Coverage Indicators Research Articles

Assessment of Documented Vaccination of Adolescent Schoolchildren in Various Cities of Russian Federation

Epidemiological surveillance of preventive vaccinations implementation is the most crucial component in the immunoprophylaxis organization. Assessment of documented vaccination coverage indicators allows to determine the quality of routine preventive vaccination and indirectly evaluate the possible state of population immunity to vaccine preventable diseases. Continuous quality control of routine vaccination, therefore, is a component of the system for epidemic management of infectious diseases. Specific decisions should be based on its results to improve preventive vaccination quality.Сomparative analysis of the vaccination history in adolescents (studying in schools in large cities of different federal districts of Russian Federation) and recommended national immunisation schedule allowed to identify widespread systemic mistakes of vaccination status. These issues led to the uprise and spread of vaccine preventable diseases. The study results confirmed the topicality of awareness-raising activities among medical staff working on preventive vaccination. Moreover, long-standing need of vaccination schemes correction is also important through development of medical technology aimed on improvement of catch-up vaccination approach.

Dataset on child vaccination in Brazil from 1996 to 2021

We present a machine-readable and open-access dataset on vaccination results among children under five years old in Brazil from 1996 to 2021. This dataset is interoperable with epidemiological data from the VAX*SIM project and reusable by the research community worldwide for other purposes, such as monitoring vaccination coverage and studying its determinants and impacts on child morbidity and mortality. The dataset gathers official and public information from the Brazilian National Immunisation Program, the Institute of Geography and Statistics, the Institute for Applied Economic Research, and the Ministry of Health. It includes 2,442,863 observations and 35 attributes aggregated by years, policy-relevant geographic units (country, macroregions, states, municipalities, and capitals), and age groups on 1,344,480,329 doses of 28 vaccines aimed to prevent 15 diseases, estimates of their target-population coverage, indicators of the vaccination coverage’s homogeneity, dropout rates, and spatial, demographic, and socioeconomic data. We automated all data processing and curation in the free and open software R. The codes can be audited, replicated, and reused to produce alternative analyses.

Operational manager’s knowledge and attitudes toward data and universal health coverage indicators in primary health clinics in Ugu, South Africa

ABSTRACT Universal health coverage (UHC) aims to ensure people have access to the health services they need. Sixteen tracer indicators were developed for implementation by countries to measure UHC in the health system. South Africa uses 15 of the proposed 16 indicators. Operational managers in the public health care sector collect data and report on these indicators at a primary health clinic level. This qualitative study explored the knowledge and attitudes of managers toward data and UHC service indicators in a sub-district in Ugu, KwaZulu-Natal, South Africa. Operational managers saw data collection as information gathering, measuring performance and driving action. They understood UHC indicators as ‘health for all’ linking them to National Department of Health Strategic plans and saw the value of indicators for health promotion. They found the lack of training, inadequate numeracy skills, requests for data from multiple spheres of government and the indicator targets that they had to reach as challenging and untenable. While operational managers made the link between data, measuring performance and action, the limited training, skills gaps and pressures from higher levels of government may impede their ability to use data for local level planning and decision making.

DEVELOPMENT OF A MATHEMATICAL MODEL OF SELECTING THE EXTENT OF A SURGICAL INTERVENTION IN SPINAL TUMOR.

The aim: To develop a mathematical model of selecting the extent of surgical intervention in the spinal tumors. Materials and methods: The retrospective study included 237 patients with spinal tumors who underwent the following surgeries: vertebroplasty (V); vertebroplasty and spinal fixation (F+V); posterior spinal decompression and spinal fixation (F+F); vertebrectomy and replacement of vertebra by a cage with posterior spinal fixation (F+F+K). The mathematical model is based on the modified Spine Instability Neoplastic Score (SINS). The patients were divided into two clusters. Cluster analysis was used to build a diagnostic decision tree model. Results: The difference between two clusters is determined by the extent of surgical intervention, the grade of the vertebral lesion, epidural compression, and local kyphosis, and neurological signs as well. The cluster 1 included 115 patients with higher values of SINS compared to the cluster 2. All cases of vertebroplasty belonged to the cluster 2. In the cluster 1 cases of surgery of large extent: F+F; F+V; F+F+K. Analysis of the decision tree model for cluster 1 showed that a type of surgery was determined for 97 patients from 115 that relates to 84.3% of overall accuracy. The decision tree model have a high predictive accuracy for the surgery F+V and better indicators of coverage and predictive accuracy for the surgery F+F+K. Conclusions: Our study developed a decision tree model to optimize spinal neoplasm surgery, achieving 84.3% accuracy based on significant prognosis criteria. The model considers surgical type, neurological signs, vertebra lesion grade, and stage of epidural compression, potentially improving clinical outcomes.

