Robust nonlinear feedback control for Rendezvous in near-circular orbits

The growing development of the space sector has been driving new technologies and innovative methods. One of these methods, the orbital rendezvous, has been around since the 1960s and consists of bringing together two spacecrafts, one of them is passive, named "target", and the other is active, called the "chaser". This second spacecraft, in turn, performs maneuvers with the aid of thrusters in order to reduce the relative distance between the two vehicles until it is approximately zero. Initially, this process was done manually, however, today technology has progressed such that the process can be completely autonomous. At the beginning of the automation of this space maneuver, the concern would only be to complete the mission, however, it has progressed towards improving this automation process taking into account propellant consumption and the amount of time spent to perform it. Thus, the present dissertation aims to develop and implement a robust controller, based on a Lyapunov’s approach, to show its performance, robustness, and effectiveness in an orbital rendezvous mission. By using a linear dynamic system, where the orbital eccentricity of the target is assumed to be a system uncertainty, the nonlinear controller can create a smooth trajectory so that the chaser approaches the target. The results show that this nonlinear controller can find the solution to the problem of rendezvous for short relative distances and low relative speeds as well as for large, always generating smooth paths without overshooting the target. It was also found that even by disturbing the system with uncertainty, the controller can generate a robust trajectory with great results. This type of controller for rendezvous missions, besides being robust and effective, as demonstrated in the obtained results, can generate excellent results for rendezvous between non-circular non-coplanar orbits.O crescente desenvolvimento do setor espacial tem vindo a impulsionar novas tecnologias e métodos inovadores. Um destes métodos, o rendezvous orbital, está presente desde a década de 60, e consiste em aproximar dois veículos espaciais, um deles passivo denominado de “target” e o outro ativo denominado de “chaser”. Este segundo, por sua vez, executa manobras com o auxílio de propulsores de modo a reduzir a distância relativa entre os dois veículos até que esta seja aproximadamente nula. Inicialmente, este processo era feito manualmente, no entanto, atualmente, a tecnologia progrediu de tal forma que o processo consegue ser completamente autónomo. No início da automação desta manobra espacial, a preocupação seria apenas completar a missão, contudo esta progrediu no sentido de melhorar este processo de automação tendo em conta o consumo de propelente e a quantidade de tempo gasto. Desta forma, a presente dissertação tem como objetivo desenvolver e implementar um controlador robusto, baseado numa metodologia de Lyapunov, de modo a mostrar a sua performance, robustez e eficácia numa missão de rendezvous orbital. Ao utilizar um sistema linear dinâmico em que a excentricidade da órbita do “target” se assume como uma incerteza do sistema, o controlador não-linear consegue criar uma trajetória suave, para que o “chaser” se aproxime do “target”. Os resultados obtidos demonstram que este controlador consegue encontrar a solução para o problema de rendezvous tanto para pequenas distâncias e velocidades relativas assim como para grandes, gerando sempre trajetórias suaves sem ultrapassar o “target”. Verifica-se também que, mesmo perturbando o sistema com a incerteza, o controlador consegue gerar uma trajetória robusta com ótimos resultados. Este tipo de controlador para missões de rendezvous, para além de ser robusto e eficaz, como demonstrado nos resultados obtidos, consegue gerar ótimos resultados para rendezvous entre órbitas não-coplanares nãocirculares

