Blood flow effects in a patient with a thoracic aortic endovascular prosthesis.

This work analyzes hemodynamic phenomena within the aorta of two elderly patients and their impact on blood flow behavior, particularly affected by an endovascular prosthesis in one of them (Patient II). Computational Fluid Dynamics (CFD) was utilized for this study, involving measurements of velocity, pressure, and wall shear stress (WSS) at various time points during the third cardiac cycle, at specific positions within two cross sections of the thoracic aorta. The first cross-section (Cross-Section 1, CS1) is located before the initial fluid bifurcation, just before the right subclavian artery. The second cross-section (Cross-Section 2, CS2) is situated immediately after the left subclavian artery. The results reveal that, under regular aortic geometries, velocity and pressure magnitudes follow the principles of fluid dynamics, displaying variations. However, in Patient II, an endoprosthesis near the CS2 and the proximal border of the endoprosthesis significantly disrupts fluid behavior owing to the pulsatile flow. The cross-sectional areas of Patient I are smaller than those of Patient II, leading to higher flow magnitudes. Although in CS1 of Patient I, there is considerable variability in velocity magnitudes, they exhibit a more uniform and predictable transition. In contrast, CS2 of Patient II, where magnitude variation is also high, displays irregular fluid behavior due to the endoprosthesis presence. This cross-section coincides with the border of the fluid bifurcation. Additionally, the irregular geometry caused by endovascular aneurysm repair contributes to flow disruption as the endoprosthesis adjusts to the endothelium, reshaping itself to conform with the vessel wall. In this context, significant alterations in velocity values, pressure differentials fluctuating by up to 10%, and low wall shear stress indicate the pronounced influence of the endovascular prosthesis on blood flow behavior. These flow disturbances, when compounded by the heart rate, can potentially lead to changes in vascular anatomy and displacement, resulting in a disruption of the prosthesis-endothelium continuity and thereby causing clinical complications in the patient.

Ectomycorrhizal fungal communities in natural and urban ecosystems: Quercus humboldtii as a study case in the tropical Andes.

Worldwide urban landscapes are expanding because of the growing human population. Urban ecosystems serve as habitats to highly diverse communities. However, studies focusing on the diversity and structure of ectomycorrhizal communities are uncommon in this habitat. In Colombia, Quercus humboldtii Bonpl. is an ectomycorrhizal tree thriving in tropical montane forests hosting a high diversity of ectomycorrhizal fungi. Q. humboldtii is planted as an urban tree in Bogotá (Colombia). We studied how root-associated fungal communities of this tree change between natural and urban areas. Using Illumina sequencing, we amplified the ITS1 region and analyzed the resulting data using both OTUs and Amplicon Sequence Variants (ASVs) bioinformatics pipelines. The results obtained using both pipelines showed no substantial differences between OTUs and ASVs for the community patterns of root-associated fungi, and only differences in species richness were observed. We found no significant differences in the species richness between urban and rural sites based on Fisher's alpha or species-accumulation curves. However, we found significant differences in the community composition of fungi present in the roots of rural and urban trees with rural communities being dominated by Russula and Lactarius and urban communities by Scleroderma, Hydnangium, and Trechispora, suggesting a high impact of urban disturbances on ectomycorrhizal fungal communities. Our results highlight the importance of urban trees as reservoirs of fungal diversity and the potential impact of urban conditions on favoring fungal species adapted to more disturbed ecosystems.

A Deep Learning Model Based on Capsule Networks for COVID Diagnostics through X-ray Images.