Spatial behavior of hepatitis A, MMR, and varicella vaccination coverage in the state of Minas Gerais, 2020.

To analyze the spatial behavior of hepatitis A, measles, mumps, and rubella (MMR), and varicella vaccination coverage in children and its relationship with socioeconomic determinants in the state of Minas Gerais. This ecological study investigated records of doses administered to children, extracted from the Immunization Information System of 853 municipalities in Minas Gerais, in 2020. We analyzed the vaccination coverage and socioeconomic factors. Spatial scan statistics were used to identify spatial clusters and measure the relative risk based on the vaccination coverage indicator and the Bivariate Moran Index, and thus detect socioeconomic factors correlated with the spatial distribution of vaccination. We used the cartographic base of the state and its municipalities and the ArcGIS and SPSS software programs. Hepatitis A (89.0%), MMR (75.7%), and varicella (89.0%) showed low vaccination coverage. All vaccines analyzed had significant clusters. The clusters most likely to vaccinate their population were mainly located in the Central, Midwest, South Central, and Northwest regions, while the least likely were in the North, Northeast, and Triângulo do Sul regions. The municipal human development index, urbanization rate, and gross domestic product were spatially dependent on vaccination coverage. The spatial behavior of hepatitis A, MMR, and varicella vaccination coverage is heterogeneous and associated with socioeconomic factors. We emphasize that vaccination records require attention and should be continuously monitored to improve the quality of information used in services and research.

The effectiveness of the tax system in promoting General revenues in Algeria -Analytical study 2000-2015.

Through this study we analyzed the evolution proceeds of tax revenue and its place in the General State budget and development of indicators of fiscal pressure and regular revenue coverage for expenses of the propulsion, And reached the low level of fiscal pressure outside, and the dominance of petroleum taxation to the budget during the study period 2000-2015, as a result of poor performance and ineffective tax system despite reforms since the year 1992.

Spatial features of lifecell mobile network in the western part of Ukraine

Today, social communications and business are increasingly moving towards the mobile Internet. However, the information revolution also has a downside, namely the need to be always in touch and on-line. Nowadays, business is no longer limited to the office, and social communications are no longer limited to certain locations. It is important to have good mobile coverage, whether you are on the move or not. As a result, entire areas become more "suitable" for living and working than others. This measurement is based on only one indicator – the availability of a mobile network. The smartphone has become an access point to the global Internet network. In 2022, the number of unique mobile Internet users was 5 billion, which is more than 60% of the world's population. Geographical studies of mobile communication networks in Ukraine are not widespread. The available publications are mostly descriptive in nature. They consider Ukraine as whole unit without any intra-regional differences. Several scientific studies on the Kyivstar mobile network have a clearly expressed territorial aspect. At the same time, other networks - primarily Vodafone Ukraine and Lifecell - remain little studied. The purpose of the study is to determine the spatial features of the Lifecell mobile network in the western part of Ukraine, and the main task is to analyse the coverage indicators of the Lifecell mobile communication network at the local level in the western part of Ukraine based on open data. The Lifecell mobile network in the western part of Ukraine creates the following spatial patterns. Lifecell is the third largest mobile operator in Western Ukraine. In terms of network volume, it is behind its main competitors Kyivstar and Vodafobe. Its 3G mobile network is larger than its 4G network. Lifecell's network coverage primarily covers large cities and their surrounding areas. In rural areas, the network is poorly developed. In terms of sub-regions, Lviv oblast and Prykarpattia have the best coverage, while the Ukrainian Carpathians (except for the territories of Lviv oblast), the eastern part of Volyn Polissya, and the southern and eastern parts of Ternopil oblast have the worst coverage of the Lifecell network.

