Global, regional, and national disability-adjusted life years (DALYs) for 306 diseases and injuries and healthy life expectancy (HALE) for 188 countries, 1990–2013: Quantifying the epidemiological transition

Background The Global Burden of Disease Study 2013 (GBD 2013) aims to bring together all available epidemiological data using a coherent measurement framework, standardised estimation methods, and transparent data sources to enable comparisons of health loss over time and across causes, age–sex groups, and countries. The GBD can be used to generate summary measures such as disability-adjusted life-years (DALYs) and healthy life expectancy (HALE) that make possible comparative assessments of broad epidemiological patterns across countries and time. These summary measures can also be used to quantify the component of variation in epidemiology that is related to sociodemographic development. Methods We used the published GBD 2013 data for age-specific mortality, years of life lost due to premature mortality (YLLs), and years lived with disability (YLDs) to calculate DALYs and HALE for 1990, 1995, 2000, 2005, 2010, and 2013 for 188 countries. We calculated HALE using the Sullivan method; 95% uncertainty intervals (UIs) represent uncertainty in age-specific death rates and YLDs per person for each country, age, sex, and year. We estimated DALYs for 306 causes for each country as the sum of YLLs and YLDs; 95% UIs represent uncertainty in YLL and YLD rates. We quantified patterns of the epidemiological transition with a composite indicator of sociodemographic status, which we constructed from income per person, average years of schooling after age 15 years, and the total fertility rate and mean age of the population. We applied hierarchical regression to DALY rates by cause across countries to decompose variance related to the sociodemographic status variable, country, and time. Findings Worldwide, from 1990 to 2013, life expectancy at birth rose by 6·2 years (95% UI 5·6–6·6), from 65·3 years (65·0–65·6) in 1990 to 71·5 years (71·0–71·9) in 2013, HALE at birth rose by 5·4 years (4·9–5·8), from 56·9 years (54·5–59·1) to 62·3 years (59·7–64·8), total DALYs fell by 3·6% (0·3–7·4), and age-standardised DALY rates per 100 000 people fell by 26·7% (24·6–29·1). For communicable, maternal, neonatal, and nutritional disorders, global DALY numbers, crude rates, and age-standardised rates have all declined between 1990 and 2013, whereas for non–communicable diseases, global DALYs have been increasing, DALY rates have remained nearly constant, and age-standardised DALY rates declined during the same period. From 2005 to 2013, the number of DALYs increased for most specific non-communicable diseases, including cardiovascular diseases and neoplasms, in addition to dengue, food-borne trematodes, and leishmaniasis; DALYs decreased for nearly all other causes. By 2013, the five leading causes of DALYs were ischaemic heart disease, lower respiratory infections, cerebrovascular disease, low back and neck pain, and road injuries. Sociodemographic status explained more than 50% of the variance between countries and over time for diarrhoea, lower respiratory infections, and other common infectious diseases; maternal disorders; neonatal disorders; nutritional deficiencies; other communicable, maternal, neonatal, and nutritional diseases; musculoskeletal disorders; and other non-communicable diseases. However, sociodemographic status explained less than 10% of the variance in DALY rates for cardiovascular diseases; chronic respiratory diseases; cirrhosis; diabetes, urogenital, blood, and endocrine diseases; unintentional injuries; and self-harm and interpersonal violence. Predictably, increased sociodemographic status was associated with a shift in burden from YLLs to YLDs, driven by declines in YLLs and increases in YLDs from musculoskeletal disorders, neurological disorders, and mental and substance use disorders. In most country-specific estimates, the increase in life expectancy was greater than that in HALE. Leading causes of DALYs are highly variable across countries. Interpretation Global health is improving. Population growth and ageing have driven up numbers of DALYs, but crude rates have remained relatively constant, showing that progress in health does not mean fewer demands on health systems. The notion of an epidemiological transition—in which increasing sociodemographic status brings structured change in disease burden—is useful, but there is tremendous variation in burden of disease that is not associated with sociodemographic status. This further underscores the need for country-specific assessments of DALYs and HALE to appropriately inform health policy decisions and attendant actions.

Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks in 188 countries, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013

Background The Global Burden of Disease, Injuries, and Risk Factor study 2013 (GBD 2013) is the first of a series of annual updates of the GBD. Risk factor quantification, particularly of modifiable risk factors, can help to identify emerging threats to population health and opportunities for prevention. The GBD 2013 provides a timely opportunity to update the comparative risk assessment with new data for exposure, relative risks, and evidence on the appropriate counterfactual risk distribution. Methods Attributable deaths, years of life lost, years lived with disability, and disability-adjusted life-years (DALYs) have been estimated for 79 risks or clusters of risks using the GBD 2010 methods. Risk–outcome pairs meeting explicit evidence criteria were assessed for 188 countries for the period 1990–2013 by age and sex using three inputs: risk exposure, relative risks, and the theoretical minimum risk exposure level (TMREL). Risks are organised into a hierarchy with blocks of behavioural, environmental and occupational, and metabolic risks at the first level of the hierarchy. The next level in the hierarchy includes nine clusters of related risks and two individual risks, with more detail provided at levels 3 and 4 of the hierarchy. Compared with GBD 2010, six new risk factors have been added: handwashing practices, occupational exposure to trichloroethylene, childhood wasting, childhood stunting, unsafe sex, and low glomerular filtration rate. For most risks, data for exposure were synthesised with a Bayesian meta-regression method, DisMod-MR 2.0, or spatial-temporal Gaussian process regression. Relative risks were based on meta-regressions of published cohort and intervention studies. Attributable burden for clusters of risks and all risks combined took into account evidence on the mediation of some risks such as high body-mass index (BMI) through other risks such as high systolic blood pressure and high cholesterol. Findings All risks combined account for 57·2% (95% uncertainty interval [UI] 55·8–58·5) of deaths and 41·6% (40·1–43·0) of DALYs. Risks quantified account for 87·9% (86·5–89·3) of cardiovascular disease DALYs, ranging to a low of 0% for neonatal disorders and neglected tropical diseases and malaria. In terms of global DALYs in 2013, six risks or clusters of risks each caused more than 5% of DALYs: dietary risks accounting for 11·3 million deaths and 241·4 million DALYs, high systolic blood pressure for 10·4 million deaths and 208·1 million DALYs, child and maternal malnutrition for 1·7 million deaths and 176·9 million DALYs, tobacco smoke for 6·1 million deaths and 143·5 million DALYs, air pollution for 5·5 million deaths and 141·5 million DALYs, and high BMI for 4·4 million deaths and 134·0 million DALYs. Risk factor patterns vary across regions and countries and with time. In sub-Saharan Africa, the leading risk factors are child and maternal malnutrition, unsafe sex, and unsafe water, sanitation, and handwashing. In women, in nearly all countries in the Americas, north Africa, and the Middle East, and in many other high-income countries, high BMI is the leading risk factor, with high systolic blood pressure as the leading risk in most of Central and Eastern Europe and south and east Asia. For men, high systolic blood pressure or tobacco use are the leading risks in nearly all high-income countries, in north Africa and the Middle East, Europe, and Asia. For men and women, unsafe sex is the leading risk in a corridor from Kenya to South Africa. Interpretation Behavioural, environmental and occupational, and metabolic risks can explain half of global mortality and more than one-third of global DALYs providing many opportunities for prevention. Of the larger risks, the attributable burden of high BMI has increased in the past 23 years. In view of the prominence of behavioural risk factors, behavioural and social science research on interventions for these risks should be strengthened. Many prevention and primary care policy options are available now to act on key risks.

Mathematics, programming, and STEM

Learning mathematics is a complex and dynamic process. In this paper, the authors adopt a semiotic framework (Yeh & Nason, 2004) and highlight programming as one of the main aspects of the semiosis or meaning-making for the learning of mathematics. During a 10-week teaching experiment, mathematical meaning-making was enriched when primary students wrote Logo programs to create 3D virtual worlds. The analysis of results found deep learning in mathematics, as well as in technology and engineering areas. This prompted a rethinking about the nature of learning mathematics and a need to employ and examine a more holistic learning approach for the learning in science, technology, engineering, and mathematics (STEM) areas.

The context of enterprise education: Insights into current practices

This paper presents the results of an investigation into contextual differences in the development and delivery of enterprise education in higher education globally. Using information gathered from an online survey distributed to enterprise educators, distinct differences in the provision of enterprise education are identified, as are differences of opinion among enterprise educators. The findings demonstrate that although enterprise education is highly diversified in terms of presentation, content and style, there are clear commonalities with regard to expected student outcomes. The respondents reported low levels of business start-up activity among students during enterprise education and/or within one year of graduation. Over 75% of the educators surveyed had personal start-up experience, and there was limited reliance on academic literature, with a preference for referencing broader stakeholder perspectives. With regard to the practical implications of this research, the international metric of enterprise education appears to be a broad set of enterprising skills that equip and enable students to recognize and exploit opportunities in order to navigate future unknowns. The commonly employed metric of business start-up appears less valid in light of this investigation.

