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Published Online August 27, 2020 ; Background: Achieving universal health coverage (UHC) involves all people receiving the health services they need, of high quality, without experiencing financial hardship. Making progress towards UHC is a policy priority for both countries and global institutions, as highlighted by the agenda of the UN Sustainable Development Goals (SDGs) and WHO's Thirteenth General Programme of Work (GPW13). Measuring effective coverage at the health-system level is important for understanding whether health services are aligned with countries' health profiles and are of sufficient quality to produce health gains for populations of all ages. Methods: Based on the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we assessed UHC effective coverage for 204 countries and territories from 1990 to 2019. Drawing from a measurement framework developed through WHO's GPW13 consultation, we mapped 23 effective coverage indicators to a matrix representing health service types (eg, promotion, prevention, and treatment) and five population-age groups spanning from reproductive and newborn to older adults (≥65 years). Effective coverage indicators were based on intervention coverage or outcome-based measures such as mortality-to-incidence ratios to approximate access to quality care; outcome-based measures were transformed to values on a scale of 0–100 based on the 2·5th and 97·5th percentile of location-year values. We constructed the UHC effective coverage index by weighting each effective coverage indicator relative to its associated potential health gains, as measured by disability-adjusted life-years for each location-year and population-age group. For three tests of validity (content, known-groups, and convergent), UHC effective coverage index performance was generally better than that of other UHC service coverage indices from WHO (ie, the current metric for SDG indicator 3.8.1 on UHC service coverage), the World Bank, and GBD 2017. We quantified frontiers of UHC effective coverage performance on the basis of pooled health spending per capita, representing UHC effective coverage index levels achieved in 2019 relative to country-level government health spending, prepaid private expenditures, and development assistance for health. To assess current trajectories towards the GPW13 UHC billion target—1 billion more people benefiting from UHC by 2023—we estimated additional population equivalents with UHC effective coverage from 2018 to 2023. Findings: Globally, performance on the UHC effective coverage index improved from 45·8 (95% uncertainty interval 44·2–47·5) in 1990 to 60·3 (58·7–61·9) in 2019, yet country-level UHC effective coverage in 2019 still spanned from 95 or higher in Japan and Iceland to lower than 25 in Somalia and the Central African Republic. Since 2010, sub-Saharan Africa showed accelerated gains on the UHC effective coverage index (at an average increase of 2·6% [1·9–3·3] per year up to 2019); by contrast, most other GBD super-regions had slowed rates of progress in 2010–2019 relative to 1990–2010. Many countries showed lagging performance on effective coverage indicators for non-communicable diseases relative to those for communicable diseases and maternal and child health, despite non-communicable diseases accounting for a greater proportion of potential health gains in 2019, suggesting that many health systems are not keeping pace with the rising non-communicable disease burden and associated population health needs. In 2019, the UHC effective coverage index was associated with pooled health spending per capita (r=0·79), although countries across the development spectrum had much lower UHC effective coverage than is potentially achievable relative to their health spending. Under maximum efficiency of translating health spending into UHC effective coverage performance, countries would need to reach $1398 pooled health spending per capita (US$ adjusted for purchasing power parity) in order to achieve 80 on the UHC effective coverage index. From 2018 to 2023, an estimated 388·9 million (358·6–421·3) more population equivalents would have UHC effective coverage, falling well short of the GPW13 target of 1 billion more people benefiting from UHC during this time. Current projections point to an estimated 3·1 billion (3·0–3·2) population equivalents still lacking UHC effective coverage in 2023, with nearly a third (968·1 million [903·5–1040·3]) residing in south Asia. Interpretation: The present study demonstrates the utility of measuring effective coverage and its role in supporting improved health outcomes for all people—the ultimate goal of UHC and its achievement. Global ambitions to accelerate progress on UHC service coverage are increasingly unlikely unless concerted action on non-communicable diseases occurs and countries can better translate health spending into improved performance. Focusing on effective coverage and accounting for the world's evolving health needs lays the groundwork for better understanding how close—or how far—all populations are in benefiting from UHC. ; GBD 2019 Universal Health Coverage Collaborators. Rafael Lozano . Peter S Azzopardi . Bernhard T Baune . Dinesh Bhandari . Liliana G Ciobanu . Tiffany K Gill . Ratilal Lalloo . Jean Jacques Noubiap . et al.

