Medicine and Health Sciences Commons^™

Survival Disparities Between Border And Non-Border Counties In Colorectal Cancer Patients Using The Tcr, Michael Machiorlatti, Michael Brian Lapelusa

Research Colloquium

Along the US Texas Mexico border constant migration, developing medical infrastructure and income disparity leads to poorer access to healthcare and poorer health outcomes. Given 32 of the 254 counties in TX are on the border with roughly 9.8% of the Texas residing in these counties (2.8 million people), this represents a significant population susceptible to adverse health outcomes. We investigate comparisons between border and non-border counties as well as how sociodemographic and diagnostic criterion influence survival of colorectal cancer. Data was obtained from the Texas Department of State Health Service’s TCR. Patients were 18 or older and excluded for …

Variation In Functional Pelvic Tilt In Patients Undergoing Total Hip Arthroplasty With Acetabular Dysplasia, Myung-Jin Cha, Joel Wells, Yin Xi, Avneesh Chhabra

Research Colloquium

Purpose: It is important to clarify the link between acetabular dysplasia and pelvic tilt to optimize surgical planning and postoperative outcomes. We sought to investigate functional pelvic tilt in patients undergoing total hip arthroplasty with acetabular dysplasia.

Materials & Methods: From 2014 to 2020, pre-operative AP Pelvis X-rays, CT scans, and other patient-specific data such as pelvic tilt, lumbar lordotic angle, etc were collected as part of surgical planning for total hip arthroplasty. From this database, we investigated 678 female patients under the age of 50 that had undergone preoperative standing AP pelvis X-rays. Analysis was performed by investigating how …

Clinical Characteristics Of Monkeypox Vaccine Injection Site Reactions: A Cohort Of Seven Patients, Anthony A. Gaspari

Department of Dermatology and Cutaneous Biology Faculty Papers

Background

Monkeypox (Mpox) infections are considered a public health emergency, prompting the need for the administration of a preventative vaccine to high-risk individuals.

Objectives

To describe the clinical course of dermatologic reactions to Mpox vaccine over time.

Methods

Seven recipients of the Mpox vaccine, administered via intradermal injection, were observed over time, and the dermatologic reactions to this vaccine were recorded.

Results

All seven recipients experienced mild to moderate localized reactions to Mpox vaccine to either the primary or booster injections. These reactions were characterized by erythema, induration and pruritus. These reactions eventually healed without any sustained reactions, eschar or …

Leveraging National And Global Political Determinants Of Health To Promote Equity In Cancer Care, Edward Christopher Dee, Michelle Ann B. Eala, Janine Patricia G. Robredo, Duvern Ramiah, Anne Hubbard, Frances Dominique V. Ho, Richard Sullivan, Ajay Aggarwal, Christopher M. Booth, Gerardo D. Legaspi, Paul L. Nguyen, C. S. Pramesh, Surbhi Grover

Ateneo School of Medicine and Public Health Publications

Health and politics are deeply intertwined. In the context of national and global cancer care delivery, political forces-the political determinants of health-influence every level of the cancer care continuum. We explore the "3-I" framework, which structures the upstream political forces that affect policy choices in the context of actors' interests, ideas, and institutions, to examine how political determinants of health underlie cancer disparities. Borrowing from the work of PA Hall, M-P Pomey, CJ Ho, and other thinkers, interests are the agendas of individuals and groups in power. Ideas represent beliefs or knowledge about what is or what should be. Institutions …

Influence Of Macrophages On Vascular Invasion Of Inflammatory Breast Cancer Emboli Measured Using An In Vitro Microfluidic Multi-Cellular Platform, Manasa Gadde, Melika Mehrabi-Dehdezi, Bisrat G Debeb, Wendy A Woodward, Marissa Nichole Rylander

Faculty, Staff and Student Publications

Inflammatory breast cancer (IBC) is an aggressive disease with a poor prognosis and a lack of effective treatments. It is widely established that understanding the interactions between tumor-associated macrophages (TAMs) and the tumor microenvironment is essential for identifying distinct targeting markers that help with prognosis and subsequent development of effective treatments. In this study, we present a 3D in vitro microfluidic IBC platform consisting of THP1 M0, M1, or M2 macrophages, IBC cells, and endothelial cells. The platform comprises a collagen matrix that includes an endothelialized vessel, creating a physiologically relevant environment for cellular interactions. Through the utilization of this …

