Global Access Research Articles

Pre-hospital telestroke and expanded hyper-acute telestroke network solutions to reduce geographic inequities: a brief review from the South Pacific

Hyper-acute stroke treatments are time sensitive, and decision-making is complex. Telemedicine has been highly effective in breaking down regional access barriers by providing front line rural hospital clinicians with remote telemedicine decision support by remote stroke experts. With the advent of mechanical thrombectomy, hyper-acute stroke care has grown even more complex from both a decision-making and logistical perspective. Mobile Stroke Units (MSU) have been deployed in a few urban settings globally but are unlikely to address all global access issues due to geographical and logistical factors. This paper reviews the feasibility and benefit of extending telestroke into the pre-hospital setting as an adjunct or alternative to MSUs. It will discuss how this service model can fit into existing stroke networks and potential deployment strategies. Finally, the paper also considers potential scalability of pre- and in-hospital telestroke support across regional and international boundaries to further reduce global hyper-acute access inequities.

The role of global health partnerships in vaccine equity: A scoping review.

The emergence of global health partnerships (GHPs) towards the end of the twentieth century reflected concerns about slow progress in access to essential medicines, including vaccines. These partnerships bring together governments, private philanthropic foundations, NGOs, and international agencies. Those in the vaccine field seek to incentivise the development and manufacture of new vaccines, raise funds to pay for them and develop and support systems to deliver them to those in need. These activities became more critical during the COVID-19 pandemic, with the COVAX Facility Initiative promoting global vaccine equity. This review identifies lessons from previous experiences with GHPs. Findings contribute to understanding the emergence of GHPs, the mechanisms they leverage to support global access to vaccines, and the inherent challenges associated with their implementation. Using Arksey and O'Malley's method, we conducted a scoping review to identify and synthesise relevant articles. We analysed data thematically to identify barriers and opportunities for success. We included 68 eligible articles of 3,215 screened. Most (65 [95%]) were discussion or review articles describing partnerships or programmes they supported, and three (5%) were commentaries. Emerging themes included policy responses (e.g., immunisation mandates), different forms of partnerships arising in vaccine innovation (e.g., product development partnerships, public-private partnerships for access), and influence on global governance decision-making processes (e.g., the rising influence of foundations, diminishing authority of WHO, lack of accountability and transparency, creation of disease silos). If global health partnerships are to maximise their contributions, they should: (1) increase transparency, especially regarding their impacts; (2) address the need for health systems strengthening; and (3) address disincentives for cooperative vaccine research and development partnerships and encourage expansion of manufacturing capacity in low and middle-income countries.

Overcoming language barriers in pediatric care: a multilingual, AI-driven curriculum for global healthcare education.

Online medical education often faces challenges related to communication and comprehension barriers, particularly when the instructional language differs from the healthcare providers' and caregivers' native languages. Our study addresses these challenges within pediatric healthcare by employing generative language models to produce a linguistically tailored, multilingual curriculum that covers the topics of team training, surgical procedures, perioperative care, patient journeys, and educational resources for healthcare providers and caregivers. An interdisciplinary group formulated a video curriculum in English, addressing the nuanced challenges of pediatric healthcare. Subsequently, it was translated into Spanish, primarily emphasizing Latin American demographics, utilizing OpenAI's GPT-4. Videos were enriched with synthetic voice profiles of native speakers to uphold the consistency of the narrative. We created a collection of 45 multilingual video modules, each ranging from 3 to 8 min in length and covering essential topics such as teamwork, how to improve interpersonal communication, "How I Do It" surgical procedures, as well as focused topics in anesthesia, intensive care unit care, ward nursing, and transitions from hospital to home. Through AI-driven translation, this comprehensive collection ensures global accessibility and offers healthcare professionals and caregivers a linguistically inclusive resource for elevating standards of pediatric care worldwide. This development of multilingual educational content marks a progressive step toward global standardization of pediatric care. By utilizing advanced language models for translation, we ensure that the curriculum is inclusive and accessible. This initiative aligns well with the World Health Organization's Digital Health Guidelines, advocating for digitally enabled healthcare education.