Astrocytes are glial cells organized in dynamic and structured networks in the brain. These plastic networks, involving key proteins such as connexin 43 (Cx43), are engaged in fine neuronal tuning and have recently been considered as emerging therapeutic targets in central nervous system disorders. We developed and validated a new application of the manganese-enhanced magnetic resonance imaging (MEMRI) technique allowing in vivo investigations of astrocyte-neuron interactions through quantification of brain Cx43 functional activity. The proof of concept has been achieved by quantification of MEMRI signals in brain after either local astrocyte-specific Cx43 knockdown with shRNA or systemic administration of Cx43 blockers. Unilateral hippocampal Cx43 genetical silencing was associated with an ipsilateral local increase of MEMRI signal. Furthermore, Cx43 blockers also enhanced MEMRI signal responses in hippocampus. Altogether, these data reveal the MEMRI technique as a tool for quantitative imaging of in vivo Cx43-dependent function in astrocytes under physiological and pathological conditions.

This species is not included on the I.U.C.N. Red List, but in Romania, due to the relative high number of individuals, it is considered to be a protected species by governmental acts. During certain periods, in exchange of a tax, hunting is accepted for a limited number of individuals. Five skulls of Eurasian lynx, owned by the Department of Anatomy Museum of the Faculty of Veterinary Medicine of Bucharest, were morphometrically examined. The dimensions of the five skulls were compared with the literature in order to fit into the subspecies called Carpathian lynx (Lynx lynx ssp. carpathicus). Cranial measurements were performed using electronic digital calipers reading a tenth of a millimeter. Cranial measurements were compared with those made by Angela von den Driesch (1976). Generally, it was observed that the results regarding the dimensions of the skulls can be compared with the results obtained by G.E. Predoiu (2011). But there are four parameters, maximum width of the skull between the orbits, the width of the canine teeth socket, maximum length of skull and length of the mandible, larger than the subspecies described by G.E. Predoiu. These dimensional differences can be explained by the fact that some of the 5 skulls from the Anatomy Department belonged to an outstanding specimen. The C.I.C. score (the value of trophy hunting that can be awarded) for 4 of the 5 studied cases show that the skulls belonged to an outstanding specimen with Gold Medal.

Setting: Tuberculosis (TB) morbidity in penitentiary sectors is one of the major barriers to ending TB in the World Health Organization (WHO) European Region. Objectives and design: a comparative analysis of TB notification rates during 2014–2018 and of treatment outcomes in the civilian and penitentiary sectors in the WHO European Region, with an assessment of risks of developing TB among people experience incarceration. Results: in the WHO European Region, incident TB rates in inmates were 4–24 times higher than in the civilian population. In 12 eastern Europe and central Asia (EECA) countries, inmates compared to civilians had higher relative risks of developing TB (RR = 25) than in the rest of the region (RR = 11), with the highest rates reported in inmates in Azerbaijan, Kazakhstan, Kyrgyzstan, Republic of Moldova, Russian Federation, and Ukraine. The average annual change in TB notification rates between 2014 and 2018 was −7.0% in the civilian sector and −10.9% in the penitentiary sector. A total of 15 countries achieved treatment success rates of over 85% for new penitentiary sector TB patients, the target for the WHO European Region. In 10 countries, there were no significant differences in treatment outcomes between civilian and penitentiary sectors. Conclusion: 42 out of 53 (79%) WHO European Region countries reported TB data for the selected time periods. Most countries in the region achieved a substantial decline in TB burden in prisons, which indicates the effectiveness of recent interventions in correctional institutions. Nevertheless, people who experience incarceration remain an at-risk population for acquiring infection, developing active disease and unfavourable treatment outcomes. Therefore, TB prevention and care practices in inmates need to be improved.

