Multisystem inflammatory syndrome in children (MIS-C) and “Near MIS-C”: A continuum?

IntroductionReports of multisystem inflammatory syndrome in children (MIS-C), following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, have been increasing worldwide, with an incidence varying significantly across studies based on the definition used for the diagnosis. At our tertiary medical center in Lebanon, we encountered several cases that presented a diagnostic challenge because they mimicked MIS-C but did not meet the US Centers for Disease Control and Prevention (CDC) definition. We decided to review these cases and describe their features in comparison with cases that met the CDC criteria of MIS-C and those that had an alternative diagnosis.MethodsThis is a retrospective chart review of subjects aged <19 years old admitted to the American University of Beirut Medical Center (AUBMC) between March 1, 2020, and May 31, 2021, with suspected or confirmed MIS-C, following documented COVID-19 infection, with sufficient or insufficient criteria for diagnosis. Subjects were classified into 3 groups: “MIS-C”, “Near MIS-C” and “Alternative Diagnosis”.ResultsA total number of 29 subjects were included in our cohort. Fever was present in all subjects. In the MIS-C group, evidence for cardiovascular system involvement was the most common feature followed by the mucocutaneous and gastrointestinal systems. In the “Near MIS-C” and “Alternative Diagnosis” group, gastrointestinal symptoms were the most common with only one patient with cardiac abnormalities and none with coagulopathy. Subjects with typical MIS-C presentation had higher inflammatory markers when compared to subjects in the other groups. Almost all the subjects had positive IgG for SARS-CoV-2. Of the 29 subjects, the Royal College of Paediatrics and Child Health (RCPCH) case definition would have identified all suspected cases without an alternative diagnosis as MIS-C, whereas the World Health Organization (WHO) and the CDC definitions would have excluded 6 and 10 subjects, respectively.ConclusionMIS-C presents a diagnostic challenge due to the nonspecific symptoms, lack of pathognomonic findings, and potentially fatal complications. More research is needed to fully understand its pathogenesis, clinical presentation spectrum, and diagnostic criteria. Based on our experience, we favor the hypothesis that MIS-C has a continuum of severity that necessitates revisiting and unifying the current definitions

Thermal properties comparison of hybrid CF/FF and BF/FF cyanate ester-based composites

