Trajectory planning for industrial robot using genetic algorithms

En las últimas décadas, debido la importancia de sus aplicaciones, se han propuesto muchas investigaciones sobre la planificación de caminos y trayectorias para los manipuladores, algunos de los ámbitos en los que pueden encontrarse ejemplos de aplicación son; la robótica industrial, sistemas autónomos, creación de prototipos virtuales y diseño de fármacos asistido por ordenador. Por otro lado, los algoritmos evolutivos se han aplicado en muchos campos, lo que motiva el interés del autor por investigar sobre su aplicación a la planificación de caminos y trayectorias en robots industriales. En este trabajo se ha llevado a cabo una búsqueda exhaustiva de la literatura existente relacionada con la tesis, que ha servido para crear una completa base de datos utilizada para realizar un examen detallado de la evolución histórica desde sus orígenes al estado actual de la técnica y las últimas tendencias. Esta tesis presenta una nueva metodología que utiliza algoritmos genéticos para desarrollar y evaluar técnicas para la planificación de caminos y trayectorias. El conocimiento de problemas específicos y el conocimiento heurístico se incorporan a la codificación, la evaluación y los operadores genéticos del algoritmo. Esta metodología introduce nuevos enfoques con el objetivo de resolver el problema de la planificación de caminos y la planificación de trayectorias para sistemas robóticos industriales que operan en entornos 3D con obstáculos estáticos, y que ha llevado a la creación de dos algoritmos (de alguna manera similares, con algunas variaciones), que son capaces de resolver los problemas de planificación mencionados. El modelado de los obstáculos se ha realizado mediante el uso de combinaciones de objetos geométricos simples (esferas, cilindros, y los planos), de modo que se obtiene un algoritmo eficiente para la prevención de colisiones. El algoritmo de planificación de caminos se basa en técnicas de optimización globales, usando algoritmos genéticos para minimizar una función objetivo considerando restricciones para evitar las colisiones con los obstáculos. El camino está compuesto de configuraciones adyacentes obtenidas mediante una técnica de optimización construida con algoritmos genéticos, buscando minimizar una función multiobjetivo donde intervienen la distancia entre los puntos significativos de las dos configuraciones adyacentes, así como la distancia desde los puntos de la configuración actual a la final. El planteamiento del problema mediante algoritmos genéticos requiere de una modelización acorde al procedimiento, definiendo los individuos y operadores capaces de proporcionar soluciones eficientes para el problema.Abu-Dakka, FJM. (2011). Trajectory planning for industrial robot using genetic algorithms [Tesis doctoral no publicada]. Universitat Politècnica de València. https://doi.org/10.4995/Thesis/10251/10294Palanci

Effect of face masks on interpersonal communication during the COVID-19 pandemic

Interpersonal communication has been severely affected during the COVID-19 pandemic. Protective measures, such as social distancing and face masks, are essential to mitigate efforts against the virus, but pose challenges on daily face-to-face communication. Face masks, particularly, muffle sounds and cover facial expressions that ease comprehension during live communication. Here, we explore the role of facial expressions in communication and we highlight how the face mask can hinder interpersonal connection. In addition, we offer coping strategies and skills that can ease communication with face masks as we navigate the current and any future pandemic

Complete Resolution of a Large Bicuspid Aortic Valve Thrombus with Anticoagulation in Primary Antiphospholipid Syndrome

Native aortic valve thrombosis in primary antiphospholipid syndrome (APLS) is a rare entity. We describe a 38-year-old man who presented with neurological symptoms and a cardiac murmur. Transthoracic echocardiography detected a large bicuspid aortic valve thrombus. Laboratory evaluation showed the presence of antiphospholipid antibodies. Anticoagulation was started, and serial echocardiographic studies showed complete resolution of the aortic valve vegetation after 4 months. The patient improved clinically and had no residual symptoms. This report and review of the literature suggests that vegetations in APLS can be treated successfully with conservative treatment, regardless of their size