Livro Verde dos Montados

O Livro Verde dos Montados apresenta diversos objectivos que se interligam: Em primeiro lugar, o Livro Verde pretende reunir e sistematizar, de uma forma simples e acessível ao público, o conhecimento produzido em Portugal pelos investigadores e técnicos de várias instituições de investigação ou de gestão que estudam o Montado. Assume-se como uma oportunidade de caracterizar o sistema tendo em conta as suas várias dimensões, identificando as principais ameaças à sua preservação assim como os caminhos que podem ajudar à sua sustentabilidade. Não sendo um documento científico, baseia-se no conhecimento científico e pretende constituir a base para uma plataforma de organização, tanto dos investigadores como do conhecimento científico actualmente produzido em Portugal sobre o Montado.Em segundo lugar, o Livro Verde deverá contribuir para um entendimento partilhado do que é o Montado, por parte do público, de técnicos e de especialistas, conduzindo a uma classificação mais clara do que pode ser considerado Montado e de quais os tipos distintos de Montados que podem ser identificados. Em terceiro lugar, o Livro Verde estabelece as bases para uma estratégia coordenada de disponibilização de informação sobre o sistema Montado, visando o seu conhecimento, apreciação e valorização pela sociedade portuguesa no seu conjunto. Deste modo, o Livro Verde poderá constituir um instrumento congregador e inspirador para a realização de acções de sensibilização e informação sobre o Montado. Em quarto lugar, pretende-se que o Livro Verde contribua para um maior reconhecimento e valorização do Montado como sistema, a nível do desenho das políticas nacionais por parte dos vários sectores envolvidos.Finalmente, o Livro Verde constituirá um documento parceiro do Livro Verde das Dehesas, produzido em Espanha em 2010, de forma a reforçar o reconhecimento e a devida valorização destes sistemas silvo-pastoris no desenho das estratégias e políticas relevantes pelas instituições europeias. Em suma, os autores pretendem que o Livro Verde dos Montados se afirme como o primeiro passo para uma efectiva definição e implementação de uma estratégia nacional para os Montados

Effect of surgical experience and spine subspecialty on the reliability of the {AO} Spine Upper Cervical Injury Classification System

OBJECTIVE The objective of this paper was to determine the interobserver reliability and intraobserver reproducibility of the AO Spine Upper Cervical Injury Classification System based on surgeon experience (< 5 years, 5–10 years, 10–20 years, and > 20 years) and surgical subspecialty (orthopedic spine surgery, neurosurgery, and "other" surgery). METHODS A total of 11,601 assessments of upper cervical spine injuries were evaluated based on the AO Spine Upper Cervical Injury Classification System. Reliability and reproducibility scores were obtained twice, with a 3-week time interval. Descriptive statistics were utilized to examine the percentage of accurately classified injuries, and Pearson’s chi-square or Fisher’s exact test was used to screen for potentially relevant differences between study participants. Kappa coefficients (κ) determined the interobserver reliability and intraobserver reproducibility. RESULTS The intraobserver reproducibility was substantial for surgeon experience level (< 5 years: 0.74 vs 5–10 years: 0.69 vs 10–20 years: 0.69 vs > 20 years: 0.70) and surgical subspecialty (orthopedic spine: 0.71 vs neurosurgery: 0.69 vs other: 0.68). Furthermore, the interobserver reliability was substantial for all surgical experience groups on assessment 1 (< 5 years: 0.67 vs 5–10 years: 0.62 vs 10–20 years: 0.61 vs > 20 years: 0.62), and only surgeons with > 20 years of experience did not have substantial reliability on assessment 2 (< 5 years: 0.62 vs 5–10 years: 0.61 vs 10–20 years: 0.61 vs > 20 years: 0.59). Orthopedic spine surgeons and neurosurgeons had substantial intraobserver reproducibility on both assessment 1 (0.64 vs 0.63) and assessment 2 (0.62 vs 0.63), while other surgeons had moderate reliability on assessment 1 (0.43) and fair reliability on assessment 2 (0.36). CONCLUSIONS The international reliability and reproducibility scores for the AO Spine Upper Cervical Injury Classification System demonstrated substantial intraobserver reproducibility and interobserver reliability regardless of surgical experience and spine subspecialty. These results support the global application of this classification system

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

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 age-sex-specific fertility, mortality, healthy life expectancy (HALE), and population estimates in 204 countries and territories, 1950-2019 : a comprehensive demographic analysis for the Global Burden of Disease Study 2019