[EN] Insights within thermal expansion, conductivity, and decomposition dependencies with temperature on symmetrical and unsymmetrical layered carbon (CF) or basalt (BF) fabrics in combination with flax fibers (FF) were approached. Driven by commercial application and environmental concerns, the paper draws attention on a modified formula of cyanate ester with a common epoxy resin under an optimized ratio of 70:30 (vol%) as well as on the hybrid reinforcements stacking sequences. Synergetic effects were debated in terms of the CF and BF stacking sequences and corresponding volume fraction followed by comparisons with values predicted by the deployment of hybrid mixtures rules (RoHM/iRoHM). CF hybrid architectures revealed enhanced effective thermophysical properties over their BF counterparts and both over the FF-reinforced polymer composite considered as a reference. Thermal conductivities spread between 0.116 and 0.299 W m-1 K-1 from room temperature up to 250 C on all hybrid specimens, giving rise to an insulator character. Concerning the coefficient of thermal expansion, CF hybrid architectures disclosed values of 1.236 10-6 K-1 and 3.102 10-6 K-1 compared with BF affine exhibiting 4.794 10-6 K-1 and 6.245 10-6 K-1, respectively, with an increase in their volume fraction.The corresponding author gratefully acknowledges the financial assistance of German Academic Exchange Service-DAAD that enabled and supported the internship with Fraunhofer Research Institution for Polymeric Materials and Composites-PYCO, Germany. Many thanks go to Dr. Christian Dreyer and Dr. Maciej Gwiazda for the resin formula and access to the composite manufacturing technology.Motoc, DL.; Ferrándiz Bou, S.; Balart, R. (2018). Thermal properties comparison of hybrid CF/FF and BF/FF cyanate ester-based composites. Journal of Thermal Analysis and Calorimetry. 133(1):509-518. https://doi.org/10.1007/s10973-018-7222-yS5095181331Assarar M, Zouari W, Sabhi H, Ayad R, Berthelot J-M. Evaluation of the damping of hybrid carbon–flax reinforced composites. Compos Struct. 2015;132:148–54.Duc F, Bourban PE, Plummer CJG, Månson JAE. Damping of thermoset and thermoplastic flax fibre composites. Compos A Appl Sci Manuf. 2014;64:115–23.Saba N, Jawaid M, Alothman OY, Paridah MT. A review on dynamic mechanical properties of natural fibre reinforced polymer composites. Constr Build Mater. 2016;106:149–59.Tian H, Zhang S, Ge X, Xiang A. Crystallization behaviors and mechanical properties of carbon fiber-reinforced polypropylene composites. J Therm Anal Calorim. 2017;128(3):1495–504.Alvarez V, Rodriguez E, Vázquez A. Thermaldegradation and decomposition of jute/vinylester composites. J Therm Anal Calorim. 2006;85(2):383–9.Manfredi LB, Rodríguez ES, Wladyka-Przybylak M, Vázquez A. Thermal degradation and fire resistance of unsaturated polyester, modified acrylic resins and their composites with natural fibres. Polym Degrad Stab. 2006;91(2):255–61.Lazko J, Landercy N, Laoutid F, Dangreau L, Huguet MH, Talon O. Flame retardant treatments of insulating agro-materials from flax short fibres. Polym Degrad Stab. 2013;98(5):1043–51.Bar M, Alagirusamy R, Das A. Flame retardant polymer composites. Fibers Polym. 2015;16(4):705–17.Kollia E, Loutas T, Fiamegkou E, Vavouliotis A, Kostopoulos V. Degradation behavior of glass fiber reinforced cyanate ester composites under hydrothermal ageing. Polym Degrad Stab. 2015;121:200–7.Jawaid M, Abdul Khalil HPS. Cellulosic/synthetic fibre reinforced polymer hybrid composites: a review. Carbohyd Polym. 2011;86(1):1–18.Azwa ZN, Yousif BF, Manalo AC, Karunasena W. A review on the degradability of polymeric composites based on natural fibres. Mater Des. 2013;47:424–42.H-y Cheung, M-p Ho, K-t Lau, Cardona F, Hui D. Natural fibre-reinforced composites for bioengineering and environmental engineering applications. Compos B Eng. 2009;40(7):655–63.Dittenber DB, GangaRao HVS. Critical review of recent publications on use of natural composites in infrastructure. Compos A Appl Sci Manuf. 2012;43(8):1419–29.Faruk O, Bledzki AK, Fink H-P, Sain M. Biocomposites reinforced with natural fibers: 2000–2010. Prog Polym Sci. 2012;37(11):1552–96.Praveen RS, Jacob S, Murthy CRL, Balachandran P, Rao YVKS. Hybridization of carbon–glass epoxy composites: an approach to achieve low coefficient of thermal expansion at cryogenic temperatures. Cryogenics. 2011;51(2):95–104.Jawaid M, Abdul Khalil HPS, Alattas OS. Woven hybrid biocomposites: dynamic mechanical and thermal properties. Compos A Appl Sci Manuf. 