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Based on the results of a social‐science study the effects of the use of robots is described.

This study aims to develop a hierarchical model that uncovers the relationships between challenges confronting Africa's organ transplant supply chain systems.

Eleven challenges (variables) were identified after a comprehensive review of the existing literature. The contextual interactions among these variables were analysed from the perspectives of health-care stakeholders in two sub-Saharan Africa (SSA) countries (Nigeria and Uganda), using Delphi-interpretive structural modelling-cross-impact matrix multiplication applied to classification (MICMAC) techniques.

The findings reveal that weak regulatory frameworks, insufficient information systems and a lack of necessary skills make it challenging for critical actors to perform the tasks effectively. The interaction effects of these challenges weaken organ supply chains and make it less efficient, giving rise to negative externalities such as black markets for donated organs and organ tourism/trafficking.

This paper establishes a solid foundation for a critical topic that could significantly impact human health and life once the government or non-profit ecosystem matures. The MICMAC analysis in this paper provides a methodological approach for future studies wishing to further develop the organ supply chain structural models.

The study provides valuable insights for experts and policymakers on where to prioritise efforts in designing interventions to strengthen organ transplantation supply chains in developing countries.

This study is one of the first to empirically examine the challenges of organ transplant supply chains from an SSA perspective, including theoretically grounded explanations from data collected in two developing countries.

Disparities in transplant rates across social categories provide limited information about gatekeeping processes in access to kidney transplantation. We hypothesized that early opportunities for discussion of kidney transplantation potentially generate social capital that serves as a resource for patients as they navigate the transplantation pathway.

A national sample of first-year dialysis patients was surveyed and asked if kidney transplantation had been discussed with them before and after starting dialysis treatment. Associations between reported discussion and patient-specific clinical and nonclinical (sociodemographic) indicators of attributed utility for transplantation were investigated, and the association of reported transplant discussion with subsequent transplant waitlisting was analyzed.

Time to placement on the kidney transplant waiting list was significantly shorter for patients who reported that transplantation had been discussed with them before, as well as after, starting dialysis. Likelihood of reported discussion varied by patient age, employment and insurance status, cardiovascular comorbidity burden, and perceived health status; in addition, women were less likely to report early discussion.

It would be valuable to know more about the nature of the transplant discussions recalled by patients to better understand how social capital may be fostered through these discussions.

Indicators of attributed utility for successful transplantation were associated with transplant discussion both before and after starting dialysis, potentially contributing to observed disparities in access to kidney transplantation.

Predialysis nephrology care and patient participation in discussion of kidney transplantation may foster social capital that facilitates navigating the transplantation pathway.

Late nephrology referral, a problem currently identified across many high income countries, has been associated with reduced opportunities for delaying or halting the progression of chronic kidney disease (CKD), delayed dialysis initiation, reduced choice in treatment modality, increased morbidity and hospitalization, and premature death. Despite a recent finding that the progression of CKD nearly always presents warning signs, and despite the fact that all Canadians are entitled to receive medically necessary health care free at the point of patient entry, each year in the province of British Columbia (BC) a substantial number of people with CKD experience late or no referral to nephrology care prior to requiring renal replacement therapy. A subset of these CKD patients experience no referral and “crash” onto dialysis (experience an acute or emergent start). Existing research has not fully explored the range of potential health determinants that may affect the timing of nephrology referral. This paper adopts a “determinants of health” framework and assesses the impact of a variety of indicators on patients’ physical health, demographics, socioeconomic status, social support, geographic and health system characteristics. Using a late referral definition of <3 months and data on BC patients who began dialysis between April 2000 and March 2003, multiple regression analysis indicates that the following determinants have an independent effect on the timing of referral: cause of end-stage renal disease (p=<0.0001); age (p=<0.0001); race/ethnicity (p=0.0019); English ability (p=0.0158); marital status (p=0.0202); proximity to care (p=0.0118); and, “age by first language” (p=0.0244).

Medical diagnosis and treatment processes exhibit a high degree of variability, as during the process execution, healthcare professionals can decide on additional steps, change the execution order or skip a task. Process models can help to document and to discuss such processes. However, depicting variability in graphical process models using standardized languages, such as Business Process Model and Notation (BPMN), can lead to large and complicated diagrams that medical staff who do not have formal training in modeling languages have difficulty understanding. This study proposes a pattern-based process visualization that medical doctors can understand without extensive training. The process descriptions using this pattern-based visualization can later be transformed into formal business process models in languages such as BPMN.

