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.

(Ap)pointing the canon Rousseau's Émile, visions of the state, and education

Jean-Jacques Rousseau’s Émile, ou de I’Education (Émile, or on Education) has been described by Rousseau scholars in latter twentieth century English-language philosophy as an educational classic. In 1995 Robert Wokler argued that together with Montesquieu, Hume, Smith, and Kant among his contemporaries, Rousseau had exerted the most profound influence on modern European intellectual history, “perhaps even surpassing anyone else of his day." For Wokler Émile is “the most significant work on education after Plato’s Republic.” Earlier in 1977, Allan Bloom questioned why Émile had not been the subject of analysis in philosophy relative to the rest of Rousseau‘s work, for “Émile is truly a great book, one that lays out for the first time and with the greatest clarity and vitality the modern way of posing the problems of psychology.” Bloom also saw Émile as “one of those rare total or synoptic books... a book comparable to Plato’s Republic, which it is meant to rival or supersede” and argued that Rousseau himself was at the source of a new tradition: “Whatever else Rousseau may have accomplished, he presented alternatives available to man more comprehensively and profoundly and articulated them in the form which has dominated discussion since his time." Even Peter Gay’s earlier commentary on John Locke and education in 1964 could not escape this central positioning of the text. The significance of Locke’s Some Thoughts on Education is weighed in relation to its impact on Rousseau‘s Émile. For Gay, the latter is “probably the most influential revolutionary tract on education that we have.”

Liberty

In terms of critical discourse, Liberty contributes to the ongoing aesthetic debate on ‘the sublime.’ Philosopher Immanuel Kant (1724–1804) defined the sublime as a failure of rationality in response to sensory overload: a state where the imagination is suspended, without definitive reference points—a state beyond unequivocal ‘knowing.’ I believe the events of September 11, 2001 eluded our understanding in much the same way, leaving us in a moment of suspension between awe and horror. It was an event that couldn’t be understood in terms of scope or scale. It was a moment of overload, which is so difficult to capture in art. With my work I attempt to rekindle that moment of suspension. Like the events of 9/11, Liberty defies definition. Its form is constantly changing; it is always presenting us with new layers of meaning. Nobody quite had a handle on the events that followed 9/11, because the implications were constantly shifting. In the same way, Liberty cannot be contained or defined at any moment in time. Like the events of 9/11, the full story cannot be told in a snapshot. One of the dictionary definitions for the word ‘sublime’ is the conversion of ‘a solid substance directly into a gas, without there being an intermediate liquid phase’. With this in mind, I would like to present Liberty as a work that is literally ‘sublime.’ But what’s really interesting to me about Liberty is that it presents the sublime on all levels: in its medium, in its subject matter (that moment of suspension), and in its formal (formless) presentation. On every level Liberty is sublime—subverting all tangible reference points and eluding capture entirely. Liberty is based on the Statue of Liberty in New York. However, unlike that statue which has stood in New York since 1886 and can be reasonably expected to stand for millennia, this work takes on diminishing proportions, carved as it is in carbon dioxide, a mysterious, previously unexplored medium—one which smokes, snows and dramatically vanishes into a harmless gas. Like the material this work is carved from, the civil liberties of the free world are diminishing fast, since 9/11 and before. This was my thought when I first conceived this work. Now it’s become evident that Liberty expresses a lot more than just this: it demonstrates the erosion of civil liberties, yes. However, it also presents the intangible, indefinable moments in the days and months that followed 9/11. The sculptural work will last for only a short time, and thereafter will exist only in documentation. During this time, the form is continually changing and self-refining, until it disappears entirely, to be inhaled, metabolised and literally taken to heart by viewers.

The global burden of injury: Incidence, mortality, disability-adjusted life years and time trends from the Global Burden of Disease study 2013

Background The Global Burden of Diseases (GBD), Injuries, and Risk Factors study used the disability-adjusted life year (DALY) to quantify the burden of diseases, injuries, and risk factors. This paper provides an overview of injury estimates from the 2013 update of GBD, with detailed information on incidence, mortality, DALYs and rates of change from 1990 to 2013 for 26 causes of injury, globally, by region and by country. Methods Injury mortality was estimated using the extensive GBD mortality database, corrections for ill-defined cause of death and the cause of death ensemble modelling tool. Morbidity estimation was based on inpatient and outpatient data sets, 26 cause-of-injury and 47 nature-of-injury categories, and seven follow-up studies with patient-reported long-term outcome measures. Results In 2013, 973 million (uncertainty interval (UI) 942 to 993) people sustained injuries that warranted some type of healthcare and 4.8 million (UI 4.5 to 5.1) people died from injuries. Between 1990 and 2013 the global age-standardised injury DALY rate decreased by 31% (UI 26% to 35%). The rate of decline in DALY rates was significant for 22 cause-of-injury categories, including all the major injuries. Conclusions Injuries continue to be an important cause of morbidity and mortality in the developed and developing world. The decline in rates for almost all injuries is so prominent that it warrants a general statement that the world is becoming a safer place to live in. However, the patterns vary widely by cause, age, sex, region and time and there are still large improvements that need to be made.

Modelling Cued-Target Recall using Quantum Inspired Models of Target Activation

This article presents and evaluates Quantum Inspired models of Target Activation using Cued-Target Recall Memory Modelling over multiple sources of Free Association data. Two components were evaluated: Whether Quantum Inspired models of Target Activation would provide a better framework than their classical psychological counterparts and how robust these models are across the different sources of Free Association data. In previous work, a formal model of cued-target recall did not exist and as such Target Activation was unable to be assessed directly. Further to that, the data source used was suspected of suffering from temporal and geographical bias. As a consequence, Target Activation was measured against cued-target recall data as an approximation of performance. Since then, a formal model of cued-target recall (PIER3) has been developed [10] with alternative sources of data also becoming available. This allowed us to directly model target activation in cued-target recall with human cued-target recall pairs and use multiply sources of Free Association Data. Featural Characteristics known to be important to Target Activation were measured for each of the data sources to identify any major differences that may explain variations in performance for each of the models. Each of the activation models were used in the PIER3 memory model for each of the data sources and was benchmarked against cued-target recall pairs provided by the University of South Florida (USF). Two methods where used to evaluate performance. The first involved measuring the divergence between the sets of results using the Kullback Leibler (KL) divergence with the second utilizing a previous statistical analysis of the errors [9]. Of the three sources of data, two were sourced from human subjects being the USF Free Association Norms and the University of Leuven (UL) Free Association Networks. The third was sourced from a new method put forward by Galea and Bruza, 2015 in which pseudo Free Association Networks (Corpus Based Association Networks - CANs) are built using co-occurrence statistics on large text corpus. It was found that the Quantum Inspired Models of Target Activation not only outperformed the classical psychological model but was more robust across a variety of data sources.