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.
Background: Infective endocarditis (IE) is still a fatal infection with high morbidity and mortality. Successful patient outcomes depend on prompt diagnosis and effective therapy. Blood cultures are ...usually time consuming and sometimes echocardiography is falsely negative. Thus, a straightforward blood test may assist early diagnosis of IE. Multiple studies have revealed that procalcitonin (PCT) was highly associated with bacteremia - the main diagnostic criteria for endocarditis - in patients with fever. Objectives: We aimed to assess the diagnostic significance of procalcitonin concentration in suspected patients of IE. Patients and methods: Twenty-two patients admitted to Assiut University Heart Hospital with a suspicion of IE were enrolled in a prospective study. Based on clinical, microbiological, and echocardiographic findings, Modified duke criteria were applied to the cases to confirm their diagnosis as definite, possible, or rejected IE cases before testing for procalcitonin was done. The study also included fifteen healthy volunteers for comparison with IE patients. Results: Procalcitonin was significantly higher (P-value <0.05) in patients diagnosed as definite and possible IE than with healthy volunteers. The area under the ROC curve was 0.705. At cutoff value of 0.425 ng/ml, the procalcitonin test's sensitivity, specificity, negative predictive value, and positive predictive values were 47.6%, 93.3%, 56%, and 90.9%, respectively. Conclusion: This study implies that procalcitonin may be a valuable supplementary diagnostic marker in IE diagnosis. A threshold value of 0.425 ng/ml should be used for ruling out endocarditis in routine clinical practice and the diagnosis of IE can be strongly excluded below this value.
The study traces the development of historiography surrounding the rulers in France in the 15th and early 16th centuries. In the first two parts, the focus is on the continuation and printing of the ...“Grandes Chroniques” in the 15th century up to the replacement of this leading text by the new, humanistically influenced works of Robert Gaguin and Paulus Aemilius. Along the way, numerous stages of development are reconstructed. Moreover, many historiographical works that have hardly been studied so far but were influenced heavily by the “Grandes Chroniques” are also discussed. For a long time during that period, the main topic of French historiography was the French Civil War (1407–1435) and the associated conflict with the English kings. The struggle of various parties for interpretative sovereignty over those decades therefore had a decisive influence on the development of French historiography in the 15th and early 16th centuries, which will be examined in the third part.
Die Studie zeichnet die Entwicklung der herrschaftsnahen Historiografie Frankreichs im 15. und frühen 16. Jahrhundert nach. Im Fokus steht dabei in den zwei ersten Teilen die Fortsetzung und Drucklegungen der »Grandes Chroniques« im 15. Jahrhundert bis hin zur Ablösung dieses Leittextes durch die neuen, humanistisch geprägten Werke von Robert Gaguin und Paulus Aemilius. Dazwischen werden zahlreiche Entwicklungsstufen rekonstruiert und auch bislang kaum untersuchte Werke thematisiert. Das Hauptthema der französischen Historiografie war in jener Zeit lange die damals jüngere Vergangenheit, das heißt der französische Bürgerkrieg (1407–1435) und der damit verbundene Konflikt mit den englischen Königen. Das Ringen verschiedener Parteien um die Deutungshoheit über jene Jahrzehnte prägte deshalb die Entwicklung der französischen Historiografie im 15. und frühen 16. Jahrhundert maßgeblich, was im dritten Teil der Arbeit untersucht wird.
À partir du xiiie siècle, les »Grandes chroniques de France«, pièce maîtresse de l’historiographie française, furent régulièrement augmentées et mises à jour. Au xve et au début du xvie siècle, le thème central de cette historiographie proche du pouvoir était la guerre civile entre Armagnacs et Bourguignons (1407–1435), et la guerre de Cent Ans, qui y était associée. Le développement historiographique était étroitement lié à la lutte de différentes parties pour la souveraineté de l’interprétation de ces conflits. Cette revendication est analysée ici pour la première fois dans un contexte où les »Grandes chroniques« ont, certes, été continuées en tant que récit historiographique, mais dans lequel, en même temps, de nouvelles œuvres d’inspiration humaniste les ont progressivement remplacées. L’étude reconstruit de nombreuses étapes de l’évolution des »Grandes chroniques« et traite également de textes créés dans leur environnement et qui n’ont guère été étudiés jusqu’à présent. Pour ce faire, manuscrits et ouvrages imprimés sont pris en compte de la même manière.