Contact With Caregivers Is Associated With Composition Of The Infant Gastrointestinal Microbiome In The First 6 Months Of Life, Kyle S. Wiley, Andrew M. Gregg, Molly M. Fox, Venu Lagishetty, Curt A. Sandman, Jonathan P. Jacobs, Laura M. Glynn

Psychology Faculty Articles and Research

Objectives

Little is known about how physical contact at birth and early caregiving environments influence the colonization of the infant gastrointestinal microbiome. We investigated how infant contact with caregivers at birth and within the first 2 weeks of life relates to the composition of the gastrointestinal microbiome in a sample of U.S. infants (n = 60).

Methods

Skin-to-skin and physical contact with caregivers at birth and early caregiving environments were surveyed at 2 weeks postpartum. Stool samples were collected from infants at 2 weeks, 2, 6, and 12 months of age and underwent 16S rRNA sequencing as a proxy …

Asynchronous Online Focus Groups For Research With People Living With Amyotrophic Lateral Sclerosis And Family Caregivers: Usefulness, Acceptability And Lessons Learned, Shelagh K. Genuis, Westerly Luth, Garnette Weber, Tania M. Bubela, Wendy S. Johnston

Office of the Provost

Background: People with amyotrophic lateral sclerosis (ALS) face disability- and travel-related barriers to research participation. We investigate the usefulness and acceptability of asynchronous, online focus groups (AOFGs) for research involving people affected by ALS (patients and family caregivers) and outline lessons learned.
Methods: The ALS Talk Project, consisting of seven AOFGs and 100 participants affected by ALS, provided context for this investigation. Hosted on the secure itracks Board™ platform, participants interacted in a threaded web forum structure. Moderators posted weekly discussion questions and facilitated discussion. Data pertaining to methodology, participant interaction and experience, and moderator technique were analyzed using itracks …

Podcasts As A Form Of Social Support For Individuals With Chronic Illness, Kate Pederson, Melanie Finney

Annual Student Research Poster Session

Chronic illness frequently decreases individuals’ abilities to receive social support. 105 listeners of health-related podcasts completed online closed and open-ended surveys. Results indicate 97% of respondents experience social isolation because of their illness, and 90% report listening to podcasts help them feel less isolated. Additionally, condition-specific podcasts allow people to gain relevant information about managing health challenges, as well as feel part of a community of people who understand them. Finally, results suggest parasocial relationships with hosts of the podcasts correlate positively with informational support, which subsequently is correlated positively with perceived emotional support.

Medical Imaging Applications Of Federated Learning, Sukhveer Singh Sandhu, Hamed Taheri Gorji, Pantea Tavakolian, Kouhyar Tavakolian, Alireza Akhbardeh

Faculty, Staff and Student Publications

Since its introduction in 2016, researchers have applied the idea of Federated Learning (FL) to several domains ranging from edge computing to banking. The technique's inherent security benefits, privacy-preserving capabilities, ease of scalability, and ability to transcend data biases have motivated researchers to use this tool on healthcare datasets. While several reviews exist detailing FL and its applications, this review focuses solely on the different applications of FL to medical imaging datasets, grouping applications by diseases, modality, and/or part of the body. This Systematic Literature review was conducted by querying and consolidating results from ArXiv, IEEE Xplorer, and PubMed. Furthermore, …

Phylogenomics Reveals The History Of Host Use In Mosquitoes, John Soghigian, Charles Sither, Silvia Andrade Justi, Gen Morinaga, Brian K. Cassel, Christopher J. Vitek, Todd Livdahl, Siyang Xia, Andrea Gloria-Soria, Jeffrey R. Powell

School of Integrative Biological & Chemical Sciences Faculty Publications

Mosquitoes have profoundly affected human history and continue to threaten human health through the transmission of a diverse array of pathogens. The phylogeny of mosquitoes has remained poorly characterized due to difficulty in taxonomic sampling and limited availability of genomic data beyond the most important vector species. Here, we used phylogenomic analysis of 709 single copy ortholog groups from 256 mosquito species to produce a strongly supported phylogeny that resolves the position of the major disease vector species and the major mosquito lineages. Our analyses support an origin of mosquitoes in the early Triassic (217 MYA [highest posterior density region: …

Improving Health Literacy Among Transgender/ Gender Non-Conforming People Using Social Media, Isha Mittal, Michelle Cordoba Kissee

Research Colloquium

Background: Health literacy has been elicited as a barrier to healthcare amongst LGBT individuals. Social media has become a popular force in transmitting health information, but often time lacks evidence-based information.