Practical Use of Robot Manipulators as Intelligent Manufacturing Systems

This paper presents features and advanced settings for a robot manipulator controller in a fully interconnected intelligent manufacturing system. Every system is made up of different agents. As also occurs in the Internet of Things and smart cities, the big issue here is to ensure not only that implementation is key, but also that there is better common understanding among the main players. The commitment of all agents is still required to translate that understanding into practice in Industry 4.0. Mutual interactions such as machine-to-machine and man-to-machine are solved in real time with cyber physical capabilities. This paper explores intelligent manufacturing through the context of industrial robot manipulators within a Smart Factory. An online communication algorithm with proven intelligent manufacturing abilities is proposed to solve real-time interactions. The algorithm is developed to manage and control all robot parameters in real-time. The proposed tool in conjunction with the intelligent manufacturing core incorporates data from the robot manipulators into the industrial big data to manage the factory. The novelty is a communication tool that implements the Industry 4.0 standards to allow communications among the required entities in the complete system. It is achieved by the developed tool and implemented in a real robot and simulation.This research was partially funded by the Ministry of Economy, Industry and Competitiveness in the project with reference RTC-2014-3070-5. In addition, the work has been partially funded by the project Strategic Action in Robotics, Computer Vision and Automation financed by University Carlos III of Madrid

Development of lower-limb rehabilitation exercises using 3-PRS Parallel Robot and Dynamic Movement Primitives

