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<header class="masthead"><a class="brand" href="#"><span class="brandmark" aria-hidden="true">↗</span><span>ASCEND<small>DECISION OBSERVATORY</small></span></a><nav aria-label="Views"><button data-tab="world" class="active" aria-current="page">World lens</button><button data-tab="landscape">Decision landscape</button><button data-tab="evidence">Evidence atlas</button></nav><button class="icon-btn" id="methods">How it works <span aria-hidden="true">↗</span></button></header>
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<section class="intro"><div><div class="eyebrow"><span class="live-dot"></span> HEALTH SYSTEMS · EXPLORATORY RESEARCH</div><h1>Find the point where<br>the decision <em>changes.</em></h1><p class="lede">Explore what is known. Make assumptions visible.<br>Discover which uncertainty is worth resolving next.</p></div><div class="intro-aside"><span class="issue">FIELD NOTE 001 / SURGICAL ACCESS</span><div class="intro-line"></div><p>More funding is only useful<br>if care can move through<br>the whole system.</p><a href="#main" id="guided">Explore a bottleneck <span>↓</span></a></div></section>
<div class="utility"><div class="view-status" id="viewStatus"><span class="badge amber">ILLUSTRATIVE SCENARIO</span><span>12-month planning model · not a policy forecast</span></div><div><button id="reset" class="text-btn">Reset</button><button id="export" class="text-btn">Export decision ↗</button><button id="share" class="text-btn">Copy view link ↗</button></div></div>
<section id="landscape" class="view" aria-label="Decision landscape" hidden>
<div class="workspace"><aside class="controls"><div class="section-label">01 / SET THE CONDITIONS</div><h2>One pathway.<br>Four alternatives.</h2><p class="muted">A hypothetical surgical programme. These inputs are editable assumptions, not estimates for any country.</p>
<label for="budget">Additional annual budget <output id="budgetValue"></output></label><input type="range" id="budget" min="0" max="6000000" step="100000" value="2400000"><div class="range-ends"><span>R$0</span><span>R$6m</span></div>
<label for="capacity">Usable surgical slots / month <output id="capacityValue"></output></label><input type="range" id="capacity" min="40" max="180" step="1" value="90"><div class="range-ends"><span>40 slots</span><span>180 slots</span></div>
<label for="referralGain">Referral improvement <output id="referralValue"></output></label><input type="range" id="referralGain" min="0" max="0.4" step="0.01" value="0.15"><div class="range-ends"><span>+0 percentage points</span><span>+40 pp</span></div>
<details class="assumptions"><summary>Inspect all assumptions</summary><div><label for="arrivals">Eligible arrivals / month</label><input type="number" id="arrivals" min="1" max="1000" value="150"><label for="unitCost">Staffed slot bundle cost (R$)</label><input type="number" id="unitCost" min="1000" max="100000" step="1000" value="12000"><p>Baseline referral throughput: 60% of arrivals. Baseline funded slots: 100/month. Initial unresolved queue: 240. Referral programme fixed cost: R$600,000. Monthly completions can be fractional expected quantities.</p><p>Capacity purchases commit funds even if slots go unused. Referral effectiveness is hypothetical. Existing backlog cannot be cleared in this deliberately limited flow model.</p></div></details>
<button id="storyPreset" class="secondary full">Try a referral bottleneck ↗</button>
</aside><div class="landscape-panel"><div class="chart-heading"><div><div class="section-label">02 / EXPLORE THE DECISION BOUNDARY</div><h2>The landscape of possibilities</h2></div><button id="saveChart" class="text-btn">Save SVG ↓</button></div><p class="chart-deck">Each region shows the option delivering the most additional procedures. Click to change the conditions.</p><div id="terrainLegend" class="legend"></div><div id="terrainWrap" class="terrain-wrap"><svg id="terrain" role="img" aria-labelledby="terrainTitle terrainDesc"></svg></div><div class="chart-note"><span>↖ Click a point, or use the sliders</span><span>Colors indicate scenario choices, not probability.</span></div><div id="decisionCallout" class="decision-callout" aria-live="polite"></div></div></div>
<div class="results-grid"><section class="flow-panel"><div class="section-label">03 / FOLLOW THE BOTTLENECK</div><h2 id="flowTitle">How care moves through the system</h2><div id="flow"></div><p class="fineprint">Schematic monthly throughput. The narrowest gate limits completions. No patient-level waiting times or survival effects are inferred.</p></section><section class="comparison-panel"><div class="section-label">04 / COMPARE THE ALTERNATIVES</div><h2>What changes over 12 months?</h2><div id="comparison"></div><p class="fineprint">Rank by additional completions; break ties by lower committed spending, then simpler option. “Combined” can tie with a single intervention.</p></section></div>
<section class="next-question"><span class="question-icon" aria-hidden="true">?</span><div><div class="section-label">THE NEXT QUESTION</div><h2 id="nextQuestion"></h2><p id="nextReason"></p></div><button id="toEvidence" class="secondary">Inspect related evidence ↗</button></section>
