Mortality due to low-quality health systems in the universal health coverage era: a systematic analysis of amenable deaths in 137 countries.

Background: Universal health coverage has been proposed as a strategy to improve health in low-income and middle-income countries (LMICs). However, this is contingent on the provision of good-quality health care. We estimate the excess mortality for conditions targeted in the Sustainable Development Goals (SDG) that are amenable to health care and the portion of this excess mortality due to poor-quality care in 137 LMICs, in which excess mortality refers to deaths that could have been averted in settings with strong health systems.

Ineffective insurance in lower and middle income countries is an obstacle to universal health coverage.

Background: Recent health policy efforts have sought to promote universal health coverage (UHC) as a means of providing affordable access to health services to populations. However, insurance schemes are heterogeneous, and some schemes may not provide necessary services to those covered. We explored the prevalence and determinants of ineffective insurance across 42 lower and middle income countries (LMICs) from the 2002-2004 World Health Survey.

Increased prevalence of subclinical coronary atherosclerosis in young patients with ankylosing spondylitis.

Introduction There is substantial evidence that spondyloarthropathies, such as ankylosing spondylitis (AS) and psoriatic arthritis (PsA), may increase cardiovascular risk. Objectives The study aimed to compare development of atherosclerotic lesions in coronary arteries between patients with AS and individuals without rheumatic dise ases. Patients and methods A total of 37 adult patients with AS (mean [SD] age, 40.

Does quality influence utilization of primary health care? Evidence from Haiti.

Background: Expanding coverage of primary healthcare services such as antenatal care and vaccinations is a global health priority; however, many Haitians do not utilize these services. One reason may be that the population avoids low quality health facilities. We examined how facility infrastructure and the quality of primary health care service delivery were associated with community utilization of primary health care services in Haiti.

Diagnostic Accuracy of a Machine-Learning Approach to Coronary Computed Tomographic Angiography-Based Fractional Flow Reserve: Result From the MACHINE Consortium.

Background: Coronary computed tomographic angiography (CTA) is a reliable modality to detect coronary artery disease. However, CTA generally overestimates stenosis severity compared with invasive angiography, and angiographic stenosis does not necessarily imply hemodynamic relevance when fractional flow reserve (FFR) is used as reference. CTA-based FFR (CT-FFR), using computational fluid dynamics (CFD), improves the correlation with invasive FFR results but is computationally demanding.

Can India's primary care facilities deliver? A cross-sectional assessment of the Indian public health system's capacity for basic delivery and newborn services.

Objectives: To assess input and process capacity for basic delivery and newborn (intrapartum care hereafter) care in the Indian public health system and to describe differences in facility capacity between rural and urban areas and across states.

Design: Cross-sectional study.

Setting: Data from the nationally representative 2012-2014 District Level Household and Facility Survey, which includes a census of community health centres (CHC) and sample of primary health centres (PHC) across 30 states and union territories in India.

Impact of measles supplementary immunisation activities on utilisation of maternal and child health services in low-income and middle-income countries.

Background: Measles supplementary immunisation activities (SIAs) are an integral component of measles elimination in low-income and middle-income countries (LMICs). Despite their success in increasing vaccination coverage, there are concerns about their negative consequences on routine services. Few studies have conducted quantitative assessments of SIA impact on utilisation of health services.

False-positive reduction in computer-aided mass detection using mammographic texture analysis and classification.

Background And Objective: The aim of computer-aided-detection (CAD) systems for mammograms is to assist radiologists by marking region of interest (ROIs) depicting abnormalities. However, the confusing appearance of some normal tissues that visually look like masses results in a large proportion of marked ROIs with normal tissues. This paper copes with this problem and proposes a framework to reduce false positive masses detected by CAD.

Comprehensive genomic analysis of patients with disorders of cerebral cortical development.

Malformations of cortical development (MCDs) manifest with structural brain anomalies that lead to neurologic sequelae, including epilepsy, cerebral palsy, developmental delay, and intellectual disability. To investigate the underlying genetic architecture of patients with disorders of cerebral cortical development, a cohort of 54 patients demonstrating neuroradiologic signs of MCDs was investigated. Individual genomes were interrogated for single-nucleotide variants (SNV) and copy number variants (CNV) with whole-exome sequencing and chromosomal microarray studies.

Swollen mixed Pluronic surfactant micelles as templates for mesoporous nanotubes with diverse bridged-organosilica frameworks.