2012;43(2):288–93.Swolfs Y, Gorbatikh L, Verpoest I. Fibre hybridisation in polymer composites: a review. Compos A Appl Sci Manuf. 2014;67:181–200.Rojo E, Alonso MV, Oliet M, Del Saz-Orozco B, Rodriguez F. Effect of fiber loading on the properties of treated cellulose fiber-reinforced phenolic composites. Compos B Eng. 2015;68:185–92.LeGault M. Natural fiber composites: market share, one part at the time. Compos World. 2016;5(2):68–75.Joshi SV, Drzal LT, Mohanty AK, Arora S. Are natural fiber composites environmentally superior to glass fiber reinforced composites? Compos A Appl Sci Manuf. 2004;35(3):371–6.Wambua P, Ivens J, Verpoest I. Natural fibres: can they replace glass in fibre reinforced plastics? Compos Sci Technol. 2003;63(9):1259–64.Bertomeu D, García-Sanoguera D, Fenollar O, Boronat T, Balart R. Use of eco-friendly epoxy resins from renewable resources as potential substitutes of petrochemical epoxy resins for ambient cured composites with flax reinforcements. Polym Compos. 2012;33(5):683–92.Alam M, Akram D, Sharmin E, Zafar F, Ahmad S. Vegetable oil based eco-friendly coating materials: a review article. Arab J Chem. 2014;7(4):469–79.Bakare FO, Ramamoorthy SK, Åkesson D, Skrifvars M. Thermomechanical properties of bio-based composites made from a lactic acid thermoset resin and flax and flax/basalt fibre reinforcements. Compos A Appl Sci Manuf. 2016;83:176–84.Pardauil JJR, de Molfetta FA, Braga M, de Souza LKC, Filho GNR, Zamian JR, et al. Characterization, thermal properties and phase transitions of amazonian vegetable oils. J Therm Anal Calorim. 2017;127(2):1221–9.Głowińska E, Datta J, Parcheta P. Effect of sisal fiber filler on thermal properties of bio-based polyurethane composites. J Therm Anal Calorim. 2017;130(1):113–22.Mosiewicki MA, Aranguren MI. A short review on novel biocomposites based on plant oil precursors. Eur Polym J. 2013;49(6):1243–56.Lligadas G, Ronda JC, Galià M, Cádiz V. Renewable polymeric materials from vegetable oils: a perspective. Mater Today. 2013;16(9):337–43.Fombuena V, Sanchez-Nacher L, Samper MD, Juarez D, Balart R. Study of the properties of thermoset materials derived from epoxidized soybean oil and protein fillers. J Am Oil Chem Soc. 2013;90(3):449–57.Pil L, Bensadoun F, Pariset J, Verpoest I. Why are designers fascinated by flax and hemp fibre composites? Compos A Appl Sci Manuf. 2016;83:193–205.Wooster TJ, Abrol S, Hey JM, MacFarlane DR. Thermal, mechanical, and conductivity properties of cyanate ester composites. Compos A Appl Sci Manuf. 2004;35(1):75–82.Mallarino S, Chailan JF, Vernet JL. Glass fibre sizing effect on dynamic mechanical properties of cyanate ester composites I. Single frequency investigations. Eur Polym J. 2005;41(8):1804–11.Sothje D, Dreyer C, Bauer M, editors. Advanced possibilities in thermoset recycling. In: The 3rd international conference on thermosets. 2013; Berlin, Germany.Yuan L, Huang S, Gu A, Liang G, Chen F, Hu Y, et al. A cyanate ester/microcapsule system with low cure temperature and self-healing capacity. Compos Sci Technol. 2013;87:111–7.Czigány T. Special manufacturing and characteristics of basalt fiber reinforced hybrid polypropylene composites: mechanical properties and acoustic emission study. Compos Sci Technol. 2006;66(16):3210–20.Marom G, Fischer S, Tuler FR, Wagner HD. Hybrid effects in composites: conditions for positive or negative effects versus rule-of-mixtures behaviour. J Mater Sci. 1978;13(7):1419–26.Torquato S. Random heterogeneous materials: microstructure and macroscopic properties. New York: Springer; 2002.Cherki A-B, Remy B, Khabbazi A, Jannot Y, Baillis D. Experimental thermal properties characterization of insulating cork–gypsum composite. Constr Build Mater. 2014;54:202–9.Bismarck A, Aranberri-Askargorta I, Springer J, Lampke T, Wielage B, Stamboulis A, et al. Surface characterization of flax, hemp and cellulose fibers; Surface properties and the water uptake behavior. Polym Compos. 2002;23(5):872–94.Motoc Luca D, Ferrandiz Bou S, Balart Gimeno R. Effects of fibre orientation and content on the mechanical, dynamic mechanical and thermal expansion properties of multi-layered glass/carbon fibre-reinforced polymer composites. J Compos Mater. 2014;49(10):1211–1221.CES EduPack. Granta Design; 2013.Monteiro SN, Calado V, Rodriguez RJS, Margem FM. Thermogravimetric behavior of natural fibers reinforced polymer composites—An overview. Mater Sci Eng, A. 2012;557:17–28

