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\"In celebration of the 50th anniversary of the Apollo 11 landing, the endlessly-mysterious moon is explored in this reprint short science fiction anthology from award-winning editor and anthologist Neil Clarke ... On July 20, 1969, mankind made what had only years earlier seemed like an impossible leap forward: when Apollo 11 became the first manned mission to land on the moon, and Neil Armstrong the first person to step foot on the lunar surface. While there have only been a handful of new missions since, the fascination with our planet's satellite continues, and generations of writers and artists have imagined the endless possibilities of lunar life. From adventures in the vast gulf of space between the earth and the moon, to journeys across the light face to the dark side, to the establishment of permanent residences on its surface, science fiction has for decades given readers bold and forward-thinking ideas about our nearest interstellar neighbor and what it might mean to humankind, both now and in our future. [This book] collects the best stories written in the fifty years since mankind first stepped foot on the lunar surface, serving as a shining reminder that the moon is and always has been our most visible and constant example of all the infinite possibility of the wider universe\"-- Provided by publisher.

Background Written discharge instructions improve patient understanding and self-management after hospitalization. While a small number of studies have evaluated the quality of hospital discharge instructions, none have focused on patients with a non-English language preference (NELP) or looked for potential disparities. Our goal was to compare the quality of patient discharge instructions between those with English language preference and NELP, including whether instructions were in the patient’s preferred language, included all content domains recommended by professional groups, and followed best practices for health literacy. Methods We analyzed 200 discharge records from inpatient adult medicine discharges at one hospital across a range of diagnoses using case matching by diagnosis and age to construct an English and NELP cohort (each n  = 100). We assessed the percentage of discharge instructions written in the patient’s preferred language, measured word count, and calculated readability scores. Lastly, two individual raters used a scale—the Quality of Discharge Instructions-Inpatient (QDI-I) scale—to rate them across six domains of content quality. Results Only 8% of patients with NELP received discharge instructions in their preferred language compared to 100% in the English cohort ( p  < 0.001). The mean overall QDI-I score was similar for the NELP and English cohorts (71.1% of perfect versus 71.3% of perfect, p  = 0.92), but the domain of return precautions was inferior among those with NELP (80.5% of perfect vs. 88.8% of perfect, p  = 0.013). Instructions in both groups were written at an eighth- to ninth-grade reading level (age 13–15). Discussion We found disparities in quality of written discharge instructions for patients with NELP. Recommended next steps include replication of our methods across health systems and larger sample sizes to examine differences between non-English language groups.

Background: The University of San Francisco, California (USFCA) and the Lesotho-Boston Health Alliance (LeBoHA) collaborated in designing and implementing an intensive, interprofessional global health immersion program for nursing and public health students from the United States. The program focused on health systems strengthening in Lesotho. This article reports on the curriculum development process, learning outcomes, and lessons learned from implementing the program. Methods: USFCA and LeBoHA began collaborating in March 2023. The partners codeveloped curriculum with the goal of introducing US students to global health systems challenges and ways to address them in a resource-constrained setting. The program sought to facilitate interprofessional collaboration between undergraduate nursing and graduate public health students, promote cross-cultural awareness and humility, and foster global perspectives and relationships to create a healthier and more humane world. The activity prioritized mutual respect in how the partner institutions worked together. Results: Three nursing and five public health students participated in the program held in January 2024 in Hlotse, Leribe District, Lesotho. The program included classroom learning sessions, health facility site visits, and extracurricular activities. Evaluation data suggested that students achieved course objectives and appreciated the active, experiential learning format. Lessons learned include planning for additional field visits and expanding the experience, possibly through Sesotho language instruction and interaction between students and LeBoHA faculty/staff before arrival and after the program ends. Conclusion: Short-term global health immersions can help to prepare nursing and public health students for careers in global health or working with underserved communities in the United States and strengthen interprofessionalism. Immersion programs should be developed in partnership and provide reciprocal benefits to the institutions involved.

