The evolution of the Global Burden of Disease framework for disease, injury and risk factor quantification: Developing the evidence base for national, regional and global public health action

Reliable, comparable information about the main causes of disease and injury in populations, and how these are changing, is a critical input for debates about priorities in the health sector. Traditional sources of information about the descriptive epidemiology of diseases, injuries and risk factors are generally incomplete, fragmented and of uncertain reliability and comparability. Lack of a standardized measurement framework to permit comparisons across diseases and injuries, as well as risk factors, and failure to systematically evaluate data quality have impeded comparative analyses of the true public health importance of various conditions and risk factors. As a consequence the impact of major conditions and hazards on population health has been poorly appreciated, often leading to a lack of public health investment. Global disease and risk factor quantification improved dramatically in the early 1990s with the completion of the first Global Burden of Disease Study. For the first time, the comparative importance of over 100 diseases and injuries, and ten major risk factors, for global and regional health status could be assessed using a common metric (Disability-Adjusted Life Years) which simultaneously accounted for both premature mortality and the prevalence, duration and severity of the non-fatal consequences of disease and injury. As a consequence, mental health conditions and injuries, for which non-fatal outcomes are of particular significance, were identified as being among the leading causes of disease/injury burden worldwide, with clear implications for policy, particularly prevention. A major achievement of the Study was the complete global descriptive epidemiology, including incidence, prevalence and mortality, by age, sex and Region, of over 100 diseases and injuries. National applications, further methodological research and an increase in data availability have led to improved national, regional and global estimates for 2000, but substantial uncertainty around the disease burden caused by major conditions, including, HIV, remains. The rapid implementation of cost-effective data collection systems in developing countries is a key priority if global public policy to promote health is to be more effectively informed.

Confirmation: Increasing resource availability for transactional workflows

The notion of compensation is widely used in advanced transaction models as means of recovery from a failure. Similar concepts are adopted for providing transaction-like behaviour for long business processes supported by workflows technology. In general, it is not trivial to design compensating tasks for tasks in the context of a workflow. Actually, a task in a workflow process does not have to be compensatable in the sense that the forcibility of reverse operations of the task is not always guaranteed by the application semantics. In addition, the isolation requirement on data resources may make a task difficult to compensate. In this paper, we first look into the requirements that a compensating task has to satisfy. Then we introduce a new concept called confirmation. With the help of confirmation, we are able to modify most non-compensatable tasks so that they become compensatable. This can substantially increase the availability of shared resources and greatly improve backward recovery for workflow applications in case of failures. To effectively incorporate confirmation and compensation into a workflow management environment, a three level bottom-up workflow design method is introduced. The implementation issues of this design are also discussed. (C) 2003 Elsevier Science Inc. All rights reserved.

Effects of reduction in heroin supply on injecting drug use: analysis of data from needle and syringe programmes

n early 2001 there was a dramatic decline in the availability of heroin in New South Wales (NSW), Australia, where previously heroin had been readily available at a low price and high purity.1 The decline was confirmed by Australia's strategic early warning system, which revealed a reduction in heroin supply across Australia and a considerable increase in price,2 particularly from January to April 2001. This "heroin shortage" provided a natural experiment in which to examine the effect of substantial changes in price and availability on injecting drug use and its associated harms in Australia's largest heroin market,2 a setting in which harm reduction strategies were widely used. Publicly funded needle and syringe programmes were introduced to Australia in 1987, and methadone maintenance programmes, which were established in the 1970s, were significantly expanded in 1985 and again in 1999.

The effect of introducing radiographer reporting on the availability of reports for Accident and Emergency and General Practitioner examinations: a time-series analysis

This study explores whether the introduction of selectively trained radiographers reporting Accident and Emergency (A&E) X-ray examinations or the appendicular skeleton affected the availability of reports for A&E and General Practitioner (GP) examinations at it typical district general hospital. This was achieved by analysing monthly data on A&E and GP examinations for 1993 1997 using structural time-series models. Parameters to capture stochastic seasonal effects and stochastic time trends were included ill the models. The main outcome measures were changes in the number, proportion and timeliness of A&E and GP examinations reported. Radiographer reporting X-ray examinations requested by A&E was associated with it 12% (p = 0.050) increase in the number of A&E examinations reported and it 37% (p

Variation in hydraulic conductivity of mangroves: influence of species, salinity, and nitrogen and phosphorus availability

We investigated how species identity and variation in salinity and nutrient availability influence the hydraulic conductivity of mangroves. Using a fertilization study of two species in Florida, we found that stem hydraulic conductivity expressed on a leaf area basis (K-leaf) was significantly different among species of differing salinity tolerance, but was not significantly altered by enrichment with limiting nutrients. Reviewing data from two additional sites (Panama and Belize), we found an overall pattern of declining leaf-specific hydraulic conductivity (K-leaf) with increasing salinity. Over three sites, a general pattern emerges, indicating that native stem hydraulic conductivity (K-h) and K-leaf are less sensitive to nitrogen (N) fertilization when N limits growth, but more sensitive to phosphorus (P) fertilization when P limits growth. Processes leading to growth enhancement with N fertilization are probably associated with changes in allocation to leaf area and photosynthetic processes, whereas water uptake and transport processes could be more limiting when P limits growth. These findings suggest that whereas salinity and species identity place broad bounds on hydraulic conductivity, the effects of nutrient availability modulate hydraulic conductivity and growth in complex ways.

Constructing internationally comparable real income aggregates by combining sparse benchmark data with annual national accounts data: A state-space approach

The importance of availability of comparable real income aggregates and their components to applied economic research is highlighted by the popularity of the Penn World Tables. Any methodology designed to achieve such a task requires the combination of data from several sources. The first is purchasing power parities (PPP) data available from the International Comparisons Project roughly every five years since the 1970s. The second is national level data on a range of variables that explain the behaviour of the ratio of PPP to market exchange rates. The final source of data is the national accounts publications of different countries which include estimates of gross domestic product and various price deflators. In this paper we present a method to construct a consistent panel of comparable real incomes by specifying the problem in state-space form. We present our completed work as well as briefly indicate our work in progress.

Increased availability and scalability for clustered services via the wait time calculation, trust based filtering and redirection of TCP connection requests

The paper describes two new transport layer (TCP) options and an expanded transport layer queuing strategy that facilitate three functions that are fundamental to the dispatching-based clustered service. A transport layer option has been developed to facilitate. the use of client wait time data within the service request processing of the cluster. A second transport layer option has been developed to facilitate the redirection of service requests by the cluster dispatcher to the cluster processing member. An expanded transport layer service request queuing strategy facilitates the trust based filtering of incoming service requests so that a graceful degradation of service delivery may be achieved during periods of overload - most dramatically evidenced by distributed denial of service attacks against the clustered service. We describe how these new options and queues have been implemented and successfully tested within the transport layer of the Linux kernel.