Claiming the future of enterprise education

Purpose The purpose of this paper is to highlight the importance of enterprise educators working collectively to develop a unique scholarship of teaching. The authors argue that the time is right for educators in this domain to secure the future of enterprise education. Acknowledging the debate between "entrepreneurship education" and "enterprise education," the authors set out to develop a unification model through which educators can act collectively to demonstrate the leadership required to secure the autonomy of the domain. Design/methodology/approach The authors bring several pertinent ideas (pedagogical content knowledge, heutagogy and academagogy) to the attention of academics/researchers involved in the design, development and delivery of enterprise education. The innovative approach to combine these ideas with prevailing thinking in this domain has facilitated a model for collective action. Findings It is at the level of the shared philosophical positions that the authors can best cooperate to shape the future direction of enterprise education. The authors argue against dwelling upon how the authors differ in terms of context and process issues. Such matters can only fragment the theory and practice of enterprise education. The authors need to develop greater appreciation of shared philosophical positions and leverage this understanding into a unique scholarship of teaching, specific to enterprise education. Practical implications – As enterprise education becomes more global, it is also likely to become more attractive to business schools that long for a new positioning tool in the increasingly overcrowded markets that they compete in. Originality/value This paper encourages enterprise educators to reflect upon the knowledge they hold of their own practice, and that of other enterprise educators.

Moving beyond the business plan in enterprise education

Purpose The purpose of this paper is to approach the debate surrounding the role of business plans in enterprise/entrepreneurship education from a different perspective; that of the student. The paper argues that much of the consternation within this stubborn debate derives from a lack of appreciation of the context actually occurring in the lives of our students. The paper aims to explore several arguments directly related to these contexts. Design/methodology/approach The approach is to build around a combining of cycles of reflective practice via the authors' iterative consultation with each other. The paper seeks to explore the world of the student via an enfolding of the literature, but ultimately we do not claim to have hidden our personal biases. Findings It is important to separate enterprise education (EE) from entrepreneurship education when discussing the role of the business plan. While the business plan has a place in the latter, it makes little sense for it to be a focal learning activity in the former. In addition, we see this outcome as a positive outcome for our field with little point in continuing on with what has become a fairly pointless debate. Practical implications: The paper concludes that once EE is viewed as being distinctly different from entrepreneurship education it is free to be considered with more precision what learning needs exist. Focusing on learning needs changes the direction of the discussion, with the business plan only up for discussion if it contributes a learning activity related to pre-determined learning outcomes. Originality/value The paper offers a constructive way forward from a debate that has been beset with extreme vested interests for too long.

The student business plan: Useful or not?

This article offers a critical discussion of the role of the business plan in current enterprise educational practice. In addition to reviewing recent work that considers the ‘for’ and ‘against’ arguments about the use of business plans in higher education, the authors suggest that the context of student learning is largely omitted from these discussions. As such, they contextualize the debate so that the purpose of the business plan can be better appreciated. They build on recent work that offers alternatives to the business plan – approaches directly focused on customer discovery and explicit testing of assumptions. In doing so, recent concerns about the value of business plans and, conversely, the views of those who argue in favour of the role of business plans in enterprise education, are noted. The article provides insights into emerging alternative practices in the field of enterprise education, practices based on students’ use of such education as a vehicle for skills and knowledge development and/or wealth creation. It is acknowledged that various biases are present in the current debate, including those of the present authors: whilst it is accepted that these biases are unlikely to disappear, the article contextualizes their origins.

Comparison of the sensitivity of different sensor technologies to imbalance severity in low speed wind turbines

Imbalance is not only a direct major cause of downtime in wind turbines, but also accelerates the degradation of neighbouring and downstream components (e.g. main bearing, generator). Along with detection, the imbalance quantification is also essential as some residual imbalance always exist even in a healthy turbine. Three different commonly used sensor technologies (vibration, acoustic emission and electrical measurements) are investigated in this work to verify their sensitivity to different imbalance grades. This study is based on data obtained by experimental tests performed on a small scale wind turbine drive train test-rig for different shaft speeds and imbalance levels. According to the analysis results, electrical measurements seem to be the most suitable for tracking the development of imbalance.