Lepuri kod Benkovca Sesar, Dora
Ars Adriatica,
02/2024, Letnik:
13, Številka:
13
Journal Article, Book Review
Recenzirano
Odprti dostop
Knjiga Lepuri kod Benkovca autora Ivana Josipovića obrađuje jedan od najvećih predromaničkih lokaliteta otkrivenih u Dalmaciji nakon završetka Drugog svjetskog rata. Detaljnom stilsko-morfološkom ...analizom i uspostavom analogija s do sada identificiranim klesarskim radionicama 9. stoljeća, obrađen je i katalogiziran znatan broj starokršćanskih i predromaničkih ulomaka arhitektonske dekoracije i liturgijskih instalacija. Ovako opširna obrada ulomaka pronađenih kod crkve Sv. Martina u Lepurima donosi nove spoznaje o hrvatskoj predromaničkoj skulpturi, radu klesarskih radionica tijekom 9. stoljeća, ali i o povijesno-društvenom kontekstu i događanjima na tom prostoru od prapovijesti do danas.
While multiple experiments have demonstrated that trees exposed to elevated CO₂can stimulate microbes to release nutrients from soil organic matter, the importance of root‐ versus mycorrhizal‐induced ...changes in soil processes are presently unknown. We analyzed the contribution of roots and mycorrhizal activities to carbon (C) and nitrogen (N) turnover in a loblolly pine (Pinus taeda) forest exposed to elevated CO₂by measuring extracellular enzyme activities at soil microsites accessed via root windows. Specifically, we quantified enzyme activity from soil adjacent to root tips (rhizosphere), soil adjacent to hyphal tips (hyphosphere), and bulk soil. During the peak growing season, CO₂enrichment induced a greater increase of N‐releasing enzymes in the rhizosphere (215% increase) than in the hyphosphere (36% increase), but a greater increase of recalcitrant C‐degrading enzymes in the hyphosphere (118%) than in the rhizosphere (19%). Nitrogen fertilization influenced the magnitude of CO₂effects on enzyme activities in the rhizosphere only. At the ecosystem scale, the rhizosphere accounted for c. 50% and 40% of the total activity of N‐ and C‐releasing enzymes, respectively. Collectively, our results suggest that root exudates may contribute more to accelerated N cycling under elevated CO₂at this site, while mycorrhizal fungi may contribute more to soil C degradation.
Introduction. Coxiella burnetii is the causative agent of Q fever, a zoonosis that is usually associated with cattle, sheep, goats and their bodily fluids, mainly milk or amniotic fluid. The disease ...manifests most commonly as an upper respiratory tract infection or pneumonia, but, in less common cases can lead to endocarditis, hepatitis, meningo-encephalitis and osteomyelitis. In the acute stage, patients usually have a self-limited febrile illness, which can progress to the chronic form of Q fever, most commonly with endocarditis. Endocarditis is the main manifestation of chronic Q fever and it usually affects patients with risk factors, such as prosthetic valves, abnormal native valves or other cardiac disease history, but it can also be seen in patients with no prior medical history, like the one we describe. The diagnosis is confirmed using the same Duke Criteria used in infectious endocarditis, with one major criterion being either a positive blood culture or PCR for C. burnetii, or a positive IgG phase I serological test >1:6400). The preferred treatment regimen is doxycycline plus hydroxychloroquine, maintained for a minimum of 18 months, along with regular follow-ups for serology testing and side-effects evaluation. Case presentation. We describe the case of a 53-year old male with no medical history who presented in our clinic for a 2-week evolution of fever, chills and weight loss. The physical examination revealed no pathological findings. The trans-esophageal cardiac echography showed small vegetations on the mitral valve and the serological test for Coxiella burnetii was positive, thus allowing us to confirm the diagnosis of Coxiella burnetii endocarditis and start treatment with Doxycycline and Hydroxychloroquine. Conclusions. Coxiella burnetii must be taken into account as a possible diagnosis for culture-negative endocarditis, even in patients with no cardiological medical history and no environmental risk factors.
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