Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013

Background: Up-to-date evidence on levels and trends for age-sex-specific all-cause and cause-specific mortality is essential for the formation of global, regional, and national health policies. In the Global Burden of Disease Study 2013 (GBD 2013) we estimated yearly deaths for 188 countries between 1990, and 2013. We used the results to assess whether there is epidemiological convergence across countries. Methods We estimated age-sex-specific all-cause mortality using the GBD 2010 methods with some refinements to improve accuracy applied to an updated database of vital registration, survey, and census data. We generally estimated cause of death as in the GBD 2010. Key improvements included the addition of more recent vital registration data for 72 countries, an updated verbal autopsy literature review, two new and detailed data systems for China, and more detail for Mexico, UK, Turkey, and Russia. We improved statistical models for garbage code redistribution. We used six different modelling strategies across the 240 causes; cause of death ensemble modelling (CODEm) was the dominant strategy for causes with sufficient information. Trends for Alzheimer's disease and other dementias were informed by meta-regression of prevalence studies. For pathogen-specific causes of diarrhoea and lower respiratory infections we used a counterfactual approach. We computed two measures of convergence (inequality) across countries: the average relative difference across all pairs of countries (Gini coefficient) and the average absolute difference across countries. To summarise broad findings, we used multiple decrement life-tables to decompose probabilities of death from birth to exact age 15 years, from exact age 15 years to exact age 50 years, and from exact age 50 years to exact age 75 years, and life expectancy at birth into major causes. For all quantities reported, we computed 95% uncertainty intervals (UIs). We constrained cause-specific fractions within each age-sex-country-year group to sum to all-cause mortality based on draws from the uncertainty distributions. Findings Global life expectancy for both sexes increased from 65·3 years (UI 65·0-65·6) in 1990, to 71·5 years (UI 71·0-71·9) in 2013, while the number of deaths increased from 47·5 million (UI 46·8-48·2) to 54·9 million (UI 53·6-56·3) over the same interval. Global progress masked variation by age and sex: for children, average absolute differences between countries decreased but relative differences increased.For women aged 25-39 years and older than 75 years and for men aged 20-49 years and 65 years and older, both absolute and relative differences increased. Decomposition of global and regional life expectancy showed the prominent role of reductions in age-standardised death rates for cardiovascular diseases and cancers in high-income regions, and reductions in child deaths from diarrhoea, lower respiratory infections, and neonatal causes in low-income regions. HIV/AIDS reduced life expectancy in southern sub-Saharan Africa. For most communicable causes of death both numbers of deaths and age-standardised death rates fell whereas for most non-communicable causes, demographic shifts have increased numbers of deaths but decreased age-standardised death rates. Global deaths from injury increased by 10·7%, from 4·3 million deaths in 1990 to 4·8 million in 2013; but age-standardised rates declined over the same period by 21%. For some causes of more than 100 000 deaths per year in 2013, age-standardised death rates increased between 1990 and 2013, including HIV/AIDS, pancreatic cancer, atrial fibrillation and flutter, drug use disorders, diabetes, chronic kidney disease, and sickle-cell anaemias. Diarrhoeal diseases, lower respiratory infections, neonatal causes, and malaria are still in the top five causes of death in children younger than 5 years. The most important pathogens are rotavirus for diarrhoea and pneumococcus for lower respiratory infections. Country-specific probabilities of death over three phases of life were substantially varied between and within regions. Interpretation For most countries, the general pattern of reductions in age-sex specific mortality has been associated with a progressive shift towards a larger share of the remaining deaths caused by non-communicable disease and injuries. Assessing epidemiological convergence across countries depends on whether an absolute or relative measure of inequality is used. Nevertheless, age-standardised death rates for seven substantial causes are increasing, suggesting the potential for reversals in some countries. Important gaps exist in the empirical data for cause of death estimates for some countries; for example, no national data for India are available for the past decade.

Assuaging death anxiety in older overseas-born Australians of culturally and linguistically diverse backgrounds hospitalised for end-of-life care

BACKGROUND: Death anxiety is a known phenomenon in older people of culturally and linguistically diverse backgrounds (CALD) hospitalised for end-of-life (EOL) care . Little is known about how nurses assuage death anxiety in this population. AIMS: To investigate strategies used by nurses to assuage death anxiety and facilitate a good death in older CALD Australians hospitalised for EOL care.