[EN] The design of rehabilitation exercises applied to sprained ankles requires extreme caution, regarding the trajectories and the speed of the movements that will affect the patient. This paper presents a technique that allows a 3-PRS parallel robot to control such exercises, consisting of dorsi/plantar flexion and inversion/eversion ankle movements. The work includes a position control scheme for the parallel robot in order to follow a reference trajectory for each limb with the possibility of stopping the exercise in mid-execution without control loss. This stop may be motivated by the forces that the robot applies to the patient, acting like an alarm mechanism. The procedure introduced here is based on Dynamic Movement Primitives (DMPs).This work has been partially funded by FEDER-CICYT project with reference DPI2017-84201-R financed by Ministerio de Economía, Industria e Innovación (Spain).Escarabajal Sánchez, RJ.; Abu Dakka, FJM.; Pulloquinga Zapata, J.; Mata Amela, V.; Vallés Miquel, M.; Valera Fernández, Á. (2020). Development of lower-limb rehabilitation exercises using 3-PRS Parallel Robot and Dynamic Movement Primitives. Multidisciplinary Journal for Education, Social and Technological Sciences. 7(2):30-44. https://doi.org/10.4995/muse.2020.13907OJS304472Abu-Dakka, F. J., Valera, A., Escalera, J. A., Vallés, M., Mata, V., & Abderrahim, M. (2015). Trajectory adaptation and learning for ankle rehabilitation using a 3-PRS parallel robot. Lecture Notes in Computer Science (Including Subseries Lecture Notes in Artificial Intelligence and Lecture Notes in Bioinformatics), 9245, 483-494. https://doi.org/10.1007/978-3-319-22876-1_41Atkeson, C. G., Moore, A. W., & Schaal, S. (1997). Locally Weighted Learning. Artificial Intelligence Review, 11(1-5), 11-73. https://doi.org/10.1007/978-94-017-2053-3_2Brockett, C. L., & Chapman, G. J. (2016). Biomechanics of the ankle. Orthopaedics and Trauma, 30(3), 232-238. https://doi.org/10.1016/j.mporth.2016.04.015Dai, J. S., Zhao, T., & Nester, C. (2004). Sprained Ankle Physiotherapy Based Mechanism Synthesis and Stiffness Analysis of a Robotic Rehabilitation Device. Autonomous Robots, 16(2), 207-218. https://doi.org/10.1023/B:AURO.0000016866.80026.d7Díaz-Rodríguez, M., Mata, V., Valera, Á., & Page, Á. (2010). A methodology for dynamic parameters identification of 3-DOF parallel robots in terms of relevant parameters. Mechanism and Machine Theory, 45(9), 1337-1356. https://doi.org/10.1016/j.mechmachtheory.2010.04.007Díaz, I., Gil, J. J., & Sánchez, E. (2011). Lower-Limb Robotic Rehabilitation: Literature Review and Challenges. Journal of Robotics, 2011(i), 1-11. https://doi.org/10.1155/2011/759764Fanger, Y., Umlauft, J., & Hirche, S. (2016). Gaussian Processes for Dynamic Movement Primitives with application in knowledge-based cooperation. IEEE International Conference on Intelligent Robots and Systems, 2016-Novem, 3913-3919. https://doi.org/10.1109/IROS.2016.7759576Gosselin, C., & Angeles, J. (1990). Singularity Analysis of Closed-Loop Kinematic Chains. IEEE Transactions on Robotics and Automation, 6(3), 281-290. https://doi.org/10.1109/70.56660Hesse, S., & Uhlenbrock, D. (2000). A mechanized gait trainer for restoration of gait. Journal of Rehabilitation Research and Development, 37(6), 701-708.Ijspeert, A. J., Nakanishi, J., Hoffmann, H., Pastor, P., & Schaal, S. (2013). Dynamical movement primitives: Learning attractor models formotor behaviors. Neural Computation, 25(2), 328-373. https://doi.org/10.1162/NECO_a_00393Ijspeert, A. J., Nakanishi, J., & Schaal, S. (2002). Movement imitation with nonlinear dynamical systems in humanoid robots. Proceedings - IEEE International Conference on Robotics and Automation, 2, 1398-1403. https://doi.org/10.1109/ROBOT.2002.1014739Liu, G., Gao, J., Yue, H., Zhang, X., & Lu, G. (2006). Design and kinematics simulation of parallel robots for ankle rehabilitation. 2006 IEEE International Conference on Mechatronics and Automation, ICMA 2006, 2006, 1109-1113. https://doi.org/10.1109/ICMA.2006.257780Nakanishi, J., Morimoto, J., Endo, G., Cheng, G., Schaal, S., & Kawato, M. (2004). Learning from demonstration and adaptation of biped locomotion. Robotics and Autonomous Systems, 47(2-3), 79-91. https://doi.org/10.1016/j.robot.2004.03.003Nemec, B., & Ude, A. (2012). Action sequencing using dynamic movement primitives. Robotica, 30(5), 837-846. https://doi.org/10.1017/S0263574711001056Patel, Y. D., & George, P. M. (2012). Parallel Manipulators Applications-A Survey. Modern Mechanical Engineering, 02(03), 57-64. https://doi.org/10.4236/mme.2012.23008Paul, R. P. (1981). Robot Manipulators: Mathematics, Programming, and Control : the Computer Control of Robot Manipulators (p. 279).Reinkensmeyer, D. J., Aoyagi, D., Emken, J. L., Galvez, J. A., Ichinose, W., Kerdanyan, G., Maneekobkunwong, S., Minakata, K., Nessler, J. A., Weber, R., Roy, R. R., De Leon, R., Bobrow, J. E., Harkema, S. J., & Reggie Edgerton, V. (2006). Tools for understanding and optimizing robotic gait training. Journal of Rehabilitation Research and Development, 43(5), 657-670. https://doi.org/10.1682/JRRD.2005.04.0073Safran, M. R., Benedetti, R. S., Bartolozzi, A. R., & Mandelbaum, B. R. (1999). Lateral ankle sprains: A comprehensive review part 1: Etiology, pathoanatomy, histopathogenesis, and diagnosis. In Medicine and Science in Sports and Exercise (Vol. 31, Issue 7 SUPPL., pp. S429-S437).https://doi.org/10.1097/00005768-199907001-00004Saglia, J. A., Tsagarakis, N. G., Dai, J. S., & Caldwell, D. G. (2013). Control strategies for patient-assisted training using the ankle rehabilitation robot (ARBOT). IEEE/ASME Transactions on Mechatronics, 18(6), 1799-1808. https://doi.org/10.1109/TMECH.2012.2214228Schaal, S. (2006). Dynamic Movement Primitives -A Framework for Motor Control in Humans and Humanoid Robotics. In Adaptive Motion of Animals and Machines (pp. 261-280). https://doi.org/10.1007/4-431-31381-8_23Sui, P., Yao, L., Lin, Z., Yan, H., & Dai, J. S. (2009). Analysis and synthesis of ankle motion and rehabilitation robots. 2009 IEEE International Conference on Robotics and Biomimetics, ROBIO 2009, 3, 2533-2538. https://doi.org/10.1109/ROBIO.2009.5420487Tsoi, Y. H., Xie, S. Q., & Graham, A. E. (2009). Design, modeling and control of an ankle rehabilitation robot. Studies in Computational Intelligence, 177, 377-399. https://doi.org/10.1007/978-3-540-89933-4_18Vallés, M., Díaz-Rodrguez, M., Valera, Á., Mata, V., & Page, Á. (2012). Mechatronic development and dynamic control of a 3-dof parallel manipulator. Mechanics Based Design of Structures and Machines, 40(4), 434-452. https://doi.org/10.1080/15397734.2012.687292Xie, S. (2016). Advanced robotics for medical rehabilitation: current state of the art and recent advances. In Springer tracts in advanced robotics (Issue 108). https://doi.org/10.1007/978-3-319-19896-5Yoon, J., Ryu, J., & Lim, K. B. (2006). Reconfigurable ankle rehabilitation robot for various exercises. Journal of Robotic Systems, 22(SUPPL.), 15-33. https://doi.org/10.1002/rob.2015

