health sector. We assessed those laws against 30 research-validated good practice measures across five legal domains: (1) pay; (2) workplace protections; (3) pensions; (4) care, family life and work-life balance; and (5) reproductive rights. In India, the pension domain and related measures were not assessed because the pension laws do not apply to the public and private sector equally. RESULTS: Several legal domains are addressed inadequately or not at all, including pay in India, reproductive rights in Kenya and the care, family life and the work-life balance domain in both countries. Additionally, we found that among the Kenyan laws reviewed, few specify accountability mechanisms, and equity and human rights measures are mainly absent from the laws assessed in both countries. Our findings highlight inadequacies in the legal environments in India and Kenya may contribute to women's under-representation in leadership in the health sector. The absence of specified accountability mechanisms may impact the effective implementation of legislation, undermining their potential to promote equal opportunities. CONCLUSIONS: Government action is needed in both countries to ensure that legislation addresses best practice provisions, equity and human rights considerations, and provides for independent review mechanisms to ensure accountability for implementation of existing and future laws. This would contribute to ensuring that legal environments uphold the equality of opportunity necessary for realising gender justice in the workplace for the health workforce. PRIMARY SOURCE OF FUNDING: Bill & Melinda Gates Foundation (INV-031372).

Strengthening accountability for tuberculosis policy implementation in South Africa: perspectives from policymakers, civil society, and communities.

Background: Translating health policy into effective implementation is a core priority for responding effectively to the tuberculosis (TB) crisis. The national TB Recovery Plan was developed in response to the negative impact that the COVID-19 pandemic had on TB care in South Africa. We aimed to explore the implementation of the TB Recovery Plan and develop recommendations for strengthening accountability for policy implementation for this and future TB policies. Methods: We interviewed 24 participants working on or impacted by TB policy implementation in South Africa. This included perspectives from national, provincial, and local health department representatives, civil society, and community representatives. In-depth interviews were conducted in English and isiXhosa and we drew on reflexive thematic methods for analysis. Results: Participants felt that there was potential for COVID-19 innovations and urgency to influence TB policy development and implementation, including the use of data dashboards. Implementation of the TB Recovery Plan predominantly used a top-down approach to implementation (cascading from national policy to local implementers) but experienced bottlenecks at provincial level. Recommendations for closing the TB policy-implementation gap included using phased implementation and enhancing provincial-level accountability. Civil society organisations were concerned about the lack of provincial implementation data which impeded advocacy for improved accountability and inadequate resourcing for implementation. Community health workers were viewed as key to implementation but were not engaged in the policy development process and were often not aware of new TB policies. At local level, there were also opportunities to strengthen community engagement in policy implementation including through community-led monitoring. Participants recommended broader multi-stakeholder engagement that includes community and community health worker representatives in the development and implementation phases of new TB policies. Conclusions: Communities affected by TB, with the support of civil society organisations, could play a bigger role in monitoring policy implementation at local level and need to be capacitated to do this. This bottom-up approach could complement existing top-down strategies and contribute to greater accountability for TB policy implementation. Supplementary Information: The online version contains supplementary material available at 10.1186/s44263-024-00077-y.

Comment on "Sexism in Academia is Bad for Science and a Waste of Public Funding".

A recent comment by Boivin et al. urges academia and governments to address sexism and fight bias at higher education and research institutions as losing female academics is costing science and society too much. Herein, I discuss further underlying reasons of sexism in academia and the importance of a deep dive into the causes of inequity at individual faculty and school levels to develop bespoke and enforceable gender equity plans, the importance of not using basic statistic as the only tool to measure equity/inequity as well as how key performance indicators could be better used to advance gender equity and end sexism in academia.

A review of authorship in herpes simplex virus type-2 (HSV-2) research conducted in low-income and middle-income countries between 2000 and 2020.

