Five insights from the Global Burden of Disease Study 2019

The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 provides a rules-based synthesis of the available evidence on levels and trends in health outcomes, a diverse set of risk factors, and health system responses. GBD 2019 covered 204 countries and territories, as well as first administrative level disaggregations for 22 countries, from 1990 to 2019. Because GBD is highly standardised and comprehensive, spanning both fatal and non-fatal outcomes, and uses a mutually exclusive and collectively exhaustive list of hierarchical disease and injury causes, the study provides a powerful basis for detailed and broad insights on global health trends and emerging challenges. GBD 2019 incorporates data from 281 586 sources and provides more than 3.5 billion estimates of health outcome and health system measures of interest for global, national, and subnational policy dialogue. All GBD estimates are publicly available and adhere to the Guidelines on Accurate and Transparent Health Estimate Reporting. From this vast amount of information, five key insights that are important for health, social, and economic development strategies have been distilled. These insights are subject to the many limitations outlined in each of the component GBD capstone papers.Peer reviewe

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. Funding Bill & Melinda Gates Foundation

Tremor suppression in wrist joint using active force control method

© 2017 National Committee on Applied Mechanics. All Rights Reserved. Tremor is a neurological disorder characterized by involuntary oscillations. Difficulties associated with tremor in patients with Parkinson’s disease have motivated the researchers to work on developing various methods for tremor suppression. Active Force Control (AFC) method for tremor attenuation in human body parts is considered in this work. This paper proposes a new AFC system based on a piezoelectric actuator. A three-degree-of-freedom musculoskeletal model including wrist flexion-extension (FE), radial-ulnar deviation (RUD), and pronation supination (PS) is developed for studying tremor in the wrist joint. The musculoskeletal model for this study contains four muscles; extensor carpi radialis longus, extensor carpi ulnaris, flexor carpi ulnaris and flexor carpi radialis. Also, the muscle model is developed from the classic Hill-type muscle model. First, simulation of the tremor generation in the model is performed and then the performance of AFC system for suppressing wrist joint tremor is investigated. A single piezoelectric actuator is embedded in AFC system for controlling the behavior of the classic proportional-derivative controller. MATLAB Simulink is used to analyze the model. Results show that the AFC-based system with a piezoelectric actuator and a PD controller is very effective in suppressing the human hand tremor

Active vibration control in human forearm model using paired piezoelectric sensor and actuator

An active vibration control system to monitor and suppress the human forearm tremor is proposed in this article. The forearm is modelled as a uniform flexible continuous beam supported by a pin joint and a rotational spring at one end, whereas the other end is free. The beam is covered with a layer of piezoelectric sensor on its top surface and a layer of piezoelectric actuator on its bottom surface to form a control system, through which a closed-loop active control paradigm is implemented for tremor suppression. The governing equation of motion is derived using the Hamilton principle as well as the Galerkin procedure, leading to a second-order ordinary differential equation in time. The vibration response of the structure to an external harmonic excitation, analogous to tremor, is obtained analytically, enabling parametric study of the control system for tremor reduction. Using the obtained analytical expression, the effects of various parameters such as the control gain, the piezoelectric coefficient and the dielectric constant on the vibration response are studied. The results indicated that the proposed active vibration control system is an effective tool for active vibration control. Increasing the control gain of the control system as well as the magnitude of the piezoelectric constant decreased the amplitude of vibration, whereas the dielectric constant of the piezoelectric material did not show to have a significant effect on the beam vibration. The obtained results will pave the way for further experimental exploration to take and fabricate the most appropriate piezoelectric material and to design an effective active vibration control system for tremor suppression in people with Parkinson’s disease

New gasochromic system: Nanoparticles in liquid

In this study, WO 3 nanocrystallites were first produced by laser ablation of W target in deionised water. To synthesize palladium, a PdCl 2 solution (0.2 g/L) was added to the liquid. Transmission electron microscope revealed successful synthesis of tungsten oxide nanocrystallites along with the production of Pd and core-shell Pd/WO3 nanoparticles. Gasochromic behavior was examined by hydrogen bubbling into Pd/WO 3 liquid in which a transition to blue absorbing state was observed. Optical absorption spectra of the colored liquid represented different sharp small polaron absorbing peaks below 3 eV and the peaks intensity was observed to be varied with Pd:WO 3 ratio. Time variations of optical density difference (δOD) were measured at constant wavelength of 632.8 nm by alternative bubbling hydrogen or oxygen gases. The δOD in the first coloring cycles were not completely reversible owing to the presence of some unreacted PdCl 2 . The further coloring bleaching indicates a normal gasochromic behavior. © 2012 Springer Science+Business Media B.V