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.

East Timor in 2008 : year of reconstruction

The article discusses reconstruction of East Timor in 2008 after the near-fatal shooting of President Jose Ramos-Horta and the death of his rival Major Alfredo Reinado. It notes near state collapse following the desertion of soldiers in 2006 and returning displaced persons to their homes in the aftermath.<br />

Learning from sustainable landscapes of death in Bali : landscape planning and Tri Hita Karana

Landscape planning in many countries is predicated upon on fulfilling the functions for human living objectives. Many land use practices have been plotted for living, busines~, trading, industrial, farming as well as providing places for dead people primarily through cemeteries. Research in Palm Beach County, FL, has demonstrated the need to plan for 30 years of demand of land use functions to service death (Coutts, Basmaj ian et al. 20 I I). Coutts et al assert that planners are required and responsible for the planning of funeral necessities. Therefore, the protection of landscapes of death is an important consideration in the planning of landscapes. Bali is popular with its beautiful landscape, hospitality, and traditional architecture as demonstrating the integrity between human, environment and God, as expressed in the Balinese Tri Hita Karana concept. Balinese commemorate life from birth to death through their traditional ceremonies which informs their traditional cultural landscape. One of the most important landscapes, which cannot be separated fi&middot;om Balinese life are graveyards which are used for deceased ceremonies. This landscape is an integral part of traditional village patterns across Bali. Culturally, Balinese people have their own traditional cremation ceremony which is call the Ngaben Ceremony. The Ceremony takes place in graveyards and thereupon ashes are placed in the sea waters surrounding Bali. An interesting point of planning in Bali is how to enable eco-friendly interment extensions to villages. This is occurring because of the increasing number of corpses that require cremation thus necessitating no accretions in land provision of graveyards. This research investigates the landscape of death in Bali expressed in its traditional values in the area of planning which implicate sustainable environments and land conservation topics. Other functions of graveyards, as noted by Strangstad ( 1988), include ceremonial and their role as educational tools for history lessons, art, sociology, geology, English lessons, as well as for scavenger hunts.

Effect of genotype and sex on fiber growth rate of alpacas for their first year of fleece production

The sale of alpaca fiber is the main income for thousands of families in the Central Andes of Peru. Little information exists on the fiber length growth rate of alpaca (FLG), especially throughout their first year of life when the fiber is most valuable. We aimed to determine the monthly FLG of 22 alpaca offspring of two genotypes (9 Suri, 13 Huacaya) and considering sex differences (10 females, 12 males) in the High Andes of Peru. FLG growth was determined using dye-bands. An additive lineal model with three factors (genotype, sex, month) was used for statistic analysis. To evaluate the effect of genotype and sex on the profile of the FLG throughout the year a two factor repeated-measures model was used. The results showed that FLG was affected by genotype and month but not sex. The Suri genotype had 20% higher FLG than Huacaya genotype alpacas (1.34 vs 1.10 cm/month, P &lt; 0.001). FLG increased over each of the first three months (P &lt; 0.05) and then maintained a near constant rate for the remainder of the first year. The resulting staple length indicates that shearing at ages from 8 to 12 months of age will provide fleeces of sufficient length for textile processing.

Multiple types of dieting prospectively predict weight gain during the freshman year of college.

The freshman year of college is a period of heightened risk for weight gain. This study examined measures of restrained eating, disinhibition, and emotional eating as predictors of weight gain during the freshman year. Using Lowe's multi-factorial model of dieting, it also examined three different types of dieting as predictors of weight gain. Sixty-nine females were assessed at three points during the school year. Weight gain during the freshman year averaged 2.1 kg. None of the traditional self-report measures of restraint, disinhibition, or emotional eating were predictive of weight gain. However, both a history of weight loss dieting and weight suppression (discrepancy between highest weight ever and current weight) predicted greater weight gain, and these effects appeared to be largely independent of one another. Individuals who said they were currently dieting to lose weight gained twice as much (5.0 kg) as former dieters (2.5 kg) and three times as much as never dieters (1.6 kg), but the import of this finding was unclear because there was only a small number of current dieters (N=7). Overall the results indicate that specific subtypes of dieting predicts weight gain during the freshman year better than more global measures of restraint or overeating.<br />

The story of fable : a narrative analysis of the experience of four registered nurses in their first year of practice

This research explores the transition from student to registered nurse from the perspective of the new graduate. This interpretive study uses narrative analysis as the methodology. Individual stories were collected and processed using the method of core story creation and emplotment (Emden 1998). Four newly registered nurses were invited to share stories related to how they were experiencing their role. Participants were encouraged to tell their stories in response to the open question 'what is it like to be a registered nurse?' In the final step of the analysis one honest and critical story has been crafted (Barone 1992) using a process termed emplotment thus disclosing the themes that allow the stories to be grasped together as a single story (Polkinghorne 1988, Emden 1998). The final story of 'Fable' gives insight into the ways in which newly registered nurses experience their role. Becoming a registered nurse is not easy however, Fable finds that nursing is more than just a job and describes many rewarding experiences. It is hoped that the outcomes of this research will be valuable to students, graduates, nurse academics and the profession of nursing generally by enhancing understandings of the relationship between the graduate and the actual employment experience.

The work of death in Brontë's and Dickinson's poetry

Death determines distinctly different, almost inverse, responses and outcomes for Emily Dickinson and Emily Brontë. Death is an imaginative poetic solution for Dickinson, demonstrating her belief that art is the only way to transcend death. But death is the ultimate solution for Brontë, for whom freedom of the imagination leads to mystical unity and continuity.

Multifaceted role of nitric oxide in an in vitro mouse neuronal injury model: transcriptomic profiling defines the temporal recruitment of death signalling cascades

Nitric oxide is implicated in the pathogenesis of various neuropathologies characterized by oxidative stress. Although nitric oxide has been reported to be involved in the exacerbation of oxidative stress observed in several neuropathologies, existent data fail to provide a holistic description of how nitrergic pathobiology elicits neuronal injury. Here we provide a comprehensive description of mechanisms contributing to nitric oxide induced neuronal injury by global transcriptomic profiling. Microarray analyses were undertaken on RNA from murine primary cortical neurons treated with the nitric oxide generator DETA-NONOate (NOC-18, 0.5 mM) for 8&ndash;24 hrs. Biological pathway analysis focused upon 3672 gene probes which demonstrated at least a &plusmn;1.5-fold expression in a minimum of one out of three time-points and passed statistical analysis (one-way anova,&ensp;<i>P&ensp;&lt; </i>0.05). Numerous enriched processes potentially determining nitric oxide mediated neuronal injury were identified from the transcriptomic profile: cell death, developmental growth and survival, cell cycle, calcium ion homeostasis, endoplasmic reticulum stress, oxidative stress, mitochondrial homeostasis, ubiquitin-mediated proteolysis, and GSH and nitric oxide metabolism. Our detailed time-course study of nitric oxide induced neuronal injury allowed us to provide the first time a holistic description of the temporal sequence of cellular events contributing to nitrergic injury. These data form a foundation for the development of screening platforms and define targets for intervention in nitric oxide neuropathologies where nitric oxide mediated injury is causative.<br />