INTRODUCTION: Equitable inclusion of low-income and middle-income country (LMIC) researchers and women in research authorship is a priority. A review of progress in addressing WHO-identified priorities provided an opportunity to examine the geographical and gender distribution of authorship in herpes simplex virus type-2 (HSV-2) research. METHODS: Publications addressing five areas prioritised in a WHO workshop and published between 2000 and 2020 were identified. Data on author country, gender, authorship position and research funding source were collected by manuscript review and internet searches and analysed using IBM SPSS V.26. RESULTS: Of, 297 eligible papers identified, (n=294) had multiple authors. Of these, 241 (82%) included at least one LMIC author and 143 (49%) and 122 (41%) had LMIC first and last authors, respectively. LMICs funded studies were more than twice as likely to include an LMIC first or last author as high-income country-funded studies (relative risk 2.36, 95% CI 1.93 to 2.89). Respectively, 129 (46%) and 106 (36%) studies had female first and last authors. LMIC first and last authorship varied widely by HSV-2 research area and increased over time to 65% and 59% by 2015-2020. CONCLUSION: Despite location of the research itself in LMIC settings, over the 20-year period, LMIC researchers held only a minority of first and last authorship positions. While LMIC representation in these positions improved over time, important inequities remain in key research areas and for women. Addressing current and historical power disparities in global health research, research infrastructure and how it is funded may be key addressing to addressing these issues.

Academic accountability to local communities and society through Programme Science: a case study from the HPV self-sampling programme HOPE in Peru.

INTRODUCTION: Health challenges in the 21st century underscore the need for adaptable and innovative approaches in public health. Academic institutions can and should contribute much more effectively to generate and translate scientific knowledge that will result in better programmes to improve societal health. Academic accountability to local communities and society requires universities to actively engage with local communities, understanding the context, their needs, and leveraging their knowledge and local experience. The Programme Science initiative provides a framework to optimize the scale, quality and impact of public health programmes, by integrating diverse approaches during the iterative cycle of research and practice within the strategic planning, programme implementation and programme management and evaluation. We illustrate how the Programme Science framework could be a useful tool for academic institutions to accomplish accountability to local communities and society through the experience of Project HOPE in Peru. DISCUSSION: Project HOPE applied the Programme Science framework to introduce HPV self-sampling into a women's health programme in Peru. Collaboration with local authorities and community members was pivotal in all phases of the project, ensuring interventions aligned with community needs and addressing social determinants of health. The HOPE Ladies-community women trained and empowered to promote and provide the HPV kits-crafted the messages used through the study and developed strategies to reach individuals and provided support to women's journey through health centres. By engaging communities in co-creating knowledge and addressing health inequities, academic institutions can generate contextually relevant and socially just scientific knowledge. The active participation of community women in Project HOPE was instrumental in improving service utilization and addressing barriers to self-sampling. CONCLUSIONS: The Programme Science approach offers a pathway for academic institutions to enhance their accountability to communities and society at large. By embedding researchers within public health programmes and prioritizing community engagement, academic institutions can ensure that research findings directly inform policy improvements and programmatic decisions. However, achieving this requires a realignment of research agendas and recognition of the value of community engagement. Establishing Programme Science networks involving academia, government and funding entities can further reinforce academic accountability and enhance the impact of public health programmes.

Community service rehabilitation therapists' understanding of social accountability.

BACKGROUND:  Social accountability is the obligation of health care providers to address the priority health concerns of the community they serve and of universities to ensure that graduates understand these social responsibilities. Although social accountability can combat systemic health inefficiencies, it is not well-understood or practised. AIM:  The study aimed to explore community service rehabilitation therapists' understanding of social accountability. SETTING:  The study was conducted in KwaZulu-Natal, South Africa. METHODS:  This study used an interpretive exploratory design and purposively recruited 27 community service rehabilitation therapists namely, audiologists, speech-language therapists, occupational therapists, and physiotherapists working in public sector health facilities in rural and peri-urban areas. Four focus group discussions and four free attitude interviews were conducted, the results being thematically analysed. RESULTS:  Despite most of the participants not being instructed in social accountability as part of their formal training or institutional induction, three themes emerged based on their experiences. These themes include describing social accountability, values of social accountability, and values of community-based rehabilitation applicable to social accountability. CONCLUSION:  Inclusion of instruction on social accountability as part of their formal training and health facility induction would contribute to rehabilitation therapists' understanding of social accountability.Contribution: The study contributes to data on rehabilitation education and community service training regarding social accountability within a South African context and has captured how experiences gained during community service contribute to the rehabilitation therapists' understanding of social accountability.

