Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990–2010 : a systematic analysis for the Global Burden of Disease Study 2010

Background Non-fatal health outcomes from diseases and injuries are a crucial consideration in the promotion and monitoring of individual and population health. The Global Burden of Disease (GBD) studies done in 1990 and 2000 have been the only studies to quantify non-fatal health outcomes across an exhaustive set of disorders at the global and regional level. Neither effort quantified uncertainty in prevalence or years lived with disability (YLDs). Methods Of the 291 diseases and injuries in the GBD cause list, 289 cause disability. For 1160 sequelae of the 289 diseases and injuries, we undertook a systematic analysis of prevalence, incidence, remission, duration, and excess mortality. Sources included published studies, case notification, population-based cancer registries, other disease registries, antenatal clinic serosurveillance, hospital discharge data, ambulatory care data, household surveys, other surveys, and cohort studies. For most sequelae, we used a Bayesian meta-regression method, DisMod-MR, designed to address key limitations in descriptive epidemiological data, including missing data, inconsistency, and large methodological variation between data sources. For some disorders, we used natural history models, geospatial models, back-calculation models (models calculating incidence from population mortality rates and case fatality), or registration completeness models (models adjusting for incomplete registration with health-system access and other covariates). Disability weights for 220 unique health states were used to capture the severity of health loss. YLDs by cause at age, sex, country, and year levels were adjusted for comorbidity with simulation methods. We included uncertainty estimates at all stages of the analysis. Findings Global prevalence for all ages combined in 2010 across the 1160 sequelae ranged from fewer than one case per 1 million people to 350 000 cases per 1 million people. Prevalence and severity of health loss were weakly correlated (correlation coefficient −0·37). In 2010, there were 777 million YLDs from all causes, up from 583 million in 1990. The main contributors to global YLDs were mental and behavioural disorders, musculoskeletal disorders, and diabetes or endocrine diseases. The leading specific causes of YLDs were much the same in 2010 as they were in 1990: low back pain, major depressive disorder, iron-deficiency anaemia, neck pain, chronic obstructive pulmonary disease, anxiety disorders, migraine, diabetes, and falls. Age-specific prevalence of YLDs increased with age in all regions and has decreased slightly from 1990 to 2010. Regional patterns of the leading causes of YLDs were more similar compared with years of life lost due to premature mortality. Neglected tropical diseases, HIV/AIDS, tuberculosis, malaria, and anaemia were important causes of YLDs in sub-Saharan Africa. Interpretation Rates of YLDs per 100 000 people have remained largely constant over time but rise steadily with age. Population growth and ageing have increased YLD numbers and crude rates over the past two decades. Prevalences of the most common causes of YLDs, such as mental and behavioural disorders and musculoskeletal disorders, have not decreased. Health systems will need to address the needs of the rising numbers of individuals with a range of disorders that largely cause disability but not mortality. Quantification of the burden of non-fatal health outcomes will be crucial to understand how well health systems are responding to these challenges. Effective and affordable strategies to deal with this rising burden are an urgent priority for health systems in most parts of the world. Funding Bill & Melinda Gates Foundation.

Ideas to improve the selection of NHMRC Project Grants

The starting point for this presentation is that applicants provide a large surplus of information when submitting a NHMRC Project Grant proposal for funding. This is costly in their time, attracts high administration costs, makes the task appear daunting for peer reviewers and may reduce the quality of the peer review leading to less than perfect reliability in decision making. We are currently experimenting with alternate models to see whether similar reliability in funding outcomes are achieved at less cost. We will compare traditional NHMRC Grant Review Panels (GRPs) with panels that use less information and journal style panels. By way of background to this experimental work, we will show some results on current levels of reliability for GRPs, the costs incurred by all who participate in Project Grant selection, and the level of reliability acceptable to researchers. By experimenting in this way and building an evidence base for how research funding should be allocated, the NHMRC is showing international leadership in this important field.

Funding : Australia’s grant system wastes time

We found that scientists in Australia spent more than five centuries' worth of time preparing research-grant proposals for consideration by the largest funding scheme of 2012. Because just 20.5% of these applications were successful, the equivalent of some four centuries of effort returned no immediate benefit to researchers and wasted valuable research time. The system needs reforming and alternative funding processes should be investigated...

