UCAT: ubiquitous context awareness tools for the blind

Tese de mestrado em Engenharia Informática, apresentada à Universidade de Lisboa, através da Faculdade de Ciências, 2013As pessoas com deficiências visuais sofrem de uma constante falta de informação sobre o ambiente que as rodeia. Esta informação pode estar relacionada com locais, objetos e até mesmo pessoas. A inexistência de ajuda para combater esta falta de informação faz com que surjam situações em que uma pessoa cega só consegue resolver o seu problema recorrendo a ajuda de outras pessoas. São exemplos a identificação da presença de pessoas, informação escrita e outros detalhes de uma rotina diária. Os dispositivos móveis dos dias de hoje vêm equipados com uma grande extensão de sensores que possibilitam colmatar algumas destas falhas. Uma pessoa normovisual está habituada a recorrer à visão para obter informação sobre o ambiente que a rodeia. Sem grande esforço pode obter informação sobre proximidade de pessoas ou a sua movimentação. A mesma facilidade ocorre em reconhecer objetos ou orientar-se e compreender os locais onde se encontra. Esta informação é algo que pessoas cegas têm dificuldade em obter. Situações normais como identificar quem são as pessoas que os rodeiam torna-se uma tarefa mais complicada especialmente se estas não seguirem as regras de etiqueta social e fizerem notar a sua presença. A acessibilidade nos dispositivos móveis é uma área que ainda está a ser explorada e existem diversas possibilidades de uso que estes dispositivos permitem que ainda não são acessíveis para pessoas cegas. Cada vez mais os dispositivos móveis, em particular desde a chegada do iPhone, fornece a utilizadores cegos a possibilidade de acederem aplicações sociais, de lazer e de produtividade. Outros sistemas operativos e dispositivos seguem pelo mesmo caminho. O conjunto de características disponibilizadas por estes dispositivos nomeadamente para a localização, comunicação, armazenamento e processamento permitem criar ferramentas de perceção do ambiente para cegos cada vez mais ricas. Existem diversos trabalhos realizados para melhorar a orientação, localização, reconhecimento de objectos e proximidade (na maioria dos casos a obstáculos). Muitos deles focam-se em ambientes interiores, outros em ambientes exteriores. Uns em objects, outros têm uma componente maos social. O problema de todos estes projectos é que nenhum deles oferece uma solução complete e acessivel para pessoas cegas. As falhas existentes em cada um destes projectos deixa em aberto a possibilidade para que fosse desenvolvido um Sistema que não só junta-se todas as caracteristicas de awareness que pudessem ajudar uma pessoa cega mas também tornar este Sistema acessivel. No entanto mesmo com tantas aplicações e projectos existe uma falha no que toca a ferramentas que tratem de perceção implícita, que forneça informação sobre o ambiente que nos rodeia dentro de contexto. O nosso projeto focou-se em identificar as necessidades de informação de uma pessoa cega no que diz respeito à falta de informação. Foi realizada uma entrevista preliminar para que pudéssemos perceber as limitações e as necessidades que as pessoas cegas enfrentam quando confrontadas com ambientes sociais. A entrevista tinha como foco um perfil básico dos utilizadores e questões sobre o seu uso da tecnologia utilizada no projeto assim como questões sobre cenários onde a perceção do ambiente é limitada. A grande maioria da entrevista focou-se em questões sobre perceção, particularmente tendo em atenção a orientação em ambientes novos e ambientes já conhecidos, as dificuldades que normalmente encontram em situações sociais e de que maneira ou que comportamentos desenvolveram para tentar facilitar o seu dia-a-dia. Tentamos perceber quais as maiores fontes de desconforto que estão habituados a enfrentar e quais delas é que causam mais transtorno. A primeira causa apontada como fonte de desconforto foi a falta de conhecimento das pessoas que os rodeiam, tanto saber quem são como quantas pessoas são. Também fizemos a questão sobre o quão fácil é para eles ter a perceção de quem os rodeia, se é uma tarefa fácil de realizar e especialmente se tinham dificuldade em perceber a entrada e saída de pessoas no seu espaço. Todos os participantes afirmaram que seria bom obter mais informação sobre o ambiente que os rodeia, apesar de apontarem que esta ferramenta deveria passar despercebida e ser subtil na sua tarefa. Após analisarmos os resultados das entrevistas e de termos em conta os cenários mencionados pelos utilizadores assim como os cenários que tínhamos pensado para a implementação do sistema foi desenvolvido um sistema com a intenção de explorar estes novos cenários e fazer uma avaliação mais completa da aplicação e os seus benefícios. Após a implementação do sistema este foi submetido a uma fase de avaliação que durou uma semana e meia efetuada com utilizadores cegos para que pudéssemos tirar resultados não só do resultado da implementação do sistema mas do seu impacto para um utilizador cego. Sobre este Sistema