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To determine whether data available to physicians in the emergency room can accurately identify which patients with acute chest pain are having myocardial infarctions, we analyzed 482 patients at one hospital. Using recursive partitioning analysis, we constructed a decision protocol in the format of a simple flow chart to identify infarction on the basis of nine clinical factors. In prospective testing on 468 other patients at a second hospital, the protocol performed as well as the physicians. Moreover, an integration of the protocol with the physicians' judgments resulted in a classification system that preserved sensitivity for detecting infarctions, significantly improved the specificity (from 67 per cent to 77 per cent, P less than 0.01) and positive predictive value (from 34 per cent to 42 per cent, P = 0.016) of admission to an intensive-care area. The protocol identified a subgroup of 107 patients among whom only 5 per cent had infarctions and for whom admission to non-intensive-care areas might be appropriate. This decision protocol warrants further wide-scale prospective testing but is not ready for routine clinical use.

Books can be purchased from the Harvard Medical Coop (333 Longwood Avenue). At the end of the course the student will be able to: • Analyze rights related to health in international and national human rights documents and application of these rights to work of public health • Evaluate different approaches to institution's promotion, monitoring, and implementation of human rights norms and analyze the value for health policies and programs • Apply human rights concepts and a human rights methodology to the analysis of health policies and programs • Conceptualize and apply a vulnerability and human rights analysis to health • Apply human rights concepts and a human rights approach to public health work Class Format Classes will consist of a background lecture, discussion of assigned readings, and case studies. Class meets on Wednesdays from 1:30-4:20 p.m. in Kresge 201. We will usually take a 10-minute break midway through the class. Class 1 (September 6) Part 1: Introduction To The Course The objectives, structure, readings, and assignments of the course will be presented. The underlying propositions and conceptual framework for the course will be discussed. The basic trends and developments in health and human rights will be briefly reviewed. Part 2: Human Rights Instruments And Core Principles The core principles of modern human rights thinking and practice will be discussed. Emphasis will be placed on the instruments comprising the International Bill of Human Rights.

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