Public-private partnerships (PPP) may increase healthcare quality but lack longitudinal evidence for success. The Queen ‘Mamohato Memorial Hospital (QMMH) in Lesotho is one of Africa’s first healthcare PPPs. We compare data from 2012 and 2018 on capacity, utilization, quality, and outcomes to understand if early documented successes have been sustained using the same measures over time. In this observational study using administrative and clinical data, we assessed beds, admissions, average length of stay (ALOS), outpatient visits, and patient outcomes. We measured triage time and crash cart stock through direct observation in 2013 and 2020. Operational hospital beds increased from 390 to 410. Admissions decreased (-5.3%) while outpatient visits increased (3.8%). ALOS increased from 5.1 to 6.5 days. Occupancy increased from 82% to 99%; half of the wards had occupancy rates ≥90%, and Neonatal ward occupancy was 209%. The proportion of crash cart stock present (82.9% to 73.8%) and timely triage (84.0% to 27.6%) decreased. While overall mortality decreased (8.0% to 6.5%) and neonatal mortality overall decreased (18.0% to 16.3%), mortality among very low birth weight neonates increased (30.2% to 36.8%). Declines in overall hospital mortality are promising. Yet, continued high occupancy could compromise infection control and impede response to infections, such as COVID-19. High occupancy in the Neonatal ward suggests that the population need for neonatal care outpaces QMMH capacity; improvements should be addressed at the hospital and systemic levels. The increase in ALOS is acceptable for a hospital meant to take the most critical cases. The decline in crash cart stock completeness and timely triage may affect access to emergency treatment. While the partnership itself ended earlier than anticipated, our evaluation suggests that generally the hospital under the PPP was operational, providing high-level, critically needed services, and continued to improve patient outcomes. Quality at QMMH remained substantially higher than at the former Queen Elizabeth II hospital.

Young women from the low-middle-income country of Lesotho in southern Africa frequently report limited knowledge regarding sexual and reproductive health issues and engage in risky sexual behaviors. The purpose of this study is to describe the adaptation of an evidence-based conversational agent system for implementation in Lesotho and provide qualitative data pertaining to the success of the said adaptation. An embodied conversational agent system used to provide preconception health advice in the United States was clinically and culturally adapted for use in the rural country of Lesotho in southern Africa. Inputs from potential end users, health leaders, and district nurses guided the adaptations. Focus group discussions with young women aged 18-28 years who had used the newly adapted system renamed \"Nthabi\" for 3-4 weeks and key informant interviews with Ministry of Health leadership were conducted to explore their views of the acceptability of the said adaptation. Data were analyzed using NVivo software, and a thematic content analysis approach was employed in the study. A total of 33 women aged 18-28 years used Nthabi for 3-4 weeks; eight (24.2%) of them were able to download and use the app on their mobile phones and 25 (75.8%) of them used the app on a tablet provided to them. Focus group participants (  = 33) reported that adaptations were culturally appropriate and provided relevant clinical information. The participants emphasized that the physical characteristics, personal and non-verbal behaviors, utilization of Sesotho words and idioms, and sensitively delivered clinical content were culturally appropriate for Lesotho. The key informants from the Ministry leadership (  = 10) agreed that the adaptation was successful, and that the system holds great potential to improve the delivery of health education in Lesotho. Both groups suggested modifications, such as using the local language and adapting Nthabi for use by boys and young men. Clinically tailored, culturally sensitive, and trustworthy content provided by Nthabi has the potential to improve accessibility of sexual and reproductive health information to young women in the low-middle-income country of Lesotho.

Public-private partnerships (PPP) are one strategy to finance and deliver healthcare in lower-resourced settings. Lesotho's Queen 'Mamohato Memorial Hospital Integrated Network (QMMH-IN) was sub-Saharan Africa's first and largest integrated healthcare PPP. We assessed successes and challenges to performance of the QMMH-IN PPP. We conducted 26 semi-structured interviews among QMMH-IN executive leadership and staff in early 2020. Questions were guided by the WHO Health System Building Blocks Framework. We conducted a thematic analysis. Facilitators of performance included: 1) PPP leadership commitment to quality improvement supported by protocols, monitoring, and actions; 2) high levels of accountability and discipline; and 3) well-functioning infrastructure, core systems, workflows, and internal referral network. Barriers to performance included: 1) human resource management challenges and 2) broader health system and referral network limitations. Respondents anticipated the collapse of the PPP and suggested better investing in training incoming managerial staff, improving staffing, and expanding QMMH-IN's role as a training facility. The PPP contract was terminated approximately five years before its anticipated end date; in mid-2021 the government of Lesotho assumed management of QMMH-IN. Going forward, the Lesotho government and others making strategic planning decisions should consider fostering a culture of quality improvement and accountability; ensuring sustained investments in human resource management; and allocating resources in a way that recognizes the interdependency of healthcare facilities and overall system strengthening. Contracts for integrated healthcare PPPs should be flexible to respond to changing external conditions and include provisions to invest in people as substantively as infrastructure, equipment, and core systems over the full length of the PPP. Healthcare PPPs, especially in lower-resource settings, should be developed with a strong understanding of their role in the broader health system and be implemented in conjunction with efforts to ensure and sustain adequate capacity and resources throughout the health system.