A Prospective Study of Reconstructive Procedures For Post Burn Hand Contractures

Objective: The hand is among the most frequent sites of burns contracture deformity. It represents a common problem and a difficult challenge for many reconstructive surgeons. It is important to restore length, function, and provide good quality skin cover. Our aim is to evaluate the different surgical procedures for resurfacing after release of post burn hand contractures in terms of functional recovery and aesthetic outcome. Methods: Totally 30 cases of post burn hand contractures were reconstructed between May 2018 and November 2019 according to site and type of contracture with individualization for each case. All cases were followed up with physiotherapy and splinting devices, functional and aesthetic outcome for each procedure. Results were analyzed as per successful reconstruction, type of procedure, complications, functional and aesthetic outcome. Most of the cases can be resurfaced with skin grafting and few cases have clear indication for flap coverage which needs to be planned and executed cautiously. Z- plasties with proper planning gives maximum length gain with no donor morbidity as other procedures and acceptable appearance. Conclusion: Postoperative physiotherapy and splinting are must for better outcome in all cases.

Estimation of bed net coverage indicators in Tanzania using mobile phone surveys: a comparison of sampling approaches

Threats to maintaining high population access with effective bed nets persist due to errors in quantification, bed net wear and tear, and inefficiencies in distribution activities. Monitoring bed net coverage is therefore critical, but usually occurs every 2-3years through expensive, large-scale household surveys. Mobile phone-based survey methodologies are emerging as an alternative to household surveys and can provide rapid estimates of coverage, however, little research on varied sampling approaches has been conducted in sub-Saharan Africa. A nationally and regionally representative cross-sectional mobile phone survey was conducted in early 2021 in Tanzania with focus on bed net ownership and access. Half the target sample was contacted through a random digit dial methodology (n = 3500) and the remaining half was reached through a voluntary opt-in respondent pool (n = 3500). Both sampling approaches used an interactive voice response survey. Standard RBM-MERG bed net indicators and AAPOR call metrics were calculated. In addition, the results of the two sampling approaches were compared. Population access (i.e., the percent of the population that could sleep under a bed net, assuming one bed net per two people) varied from a regionally adjusted low of 48.1% (Katavi) to a high of 65.5% (Dodoma). The adjusted percent of households that had a least one bed net ranged from 54.8% (Pemba) to 75.5% (Dodoma); the adjusted percent of households with at least one bed net per 2 de facto household population ranged from 35.9% (Manyara) to 55.7% (Dodoma). The estimates produced by both sampling approaches were generally similar, differing by only a few percentage points. An analysis of differences between estimates generated from the two sampling approaches showed minimal bias when considering variation across the indicator for households with at least one bed net per two de facto household population. The results generated by this survey show that overall bed net access in the country appears to be lower than target thresholds. The results suggest that bed net distribution is needed in large sections of the country to ensure that coverage levels remain high enough to sustain protection against malaria for the population.

Temporal and Spatial Variation in Vegetation Coverage and Its Response to Climatic Change in Marshes of Sanjiang Plain, China

Sanjiang Plain is the most extensive marsh distribution region in China. Marshes in this region can protect biodiversity, regulate climate, and provide habitats for wild animals and plants. The normalized difference vegetation index (NDVI) is a crucial indicator of vegetation coverage, which may reflect ecosystem structure and functional features. Clarifying the spatiotemporal change of marsh coverage and its climatic drivers is vital for observing and predicting vegetation change in Sanjiang Plain. Using meteorological dataand MODIS NDVI data from 2000 to 2020, we analyzed the spatiotemporal variation in marsh vegetation coverage and climatic change effects in Sanjiang Plain. We found that the growing season vegetation NDVI of marsh increased significantly at a rate of 0.011/decade, indicating that the marsh vegetation growth has obviously improved during the past 21 years. Furthermore, we found that the increase of minimum (Tmin) and maximum (Tmax) temperature in July can significantly promote the marsh plant growth, and increasing nighttime Tmin has a stronger impact on promoting the growth than increasing daytime Tmax in this month. In addition, the increase of daytime Tmax in August can promote the marsh vegetation growth, whereas the increasing precipitation in August was unfavorable for the growth in Sanjiang Plain.

Disparities in the implementation of the Health Extension Program in Ethiopia: Doing more and better towards universal health coverage.