Background: It is predicted that stroke's incidence and impact will increase considerably over time. Proper management of stroke depends on a reliable and urgent diagnosis that includes patient / relative - emergency team - hospital chain, so the diagnosis begins with the recognition of the first signs of stroke. In order to act promptly in the acute period and subsequently assess the risk factors, the neurological service needs to be equipped with highperformance neuroimaging and clinical laboratory. The specific treatment of acute ischemic stroke is nowadays the reperfusion procedure, performed by thrombolytic therapy and, since 2015, by the endovascular treatment. Stroke is also a leading cause of severe long-term disability. The rehabilitation of post-stroke patients requires an interdisciplinary approach, in order to prevent recurrences, combat complications and reintegrate the patient into society. Conclusions: Stroke remains one of the leading determinants of death and severe disability worldwide and the Republic of Moldova is not an exception. Considering the narrow window for recognition and administration of outcome-modifying treatment, the management of stroke focuses mainly on rapid reperfusion via intravenous thrombolysis and endovascular thrombectomy. The availability of this specialized treatment in the Stroke Unit could improve the patient's outcome and decrease the disability's level and economical burden. There is clear evidence that preventing a stroke is much more effective than treating it, so we should seize the opportunity and act involving not only the medical staff, but also the government, health decision makers, specialists in public health and international agencies

The process of the kinetics of caffeine adsorption from aqueous solutions on activated carbon AC-0-9, obtained from apple wood, was studied. Analysis of nitrogen adsorption-desorption isotherms demonstrated that this carbon adsorbent is basically mesoporous. The pseudo-two model describes best the kinetic process, highlighting the role of functional groups on the activated carbon surface. The pseudo-one model only initially describes the kinetic process of caffeine adsorption on this activated carbon. It was found that the kinetics ofthe adsorption process of caffeine on AC-0-9 activated carbon takes place in two stages. In the first stage, the speed of intraparticle diffusion is high, due to the adsorption of caffeine molecules in macroand mesopores, and in the second stage, the speed of intraparticle diffusion is low, given the fact that adsorption occurs in micro- and supermicropores.

Funding: This research was funded by a Strategic Award grant from the European and Developing Countries Clinical Trials Partnership (grant DRIA2014-309) and its cofounders, the Medical Research Council UK, and Institutode Salud Carlos III (ISCIII), Spain (PI116/01912); and from the European Union's Horizon 2020 Research and Innovation Programme under the Marie Skłodowska-Curie grant agreement no. 823854 (INNOVA4TB). ; Tuberculosis (TB) diagnosis is increasingly based on the detection of Mycobacterium tuberculosis complex (MTBC) DNA in sputum using molecular diagnostic tests as the first test for diagnosis. However, sputum can be difficult to obtain in children, patients without productive cough, and the elderly and approaches testing non-sputum samples are needed. We evaluated whether TB can be detected from the oral mucosa of patients with TB. Adults with presumptive TB were examined using culture, Xpert MTB/RIF, smear microscopy and X-Rays. Oral mucosa swabs collected on PrimeStore-MTM, stored at room temperature if tested within 30 days or at −20 °C if examined at a later time. RT-PCR was performed to detect M. tuberculosis DNA. Eighty patients had bacteriologically-confirmed TB, 34 had bacteriologically-negative TB (negative tests but abnormal X-rays) and 152 were considered not to have TB (not TB). Oral swabs RT-PCR were positive in 29/80 (36.3%) bacteriologically-confirmed, 9/34 (26.5%) bacteriologically-negative and 29/152 (19.1%) not TB. The yield varied among samples stored for less and more than 30 days (p = 0.013) from 61% (11/18) and 29% (18/62) among bacteriologically confirmed, and 30.8% (4/13) and 23.8% (5/21) among bacteriologically-negative participants. Among not TB patients, the specificity was 80.9% (123/152), being 78.3% (18/23) among samples stored less than 30 days and 81.4% (105/129) among samples stored for more than 30 days (p = 0.46). The detection of M. tuberculosis in oral mucosa samples is feasible, but storage conditions may affect the yield. ; Publisher PDF ; Peer reviewed