X-ray diagnostics are widely used to detect various diseases, such as bone fracture, pneumonia, or intracranial hemorrhage. This method is simple and accessible in most hospitals, but requires an expert who is sometimes unavailable. Today, some diagnoses are made with the help of deep learning algorithms based on Convolutional Neural Networks (CNN), but these algorithms show limitations. Recently, Capsule Networks (CapsNet) have been proposed to overcome these problems. In our work, CapsNet is used to detect whether a chest X-ray image has disease (COVID or pneumonia) or is healthy. An improved model called DRCaps is proposed, which combines the advantage of CapsNet and the dilation rate (dr) parameter to manage images with 226 × 226 resolution. We performed experiments with 16,669 chest images, in which our model achieved an accuracy of 90%. Furthermore, the model size is 11M with a reconstruction stage, which helps to avoid overfitting. Experiments show how the reconstruction stage works and how we can avoid the max-pooling operation for networks with a stride and dilation rate to downsampling the convolution layers. In this paper, DRCaps is superior to other comparable models in terms of accuracy, parameters, and image size handling. The main idea is to keep the model as simple as possible without using data augmentation or a complex preprocessing stage.

The role of civil society organizations in alcohol control during the COVID-19 pandemic across six countries in Africa.

Background: The differing global trends in alcohol consumption and policy measures implemented during the COVID-19 pandemic warrant a closer look at the actions taken by civil society organisations (CSOs) and community-led efforts to describe how they may influence and accelerate action for change in alcohol control measures. This paper analyses actions undertaken by CSOs at the national and local levels to safeguard communities and improve alcohol control policies during the COVID-19 pandemic in six African countries. Methods: A cross-sectional survey was distributed via email to CSOs involved in alcohol prevention, outreach and policy development in Kenya, Lesotho, Namibia, South Africa, Tanzania and Zimbabwe. Individuals (n = 19) working at CSOs responded to the questionnaire from February to March 2022. Questions related to the role of CSOs during the pandemic are analysed and synthesised in this paper. 19 CSOs respondents representing the six countries were included in the study. Results: Action areas led by CSOs during the COVID-19 pandemic included: (i) direct lobbying advocacy, (ii) conducting public awareness media campaigns and (iii) legal and regulatory interventions linked to the pandemic. Conclusions: Given the size of the challenges governments faced during the COVID-19 pandemic, the role of CSOs, during the ongoing pandemic and beyond, has become even more relevant to strengthen advocacy and public health interventions for alcohol control in Southern Africa. For this, CSOs should have a "seat at the table" when public health policies are designed, discussed and enforced.

Identification of Clinically Relevant HIV Vif Protein Motif Mutations through Machine Learning and Undersampling.

Human Immunodeficiency virus (HIV) and its clinical entity, the Acquired Immunodeficiency Syndrome (AIDS) continue to represent an important health burden worldwide. Although great advances have been made towards determining the way viral genetic diversity affects clinical outcome, genetic association studies have been hindered by the complexity of their interactions with the human host. This study provides an innovative approach for the identification and analysis of epidemiological associations between HIV Viral Infectivity Factor (Vif) protein mutations and four clinical endpoints (Viral load and CD4 T cell numbers at time of both clinical debut and on historical follow-up of patients. Furthermore, this study highlights an alternative approach to the analysis of imbalanced datasets, where patients without specific mutations outnumber those with mutations. Imbalanced datasets are still a challenge hindering the development of classification algorithms through machine learning. This research deals with Decision Trees, Naïve Bayes (NB), Support Vector Machines (SVMs), and Artificial Neural Networks (ANNs). This paper proposes a new methodology considering an undersampling approach to deal with imbalanced datasets and introduces two novel and differing approaches (MAREV-1 and MAREV-2). As theses approaches do not involve human pre-determined and hypothesis-driven combinations of motifs having functional or clinical relevance, they provide a unique opportunity to discover novel complex motif combinations of interest. Moreover, the motif combinations found can be analyzed through traditional statistical approaches avoiding statistical corrections for multiple tests.

Development of alcohol control law, Sao Tome and Principe.