Measuring performance on the Healthcare Access and Quality Index for 195 countries and territories and selected subnational locations: a systematic analysis from the Global Burden of Disease Study 2016

Background A key component of achieving universal health coverage is ensuring that all populations have access to quality health care. Examining where gains have occurred or progress has faltered across and within countries is crucial to guiding decisions and strategies for future improvement. We used the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) to assess personal health-care access and quality with the Healthcare Access and Quality (HAQ) Index for 195 countries and territories, as well as subnational locations in seven countries, from 1990 to 2016.Methods Drawing from established methods and updated estimates from GBD 2016, we used 32 causes from which death should not occur in the presence of effective care to approximate personal health-care access and quality by location and over time. To better isolate potential effects of personal health-care access and quality from underlying risk factor patterns, we risk-standardised cause-specific deaths due to non-cancers by location-year, replacing the local joint exposure of environmental and behavioural risks with the global level of exposure. Supported by the expansion of cancer registry data in GBD 2016, we used mortality-to-incidence ratios for cancers instead of risk-standardised death rates to provide a stronger signal of the effects of personal health care and access on cancer survival. We transformed each cause to a scale of 0–100, with 0 as the first percentile (worst) observed between 1990 and 2016, and 100 as the 99th percentile (best); we set these thresholds at the country level, and then applied them to subnational locations. We applied a principal components analysis to construct the HAQ Index using all scaled cause values, providing an overall score of 0–100 of personal health-care access and quality by location over time. We then compared HAQ Index levels and trends by quintiles on the Socio-demographic Index (SDI), a summary measure of overall development. As derived from the broader GBD study and other data sources, we examined relationships between national HAQ Index scores and potential correlates of performance, such as total health spending per capita.Background A key component of achieving universal health coverage is ensuring that all populations have access to quality health care. Examining where gains have occurred or progress has faltered across and within countries is crucial to guiding decisions and strategies for future improvement. We used the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) to assess personal health-care access and quality with the Healthcare Access and Quality (HAQ) Index for 195 countries and territories, as well as subnational locations in seven countries, from 1990 to 2016.Methods Drawing from established methods and updated estimates from GBD 2016, we used 32 causes from which death should not occur in the presence of effective care to approximate personal health-care access and quality by location and over time. To better isolate potential effects of personal health-care access and quality from underlying risk factor patterns, we risk-standardised cause-specific deaths due to non-cancers by location-year, replacing the local joint exposure of environmental and behavioural risks with the global level of exposure. Supported by the expansion of cancer registry data in GBD 2016, we used mortality-to-incidence ratios for cancers instead of risk-standardised death rates to provide a stronger signal of the effects of personal health care and access on cancer survival. We transformed each cause to a scale of 0–100, with 0 as the first percentile (worst) observed between 1990 and 2016, and 100 as the 99th percentile (best); we set these thresholds at the country level, and then applied them to subnational locations. We applied a principal components analysis to construct the HAQ Index using all scaled cause values, providing an overall score of 0–100 of personal health-care access and quality by location over time. We then compared HAQ Index levels and trends by quintiles on the Socio-demographic Index (SDI), a summary measure of overall development. As derived from the broader GBD study and other data sources, we examined relationships between national HAQ Index scores and potential correlates of performance, such as total health spending per capita

Measuring performance on the Healthcare Access and Quality Index for 195 countries and territories and selected subnational locations: A systematic analysis from the Global Burden of Disease Study 2016