Background Healthcare resources have been concentrated in urban areas, leaving rural regions vulnerable to poorer health outcomes. The Problem Solving for Better Health (PSBH) program was implemented to enhance healthcare systems in resource-limited regions by training personnel to maximize existing resources in problem-solving. This study evaluated the implementation effectiveness of PSBH-Nursing (PSBHN), a nationally led initiative to train nurses in PSBH in Lesotho. Methods A mixed-methods study employing a single-group pre-test post-test design was conducted, guided by the RE-AIM theory. Training occurred from November 2021 to June 2022. Nurses completed the Problem-Solving Inventory (PSI) before and 3–6 months after training to measure changes in problem-solving efficacy. Quality scores were assigned to nurses’ planned quality improvement projects; project implementation was assessed 3–6 months after training. In-depth interviews (IDIs) explored changes in knowledge, problem-solving efficacy, and skills. Statistical analyses utilized paired T-tests and logistic regressions using STATA 17; content analysis was conducted on IDIs using NVivo12. Results Of 300 nurses, 89 were trained (30%) in the first year. Mainly medium or high-quality scores were achieved for the project designed. However, among 79 participants, only 49.4% reported initiating their projects. Overall problem-solving efficacy improved 3–6 months after training, but the increase was not statistically significant. Nurses reported improved knowledge, confidence and communication skills, enhanced problem-solving approaches, and increased emotional maturity in solving problems. A one-unit increase in project quality score correlated with a 35.0% increase in the odds of project initiation. Conclusion PSBHN demonstrated improved knowledge and minimal improvement in problem-solving efficacy among nurses 3–6 months post-training. However, application of skills gained in implementing their projects was insufficient. Still, PSBHN shows promise in addressing healthcare challenges in resource-limited settings. Some participants were able to start their projects but the inconsistency in follow-through suggests a need for more research into the factors that can improve completion of implementation for better health outcomes.

Background Improving the health of women before pregnancy and throughout a woman’s lifespan could mitigate disparities and improve the health and wellbeing of women, infants and children. The preconception period is important for reducing health risks associated with poor maternal, perinatal and neonatal outcomes, and eliminating racial and ethnic disparities in maternal and child health. Low cost health information technology interventions provided in community-based settings have the potential to reach and reduce disparities in health outcomes for socially disadvantaged, underserved and health disparity populations. These interventions are particularly important for Black and African American women who have a disproportionate burden of pregnancy-related complications and infant mortality rates compared to any other racial and ethnic group in the U.S. Methods This is a hybrid type II implementation-effectiveness cohort study aimed at evaluating appropriateness, acceptability and feasibility implementation outcomes, while also systematically examining the clinical effectiveness of a preconception care (PCC) intervention, the Gabby System, for Black and African American women receiving health services in community-based sites. The intervention will be implemented in six Community Health Centers and six Healthy Start programs across the U.S. Each study site will recruit and enroll 25–50 young Black and African American women who will participate in the intervention for a 6-month period. Appropriateness, acceptability and feasibility of implementing the PCC intervention will be assessed using: 1) Qualitative data derived from individual interviews with Gabby System end-users (clients and patients) and site staff; and, 2) Quantitative data from staff surveys, Gabby System usage and uptake. Aggregate health risk and utilization measures collected directly from the Gabby server will be used to examine the effectiveness of the Gabby System on self-reported behavior change. Discussion This study will examine implementation outcomes and clinical effectiveness of an evidence-based PCC intervention for Black and African American women receiving services in Healthy Start programs and Community Health Centers. Contextual factors that influence uptake and appropriate implementation strategies will be identified to inform future scalability of the intervention. Trial registration ClinicalTrials.gov NCT04514224 . Date of registration: August 14, 2020. Retrospectively Registered.