The World Health Organization (WHO) African Region is struggling with increasing harm associated with alcohol consumption. Legislators of Sao Tome and Principe, concerned about this harm and the high prevalence of alcohol use disorders, designed a comprehensive alcohol control bill to tackle this situation. Input into the design of the bill was obtained through interviews involving many stakeholders. The process had five phases: (i) scoping the problem to understand the social burden of the harm caused by alcohol consumption; (ii) updating the evidence on alcohol policies and identifying areas for legislative interventions; (iii) drafting the bill; (iv) aligning the legislative framework of the bill; and (v) initiating the parliamentary procedure. The new bill scored 92/100 using a standardized alcohol control policy scale. The bill covers all domains of WHO's 2010 global strategy to reduce the harmful use of alcohol, and includes the three most cost-effective interventions for reducing alcohol consumption: increased excise taxes on alcohol; bans or comprehensive restrictions on exposure to alcohol advertising; and restrictions on the availability of retailed alcohol through reduced hours of sale. The National Assembly plenary session upheld the bill, which is now under evaluation of the specialized First Commission on Political, Legal, Constitutional and Ethical Affairs. Approval of the bill requires the final voting once it is back with the National Assembly and its promulgation by the President. Drafting an alcohol control bill which is country-led, inclusive, evidence-based and free of interference by the alcohol industry helps prioritize public health objectives over other interests.

La Région africaine de l'Organisation mondiale de la Santé (OMS) fait face à une hausse des dégâts causés par l'alcool. Préoccupés par la situation et par la forte prévalence des troubles liés à cette consommation, les législateurs de Sao Tomé-et-Principe ont élaboré un projet de loi détaillé afin d'y remédier. À l'origine de sa conception, plusieurs entretiens avec différentes parties prenantes. Le processus s'est divisé en cinq phases: (i) définir l'étendue du problème pour évaluer le fardeau que les dégâts provoqués par l'alcool font peser sur la société; (ii) actualiser les données probantes relatives aux politiques en matière d'alcool et identifier les domaines nécessitant une intervention législative; (iii) rédiger le projet de loi; (iv) aligner le cadre législatif du projet de loi; et enfin, (v) initier la procédure parlementaire. Le nouveau projet de loi a obtenu un score de 92/100 sur une échelle d'évaluation standard des mesures de lutte contre l'alcool. Il couvre tous les thèmes repris dans la Stratégie mondiale de l'OMS visant à réduire l'usage nocif de l'alcool, publiée en 2010. Il prévoit également les trois interventions les plus rentables en termes de diminution de la consommation d'alcool: l'augmentation des taxes d'accise sur l'alcool; l'interdiction ou l'instauration de conditions strictes en matière d'exposition à la publicité pour l'alcool; et une disponibilité restreinte des boissons alcoolisées dans le commerce en limitant les heures de vente. L'Assemblée nationale a soutenu le projet de loi en séance plénière. Il est désormais en cours d'évaluation au sein de la première Commission spécialisée en affaires politiques, juridiques, constitutionnelles et éthiques. Pour être adopté, le projet de loi doit revenir à l'Assemblée nationale pour un vote final, puis être promulgué par le président. Une loi globale de lutte contre l'alcool, élaborée par le pays lui-même, fondée sur des faits et n'ayant subi aucune ingérence de la part de l'industrie de l'alcool contribue à faire passer les objectifs de santé publique avant d'autres intérêts.

La Región de África de la Organización Mundial de la Salud (OMS) está tratando de hacer frente a los crecientes daños derivados del consumo de alcohol. Los legisladores de Santo Tomé y Príncipe, preocupados por estos daños y por la alta prevalencia de los trastornos por consumo de alcohol, diseñaron un proyecto de ley integral para el control del alcohol con el fin de solucionar esta situación. Las contribuciones al diseño del proyecto de ley se obtuvieron a través de entrevistas en las que participaron muchas partes interesadas. El proceso constó de cinco fases: (i) la delimitación del problema para comprender la carga social de los daños causados por el consumo de alcohol; (ii) la actualización de los datos sobre las políticas de alcohol y la identificación de las áreas de intervención legislativa; (iii) la redacción del proyecto de ley; (iv) la adaptación del marco legislativo del proyecto de ley; y (v) el inicio del procedimiento parlamentario. El nuevo proyecto de ley obtuvo una puntuación de 92/100 según una escala estandarizada de políticas para el control del alcohol. El proyecto de ley abarca todos los ámbitos de la estrategia mundial que la OMS puso en marcha en 2010 para reducir el uso nocivo del alcohol, e incluye las tres intervenciones más rentables para reducir el consumo de alcohol: el aumento de los impuestos especiales sobre el alcohol; la prohibición o la restricción general de la exposición a la publicidad del alcohol; y la restricción de la disponibilidad del alcohol al por menor mediante la reducción del horario de venta. La sesión plenaria de la Asamblea Nacional respaldó el proyecto de ley, que ahora está bajo evaluación de la Comisión Primera especializada en Asuntos Políticos, Jurídicos, Constitucionales y Éticos. La aprobación del proyecto de ley requiere la votación final una vez que regrese a la Asamblea Nacional y que el Presidente lo promulgue. La elaboración de un proyecto de ley para el control del alcohol que sea liderado por el país, inclusivo, basado en la evidencia y libre de interferencias por parte de la industria del alcohol ayuda a priorizar los objetivos de salud pública sobre otros intereses.

