Insufficient awareness of the centrality of pathology and laboratory medicine (PALM) to a functioning health-care system at policy and governmental level, with the resultant inadequate investment, ...has meant that efforts to enhance PALM in low-income and middle-income countries have been local, fragmented, and mostly unsustainable. Responding to the four major barriers in PALM service delivery that were identified in the first paper of this Series (workforce, infrastructure, education and training, and quality assurance), this second paper identifies potential solutions that can be applied in low-income and middle-income countries (LMICs). Increasing and retaining a quality PALM workforce requires access to mentorship and continuing professional development, task sharing, and the development of short-term visitor programmes. Opportunities to enhance the training of pathologists and allied PALM personnel by increasing and improving education provision must be explored and implemented. PALM infrastructure must be strengthened by addressing supply chain barriers, and ensuring laboratory information systems are in place. New technologies, including telepathology and point-of-care testing, can have a substantial role in PALM service delivery, if used appropriately. We emphasise the crucial importance of maintaining PALM quality and posit that all laboratories in LMICs should participate in quality assurance and accreditation programmes. A potential role for public-private partnerships in filling PALM services gaps should also be investigated. Finally, to deliver these solutions and ensure equitable access to essential services in LMICs, we propose a PALM package focused on these countries, integrated within a nationally tiered laboratory system, as part of an overarching national laboratory strategic plan.
Abstract
We describe the Arizona-NOIRLab Temporal Analysis and Response to Events System (ANTARES), a software instrument designed to process large-scale streams of astronomical time-domain alerts. ...With the advent of large-format CCDs on wide-field imaging telescopes, time-domain surveys now routinely discover tens of thousands of new events each night, more than can be evaluated by astronomers alone. The ANTARES event broker will process alerts, annotating them with catalog associations and filtering them to distinguish customizable subsets of events. We describe the data model of the system, the overall architecture, annotation, implementation of filters, system outputs, provenance tracking, system performance, and the user interface.
The European Union and the Austrian government have set ambitious plans to expand renewable energy sources and lower carbon dioxide emissions. However, the expansion of volatile renewable energy ...sources may affect today’s energy system. To investigate future challenges in Austria’s energy system, a suitable simulation methodology, temporal and spatially resolved generation and consumption data and energy grid depiction, is necessary. In this paper, we introduce a flexible multi-energy simulation framework with optimization capabilities that can be applied to a broad range of use cases. Furthermore, it is shown how a spatially and temporally resolved multi-energy system model can be set up on a national scale. To consider actual infrastructure properties, a detailed energy grid depiction is considered. Three scenarios assess the potential future energy system of Austria, focusing on the power grid, based on the government’s renewable energy sources expansion targets in the year 2030. Results show that the overwhelming majority of line overloads accrue in Austria’s power distribution grid. Furthermore, the mode of operation of flexible consumer and generation also affects the number of line overloads as well.
We present time-series imaging polarimetry observations of a nearby tidal disruption event (TDE) AT2019DSG at z = 0.0512 to probe the disruption mechanism and shed light on the accretion process. We ...obtain linear polarimetry using the Alhambra Faint Object Spectrograph and Camera on board the 2.5 m Nordic Optical Telescope. Our observations showed a polarization at the 9.2% 2.7% level early on, decreasing to less than 2.7% (at the 68% confidence level) one month later. While the high level of polarization in the early epoch is similar to that of Swift J164449.3+573451 and Swift J2058+0516, the low level of polarization in the later epoch is in agreement with that of OGLE16aaa. Our results thus show the temporal evolution of optical polarization from a TDE. As the degree of polarization changes over time, it is unlikely to be attributed to host galaxy dust, but may originate from a non-isotropic accreting disk, or associated with the relativistic jet emission.