Large-scale implementation of the Health Extension Program (HEP) has enabled Ethiopia to make significant progress in health services coverage and health outcomes. However, evidence on equity and disparities in the implementation of the HEP is limited. The aim of this study was to examine disparities in the implementation of the HEP in Ethiopia. We used data from the 2019 National HEP assessment which was conducted between Oct 2018 and Sept 2019 in nine regions in the country. Data were collected from 62 districts, 343 Health posts, 179 Health centres, 584 Health Extension Workers (HEWs), and 7043 women from 7122 Households. This study focused on selected input, service delivery, and coverage indicators. We used rate differences, rate ratios and index of disparity to assess disparities in HEP implementation across regions. We found wide inter-regional disparities in HEP implementation. Developing regional states (DRS) had significantly lower availability of qualified HEWs (Rate Ratio (RR) = 0.54), proportion of households visited by Health Extension workers (RR = 0.40), and proportion of mothers who received education on child nutrition (RR = 0.45) as compared national average. There were also significant disparities in HEP implementation among DRS in the proportion of households visited by HEWs in the past 12 months (Index of disparity = 1.58) and proportion of adolescents who interacted with HEWs (Index of disparity = 1.43). Despite low overall coverage of health services in DRS, the contribution of the HEP for maternal health services was relatively high. There were significant inter-regional disparities in the implementation HEP in Ethiopia. The level of disparity among DRS was also remarkable. To achieve Universal Health Coverage, it is important that these disparities are addressed systematically and strategically. We recommend a tailored approach in HEP implementation in DRS.

Trends and projections of universal health coverage indicators in China, 1993–2030: an analysis of data from four nationwide household surveys

Universal health coverage (UHC) is a core element of Sustainable Development Goals and has become a global healthcare priority. China has been committing to provide all citizens with affordable and equitable basic healthcare over past decades. However, progress towards UHC in China has not been comprehensively assessed. This study aims to comprehensively evaluate the progress towards UHC in China by examining trends in service coverage and financial protection from 1993 to 2018, and estimating the probability of achieving UHC targets by2030. Following the framework proposed by World Health Organization and World Bank, we selected 12 prevention service indicators, 12 treatment service indicators, and two financial protection indicators to evaluate China's progress towards UHC. We used data from four nationally representative household surveys to assess the trends in service coverage and financial protection between 1993 and 2018, as well as their inequalities across subgroups. Meta-analysis was used to construct the composite prevention and treatment indices. The regression-based relative index of inequality was used to measure the income-related inequality of UHC indicators. Bayesian linear regression was conducted to predict progress towards UHC by 2030, and the probability of achieving UHC targets. Of the 24 service coverage indicators used in this study, most of them experienced improvements between 1993 and 2018. The composite prevention index increased from 65.6% (95% CI: 52.1%-77.9%) to 87.7% (95% CI: 81.8%-92.6%) and the composite treatment index increased from 57.1% (95% CI: 43.5%-70.1%) to 75.5% (95% CI: 66.6%-83.5%). The inequalities of service coverage experienced significant declines during this period. Based on our projections, most indicators except ones in the area of non-communicable diseases (NCD) will achieve the 80% coverage target by 2030, and the prevention and treatment indices will increase to 92.7% (95% CrI: 90.3%-94.7%) and 83.2% (95% CrI: 75.1%-88.8%) by then. However, we observed limited reductions in the incidences of catastrophic health expenditure and medical impoverishment. Inequalities in financial protection remained large in2018. China had made significant progress in improving healthcare service coverage and reducing inequalities between 1993 and 2018. However, China faces great challenges in improving financial protection and controlling NCD on its path towards UHC. Establishment of a primary-healthcare-based integrated delivery system and provision of better financial protection for vulnerable population should be prioritized. None.

State of anti-rubella virus population immunity in the Republic of Belarus and Russian Federation