Measuring performance on the Healthcare Access and Quality Index for 195 countries and territories and selected subnational locations: A systematic analysis from the Global Burden of Disease Study 2016

Copyright © 2018 The Author(s). Published by Elsevier Ltd. Background A key component of achieving universal health coverage is ensuring that all populations have access to quality health care. Examining where gains have occurred or progress has faltered across and within countries is crucial to guiding decisions and strategies for future improvement. We used the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) to assess personal health-care access and quality with the Healthcare Access and Quality (HAQ) Index for 195 countries and territories, as well as subnational locations in seven countries, from 1990 to 2016. Methods Drawing from established methods and updated estimates from GBD 2016, we used 32 causes from which death should not occur in the presence of effective care to approximate personal health-care access and quality by location and over time. To better isolate potential effects of personal health-care access and quality from underlying risk factor patterns, we risk-standardised cause-specific deaths due to non-cancers by location-year, replacing the local joint exposure of environmental and behavioural risks with the global level of exposure. Supported by the expansion of cancer registry data in GBD 2016, we used mortality-to-incidence ratios for cancers instead of risk-standardised death rates to provide a stronger signal of the effects of personal health care and access on cancer survival. We transformed each cause to a scale of 0-100, with 0 as the first percentile (worst) observed between 1990 and 2016, and 100 as the 99th percentile (best); we set these thresholds at the country level, and then applied them to subnational locations. We applied a principal components analysis to construct the HAQ Index using all scaled cause values, providing an overall score of 0-100 of personal health-care access and quality by location over time. We then compared HAQ Index levels and trends by quintiles on the Socio-demographic Index (SDI), a summary measure of overall development. As derived from the broader GBD study and other data sources, we examined relationships between national HAQ Index scores and potential correlates of performance, such as total health spending per capita. Findings In 2016, HAQ Index performance spanned from a high of 97·1 (95% UI 95·8-98·1) in Iceland, followed by 96·6 (94·9-97·9) in Norway and 96·1 (94·5-97·3) in the Netherlands, to values as low as 18·6 (13·1-24·4) in the Central African Republic, 19·0 (14·3-23·7) in Somalia, and 23·4 (20·2-26·8) in Guinea-Bissau. The pace of progress achieved between 1990 and 2016 varied, with markedly faster improvements occurring between 2000 and 2016 for many countries in sub-Saharan Africa and southeast Asia, whereas several countries in Latin America and elsewhere saw progress stagnate after experiencing considerable advances in the HAQ Index between 1990 and 2000. Striking subnational disparities emerged in personal health-care access and quality, with China and India having particularly large gaps between locations with the highest and lowest scores in 2016. In China, performance ranged from 91·5 (89·1-93·6) in Beijing to 48·0 (43·4-53·2) in Tibet (a 43·5-point difference), while India saw a 30·8-point disparity, from 64·8 (59·6-68·8) in Goa to 34·0 (30·3-38·1) in Assam. Japan recorded the smallest range in subnational HAQ performance in 2016 (a 4·8-point difference), whereas differences between subnational locations with the highest and lowest HAQ Index values were more than two times as high for the USA and three times as high for England. State-level gaps in the HAQ Index in Mexico somewhat narrowed from 1990 to 2016 (from a 20·9-point to 17·0-point difference), whereas in Brazil, disparities slightly increased across states during this time (a 17·2-point to 20·4-point difference). Performance on the HAQ Index showed strong linkages to overall development, with high and high-middle SDI countries generally having higher scores and faster gains for non-communicable diseases. Nonetheless, countries across the development spectrum saw substantial gains in some key health service areas from 2000 to 2016, most notably vaccine-preventable diseases. Overall, national performance on the HAQ Index was positively associated with higher levels of total health spending per capita, as well as health systems inputs, but these relationships were quite heterogeneous, particularly among low-to-middle SDI countries. Interpretation GBD 2016 provides a more detailed understanding of past success and current challenges in improving personal health-care access and quality worldwide. Despite substantial gains since 2000, many low-SDI and middle- SDI countries face considerable challenges unless heightened policy action and investments focus on advancing access to and quality of health care across key health services, especially non-communicable diseases. Stagnating or minimal improvements experienced by several low-middle to high-middle SDI countries could reflect the complexities of re-orienting both primary and secondary health-care services beyond the more limited foci of the Millennium Development Goals. Alongside initiatives to strengthen public health programmes, the pursuit of universal health coverage hinges upon improving both access and quality worldwide, and thus requires adopting a more comprehensive view - and subsequent provision - of quality health care for all populations