Describing and mapping scientific articles on alcohol globally for the period 2010-2021: a bibliometric analysis.

OBJECTIVES: To describe and map scientific literature related to alcohol consumption, its determinants, governance, harm and control policies by publication output, author affiliations, funding, countries of study and research themes. DESIGN: Bibliometric analysis using performance analysis and science mapping techniques. DATA SOURCES: Scientific articles. ELIGIBILITY CRITERIA: Indexed scientific articles published between 1 January 2010 and 31 December 2021 with an English abstract focused on alcohol consumption, its determinants, harms, governance and control policies. DATA EXTRACTION AND SYNTHESIS: Searches were run in Web of Science and PubMed. Performance metrics were analysed using descriptive statistics. Keywords were used for science mapping in a deductive approach to cluster articles by five main research themes. The 'policy response' theme was further analysed by six subthemes. RESULTS: 4553 articles were included in the analysis. Three out of four articles (3479/4553, 76.4%) were authored solely by authors affiliated with HIC institutions. One in five articles (906/4553, 19.9%) had at least one author affiliated to an institution from an upper-middle-income, middle-income or low-income country context. Governments, followed by research institutions, were the predominant funding source. Half (53.1%) studied a single country and, of these, 77.0% were high-income countries (HICs). Australia, USA and UK were the most studied countries, together accounting for 44.9% (975/2172) of country-specific articles. Thematically, 'consumption' was most studied, and 'alcohol determinants', least. 'Policy response' articles were predominately conducted in HIC contexts. CONCLUSIONS: Although the attributable harm of alcohol is known to affect more significantly lower-income and middle-income countries, scientific publications primarily report on HIC contexts by authors from HICs. Research themes reflect known cost-effective policy actions, though skewed towards HICs and a focus on consumption. The implementation of context-specific alcohol control policies requires addressing the determinants of the uneven geographical and thematic distribution of research.

Design of a Low-Power Embedded System Based on a SoC-FPGA and the Honeybee Search Algorithm for Real-Time Video Tracking.

Video tracking involves detecting previously designated objects of interest within a sequence of image frames. It can be applied in robotics, unmanned vehicles, and automation, among other fields of interest. Video tracking is still regarded as an open problem due to a number of obstacles that still need to be overcome, including the need for high precision and real-time results, as well as portability and low-power demands. This work presents the design, implementation and assessment of a low-power embedded system based on an SoC-FPGA platform and the honeybee search algorithm (HSA) for real-time video tracking. HSA is a meta-heuristic that combines evolutionary computing and swarm intelligence techniques. Our findings demonstrated that the combination of SoC-FPGA and HSA reduced the consumption of computational resources, allowing real-time multiprocessing without a reduction in precision, and with the advantage of lower power consumption, which enabled portability. A starker difference was observed when measuring the power consumption. The proposed SoC-FPGA system consumed about 5 Watts, whereas the CPU-GPU system required more than 200 Watts. A general recommendation obtained from this research is to use SoC-FPGA over CPU-GPU to work with meta-heuristics in computer vision applications when an embedded solution is required.