foi feita uma avaliação de uma semana e meia, efectuada com utilizadores cegos durante a qual eles tiveram a oportunidade de explorer as capacidades do Sistema e utilizar durante o seu dia a dia normal a aplicaçao e retirar o máximo que conseguissem. Foi uma avaliação sem guião, logo os utilizadores não tinham tarefas explicitas apenas tinham que utilizar o Sistema à sua conveniência. Durante esse período de avaliação os utilizadores deram-nos feedback diário de como se estava a comportar o Sistema para que pudéssemos obter dados de uso diário. Foi também efectuado no final da avaliação questionários e uma entrevista final para recolher todas as informações possíveis por parte dos utilizadores que fizeram parte da avaliação. Analisamos esses dados e retirámos algumas conclusões. No geral os utilizadores estiveram satisfeitos com a informação produzida pela aplicação, foi de facto um aumento, na grande maioria dos casos, aquilo a que estão normalmente habituados. Sempre que eram notificados sentiram necessidade de explorar a notificação e perceber melhor qual a informação que a aplicação lhes estava a tentar fornecer. Verificou-se o interesse por parte dos participantes quando estes tentavam procurar por pessoas novas implicitamente. Todos os participantes confirmaram que o conhecimento sobre o ambiente que os rodeava foi de facto enriquecido. Houve mais facilidade em identificar pessoas quando estas chegavam a um local. Nos últimos anos tem sido feito um esforço para aumentar a acessibilidade a dispositivos e à informação disponível nestes (Ex: através de leitores de ecrã). No entanto, o mundo real apresenta muita informação que é oferecida de forma visualmente que é assim inacessível a uma pessoa cega. Esta é uma limitação a ter em consideração que pode ajudar à interação social e a compreensão do ambiente que rodeia o utilizador. Não existem sistemas que sejam capazes de fornecer a uma pessoa cega informação tão simples como quem é que se encontra à sua volta, quem é que passou próximo de si, quem é que ainda se encontra numa sala, quais as lojas mais próximas de si ou restaurantes ou simplesmente o que está escrito no placard de notícias. Da mesma maneira, existe a falta de ferramentas que lhes permitam adicionar a sua própria informação a ambientes, que possam partilhar essa informação e servirem-se dela para se entreajudarem em situações mais complicadas. Mostramos estas limitações, necessidades e desejos das pessoas cegas em obter informação sobre o ambiente que as rodeia. Tentando dar o enfâse no aspeto social da ferramenta, focámo-nos muito nas pessoas e na necessidade pessoal de cada individuo.Visually impaired people are often confronted with new environments and they find themselves face to face with an innumerous amount of difficulties when facing these environments. Having to surpass and deal with these difficulties that arise with their condition is something that we can help diminish. They are one sense down when trying to understand their surrounding environments and gather information about what is happening around them. It is difficult for blind people to be comfortable in places where they can’t achieve a proper perception of the environment, considering the difficulty to understand where they are, where are the things they want, who are the people around them, what is around them and how to safely get somewhere or accomplish a particular task. Nowadays, mobile devices present significant computing and technological capacity which has been increasing to the point where it is very common for most people to have access to a device with Bluetooth, GPS, Wi-Fi, and both high processing and storage capacities. This allows us to think of applications that can do so much to help people with difficulties. In the particular case of blind people, the lack of visual information can be bypassed with other contextual information retrieved by their own personal devices. Mobile devices are ubiquitous and are able to be used virtually anywhere and allow connectivity with one another. This also allows their users to save information and convey it through several devices, which means that we can easily share data, augmenting our possibilities beyond what a single device can do. Our goal is to provide information to blind users, be able to give them information about the context that surrounds them. We wanted to provide the blind users with the tools to create information and be able to share this information between each other, information about people, locations or objects. Our approach was to split the project into a data and information gathering phase where we did our field search and interviewed and elaborated on how is the situation of environment perception for blind users, followed by a technical phase where we implement a system based on the first stage. Our results gathered from both the collecting phase and our implementing phase showed that there is potential to use these tools in the blind community and that they welcome the possibilities and horizons that it opens them

