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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. 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. 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. 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. Bill & Melinda Gates Foundation.

\"The former governor of Virginia tells the behind-the-scenes story of the violent Unite the Right rally in Charlottesville--and shows how we can prevent other Charlottesvilles from happening\"-- Provided by publisher.

Exposing the white supremacists and Neo-Nazis involved in the 2017 Charlottesville rally, an investigation with ProPublica shows how some of those behind the racist violence went unpunished and continued to operate around the country.

The authors examine consumer activism as a form of power used by individuals when they experience a perceived failure with organizational service performance. Consumer citizens demonstrate the power of their voices through digital vigilantism consisting of injurious and constructive digital content sharing. The authors use agency theory and power concepts to study an instance in which a public service provider breached consumer performance expectations. They study digital responses to the 2017 Charlottesville Unite the Right rally because an independent review found the public service providers culpable. Tweets (n = 73,649) were analyzed utilizing qualitative thematic coding, cluster analysis, and sentiment analysis. Consumer conversations (tweets) during and after the rally yielded five types of digital vigilantism characterized by the following consumer voice clusters: “Shame on them!”, “Hear ye, hear ye…”, “Can you believe this?”, “Let’s get ‘em!”, and “Do the right thing.” The authors also present a new facet of digital vigilantism represented by the pessimistic and optimistic power of consumer voice. Several proactive and reactive responses are presented for policy and practice when responding to digital vigilantism.

Cole Connor has become a patient teacher, and now he has invited three struggling teenagers to visit him on his front porch to learn about Rex Connor--and the Seventeen Second Miracle. Together they will learn how Rex Connor could have allowed seventeen seconds to destroy him, but instead he chose to live every day believing the smallest of acts could change the world for good.

Heat waves have been linked to increases in emergency-related morbidity, but more research is needed on the demographic and disease-specific aspects of these morbidities. Using a case-crossover approach, over 700,000 daily emergency department hospital admissions in Charlottesville, Virginia, U.S.A. from 2005–2016 are compared between warm season heat wave and non-heat wave periods. Heat waves are defined based on the exceedance, for at least three consecutive days, of two apparent temperature thresholds (35 °C and 37 °C) that account for 3 and 6% of the period of record. Total admissions and admissions for whites, blacks, males, females, and 20–49 years old are significantly elevated during heat waves, as are admissions related to a variety of diagnostic categories, including diabetes, pregnancy complications, and injuries and poisoning. Evidence that heat waves raise emergency department admissions across numerous demographic and disease categories suggests that heat exerts comorbidity influences that extend beyond the more well-studied direct relationships such as heat strokes and cardiac arrest.

This short piece recounts the experience of listening to recordings of Sean Bonney’s work in Charlottesville, Virginia, in the years preceding and following the white supremacist rally held there in 2017. It argues that Bonney’s poetry provides a poetics of despair that resists complacency and paradoxically offers comfort.

This year marked the first anniversary of the white supremacist rally that terrorized Charlottesville, Virginia, and the 150th anniversary of the vote to ratify the 14th Amendment to the United States Constitution. The confluence of these two commemorations offers an opportunity to draw lessons from the national resurgence of racism and nationalism that has erupted in Charlottesville and throughout the country, in light of the 14th Amendment's still unfulfilled promise of equality. Section 1 of the 14th Amendment forbids any State to \"deny to any person within its jurisdiction the equal protection of the laws\" in America. Known as the \"Reconstruction Amendment,\" it granted citizenship to enslaved Americans and \"[a]ll persons born or naturalized in the United States.\" It further forbid states from lawfully discriminating against \"any person within its jurisdiction.\" Yet, by 1883, the United States Supreme Court had reversed congressional efforts to ensure that states would uphold equal rights for African Americans, and instead acquiesced to the segregationist interpretation that argued that constitutional equality did not mean social equality. In The Civil Rights Cases, the Supreme Court interpreted the 14th Amendment to allow racial segregation and discrimination by private actors.6 Then in 1896, the Supreme Court upheld the constitutionality of state laws that enforced racial segregation in public spaces, by declaring the Constitution of the United States powerless to put the \"inferior\" colored race on the same social plane as the white race. Thus, the Supreme Court gave legal grounding to gross inequities of the Jim Crow era and restored constitutional protection to the dehumanization of blacks. Indeed, the conviction that blacks are less than or a lesser form of human is the animating assumption that underlies and unites explicitly and implicitly racist American laws. Specifically, dehumanization undergirds explicit and implicit segregation.