To confirm a progress towards the rubella elimination, immunization coverage indicators and the results of serological studies are used. At the same time, the most objective method of assessing collective immunity is a serological examination. The purpose of this work was to compare the results of assessing state of population immunity against rubella virus in the Republic of Belarus and the Russian Federation using various vaccines and different approaches to study organization and cohort selection screening and monitoring. 2019 laboratory studies to determine IgG antibodies against rubella virus were carried out by ELISA method of the unified enzyme immunoassay system Ecolab (Russia). The serum study results of 701 subjects aged 245 years from all the 7 regions of the Republic of Belarus (screening study) and 55 082 subjects aged 349 years (monitoring) from 85 regions of the Russian Federation were analyzed. The results were evaluated in three age groups children, adults, total cohort by using a threshold level of 8385% seropositive individuals sufficient to prevent virus transmission. The antigenic composition of the rubella component in the mono- and complex vaccines respectively used in the Russian Federation and the Republic of Belarus is identical, which allows to compare the state of population immunity against rubella virus therein without taking into account an influence of the vaccine strain. Studies have shown that while using varying vaccine preparations and approaches to organization of serological examination, both in the Republic of Belarus and the Russian Federation, rubella virus-specific IgG level was detected at rather high level in all age groups comprising more than 90%. The portion of rubella seropositive subjects in entire country was 95.44% in the Republic of Belarus and 97.14% in the Russian Federation. Moreover, the level of specific antibodies remains high, despite the low incidence rate and absence of booster effect in both countries. The mean group antibody concentration in seropositive patients in all age groups was quite high and exceeded the minimum protective concentration (11 IU/ml) by 10 or more times. The data obtained indicate the legitimacy of using a serological study of collective rubella immunity as a routine or seromonitoring as well as periodic or screening investigation.

Vaccination coverage trends in European Union from 1980 to 2020: A joinpoint Regression Analysis

Abstract Vaccinations are successful, cost-effective public health interventions; nevertheless, vaccine hesitancy represents a concern and several EU countries have implemented mandatory vaccinations to counteract it. The assessment of vaccination coverage data is helpful to clarify the reason behind this choice better and assess its impact. Data were extracted from the WUENIC database as of July 2021. All the 27 EU countries were included, considering the period from 1980 to 2020 (depending on data availability). Coverage indicators on seven vaccinations scheduled during the first year of life to prevent nine vaccine-preventable diseases were considered. Joinpoint regression was run using Joinpoint Trend Analysis Software 4.9.0.0. For each coverage indicator, the last two trends in time identified by the joinpoint regression were considered to identify countries with a positive vaccination coverage trend (having either the last trend significantly positive or the second last significantly negative but followed by a trend reversal) or a negative coverage trend (having either the last trend significantly negative or the second last significantly positive but followed by a trend reversal). To assess each country, we collated together information on each coverage indicator. A total of 180 jointpoint regressions were run. At least one joinpoint was observed in 144 cases: 39 (27.1%) showed a significant positive trend, and 49 (34%) had a significantly negative one. In 36 cases, there was a single trend lacking a joinpoint, either positive (21, 58.3%), negative (8, 22.2%), or not showing a change (7, 19.4%). Overall, 14 countries had mostly negative vaccination coverage trends, whereas 13 had mostly positive vaccination coverage trends. Systematised data collection and analysis of vaccination coverage trends are needed to support public health systems. EU countries differ broadly, but the overall situation shows that coverage trends are a key issue to be addressed. Key messages • Vaccination coverage in the EU shows a general negative trend. The assessment and comparison of coverage trends across EU countries could make policymakers able to respond to critical issues timely. • Mandatory vaccinations have been issued in different countries to prevent vaccination coverages from decreasing. Some countries have not issued any mandate but show high vaccination coverages.

Walk the path of cervical cancer elimination in Italy: current scenario and shared recommendations

Abstract Issue/problem In 2020, the World Health Organization (WHO) called for the elimination of cervical cancer. In order to get it, vaccination against Human Papillomavirus (HPV), screening of cervical cancer and treatment of high-grade cervical disease and cancer must be implemented at country level. Description of the problem Italy has implemented HPV vaccination and cervical cancer screening for many years. Nevertheless, nationwide data show that both vaccination coverage and adherence to screening programs are unsatisfactory as compared to the WHO 90 and 70 targets, namely 90% of girls fully vaccinated by the age of 15 years and 70% of women screened with a high-performance test (i.e., HPV-DNA test) by age 35 and again by 45. Results In order to address the progress of vaccination and screening at regional level in Italy, a project was conducted in 2021-2022 in order to collect data on relevant indicators and issues. In particular, information was collected on both coverage indicators (for both vaccination and screening) adherence (for screening) and history and characteristics of the vaccination offer (e.g., targets, gratuity) and of screening (e.g., presence of clinical pathways, type of tests used). Collected data were shared with a multidisciplinary panel of experts on HPV-related diseases to issue recommendations to foster the elimination of cervical cancer in Italy. For this purpose, a survey was also conducted to identify potential actions in respect to vaccination, screening and treatment. Lessons A great heterogeneity across Italian regions was observed. The following actions were identified to implement vaccination, screening and treatment: educational campaigns, reminders and active calls for both vaccination and screening and more interoperability of data and definition of clinical pathway involving a multidisciplinary medical team for the proper management of all HPV-related diseases. Key messages • Actions are requested at national level to achieve the goals set by the global strategy for cervical cancer elimination with respect to vaccination, screening and treatment. • Actions identified to foster cervical cancer elimination in Italy includes educational campaigns, reminders and active calls, better interoperability of data and integrated medical team.