Measuring performance on the Healthcare Access and Quality Index for 195 countries and territories and selected subnational locations : a systematic analysis from the Global Burden of Disease Study 2016

Background A key component of achieving universal health coverage is ensuring that all populations have access to quality health care. Examining where gains have occurred or progress has faltered across and within countries is crucial to guiding decisions and strategies for future improvement. We used the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) to assess personal health-care access and quality with the Healthcare Access and Quality (HAQ) Index for 195 countries and territories, as well as subnational locations in seven countries, from 1990 to 2016. Methods Drawing from established methods and updated estimates from GBD 2016, we used 32 causes from which death should not occur in the presence of effective care to approximate personal health-care access and quality by location and over time. To better isolate potential effects of personal health-care access and quality from underlying risk factor patterns, we risk-standardised cause-specific deaths due to non-cancers by location-year, replacing the local joint exposure of environmental and behavioural risks with the global level of exposure. Supported by the expansion of cancer registry data in GBD 2016, we used mortality-to-incidence ratios for cancers instead of risk-standardised death rates to provide a stronger signal of the effects of personal health care and access on cancer survival. We transformed each cause to a scale of 0-100, with 0 as the first percentile (worst) observed between 1990 and 2016, and 100 as the 99th percentile (best); we set these thresholds at the country level, and then applied them to subnational locations. We applied a principal components analysis to construct the HAQ Index using all scaled cause values, providing an overall score of 0-100 of personal health-care access and quality by location over time. We then compared HAQ Index levels and trends by quintiles on the Socio-demographic Index (SDI), a summary measure of overall development. As derived from the broader GBD study and other data sources, we examined relationships between national HAQ Index scores and potential correlates of performance, such as total health spending per capita. Findings In 2016, HAQ Index performance spanned from a high of 97.1 (95% UI 95.8-98.1) in Iceland, followed by 96.6 (94.9-97.9) in Norway and 96.1 (94.5-97.3) in the Netherlands, to values as low as 18.6 (13.1-24.4) in the Central African Republic, 19.0 (14.3-23.7) in Somalia, and 23.4 (20.2-26.8) in Guinea-Bissau. The pace of progress achieved between 1990 and 2016 varied, with markedly faster improvements occurring between 2000 and 2016 for many countries in sub-Saharan Africa and southeast Asia, whereas several countries in Latin America and elsewhere saw progress stagnate after experiencing considerable advances in the HAQ Index between 1990 and 2000. Striking subnational disparities emerged in personal health-care access and quality, with China and India having particularly large gaps between locations with the highest and lowest scores in 2016. In China, performance ranged from 91.5 (89.1-936) in Beijing to 48.0 (43.4-53.2) in Tibet (a 43.5-point difference), while India saw a 30.8-point disparity, from 64.8 (59.6-68.8) in Goa to 34.0 (30.3-38.1) in Assam. Japan recorded the smallest range in subnational HAQ performance in 2016 (a 4.8-point difference), whereas differences between subnational locations with the highest and lowest HAQ Index values were more than two times as high for the USA and three times as high for England. State-level gaps in the HAQ Index in Mexico somewhat narrowed from 1990 to 2016 (from a 20.9-point to 17.0-point difference), whereas in Brazil, disparities slightly increased across states during this time (a 17.2-point to 20.4-point difference). Performance on the HAQ Index showed strong linkages to overall development, with high and high-middle SDI countries generally having higher scores and faster gains for non-communicable diseases. Nonetheless, countries across the development spectrum saw substantial gains in some key health service areas from 2000 to 2016, most notably vaccine-preventable diseases. Overall, national performance on the HAQ Index was positively associated with higher levels of total health spending per capita, as well as health systems inputs, but these relationships were quite heterogeneous, particularly among low-to-middle SDI countries. Interpretation GBD 2016 provides a more detailed understanding of past success and current challenges in improving personal health-care access and quality worldwide. Despite substantial gains since 2000, many low-SDI and middle-SDI countries face considerable challenges unless heightened policy action and investments focus on advancing access to and quality of health care across key health services, especially non-communicable diseases. Stagnating or minimal improvements experienced by several low-middle to high-middle SDI countries could reflect the complexities of re-orienting both primary and secondary health-care services beyond the more limited foci of the Millennium Development Goals. Alongside initiatives to strengthen public health programmes, the pursuit of universal health coverage upon improving both access and quality worldwide, and thus requires adopting a more comprehensive view and subsequent provision of quality health care for all populations. Copyright (C) 2018 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.Peer reviewe

