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.”

Embedding EfS in teacher education through a multi-level systems approach: Lessons from Queensland

This paper reports on the fourth stage of an evolving study to develop a systems model for embedding education for sustainability (EfS) into pre-service teacher education. The fourth stage trialled the extension of the model to a comprehensive state-wide systems approach involving representatives from all eight Queensland teacher education institutions and other key policy agencies and professional associations. Support for trialling the model included regular meetings among the participating representatives and an implementation guide. This paper describes the first three stages of developing and trialling the model before presenting the case study and action research methods employed, four key lessons learned from the project, and the implications of the major outcomes for teacher education policies and practices. The Queensland-wide multi-site case study revealed processes and strategies that can enable institutional change agents to engage productively in building capacity for embedding EfS at the individual, institutional and state levels in pre-service teacher education. Collectively, the project components provide a system-wide framework that offers strategies, examples, insights and resources that can serve as a model for other states and/or territories wishing to implement EfS in a systematic and coherent fashion.

Ajan sisäkkäiset tilat. Arkkitehtuuri, valokuva ja menneisyyden esittäminen W. G. Sebaldin romaanissa Austerlitz

In her thesis, Kaisa Kaakinen analyzes how the German emigrant author W. G. Sebald (1944-2001) uses architecture and photography in his last novel "Austerlitz" to represent time, history and remembering. Sebald describes time in spatial terms: it is like a building, the rooms and chambers of which are connected to each other. The poetics of spatial time manifests itself on multiple levels of the text. Kaakinen traces it in architectural representations, photographic images, intertextuality, as well as in the form of the text, using the concept of spatial form by Joseph Frank. Architectural and photographic representations serve as meeting points for different aspects and angles of the novel and illustrate the idea of a layered present that has multiple connections to the past. The novel tells a story of Jacques Austerlitz, who as a small child was sent from Prague to Britain in one of the so-called Kindertransports that saved children from Central Europe occupied by the National Socialists. Only gradually he remembers his Jewish parents, who have most likely perished in Nazi concentration camps. The novel brings the problematic of writing about another person's past to the fore by the fact that Austerlitz's story is told by an anonymous narrator, Austerlitz's interlocutor, who listens to and writes down Austerlitz's story. Kaakinen devotes the final part of her thesis to study the demands of representing a historical trauma, drawing on authors such as Dominick LaCapra and Michael Rothberg. Through the analysis of architectural and photographic representations in the novel, she demonstrates how Austerlitz highlights the sense of singularity and inaccessibility of memories of an individual, while also stressing the necessity - and therefore a certain kind of possibility - of passing these memories to another person. The coexistence of traumatic narrowness and of the infinity of history is reflected in ambivalent buildings. Some buildings in the novel resemble reversible figures: they can be perceived simultaneously as ruins and as construction sites. Buildings are also shown to be able to both cover and preserve memories - an idea that also is repeated in the use of photography, which tends to both replace memories and cause an experience of the presence of an absent thing. Commenting and critisizing some recent studies on Sebald, the author develops a reading which stresses the ambivalence inherent in Sebald's view on history and historiography. Austerlitz shows the need to recognize the inevitable absence of the past as well as the distance from the experiences of others. Equally important, however, is the refusal to give up narrating the past: Sebald's novel stresses the necessity to preserve the sites of the past, which carry silent traces of vanished life. The poetics of Austerlitz reflects the paradox of the simultaneous impossibility and indispensability of writing history.

Therese Godshaw's nee Molling 70th birthday party at the Krakauer home; Boston Portraits Family

Left to right behind table: John Krakauer, Donald, Michael and Robert Godshaw (Children of Hal and Anne), Grandma Therese Godshaw nee Molling, Julius Pick (Grandfather of Robert, Michael and Donald). In front of table: Wendy and Gerry Godshaw (children of Kurt and Edith.

Outdoor family portrait after the memorial services for Therese Godshaw nee Molling at Hal Godshaws house; Argonne Drive, Kenmore, New York.

