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.

The measurement of intraocular pressure over positive soft contact lenses by rebound tonometry [Medición de la presión intraocular sobre lentes de contacto blandas positivas, mediante tonometría de rebote]

Purpose To investigate if the accuracy of intraocular pressure (IOP) measurements using rebound tonometry over disposable hydrogel (etafilcon A) contact lenses (CL) is affected by the positive power of the CLs. Methods The experimental group comprised 26 subjects, (8 male, 18 female). IOP measurements were undertaken on the subjects’ right eyes in random order using a Rebound Tonometer (ICare). The CLs had powers of +2.00D and +6.00D. Measurements were taken over each contact lens and also before and after the CLs had been worn. Results The IOP measure obtained with both CLs was significantly lower compared to the value without CLs (t test; p<0.001) but no significant difference was found between the two powers of CLs. Conclusions Rebound tonometry over positive hydrogel CLs leads to a certain degree of IOP underestimation. This result didn’t change for the two positive lenses used in the experiment, despite their large difference in power and therefore in lens thickness. Optometrists should bear this in mind when measuring IOP with the rebound tonometer over plus power contact lenses.

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.

Genetic studies of body mass index yield new insights for obesity biology

Obesity is heritable and predisposes to many diseases. To understand the genetic basis of obesity better, here we conduct a genome-wide association study and Metabochip meta-analysis of body mass index (BMI), a measure commonly used to define obesity and assess adiposity, in up to 339,224 individuals. This analysis identifies 97 BMI-associated loci (P < 5 × 10−8), 56 of which are novel. Five loci demonstrate clear evidence of several independent association signals, and many loci have significant effects on other metabolic phenotypes. The 97 loci account for ~2.7% of BMI variation, and genome-wide estimates suggest that common variation accounts for >20% of BMI variation. Pathway analyses provide strong support for a role of the central nervous system in obesity susceptibility and implicate new genes and pathways, including those related to synaptic function, glutamate signalling, insulin secretion/action, energy metabolism, lipid biology and adipogenesis.

Job-related diversity and team performance: An empirical analysis of the US music industry

A significant amount of research has been carried out to investigate the existing bonds between team characteristics and team outcomes in contexts of social creativity. Specifically, how work group diversity affects its performance is of great relevance but unfortunately, there is no clear understanding of the diversity-performance relationship. Therefore, to improve our understanding of this phenomenon, it would be worthwhile to investigate further empirical settings. For this reason, we decided to study the music industry that, to our knowledge, has never been chosen as empirical setting for the application of the theoretical constructs linked to the topic of team diversity and performance. Our research aims at analyze the US music industry to study the relationship between job-related characteristics of team diversity and team performances.

Max James Kohler papers, 1888-1934.

Contains scrapbooks, correspondence and reports relating to Kohler's extensive activities on behalf of liberal immigration and naturalization laws in the United States, his opposition to the registration of aliens, the problems of Chinese immigration to the United States, his opposition to the use of the term "Hebrew Race" in the classification of immigrants, the drafting of minority clauses at the Paris Peace Conference in 1919, Jewish and Christian relations in the U.S., and the condition of Jews in Russia, Roumania, Poland and Nazi-Germany with the following institutions: the American Civil Liberties Union, 1926-1934, the American Jewish Committee, 1909-1934, B'nai Brith, 1930-1933, the Union of American Hebrew Congregations - Board of Delegates on Civil Rights, the Committee on Ellis Island, the Foreign Language Information Service, the Hebrew Benevolent Society of Baltimore, the Hebrew Sheltering and Immigrant Aid Society, the Jewish Immigrants' Information Bureau in Galveston, Texas, the Industrial Removal Office, the National Conference of Jews and Christians, the National Council of Jewish Women, the National Council on Naturalization and Citizenship, the Bureau of Immigration to the United States Department of Laborm the United States Department of Commerce and Labor, the Department of State and individual United States Congressmen.