Review of Capsule Endoscope Technology

This essay explores the dynamic landscape of gastrointestinal health, highlighting the increasing incidence of conditions such as infections, ulcers, bleeding, and cancers. The crucial imperative of timely detection and diagnosis is emphasized, leading to examining capsule endoscopy and the transformative impact of magnetic sensor-based positioning techniques. From the initial development of capsule endoscopy in 2001 to the evolution of Simultaneous Magnetic Actuation and Localization (SMAL), the essay delves into advancements that enhance precision and control within the intricate gastrointestinal tract. Notwithstanding notable progress, challenges such as the necessity for miniaturization, reliance on external magnetic fields, and safety considerations are acknowledged. Future developments in navigation algorithms, wireless communication, and power management are anticipated and discussed as potential solutions. Envisioning a future where magnetic sensor-based capsule endoscopy integrates with artificial intelligence, the essay foresees personalized medicine, home-based monitoring, and global healthcare accessibility. Ultimately, the collaborative efforts needed to overcome challenges and unleash the full potential of this technology are emphasized, shaping the trajectory of gastrointestinal healthcare.

Genetic drivers of heterogeneity in type 2 diabetes pathophysiology

Type 2 diabetes (T2D) is a heterogeneous disease that develops through diverse pathophysiological processes1,2 and molecular mechanisms that are often specific to cell type3,4. Here, to characterize the genetic contribution to these processes across ancestry groups, we aggregate genome-wide association study data from 2,535,601 individuals (39.7% not of European ancestry), including 428,452 cases of T2D. We identify 1,289 independent association signals at genome-wide significance (P < 5 × 10−8) that map to 611 loci, of which 145 loci are, to our knowledge, previously unreported. We define eight non-overlapping clusters of T2D signals that are characterized by distinct profiles of cardiometabolic trait associations. These clusters are differentially enriched for cell-type-specific regions of open chromatin, including pancreatic islets, adipocytes, endothelial cells and enteroendocrine cells. We build cluster-specific partitioned polygenic scores5 in a further 279,552 individuals of diverse ancestry, including 30,288 cases of T2D, and test their association with T2D-related vascular outcomes. Cluster-specific partitioned polygenic scores are associated with coronary artery disease, peripheral artery disease and end-stage diabetic nephropathy across ancestry groups, highlighting the importance of obesity-related processes in the development of vascular outcomes. Our findings show the value of integrating multi-ancestry genome-wide association study data with single-cell epigenomics to disentangle the aetiological heterogeneity that drives the development and progression of T2D. This might offer a route to optimize global access to genetically informed diabetes care.

Advancements in Minimally Invasive Surgical Techniques: A Comprehensive Review

Introduction: Minimally Invasive Surgical (MIS) techniques have revolutionized the field of surgery, offering significant benefits over traditional open surgery. This narrative review examines the historical evolution, current advancements, and prospects of MIS, with a focus on its impact on patient outcomes, surgical training, and healthcare systems. Objective: To provide a comprehensive overview of the advancements in MIS, highlighting technological innovations, changes in clinical practice, and the evolution of surgical education. The review also aims to discuss the challenges and future directions of MIS. Methods: The review included 24 articles published from 2004 to 2023. Criteria for inclusion were relevance to MIS development and impact, with exclusion for non-English and unrelated articles. Data were synthesized to outline the progression, current state, and future trends in MIS. Results: Key findings include significant advancements in surgical technologies such as robotics and enhanced imaging, the expansion of MIS across various specialties, and improved patient outcomes like reduced recovery times and lower complication rates. Challenges identified include the steep learning curve for surgeons and disparities in global access to MIS. Future trends indicate a move towards AI integration, personalized surgical approaches, and further refinement of robotic systems. Conclusions: MIS represents a paradigm shift in surgical practice, characterized by technological innovation and improved patient care. Despite challenges, its future is promising, with continuous advancements expected to further reshape surgical procedures.

A Local Pre-Rerouting Algorithm to Combat Sun Outage for Inter-Satellite Links in Low Earth Orbit Satellite Networks

Satellite networks show the development trend in global coverage, flexible access, and reliable transmission. They are the key to building a wide coverage, massive connection, three-dimensional, all-round, all-weather, space-, air- and ground-integrated information network. Due to its high frequency and large bandwidth, the laser inter-satellite link (ISL) is easily interfered with by sunlight. When sun outage occurs, the laser inter-satellite link will be interrupted for a long time. Most of the existing satellite link failure-routing algorithms are distributed and have poor load balancing capabilities. The centralized algorithm calculates paths independently for different services, and the effect is not ideal. In this paper, a local pre-rerouting algorithm (LPRA) is proposed. The center node collects the link information from the limited area before sun outage and the service information in the link that is about to be interrupted, and reroutes these services before sun outage occurs. After the occurrence of sun outage, services that originally needed to go through the failed link are forwarded according to the path calculated in advance, thereby avoiding link congestion and reducing the packet loss rate. Simulation results show that the proposed algorithm performs better than existing algorithms in terms of packet loss ratio, total delay and load balancing capabilities.