Development of alcohol control law, Sao Tome and Principe

The World Health Organization (WHO) African Region is struggling with increasing harm associated with alcohol consumption. Legislators of Sao Tome and Principe, concerned about this harm and the high prevalence of alcohol use disorders, designed a comprehensive alcohol control bill to tackle this situation. Input into the design of the bill was obtained through interviews involving many stakeholders. The process had five phases: (i) scoping the problem to understand the social burden of the harm caused by alcohol consumption; (ii) updating the evidence on alcohol policies and identifying areas for legislative interventions; (iii) drafting the bill; (iv) aligning the legislative framework of the bill; and (v) initiating the parliamentary procedure. The new bill scored 92/100 using a standardized alcohol control policy scale. The bill covers all domains of WHO's 2010 global strategy to reduce the harmful use of alcohol, and includes the three most cost-effective interventions for reducing alcohol consumption: increased excise taxes on alcohol; bans or comprehensive restrictions on exposure to alcohol advertising; and restrictions on the availability of retailed alcohol through reduced hours of sale. The National Assembly plenary session upheld the bill, which is now under evaluation of the specialized First Commission on Political, Legal, Constitutional and Ethical Affairs. Approval of the bill requires the final voting once it is back with the National Assembly and its promulgation by the President. Drafting an alcohol control bill which is country-led, inclusive, evidence-based and free of interference by the alcohol industry helps prioritize public health objectives over other interests.

Hospitalization for ambulatory care sensitive conditions: What conditions make inter-country comparisons possible?

Hospitalizations for ambulatory care sensitive conditions have been extensively used in health services research to assess access, quality and performance of primary health care. Inter-country comparisons can assist policy-makers in pursuing better health outcomes by contrasting policy design, implementation and evaluation. The objective of this study is to identify the conceptual, methodological, contextual and policy dimensions and factors that need to be accounted for when comparing these types of hospitalizations across countries. A conceptual framework for inter-country comparisons was drawn based on a review of 18 studies with inter-country comparison of ambulatory care sensitive conditions hospitalizations. The dimensions include methodological choices; population's demographic, epidemiologic and socio-economic profiles and features of the health services and system. Main factors include access and quality of primary health care, availability of health workforce and health facilities, health interventions and inequalities. The proposed framework can assist in designing studies and interpreting findings of inter-country comparisons of ambulatory care sensitive conditions hospitalizations, accelerating learning and progress towards universal health coverage.

Computational Forecasting Methodology for Acute Respiratory Infectious Disease Dynamics.

The study of infectious disease behavior has been a scientific concern for many years as early identification of outbreaks provides great advantages including timely implementation of public health measures to limit the spread of an epidemic. We propose a methodology that merges the predictions of (i) a computational model with machine learning, (ii) a projection model, and (iii) a proposed smoothed endemic channel calculation. The predictions are made on weekly acute respiratory infection (ARI) data obtained from epidemiological reports in Mexico, along with the usage of key terms in the Google search engine. The results obtained with this methodology were compared with state-of-the-art techniques resulting in reduced root mean squared percentage error (RMPSE) and maximum absolute percent error (MAPE) metrics, achieving a MAPE of 21.7%. This methodology could be extended to detect and raise alerts on possible outbreaks on ARI as well as for other seasonal infectious diseases.

Transport safety and human factors in the era of automation: What can transport modes learn from each other?

One of the main aims of introducing automation in transport is to improve safety by reducing or eliminating human errors; it is often argued however that this may induce new types of errors. There is different level of maturity with automation in different transport modes (road, aviation, maritime and rail), however no systematic research has been conducted on the lessons learned in different sectors, so that they can be exploited for the design of safer automated systems. The aim of this paper is to review the impact of key human factors on the safety of automated transport systems, with focus on relevant experiences from different transport sectors. A systematic literature review is carried out on the following topics: the level of trust in automation - in particular the impact of mis-aligned trust, i.e. mistrust vs overreliance, the resulting impact on operator situation awareness (SA), the implications for takeover control from machine to human, and the role of experience and training on using automated transport systems. The results revealed several areas where experiences from the aviation and road domain can be transferable to other sectors. Experiences from maritime and rail transport, although limited, tend to confirm the general patterns. Remarkably, in the road sector where higher levels of automation are only recently introduced, there are clearer and more quantitative approaches to human factors, while other sectors focus only on mental modes. Other sectors could use similar approaches to define their own context-specific metrics. The paper makes a synthesis of key messages on automation safety in different transport sectors, and presents an assessment of their transferability.