METHODS: Advanced as a qualitative descriptive inquiry, a purposeful sample of 22 nurses was recruited from four Victorian healthcare services. Interviews were transcribed verbatim and analysed using thematic analysis processes.

FINDINGS: Nurses used three key strategies: recognising death anxiety; delineating its dimensions; and initiating conventional nursingcaring behaviours to help contain it. Contrary to expectations, cultural similarities rather than differences were found in the strategies used.

CONCLUSIONS: Nursing strategies for recognising, delineating, and managing death anxiety in older CALD people hospitalised at the EOL is an important component of quality EOL care.

Generational and cultural indicators of technology and innovation in family business

The internet revolution has affected everybody in some way. Technologies used in business range from telephones to industry-specific machinery. Mostly though, business technology has come to mean the internet. In literature concerning innovation and the adoption of technology in business, research invariably centres on small to medium businesses (SI'v1Es), as these can be defined reasonably easily. Statistics on family businesses are limited, however, because family businesses are so difficult to categorize and define.

The Australian Family Business Survey of 1993 (Institute of Chartered Accountants) determined that family business is the largest form of business ownership in Australia and represents 83% of all business enterprises, although Basu (2004) believes that over two thirds of all world-wide businesses are owned or managed by families and around half of all businesses in Australia are family businesses. The Australian Institute of Management (AIM) (2004) states that the wealth of family and private businesses is estimated at $3.6 trillion and that family firms generate 50 per cent of Australia's employment growth, account for 40 per cent of Australia's private sector output, and are a seed bed for innovation and the information of large companies.

The difficulty in defining a family business is heightened because family businesses can take many forms ranging from sole traders to private companies to public companies. Hence, when talking about family business, you could be referring to the sole trader dealing with organic produce to an IT organisation employing hundreds of staff. Basu (2004) thinks that while ordinarily, in non-family businesses, the business and family domains remain separate, the key distinctive characteristic of family businesses is that family members work together for economic purposes. In other words, the family is not merely a social unit but also an economic unit. Craig and Lindsay (2002) believe that family involvement in the business is what makes the family business different... researchers, however, cannot seem to agree as to what constitutes 'family involvement' in a business so that it can be defined as a family business and that family business is ... a business that is governed and/or managed with the intention to shape and pursue the vision of the business held by a dominant coalition that is controlled by members of the same family or a small number of families in a manner that is potentially sustainable across generations of the family or families.

McCoy and Clarke : their dispute over the age of Australia's black coal

From 1847 until his death in 1899, Professor Frederick McCoy, palaeontologist in Melbourne, maintained a war of words in the scientific literature with Rev. William Clarke, geologist in Sydney, concerning the age of Australia’s black coal deposits. McCoy was convinced that the coals were all of Mesozoic age and Clarke, during the period from 1847 to his death in 1878, maintained equally vehemently that they were Palaeozoic. In fact, Clarke was correct in placing the New South Wales coals in the Palaeozoic, and McCoy’s placing of the Victorian coals in the Mesozoic was also correct. The two men were both particularly stubborn and neither would admit that they might have been arguing about coals of differing ages. Both stood unbendingly by their Northern Hemisphere, European backgrounds, and neither would change their views in the face of new evidence from the Colonies.

Entrepreneurship, marketing and leadership in non-profit performing arts organisations

This paper argues that the entrepreneurial leader in non-profit PAOs has received too little attention in literature pertaining to these organisations. This criticism also applies to museums. The paper explores how leaders in non-profit performing arts organisations balance the interests of the various funding sources and market opportunities to service their revenue requirements. It reviews a tension in non-profit performing arts organisations: the relationship between limited funding and the subsequent need to act entrepreneurially and innovatively among the various funding sources. Using longitudinal analysis of annual reports, the paper uncovers interplay essential to entrepreneurship. Hence, strategies and tensions are highlighted that non-profit leaders have used. Comparisons are made with non-profit art museums which previous research has shown have the same funding tensions.

Why invest in a national public health program for stroke? An example using Australian data to estimate the potential benefits and cost implications

Objectives: Stroke is the world’s second leading cause of death in people aged over 60 years. Approximately 50,000 strokes occur annually in Australia with numbers predicted to increase by about one third over 10-years. Our objectives were to assess the economic implications of a public health program for stroke by: (1) predicting what potential health-gains and cost-offsets could be achieved; and (2) determining the net level of annual investment that would offer value-for-money.

