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.

William James, Sciences of Mind, and Anti-imperial Discourse

In the past few decades, the humanities and social sciences have developed new methods of reorienting their conceptual frameworks in a “world without frontiers.” In this book, Bernadette M. Baker offers an innovative approach to rethinking sciences of mind as they formed at the turn of the twentieth century, via the concerns that have emerged at the turn of the twenty-first. The less-visited texts of Harvard philosopher and psychologist William James provide a window into contemporary debates over principles of toleration, anti-imperial discourse, and the nature of ethics. Baker revisits Jamesian approaches to the formation of scientific objects including the child mind, exceptional mental states, and the ghost to explore the possibilities and limits of social scientific thought dedicated to mind development and discipline formation around the construct of the West.

Stenotaphrum secundatum, Buffalo Grass 'Sir James'

Spontaneous mutation: discovered in February 2001 as a superior plant growing among “Common” buffalo grass growing on the breeder’s property at Saltash in the Hunter Valley (NSW). The selected material has smaller (finer) leaves and showed better growth and colour than the parent variety with minimal inputs (water, fertiliser) under stressful climatic conditions. Subsequently, it also showed better leaf colour retention than the parent variety during winter. A vegetative plug taken from the original plant has now undergone four subsequent vegetative divisions to expand the original material for performance trials in NSW and Queensland without showing any discernible off types. Main selection criteria: winter colour retention, small leaves, low fertiliser requirement. Propagation: vegetative. Breeder: Brent Redman, Maitland North, NSW. PBR Certificate Number 2715, Application Number 2002/283, granted 18 March 2005.

Portrait of Ralph and Joan Grahme with Ralph's sister Ilse Schuster nee Gottschalk and her husband James at restaurant "Old Vienna"; London, England.

Left to right: Ralph Grahme, Joan Grahme, Ilse Schuster nee Gottschalk, and James Schuster;

Portrait of Ralph and Joan Grahme with Ralph's sister Ilse Schuster nee Gottschalk and her husband James at restaurant "Old Vienna"; London, England.

Left to right: Ralph Grahme, Joan Grahme, Ilse Schuster nee Gottschalk, and James Schuster;

Uriah P. Levy collection undated, 1787-1948, 1959, 1961, 1985, 2005.

Contains the notebook and correspondence of Abram Kanof relating to the naval career and activities of Uriah P. Levy; the correspondence, memoranda, newspaper clippings, and a manuscript paper of Isaac Markens pertaining to the alleged claim that Levy was instrumental in abolishing flogging in the Navy; personal documents including a letter to Captain E.A.F. Lavalette concerning the behavior of officers under Levy's command as commodore of the Mediterranean fleet (1859), a photostatic copy of his will and the inventory of his estate (1862), and published material by and about Uriah Phillips Levy including a bound typewritten copy of "Record of Naval Court of Inquiry, 1857;" An essay on flogging in the Navy, 1849; Memorial of Uriah P. Levy, ... 1855; an original copy of a Manual of rules for men-of-war by Captain U.P. Levy, 1862; and Monticello and its preservation, since Jefferson's death, 1862-1902, by George Alfred Townsend. Also contains the halitza of Virginia Lopez Levy, widow of Uriah P. Levy, 1866, signed by J.J. Lyons; copies of letters of Michael Levy to Henry Deering and Dudley Woolridge, 1787-1788, and a published copy of The defense of Captain Jonas P. Levy. Gift, in part, of the Elsie O. and Philip D. Sang Foundation, 1979 and of Herman Herst, Jr., 1987.

Aaron Lopez papers, undated, 1752-1794, 1846, 1852, 1953.

Contains approximately 6800 manuscripts arranged chronologically by year for years 1752-1794. Approximately 100 are letters received or written by Lopez, his partner and father-in-law, Jacob Rodriguez Rivera, members of his family and company, and commercial agents pertaining to business activities and sailing orders for the captains of various ships. Several also refer to personal matters and acquaintances, including a series of six letters from Silas Cooke of White Hall (Middletown), R.I., to Aaron Lopez, asking his aid in returning a run-away slave (1776). The great majority of the collection consists of account records, bills of sale, orders, shipping agreements, lists of sailors on the various ships, repair records and cargo invoices. Of particular interest are a receipt for payment of a half-year's subscription to the "tzedakah" of Congregation Nefutzei Israel, Newport (1755) and several documents that reveal Lopez as a supplier of kosher meat and other religious articles to people in various parts of the colonies, Surinam, and Jamaica. Also included in this group are copies of sailing lists, documents pertaining to Lopez's naturalization which shed light upon the status of a Jew applying for citizenship in Massachusetts and a check to Lopez from the United States government for a loan made during the Revolutionary War (1779).