The effect of the COVID-19 pandemic on routine childhood immunization coverage and timeliness in India: retrospective analysis of the National Family Health Survey of 2019-2021 data.

BackgroundThe COVID-19 pandemic has disrupted health systems globally. We estimated the effect of the pandemic on the coverage and timeliness of routine childhood immunization in India through April 2021.MethodsWe used data from India’s National Family Health Survey 2019-2021 (NFHS-5), a cross-sectional survey which collected immunization information of under-five children from a nationally representative sample of households between June 2019 and April 2021. We used a mother fixed-effects regression model – accounting for secular trends and confounding factors – to compare COVID-affected children with their COVID-unaffected siblings (n=59,144). Children who were eligible for a vaccine after January 30, 2020 (date of the first COVID case in India) were considered as the COVID-affected group and those eligible for a vaccine after this date were included in the COVID-unaffected group. Coverage of the following vaccine doses was considered—Bacillus Calmette–Guérin (BCG), hepatitis B birth dose (hepB0), DPT1 (diphtheria, pertussis, and tetanus, first dose), DPT2, DPT3, polio1, polio2, polio3, and measles first dose (MCV1). Indicators of vaccine coverage and vaccine timeliness (defined as receiving a dose within 45 days of minimum eligibility age) were separately examined.FindingsImmunization coverage was lower in COVID-affected children as compared with unaffected children, ranging from 2% lower for BCG and hepB0 to 9% for DPT3 and 10% for polio3. There was no significant difference in MCV1 coverage. Coverage reduction was greater for vaccines doses given at later age groups. The rate of timely receipt of polio and DPT vaccine doses was 3%-5% lower among COVID-affected children relative to unaffected children. Among population subgroups, COVID-affected male children and those from rural areas experienced the highest reduction in vaccine coverage.InterpretationChildren in India experienced lower routine immunization coverage and greater delays in immunization during the COVID-19 pandemic.FundingThe Bill & Melinda Gates Foundation.

A NSGA-II variant for the dynamic economic emission dispatch considering plug-in electric vehicles

The dynamic economic emission dispatch considering plug-in electric vehicles (DEED-PEV) belongs to a nonlinear constrained optimization problem and has the multimodal and discontinuity characteristics. The first characteristic mainly comes from the cost function with valve-point effects, and the second one is associated with the constraints of prohibited operating zones. In this paper, a novel NSGA-II (NNSGA-II) is proposed to deal with DEED-PEV. NNSGA-II replaces the simulated binary crossover operator by the one based on Gaussian distribution, and adaptively adjusts the crossover rate of each individual according to its rank in population. Also, it incorporates a rewarding coefficient into the crowding distance in density estimation, which gives considerations to both density and evenness of solutions. Accordingly, NNSGA-II is able to perform extensive searches in solution space and achieve a series of individuals with high diversity and good evenness. Experimental results suggest that NNSGA-II outperforms the other seven MOEAs for nine DEED-PEV problems with different charging and discharging scenarios of plug-in electric vehicles, and its obtained solutions are superior to those of the other seven MOEAs according to the hypervolume and coverage indicators. In short, NNSGA-II is a potential alternative for minimizing the generation cost and pollutant emission of DEED-PEV.