The Theory of the Evolution of Economic Relations as an Approach to Generalize the Theory of Games

The Theory of Games in the classical sense uses the idea of a system of economic relations of one type, namely economic relations of a private nature when the goal of rational behavior of the subject of economic relations (ER) is to maximize the benefit (own profit). In the process of evolution, economic relations go through several stages (namely 16), and for each stage, the set of characteristics of the basic elements strictly differs from the set of other stages. The rational behavior of the subjects is largely determined by this particular set of characteristics. Thus, the corresponding Theory of Rational Behavior of Economic Subjects (TRES) is the generalization of the Theory of Games for application in economics (that is, it applies not only to one type of economic relations, aiming at private benefit). Another aspect of the generalization of the Theory of Games in conditions of global information and computer accessibility is the transition from money as a medium of exchange that was a “transferable numerical utility” to another medium of exchange - a full range of goods with the complete dynamically changing set of exchange coefficients as a “generalized medium of exchange” that organically corresponds to the economic content of the production process.

Genome-wide ATAC-see screening identifies TFDP1 as a modulator of global chromatin accessibility.

Chromatin accessibility is a hallmark of active regulatory regions and is functionally linked to transcriptional networks and cell identity. However, the molecular mechanisms and networks that govern chromatin accessibility have not been thoroughly studied. Here we conducted a genome-wide CRISPR screening combined with an optimized ATAC-see protocol to identify genes that modulate global chromatin accessibility. In addition to known chromatin regulators like CREBBP and EP400, we discovered a number of previously unrecognized proteins that modulate chromatin accessibility, including TFDP1, HNRNPU, EIF3D and THAP11 belonging to diverse biological pathways. ATAC-seq analysis upon their knockouts revealed their distinct and specific effects on chromatin accessibility. Remarkably, we found that TFDP1, a transcription factor, modulates global chromatin accessibility through transcriptional regulation of canonical histones. In addition, our findings highlight the manipulation of chromatin accessibility as an approach to enhance various cell engineering applications, including genome editing and induced pluripotent stem cell reprogramming.

Sequential logic circuit gold codes for electronics and communication technologies

The linear feedback shift register (LFSR) and Gold codes are used in telecommunications, Global Positioning System (GPS), satellite navigation, wireless systems, and code division multiple access (CDMA) dependent channel schemes for numerous radio communication technologies Gold codes are distinguished by their capacity to provide various orthogonal sequences.•The objective of the article is to focus on the design and simulation of the LFSR-based gold code generator chip in Xilinx ISE 14.7 software with the logic synthesis in Virtex-5 field programmable gate array (FPGA) and check the switching behavior with large frequency support applicable in fast-switching optical, and wireless electronics systems.•The methodology comprises design, functional simulation with different test inputs, and FPGA synthesis. The chip design is verified for the 10-bit seeding sequence of LFSRs to result in 1023-bit code with the frequency support of 310 MHz, and 9.285 ns delay.•The chip design is simulated based on seed data and different tap points of LFSR registers from which the bits are considered to generate the feedback. The design is scalable and has greater potential to extend to a larger extent. The behavior of the gold code depends on the maximum length sequence, absolute cross-correlation, and size of LFSR.

COVID and structural cartelisation: market-state-society ties and the political economy of Pharma

ABSTRACT The big profits and influence of pharmaceutical firms that again rose to prominence during the COVID pandemic illustrate far more than just the global reach and market power of Big Pharma. Here we instead explain the power of these firms as a consequence of structural cartelisation that is networked and nested across hybrid state and market relations. Global inequalities in access to COVID vaccines exposed the inequity outcomes of the cartelisation of the pharmaceutical sector in dramatic new ways. To come to critical terms with this cartelisation, we describe how it is comprised of three kinds of nested and networked layers of structural collusion: namely, (i) firm-firm collusion, (ii) firm-state collusion; and (iii) firm-state-philanthropy collusion. By suggesting that these kinds of collusional relations are nested, overlapping and deeply networked, we explain how they have come to work together structurally. And, in doing so, we argue, they serve to capture value from biomedical innovation in ways that limit global access to medicines while simultaneously entrenching the dominance of high-income countries, lead firms and the interests of investors.