Caracterização morfométrica e microbiota endógena de populações do marisco Anomalocardia flexuosa Linnaeus, 1767 (Bivalvia: Veneridae)

A catação do marisco-pedra Anomalocardia flexuosa L. é essencial para as comunidades tradicionais, que vivem em regiões litorâneas e dependem dessa atividade. O estudo objetivou investigar a microbiota endógena de A. flexuosa associada à morfometria da concha. Foram realizadas coletas no estuário do Rio Paraíba do Norte, nos meses de setembro e outubro de 2017, em quatro croas, com níveis diferentes de poluição. Os mariscos foram coletados manualmente e a água do rio foi coletada com o auxílio de garrafa plástica. A morfometria do marisco-pedra foi feita com o auxílio de paquímetro e a inoculação para o crescimento dos micro-organismos utilizou os meios de cultivo: Ágar Sabouraud (SAB) e Malte, para fungos, e Agar Tryptic soy (TSA) e Mueller Hinton (MH), para bactérias. Foram encontradas conchas com tamanho variando entre 14,14 mm e 21,5 mm e 33 morfotipos da microbiota endógena, sendo 14 de bactérias e 19 de fungos. Os indivíduos da croa Cidade, por estarem mais próximas da zona urbana, recebem maior carga de poluição, refletindo no tamanho médio das conchas das populações de A. flexuosa. As croas mais conservadas e distantes do centro urbano (Portinho, Marisco e Lombo da Vara) mostraram uma maior riqueza de bactérias endógenas, enquanto os fungos não apresentaram diferença estatística significativa associadas ao tamanho médio maior da concha. Medidas mitigatórias são necessárias para o melhor rendimento da atividade de catação de marisco, tendo como pressuposto a minimização da poluição hídrica, advinda dos centros urbanos e o manejo adequado da mariscagem

Agronomic evaluation of varieties of sugar cane inoculated with diazotrophic bacteria and fertilized with nitrogen