Bridged-organosilica nanotubes with a variety of bridging groups (methylene, ethylene, ethenylene, phenylene and p-xylylene) were synthesized using swollen mixtures of Pluronic triblock copolymer surfactants as micellar templates. The mixtures consisted of Pluronic F127 surfactant (EOPOEO) with long poly(ethylene oxide), PEO, blocks, which help prevent the formation of consolidated structures, and another Pluronic with shorter PEO blocks and higher poly(propylene oxide) content, which promote swelling and the cylindrical micelle morphology. In the presence of toluene as a swelling agent, the use of Pluronic P123 (EOPOEO) in the mixture allowed us to readily generate organosilica nanotubes, but the products were often contaminated, sometimes substantially, with large nanospheres and other impurities.

Distribution and determinants of pneumonia diagnosis using Integrated Management of Childhood Illness guidelines: a nationally representative study in Malawi.

Background: Pneumonia remains the leading cause of child mortality in sub-Saharan Africa. The Integrated Management of Childhood Illness (IMCI) strategy was developed to standardise care in low-income and middle-income countries for major childhood illnesses and can effectively improve healthcare worker performance. Suboptimal clinical evaluation can result in missed diagnoses and excess morbidity and mortality.

Temperature Effects Explain Continental Scale Distribution of Cyanobacterial Toxins.

Insight into how environmental change determines the production and distribution of cyanobacterial toxins is necessary for risk assessment. Management guidelines currently focus on hepatotoxins (microcystins). Increasing attention is given to other classes, such as neurotoxins (e.

Effective coverage of primary care services in eight high-mortality countries.

Introduction: Measurement of effective coverage (quality-corrected coverage) of essential health services is critical to monitoring progress towards the Sustainable Development Goal for health. We combine facility and household surveys from eight low-income and middle-income countries to examine effective coverage of maternal and child health services.

Methods: We developed indices of essential clinical actions for antenatal care, family planning and care for sick children from existing guidelines and used data from direct observations of clinical visits conducted in Haiti, Kenya, Malawi, Namibia, Rwanda, Senegal, Tanzania and Uganda between 2007 and 2015 to measure quality of care delivered.

Body satisfaction and body weight in under- and healthy-weight adolescents: mediating effects of restrictive dieting, healthy and unhealthy food intake.

Purpose: Theoretical models, such as the transdiagnostic model of eating disorders highlight the role of cognitive factors (e.g., the way people perceive their bodies) and their associations with maladaptive weight management behaviors resulting in underweight.

Content of Care in 15,000 Sick Child Consultations in Nine Lower-Income Countries.

Objective: Describe content of clinical care for sick children in low-resource settings.

Data Sources: Nationally representative health facility surveys in Haiti, Kenya, Malawi, Namibia, Nepal, Rwanda, Senegal, Tanzania, and Uganda from 2007 to 2015.

Study Design: Clinical visits by sick children under 5 years were observed and caregivers interviewed.

Device Thrombosis After Percutaneous Left Atrial Appendage Occlusion Is Related to Patient and Procedural Characteristics but Not to Duration of Postimplantation Dual Antiplatelet Therapy.

Background: Device-related thrombus (DRT) after left atrial appendage occlusion is a worrisome finding with little knowledge about when to expect it and how to prevent it. This study sought to investigate correlates of DRT after left atrial appendage occlusion, its time of diagnosis, and particularly, association with postimplantation dual antiplatelet therapy duration.

Methods And Results: Consecutive patients (n=102) after left atrial appendage occlusion with AMPLATZER Cardiac Plug/Amulet (n=59) or WATCHMAN (n=43) were included in a prospective registry (October 2011-May 2016).

Measurements of Lumen Areas and Diameters of Proximal and Middle Coronary Artery Segments in Subjects Without Coronary Atherosclerosis.

There are plenty of data on morphology and lumen dimensions of diseased coronary arteries. However, information on normal coronary vessel anatomy is scarce. We provided computed tomography angiography-derived reference values of lumen dimensions in proximal and middle coronary segments in a healthy population with respect to gender and vessel dominance.

Disrespectful and abusive treatment during facility delivery in Tanzania: a facility and community survey.

Although qualitative studies have raised attention to humiliating treatment of women during labour and delivery, there are no reliable estimates of the prevalence of disrespectful and abusive treatment in health facilities. We measured the frequency of reported abusive experiences during facility childbirth in eight health facilities in Tanzania and examined associated factors. The study was conducted in rural northeastern Tanzania.

Association between infrastructure and observed quality of care in 4 healthcare services: A cross-sectional study of 4,300 facilities in 8 countries.

Background: It is increasingly apparent that access to healthcare without adequate quality of care is insufficient to improve population health outcomes. We assess whether the most commonly measured attribute of health facilities in low- and middle-income countries (LMICs)-the structural inputs to care-predicts the clinical quality of care provided to patients.

Methods And Findings: Service Provision Assessments are nationally representative health facility surveys conducted by the Demographic and Health Survey Program with support from the US Agency for International Development.