Measuring performance on the Healthcare Access and Quality Index for 195 countries and territories and selected subnational locations: a systematic analysis from the Global Burden of Disease Study 2016

Background A key component of achieving universal health coverage is ensuring that all populations have access to quality health care. Examining where gains have occurred or progress has faltered across and within countries is crucial to guiding decisions and strategies for future improvement. We used the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) to assess personal health-care access and quality with the Healthcare Access and Quality (HAQ) Index for 195 countries and territories, as well as subnational locations in seven countries, from 1990 to 2016.Methods Drawing from established methods and updated estimates from GBD 2016, we used 32 causes from which death should not occur in the presence of effective care to approximate personal health-care access and quality by location and over time. To better isolate potential effects of personal health-care access and quality from underlying risk factor patterns, we risk-standardised cause-specific deaths due to non-cancers by location-year, replacing the local joint exposure of environmental and behavioural risks with the global level of exposure. Supported by the expansion of cancer registry data in GBD 2016, we used mortality-to-incidence ratios for cancers instead of risk-standardised death rates to provide a stronger signal of the effects of personal health care and access on cancer survival. We transformed each cause to a scale of 0–100, with 0 as the first percentile (worst) observed between 1990 and 2016, and 100 as the 99th percentile (best); we set these thresholds at the country level, and then applied them to subnational locations. We applied a principal components analysis to construct the HAQ Index using all scaled cause values, providing an overall score of 0–100 of personal health-care access and quality by location over time. We then compared HAQ Index levels and trends by quintiles on the Socio-demographic Index (SDI), a summary measure of overall development. As derived from the broader GBD study and other data sources, we examined relationships between national HAQ Index scores and potential correlates of performance, such as total health spending per capita.Background A key component of achieving universal health coverage is ensuring that all populations have access to quality health care. Examining where gains have occurred or progress has faltered across and within countries is crucial to guiding decisions and strategies for future improvement. We used the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) to assess personal health-care access and quality with the Healthcare Access and Quality (HAQ) Index for 195 countries and territories, as well as subnational locations in seven countries, from 1990 to 2016.Methods Drawing from established methods and updated estimates from GBD 2016, we used 32 causes from which death should not occur in the presence of effective care to approximate personal health-care access and quality by location and over time. To better isolate potential effects of personal health-care access and quality from underlying risk factor patterns, we risk-standardised cause-specific deaths due to non-cancers by location-year, replacing the local joint exposure of environmental and behavioural risks with the global level of exposure. Supported by the expansion of cancer registry data in GBD 2016, we used mortality-to-incidence ratios for cancers instead of risk-standardised death rates to provide a stronger signal of the effects of personal health care and access on cancer survival. We transformed each cause to a scale of 0–100, with 0 as the first percentile (worst) observed between 1990 and 2016, and 100 as the 99th percentile (best); we set these thresholds at the country level, and then applied them to subnational locations. We applied a principal components analysis to construct the HAQ Index using all scaled cause values, providing an overall score of 0–100 of personal health-care access and quality by location over time. We then compared HAQ Index levels and trends by quintiles on the Socio-demographic Index (SDI), a summary measure of overall development. As derived from the broader GBD study and other data sources, we examined relationships between national HAQ Index scores and potential correlates of performance, such as total health spending per capita

Measuring progress from 1990 to 2017 and projecting attainment to 2030 of the health-related Sustainable Development Goals for 195 countries and territories: a systematic analysis for the Global Burden of Disease Study 2017

