Measuring the health-related Sustainable Development Goals in 188 countries: a baseline analysis from the Global Burden of Disease Study 2015

BACKGROUND: In September, 2015, the UN General Assembly established the Sustainable Development Goals (SDGs). The SDGs specify 17 universal goals, 169 targets, and 230 indicators leading up to 2030 ..

Healthcare Access and Quality Index based on mortality from causes amenable to personal health care in 195 countries and territories, 1990-2015 : a novel analysis from the Global Burden of Disease Study 2015

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-systemcharacteristics 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. Copyright (C) The Author(s). Published by Elsevier Ltd.Peer reviewe

Measuring the health-related Sustainable Development Goals in 188 countries : a baseline analysis from the Global Burden of Disease Study 2015

Background In September, 2015, the UN General Assembly established the Sustainable Development Goals (SDGs). The SDGs specify 17 universal goals, 169 targets, and 230 indicators leading up to 2030. We provide an analysis of 33 health-related SDG indicators based on the Global Burden of Diseases, Injuries, and Risk Factors Study 2015 (GBD 2015). Methods We applied statistical methods to systematically compiled data to estimate the performance of 33 health-related SDG indicators for 188 countries from 1990 to 2015. We rescaled each indicator on a scale from 0 (worst observed value between 1990 and 2015) to 100 (best observed). Indices representing all 33 health-related SDG indicators (health-related SDG index), health-related SDG indicators included in the Millennium Development Goals (MDG index), and health-related indicators not included in the MDGs (non-MDG index) were computed as the geometric mean of the rescaled indicators by SDG target. We used spline regressions to examine the relations between the Socio-demographic Index (SDI, a summary measure based on average income per person, educational attainment, and total fertility rate) and each of the health-related SDG indicators and indices. Findings In 2015, the median health-related SDG index was 59.3 (95% uncertainty interval 56.8-61.8) and varied widely by country, ranging from 85.5 (84.2-86.5) in Iceland to 20.4 (15.4-24.9) in Central African Republic. SDI was a good predictor of the health-related SDG index (r(2) = 0.88) and the MDG index (r(2) = 0.2), whereas the non-MDG index had a weaker relation with SDI (r(2) = 0.79). Between 2000 and 2015, the health-related SDG index improved by a median of 7.9 (IQR 5.0-10.4), and gains on the MDG index (a median change of 10.0 [6.7-13.1]) exceeded that of the non-MDG index (a median change of 5.5 [2.1-8.9]). Since 2000, pronounced progress occurred for indicators such as met need with modern contraception, under-5 mortality, and neonatal mortality, as well as the indicator for universal health coverage tracer interventions. Moderate improvements were found for indicators such as HIV and tuberculosis incidence, minimal changes for hepatitis B incidence took place, and childhood overweight considerably worsened. Interpretation GBD provides an independent, comparable avenue for monitoring progress towards the health-related SDGs. Our analysis not only highlights the importance of income, education, and fertility as drivers of health improvement but also emphasises that investments in these areas alone will not be sufficient. Although considerable progress on the health-related MDG indicators has been made, these gains will need to be sustained and, in many cases, accelerated to achieve the ambitious SDG targets. The minimal improvement in or worsening of health-related indicators beyond the MDGs highlight the need for additional resources to effectively address the expanded scope of the health-related SDGs.Peer reviewe

Outage Performance of Exponentiated Weibull FSO Links Under Generalized Pointing Errors

Política de acceso abierto tomada de: https://v2.sherpa.ac.uk/id/publication/42774Even in clear conditions, free-space optical (FSO) links are impaired by scintillation and dynamic misalignment which result in a slow fading channel. This paper presents the first characterization of outage performance for single-input/single-output FSO links over exponentiated Weibull atmospheric turbulence and generalized misalignment. A novel feature of this paper is that a generalized pointing error model is employed which not only takes into account the impact of different jitters for the elevation and the horizontal displacement but also the effect of different boresight errors for each axis. The developed asymptotic expressions are used to find optimum beam widths that minimize the impact of pointing error effects in a variety of atmospheric turbulence conditions. Obtained results corroborate that the impact of generalized pointing errors is approximately the same over moderate and strong turbulence conditions when an aperture-averaged receiver is considered. Additionally, the use of a transmitter with optimized beam width can result in large gains on the order of 5 dB or even greater

On the Effect of Air Bubbles-Induced Scattering on Turbid Waters: An Experimental UOWC Channel Modeling Approach

The influence of the oceanic medium on the underwater optical wireless communication (UOWC) highlights the need for an accurate mathematical channel characterization that models the properties of realistic oceanic environments, significantly optimizing the development of practical UOWC system designs. However, a need remains to provide a deeper insight into the behavior of air bubbles in turbid waters. This article presents an analysis and a statistical characterization of the received optical power fluctuations when considering different air bubble sizes and levels of particle-induced scattering. Experimental measurements were conducted in a water tank, manipulating water turbidity levels by dissolving a commercial antacid. Afterward, some evaluation metrics, such as the scintillation index, the average outage duration, and the coherence time, are calculated to provide an analytical framework of the air bubbles-induced fading in turbid environments. Additionally, the statistical behavior of small and large air bubbles are analytically described through the generalized Gamma distribution and a mixture of two generalized Gamma distributions, respectively, and validated with a coefficient of determination above 0.95 for all the considered turbid waters. Results demonstrate that water turbidity dramatically affects the stochastic behavior of the underwater channel in the presence of air bubbles, resulting in a significant reduction in light blockage due to the collection of scattered photons. As a result, the scintillation index and the average outage duration are noticeably reduced for more turbid water

Process Mineralogy of the Tailings from Llallagua: Towards a Sustainable Activity

There are significant tin reserves in the dumps and tailings from Llallagua. Currently, this waste is being processed using gravity concentration or a combination of gravity concentration with a final stage of froth flotation. A process mineralogy study of the tailings and their products after processing in Llallagua was carried out to determine the failings of the processing system in order to contribute to designing an improved new processing scheme. The mineralogy of the feed tailings, concentrate, and final tailings was determined by X-ray diffraction, scanning electron microscopy, and mineral liberation analysis. The tailings were composed of quartz, tourmaline, illite, K-feldspar, plagioclase, cassiterite, rutile, zircon, and monazite. The concentrate essentially contains cassiterite (57.4 wt.%), tourmaline, quartz, hematite, rutile and rare earth minerals, mainly monazite and minor amounts of xenotime and florencite. The concentrate contained 52-60 wt.% of SnO2 and 0.9-1.3 wt.% REE. The final tailings contained 0.23-0.37 wt.% SnO2 and 0.02 wt.% of Rare Earth Elements (REE). Only 57.6 wt.% of cassiterite from the concentrate was liberated. The non-liberated cassiterite was mainly associated with quartz, tourmaline, and rutile. The average grain size of monazite was 45 µm and 57.5 wt.% of this was liberated. In other cases, it occurs in mixed particles associated with tourmaline, quartz, cassiterite, and muscovite. To improve the sustainability of this mining activity, the concentrate grade and the metal recovery must be improved. Reducing the particle size reduction of the processed tailings would increase the beneficiation process rates. In addition, the recovery of the REE present in the concentrate as a by-product should be investigated