Young women in Lesotho face myriad sexual and reproductive health problems. There is little time to provide health education to women in low-resource settings with critical shortages of human resources for health. This study aims to determine the acceptability and usability of a conversational agent system, the Nthabi health promotion app, which was culturally adapted for use in Lesotho. We conducted a descriptive quantitative study, using a 22-item Likert scale survey to assess the perceptions of the usability and acceptability of 172 young women aged 18-28 years in rural districts of Lesotho, who used the system on either smartphones or tablets for up to 6 weeks. Descriptive statistics were used to calculate the averages and frequencies of the variables. χ tests were used to determine any associations among variables. A total of 138 participants were enrolled and completed the survey. The mean age was 22 years, most were unmarried, 56 (40.6%) participants had completed high school, 39 (28.3%) participants were unemployed, and 88 (63.8%) participants were students. Respondents believed the app was helpful, with 134 (97.1%) participants strongly agreeing or agreeing that the app was \"effective in helping them make decisions\" and \"could quickly improve health education and counselling.\" In addition, 136 (98.5%) participants strongly agreed or agreed that the app was \"simple to use,\" 130 (94.2 %) participants reported that Nthabi could \"easily repeat words that were not well understood,\" and 128 (92.7%) participants reported that the app \"could quickly load the information on the screen.\" Respondents were generally satisfied with the app, with 132 (95.6%) participants strongly agreeing or agreeing that the health education content delivered by the app was \"well organised and delivered in a timely way,\" while 133 (96.4%) participants \"enjoyed using the interface.\" They were satisfied with the cultural adaptation, with 133 (96.4%) participants strongly agreeing or agreeing that the app was \"culturally appropriate and that it could be easily shared with a family or community members.\" They also reported that Nthabi was worthwhile, with 127 (92%) participants reporting that they strongly agreed or agreed that they were \"satisfied with the application and intended to continue using it,\" while 135 (97.8%) participants would \"encourage others to use it.\" Participants aged 18-24 years (vs those aged 25-28 years) agreed that the \"Nthabi app was simple to use\" (106/106, 100% vs 30/32, 98.8%; P=.01), and agreed that \"the educational content was well organised and delivered in a timely way\" (104/106, 98.1% vs 28/32, 87.5%; P=.01). These results support further study of conversational agent systems as alternatives to traditional face-to-face provision of health education services in Lesotho, where there are critical shortages of human resources for health. ClinicalTrials.gov NCT04354168; https://www.clinicaltrials.gov/study/NCT04354168.

To improve the delivery and reach of primary health care, a robust scientific foundation driven by research is needed. However, few family physicians conduct research, especially in sub-Saharan Africa. Early-career and trainee family physicians are a key part of the primary care research pipeline and have an expressed need for research training and mentorship. AfriWon Research Collaborative (ARC) was an online research training and mentorship pilot program whose objective was to increase research activity among participants from AfriWon Renaissance, the family physician young doctors' movement of sub-Saharan Africa. ARC utilized a 10-module online curriculum, supported by peer and faculty e-mentorship, to guide participants through writing a research protocol. The feasibility, acceptability, and scalability of this program was evaluated via a mixed-methods RE-AIM-guided process evaluation using descriptive statistics and inductive/deductive thematic analysis. The pilot reached participants from Botswana, Democratic Republic of the Congo, Ghana, Nigeria and Sierra Leone and was adopted by mentors from 11 countries across three continents. Four of the 10 pilot participants completed a full research protocol by the end of the six-month core program. Seven out of the 10 participants, and nine out of the 15 mentors, planned to continue their mentorship relationships beyond the core program. The program helped instill a positive research culture in active participants. Some participants' and mentors' engagement with the ARC program was limited by confusion over mentorship structure and role, poor network connectivity, and personal life challenges. Online research training and mentorship for trainee and early-career family physicians in sub-Saharan Africa is feasible and acceptable to participants and mentors. Similar programs must pay careful attention to mentorship training and provide a flexible yet clearly organized structure for mentee-mentor engagement. Additional work is needed to determine optimal implementation strategies and ability to scale.