Background Efforts to establish the 2015 baseline and monitor early implementation of the UN Sustainable Development Goals (SDGs) highlight both great potential for and threats to improving health by 2030. To fully deliver on the SDG aim of “leaving no one behind”, it is increasingly important to examine the health-related SDGs beyond national-level estimates. As part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017), we measured progress on 41 of 52 health-related SDG indicators and estimated the health-related SDG index for 195 countries and territories for the period 1990–2017, projected indicators to 2030, and analysed global attainment. Methods We measured progress on 41 health-related SDG indicators from 1990 to 2017, an increase of four indicators since GBD 2016 (new indicators were health worker density, sexual violence by non-intimate partners, population census status, and prevalence of physical and sexual violence [reported separately]). We also improved the measurement of several previously reported indicators. We constructed national-level estimates and, for a subset of health-related SDGs, examined indicator-level differences by sex and Socio-demographic Index (SDI) quintile. We also did subnational assessments of performance for selected countries. To construct the health-related SDG index, we transformed the value for each indicator on a scale of 0–100, with 0 as the 2·5th percentile and 100 as the 97·5th percentile of 1000 draws calculated from 1990 to 2030, and took the geometric mean of the scaled indicators by target. To generate projections through 2030, we used a forecasting framework that drew estimates from the broader GBD study and used weighted averages of indicator-specific and country-specific annualised rates of change from 1990 to 2017 to inform future estimates. We assessed attainment of indicators with defined targets in two ways: first, using mean values projected for 2030, and then using the probability of attainment in 2030 calculated from 1000 draws. We also did a global attainment analysis of the feasibility of attaining SDG targets on the basis of past trends. Using 2015 global averages of indicators with defined SDG targets, we calculated the global annualised rates of change required from 2015 to 2030 to meet these targets, and then identified in what percentiles the required global annualised rates of change fell in the distribution of country-level rates of change from 1990 to 2015. We took the mean of these global percentile values across indicators and applied the past rate of change at this mean global percentile to all health-related SDG indicators, irrespective of target definition, to estimate the equivalent 2030 global average value and percentage change from 2015 to 2030 for each indicator.Background Efforts to establish the 2015 baseline and monitor early implementation of the UN Sustainable Development Goals (SDGs) highlight both great potential for and threats to improving health by 2030. To fully deliver on the SDG aim of “leaving no one behind”, it is increasingly important to examine the health-related SDGs beyond national-level estimates. As part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017), we measured progress on 41 of 52 health-related SDG indicators and estimated the health-related SDG index for 195 countries and territories for the period 1990–2017, projected indicators to 2030, and analysed global attainment. Methods We measured progress on 41 health-related SDG indicators from 1990 to 2017, an increase of four indicators since GBD 2016 (new indicators were health worker density, sexual violence by non-intimate partners, population census status, and prevalence of physical and sexual violence [reported separately]). We also improved the measurement of several previously reported indicators. We constructed national-level estimates and, for a subset of health-related SDGs, examined indicator-level differences by sex and Socio-demographic Index (SDI) quintile. We also did subnational assessments of performance for selected countries. To construct the health-related SDG index, we transformed the value for each indicator on a scale of 0–100, with 0 as the 2·5th percentile and 100 as the 97·5th percentile of 1000 draws calculated from 1990 to 2030, and took the geometric mean of the scaled indicators by target. To generate projections through 2030, we used a forecasting framework that drew estimates from the broader GBD study and used weighted averages of indicator-specific and country-specific annualised rates of change from 1990 to 2017 to inform future estimates. We assessed attainment of indicators with defined targets in two ways: first, using mean values projected for 2030, and then using the probability of attainment in 2030 calculated from 1000 draws. We also did a global attainment analysis of the feasibility of attaining SDG targets on the basis of past trends. Using 2015 global averages of indicators with defined SDG targets, we calculated the global annualised rates of change required from 2015 to 2030 to meet these targets, and then identified in what percentiles the required global annualised rates of change fell in the distribution of country-level rates of change from 1990 to 2015. We took the mean of these global percentile values across indicators and applied the past rate of change at this mean global percentile to all health-related SDG indicators, irrespective of target definition, to estimate the equivalent 2030 global average value and percentage change from 2015 to 2030 for each indicator

Measuring performance on the Healthcare Access and Quality Index for 195 countries and territories and selected subnational locations: A systematic analysis from the Global Burden of Disease Study 2016