Background A key component of achieving universal health coverage is ensuring that all populations have access to quality health care. Examining where gains have occurred or progress has faltered across and within countries is crucial to guiding decisions and strategies for future improvement. We used the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) to assess personal health-care access and quality with the Healthcare Access and Quality (HAQ) Index for 195 countries and territories, as well as subnational locations in seven countries, from 1990 to 2016. Methods Drawing from established methods and updated estimates from GBD 2016, we used 32 causes from which death should not occur in the presence of effective care to approximate personal health-care access and quality by location and over time. To better isolate potential effects of personal health-care access and quality from underlying risk factor patterns, we risk-standardised cause-specific deaths due to non-cancers by location-year, replacing the local joint exposure of environmental and behavioural risks with the global level of exposure. Supported by the expansion of cancer registry data in GBD 2016, we used mortality-to-incidence ratios for cancers instead of risk-standardised death rates to provide a stronger signal of the effects of personal health care and access on cancer survival. We transformed each cause to a scale of 0–100, with 0 as the first percentile (worst) observed between 1990 and 2016, and 100 as the 99th percentile (best); we set these thresholds at the country level, and then applied them to subnational locations. We applied a principal components analysis to construct the HAQ Index using all scaled cause values, providing an overall score of 0–100 of personal health-care access and quality by location over time. We then compared HAQ Index levels and trends by quintiles on the Socio-demographic Index (SDI), a summary measure of overall development. As derived from the broader GBD study and other data sources, we examined relationships between national HAQ Index scores and potential correlates of performance, such as total health spending per capita. Findings In 2016, HAQ Index performance spanned from a high of 97·1 (95% UI 95·8–98·1) in Iceland, followed by 96·6 (94·9–97·9) in Norway and 96·1 (94·5–97·3) in the Netherlands, to values as low as 18·6 (13·1–24·4) in the Central African Republic, 19·0 (14·3–23·7) in Somalia, and 23·4 (20·2–26·8) in Guinea-Bissau. The pace of progress achieved between 1990 and 2016 varied, with markedly faster improvements occurring between 2000 and 2016 for many countries in sub-Saharan Africa and southeast Asia, whereas several countries in Latin America and elsewhere saw progress stagnate after experiencing considerable advances in the HAQ Index between 1990 and 2000. Striking subnational disparities emerged in personal health-care access and quality, with China and India having particularly large gaps between locations with the highest and lowest scores in 2016. In China, performance ranged from 91·5 (89·1–93·6) in Beijing to 48·0 (43·4–53·2) in Tibet (a 43·5-point difference), while India saw a 30·8-point disparity, from 64·8 (59·6–68·8) in Goa to 34·0 (30·3–38·1) in Assam. Japan recorded the smallest range in subnational HAQ performance in 2016 (a 4·8-point difference), whereas differences between subnational locations with the highest and lowest HAQ Index values were more than two times as high for the USA and three times as high for England. State-level gaps in the HAQ Index in Mexico somewhat narrowed from 1990 to 2016 (from a 20·9-point to 17·0-point difference), whereas in Brazil, disparities slightly increased across states during this time (a 17·2-point to 20·4-point difference). Performance on the HAQ Index showed strong linkages to overall development, with high and high-middle SDI countries generally having higher scores and faster gains for non-communicable diseases. Nonetheless, countries across the development spectrum saw substantial gains in some key health service areas from 2000 to 2016, most notably vaccine-preventable diseases. Overall, national performance on the HAQ Index was positively associated with higher levels of total health spending per capita, as well as health systems inputs, but these relationships were quite heterogeneous, particularly among low-to-middle SDI countries. Interpretation GBD 2016 provides a more detailed understanding of past success and current challenges in improving personal health-care access and quality worldwide. Despite substantial gains since 2000, many low-SDI and middle- SDI countries face considerable challenges unless heightened policy action and investments focus on advancing access to and quality of health care across key health services, especially non-communicable diseases. Stagnating or minimal improvements experienced by several low-middle to high-middle SDI countries could reflect the complexities of re-orienting both primary and secondary health-care services beyond the more limited foci of the Millennium Development Goals. Alongside initiatives to strengthen public health programmes, the pursuit of universal health coverage hinges upon improving both access and quality worldwide, and thus requires adopting a more comprehensive view—and subsequent provision—of quality health care for all populations.info:eu-repo/semantics/publishedVersio