Letter to trustees of K.K.S.I. from James Foster, regarding his desire to become a Jew

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Kutsu kuuliaisuuteen : James I. Packerin liittonomistinen raamattukäsitys

This dissertation examines James I. Packer s view of the Bible as the book of God s revelation. However, this study could not be complete without discussion of his background ideas about God, man and the foundations of theology. The research method used in this dissertation is systematic analysis. I analyse key theological concepts in the data, such as inerrancy, God s word and the covenant of grace, and examine Packer s concepts primarily in the context of the reformed tradition that he represents. Although the dissertation presents the philosophical premises of Packer s thought, the focus is on an analysis of theological concepts. Packer claims to approach theological issues broadly and to reject legalism. However, he also considers Calvinist thinking to be best suited to theological work and emphasises the central role of law in his view of the Bible. My dissertation pays particular attention to the status of law in Packer s theology and especially in the covenant of grace. The dissertation shows that the fundamental theological structure of Packer s view of the Bible is based on Puritan covenant theology, which consists of the temporally successive covenant of works and covenant of grace. Covenant theology stresses the connection and friendship between God and man. Man s highest goal according to the Westminster Confession of Faith (1647) is to glorify the triune God and to rejoice in him for all eternity. After the fall of man, this friendship between God and man can only take place in the covenant of grace. For Packer, the covenant of grace encompasses not only the time of the Gospel, but also the time of the law before the Gospel. Consequently, the covenant of grace incorporates in its very essence the demand of obedience to God s law. Covenant theology forms the foundation for both his view of the Bible and his idea that a believer lives in a covenant of grace, the key aspects of which are God s commandments and man s works. Law and the Gospel are not considered fundamental opposites in the covenant of grace, unlike in justification. In the covenant of grace, man has become God s friend who obeys the law as the law of Christ in a way which differs from Luther s view of obedience to the faith . For Packer, covenant theology is a Puritan instrument to link predestination and sanctification. Works committed in obedience show that the believer belongs to the covenant of grace and will be among the saved. Although voluntary obedience to God s commandments is not a direct instrument to achieve salvation, it is a pivotal sign of predestination. God calls the predestined to salvation with an effectual calling, the reliable message of the Bible. In sanctification, God guides a believer living in the context of covenantal nomism. In that sense, the Bible is above all an instrument of law guided by reason. In man s obedience, God completes man s nature and restores the imago Dei in man.

Comments on: "The role of the social environment in psychiatric research: Outstanding challenges and future directions by Dana March, James Kirkbride, Wim Veling"

On 17 March 2009, we hosted a live discussion of fresh new ideas in the epidemiology of schizophrenia. Discussion leaders Dana March of Columbia University, James Kirkbride of the University of Cambridge, and Wim Veling of Parnassia Psychiatric Institute delivered a wide-ranging discussion of social factors such as migration, ethnicity, and urbanicity, but also asked how this research could benefit from genetic insights. Finally, they discussed possible biological mechanisms that might transduce social factors into psychosis

Clathrin-independent carriers form a high capacity endocytic sorting system at the leading edge of migrating cells

Although the importance of clathrin- and caveolin-independent endocytic pathways has recently emerged, key aspects of these routes remain unknown. Using quantitative ultrastructural approaches, we show that clathrin-independent carriers (CLICs) account for approximately three times the volume internalized by the clathrin-mediated endocytic pathway, forming the major pathway involved in uptake of fluid and bulk membrane in fibroblasts. Electron tomographic analysis of the 3D morphology of the earliest carriers shows that they are multidomain organelles that form a complex sorting station as they mature. Proteomic analysis provides direct links between CLICs, cellular adhesion turnover, and migration. Consistent with this, CLIC-mediated endocytosis of key cargo proteins, CD44 and Thy-1, is polarized at the leading edge of migrating fibroblasts, while transient ablation of CLICs impairs their ability to migrate. These studies provide the first quantitative ultrastructural analysis and molecular characterization of the major endocytic pathway in fibroblasts, a pathway that provides rapid membrane turnover at the leading edge of migrating cells.