Background A key component of achieving universal health coverage is ensuring that all populations have access to quality health care. Examining where gains have occurred or progress has faltered across and within countries is crucial to guiding decisions and strategies for future improvement. We used the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) to assess personal health-care access and quality with the Healthcare Access and Quality (HAQ) Index for 195 countries and territories, as well as subnational locations in seven countries, from 1990 to 2016. Methods Drawing from established methods and updated estimates from GBD 2016, we used 32 causes from which death should not occur in the presence of effective care to approximate personal health-care access and quality by location and over time. To better isolate potential effects of personal health-care access and quality from underlying risk factor patterns, we risk-standardised cause-specific deaths due to non-cancers by location-year, replacing the local joint exposure of environmental and behavioural risks with the global level of exposure. Supported by the expansion of cancer registry data in GBD 2016, we used mortality-to-incidence ratios for cancers instead of risk-standardised death rates to provide a stronger signal of the effects of personal health care and access on cancer survival. We transformed each cause to a scale of 0–100, with 0 as the first percentile (worst) observed between 1990 and 2016, and 100 as the 99th percentile (best); we set these thresholds at the country level, and then applied them to subnational locations. We applied a principal components analysis to construct the HAQ Index using all scaled cause values, providing an overall score of 0–100 of personal health-care access and quality by location over time. We then compared HAQ Index levels and trends by quintiles on the Socio-demographic Index (SDI), a summary measure of overall development. As derived from the broader GBD study and other data sources, we examined relationships between national HAQ Index scores and potential correlates of performance, such as total health spending per capita. Findings In 2016, HAQ Index performance spanned from a high of 97·1 (95% UI 95·8–98·1) in Iceland, followed by 96·6 (94·9–97·9) in Norway and 96·1 (94·5–97·3) in the Netherlands, to values as low as 18·6 (13·1–24·4) in the Central African Republic, 19·0 (14·3–23·7) in Somalia, and 23·4 (20·2–26·8) in Guinea-Bissau. The pace of progress achieved between 1990 and 2016 varied, with markedly faster improvements occurring between 2000 and 2016 for many countries in sub-Saharan Africa and southeast Asia, whereas several countries in Latin America and elsewhere saw progress stagnate after experiencing considerable advances in the HAQ Index between 1990 and 2000. Striking subnational disparities emerged in personal health-care access and quality, with China and India having particularly large gaps between locations with the highest and lowest scores in 2016. In China, performance ranged from 91·5 (89·1–93·6) in Beijing to 48·0 (43·4–53·2) in Tibet (a 43·5-point difference), while India saw a 30·8-point disparity, from 64·8 (59·6–68·8) in Goa to 34·0 (30·3–38·1) in Assam. Japan recorded the smallest range in subnational HAQ performance in 2016 (a 4·8-point difference), whereas differences between subnational locations with the highest and lowest HAQ Index values were more than two times as high for the USA and three times as high for England. State-level gaps in the HAQ Index in Mexico somewhat narrowed from 1990 to 2016 (from a 20·9-point to 17·0-point difference), whereas in Brazil, disparities slightly increased across states during this time (a 17·2-point to 20·4-point difference). Performance on the HAQ Index showed strong linkages to overall development, with high and high-middle SDI countries generally having higher scores and faster gains for non-communicable diseases. Nonetheless, countries across the development spectrum saw substantial gains in some key health service areas from 2000 to 2016, most notably vaccine-preventable diseases. Overall, national performance on the HAQ Index was positively associated with higher levels of total health spending per capita, as well as health systems inputs, but these relationships were quite heterogeneous, particularly among low-to-middle SDI countries. Interpretation GBD 2016 provides a more detailed understanding of past success and current challenges in improving personal health-care access and quality worldwide. Despite substantial gains since 2000, many low-SDI and middle- SDI countries face considerable challenges unless heightened policy action and investments focus on advancing access to and quality of health care across key health services, especially non-communicable diseases. Stagnating or minimal improvements experienced by several low-middle to high-middle SDI countries could reflect the complexities of re-orienting both primary and secondary health-care services beyond the more limited foci of the Millennium Development Goals. Alongside initiatives to strengthen public health programmes, the pursuit of universal health coverage hinges upon improving both access and quality worldwide, and thus requires adopting a more comprehensive view—and subsequent provision—of quality health care for all populations.info:eu-repo/semantics/publishedVersio