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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 Nordic Centre of Excellence CRAICC (Cryosphere–Atmosphere Interactions in a Changing Arctic Climate), funded by NordForsk in the years 2011–2016, is the largest joint Nordic research and innovation initiative to date, aiming to strengthen research and innovation regarding climate change issues in the Nordic region. CRAICC gathered more than 100 scientists from all Nordic countries in a virtual centre with the objectives of identifying and quantifying the major processes controlling Arctic warming and related feedback mechanisms, outlining strategies to mitigate Arctic warming, and developing Nordic Earth system modelling with a focus on short-lived climate forcers (SLCFs), including natural and anthropogenic aerosols. The outcome of CRAICC is reflected in more than 150 peer-reviewed scientific publications, most of which are in the CRAICC special issue of the journal Atmospheric Chemistry and Physics. This paper presents an overview of the main scientific topics investigated in the centre and provides the reader with a state-of-the-art comprehensive summary of what has been achieved in CRAICC with links to the particular publications for further detail. Faced with a vast amount of scientific discovery, we do not claim to completely summarize the results from CRAICC within this paper, but rather concentrate here on the main results which are related to feedback loops in climate change–cryosphere interactions that affect Arctic amplification.

Study DesignSurvey based study.ObjectivesTo evaluate current patterns for managing SCI among spine surgeons in North America.MethodsA survey of the North American Clinical Trials Network (NACTN) and other institutions collected institutional demographics and specific practices on acute SCI management. Variables included trauma level designation, annual case volumes (patient number, spine fracture and surgery performed), steroid usage, emergent cervical traction, magnetic resonance imaging (MRI) access, surgical decompression timing, intraoperative ultrasound and neuromonitoring use, mean arterial pressure (MAP) and spinal cord perfusion pressure (SCPP) targets, lumbar drain use, and the influence of American Spinal Injury Association (ASIA) Impairment Scale (AIS) grade on decision-making.ResultsThirty surgeons from 23 institutions responded (93.3% Level 1 trauma centers). Most centers (93.3%) had immediate MRI access; about 70% of physicians did not use steroids. Emergent cervical traction was used by 60%. An aim of surgical decompression within 24 h was reported by 90%, with 20% operating immediately upon arrival. MAP goals were used by 93.3%, most targeting 85-90 mmHg for ≥5 days. Lumbar drains for SCPP optimization were used in 30%, typically targeting intrathecal pressure (ITP) < 15 mmHg and SCPP >60 mmHg. Management varied by AIS grade in 43.4%.ConclusionDespite agreement in the general scope of acute SCI care, significant implementation heterogeneity exists across North American spine centers. Variability was pronounced in steroid use, timing of decompression (90% within 24 h), cervical traction, and lumbar drain utilization. These findings call for evidence-based protocols to guide acute SCI management and reduce inter-institutional practice variation.

Clinical studies have shown that individuals with spinal cord injury (SCI) are particularly susceptible to infectious diseases, resulting in a syndrome called SCI-induced immunodeficiency syndrome (SCI-IDS), which is the leading cause of death after SCI. It is believed that SCI-IDS is associated with exaggerated activation of sympathetic preganglionic neurons (SPNs). After SCI, disruption of bulbospinal projections from the medulla oblongata C1 neurons to the SPNs results in the loss of sympathetic inhibitory modulation from the brain and brainstem and the occurrence of abnormally high levels of spinal sympathetic reflexes (SSR), named sympathetic hyperreflexia. As the post-injury survival time lengthens, mass recruitment and anomalous sprouting of excitatory interneurons within the spinal cord result in increased SSR excitability, resulting in an excess sympathetic output that disrupts the immune response. Therefore, we first analyze the structural underpinnings of the spinal cord-sympathetic nervous system-immune system after SCI, then demonstrate the progress in highlighting mechanisms of SCI-IDS focusing on norepinephrine (NE)/Beta 2-adrenergic receptor (β2-AR) signal pathways, and summarize recent preclinical studies examining potential means such as regulating SSR and inhibiting β2-AR signal pathways to improve immune function after SCI. Finally, we present research perspectives such as to promote the effective regeneration of C1 neurons to rebuild the connection of C1 neurons with SPNs, to regulate excitable or inhibitory interneurons, and specifically to target β2-AR signal pathways to re-establish neuroimmune balance. These will help us design effective strategies to reverse post-SCI sympathetic hyperreflexia and improve the overall quality of life for individuals with SCI.

Traumatic spinal cord injury (SCI) is a devastating condition that is often associated with significant loss of function and/or permanent disability. The pathophysiology of SCI is complex and occurs in two phases. First, the mechanical damage from the trauma causes immediate acute cell dysfunction and cell death. Then, secondary mechanisms of injury further propagate the cell dysfunction and cell death over the course of days, weeks, or even months. Among the secondary injury mechanisms, inflammation has been shown to be a key determinant of the secondary injury severity and significantly worsens cell death and functional outcomes. Thus, in addition to surgical management of SCI, selectively targeting the immune response following SCI could substantially decrease the progression of secondary injury and improve patient outcomes. In order to develop such therapies, a detailed molecular understanding of the timing of the immune response following SCI is necessary. Recently, several studies have mapped the cytokine/chemokine and cell proliferation patterns following SCI. In this review, we examine the immune response underlying the pathophysiology of SCI and assess both current and future therapies including pharmaceutical therapies, stem cell therapy, and the exciting potential of extracellular vesicle therapy.