O objetivo deste trabalho foi avaliar a eficiência da inoculação de bactérias diazotróficas e da adubaçãonitrogenada, em duas variedades de cana‑de‑açúcar, cultivadas nas mesmas condições edafoclimáticas. O experimento foi conduzido durante os anos agrícolas de 2006/2007 e 2008/2009, em delineamento experimental de blocos ao acaso, com quatro repetições, instalado em março de 2006 em área de cultivo comercial, no Município de Campos dos Goytacazes, RJ. Os tratamentos foram: inoculação com bactérias diazotróficas, adubação com 120 kg ha‑1 de N, e o controle sem inoculação e sem adubação com nitrogênio. As variedades de cana‑de‑açúcar avaliadas foram RB72454 e RB867515. O inoculante continha estirpes de cinco espécies de bactérias diazotróficas. Foram feitas avaliações quanto à produtividade de colmos frescos, ao acúmulo de matéria seca total, ao N total da parte aérea e quanto à abundância natural de 15N do N disponível no solo e na cana‑de‑açúcar. As variedades apresentaram comportamentos distintos com os tratamentos, em que a RB867515 foi responsiva e a RB72454 não responsiva àinoculação e à adubação nitrogenada. Na variedade RB867515, o crescimento e o acúmulo de N total na parte aérea das plantas, promovidos pela inoculação, foram similares aos do tratamento com adubação nitrogenada.The objective of this work was to evaluate the efficiency of inoculation with diazotrophic bacteria and nitrogen fertilization, in two varieties of sugarcane grown under the same edaphic and climatic conditions. The experiment was carried out during the agricultural years 2006/2007 and 2008/2009, in a randomized block design with four replicates, installed in March 2006 in an area of commercial cultivation in Campos dos Goytacazescity, in Rio de Janeiro state, Brazil. The treatments were: inoculation with diazotrophic bacteria, fertilization with120 kg ha‑1 N, and a control without inoculation and without nitrogen fertilization. The sugarcane varieties evaluated were RB72454 and RB867515. The inoculant was composed of five strains of diazotrophic bacteria. Evaluations were done for fresh stalk yield, total dry matter accumulation, total N of shoots, and 15N natural abundance from available N in the soil and in sugarcane. The varieties performed differently to treatments, in which RB867515 was responsive and RB72454 unresponsive to inoculation and nitrogen fertilization. In the variety RB867515, growth and accumulation of total N in the shoots, promoted by inoculation, were similar to the ones in the treatment with N fertilization

Mitochondrial physiology

As the knowledge base and importance of mitochondrial physiology to evolution, health and disease expands, the necessity for harmonizing the terminology concerning mitochondrial respiratory states and rates has become increasingly apparent. The chemiosmotic theory establishes the mechanism of energy transformation and coupling in oxidative phosphorylation. The unifying concept of the protonmotive force provides the framework for developing a consistent theoretical foundation of mitochondrial physiology and bioenergetics. We follow the latest SI guidelines and those of the International Union of Pure and Applied Chemistry (IUPAC) on terminology in physical chemistry, extended by considerations of open systems and thermodynamics of irreversible processes. The concept-driven constructive terminology incorporates the meaning of each quantity and aligns concepts and symbols with the nomenclature of classical bioenergetics. We endeavour to provide a balanced view of mitochondrial respiratory control and a critical discussion on reporting data of mitochondrial respiration in terms of metabolic flows and fluxes. Uniform standards for evaluation of respiratory states and rates will ultimately contribute to reproducibility between laboratories and thus support the development of data repositories of mitochondrial respiratory function in species, tissues, and cells. Clarity of concept and consistency of nomenclature facilitate effective transdisciplinary communication, education, and ultimately further discovery

Mitochondrial physiology

As the knowledge base and importance of mitochondrial physiology to evolution, health and disease expands, the necessity for harmonizing the terminology concerning mitochondrial respiratory states and rates has become increasingly apparent. The chemiosmotic theory establishes the mechanism of energy transformation and coupling in oxidative phosphorylation. The unifying concept of the protonmotive force provides the framework for developing a consistent theoretical foundation of mitochondrial physiology and bioenergetics. We follow the latest SI guidelines and those of the International Union of Pure and Applied Chemistry (IUPAC) on terminology in physical chemistry, extended by considerations of open systems and thermodynamics of irreversible processes. The concept-driven constructive terminology incorporates the meaning of each quantity and aligns concepts and symbols with the nomenclature of classical bioenergetics. We endeavour to provide a balanced view of mitochondrial respiratory control and a critical discussion on reporting data of mitochondrial respiration in terms of metabolic flows and fluxes. Uniform standards for evaluation of respiratory states and rates will ultimately contribute to reproducibility between laboratories and thus support the development of data repositories of mitochondrial respiratory function in species, tissues, and cells. Clarity of concept and consistency of nomenclature facilitate effective transdisciplinary communication, education, and ultimately further discovery

Measuring universal health coverage based on an index of effective coverage of health services in 204 countries and territories, 1990–2019 : A systematic analysis for the Global Burden of Disease Study 2019