Measuring performance on the Healthcare Access and Quality Index for 195 countries and territories and selected subnational locations: A systematic analysis from the Global Burden of Disease Study 2016

Background: A key component of achieving universal health coverage is ensuring that all populations have access to quality health care. Examining where gains have occurred or progress has faltered across and within countries is crucial to guiding decisions and strategies for future improvement. We used the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) to assess personal health-care access and quality with the Healthcare Access and Quality (HAQ) Index for 195 countries and territories, as well as subnational locations in seven countries, from 1990 to 2016. Methods Drawing from established methods and updated estimates from GBD 2016, we used 32 causes from which death should not occur in the presence of effective care to approximate personal health-care access and quality by location and over time. To better isolate potential effects of personal health-care access and quality from underlying risk factor patterns, we risk-standardised cause-specific deaths due to non-cancers by location-year, replacing the local joint exposure of environmental and behavioural risks with the global level of exposure. Supported by the expansion of cancer registry data in GBD 2016, we used mortality-to-incidence ratios for cancers instead of risk-standardised death rates to provide a stronger signal of the effects of personal health care and access on cancer survival. We transformed each cause to a scale of 0-100, with 0 as the first percentile (worst) observed between 1990 and 2016, and 100 as the 99th percentile (best); we set these thresholds at the country level, and then applied them to subnational locations. We applied a principal components analysis to construct the HAQ Index using all scaled cause values, providing an overall score of 0-100 of personal health-care access and quality by location over time. We then compared HAQ Index levels and trends by quintiles on the Socio-demographic Index (SDI), a summary measure of overall development. As derived from the broader GBD study and other data sources, we examined relationships between national HAQ Index scores and potential correlates of performance, such as total health spending per capita. Findings In 2016, HAQ Index performance spanned from a high of 97\ub71 (95% UI 95\ub78-98\ub71) in Iceland, followed by 96\ub76 (94\ub79-97\ub79) in Norway and 96\ub71 (94\ub75-97\ub73) in the Netherlands, to values as low as 18\ub76 (13\ub71-24\ub74) in the Central African Republic, 19\ub70 (14\ub73-23\ub77) in Somalia, and 23\ub74 (20\ub72-26\ub78) in Guinea-Bissau. The pace of progress achieved between 1990 and 2016 varied, with markedly faster improvements occurring between 2000 and 2016 for many countries in sub-Saharan Africa and southeast Asia, whereas several countries in Latin America and elsewhere saw progress stagnate after experiencing considerable advances in the HAQ Index between 1990 and 2000. Striking subnational disparities emerged in personal health-care access and quality, with China and India having particularly large gaps between locations with the highest and lowest scores in 2016. In China, performance ranged from 91\ub75 (89\ub71-93\ub76) in Beijing to 48\ub70 (43\ub74-53\ub72) in Tibet (a 43\ub75-point difference), while India saw a 30\ub78-point disparity, from 64\ub78 (59\ub76-68\ub78) in Goa to 34\ub70 (30\ub73-38\ub71) in Assam. Japan recorded the smallest range in subnational HAQ performance in 2016 (a 4\ub78-point difference), whereas differences between subnational locations with the highest and lowest HAQ Index values were more than two times as high for the USA and three times as high for England. State-level gaps in the HAQ Index in Mexico somewhat narrowed from 1990 to 2016 (from a 20\ub79-point to 17\ub70-point difference), whereas in Brazil, disparities slightly increased across states during this time (a 17\ub72-point to 20\ub74-point difference). Performance on the HAQ Index showed strong linkages to overall development, with high and high-middle SDI countries generally having higher scores and faster gains for non-communicable diseases. Nonetheless, countries across the development spectrum saw substantial gains in some key health service areas from 2000 to 2016, most notably vaccine-preventable diseases. Overall, national performance on the HAQ Index was positively associated with higher levels of total health spending per capita, as well as health systems inputs, but these relationships were quite heterogeneous, particularly among low-to-middle SDI countries. Interpretation GBD 2016 provides a more detailed understanding of past success and current challenges in improving personal health-care access and quality worldwide. Despite substantial gains since 2000, many low-SDI and middle- SDI countries face considerable challenges unless heightened policy action and investments focus on advancing access to and quality of health care across key health services, especially non-communicable diseases. Stagnating or minimal improvements experienced by several low-middle to high-middle SDI countries could reflect the complexities of re-orienting both primary and secondary health-care services beyond the more limited foci of the Millennium Development Goals. Alongside initiatives to strengthen public health programmes, the pursuit of universal health coverage hinges upon improving both access and quality worldwide, and thus requires adopting a more comprehensive view-and subsequent provision-of quality health care for all populations