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<section id="world" class="view active" aria-label="World lens"><div class="world-head"><div><div class="section-label">OBSERVATIONS, NOT CAUSAL EFFECTS</div><h1>One world.<br><em>Many possible futures.</em></h1><p class="muted">Public health-system indicators for every World Bank economy, including the Lancet Commission on Global Surgery indicators. National averages describe systems; they do not measure an individual's access to surgery.</p></div><div class="world-filters"><label for="year">Reference year</label><select id="year"></select><label for="worldMetric">Compare indicator</label><select id="worldMetric"></select><label for="regionFilter">Region</label><select id="regionFilter"></select></div></div><div class="globe-explorer"><section class="globe-panel" aria-label="Interactive world globe"><div class="globe-topbar"><div><div class="section-label">THE WORLD IN CONTEXT</div><h2>Explore the systems behind the numbers.</h2></div><button id="saveGlobe" class="globe-text" aria-label="Save globe image">Save globe image ↓</button></div><div class="globe-readout"><label for="globeMetric">Colour countries by</label><select id="globeMetric"></select><span id="globeSelected"></span></div><div class="globe-layers" id="globeLayers" hidden><label><input type="checkbox" id="overlayToggle"> Show travel-time surface</label><select id="overlaySurface" aria-label="Travel-time surface"><option value="motorized">motorised</option><option value="walking">walking only</option></select><span id="overlayLegend"></span><button id="liveGlobe" class="globe-text live-btn" hidden>Recolour from UN Data Commons (live) ↗</button></div><div id="worldGlobe" class="world-globe" aria-label="Drag to rotate the world; click a country to inspect it"><div id="globeTip" class="globe-tip" hidden></div></div><div class="globe-bottom"><div id="globeLegend" class="globe-legend"></div><div class="globe-controls" aria-label="Globe navigation"><button id="rotateWest" aria-label="Rotate west">←</button><button id="rotateEast" aria-label="Rotate east">→</button><button id="globeZoomOut" aria-label="Zoom out">−</button><button id="globeZoomIn" aria-label="Zoom in">+</button><button id="globeReset" aria-label="Focus selected country">◎</button><button id="globeRotate" aria-pressed="true">Pause rotation</button></div></div><p id="globeCoverage" class="globe-coverage"></p><p class="globe-guide">Drag to rotate · scroll or use + / − to zoom · click a country to select it. Grey means no observation for this indicator and year. Economies without 1:110m reference geometry (small states and territories) appear as capital markers.</p></section><aside class="country-detail" id="countryDetail"></aside></div><div class="globe-country-selector"><label for="globeCountry">Find a system</label><select id="globeCountry"></select><p>Reference geometry is Natural Earth 1:110m and expresses no position on disputed territories. Markers use World Bank capital coordinates.</p></div><div class="world-layout"><section class="scatter-panel"><div class="section-label">COMPARE THE OBSERVATIONS</div><h2>A different perspective on the same systems</h2><p class="chart-deck" id="scatterDeck"></p><div id="worldChart"></div><p id="worldMissing" class="fineprint"></p><div id="regionLegend" class="chips" aria-label="World Bank regions"></div></section></div><section class="world-table"><div class="table-head"><h3>Inspect the observations</h3><input id="tableFilter" type="search" placeholder="Filter economies…" aria-label="Filter economies"></div><div class="table-scroll"><table id="observationTable"></table></div><p class="fineprint" id="tableNote"></p></section></section>
<section id="evidence" class="view" aria-label="Evidence atlas" hidden><div class="evidence-head"><div><div class="section-label">TRACEABLE SOURCES / OPEN QUESTIONS</div><h2>Evidence has a place.<br>So does uncertainty.</h2><p class="muted">Publications and trial registrations are discovery leads. None automatically calibrates the scenario model.</p></div><div class="search-box"><label for="paperSearch">Explore publications</label><div><input id="paperSearch" type="search" placeholder="Search title, abstract, author…"><button id="liveSearch" class="secondary">Search Europe PMC ↗</button></div><p id="searchStatus" class="fineprint" aria-live="polite"></p></div></div><div class="evidence-categories"><button class="active" data-evidence="all">All sources</button><button data-evidence="capacity">Capacity</button><button data-evidence="access">Access & referral</button><button data-evidence="financing">Financing</button></div><div id="evidenceCards" class="evidence-cards"></div><section class="trial-section"><div class="section-label">RESEARCH IN PROGRESS</div><h2>Registered studies on surgical access and capacity</h2><p class="muted">Registrations describe research activity, not proven benefit or routine treatment capacity. Registry coverage of health-system interventions is thin; absence here is not absence of research.</p><div id="trials" class="trial-grid"></div></section><section class="source-section"><div class="section-label">SOURCE HEALTH</div><h2>Where the data come from</h2><div id="sourceRegistry" class="source-grid"></div><p id="snapshotNote" class="fineprint"></p></section></section>