Blockchain Enabled Smart Contracts for Digital Assets

The diverse applications and benefits of blockchain technology and smart contracts across various sectors are explored in this overview. Decentralized Finance (DeFi) projects, supply chain management, tokenization of assets, NFT platforms, and identity verification stand out as prominent examples. Smart contracts are lauded for their cost efficiency and security, underpinned by blockchain's cryptographic features that fortify system integrity. Blockchain's global accessibility facilitates cross-border transactions, while decentralized exchanges (DEX) mitigate censorship and counterparty risks, empowering users with asset control. Moreover, blockchain expands investment opportunities through asset tokenization, encompassing diverse classes such as real estate and intellectual property, bolstering security and transparency through immutable ownership records. Oracles play a vital role in integrating real-time data into DeFi ecosystems, informing decision-making by linking off-chain data with blockchain networks.Diverse token standards like ERC-20 and ERC-721 are pivotal, catering to fungible and non-fungible token ecosystems respectively. Lastly, the advantages of proof of stake (PoS) over proof of work (PoW) are highlighted, emphasizing PoS's energy efficiency, transaction throughput, and scalability

Social media as a primary source of information: Exploring its role in disseminating the current situation in Palestine

The proliferation of social media has changed the global information paradigm, enabling immediate and direct access to breaking news. This research examines the role of social media as a primary source of information, focusing on the context of the conflict in Palestine. Through a qualitative desk research approach, it explores how social media contributes to disseminating current events in Palestine. The analysis involved a review of literature related to social media development, conflict information dynamics, and its impact on public opinion. The results show that social media has become an essential tool in accelerating and expanding the reach of information about the situation in Palestine. Individual actions, such as sharing news or personal views, can trigger significant public responses and shape narratives that influence global perceptions. Moreover, the active engagement of social media users in relaying actual information plays a key role in shaping opinions and attitudes toward the conflict. This research provides insight into the complex dynamics of social media as a key source of information, illustrating how information is disseminated and understood in the context of the Palestinian conflict. The implications of this research can contribute to further understanding social media's role in shaping public opinion and influencing the global narrative on sensitive issues such as the Palestinian conflict.

Global Expanded Access Program for Pemigatinib in Patients with Previously Treated Locally Advanced or Metastatic Cholangiocarcinoma and Fibroblast Growth Factor Receptor Gene Alterations.

Pemigatinib is a fibroblast growth factor receptor-2 (FGFR2) inhibitor approved for use in patients with previously treated cholangiocarcinoma (CCA) and FGFR2 fusions or rearrangements. This ongoing global Expanded Access Program (EAP) allows physicians in regions where pemigatinib is not commercially available to request pemigatinib for patients with locally advanced or metastatic CCA who, in the physician's opinion, could benefit from pemigatinib treatment. Eighty-nine patients from Europe, North America, and Israel were treated from January 2020 through September 2021. Patients had FGFR gene fusions (68.5%), rearrangements (12.4%), translocations (5.6%), amplifications (2.2%), and other alterations (11.2%). Median duration of treatment in the EAP was 4.0 months (range, 0.1 to 13.6 months). The most frequently reported adverse event (AE) was hyperphosphatemia (22.5%); the most common serious AE was cholangitis (3.4%). Treatment discontinuation was associated with reports of AEs for seven patients (7.9%). AEs associated with pemigatinib were consistent with those observed in clinical trials. Efficacy was not assessed in this EAP. However, some patients remained on treatment for up to a year, suggesting that they observed a benefit from treatment. Patients with CCA should undergo molecular testing to identify those who could benefit from targeted treatments such as pemigatinib.