Comparison of CBCT Prescriptions among Different Campuses of East Carolina University School of Dental Medicine

Objectives East Carolina University School of Dental Medicine (ECU SoDM) has established a unique education model that delivers the dental curriculum through student rotations at community service learning centers (CSLCs) in underserved areas across North Carolina in their senior year. The objective of the study is to analyze the patient composition and CBCT prescription patterns at the main campus (Ross Hall) and eight CSLCs, to determine if students have comparable training at various sites. Methods CBCTs taken at ECU SoDM in 2017–2021 were evaluated. One-way analysis of variance and the Wilcoxon Rank Sum Test were used to determine any differences in demographics, Medicaid coverage, and scan indications at various sites. Results A total of 1444 patients were included, with an age range of 4–90 years old; male 685, female 758; 1130 non-Hispanic/Latino, 71 Hispanic/Latino. For races, Caucasian 1106, African-American 156, American Indian/Alaskan Native 32, Asian 18, mixed 13, other 73. For Medicaid, there are 75 with and 1369 without coverage. Ross Hall has the largest amount of patients at 537, followed by Davidson 218, Brunswick 189, and Lillington 169, with Elizabeth City being the least with 45 patients. The top four reasons for taking CBCTs were implants, endodontics, oral pathology, and 3rd molar assessment. There was no significant difference in the indications for CBCTs or Medicaid coverage, among various sites. Conclusions The demographics, Medicaid coverage and CBCT prescription patterns were comparable among various sites. There was a site-related difference in the amount of scans taken, warranting the necessity to monitor CSLC rotation selections to ensure a consistent learning experience.

Measuring Progress toward Universal Health Coverage in Iran: Two Years after the Implementation of the Health Transformation Plan

Introduction: One of the most important 2015-post agendas of countries’ health systems is achieving Universal Health Coverage (UHC), so countries should monitor the activities carried out. The present study aimed to investigate the UHC status two years after Health Transformation Plan (HTP) in Iran.
 Methods: This is a secondary analysis of the national household income and expenditure survey (with close 40,000 households as the survey sample). The survey was used to estimate financial protection indicators (out-of-pocket payment, catastrophic and impoverishment health expenditure) in 2016. Estimation for service coverage index provided by international databases was applied at the country level. Indicators of financial protection and service coverage were evaluated in relation to each other using the World Health Organization joint levels assessment method, which indicates UHC attainment in terms of a plot with four zones. The relationship was estimated for the entire population, first quintile, and fifth quintile in 2000, 2017, and 2030.
 Results: The average per capita of OOP annually was 1,940,613 Rials (162.415 PPP int $). About 15.85% of households endured catastrophic health expenditures at the 10% threshold. The impoverishment health expenditure is about 0.6. Accordingly, Iran is on the border between zones 1 and 2 in 2017 in terms of achieving UHC and will move to zone 1 in 2030 with the current trend.
 Conclusion: According to the results of this study, universal health coverage has not been achieved even despite the implementation of the HTP. Even with improved service coverage, achieving UHC by 2030 may seem impossible with the current trends.

Multiobjective evolutionary computation for high-order genetic interactions

A number of research works support the relationship between Single Nucleotide Polymorphisms (SNPs) and neurodegenerative diseases (e.g. Alzheimer’s or Parkinson’s Disease). It has been proven that these neurodegenerative diseases are mainly caused by the interaction of different SNPs. The complexity of identifying genetic interactions increases exponentially with two factors: (i) the number of SNPs contained in the biological dataset under study and (ii) the number of SNPs involved in the interaction. Therefore, this paper proposes the application of two of the most successful multiobjective evolutionary algorithms to solve this problem: a Reference-point based Many-objective Fast Non-dominated Sorting Genetic Algorithm (NSGA-III) and a Multiobjective Evolutionary Algorithm based on Decomposition with Dynamical Resource Allocation (MOEA/D-DRA). These algorithms have been tested with four datasets (including a real dataset about Bipolar Disorder with 425,574 SNPs) and three interaction sizes: 2, 5, and 8 loci. In addition, they have been compared against well-known and relevant approaches published in the literature, in both multiobjective and biological terms. The results clearly show the advantages of the approach based on NSGA-III. Particularly, NSGA-III improves the results obtained by other algorithms in multiobjective terms (by means of Hypervolume and Set Coverage indicators) and in biological terms (by means of Power, Recall, Precision, and F-measure metrics). Moreover, it reveals new 2 and 5 loci interactions over a Bipolar Disorder real dataset. Therefore, NSGA-III represents a relevant approach to detect high-order genetic interactions.