Measuring performance on the Healthcare Access and Quality Index for 195 countries and territories and selected subnational locations: A systematic analysis from the Global Burden of Disease Study 2016

Copyright © 2018 The Author(s). Published by Elsevier Ltd. Background A key component of achieving universal health coverage is ensuring that all populations have access to quality health care. Examining where gains have occurred or progress has faltered across and within countries is crucial to guiding decisions and strategies for future improvement. We used the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) to assess personal health-care access and quality with the Healthcare Access and Quality (HAQ) Index for 195 countries and territories, as well as subnational locations in seven countries, from 1990 to 2016. Methods Drawing from established methods and updated estimates from GBD 2016, we used 32 causes from which death should not occur in the presence of effective care to approximate personal health-care access and quality by location and over time. To better isolate potential effects of personal health-care access and quality from underlying risk factor patterns, we risk-standardised cause-specific deaths due to non-cancers by location-year, replacing the local joint exposure of environmental and behavioural risks with the global level of exposure. Supported by the expansion of cancer registry data in GBD 2016, we used mortality-to-incidence ratios for cancers instead of risk-standardised death rates to provide a stronger signal of the effects of personal health care and access on cancer survival. We transformed each cause to a scale of 0-100, with 0 as the first percentile (worst) observed between 1990 and 2016, and 100 as the 99th percentile (best); we set these thresholds at the country level, and then applied them to subnational locations. We applied a principal components analysis to construct the HAQ Index using all scaled cause values, providing an overall score of 0-100 of personal health-care access and quality by location over time. We then compared HAQ Index levels and trends by quintiles on the Socio-demographic Index (SDI), a summary measure of overall development. As derived from the broader GBD study and other data sources, we examined relationships between national HAQ Index scores and potential correlates of performance, such as total health spending per capita. Findings In 2016, HAQ Index performance spanned from a high of 97·1 (95% UI 95·8-98·1) in Iceland, followed by 96·6 (94·9-97·9) in Norway and 96·1 (94·5-97·3) in the Netherlands, to values as low as 18·6 (13·1-24·4) in the Central African Republic, 19·0 (14·3-23·7) in Somalia, and 23·4 (20·2-26·8) in Guinea-Bissau. The pace of progress achieved between 1990 and 2016 varied, with markedly faster improvements occurring between 2000 and 2016 for many countries in sub-Saharan Africa and southeast Asia, whereas several countries in Latin America and elsewhere saw progress stagnate after experiencing considerable advances in the HAQ Index between 1990 and 2000. Striking subnational disparities emerged in personal health-care access and quality, with China and India having particularly large gaps between locations with the highest and lowest scores in 2016. In China, performance ranged from 91·5 (89·1-93·6) in Beijing to 48·0 (43·4-53·2) in Tibet (a 43·5-point difference), while India saw a 30·8-point disparity, from 64·8 (59·6-68·8) in Goa to 34·0 (30·3-38·1) in Assam. Japan recorded the smallest range in subnational HAQ performance in 2016 (a 4·8-point difference), whereas differences between subnational locations with the highest and lowest HAQ Index values were more than two times as high for the USA and three times as high for England. State-level gaps in the HAQ Index in Mexico somewhat narrowed from 1990 to 2016 (from a 20·9-point to 17·0-point difference), whereas in Brazil, disparities slightly increased across states during this time (a 17·2-point to 20·4-point difference). Performance on the HAQ Index showed strong linkages to overall development, with high and high-middle SDI countries generally having higher scores and faster gains for non-communicable diseases. Nonetheless, countries across the development spectrum saw substantial gains in some key health service areas from 2000 to 2016, most notably vaccine-preventable diseases. Overall, national performance on the HAQ Index was positively associated with higher levels of total health spending per capita, as well as health systems inputs, but these relationships were quite heterogeneous, particularly among low-to-middle SDI countries. Interpretation GBD 2016 provides a more detailed understanding of past success and current challenges in improving personal health-care access and quality worldwide. Despite substantial gains since 2000, many low-SDI and middle- SDI countries face considerable challenges unless heightened policy action and investments focus on advancing access to and quality of health care across key health services, especially non-communicable diseases. Stagnating or minimal improvements experienced by several low-middle to high-middle SDI countries could reflect the complexities of re-orienting both primary and secondary health-care services beyond the more limited foci of the Millennium Development Goals. Alongside initiatives to strengthen public health programmes, the pursuit of universal health coverage hinges upon improving both access and quality worldwide, and thus requires adopting a more comprehensive view - and subsequent provision - of quality health care for all populations