The three ages of the European policy for productive investments

Across the EU sectoral policies, a variety of instruments are used to foster investments and to transform Europe’s productive capacities. Reading beyond the traditional bureaucratic and policy silos, this paper shows how such a composite repertoire of instruments crystalised, taking advantage of two complementary historical fieldworks. Using the sociological concept of ‘age’, we show how a European policy for productive investments emerged, supported by specific rationales and staff, to address episodes of budgetary constraints over investment policies. We first distinguish an ‘age of infrastructure’ (from the 1950s), where the first EEC bureaucrats in charge of these policies – mainly lawyers and engineers – designed loans strategies to continue reconstruction efforts, targeting heavy infrastructural investments in energy or transportation. Then, we show how in the 1970s context of rising budgetary tensions, economists urged their colleagues to take advantage of the Common Market to create European champions, through grants and co-financing, and by promoting SMEs as growth drivers: this marks the ‘integrative age’. Finally, from the 1990s, bureaucrats with a background in finance reoriented PI policies to overcome so-called ‘markets failures’ through loans, guarantees and equity, initiating an ‘age of leverage’ in EU public action. Here, the global access to (publicly subsidized) finance and the rise of derisking activities became a new standard. By capturing the way these successive policy ages concatenated and gave the EU Investor State its current shape, our approach accounts for both stability and change in EU policies.

What COVID-19 Vaccine Distribution Disparity Reveals About Solidarity

What COVID-19 Vaccine Distribution Disparity Reveals About Solidarity

Life-Saving Treatments for Spinal Muscular Atrophy: Global Access and Availability.

Spinal muscular atrophy (SMA) is a neurodegenerative disorder manifesting with progressive muscle weakness and atrophy. SMA type 1 used to be fatal within the first 2 years of life, but is now treatable with therapies targeting splicing modification and gene replacement. Nusinersen, risdiplam, and onasemnogene abeparvovec-xioi improve survival, motor strength, endurance, and ability to thrive, allowing many patients to potentially attain a normal life; all have been recently approved by major regulatory agencies. Although these therapies have revolutionized the world of SMA, they are associated with a high economic burden, and access to these therapies is limited in some countries. The primary objective of this study was to compare the availability and implementation of treatment of SMA from different regions of the world. In this qualitative study, we surveyed health care providers from 21 countries regarding their experiences caring for patients with SMA. The main outcome measures were provider survey responses on newborn screening, drug availability/access, barriers to treatment, and related questions. Twenty-four providers from 21 countries with decades of experience (mean 26 years) in treating patients with SMA responded to the survey. Nusinersen was the most available therapy for SMA. Our survey showed that while genetic testing is usually available, newborn screening is still unavailable in many countries. The provider-reported treatment cost also varied between countries, and economic burden was a major barrier in treating patients with SMA. Overall, this survey highlights the global inequality in managing patients with SMA. The spread of newborn screening is essential in ensuring improved access to care for patients with SMA. With the advancement of neurotherapeutics, more genetic diseases will soon be treatable, and addressing the global inequality in clinical care will require novel approaches to mitigate such inequality in the future.

Abstract WMP46: Rurality Affects Access to Mechanical Thrombectomy for Large Vessel Occlusion Stroke on a Global Scale

Introduction: Global mechanical thrombectomy access (MTA) for large vessel occlusion (LVO) stroke is extremely low. Rural patients are less likely to receive initial care at a thrombectomy-capable hospital. While regional studies have suggested rurality as a barrier to MTA, the magnitude and variability of this effect across countries is unknown. The aim of this study is to evaluate the association of country-level % of the rural population with access to mechanical thrombectomy. Methods: We conducted an online survey of 75 countries through the Mission Thrombectomy 2020+ (MT2020+) global professional peer network between November 22, 2020, and February 28, 2021. Questions included country-level availability of MT centers, operators, procedures, reimbursement, emergency medical services, cultural barriers, and other factors affecting systems of stroke care. MTA was defined as the estimated proportion of patients with thrombectomy-eligible LVOs receiving MT in each region annually. We used the World Bank data to obtain the income class based on per capita GNI of a country and the proportion of rural population expressed as % of total population of each country. In the final analysis, 60 countries were included. We used multivariable-adjusted generalized linear models with logit link to evaluate the association of rural population % with MT access. Results: The median country-level % of rural population among 60 countries was 30.5% (IQR 16.1-45.7%). In univariable generalized linear models, each 5% increase in country-level % of rural population was associated with 22% lower odds of MT access (OR 0.78, 95%CI 0.70-0.86, p&lt;0.001). After adjustment for differences in country-level % of GDP spent on healthcare, reimbursement for MT, country’s income class, prehospital emergency services (EMS) system availability, training, and triage systems, each 5% increase in % of rural population was associated with 6% lower odds of MT access (OR 0.94, 95%CI 0.90-0.99, p=0.013). Conclusion: The % of rural population of countries is a significant independent negative predictor of access to mechanical thrombectomy. The % of rural populations and its distribution within countries needs to be carefully studied, as policies to improve access are created and implemented.