Aims/purpose: The TikTok channel GenderDefenders was created to address the lack of reliable evidence-based information for transgender and gender-non conforming (TGNC) individuals.

Methods: Data was collected from current TikTok videos that were tagged with TGNC terminology to identify gaps in knowledge and commonly asked questions. Themes were selected and educational video recordings were created using WPATH and UCSF guidelines for transgender healthcare. Some topics included what …

Évaluation De L’Impact De La Coexposition Sur Les Biomarqueurs D’Exposition Aux Pesticides Pyréthrinoïdes Chez Les Travailleurs Agricoles, Michèle Bouchard, Marc Bossou, Jonathan Côté

Rapports de recherche scientifique

Il existe peu de données publiées sur l'impact de la coexposition sur la toxicocinétique des pesticides chez les travailleurs agricoles, nécessaires pour une interprétation adéquate des données de biosurveillance de l’exposition. La présente recherche a visé à évaluer l’impact de la coexposition sur les niveaux de biomarqueurs d’exposition aux pesticides pyréthrinoïdes chez les travailleurs agricoles. Le pyréthrinoïde lambda-cyhalothrine (LCT) et le fongicide captane ont été utilisés comme pesticides sentinelles, puisqu’ils sont largement employés en culture agricole.

Dans le volet 1, les profils temporels individuels des biomarqueurs d'exposition à la lambda-cyhalothrine ont été comparés chez des opérateurs après un épisode …

In-Utero Exposure To Antibiotics And Risk Of Colorectal Cancer In A Prospective Cohort Of 18 000 Adult Offspring, Caitlin C Murphy, Piera M Cirillo, Nickilou Y Krigbaum, Amit G Singal, Dean P Jones, Timothy Zaki, Barbara A Cohn

Faculty, Staff and Student Publications

BACKGROUND: Incidence rates of colorectal cancer (CRC) are increasing among younger adults and in mid-life, implicating exposures in early life as risk factors. We examined the association between in-utero exposure to antibiotics and risk of CRC in adult offspring.

METHODS: The Child Health and Development Studies is a prospective cohort of women receiving prenatal care between 1959 and 1966 in Oakland, California, with deliveries through June 1967. Diagnosed conditions and all prescribed medications were abstracted from mothers' medical records beginning 6 months prior to pregnancy through delivery. We identified mothers who received antibiotics in pregnancy, including penicillins, tetracyclines, short-acting sulfonamides …

The Use Of Electronic Health Record Data To Identify Variation In Referral, Consent, And Engagement In A Pediatric Intervention For Overweight And Obesity: A Cross-Sectional Study, Joshua S Yudkin, Marlyn A Allicock, Folefac D Atem, Carol A Galeener, Sarah E Messiah, Sarah E Barlow

Faculty, Staff and Student Publications

Clinical weight management programs face low participation. The authors assessed whether using electronic health record (EHR) data can identify variation in referral, consent, and engagement in a pediatric overweight and obesity (OW/OB) intervention. Using Epic EHR data collected between August 2020 and April 2021, sociodemographic and clinical diagnostic data (ie, International Classification of Disease [ICD] codes from visit and problem list [PL]) were analyzed to determine their association with referral, consent, and engagement in an OW/OB intervention. Bivariate analyses and multivariable logistic regression modeling were performed, with Bayesian inclusion criterion score used for model selection. Compared with the 581 eligible …

Antimicrobial Resistance And Rational Prescription Practices: Knowledge, Perceptions And Confidence Of Health Profession Interns In Uganda, Shamim Nabidda, Rogers Ssennyonjo, Joseph Atwaru, Andrew Marvin Kanyike, Shiellah Baryayaka, Kennedy Pangholi, Jonans Tusiimire

School of Nursing & Midwifery, East Africa

Background

Antimicrobial resistance (AMR) is significantly driven by misuse and overuse of antibiotics. Graduate health profession interns often prescribe antimicrobials under minimum supervision.

Objectives

This study explored the knowledge, perceptions and confidence of health profession interns in Uganda regarding AMR and rational prescription practices.

