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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.

Purpose - The purpose of this paper is to present eight local elasto-plastic beam element formulations incorporated into the corotational framework for two-noded three-dimensional beams. These formulations capture the warping torsional effects of open cross-sections and are suitable for the analysis of the nonlinear buckling and post-buckling of thin-walled frames with generic cross-sections. The paper highlights the similarities and discrepancies between the different local element formulations. The primary goal of this study is to compare all the local element formulations in terms of accuracy, efficiency and CPU-running time.Design methodology approach - The definition of the corotational framework for a two-noded three-dimensional beam element is presented, based upon the works of Battini .The definitions of the local element kinematics and displacements shape functions are developed based on both Timoshenko and Bernoulli assumptions, and considering low-order as well as higher-order terms in the second-order approximation of the Green-Lagrange strains. Element forces interpolations and generalized stress resultant vectors are then presented for both mixed-based Timoshenko and Bernoulli formulations. Subsequently, the local internal force vector and tangent stiffness matrix are derived using the principle of virtual work for displacement-based elements and the two-field Hellinger-Reissner assumed stress variational principle for mixed-based formulations, respectively. A full comparison and assessment of the different local element models are performed by means of several numerical examples.Findings - In this study, it is shown that the higher order elements are more accurate than the low-order ones, and that the use of the higher order mixed-based Bernoulli element seems to require the least number of FEs to accurately model the structural behavior, and therefore allows some reduction of the CPU time compared to the other converged solutions; where a larger number of elements are needed to efficiently discretize the structure.Originality value - The paper reports computation times for each model in order to assess their relative efficiency. The effect of the numbers of Gauss points along the element length and within the cross-section are also investigated.

Evidence-based medicine is becoming the Western norm, but it's still a remote concept in Russia. Dr. Vasiliy Vlassov, the Moscow-based editor of the International Journal of Medical Practice, is on a crusade to change this. However, he says he faces a tough task in a country where physicians see nothing wrong with having \"romantic relationships\" with patients, where medical associations don't enforce ethical standards and where medical school lecturers routinely take cash in exchange for emphasizing specific drugs. Some physicians also accept bribes for providing services - hardly a surprise when surgeons earn the equivalent of about US$100 a month. A major obstacle to professionalism and professional clout is the lack of a national medical association within the country. Three associations claim to be the Russian medical association, but none is truly national. And none is offering certification or evaluation or serving the same function as Canada's provincial colleges of physicians and surgeons. This means there are no restrictions in areas such as romantic relationships between physicians and their patients. \"Most doctors don't understand what's wrong with it,\" says Vlassov. The underlying problem is a lack of health care funding. The annual allocation is only between US$20 and $50 per person. \"In Russia, everybody is promised the health care he or she needs, but in reality it's available to people who have power or money,\" Vlassov says. For example, a Russian with cancer can get surgical care and radiation therapy, but chemotherapy is too expensive and is provided only \"as available.\"

At the end of some text toing-and-froing came the sting in the tail. The final text read: 'We can't afford to go south of France but checked on internet. Cheap flights to Knock airport. We're free next weekend.' Free? You'd be right. What a surprise! Now that I'm ensconced in Connemara, they miraculously love Ireland once again. When they arrived eventually, in fairness, they said: 'Oh don't cook tonight, we'll go out for dinner.' I was delighted. Until, when the bill eventually arrived after a long and languorous meal, they declared: 'Oh, we'll just pay for ourselves. You pay for yourself.' Pay for myself? Who is paying the rent on my apartment? They left quite early the next day, having emptied my bottle of whiskey the night before. It would have been easier and less expensive for me to book into an hotel and just hand them the keys to my place. I might also mention that I have not yet had a 'thank you' text.

Unas 3 mil aves de corral fueron sacrificadas en la aldea de Landovka, en la region rusa de Tula, unos 200 kilometros al sur de Moscu, luego de que se descubrio el virus de la gripe aviar en siete granjas privadas, dijo el subjefe del departamento de control veterinario del Ministerio de Agricultura, Nikolai Vlassov. \"Este caso no presenta mas peligro\", ya que todas las aves de este criadero fueron sacrificadas, pero el hecho de que el virus se haya acercado a Moscu es muy inquietante, pues la region de la capital rusa tiene numerosas fabricas de aves\", explico. La Organizacion de Naciones Unidas para la Agricultura y la Alimentacion (FAO), en tanto, advirtio ayer que la presencia de la gripe aviar en Europa central tambien supone una amenaza para frica y los paises de Medio Oriente.

Patrick Chan of Toronto and Kevin Reynolds of Coquitlam, B.C., advanced through the qualifying phase of men's singles competition yesterday in the world junior championships at Ljubljana, Slovenia.

Vladimir Vlassov concerned about Iran Military build-up and implications for Regional security; Aleksei N. Kosygin visiting Iran as recompense for Soviet Union friendship with Iraq; Soviet Union Embassy. Iran relations with [Iran; United States Embassy. Iran]

The brunt of defending Ukraine's existence, however, falls on the Embassy's press and information counselor, Dmitro Markov, who says that changing the media's pro-Russia bias is a hard struggle. \"Ukraine is very unlucky -- it is a successor state to the legislation of the Soviet Union, but not to the media.\" With Russia controlling the media, it will be difficult to break the media's association of Ukraine with missiles, said the former editor-in-chief of Radio Ukraine. Despite the impediments, Mr. Markov, who is the only member of the Embassy's media staff, has attempted to expand media relations: in 1993, the Embassy released 71 press releases, afforded Ambassador Bilorus 200 press exposures, held 13 press conferences and 40 briefings. Mr. Markov is also working toward bringing more Ukrainian journalists to the United States -- Ukraine has only one accredited journalist here -- \"so that the people of Ukraine know why close cooperation is important with the United States.\" The Embassy does not, however, consult with the Ukrainian American organizations that for years have lobbied Washington on behalf of Ukraine. \"The Embassy has certainly not made full use of the Ukrainian community through the Ukrainian Congress Committee of America and the Ukrainian National Association Washington offices,\" said Askold Lozynskyj, president of the UCCA. \"It operates on its own and seems to think of the Ukrainian diaspora only as a money cow. I don't think this is a policy of Ambassador Bilorus. This is the way the Ukrainian government with President [Leonid Kravchuk] at the helm operates.\"

Vladimir Vlassov believes Mardom Party (Iran) was reestablished by Mohammad Reza Pahlavi as a check on Abbas Hoveyda and the Iran Novin Party; Vladimir Vlassov comments on recent developments relating to Pakistan and Afghanistan

Vladimir Vlassov remarks concerning [India; Iran; Persian Gulf; Oman; Regional security; Pakistan; Kuwait; Iraq]