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

Electromagnetic waves in stratified media

Some problems which arise in the analysis and design of multilayer filters are discussed in this thesis. The filters consist of sequences of parallel-sided media which reflect and transmit electromagnetic radiation. The cases considered are those appropriate to the optical region of the spectrum although the analysis is quite general.In the optical region, the refractive index of a thin film is generally measured by the Abeles method, which entails determining the angle of incidence at which the film and the bare substrate have the same value of Rp. The presence of a small amount of absorption can produce errors in measurements of this kind. Two ways of estimating the magnitude of this error are given. Considerable broadening of the reflectance band of a multilayer may be obtained by 'staggering' the layer thicknesses in such a way that they form either an arithmetic or geometric progression. Results are shown for fifteen, twenty-five and thirty-five layers. The presence of the narrow band transmission peaks exhibited by the symmetric filters is explained, and the advantages of the use of this type of filter as an interference filter arediscussed. A closed form expression for the matrix product of staggered layers is obtained for the case when the difference in thickness is small. A 'least squares' method of filter design is introduced. This method may be used either to design a filter automatically if no initial design is available, or to 'refine' an existing design. The method is applied to the design of antireflection coatings, beam splitters, low-and high-pass filters and broad-band high reflectance coatings. In addition, one or two well-known filter designs are used to test the method.<p

High Performance Computing For All

A Consortium of four partners - the University of Kent, University of Southampton, University of Wales College of Cardiff and Queen Mary and Westfield College have been pooling efforts to produce hypertext courseware to help teach High Performance Computing, jointly funded under the TLTP Phase II Programme by the Higher Education Funding Councils HEFCE, HEFCE,SHEFC and DENI. By high performance Computing we mean all aspects of parallelism:- Data Parallel concepts, Paradigms, Algorithms, Languages such as Fortran 90, High Performance Fortran, Occam, Message Passing. Architectures such as the Single Instruction Multiple Data(SIMD) eg. Maspar, Multiple Instruction Multiple Data (MIMD) eg Transputer Systems, NCube etc Users can choose the section of material, page order, point to clickable maps and explore to different levels of detail by following hyperlinks. This interaction only allows the user control over navigation. Electronic forms allow data input and this is going to be used in a variety of ways to provide self assessment and input of source code for example. Password control is another feature now available which has enabled control of particular resources to be set up and this opens the way for safe remote access. The multi media capabilities of the WEB system are now well known but at present the project has not sought to avail itself of for example, video or sound, but future enhancements will certainly do so

Recognising the Dynamics of Faces across Multiple Views

We present an integrated framework for dynamic face detection and recognition, where head pose is estimated using Support Vector Regression, face detection is performed by Support Vector Classification, and recognition is carried out in a feature space constructed by Linear Discriminant Analysis. Unlike mos

Characterization of a new intermediate macrophage subpopulation : SDC-1 positive SPM-like macrophages possess immunosuppressive functions in early mesotheliomagenic responses to carbon nanotubes

Malignant mesothelioma is a disease caused by inhalation of needle-like shaped particles and whose pathogenesis is not yet fully elucidated. A long-lasting general inflammation caused by persistent mesotheliomagenic particles is not sufficient to explain mesothelioma onset. Indeed, challenging data have shown that mesothelioma occurs without chronic inflammation. Our research team previously helped to discover that, beside inflammation, particles such as silica also induce a selective, rapid and sustained accumulation of immunosuppressive cells (regulatory T lymphocytes, myeloid derived suppressive cells and M2/regulatory macrophages) participating to fibrogenesis. To determine whether carcinogenic particles such as asbestos and carbon nanotubes (CNT) also elicit immunosuppressive responses, we investigated the impact of these particles on macrophage turnover, phenotype and immunosuppressive activity. With that purpose, we intraperitoneally injected mesotheliomagenic CNT-7 (needle-like, Mitsui & Co) and non-mesotheliomagenic CNT-T (tangled, Nagoya University) particles in Wistar rats and compared the effects on peritoneal macrophage subpopulations. We showed that macrophages die very rapidly in the attempt to phagocyte mesotheliomagenic CNT. They are later replenished by monocytic-derived small peritoneal macrophages (SPM-like macrophages) possessing comparable immunosuppressive functions and signatures to Tumor-Associated Macrophages (TAM), which infiltrate mesothelioma and block T cell antitumor activities. Early immunosuppressive SPM-like macrophages express and release the shed form of the immunoregulatory syndecan-1 glycoprotein, which could explain the immunosuppression that they exert on T cells. Non-mesotheliomagenic peritoneal responses induced by CNT-T are, in contrast, characterized by a recruitment of self-proliferating large peritoneal macrophages (LPM-like macrophages) that correspond to homeostatic macrophages without immunosuppressive activity. Our observations indicate that mesotheliomagenic particles elicit a prompt immunosuppressive response involved in an early environment favouring tumoral cell evasion from T cell surveillance. Since our RNA sequencing data indicated that immunosuppressive SPM-like macrophages have an intermediate polarization state between M1/inflammatory and M2/regulatory macrophages, we suggest that they may represent the gap between the short-term (inflammation) and long-term (tumor immunosuppression) responses to mesotheliomagenic particles. These observations offer new therapeutic targets (SPM or syndecan-1) and in vivo bioassays (macrophage replenishment) to anticipate particle hazard and carcinogenicity.(BIFA - Sciences biomédicales et pharmaceutiques) -- UCL, 202

Support Vector Regression and Classification Based Multi-view Face Detection and Recognition

A Support Vector Machine based multi-view face detection and recognition framework is described in this paper. Face detection is carried out by constructing several detectors, each of them in charge of one specific view. The symmetrical property of face images is employed to simplify the complexity of the modelling. The estimation of head pose, which is achieved by using the Support Vector Regression technique, provides crucial information for choosing the appropriate face detector. This helps to improve the accuracy and reduce the computation in multi-view face detection compared to other methods. For video sequences, further computational reduction can be achieved by using Pose Change Smoothing strategy. When face detectors find a face in frontal view, a Support Vector Machine based multi-class classifier is activated for face recognition. All the above issues are integrated under a Support Vector Machine framework. Test results on four video sequences are presented, among them, detection rate is above 95%, recognition accuracy is above 90%, average pose estimation error is around 10°, and the full detection and recognition speed is up to 4 frames/second on a PentiumII300 PC

Modelling Faces Dynamically Across Views and Over Time

A comprehensive novel multi-view dynamic face model is presented in this paper to address two challenging problems in face recognition and facial analysis: modelling faces with large pose variation and modelling faces dynamically in video sequences. The model consists of a sparse 3D shape model learnt from 2D images, a shape-and-posefree texture model, and an affine geometrical model. Model fitting is performed by optimising (1) a global fitting criterion on the overall face appearance whilst it changes across views and over time, (2) a local fitting criterion on a set of landmarks, and (3) a temporal fitting criterion between successive frames in a video sequence. By temporally estimating the model parameters over a sequence input, the identity and geometrical information of a face is extracted separately. The former is crucial to face recognition and facial analysis. The latter is used to aid tracking and aligning faces. We demonstrate the results of successfully applying this model on faces with large variation of pose and expression over time