Contested notions of civics and citizenship education as national education in the Australian curriculum

Civics and Citizenship (CC) education is a contested concept and a learning area that creates curriculum and implementation challenges for schools in many nations. The current development of the first national curriculum to be implemented in Australia, the Australian Curriculum, provides a national opportunity for educators to rethink curriculum priorities and to decide on new emphases for learning in schools, in response to policy that emphasizes the importance of CC for all young Australians. In this paper, we discuss the contested notion of citizenship education as ‘national education’ in Australia, the development of this learning area and some challenges schools will encounter implementing CC in the Australian Curriculum.

Walk@Work : an automated intervention to increase walking in university employees not achieving 10,000 daily steps

This study assessed the workday step counts of lower active (<10,000 daily steps) university employees using an automated, web-based walking intervention (Walk@Work). METHODS: Academic and administrative staff (n=390; 45.6±10.8years; BMI 27.2±5.5kg/m2; 290 women) at five campuses (Australia [x2], Canada, Northern Ireland and the United States), were given a pedometer, access to the website program (2010-11) and tasked with increasing workday walking by 1000 daily steps above baseline, every two weeks, over a six week period. Step count changes at four weeks post intervention were evaluated relative to campus and baseline walking. RESULTS: Across the sample, step counts significantly increased from baseline to post-intervention (1477 daily steps; p=0.001). Variations in increases were evident between campuses (largest difference of 870 daily steps; p=0.04) and for baseline activity status. Those least active at baseline (<5000 daily steps; n=125) increased step counts the most (1837 daily steps; p=0.001), whereas those most active (7500-9999 daily steps; n=79) increased the least (929 daily steps; p=0.001). CONCLUSIONS: Walk@Work increased workday walking by 25% in this sample overall. Increases occurred through an automated program, at campuses in different countries, and were most evident for those most in need of intervention.

Application of multi-criteria decision making methods to compression ignition engine efficiency and gaseous, particulate and greenhouse gas emissions

Compression ignition (CI) engine design is subject to many constraints which presents a multi-criteria optimisation problem that the engine researcher must solve. In particular, the modern CI engine must not only be efficient, but must also deliver low gaseous, particulate and life cycle greenhouse gas emissions so that its impact on urban air quality, human health, and global warming are minimised. Consequently, this study undertakes a multi-criteria analysis which seeks to identify alternative fuels, injection technologies and combustion strategies that could potentially satisfy these CI engine design constraints. Three datasets are analysed with the Preference Ranking Organization Method for Enrichment Evaluations and Geometrical Analysis for Interactive Aid (PROMETHEE-GAIA) algorithm to explore the impact of 1): an ethanol fumigation system, 2): alternative fuels (20 % biodiesel and synthetic diesel) and alternative injection technologies (mechanical direct injection and common rail injection), and 3): various biodiesel fuels made from 3 feedstocks (i.e. soy, tallow, and canola) tested at several blend percentages (20-100 %) on the resulting emissions and efficiency profile of the various test engines. The results show that moderate ethanol substitutions (~20 % by energy) at moderate load, high percentage soy blends (60-100 %), and alternative fuels (biodiesel and synthetic diesel) provide an efficiency and emissions profile that yields the most “preferred” solutions to this multi-criteria engine design problem. Further research is, however, required to reduce Reactive Oxygen Species (ROS) emissions with alternative fuels, and to deliver technologies that do not significantly reduce the median diameter of particle emissions.

Exit humidity of wet scrubbers for underground coal mines

A wet scrubber is a device used in underground coal mines for the exhaust treatment system of various internal combustion engines (generally diesel) primarily as a spark arrestor with a secondary function to remove pollutants from the exhaust gas. A pool of scrubbing liquid (generally water based) is used in conjunction with a Diesel Particulate Filter (DPF). Scrubbers are widely used in underground applications of diesel engines as their exhaust contains high concentration of harmful diesel particulate matter (DPM) and other pollutant gases. Currently the DPFs have to be replaced frequently because moisture output from the wet scrubber blocks the filter media and causes reduced capacity. This paper presents experimental and theoretical studies on the heat and mass transfer mechanisms of the exhaust flow both under and above the water surface, aiming at finding the cause and effects of the moisture reaching the filters and employing a solution to reduce the humidity and DPM output, and to prolong the change-out period of the DPF. By assuming a steady flow condition, heat transfer from the inlet exhaust gas balances energy required for the water evaporation. Hence the exit humidity will decrease with the increase of exit temperature. Experiments on a real scrubber are underway.