Abstract
Placement of pathology and laboratory medicine (PALM) services requires balancing efficiency (maximizing test volume) with equitable urban–rural access. We compared the association between ...population density (proxy for efficiency) and travel time to the closest facility (proxy for equitable access) across levels of Tanzania’s public sector health system. We linked geospatial data for Tanzania from multiple sources. Data on facility locations and other geographic measures were collected from government and non-governmental databases. We classified facilities assuming increasing PALM availability by tier: (1) dispensaries, (2) health centres, (3) district hospitals and (4) regional/referral hospitals. We used the AccessMod 5 algorithm to estimate travel time to the closest facility for each tier across Tanzania with 500-m resolution. District-level average population density and travel time to the closest facility were calculated and presented using medians and interquartile ranges. Spatial correlations between these variables were estimated using the global Moran’s I and bivariate Local Indicator of Spatial Autocorrelation, specifying a queen’s neighbourhood matrix. Spatial analysis was restricted to 171 contiguous districts. The study included 5406 dispensaries, 675 health centres, 186 district hospitals and 37 regional/referral hospitals. District-level travel times were shortest for Tier 1 (median: IQR: 45.4 min 30.0–74.7) and longest for Tier 4 facilities (160.2 min 107.3–260.0). There was a weak spatial autocorrelation across tiers (Tier 1: −0.289, Tier 2: −0.292, Tier 3: −0.271 and Tier 4: −0.258) and few districts were classified as significant spatial outliers. Across tiers, geographic patterns of populated districts surrounded by neighbours with short travel time and sparsely populated districts surrounded by neighbours with long travel time were observed. Similar spatial correlation measures across health system levels suggest that Tanzania’s health system reflects equitable urban–rural access to different PALM services. Longer travel times to hospital-based care could be ameliorated by shifting specialized diagnostics to more accessible lower tiers.
IntroductionDecisions regarding the geographical placement of healthcare services require consideration of trade-offs between equity and efficiency, but few empirical assessments are available. We ...applied a novel geospatial framework to study these trade-offs in four African countries.MethodsGeolocation data on population density (a surrogate for efficiency), health centres and cancer referral centres in Kenya, Malawi, Tanzania and Rwanda were obtained from online databases. Travel time to the closest facility (a surrogate for equity) was estimated with 1 km resolution using the Access Mod 5 least cost distance algorithm. We studied associations between district-level average population density and travel time to closest facility for each country using Pearson’s correlation, and spatial autocorrelation using the Global Moran’s I statistic. Geographical clusters of districts with inefficient resource allocation were identified using the bivariate local indicator of spatial autocorrelation.ResultsPopulation density was inversely associated with travel time for all countries and levels of the health system (Pearson’s correlation range, health centres: −0.89 to −0.71; cancer referral centres: −0.92 to −0.43), favouring efficiency. For health centres, negative spatial autocorrelation (geographical clustering of dissimilar values of population density and travel time) was weaker in Rwanda (−0.310) and Tanzania (−0.292), countries with explicit policies supporting equitable access to rural healthcare, relative to Kenya (−0.579) and Malawi (−0.543). Stronger spatial autocorrelation was observed for cancer referral centres (Rwanda: −0.341; Tanzania: −0.259; Kenya: −0.595; Malawi: −0.666). Significant geographical clusters of sparsely populated districts with long travel times to care were identified across countries.ConclusionNegative spatial correlations suggested that the geographical distribution of health services favoured efficiency over equity, but spatial autocorrelation measures revealed more equitable geographical distribution of facilities in certain countries. These findings suggest that even when prioritising efficiency, thoughtful decisions regarding geographical allocation could increase equitable physical access to services.
Like in all areas of science, it is important for funders and investigators of pathology to work together to develop a well-designed, well-executed clinical research agenda. In the first section of ...this article, the authors discuss how the National Institutes of Health (NIH) peer-review process applies to global health pathology research projects. Then, the authors present an illustrative sampling of NIH-funded projects with performance sites in low- and middle-income countries with 2 examples focused on cancer and anatomic pathology. Finally, the authors relate the research agenda to overarching strategic recommendations for enhancing global pathology.
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