Implementation of bamboo and monkey-pot traps for the sampling cavity-breeding mosquitoes in Darién, Panama.

Despite the importance of Aedes, Haemagogus and Sabethes in the transmission of yellow fever virus (YFV) and the public health impacts of recent YFV epidemics in the Americas, relatively little has been reported on the biology and ecology of these vectors. Many Aedes, Haemagogus and Sabethes spp. in the American tropics inhabit and develop in the forest canopy and are difficult to sample with conventional entomological surveillance methods. We tested the utility of two previously developed phytotelmata-style oviposition traps (bamboo Guadua angustifolia) and (monkey-pot Lecythis minor), for collecting immature forms of these mosquitoes in a forest near the community of Aruza Abajo, Darién Province, Panama. Our results showed distribution of mosquito species emerging from the two types of traps was found to be significantly different (X2 = 210.23; df = 14; P < 0.001), with significantly greater numbers of Sabethes (Peytonulus) aurescens (Lutz) and Sabethes (Peytonulus) undosus (Coquillett) emerging from the bamboo traps. More females of Sabethes (Sabethes) cyaneus (Fabricius) were captured in the monkey-pot traps, although the difference was not significant. No differences were observed in the average time to emergence for the two traps. These results suggest that various phytotelmata-style traps, including monkey-pot and bamboo, could be used to improve entomological surveillance of YFV vectors in the American tropic.

Review of 128 quality of care mechanisms: A framework and mapping for health system stewards.

Health system stewards have the critical task to identify quality of care deficiencies and resolve underlying system limitations. Despite a growing evidence-base on the effectiveness of certain mechanisms for improving quality of care, frameworks to facilitate the oversight function of stewards and the use of mechanisms to improve outcomes remain underdeveloped. This review set out to catalogue a wide range of quality of care mechanisms and evidence on their effectiveness, and to map these in a framework along two dimensions: (i) governance subfunctions; and (ii) targets of quality of care mechanisms. To identify quality of care mechanisms, a series of searches were run in Health Systems Evidence and PubMed. Additional grey literature was reviewed. A total of 128 quality of care mechanisms were identified. For each mechanism, searches were carried out for systematic reviews on their effectiveness. These findings were mapped in the framework defined. The mapping illustrates the range and evidence for mechanisms varies and is more developed for some target areas such as the health workforce. Across the governance sub-functions, more mechanisms and with evidence of effectiveness are found for setting priorities and standards and organizing and monitoring for action. This framework can support system stewards to map the quality of care mechanisms used in their systems and to uncover opportunities for optimization backed by systems thinking.

Risk assessment methodology for trajectory planning in keyhole neurosurgery using genetic algorithms.

BACKGROUND: Preoperative assessment to find the safest trajectory in keyhole neurosurgery can reduce post operative complications. METHODS: We introduced a novel preoperative risk assessment semiautomated methodology based on the sum of N maximum risk values using a generic genetic algorithm for the safest trajectory search. RESULTS: A set of candidates trajectories were found for two surgical procedures. The trajectories search is done using a risk map considering the proximity of voxels within risk structures in multiple points and a genetic algorithm to avoid an exhaustive search. The trajectories were validated by a group of neurosurgeons. CONCLUSIONS: The trajectories obtained with the proposal method were shorter in 5% and have greater distance from the voxels within the blood vessels in 4.7%. The use of genetic algorithm (GA) speeds up the search for the safest trajectory, decreasing in 99.9% the time required for an exhaustive search.

Creating performance intelligence for primary health care strengthening in Europe.