Methods: Lifetime costs and outcomes were calculated for additional cases that would benefit if ‘current practice’ was feasibly improved, estimated for one indicative year using: (i) local epidemiological data, coverage rates and costs; and (ii) pooled effect sizes from systematic reviews.

Interventions: blood pressure lowering; warfarin for atrial fibrillation; increased access to stroke units; intravenous thrombolysis and aspirin for ischemic events; and carotid endarterectomy. Value-for-money threshold: AUD$30,000/DALY recovered.

Results: Improved, prevention and management could prevent about 27,000 (38%) strokes in 2015. In present terms (2004), about 85,000 DALYs and AUD$1.06 billion in lifetime cost-offsets could be recovered. The net level of annual warranted investment was AUD$3.63 billion.

Conclusions: Primary prevention, in particular blood pressure lowering, was most effective. A public health program for stroke
is warranted

A cross-continental examination and comparison of descriptive criteria in marketing journals-AMJ, EJM and JM

The objective is to perform a cross-continental examination and comparison of non-traditional descriptive criteria in a selection of leading academic journals in marketing. The sample of journals is restricted to the examination and comparison of three academic journals in marketing. The journal sample consists of the Australasian Marketing Journal (AMJ), the European Journal of Marketing (EJM) and the Journal of Marketing (JM). Empirical research manuscripts dominate in the selected marketing journals. In addition, in the selected journals regular issues dominate in favour of special issues. The descriptive criteria examined and compared in AMJ, EJM and JM are based upon the content analysis of 811 manuscripts published during a six-year period, namely 2000-2005. Manuscripts of types other than empirical research, such as general reviews, literature reviews, conceptual papers, commentaries and book reviews are less likely to get published. Special issues or special sections are less frequent in these journals. This may lead to the situation that specialized journals in sub-areas of marketing may provide better and more comprehensive leading edge coverage and knowledge. The insights provided are in particular valuable for those scholars that do not usually get involved in academic publishing and consequently have a limited understanding and experience of the publication arena of manuscripts in leading academic journals. These insights also will be informative for more experienced academic publishers as they highlight certain characteristics of these journals that enlighten one as to the journals that one should target for publication and the difficulty, just on a numbers basis alone, of getting published in one of these three journals. The principal contribution of this research is the examination and comparison of descriptive criteria in AMJ, EJM and JM – a cross-continental sample of journals and criteria that have not been explored or reported previously in literature.

Effects of Salvia miltiorrhiza after acute myocardial infarction in rats

Acute myocardial infarction (M!) is the commonest cause of death in the developed countries, and it is on the rise in developing countries. Ramipril is a well-knownAngiotensin-converting enzyme (ACE) inhibitorwhich inhibits conversion ofinactive angiotensin I to active angiotensin II. Experimental studies have shown thatACE inhibitors administered chronicallybefore acuteMImight limitmyocardial infarct size, improve cardiac function and prevent cardiac hypertrophy [1, 2]. The Chinese herb, Salvia miltiorrhiza (SM), has been widely and successfully usedmainly for anginapectoris,MI and stroke [3]. Compared to ramipril, however, there is very limited biochemical information availableto demonstrate themechanismsofSMs
cardio-protective effects. This study thus investigates the possible
biochemical and molecularmechanisms ofsuch effects ofSMin Wistar rats in comparison with those oframipril.

Injury profiles of Indigenous and non-Indigenous people in New South Wales

Objectives:
To compare the injury profiles of the Indigenous population in New South Wales with that of the non-Indigenous population.
Design and setting:
Descriptive analysis of NSW Health data obtained from the Health Outcomes Information and Statistical Toolkit (HOIST) database. Hospitalisation data were collected for the period 1 July 1999 to 30 June 2003. Mortality data were collected for the period 1 January 1999 to 31 December 2002.
Main outcome measures:
Hospitalisation and death rates due to injury by age, sex, injury mechanism and Indigenous status. Rate ratios for comparison between Indigenous and non-Indigenous populations.
Results:
Rates of death from injury were higher for all age groups in the Indigenous population, except people older than 65 years. Indigenous people aged 25–44 years were twice as likely to be hospitalised as their non-Indigenous counterparts (rate ratio [RR], 2.09; 95% CI, 2.03–2.14), and five times as likely to be hospitalised for interpersonal violence (RR, 5.19; 95% CI, 4.98–5.40).
Conclusion:
The higher rates of injury-related hospitalisation and death in the Indigenous population in NSW are consistent with data reported for other parts of Australia. Of particular concern is the number of Indigenous deaths and hospitalisations due to interpersonal violence.