</main><footer><div class="footer-brand">ASCEND <span>Make the assumptions visible.</span></div><p id="footerNote">Independent research prototype by Matheus Machado Rech. Indicators: World Bank (CC BY 4.0) and WHO Global Health Observatory; geometry: Natural Earth (public domain). Observational data; not a policy forecast.</p><button id="methodsFooter" class="text-btn">Model & sources ↗</button></footer>
<dialog id="methodDialog"><button id="closeMethods" class="close" aria-label="Close methods">×</button><div class="section-label">READ BEFORE INTERPRETING</div><h2>A decision laboratory,<br>with its assumptions exposed.</h2><div class="method-content"><h3>What is real?</h3><p>The World Lens uses retrieved World Bank and WHO Global Health Observatory observations for all 217 World Bank economies, 2000–2024, with the observation year always shown and missing values preserved. "Latest available" mode shows each economy's most recent observation, which can be many years old; fixed-year mode never carries values forward. The 3D globe colours Natural Earth 1:110m country geometry by the selected indicator (grey = no observation) and uses capital markers for small economies without geometry. Literature comes from Europe PMC; trial registrations from ClinicalTrials.gov. Snapshots remain inspectable when a service is unavailable.</p><h3>The surgical indicators</h3><p>Four of the six Lancet Commission on Global Surgery indicators are shown as compiled in World Development Indicators: specialist surgical workforce (surgeons, anaesthetists and obstetricians per 100,000), surgical volume (procedures per 100,000), and the shares of the population at risk of catastrophic and impoverishing expenditure if they needed surgery. The 2030 targets displayed are the Commission's: at least 20 providers and 5,000 procedures per 100,000, and 100% protection against both forms of expenditure. Two-hour geographic access and perioperative mortality are not available as comparable country series in these sources.</p><h3>Geographic access (modelled)</h3><p>ASCEND computes, for every economy, the share of the 2020 population living within one and two hours of the nearest healthcare facility and the population-weighted mean travel time, using the Malaria Atlas Project 2019 travel-time surfaces (motorised and walking-only; Weiss et al., Nature Medicine 2020) weighted by WorldPop 2020 counts at 1 km, over Natural Earth 1:10m polygons. The optional globe layer paints the same surface. These are modelled quantities about <em>any</em> facility, not the Lancet Commission's Bellwether 2-hour indicator, so they overstate surgical access; economies with fewer than half their population on valid pixels are left missing.</p><h3>UN System Data Commons</h3><p>Three indicators (UHC service coverage index, catastrophic health spending above 10%, physician density) carry a UN System Data Commons identifier (DCID). The refresh script stores each economy's latest UN Data Commons value next to the World Bank/WHO series and reports agreement at the latest common year; the country card shows both, and the "live" controls query the Commons' public V2 observation endpoint directly from your browser, replacing snapshot values only for the current session and only where marked. The same identifiers can be used with the UN System Data Commons MCP server by any MCP-capable research assistant; <code>tools/undc_probe.py</code> reproduces the discovery, metadata and retrieval steps used to select them.</p><h3>What is hypothetical?</h3><p>Every number in the Decision Landscape is an illustrative input. The model compares current practice, additional staffed surgical capacity, improved referrals, and both. It is not calibrated to a country, hospital, cancer type, or real financing policy.</p><h3>The calculation</h3><p>Each month: completions = minimum of patients available, referral throughput, usable capacity, and funded slots. Unresolved cases carry forward. Added budget buys staffed and funded slots; a referral programme first incurs its fixed cost. The comparison maximizes completed procedures, with spending and simpler interventions breaking ties.</p><h3>What the colors mean</h3><p>Regions show which strategy wins under a pair of capacity and referral assumptions. This is a sensitivity map, not a causal estimate, probability surface, or formal value-of-information analysis. Changing the objective could change the preferred strategy.</p><h3>What remains unknown?</h3><p>True unmet need, usable theatre capacity, implementation response, marginal costs, and patient outcomes require local evidence. National spending and life expectancy are contextual observations and never become model inputs automatically.</p><h3>AI and evidence</h3><p>AI assisted the development and source discovery for this prototype. The running app uses a transparent calculation and literature search, not a hidden language model. Publication relevance tags are keyword-based; they do not assess study quality or confirm causality.</p><h3>Provenance</h3><p>ASCEND is an independent research prototype. Earlier health-system explainers (including CADUCEUS) were an inspiration only; no framework, code or multipliers were reproduced. Indicator definitions and targets are credited to their publishers in the Source health panel.</p></div></dialog>
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