Background: Accurate and up-to-date assessment of demographic metrics is crucial for understanding a wide range of social, economic, and public health issues that affect populations worldwide. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 produced updated and comprehensive demographic assessments of the key indicators of fertility, mortality, migration, and population for 204 countries and territories and selected subnational locations from 1950 to 2019. Methods: 8078 country-years of vital registration and sample registration data, 938 surveys, 349 censuses, and 238 other sources were identified and used to estimate age-specific fertility. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate age-specific fertility rates for 5-year age groups between ages 15 and 49 years. With extensions to age groups 10–14 and 50–54 years, the total fertility rate (TFR) was then aggregated using the estimated age-specific fertility between ages 10 and 54 years. 7417 sources were used for under-5 mortality estimation and 7355 for adult mortality. ST-GPR was used to synthesise data sources after correction for known biases. Adult mortality was measured as the probability of death between ages 15 and 60 years based on vital registration, sample registration, and sibling histories, and was also estimated using ST-GPR. HIV-free life tables were then estimated using estimates of under-5 and adult mortality rates using a relational model life table system created for GBD, which closely tracks observed age-specific mortality rates from complete vital registration when available. Independent estimates of HIV-specific mortality generated by an epidemiological analysis of HIV prevalence surveys and antenatal clinic serosurveillance and other sources were incorporated into the estimates in countries with large epidemics. Annual and single-year age estimates of net migration and population for each country and territory were generated using a Bayesian hierarchical cohort component model that analysed estimated age-specific fertility and mortality rates along with 1250 censuses and 747 population registry years. We classified location-years into seven categories on the basis of the natural rate of increase in population (calculated by subtracting the crude death rate from the crude birth rate) and the net migration rate. We computed healthy life expectancy (HALE) using years lived with disability (YLDs) per capita, life tables, and standard demographic methods. Uncertainty was propagated throughout the demographic estimation process, including fertility, mortality, and population, with 1000 draw-level estimates produced for each metric. Findings: The global TFR decreased from 2·72 (95% uncertainty interval [UI] 2·66–2·79) in 2000 to 2·31 (2·17–2·46) in 2019. Global annual livebirths increased from 134·5 million (131·5–137·8) in 2000 to a peak of 139·6 million (133·0–146·9) in 2016. Global livebirths then declined to 135·3 million (127·2–144·1) in 2019. Of the 204 countries and territories included in this study, in 2019, 102 had a TFR lower than 2·1, which is considered a good approximation of replacement-level fertility. All countries in sub-Saharan Africa had TFRs above replacement level in 2019 and accounted for 27·1% (95% UI 26·4–27·8) of global livebirths. Global life expectancy at birth increased from 67·2 years (95% UI 66·8–67·6) in 2000 to 73·5 years (72·8–74·3) in 2019. The total number of deaths increased from 50·7 million (49·5–51·9) in 2000 to 56·5 million (53·7–59·2) in 2019. Under-5 deaths declined from 9·6 million (9·1–10·3) in 2000 to 5·0 million (4·3–6·0) in 2019. Global population increased by 25·7%, from 6·2 billion (6·0–6·3) in 2000 to 7·7 billion (7·5–8·0) in 2019. In 2019, 34 countries had negative natural rates of increase; in 17 of these, the population declined because immigration was not sufficient to counteract the negative rate of decline. Globally, HALE increased from 58·6 years (56·1–60·8) in 2000 to 63·5 years (60·8–66·1) in 2019. HALE increased in 202 of 204 countries and territories between 2000 and 2019

Global, regional, and national progress towards Sustainable Development Goal 3.2 for neonatal and child health: all-cause and cause-specific mortality findings from the Global Burden of Disease Study 2019