Methods

This was a cross-sectional survey employing quantitative techniques carried out between October and November 2022 at six tertiary hospitals in Uganda. Health profession interns including doctors, nurses, midwives and pharmacists were recruited as study participants. Data were collected using online Kobo toolbox software. Data analysis was performed using STATA (StataCorp) version 16. Bivariate analysis and …

Association Of Atherosclerotic Cardiovascular Disease, Hypertension, Diabetes, And Hyperlipidemia With Gulf War Illness Among Gulf War Veterans, Sarah T Ahmed, Ruosha Li, Peter Richardson, Saurendro Ghosh, Lea Steele, Donna L White, Alice Nono Djotsa, Kellie Sims, Elizabeth Gifford, Elizabeth R Hauser, Salim S Virani, Robert Morgan, George Delclos, Drew A Helmer

Faculty, Staff and Student Publications

BACKGROUND: Approximately 30% of the 700 000 Gulf War veterans report a chronic symptom-based illness of varying severity referred to as Gulf War illness (GWI). toxic deployment-related exposures have been implicated in the cause of GWI, some of which contribute to metabolic dysregulation and lipid abnormalities. As this cohort ages, the relationship between GWI and atherosclerotic cardiovascular disease (ASCVD) is a growing concern. We evaluated associations between GWI and ASCVD, diabetes, hyperlipidemia, and hypertension in veterans of the Gulf War (1990-1991).

METHODS AND RESULTS: Analysis of survey data collected in 2014 to 2016 from a national sample of deployed Gulf …

Availability Of Family Caregiver Programs In Us Cancer Centers, J Nicholas Odom, Allison Applebaum, Marie A Bakitas, Tara Bryant, Erin Currie, Kayleigh Curry, Heidi Donovan, Maria E Fernandez, Betty Ferrell, Andres Azuero, Tamryn F Gray, Bailey A Hendricks, Diane Meier, Chandylen Nightingale, Susan Reinhard, Timothy S Sannes, Katherine Sterba, Heather M Young

Faculty, Staff and Student Publications

Importance: Family caregivers provide the majority of health care to the 18 million patients with cancer in the US. Yet despite providing complex medical and nursing care, a large proportion of caregivers report no formal support or training. In recognition of this gap, many interventions to support cancer caregivers have been developed and tested over the past 2 decades. However, there are few system-level data on whether US cancer centers have adopted and implemented these interventions.

Objective: To describe and characterize the availability of family caregiver support programs in US cancer centers.

Design, setting, and participants: This cross-sectional national survey …

Association Of Parental Status And Gender With Burden Of Multidisciplinary Tumor Boards Among Oncology Physicians, Brittney L Chau, Jonnby S Laguardia, Sungjin Kim, Samuel C Zhang, Eric Pletcher, Nina N Sanford, Ann C Raldow, Lisa Singer, Jun Gong, Sukhmani K Padda, Mitchell Kamrava, Tara Cohen, Devarati Mitra, Katelyn M Atkins

Faculty, Staff and Student Publications

IMPORTANCE: Tumor boards are integral to the care of patients with cancer. However, data investigating the burden of tumor boards on physicians are limited.

OBJECTIVE: To investigate what physician-related and tumor board-related factors are associated with higher tumor board burden among oncology physicians.

DESIGN, SETTING, AND PARTICIPANTS: Tumor board burden was assessed by a cross-sectional convenience survey posted on social media and by email to Cedars-Sinai Medical Center cancer physicians between March 3 and April 3, 2022. Tumor board start times were independently collected by email from 22 top cancer centers.

MAIN OUTCOMES AND MEASURES: Tumor board burden was measured …

Outbreak Communication: Exploring The Relationships Between Health Information Seeking Behaviors, Vested Interests, And Covid-19 Knowledge In U.S. Midwest Populations, Alicia Mason, Josh Compton, Elizabeth Spencer, Kaitlin Barnett

Faculty Submissions

On February 15, 2020, the World Health Organization (WHO) Director, General Tedros Adhanom Ghebreyesus, stated at a Munich Security Conference, “We’re not just fighting an epidemic; we’re fighting an infodemic,” (Zarocostas, 2020, p. 676). The term ‘infodemic’ refers to the onslaught of both accurate and inaccurate health information surrounding the COVID-19 pandemic. The concept of an ‘infodemic’ was quickly integrated into mass media, popular culture (i.e., documentaries, podcasts), and eventually scholarly literature. In response to COVID-19, health communication scholars have centered on understanding specific messaging strategies such as the use of fear appeals (Stolow et al., 2020), nature of advertising …