Background Achieving universal health coverage (UHC) involves all people receiving the health services they need, of high quality, without experiencing financial hardship. Making progress towards UHC is a policy priority for both countries and global institutions, as highlighted by the agenda of the UN Sustainable Development Goals (SDGs) and WHO's Thirteenth General Programme of Work (GPW13). Measuring effective coverage at the health-system level is important for understanding whether health services are aligned with countries' health profiles and are of sufficient quality to produce health gains for populations of all ages. Methods Based on the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we assessed UHC effective coverage for 204 countries and territories from 1990 to 2019. Drawing from a measurement framework developed through WHO's GPW13 consultation, we mapped 23 effective coverage indicators to a matrix representing health service types (eg, promotion, prevention, and treatment) and five population-age groups spanning from reproductive and newborn to older adults (≥65 years). Effective coverage indicators were based on intervention coverage or outcome-based measures such as mortality-to-incidence ratios to approximate access to quality care; outcome-based measures were transformed to values on a scale of 0–100 based on the 2·5th and 97·5th percentile of location-year values. We constructed the UHC effective coverage index by weighting each effective coverage indicator relative to its associated potential health gains, as measured by disability-adjusted life-years for each location-year and population-age group. For three tests of validity (content, known-groups, and convergent), UHC effective coverage index performance was generally better than that of other UHC service coverage indices from WHO (ie, the current metric for SDG indicator 3.8.1 on UHC service coverage), the World Bank, and GBD 2017. We quantified frontiers of UHC effective coverage performance on the basis of pooled health spending per capita, representing UHC effective coverage index levels achieved in 2019 relative to country-level government health spending, prepaid private expenditures, and development assistance for health. To assess current trajectories towards the GPW13 UHC billion target—1 billion more people benefiting from UHC by 2023—we estimated additional population equivalents with UHC effective coverage from 2018 to 2023. Findings Globally, performance on the UHC effective coverage index improved from 45·8 (95% uncertainty interval 44·2–47·5) in 1990 to 60·3 (58·7–61·9) in 2019, yet country-level UHC effective coverage in 2019 still spanned from 95 or higher in Japan and Iceland to lower than 25 in Somalia and the Central African Republic. Since 2010, sub-Saharan Africa showed accelerated gains on the UHC effective coverage index (at an average increase of 2·6% [1·9–3·3] per year up to 2019); by contrast, most other GBD super-regions had slowed rates of progress in 2010–2019 relative to 1990–2010. Many countries showed lagging performance on effective coverage indicators for non-communicable diseases relative to those for communicable diseases and maternal and child health, despite non-communicable diseases accounting for a greater proportion of potential health gains in 2019, suggesting that many health systems are not keeping pace with the rising non-communicable disease burden and associated population health needs. In 2019, the UHC effective coverage index was associated with pooled health spending per capita (r=0·79), although countries across the development spectrum had much lower UHC effective coverage than is potentially achievable relative to their health spending. Under maximum efficiency of translating health spending into UHC effective coverage performance, countries would need to reach $1398 pooled health spending per capita (US$ adjusted for purchasing power parity) in order to achieve 80 on the UHC effective coverage index. From 2018 to 2023, an estimated 388·9 million (358·6–421·3) more population equivalents would have UHC effective coverage, falling well short of the GPW13 target of 1 billion more people benefiting from UHC during this time. Current projections point to an estimated 3·1 billion (3·0–3·2) population equivalents still lacking UHC effective coverage in 2023, with nearly a third (968·1 million [903·5–1040·3]) residing in south Asia. Interpretation The present study demonstrates the utility of measuring effective coverage and its role in supporting improved health outcomes for all people—the ultimate goal of UHC and its achievement. Global ambitions to accelerate progress on UHC service coverage are increasingly unlikely unless concerted action on non-communicable diseases occurs and countries can better translate health spending into improved performance. Focusing on effective coverage and accounting for the world's evolving health needs lays the groundwork for better understanding how close—or how far—all populations are in benefiting from UHC