Background Sustainable Development Goal 3.2 has targeted elimination of preventable child mortality, reduction of neonatal death to less than 12 per 1000 livebirths, and reduction of death of children younger than 5 years to less than 25 per 1000 livebirths, for each country by 2030. To understand current rates, recent trends, and potential trajectories of child mortality for the next decade, we present the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 findings for all-cause mortality and cause-specific mortality in children younger than 5 years of age, with multiple scenarios for child mortality in 2030 that include the consideration of potential effects of COVID-19, and a novel framework for quantifying optimal child survival. Methods We completed all-cause mortality and cause-specific mortality analyses from 204 countries and territories for detailed age groups separately, with aggregated mortality probabilities per 1000 livebirths computed for neonatal mortality rate (NMR) and under-5 mortality rate (USMR). Scenarios for 2030 represent different potential trajectories, notably including potential effects of the COVID-19 pandemic and the potential impact of improvements preferentially targeting neonatal survival. Optimal child survival metrics were developed by age, sex, and cause of death across all GBD location-years. The first metric is a global optimum and is based on the lowest observed mortality, and the second is a survival potential frontier that is based on stochastic frontier analysis of observed mortality and Healthcare Access and Quality Index. Findings Global U5MR decreased from 71.2 deaths per 1000 livebirths (95% uncertainty interval WI] 68.3-74-0) in 2000 to 37.1 (33.2-41.7) in 2019 while global NMR correspondingly declined more slowly from 28.0 deaths per 1000 live births (26.8-29-5) in 2000 to 17.9 (16.3-19-8) in 2019. In 2019,136 (67%) of 204 countries had a USMR at or below the SDG 3.2 threshold and 133 (65%) had an NMR at or below the SDG 3.2 threshold, and the reference scenario suggests that by 2030,154 (75%) of all countries could meet the U5MR targets, and 139 (68%) could meet the NMR targets. Deaths of children younger than 5 years totalled 9.65 million (95% UI 9.05-10.30) in 2000 and 5.05 million (4.27-6.02) in 2019, with the neonatal fraction of these deaths increasing from 39% (3.76 million 95% UI 3.53-4.021) in 2000 to 48% (2.42 million; 2.06-2.86) in 2019. NMR and U5MR were generally higher in males than in females, although there was no statistically significant difference at the global level. Neonatal disorders remained the leading cause of death in children younger than 5 years in 2019, followed by lower respiratory infections, diarrhoeal diseases, congenital birth defects, and malaria. The global optimum analysis suggests NMR could be reduced to as low as 0.80 (95% UI 0.71-0.86) deaths per 1000 livebirths and U5MR to 1.44 (95% UI 1-27-1.58) deaths per 1000 livebirths, and in 2019, there were as many as 1.87 million (95% UI 1-35-2.58; 37% 95% UI 32-43]) of 5.05 million more deaths of children younger than 5 years than the survival potential frontier. Interpretation Global child mortality declined by almost half between 2000 and 2019, but progress remains slower in neonates and 65 (32%) of 204 countries, mostly in sub-Saharan Africa and south Asia, are not on track to meet either SDG 3.2 target by 2030. Focused improvements in perinatal and newborn care, continued and expanded delivery of essential interventions such as vaccination and infection prevention, an enhanced focus on equity, continued focus on poverty reduction and education, and investment in strengthening health systems across the development spectrum have the potential to substantially improve USMR. Given the widespread effects of COVID-19, considerable effort will be required to maintain and accelerate progress. Copyright (C) 2021 The Author(s). Published by Elsevier Ltd

Mensuração da curva escoliótica pela técnica de cobb intraobservadores e interobservadores e sua importância clínica Medición de la curva de escoliosis mediante la técnica de cobb para intraobservadores e interobservadores y su significación clínica Measurement of the scoliotic curve by cobb technique for intra-observer and inter-observer and its clinical significance