Improving Acceptability, Use, And Continuation Of Iud In Bangladesh, Sharif M.I. Hossain, Abdullah Al Mahmud Shohag, Zakaria Hossain, Shongkour Roy, Ubaidur Rob

Sexual and Reproductive Health, Rights, and Choices

Although the nonhormonal copper intra-uterine device (IUD) is the safest and cheapest long-acting contraceptive method, its use has been declining day-by-day in Bangladesh. Less than 1% of married women 15-49 years of age who currently use a contraceptive method use an IUD. Researchers conducted a quasi-experimental pre-post-test non-equivalent control group designed study to test a simple intervention intended to increase acceptance, use, and continuation of the IUD among married women of reproductive age (18 to 45 years) in Keraniganj, Savar, and Nawabganj Upazilas (sub-districts) in Bangladesh. The study was conducted in a real-life situation of Union Health and Family Welfare …

Factors Influencing Human Papillomavirus Vaccination Among Asian Immigrant College Students During The Covid-19 Pandemic, Shinhi Han, Hee Sun Kang, Koun Eum, Jin Young Seo, Kathleen Karsten

Publications and Research

Despite strenuous efforts to increase vaccination rates against human papillomavirus (HPV), the rate of vaccination remains low in the U.S. The COVID-19 pandemic poses an additional challenge to HPV vaccination. This study aimed to explore the factors that contribute to HPV vaccination among Asian immigrant college students, based on the Theory of Planned Behavior (TPB), with HPV vaccine literacy and HPV vaccine hesitancy as additional constructs. This cross-sectional survey used convenience sampling, with133 Asian immigrant college students from New York City as study participants. Data were collected online using self-reported measures of the following study variables: HPV vaccine literacy, attitudes, …

Virus Control Aboard A Commuter Bus, Hamid Rahai, Jeremy Bonifacio

Mineta Transportation Institute

A major health concern for public transit users is exposure to viruses from other passengers. This numerical study examines virus containment aboard a public bus with changes to the bus ventilation system. The virus was modeled as a 2.5 µm round solid particle released from the mouth of the infectious passenger at a rate of 21 particles per second at a mouth velocity of 0.278 m/sec. The air delivery to the cabin was two linear ceiling slots spanning the length of the bus delivering 59.38 m3/min (2,097 CFM) of air at a mean velocity of 1 m/sec. Two different axial …

Financial Alignment Initiative: New York Fully Integrated Duals Advantage For Individuals With Intellectual And Developmental Disabilities: Preliminary Third Evaluation Report, Kimberly I. Snow Mhsa, Elizabeth Gattine Jd, Amy Kandilow Phd, Matthew Toth Phd, Amy Chepaitis Phd

Disability & Aging

The New York FIDA-IDD demonstration was launched in 2016 in nine downstate counties and was the first comprehensive managed care demonstration exclusively serving individuals with intellectual and developmental disabilities (IDD) in the nation. Due at least in part to a lack of provider participation, less than 8 percent of eligible beneficiaries enrolled. Beneficiaries who did enroll reported high levels of satisfaction, especially with care coordination and the ease of obtaining durable medical equipment. The MedicareMedicaid Plan’s (MMP) assessment and care coordination model provided person-centered care planning that identified goals and helped to achieve them, improving enrollees’ quality of life. The …

Does Spasticity Correlate With Motor Impairment In The Upper And Lower Limbs In Ambulatory Chronic Stroke Survivors??, Sheng Li, Jaskiran Ghuman, Javier Gonzalez-Buonomo, Xinran Huang, Aila Malik, Nuray Yozbatiran, Gerard E Francisco, Hulin Wu, Walter R Frontera

Faculty, Staff and Student Publications

OBJECTIVE: This study aimed to explore correlations between spasticity and motor impairments in the upper and lower limbs in ambulatory chronic stroke survivors.

DESIGN: We performed clinical assessments in 28 ambulatory chronic stroke survivors with spastic hemiplegia (female: 12; male: 16; mean ages = 57.8 ± 11.8 yrs; 76 ± 45 mos after stroke).