Adolescent transport and unintentional injuries: a systematic analysis using the Global Burden of Disease Study 2019

Background: Globally, transport and unintentional injuries persist as leading preventable causes of mortality and morbidity for adolescents. We sought to report comprehensive trends in injury-related mortality and morbidity for adolescents aged 10–24 years during the past three decades. Methods: Using the Global Burden of Disease, Injuries, and Risk Factors 2019 Study, we analysed mortality and disability-adjusted life-years (DALYs) attributed to transport and unintentional injuries for adolescents in 204 countries. Burden is reported in absolute numbers and age-standardised rates per 100 000 population by sex, age group (10–14, 15–19, and 20–24 years), and sociodemographic index (SDI) with 95% uncertainty intervals (UIs). We report percentage changes in deaths and DALYs between 1990 and 2019. Findings: In 2019, 369 061 deaths (of which 214 337 [58%] were transport related) and 31·1 million DALYs (of which 16·2 million [52%] were transport related) among adolescents aged 10–24 years were caused by transport and unintentional injuries combined. If compared with other causes, transport and unintentional injuries combined accounted for 25% of deaths and 14% of DALYs in 2019, and showed little improvement from 1990 when such injuries accounted for 26% of adolescent deaths and 17% of adolescent DALYs. Throughout adolescence, transport and unintentional injury fatality rates increased by age group. The unintentional injury burden was higher among males than females for all injury types, except for injuries related to fire, heat, and hot substances, or to adverse effects of medical treatment. From 1990 to 2019, global mortality rates declined by 34·4% (from 17·5 to 11·5 per 100 000) for transport injuries, and by 47·7% (from 15·9 to 8·3 per 100 000) for unintentional injuries. However, in low-SDI nations the absolute number of deaths increased (by 80·5% to 42 774 for transport injuries and by 39·4% to 31 961 for unintentional injuries). In the high-SDI quintile in 2010–19, the rate per 100 000 of transport injury DALYs was reduced by 16·7%, from 838 in 2010 to 699 in 2019. This was a substantially slower pace of reduction compared with the 48·5% reduction between 1990 and 2010, from 1626 per 100 000 in 1990 to 838 per 100 000 in 2010. Between 2010 and 2019, the rate of unintentional injury DALYs per 100 000 also remained largely unchanged in high-SDI countries (555 in 2010 vs 554 in 2019; 0·2% reduction). The number and rate of adolescent deaths and DALYs owing to environmental heat and cold exposure increased for the high-SDI quintile during 2010–19. Interpretation: As other causes of mortality are addressed, inadequate progress in reducing transport and unintentional injury mortality as a proportion of adolescent deaths becomes apparent. The relative shift in the burden of injury from high-SDI countries to low and low–middle-SDI countries necessitates focused action, including global donor, government, and industry investment in injury prevention. The persisting burden of DALYs related to transport and unintentional injuries indicates a need to prioritise innovative measures for the primary prevention of adolescent injury. Funding: Bill & Melinda Gates Foundation