Directional dominance on stature and cognition in diverse human populations

Homozygosity has long been associated with rare, often devastating, Mendelian disorders1, and Darwin was one of the first to recognize that inbreeding reduces evolutionary fitness2. However, the effect of the more distant parental relatedness that is common in modern human populations is less well understood. Genomic data now allow us to investigate the effects of homozygosity on traits of public health importance by observing contiguous homozygous segments (runs of homozygosity), which are inferred to be homozygous along their complete length. Given the low levels of genome-wide homozygosity prevalent in most human populations, information is required on very large numbers of people to provide sufficient power3, 4. Here we use runs of homozygosity to study 16 health-related quantitative traits in 354,224 individuals from 102 cohorts, and find statistically significant associations between summed runs of homozygosity and four complex traits: height, forced expiratory lung volume in one second, general cognitive ability and educational attainment (P < 1 × 10−300, 2.1 × 10−6, 2.5 × 10−10 and 1.8 × 10−10, respectively). In each case, increased homozygosity was associated with decreased trait value, equivalent to the offspring of first cousins being 1.2 cm shorter and having 10 months’ less education. Similar effect sizes were found across four continental groups and populations with different degrees of genome-wide homozygosity, providing evidence that homozygosity, rather than confounding, directly contributes to phenotypic variance. Contrary to earlier reports in substantially smaller samples5, 6, no evidence was seen of an influence of genome-wide homozygosity on blood pressure and low density lipoprotein cholesterol, or ten other cardio-metabolic traits. Since directional dominance is predicted for traits under directional evolutionary selection7, this study provides evidence that increased stature and cognitive function have been positively selected in human evolution, whereas many important risk factors for late-onset complex diseases may not have been.

Synthesis and Characterization of Carbon Nanotube-Polymer Multilayer Structures

We develop lightweight, multilayer materials composed of alternating layers of poly dimethyl siloxane (PDMS) polymer and vertically aligned carbon nanotube (CNT) arrays, and characterize their mechanical response in compression. The CNT arrays used In the assembly are synthesized with graded mechanical properties along their thickness, and their use enables the creation of multilayer structures with low density (0.12-0.28 g/cm(3)). We test the mechanical response of structures composed of different numbers of CNT layers partially embedded in PDMS polymer, under quasi-static and dynamic loading. The resulting materials exhibit a hierarchical, fibrous structure with unique mechanical properties: They can sustain large compressive deformations (up to similar to 0.8 strain) with a nearly complete recovery and present strain localization in selected sections of the materials. Energy absorption, as determined by the hysteresis observed In stress-strain curves, is found to be at least 3 orders of magnitude larger than that of natural and synthetic cellular materials of comparable density. Conductive bucky paper Is Included within the polymer interlayers. This allows the measurement of resistance variation as a function of applied stress, showing strong correlation with the observed strain localization In compression.

Nonlinear viscoelasticity of freestanding and polymer-anchored vertically aligned carbon nanotube foams

Vertical arrays of carbon nanotubes (VACNTs) show unique mechanical behavior in compression, with a highly nonlinear response similar to that of open cell foams and the ability to recover large deformations. Here, we study the viscoelastic response of both freestanding VACNT arrays and sandwich structures composed of a VACNT array partially embedded between two layers of poly(dimethylsiloxane) (PDMS) and bucky paper. The VACNTs tested are similar to 2 mm thick foams grown via an injection chemical vapor deposition method. Both freestanding and sandwich structures exhibit a time-dependent behavior under compression. A power-law function of time is used to describe the main features observed in creep and stress-relaxation tests. The power-law exponents show nonlinear viscoelastic behavior in which the rate of creep is dependent upon the stress level and the rate of stress relaxation is dependent upon the strain level. The results show a marginal effect of the thin PDMS/bucky paper layers on the viscoelastic responses. At high strain levels (epsilon - 0.8), the peak stress for the anchored CNTs reaches similar to 45 MPa, whereas it is only similar to 15MPa for freestanding CNTs, suggesting a large effect of PDMS on the structural response of the sandwich structures. (C) 2012 American Institute of Physics. http://dx.doi.org/10.1063/1.3699184]