U18666A-mediated apoptosis in cultured murine cortical neurons : role of caspases, calpains and kinases

Studies have suggested that cholesterol imbalance in the brain might be related to the development of neurological disorders such as Alzheimer's disease and Niemann–Pick disease type C. Previously, we have reported that U18666A, a cholesterol transport-inhibiting agent, leads to apoptosis and intracellular cholesterol accumulation in primary cortical neurons. In this study, we examined the effects of U18666A-mediated neuronal apoptosis, and found that chronic exposure to U18666A led to the activation of caspases and calpains and hyperphosphorylation of tau. Tau hyperphosphorylation is regulated by several kinases that phosphorylate specific sites of tau in vitro. Surprisingly, the kinase activity of cyclin-dependent kinase 5 decreased in U18666A-treated cortical neurons whereas its protein level remained unchanged. The amount of glycogen synthase kinase 3 and mitogen-activated protein kinases were found to decrease in their phosphorylated states by Western blot analysis. Gene transcription was further studied using microarray analysis. Genes encoding for kinases and phosphatases were differentially expressed with most up-regulated and some down-regulated in expression upon U18666A treatment. The activation of cysteine proteases and cholesterol accumulation with tauopathies may provide clues to the cellular mechanism of the inhibition of cholesterol transport-mediated cell death in neurodegenerative diseases.

A randomized trial of protocol-directed sedation management for mechanical ventilation in an Australian intensive care unit

Objective: To compare protocol-directed sedation management with traditional non-protocol-directed practice in mechanically ventilated patients. Design: Randomized, controlled trial. Setting: General intensive care unit (24 beds) in an Australian metropolitan teaching hospital. Patients: Adult, mechanically ventilated patients (n = 312). Interventions: Patients were randomly assigned to receive sedation directed by formal guidelines (protocol group, n = 153) or usual local clinical practice (control, n = 159). Measurements and Main Results: The median (95% confidence interval) duration of ventilation was 79 hrs (56-93 hrs) for patients in the protocol group compared with 58 hrs (44-78 hrs) for patients who received control care (p = .20). Lengths of stay (median [range]) in the intensive care unit (94 [2-1106] hrs vs. 88 (14-962) hrs, p = .58) and hospital (13 [1-113] days vs. 13 (1-365) days, p = .97) were similar, as were the proportions of subjects receiving a tracheostomy (17% vs. 15%, p = .64) or undergoing unplanned self-extubation (1.3% vs. 0.6%, p = .61). Death in the intensive care unit occurred in 32 (21%) patients in the protocol group and 32 (20%) control subjects (p = .89), with a similar overall proportion of deaths in hospital (25% vs. 22%, p = .51). A Cox proportional hazards model, after adjustment for age, gender, Acute Physiology and Chronic Health Evaluation II score, diagnostic category, and doses of commonly used drugs, estimated that protocol sedation management was associated with a 22% decrease (95% confidence interval 40% decrease to 2% increase, p = .07) in the occurrence of successful weaning from mechanical ventilation. Conclusions: This randomized trial provided no evidence of a substantial reduction in the duration of mechanical ventilation or length of stay, in either the intensive care unit or the hospital, with the use of protocol-directed sedation compared with usual local management. Qualified high-intensity nurse staffing and routine Australian intensive care unit nursing responsibility for many aspects of ventilatory practice may explain the contrast between these findings and some recent North American studies. (C) 2008 Lippincott Williams & Wilkins, Inc.

A politics of the Dreamtime : destructive and regenerative rainbows in Alexis Wright's Carpentaria

A literary criticism of the book "Carpentaria," by Alexis Wright is presented. It discusses the representation of indigenous knowledge in the novel. It outlines the characters and explores the symbolic significance of these characters. It examines the themes of the novel, including the dreamtime mythology as an alternative form of scientific discourse. An overview of the story of the novel is also given.

Beyond God the father : the metaphysical in a physical world

[No Abstract]

Commonsense, manners, guts' : 'manliness' in the English school story 1887-1917

[No Abstract]