Measuring performance on the Healthcare Access and Quality Index for 195 countries and territories and selected subnational locations: a systematic analysis from the Global Burden of Disease Study 2016.

BACKGROUND: A key component of achieving universal health coverage is ensuring that all populations have access to quality health care. Examining where gains have occurred or progress has faltered across and within countries is crucial to guiding decisions and strategies for future improvement. We used the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) to assess personal health-care access and quality with the Healthcare Access and Quality (HAQ) Index for 195 countries and territories, as well as subnational locations in seven countries, from 1990 to 2016. METHODS: Drawing from established methods and updated estimates from GBD 2016, we used 32 causes from which death should not occur in the presence of effective care to approximate personal health-care access and quality by location and over time. To better isolate potential effects of personal health-care access and quality from underlying risk factor patterns, we risk-standardised cause-specific deaths due to non-cancers by location-year, replacing the local joint exposure of environmental and behavioural risks with the global level of exposure. Supported by the expansion of cancer registry data in GBD 2016, we used mortality-to-incidence ratios for cancers instead of risk-standardised death rates to provide a stronger signal of the effects of personal health care and access on cancer survival. We transformed each cause to a scale of 0-100, with 0 as the first percentile (worst) observed between 1990 and 2016, and 100 as the 99th percentile (best); we set these thresholds at the country level, and then applied them to subnational locations. We applied a principal components analysis to construct the HAQ Index using all scaled cause values, providing an overall score of 0-100 of personal health-care access and quality by location over time. We then compared HAQ Index levels and trends by quintiles on the Socio-demographic Index (SDI), a summary measure of overall development. As derived from the broader GBD study and other data sources, we examined relationships between national HAQ Index scores and potential correlates of performance, such as total health spending per capita

Prévention et traitement de la dysharmonie dento-maxillaire

La dysharmonie dento-maxillaire présente de nombreux signes cliniques et radiologiques permettant au praticien de poser un diagnostic précoce. Face à un manque de place sur l'arcade, l'orthodontiste dispose d'une large variété de possibilités thérapeutiques nécessitant relativement peu de coopération de la part du jeune patient, dont la durée est souvent limitée, et dont le but est de corriger une malocclusion débutante en dentition mixte ou d'éviter qu'elle ne s'aggrave. Le type de dysharmonie, sa sévérité et son étiologie orientent le choix thérapeutique entre la gestion de l'espace, l'augmentation de longueur d'arcade ou encore la réalisation d'extractions planifiées. Les objectifs principaux de l'intervention précoce en cas de dysharmonie dento-maxillaire sont de rétablir une occlusion équilibrée, mais également de réduire la durée et la complexité du traitement orthodontique en denture définitive

The Role of External Consultants in R&D Project Selection, and the Contributions of a Decision Support System

International audienc

The Role of External Consultants in R&D Project Selection, and the Contributions of a Decision Support System

International audienc