Summary Background National levels of personal health-care access and quality can be approximated by measuring mortality rates from causes that should not be fatal in the presence of effective ...medical care (ie, amenable mortality). Previous analyses of mortality amenable to health care only focused on high-income countries and faced several methodological challenges. In the present analysis, we use the highly standardised cause of death and risk factor estimates generated through the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) to improve and expand the quantification of personal health-care access and quality for 195 countries and territories from 1990 to 2015. Methods We mapped the most widely used list of causes amenable to personal health care developed by Nolte and McKee to 32 GBD causes. We accounted for variations in cause of death certification and misclassifications through the extensive data standardisation processes and redistribution algorithms developed for GBD. To isolate the effects of personal health-care access and quality, we risk-standardised cause-specific mortality rates for each geography-year by removing the joint effects of local environmental and behavioural risks, and adding back the global levels of risk exposure as estimated for GBD 2015. We employed principal component analysis to create a single, interpretable summary measure–the Healthcare Quality and Access (HAQ) Index–on a scale of 0 to 100. The HAQ Index showed strong convergence validity as compared with other health-system indicators, including health expenditure per capita (r=0·88), an index of 11 universal health coverage interventions ( r =0·83), and human resources for health per 1000 ( r =0·77). We used free disposal hull analysis with bootstrapping to produce a frontier based on the relationship between the HAQ Index and the Socio-demographic Index (SDI), a measure of overall development consisting of income per capita, average years of education, and total fertility rates. This frontier allowed us to better quantify the maximum levels of personal health-care access and quality achieved across the development spectrum, and pinpoint geographies where gaps between observed and potential levels have narrowed or widened over time. Findings Between 1990 and 2015, nearly all countries and territories saw their HAQ Index values improve; nonetheless, the difference between the highest and lowest observed HAQ Index was larger in 2015 than in 1990, ranging from 28·6 to 94·6. Of 195 geographies, 167 had statistically significant increases in HAQ Index levels since 1990, with South Korea, Turkey, Peru, China, and the Maldives recording among the largest gains by 2015. Performance on the HAQ Index and individual causes showed distinct patterns by region and level of development, yet substantial heterogeneities emerged for several causes, including cancers in highest-SDI countries; chronic kidney disease, diabetes, diarrhoeal diseases, and lower respiratory infections among middle-SDI countries; and measles and tetanus among lowest-SDI countries. While the global HAQ Index average rose from 40·7 (95% uncertainty interval, 39·0–42·8) in 1990 to 53·7 (52·2–55·4) in 2015, far less progress occurred in narrowing the gap between observed HAQ Index values and maximum levels achieved; at the global level, the difference between the observed and frontier HAQ Index only decreased from 21·2 in 1990 to 20·1 in 2015. If every country and territory had achieved the highest observed HAQ Index by their corresponding level of SDI, the global average would have been 73·8 in 2015. Several countries, particularly in eastern and western sub-Saharan Africa, reached HAQ Index values similar to or beyond their development levels, whereas others, namely in southern sub-Saharan Africa, the Middle East, and south Asia, lagged behind what geographies of similar development attained between 1990 and 2015. Interpretation This novel extension of the GBD Study shows the untapped potential for personal health-care access and quality improvement across the development spectrum. Amid substantive advances in personal health care at the national level, heterogeneous patterns for individual causes in given countries or territories suggest that few places have consistently achieved optimal health-care access and quality across health-system functions and therapeutic areas. This is especially evident in middle-SDI countries, many of which have recently undergone or are currently experiencing epidemiological transitions. The HAQ Index, if paired with other measures of health-system characteristics such as intervention coverage, could provide a robust avenue for tracking progress on universal health coverage and identifying local priorities for strengthening personal health-care quality and access throughout the world. Funding Bill & Melinda Gates Foundation.
The editors survey the theoretical frameworks of feminism and disability studies, locating the points of overlap crucial to a study of disability and mothering. Organized in five sections, the book ...engages questions about reproductive technologies; diagnoses and cultural scripts; the ability to rewrite narratives of mothering and disability; political activism; and the tensions formed by the overlapping identities of race, class, nation, and disability. The essays speak to a broad audience—from undergraduate and graduate students in women’s studies and disability studies, to therapeutic and health care professionals, to anyone grappling with issues such as genetic testing and counseling, raising a child with disability, or being disabled and contemplating starting a family.
What do we mean when we talk about disability in the Middle Ages? This volume brings together dynamic scholars working on the subject in medieval literature and history, who use the latest approaches ...from the field to address this central question. Contributors discuss such standard medieval texts as the Arthurian Legend, The Canterbury Tales and Old Norse Sagas, providing an accessible entry point to the field of medieval disability studies to medievalists. The essays explore a wide variety of disabilities, including the more traditionally accepted classifications of blindness and deafness, as well as perceived disabilities such as madness, pregnancy and age.
Adopting a ground-breaking new approach to the study of disability in the medieval period, this provocative book will interest medievalists and scholars of disability throughout history.