RESULTS: In the upper limb, spasticity index and Fugl-Meyer Motor Assessment showed a significant correlation. Spasticity index for the upper limb showed a significant negative correlation with handgrip strength of the affected side ( r = -0.4, P = 0.035) while Fugl-Meyer Motor Assessment for the …

Multilevel Community Engagement To Inform A Randomized Clinical Trial, Kirby L. Wycoff, Jabina G. Coleman, Christine M. Santoro, Leah L. Zullig, Niesha Darden, Porsche M. Holland, Jane F. Cruice, Shukriyyah Mitchell, Michelle Smith, Saleemah J. Mcneil, Sharon J. Herring

Counseling and Behavioral Health Faculty Papers

OBJECTIVE: To explore how patients, community-based perinatal support professionals, and health system clinicians and staff perceived facilitators and barriers to implementation of a randomized clinical trial (RCT) designed to optimize Black maternal heart health.

METHODS: This article describes the formative work that we believed needed to occur before the start of the Change of H.E.A.R.T (Here for Equity, Advocacy, Reflection and Transformation) RCT. We used a qualitative, descriptive design and community-based, participatory approach, the latter of which allowed our team to intentionally focus on avoiding harm and equalizing power dynamics throughout the research process. Data were collected between November 2021 …

Testing A Standard Approach To Match Patients With Addiction On To Treatment Based On Their Needs, Reach Dissemination Committee, Maine, Usa

REACH: Research Evidence-to-Action for Community Health

The study suggests that use of the ASAM standard of care approach to match patients to treatment may result in improved retention in residential treatment and better patient information and shared decision-making about level of-care decisions.

Does A Program That Focuses On Lifestyle Changes Reduce Heart Disease Risk Factors In A Rural Community?, Reach Dissemination Committee, Maine, Usa

REACH: Research Evidence-to-Action for Community Health

Interventions like HeartHealth—that focus on self-care of heart disease risk factors and that are driven by collaboration with the community of interest—are effective in medically underserved, socioeconomically distressed rural areas.

Sexual Risk-Taking Behavior Amongst Emerging Adults In A Tertiary Institution Of Learning In Coastal Kenya: A Qualitative Study Of Stakeholders’ Perspectives Using Causal Loop Mapping, Stevenson K. Chea, Vincent A. Kagonya, Eunice A. Oyugi, Carophine Nasambu, Isaac Menza, Fauz Ibrahim, Osman Abdullahi, Alice Anika, Amin S. Hassan, Amina Abubakar

Institute for Human Development, East Africa

Background It is known from previous studies that university students in sub-Saharan Africa (sSA) engage in sexual risk-taking behaviour (SRTB). However, there is paucity of data on factors contributing to SRTB among university students (emerging adults) at the Kenyan Coast thus hindering intervention planning. This study seeks to provide an in-depth qualitative understanding of the factors contributing to SRTB and their interconnectedness among university students at the Kenyan Coast combining qualitative research with a systems thinking approach.

Methods Using the ecological model, and employing in-depth interviews, we explored the perceptions of twenty-six key informants (twenty-one emerging adults and five other …

No Woman Left Behind: Women’S Lived Experiences, Purposes, And Perceptions On Female Genital Mutilation (Fgm) Of Maasai And Datoga Communities In Arusha, Tanzania, Audrey Tirrill

Independent Study Project (ISP) Collection

Female genital mutilation (FGM) has been practiced for centuries around the world, currently FGM occurs in Africa, Asia and the Middle East. Even though many counties like Tanzania has outlawed FGM and stating it is a violation of human rights, many people continue the procedure without adequate education on FGM. While believing the decline in number of FGM incidences and there is still a lack of local women perspectives and their respective lived experiences on the matter. This is particularly true in some Tanzanian rural and male dominated tribes where most women are educated with limited freedom of speech such …

Measuring Quality Of Care For Universal Health Coverage In The Western Pacific, Arianna Maever Loreche, Veincent Christian F. Pepito, Kenneth Y. Hartigan-Go, Manuel M. Dayrit

Ateneo School of Medicine and Public Health Publications

To deliver on the promise of universal health coverage, regions and countries need to invest in high-quality health systems and put quality of care at the forefront of priority setting and agenda. The Western Pacific Region and its member countries should establish measurements and standards to ensure delivery of high-quality services. In order to effectively do so, individual and system capacities to measure and use quality-of-care data should be strengthened, localized initiatives to develop quality-of-care measures of practice and policy relevance need to be carried out, accountability mechanisms should be in place, and the role of quality as a driver …