Measuring universal health coverage based on an index of effective coverage of health services in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Background Achieving universal health coverage (UHC) involves all people receiving the health services they need, of high quality, without experiencing financial hardship. Making progress towards UHC is a policy priority for both countries and global institutions, as highlighted by the agenda of the UN Sustainable Development Goals (SDGs) and WHO's Thirteenth General Programme of Work (GPW13). Measuring effective coverage at the health-system level is important for understanding whether health services are aligned with countries' health profiles and are of sufficient quality to produce health gains for populations of all ages. Methods Based on the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we assessed UHC effective coverage for 204 countries and territories from 1990 to 2019. Drawing from a measurement framework developed through WHO's GPW13 consultation, we mapped 23 effective coverage indicators to a matrix representing health service types (eg, promotion, prevention, and treatment) and five population-age groups spanning from reproductive and newborn to older adults (≥65 years). Effective coverage indicators were based on intervention coverage or outcome-based measures such as mortality-to-incidence ratios to approximate access to quality care; outcome-based measures were transformed to values on a scale of 0–100 based on the 2·5th and 97·5th percentile of location-year values. We constructed the UHC effective coverage index by weighting each effective coverage indicator relative to its associated potential health gains, as measured by disability-adjusted life-years for each location-year and population-age group. For three tests of validity (content, known-groups, and convergent), UHC effective coverage index performance was generally better than that of other UHC service coverage indices from WHO (ie, the current metric for SDG indicator 3.8.1 on UHC service coverage), the World Bank, and GBD 2017. We quantified frontiers of UHC effective coverage performance on the basis of pooled health spending per capita, representing UHC effective coverage index levels achieved in 2019 relative to country-level government health spending, prepaid private expenditures, and development assistance for health. To assess current trajectories towards the GPW13 UHC billion target—1 billion more people benefiting from UHC by 2023—we estimated additional population equivalents with UHC effective coverage from 2018 to 2023. Findings Globally, performance on the UHC effective coverage index improved from 45·8 (95% uncertainty interval 44·2–47·5) in 1990 to 60·3 (58·7–61·9) in 2019, yet country-level UHC effective coverage in 2019 still spanned from 95 or higher in Japan and Iceland to lower than 25 in Somalia and the Central African Republic. Since 2010, sub-Saharan Africa showed accelerated gains on the UHC effective coverage index (at an average increase of 2·6% [1·9–3·3] per year up to 2019); by contrast, most other GBD super-regions had slowed rates of progress in 2010–2019 relative to 1990–2010. Many countries showed lagging performance on effective coverage indicators for non-communicable diseases relative to those for communicable diseases and maternal and child health, despite non-communicable diseases accounting for a greater proportion of potential health gains in 2019, suggesting that many health systems are not keeping pace with the rising non-communicable disease burden and associated population health needs. In 2019, the UHC effective coverage index was associated with pooled health spending per capita (r=0·79), although countries across the development spectrum had much lower UHC effective coverage than is potentially achievable relative to their health spending. Under maximum efficiency of translating health spending into UHC effective coverage performance, countries would need to reach $1398 pooled health spending per capita (US$ adjusted for purchasing power parity) in order to achieve 80 on the UHC effective coverage index. From 2018 to 2023, an estimated 388·9 million (358·6–421·3) more population equivalents would have UHC effective coverage, falling well short of the GPW13 target of 1 billion more people benefiting from UHC during this time. Current projections point to an estimated 3·1 billion (3·0–3·2) population equivalents still lacking UHC effective coverage in 2023, with nearly a third (968·1 million [903·5–1040·3]) residing in south Asia. Interpretation The present study demonstrates the utility of measuring effective coverage and its role in supporting improved health outcomes for all people—the ultimate goal of UHC and its achievement. Global ambitions to accelerate progress on UHC service coverage are increasingly unlikely unless concerted action on non-communicable diseases occurs and countries can better translate health spending into improved performance. Focusing on effective coverage and accounting for the world's evolving health needs lays the groundwork for better understanding how close—or how far—all populations are in benefiting from UHC

Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Background: In an era of shifting global agendas and expanded emphasis on non-communicable diseases and injuries along with communicable diseases, sound evidence on trends by cause at the national level is essential. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic scientific assessment of published, publicly available, and contributed data on incidence, prevalence, and mortality for a mutually exclusive and collectively exhaustive list of diseases and injuries. Methods: GBD estimates incidence, prevalence, mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) due to 369 diseases and injuries, for two sexes, and for 204 countries and territories. Input data were extracted from censuses, household surveys, civil registration and vital statistics, disease registries, health service use, air pollution monitors, satellite imaging, disease notifications, and other sources. Cause-specific death rates and cause fractions were calculated using the Cause of Death Ensemble model and spatiotemporal Gaussian process regression. Cause-specific deaths were adjusted to match the total all-cause deaths calculated as part of the GBD population, fertility, and mortality estimates. Deaths were multiplied by standard life expectancy at each age to calculate YLLs. A Bayesian meta-regression modelling tool, DisMod-MR 2.1, was used to ensure consistency between incidence, prevalence, remission, excess mortality, and cause-specific mortality for most causes. Prevalence estimates were multiplied by disability weights for mutually exclusive sequelae of diseases and injuries to calculate YLDs. We considered results in the context of the Socio-demographic Index (SDI), a composite indicator of income per capita, years of schooling, and fertility rate in females younger than 25 years. Uncertainty intervals (UIs) were generated for every metric using the 25th and 975th ordered 1000 draw values of the posterior distribution. Findings: Global health has steadily improved over the past 30 years as measured by age-standardised DALY rates. After taking into account population growth and ageing, the absolute number of DALYs has remained stable. Since 2010, the pace of decline in global age-standardised DALY rates has accelerated in age groups younger than 50 years compared with the 1990–2010 time period, with the greatest annualised rate of decline occurring in the 0–9-year age group. Six infectious diseases were among the top ten causes of DALYs in children younger than 10 years in 2019: lower respiratory infections (ranked second), diarrhoeal diseases (third), malaria (fifth), meningitis (sixth), whooping cough (ninth), and sexually transmitted infections (which, in this age group, is fully accounted for by congenital syphilis; ranked tenth). In adolescents aged 10–24 years, three injury causes were among the top causes of DALYs: road injuries (ranked first), self-harm (third), and interpersonal violence (fifth). Five of the causes that were in the top ten for ages 10–24 years were also in the top ten in the 25–49-year age group: road injuries (ranked first), HIV/AIDS (second), low back pain (fourth), headache disorders (fifth), and depressive disorders (sixth). In 2019, ischaemic heart disease and stroke were the top-ranked causes of DALYs in both the 50–74-year and 75-years-and-older age groups. Since 1990, there has been a marked shift towards a greater proportion of burden due to YLDs from non-communicable diseases and injuries. In 2019, there were 11 countries where non-communicable disease and injury YLDs constituted more than half of all disease burden. Decreases in age-standardised DALY rates have accelerated over the past decade in countries at the lower end of the SDI range, while improvements have started to stagnate or even reverse in countries with higher SDI. Interpretation: As disability becomes an increasingly large component of disease burden and a larger component of health expenditure, greater research and developm nt investment is needed to identify new, more effective intervention strategies. With a rapidly ageing global population, the demands on health services to deal with disabling outcomes, which increase with age, will require policy makers to anticipate these changes. The mix of universal and more geographically specific influences on health reinforces the need for regular reporting on population health in detail and by underlying cause to help decision makers to identify success stories of disease control to emulate, as well as opportunities to improve. Funding: Bill & Melinda Gates Foundation. © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licens

Search for heavy resonances decaying to two Higgs bosons in final states containing four b quarks

A search is presented for narrow heavy resonances X decaying into pairs of Higgs bosons (H) in proton-proton collisions collected by the CMS experiment at the LHC at root s = 8 TeV. The data correspond to an integrated luminosity of 19.7 fb(-1). The search considers HH resonances with masses between 1 and 3 TeV, having final states of two b quark pairs. Each Higgs boson is produced with large momentum, and the hadronization products of the pair of b quarks can usually be reconstructed as single large jets. The background from multijet and t (t) over bar events is significantly reduced by applying requirements related to the flavor of the jet, its mass, and its substructure. The signal would be identified as a peak on top of the dijet invariant mass spectrum of the remaining background events. No evidence is observed for such a signal. Upper limits obtained at 95 confidence level for the product of the production cross section and branching fraction sigma(gg -> X) B(X -> HH -> b (b) over barb (b) over bar) range from 10 to 1.5 fb for the mass of X from 1.15 to 2.0 TeV, significantly extending previous searches. For a warped extra dimension theory with amass scale Lambda(R) = 1 TeV, the data exclude radion scalar masses between 1.15 and 1.55 TeV