BACKGROUND: Primary health care and its strengthening through performance measurement is essential for sustainably working towards universal health coverage. Existing performance frameworks and indicators to measure primary health care capture system functions like governance, financing and resourcing but to a lesser extent the function of services delivery and its heterogeneous nature. Moreover, most frameworks have weak links with routine information systems and national health priorities, especially in the context of high- and middle-income countries. This paper presents the development of a tool that responds to this context with the aim to create primary health care performance intelligence for the 53 countries of the WHO European Region. METHODS: The work builds-off of an existing systematic review on primary care and draws on priorities of current European health policies and available (inter)national information systems. Its development included: (i) reviewing and classifying features of primary care; (ii) constructing a set of tracer conditions; and (iii) mapping existing indicators in the framework resulting from (i). The analysis was validated through a series of reviews: in-person meetings with country-nominated focal points and primary care experts; at-distance expert reviews; and, preliminary testing with country informants. RESULTS: The resulting framework applies a performance continuum in the classical approach of structures-processes-outcomes spanning 6 domains - primary care structures, model of primary care, care contact, primary care outputs, health system outcomes, and health outcomes - that are further classified by 26 subdomains and 63 features of primary care. A care continuum was developed using a set of 12 tracer conditions. A total of 139 indicators were mapped to the classification, each with an identified data source to safeguard measurability. Individual indicator passports and a glossary of terms were developed to support the standardization of the findings. CONCLUSION: The resulting framework and suite of indicators, coined the Primary Health Care Impact, Performance and Capacity Tool (PHC-IMPACT), has the potential to be applied in Europe, closing the gap on existing data collection, analysis and use of performance intelligence for decision-making towards primary health care strengthening.

Improving clinical practice in primary care for the prevention and control of noncommunicable diseases: a multi-actor approach to two regional pilot projects in Kazakhstan.

Improving access to quality services is integral to achieving better outcomes for noncommunicable diseases (NCDs). In Kazakhstan, like other countries with historically centralized governance models, key to improving quality is instilling a common and shared understanding of the roles and responsibilities in correspondence with the multifaceted nature of quality of care. This review details the experience of two pilot projects implemented in Kazakhstan's regions of Kyzylorda and Mangystau over a three-year period with the aim to improve clinical practice through a multi-actor, multi-intervention approach. Adopting a health system perspective, the pilots, by design, introduced interventions targeting four actors: policy-makers; health facility managers; health practitioners and patients. The review draws on the following sources of data: rapid baseline assessments; implementation plans, curriculums and other pilot-related material; a mid-way joint implementation meeting; intervention-specific evaluations; and a final external evaluation. The multi-actor, multi-intervention approach to the pilot projects showed some improvements to service outputs, in particular for cardiovascular disease (CVD) risk assessment and decreases in hospitalization rates for hypertension. The pilot projects also illustrated progress in working towards a shared understanding of the different roles of actors for improving quality of care, appreciating the complementarity of individual actors working towards improved population health and in establishing a culture of learning through the exchange of ideas and practices. The importance of responsibility across health system actors for outcomes is vital for the NCD agenda. This approach offers relevant policy lessons for similar centralized governance systems.

Cross-programmatic consultation on the role of primary care in the responsible use of medicines and the reduction of antimicrobial resistance.

This meeting was held from the 30 October to the 1 November 2018 in Almaty, Kazakhstan. The meeting brought together participants from 16 countries of central Asia, Caucasus, eastern Europe and expert speakers from western Europe and India. Participants discussed the analysis and use of data on antimicrobial medicines consumption, country experiences in enforcing legislation for prescription-only access to antibiotics, the role of primary health care (PHC) in tackling antimicrobial resistance (AMR), strategies to improving competencies of practitioners using evidence-based clinical protocols and public engagement in the responsible use of medicines. Moving toward prescription-only access to antibiotics requires that government involve, from the onset, different stakeholders, e.g. public, patients, practitioners, pharmacists and pharmaceutical industry in designing and applying policies that ensure access to antibiotics accompanied by measures that promote responsible use and limit excessive use.