The authors derived patterns for expressing variability in healthcare processes from the literature and medical guidelines. Then, the authors evaluated and revised these patterns based on interviews with physicians in a Danish hospital.

A set of business process variability patterns was proposed to express situations with variability in hospital treatment and diagnosis processes. The interviewed medical doctors could translate the patterns into their daily work practice, and the patterns were used to model a hospital process.

When communicating with medical personnel, the patterns can be used as building blocks for documenting and discussing variable processes.

The patterns can reduce complexity in process visualization. This study provides the first validation of these patterns in a hospital.

Recent research has suggested the beneficial effects of omega-3 fatty acids on kidney function; however, differences in these benefits have not been well-documented with respect to different omega-3 fatty acid sources. Hence, the purpose of this study is to compare the effects of plants, marine sources of omega-3 fatty acids and their combination on biomarkers of renal function in overweight and obese individuals.

Ninety-nine overweight and obese women from a weight loss clinic received three weight-reducing diets with fish (300 g/week), walnuts (18 walnuts/week) or fish + walnuts (150 g fish + 9 walnuts/week) for 12 weeks. Serum biomarkers of renal function were measured at the beginning and the end of the intervention.

After 12 weeks, a reduction in serum creatinine was statistically higher for both the fish + walnut (−0.16 ± 0.09 mg/dL, p = 0.001) and walnut (−0.15 ± 0.05 mg/dL, p = 0.001) diets compared with the fish diet (−0.05 ± 0.04 mg/dL). A significant decrease was seen in blood urea nitrogen (BUN) level in the fish + walnut group (−0.12 ± 0.05 mg/dL, p = 0.03) and walnut group (−0.10 ± 0.04 mg/dL, p = 0.03) compared to the fish group (−0.05 ± 0.03 mg/dL). The effect of serum creatinine and BUN in the fish + walnut diet group was relatively higher than in the walnut diet group. Also, a significant difference was observed regarding weight loss in the fish + walnut diet (−7.2 ± 0.9 kg, p = 0.03) compared to in the other groups. The change in other indices was not different among the three diets.

This study found synergistic benefits of the plant and marine omega-3 fatty acids in reducing serum creatinine, BUN and weight compared with isolated marine omega-3s in overweight and obese women.

Non‐discursive practices such as the economy and political constellations have always caused shifts in history. However, in the network society of today, these shifts have become omnipresent. Globalization of health and medical tourism have created a shift or rupture in the history of healthcare provision and into the lives of different stakeholders. The purpose of this paper is to detect and assess the rupture caused by global health care or medical tourism within the field of the written media, in order to define the reality of medical tourism as a trans‐historical field.

The methodology of this study comprised an extensive discourse analysis of written and new media performed over a time frame of more than a decade. Market, medical, ethical and patient discourses were detected along scientific sources, international and local newspapers.

Results indicate that a change in the market discourse has caused a shift in the attitude towards medical tourism, where ethical voices are seen as submissive to the market logic. In the current time perspective, medical tourism has become more mature with the development of non‐ethical counterparts such as organ tourism and reproductive tourism as a consequence.

The research framework shows that the general public receives a normative message from the medical tourism sector.

Currently, human hearts destined for transplantation can be used for 4.5 hours which is often insufficient to test the heart, the purpose of this paper is to find a compatible recipient and transport the heart to larger distances. Cooling systems with simultaneous internal and external liquid cooling were numerically simulated as a method to extend the usable life of human hearts.

Coolant was pumped inside major veins and through the cardiac chambers and also between the heart and cooling container walls. In Case 1, two inlets and two outlets on the container walls steadily circulated the coolant. In the Case 2, an additional inlet was specified on the container wall thus creating a steady jet impinging one of the thickest parts of the heart. Laminar internal flow and turbulent external flow were used in both cases. Unsteady periodic inlet velocities at two frequencies were applied in Case 3 and Case 4 that had four inlets and four outlets on walls with turbulent flows used for internal and external circulations.

Computational results show that the proposed cooling systems are able to reduce the heart temperature from +37°C to almost uniform +5°C within 25 min of cooling, thus reducing its metabolic rate of decay by 95 percent. Calculated combined thermal and hydrodynamic stresses were below the allowable threshold. Unsteady flows did not make any noticeable difference in the speed of cooling and uniformity of temperature field.

This is the pioneering numerical study of conjugate convective cooling schemes capable of cooling organs much faster and more uniformly than currently practiced.