Front row from left to right: Robert Godshaw, Wendy Godshaw, Rosel Pick (Anne Godshaw's mother), Debbie Godshaw born Mariner, Hal Godshaaw, Francis Schlosstein; 2nd row from left to right: David Dysert, Mickey Sloan born McMath, Edith Godshaw nee Osterer, baby (probably Gary Godshaw), Anne Godshaw born Pick, Julius Pick (Anne's father), Ursula Schlosstein born Gottschalk, Elizabeth Krakauer nee Gottschalk, Michael Godshaw; back row from left to right: Charles (Karl-Hermann Solomon) Sloan, Gerald Godshaw (partially hidden), unknown (probably Peter Godshaw), Kurt Godshaw, John Krakauer, Donald Godshaw, Tom Krakauer, Ralph Schlosstein, John Schlosstein.

Outdoor family portrait after the memorial services for Therese Godshaw nee Molling at Hal Godshaws house; Argonne Drive, Kenmore, New York.

Front row from left to right: Robert Godshaw, Wendy Godshaw, Rosel Pick (Anne Godshaw's mother), Debbie Godshaw born Mariner, Hal Godshaaw, Francis Schlosstein; 2nd row from left to right: David Dysert, Mickey Sloan born McMath, Edith Godshaw nee Osterer, baby (probably Gary Godshaw), Anne Godshaw born Pick, Julius Pick (Anne's father), Ursula Schlosstein born Gottschalk, Elizabeth Krakauer nee Gottschalk, Michael Godshaw; back row from left to right: Charlie Sloan, Gerald Godshaw (partially hidden), unknown, Kurt Godshaw, John Krakauer, Donald Godshaw, Tom Krakauer, Ralph Schlosstein, John Schlosstein.

Portrait of Elly Goldschmidt and her children Ilse and Robert. Portraits Family

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Ilse and Robert Goldschmidt with their parents Albert Goldschmidt and Elly nee Schoenbeck grandfather Albert Schoenbeck and great grandmother Sophie Schoenbeck nee Mahler. Portraits Family

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Portrait of the engineer and geneologist Robert Goldschmidt Portraits Men

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Hal Godshaw (Gottschalk) with his wife Anne nee Pick Portraits Couples

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Members of the Godshaw (Gottschalk) family, Anne, Donald, Molly, Freddy, Jan and Hal; Hannover, Germany. Portraits Family

The family was in Hannover, Germany, for the dedication of the memorial to the Holocaust, the Mahnmal am Opernplatz; from left to right: Anne Godshaw nee Pick, Donald Godshaw, Molly Godshaw nee Peck, Freddy Godshaw, Jan Godshaw nee McKay, and Hal (Hans Ludwig Gottschalk) Godshaw.

New genetic loci link adipose and insulin biology to body fat distribution

Body fat distribution is a heritable trait and a well-established predictor of adverse metabolic outcomes, independent of overall adiposity. To increase our understanding of the genetic basis of body fat distribution and its molecular links to cardiometabolic traits, here we conduct genome-wide association meta-analyses of traits related to waist and hip circumferences in up to 224,459 individuals. We identify 49 loci (33 new) associated with waist-to-hip ratio adjusted for body mass index (BMI), and an additional 19 loci newly associated with related waist and hip circumference measures (P < 5 × 10−8). In total, 20 of the 49 waist-to-hip ratio adjusted for BMI loci show significant sexual dimorphism, 19 of which display a stronger effect in women. The identified loci were enriched for genes expressed in adipose tissue and for putative regulatory elements in adipocytes. Pathway analyses implicated adipogenesis, angiogenesis, transcriptional regulation and insulin resistance as processes affecting fat distribution, providing insight into potential pathophysiological mechanisms.

Solutions for archiving data in long-term studies: A reply to Whitlock et al.

In our recent paper [1], we discussed some potential undesirable consequences of public data archiving (PDA) with specific reference to long-term studies and proposed solutions to manage these issues. We reaffirm our commitment to data sharing and collaboration, both of which have been common and fruitful practices supported for many decades by researchers involved in long-term studies. We acknowledge the potential benefits of PDA (e.g., [2]), but believe that several potential negative consequences for science have been underestimated [1] (see also 3 and 4). The objective of our recent paper [1] was to define practices to simultaneously maximize the benefits and minimize the potential unwanted consequences of PDA.