Als Schwellenräume zwischen Leben und Tod kommt Sterbeorten eine besondere Bedeutung zu. Mit dem Überführen des Sterbens aus dem privaträumlichen Wohnumfeld in medizinische und pflegerische ...Institutionen wird ihre Gestaltung und Verortung im Kontext der gebauten Lebenswelt und im gesellschaftlichen Diskurs daher zur Architekturaufgabe. Katharina Voigt dokumentiert die typologische Genese von Sterbeorten, führt zeitgenössische künstlerische Positionen zur Körperlichkeit, Transformation und Räumlichkeit des Sterbens an und entwickelt daraus Grundlagen für ein angemessenes Raumgeben am Lebensende. In Gesprächen über das Sterben kommen Protagonist*innen unterschiedlicher Disziplinen zu Wort, darunter Barbara Camilla Tucholski, Charlotte Uzarewicz, Frère Alain Durand und Stefan Kaegi. Mit einer Einführung von Uta Graff.
The root of the eukaryote tree of life defines some of the most fundamental relationships among species. It is also critical for defining the last eukaryote common ancestor (LECA), the shared ...heritage of all extant species. The unikont-bikont root has been the reigning paradigm for eukaryotes for more than 10 years 1 but is becoming increasingly controversial 2–4. We developed a carefully vetted data set, consisting of 37 nuclear-encoded proteins of close bacterial ancestry (euBacs) and their closest bacterial relatives, augmented by deep sequencing of the Acrasis kona (Heterolobosea, Discoba) transcriptome. Phylogenetic analysis of these data produces a highly robust, fully resolved global phylogeny of eukaryotes. The tree sorts all examined eukaryotes into three megagroups and identifies the Discoba, and potentially its parent taxon Excavata 5, as the sister group to the bulk of known eukaryote diversity, the proposed Neozoa (Amorphea + Stramenopila+Alveolata+Rhizaria+Plantae SARP 6). All major alternative hypotheses are rejected with as little as ∼50% of the data, and this resolution is unaffected by the presence of fast-evolving alignment positions or distant outgroup sequences. This “neozoan-excavate” root revises hypotheses of early eukaryote evolution and highlights the importance of the poorly studied Discoba for understanding the evolution of eukaryotic diversity and basic cellular processes.
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•A new 37-protein data set produces a robust and rooted eukaryote tree•All examined eukaryotes form three megagroups: Amorphea, SARP, and Excavata•A new neozoan-excavate root is proposed with strong statistical support•Discoba (Excavata) has a long, unique, and largely unknown evolutionary history
He et al. developed a novel data set of 37 eukaryotic proteins of bacterial ancestry (euBacs) to explore the major radiations of eukaryotes. A neozoan-excavate root is found, with the little-known Discoba (and potentially its parent taxon Excavata) identified as sister group to the bulk of known eukaryote diversity.
Antimicrobial resistance is an increasing problem on a global scale. Rapid antibiotic susceptibility testing (AST) is urgently needed in the clinic to enable personalized prescriptions in ...high-resistance environments and to limit the use of broad-spectrum drugs. Current rapid phenotypic AST methods do not include species identification (ID), leaving time-consuming plating or culturing as the only available option when ID is needed to make the sensitivity call. Here we describe a method to perform phenotypic AST at the single-cell level in a microfluidic chip that allows subsequent genotyping by in situ FISH. By stratifying the phenotypic AST response on the species of individual cells, it is possible to determine the susceptibility profile for each species in a mixed sample in 2 h. In this proof-of-principle study, we demonstrate the operation with four antibiotics and mixed samples with combinations of seven species.
Through an analysis of relevant literature and open-ended survey responses from 2501 Singaporeans, this article proposes a conceptual framework to understand how individuals authenticate the ...information they encounter on social media. In broad strokes, we find that individuals rely on both their own judgment of the source and the message, and when this does not adequately provide a definitive answer, they turn to external resources to authenticate news items.
In order to search for new desalination technologies to meet the growing water needs, this paper presents a parametric study of a novel, high-vacuum multiple-effect desalination system with ...barometric ejector-condensation activated with solar thermal energy, to demonstrate its technical feasibility. Aspen Plus simulation software was used for the parametric study, which was validated with the results reported in the literature. The high-vacuum multiple-effect distillation system has 14 effects, Top Brine Temperature of 68 °C and produces 96,033.6 L/d of water. The increase in the range of the pressure cascade (28.6–0.8 kPa), as well as of the temperature (68–4 °C), increases the capacity and efficiency of the desalination system. This is possible due to the implementation of an ejector that pumps, drags, and compresses vapor at 4 °C from the last effect of the system in order to condense it. In comparison to a conventional multiple-effect distillation, the Gain Output Ratio increases in 34.1 % because 25.4 % less energy from the generator is consumed. Furthermore, the system has a Recovery Ratio of 0.83, which corresponds approximately to a 120 % increase. Hence, the proposed desalination system significantly increases the potentiality of multiple-effect distillation systems.
•A new MED system configuration that operates at high-vacuum;•A barometric ejector-condensation process is proposed to condense the vapor at 4 °C;•New operating conditions, which increase the efficiency of the system, are set;•The maximum sea-water pre-heating level is reached using less pre-heaters;•A variable-flow pump is used in order to ensure the proper functioning of ejector.
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