Regulation of YAP Promotor Accessibility in Endothelial Mechanotransduction.

Endothelial cells are constantly exposed to mechanical forces in the form of fluid shear stress, extracellular stiffness, and cyclic strain. The mechanoresponsive activity of YAP (Yes-associated protein) and its role in vascular development are well described; however, whether changes to transcription or epigenetic regulation of YAP are involved in these processes remains unanswered. Furthermore, how mechanical forces are transduced to the nucleus to drive transcriptional reprogramming in endothelial cells is poorly understood. The YAP target gene, AmotL2 (angiomotin-like 2), is a junctional mechanotransducer that connects cell-cell junctions to the nuclear membrane via the actin cytoskeleton. We applied mechanical manipulations including shear flow, stretching, and substrate stiffness to endothelial cells to investigate the role of mechanical forces in modulating YAP transcription. Using in vitro and in vivo endothelial depletion of AmotL2, we assess nuclear morphology, chromatin organization (using transposase-accessible chromatin sequencing), and whole-mount immunofluorescent staining of the aorta to determine the regulation and functionality of YAP. Finally, we use genetic and chemical inhibition to uncouple the nuclear-cytoskeletal connection to investigate the role of this pathway on YAP transcription. Our results reveal that mechanical forces sensed at cell-cell junctions by the YAP target gene AmotL2 are directly involved in changes in global chromatin accessibility and activity of the histone methyltransferase EZH2, leading to modulation of YAP promotor activity. Functionally, shear stress-induced proliferation of endothelial cells in vivo was reliant on AmotL2 and YAP/TAZ (transcriptional coactivator with PDZ-binding motif) expression. Mechanistically, uncoupling of the nuclear-cytoskeletal connection from junctions and focal adhesions led to altered nuclear morphology, chromatin accessibility, and YAP promotor activity. Our findings reveal a role for AmotL2 and nuclear-cytoskeletal force transmission in modulating the epigenetic and transcriptional regulation of YAP to maintain a mechano-enforced positive feedback loop of vascular homeostasis. These findings may offer an explanation as to the proinflammatory phenotype that leads to aneurysm formation observed in AmotL2 endothelial deletion models.

Abstract WP102: Impact of National Universal Health Coverage on Access to Mechanical Thrombectomy: A Sub-Analysis of the Mechanical Thrombectomy Global Access for Stroke (MT Glass)- A Mission Thrombectomy Study

Background: The WHO’s third Sustainable Development Goal (SDG Target 3.8) identifies Universal health coverage (UHC) as a target for countries to attain by 2030. The availability of UHC is intricately linked to access to emergency healthcare without incurring financial hardship. The MT-GLASS study demonstrated that access to mechanical thrombectomy (MT) on a global level is minuscule, with enormous disparities between countries. We aim to study the impact of national UHC on access to MT. Methods: The MT-GLASS survey was conducted in 75 countries through the Mission Thrombectomy 2020+ (MT2020+) global professional peer volunteer network. The primary endpoints were the current annual Mechanical Thrombectomy Access (MTA), MT operator availability, and MT center availability in the country. MTA was defined as the estimated proportion of patients with LVO receiving MT annually. The availability metrics were defined as ([current MT operatorsх50/current annual number of estimated thrombectomy-eligible LVOs]х100 = MT operator availability) and ([current MT centersх150/current annual number of estimated thrombectomy-eligible LVOs]х100= MT center availability). The metrics used an optimal MT volume per operator of 50 and an optimal MT volume per center of 150. UHC was measured using the service coverage index (SCI: ranges 1-100- per WHO). Results: Of the 59 countries with complete data, the median SCI was 72 (61-78) [Figure-1A- Countries in SCI groups]. Countries with SCI &lt;72 have significantly lower MT access rates, MT center and operator availability, reimbursement facilities, and healthcare spending by GDP (Table in Figure-1B). On multivariable regression analyses, SCI is an independent predictor of MT access [OR-4.5 (1.2-8.2) p=0.02]. Conclusions: National universal health coverage is a significant predictor of access to mechanical thrombectomy for LVO stroke patients.