The low-income group is viewed as a vulnerable segment of the society, with many difficulties in various aspects of life, including finances. While the government is concerned with the financial well-being (FWB) of its citizens, particularly those in low-income groups, little is known about the FWB of women in this group in Malaysia. The objectives of this study are two-fold. First, we investigate the effect of low-income women's financial literacy (FL) on their FWB. Second, we examine the moderating effect of capability on the relationship between low-income women's FL and FWB. A survey of 320 low-income women in Malaysia was conducted. The results showed that FL, in terms of financial behavior, had a significant positive effect on the FWB of low-income women. FL in terms of financial attitude and financial knowledge, on the other hand, had significant negative effects on the FWB of low-income women. However, capability did not moderate the relationship between any of the FL components and FWB. The results provide insights for relevant parties to develop strategies to improve the FWB of low-income women in Malaysia.

This study investigates the entrepreneurial financial performance of women micro, small, and medium enterprise (MSME) actors in Indonesia, drawing upon social cognitive theory to assess the interplay of psychological capital (PsyCap), technology readiness, and entrepreneurial orientation. Recognizing women entrepreneurs in MSMEs as pivotal economic contributors, this study examined the moderating effect of technology readiness on the entrepreneurial outcomes facilitated by PsyCap. Simultaneously, we explore how entrepreneurial orientation mediates this relationship. The sample comprised 920 female MSME actors from West Java, D.I.Y. Yogyakarta, and West Sumatra, selected through quota sampling. Data were collected via self-reported questionnaires measuring PsyCap, technology readiness, entrepreneurial orientation, and entrepreneurs’ financial performance. The data was analyzed using structural equation modeling. These findings indicate that technological readiness significantly moderates the relationship between PsyCap and entrepreneurs’ financial performance. Although technology readiness directly influences entrepreneurial orientation, it does not alter the overall model’s efficacy. This suggests that technology readiness can enhance performance, but it does not impact the PsyCap factors that propel women entrepreneurs’ financial performance. These insights can inform potential government interventions to bolster female entrepreneurship. This study contributes novel empirical evidence to entrepreneurial literature by presenting a comprehensive model that elucidates the mediating and moderating processes necessary for fostering entrepreneurial financial performance. It offers practical implications for SME governance and policymakers aiming to elevate the competitive stance of women entrepreneurs in a demanding business ecosystem.

Objective To examine publication rates of the full texts of abstracts presented at the 2010 World Congress on Pain (WCP) of the International Association for the Study of Pain. Methods Poster presentations published in the abstract booklet of the 13th WCP in 2010 were examined. The post-congress status of each abstract was investigated by searching titles, first author, and co-authors, in order, using local search engines. The year of publication, country, index, impact factor (IF) of the publishing journal, and name and title consistencies between the abstract and published text were recorded. Results A total 1907 poster presentations were investigated. Of these, 525 (27.5%) were published in scientific journals. The most poster presentations (402, 37%) were from the United States. The most published presentations appeared in scientific journals in 2011. Science Citation Index (SCI), SCI Expanded, and Emerging Sources Citation Index published 491 abstracts as full texts. The mean IF of journals in which articles were published was 3.90 ± 3.64. Conclusions As with scientific journals, a communication process should be established with authors during assessment of poster presentations at congresses regarding critical progression and rectification of deficiencies, which will increase the likelihood of presentation abstracts being published.

Data-driven innovations (DDI) have significantly impacted firms’ operations thanks to the massive exploitation of huge data. However, to leverage big data and achieve supply chain innovation, a variety of complementary resources are necessary. In this study, we hypothesise that supply chain innovation (SCI) is dependent on firms’ big data analytics capabilities (BAC). Furthermore, we propose that this relation is mediated by two crucial capabilities of agility and adaptability that enable firms to efficiently meet the challenges of supply chain ambidexterity. Finally, we also test the moderating role of technology uncertainty in our research model. We collected data from 386 manufacturing firms in Pakistan and tested our model using structural equation modelling. The results confirmed our initial hypotheses that agility and adaptability both mediated our baseline relationship of BAC and big data innovation in supply chains. We further found support for the moderating role of technology uncertainty. Furthermore, technology uncertainty moderates the relationship between BAC and SCI. This study extends the current literature on digital analytics capabilities and innovation along the supply chain. Practically, our research suggests that investment in big data can result in affirmative consequences, if firms cultivate capabilities to encounter supply chain ambidexterity through agility and adaptability. Accordingly, we suggest that managers belonging to manufacturing firms need to build up these internal capabilities and to monitor and assess technology uncertainty in the environment.

The website Sci-Hub enables users to download PDF versions of scholarly articles, including many articles that are paywalled at their journal’s site. Sci-Hub has grown rapidly since its creation in 2011, but the extent of its coverage has been unclear. Here we report that, as of March 2017, Sci-Hub’s database contains 68.9% of the 81.6 million scholarly articles registered with Crossref and 85.1% of articles published in toll access journals. We find that coverage varies by discipline and publisher, and that Sci-Hub preferentially covers popular, paywalled content. For toll access articles, we find that Sci-Hub provides greater coverage than the University of Pennsylvania, a major research university in the United States. Green open access to toll access articles via licit services, on the other hand, remains quite limited. Our interactive browser at https://greenelab.github.io/scihub allows users to explore these findings in more detail. For the first time, nearly all scholarly literature is available gratis to anyone with an Internet connection, suggesting the toll access business model may become unsustainable.