Social accountability challenges and recommendations by community service rehabilitation therapists.

BACKGROUND:  Social accountability entails providing equitable and accessible services that are tailor-made for the community's healthcare needs and enable rehabilitation therapists to improve the efficiency and efficacy of healthcare delivery and their response. Enabling them to provide optimal care during their community service year requires understanding the gaps in their knowledge, experience and the support they provide to the communities they service. METHODS:  Four in-depth individual interviews and four focus group discussions were conducted via Zoom. The qualitative responses to the questions related to the challenges and recommendations associated with social accountability in clinical settings were analysed using an inductive thematic approach via NVIVO. RESULTS:  Four sub-themes emerged for each of the two areas of interest: the challenges relating to (1) budget and equipment constraints, (2) staff shortages, (3) cultural and language barriers and (4) scope of practice limitations. The recommendations related to (5) collaboration with community caregivers, (6) service inclusion in primary health care clinics, (7) improved executive management support and (8) continuing professional development. CONCLUSION:  Equipping graduates with the knowledge, skills and support needed to work in an under-resourced setting is essential for community service rehabilitation therapists to ensure social accountability, given that they often work alone, specifically in rural settings.Contribution: Being aware of the challenges that face community service rehabilitation therapists, having the necessary tools and health facility management support will enable ongoing improvements in their ability to provide socially accountable services.

Clarifying middle authorship contributions to reduce abuses in science publishing and assessment of top-ranked SJR biochemistry and pharmacology journals' authorship criteria.

So-called "middle authors," being neither the first, last, nor corresponding author of an academic paper, have made increasing relative contributions to academic scholarship over recent decades. No work has specifically and explicitly addressed the roles, rights, and responsibilities of middle authors, an authorship position which we believe is particularly vulnerable to abuse via growing phenomena such as paper mills. Responsible middle authorship requires transparent declarations of intellectual and other scientific contributions that journals can and should require of co-authors and established guidelines and criteria to achieve this already exist (ICMJE/CRediT). Although publishers, editors, and authors need to collectively uphold a situation of shared responsibility for appropriate co-authorship, current models have failed science since verification of authorship is impossible, except through blind trust in authors' statements. During the retraction of a paper, while the opinion of individual co-authors might be noted in a retraction notice, the retraction itself practically erases the relevance of co-author contributions and position/status (first, leading, senior, last, co-corresponding, etc.). Paper mills may have successfully proliferated because individual authors' roles and responsibilities are not tangibly verifiable and are thus indiscernible. We draw on a historical example of manipulated research to argue that authors and editors should publish publicly available, traceable contributions to the intellectual content of an article-both classical authorship or technical contributions-to maximize both visibility of individual contributions and accountability. To make our article practically more relevant to this journal's readership, we reviewed the top 50 Q1 journals in the fields of biochemistry and pharmacology, as ranked by the SJR, to appreciate which journals adopted the ICMJE or CRediT schools of authorship contribution, finding significant variation in adhesion to ICMJE guidelines nor the CRediT criteria and wording of author guidelines.

Describing a medical school's rural activity footprint: setting selection and workforce distribution priorities.