OBJETIVO: Analisar a mensuração manual do ângulo de Cobb entre profissionais com diferentes experiências da área de Ortopedia e Traumatologia e Cirurgia da Coluna Vertebral, para observar se existem diferenças na avaliação das radiografias de pacientes portadores de escoliose idiopática intra e interobservadores, a ponto de influenciar no tratamento e seguimento desses pacientes. MÉTODOS: Foram utilizadas para este estudo 22 radiografias simples da coluna toracolombar, póstero-anterior, de pacientes portadores de escoliose idiopática, em acompanhamento regular no ambulatório do Grupo da Coluna do Hospital São Paulo. Os exames foram avaliados por quatro diferentes categorias de profissionais ortopedistas e cirurgiões da coluna vertebral e realizada a mensuração das curvas escolióticas através do método de Cobb. As vértebras terminais das curvas não foram previamente marcadas. Somente foram mensuradas as curvas principais (consideradas as de maior valor angular) de cada radiografia. A reprodutibilidade das mensurações feitas pelos diferentes Observadores (inter-observadores) e entre as duas mensurações de cada Observador (intraobservador) foi analisada pelo Coeficiente de Correlação Intraclasse (CCI). RESULTADOS: Foram observadas, quanto às medidas dos ângulos, concordâncias excelentes entre as avaliações intraobservadores, e observadas concordâncias excelentes entre as avaliações interobservadores, uma vez que o CCI em todas as situações manteve-se maior que 0,75, o que representa excelente reprodutibilidade. CONCLUSÃO: Concluímos que houve concordância excelente (CCI > 0,75) na avaliação dos ângulos nas mensurações das curvas escolióticas intra e interobservadores. Ao mesmo tempo, as mensurações apresentaram variação de até 13,58º intraobservadores, e de até 12,72º interobservadores.<br>OBJETIVO: Analizar la medición manual del ángulo de Cobb entre profesionales con diferentes experiencias de Ortopedia y Traumatología y Cirugía de la Columna Vertebral, para ver si hay diferencias en la evaluación de radiografías de pacientes con escoliosis idiopática intra e interobservadores, al punto para influir en el tratamiento y el seguimiento de estos pacientes. MÉTODOS: Se utilizaron para este estudio, 22 radiografías simples de la columna toracolumbar, posteroanterior en pacientes con escoliosis idiopática, y con seguimiento regular en la clínica de consulta externa del Grupo de Columna Vertebral del Hospital San Pablo. Los exámenes fueron evaluados por cuatro categorías diferentes de profesionales ortopedistas y cirujanos de la columna vertebral, y se hizo la medición de las curvas de escoliosis por el método de Cobb. Vértebras terminales de las curvas no fueron marcados previamente. Sólo las curvas principales se midieron (considerado el mayor ángulo de valor) en cada radiografía. La reproducibilidad de las mediciones realizadas por distintos observadores (interobservadores) y entre las dos mediciones de cada observador (intraobservador) fue analizada por el Coeficiente de Correlación Intraclase (CCI). RESULTADOS: Se observó, en las medidas de los ángulos, excelentes concordancias entre las evaluaciones intraobservadores y fueron observadas excelentes concordancias entre las evaluaciones interobservadores, ya que el CCI en todas las situaciones se mantuvo superior a 0,75, lo que representa una excelente reproducibilidad. CONCLUSIÓN: Se concluye en que hay un excelente acuerdo (CCI> 0,75) en la evaluación de los ángulos en las mediciones de las curvas de escoliosis intra e interobservadores. Al mismo tiempo, las mediciones mostraron variaciones de hasta 13,58º intraobservadores, y de hasta 12, 72º ·interobservadores.<br>OBJECTIVE: To examine the manual measurement of the Cobb angle between professionals with different experiences of Orthopedics and Traumatology and Spine Surgery, to see if there are differences in the evaluation of radiographs of patients with idiopathic scoliosis intra- and inter-observer, and it's influence in the treatment and follow-up of these patients. METHODS: We used for this study, 22 radiographs of the thoracolumbar spine, posterior-anterior in patients with idiopathic scoliosis, and regularly monitored at the outpatient clinic of the Spine Group of the Hospital São Paulo. The exams were evaluated by four different categories of professional orthopedists and spine surgeons and made the measurement of scoliotic curves by the method of Cobb. End-vertebrae of the curves were not previously marked. Only the principal curves were measured (considered the highest value angle) of each radiograph. The reproducibility of measurements made by different observers (inter-observer) and between the two measurements of each observer (intra-observer) was analyzed by intraclass correlation coefficient (ICC). RESULTS: We observed on the measures of angles, excellent concordance between assessments intra-observer and observed excellent concordance between assessments inter-observer, since the ICC at all times remained higher than 0.75, which represents excellent reproducibility. CONCLUSION: There was excellent concordance (ICC > 0.75) in the evaluation of measurements of angles in the scoliotic curves intra- and inter-observers. At the same time, measurements showed variations of up to 13.58° intra-observer, and up to 12.72° inter-observer

Ketamine in the treatment of cocaine use disorders

Introduction: ketamine is a dissociative anesthetic and, recently, its antidepressant properties has been described. Besides, its safety has been proven in the treatment of Stimulant Use Disorders. Objective: to evaluate the use of ketamine in the treatment of Stimulant Use Disorders (specially cocaine and its byproducts). Methods: patient's motivation for change was measured by URICA scale and psychiatric symptoms by EAS-40 score, both before and after the intervention. Results: it was verified, after the comparison between the Readiness Score means, an increase in the motivation for change after ketamine’s single administration, when compared to the moments before and after the intervention. Analyzing the Global Severity Index before and after ketamine administration, by EAS-40 score, we noticed a slight reduction of the psychiatric symptoms before and after the intervention. Conclusion: it was proven that ketamine's single administration led to a quick and lasting improvement on the user's motivation without worsening the mental health status