La representación política

Hace ya algún tiempo Pier Luigi Zampetti, Profesor de la Universidad de Trieste, se preguntaba si el sistema representativo habría llegado a su ocaso: “Las instituciones representativas parecían haberse convertido en fórmulas abstractas, incapaces de insertarse en la realidad viva y concreta de la experiencia”. La inquietud del profesor italiano, más allá del acierto en sus propuestas de solución, se origina en la pérdida de prestigio de las llamadas instituciones representativas, la desconfianza respecto de las mismas y la creciente insatisfacción en los electores por la conducta de sus elegidos. El estudio de los problemas suscitados puede ser realizado desde distintos ángulos: uno de ellos es si es posible una auténtica representación política del modo en que fuera modernamente concebida, o si se está solamente ante una trasposición indebida de una figura propia del derecho privado al ámbito del derecho público y el otro ángulo es el de la función que se le asigna al sistema representativo en el orden político...

De magistro : apropiación y transmisión crítica del sentido

Resumen: Desde la identificación de algunos trazos distintivos de la autoconciencia posmoderna prevalente (Vattimo-Rorty), el A. aborda la implicación de ésta en lo que H. Arendt denomina „la crisis de la educación‟, como incapacidad teorizada de transmisión propositivo-crítica de sentido. El A. aborda luego el pasaje de esa crisis, en la que el „yo‟ desaparece, a las condiciones ontológico-gnoseológicas del encuentro del „yo‟ en el vínculo vivo presente-pasado, inherente a la relación educativa como gestación del futuro en el presente. A partir del concepto de „testamento‟ (H. Arendt) y de „tradicionalidad‟ (P. Ricoeur), el A. desarrolla la dialéctica entre reconocimiento y transmisión crítica del sentido. El contenido ético de tal dialéctica de la historicidad concreta, asume y traspasa el concepto de tradicionalidad como transmisión de un discurso cultural, para acceder al concepto de „natalidad‟, en cuanto esclarece el renacimiento del „yo‟ en la relación educativa H.Arendt-Luigi Giussani), ahora entendida como creación de personalidad y de historia, bajo la guía del „principio de realidad‟, constitutivo de la identidad abierta propia de la tradición dramática de Occidente (Rémi Brague).

Doctrina Social de la Iglesia y Teoría Económica : dos enfoques divergentes para un mundo en transformación

Resumen: El artículo tiene por tema central la importancia de la intervención de la Iglesia en asuntos socio-económicos. El autor parte de dos interrogantes: el motivo por el cual se instauró la Doctrina Social de la Iglesia a finales del siglo XIX y no anteriormente, y las razones que condujeron al quiebre entre la Doctrina Social de la Iglesia y la teoría económica dominante. Para dar respuesta a estas cuestiones, Pasinetti se remonta a los inicios del Cristianismo, y realiza un análisis histórico del desarrollo de la teoría económica hasta la proclamación de la encíclica Rerum Novarum en 1891. El autor explica que ese corpus doctrinal surgió como resultado de tres eventos históricos: la Revolución Industrial, el impacto de la obra de Karl Marx, y la falla en formular una teoría económica capaz de resolver los problemas de un mundo nuevo. La Doctrina Social de la Iglesia, entonces, está llamada a superar estas dificultades ya que posee las herramientas necesarias para lograrlo.

Reforma tributária : competitividade, equidade e equilíbrio federativo

A publicação "é produto do ciclo de conferências, realizado pela Comissão de Finanças e Tributação (CFT) da Câmara dos Deputados, em maio de 2011, para debater temas componentes das agendas referentes ao aperfeiçoamento institucional do sistema tributário brasileiro, em especial aos aspectos relacionados à competitividade empresarial, à equidade social e ao equilíbrio federativo vertical e horizontal."

Copia de una carta remitida por el Secretario de Estado de la Santa Sede al obispo Mateo Múgica.

Fecha: 30-3-1939 (>1970 copia) / Unidad de instalación: Carpeta 45 - Expediente 2-6 / Nº de pág.: 1 (mecanografiada)