CONTEXT: There is growing evidence supporting a shift towards 'grow your own' approaches to recruiting, training and retaining health professionals from and for rural communities. To achieve this, there is a need for sound methodologies by which universities can describe their area of geographic focus in a precise way that can be utilised to recruit students from their region and evaluate workforce outcomes for partner communities. In Australia, Deakin University operates a Rural Health Multidisciplinary Training (RHMT) program funded Rural Clinical School and University Department of Rural Health, with the purpose of producing a graduate health workforce through the provision of rural clinical placements in western and south-western Victoria. The desire to establish a dedicated Rural Training Stream within Deakin's Doctor of Medicine course acted as a catalyst for us to describe our 'rural footprint' in a way that could be used to prioritise local student recruitment as well as evaluate graduate workforce outcomes specifically for this region. ISSUE: In Australia, selection of rural students has relied on the Australian Statistical Geography Standard Remoteness Areas (ASGS-RA) or Modified Monash Model (MMM) to assign rural background status to medical course applicants, based on a standard definition provided by the RHMT program. Applicants meeting rural background criteria may be preferentially admitted to any medical school according to admission quotas or dedicated rural streams across the country. Until recently, evaluations of graduate workforce outcomes have also used these rurality classifications, but often without reference to particular geographic areas. Growing international evidence supports the importance of place-based connection and training, with medical graduates more likely to work in a region that they are from or in which they have trained. For universities to align rural student recruitment more strategically with training in specific geographic areas, there is a need to develop precise geographical definitions of areas of rural focus that can be applied during admissions processes. LESSONS LEARNED: As we strived to describe our rural activity area precisely, we modelled the application of several geographical and other frameworks, including the MMM, ASGS-RA, Primary Healthcare Networks (PHN), Local Government Areas (LGAs), postcodes and Statistical Areas. It became evident that there was no single geographical or rural framework that (1) accurately described our area of activity, (2) accurately described our desired workforce focus, (3) was practical to apply during the admissions process. We ultimately settled on a bespoke approach using a combination of the PHN and MMM to achieve the specificity required. This report provides an example of how a rural activity footprint can be accurately described and successfully employed to prioritise students from a geographical area for course admission. Lessons learned about the strengths and limitations of available geographical measures are shared. Applications of a precise footprint definition are described including student recruitment, evaluation of workforce outcomes for a geographic region, benefits to stakeholder relationships and an opportunity for more nuanced RHMT reporting.

The Role of Patient Satisfaction Scores in Clinical Care and Physician Wellness.

Patient satisfaction scores have become an integral part of the vocabulary of medical practitioners. Patient satisfaction scores are a domain far ignored, but which have recently gained prominence as patients have demanded a fair share of their own assessments of their medical caregivers. This has created a complex interplay of meeting patients' demands and satisfying their wants and needs, which at times may not completely align with the best possible approach to management and standard of care algorithms. Here we present a commentary on patient satisfaction scores and their impact on physician well-being. We present historical aspects from both patient and provider perspectives and how they vary in private versus academic practice, and create some guidance for future refinement and implementation of these scores to serve two purposes: first, to allow for optimal doctor-patient relationships; and second, to enhance overall satisfaction for the patient as well as the physician.

Legislation strengthening Maternal and Perinatal Death Surveillance and Response systems.

Historically, countries have primarily relied on policy rather than legislation to implement Maternal and Perinatal Death Surveillance and Response systems (MPDSR). However, evidence shows significant disparities in how MPDSR is implemented among different countries. In this article, we argue for the importance of establishing MPDSR systems mandated by law and aligned with the country's constitutional provisions, regional and international human rights obligations, and public health commitments. We highlight how a "no blame" approach can be regulated to provide a balance between confidentiality of the system and access to justice and remedies.

AI as a user of AI: Towards responsible autonomy.

Recent advancements in Artificial Intelligence (AI), particularly in generative language models and algorithms, have led to significant impacts across diverse domains. AI capabilities to address prompts are growing beyond human capability but we expect AI to perform well also as a prompt engineer. Additionally, AI can serve as a guardian for ethical, security, and other predefined issues related to generated content. We postulate that enforcing dialogues among AI-as-prompt-engineer, AI-as-prompt-responder, and AI-as-Compliance-Guardian can lead to high-quality and responsible solutions. This paper introduces a novel AI collaboration paradigm emphasizing responsible autonomy, with implications for addressing real-world challenges. The paradigm of responsible AI-AI conversation establishes structured interaction patterns, guaranteeing decision-making autonomy. Key implications include enhanced understanding of AI dialogue flow, compliance with rules and regulations, and decision-making scenarios exemplifying responsible autonomy. Real-world applications envision AI systems autonomously addressing complex challenges. We have made preliminary testing of such a paradigm involving instances of ChatGPT autonomously playing various roles in a set of experimental AI-AI conversations and observed evident added value of such a framework.