Hybrid graphene/titania nanocomposite : interface charge transfer, hole doping, and sensitization for visible light response

We demonstrated for the first time by large-scale ab initio calculations that a graphene/titania interface in the ground electronic state forms a charge-transfer complex due to the large difference of work functions between graphene and titania, leading to substantial hole doping in graphene. Interestingly, electrons in the upper valence band can be directly excited from graphene to the conduction band, that is, the 3d orbitals of titania, under visible light irradiation. This should yield well-separated electron−hole pairs, with potentially high photocatalytic or photovoltaic performance in hybrid graphene and titania nanocomposites. Experimental wavelength-dependent photocurrent generation of the graphene/titania photoanode demonstrated noticeable visible light response and evidently verified our ab initio prediction.

Desperately seeking Asia through China: Reading ‘China’ in the Australian Curriculum: History through children’s literature

This paper considers how Asia can be meaningfully studied and understood in the first national history curriculum to be implemented in Australia. Its focus is on how empathy might be conceptualised as part of the process of becoming ‘Asia literate’ and the ways in which an empathetic understanding can be developed in the Australian Curriculum: History by engaging students with children’s literature. We argue that stories about Chinese experiences in Australia from particular episodes in the nation’s past can be utilised for their potential to prompt historical inquiry and empathetic engagement in the classroom.

Communicating personal amnesty : a dismodernist approach to arts intersections between disability, personal stories and well-being

This thesis investigates the role of narrative devices in the process of improving an individual’s psychological and physiological experience of health and well-being using two methods of inquiry: a theoretical research project and a comparative analysis of two case studies. Through these two approaches the research examines how the health status of people experiencing disability can be re-positioned and re-designed to develop creative, narrative-based approaches to strengthen communication between the mainstream community and those marginalised by pathological, social and biological illness-centric policy. The theoretical section of the thesis examines two different, but complementary bodies of research: health and well-being, and narrative reconstruction. By invoking Antonovksy’s (1985a) theory of salutogenesis and Davis’s (2002) theory of dismodernism, the study examines the role of language and narrative in the defining of health in social, pathological and ableist spheres. The research positions health and well-being as disparate from historical and contemporary readings of illness and disability and presents literature to support the potential to improve health well-being through a creative re-narration of the experience of disability. The research examines the theoretical concepts of resilience, autonomy and social inclusion through a detailed examination of narratology and the amnesty narrative. The study links these theoretical approaches to a practical Arts-Health intersection program developed for the research project called Communicating Personal Amnesty. Through a comparative analysis of a Pilot Study and Major Case study, the research presents findings derived from theory-building participatory action research showing the efficacy of the program. The research provides a detailed analysis of key narrative structures through a variety of experimental methodological approaches to encourage an important dialogue between the creative components of the thesis and the more traditional health-based academic critique. The research is an example of emergent translational health methodologies, in disability studies.

Linking scientific evidence and decision making : A case study of hand hygiene interventions

We consider how data from scientific research should be used for decision making in health services. Whether a hand hygiene intervention to reduce risk of nosocomial infection should be widely adopted is the case study. Improving hand hygiene has been described as the most important measure to prevent nosocomial infection. 1 Transmission of microorganisms is reduced, and fewer infections arise, which leads to a reduction in mortality2 and cost savings.3 Implementing a hand hygiene program is itself costly, so the extra investment should be tested for cost-effectiveness.4,5 The first part of our commentary is about cost-effectiveness models and how they inform decision making for health services. The second part is about how data on the effectiveness of hand hygiene programs arising from scientific studies are used, and 2 points are made: the threshold for statistical inference of .05 used to judge effectiveness studies is not important for decision making,6,7 and potentially valuable evidence about effectiveness might be excluded by decision makers because it is deemed low quality.8 The ideas put forward will help researchers and health services decision makers to appraise scientific evidence in a more powerful way.

Surgical site infection prevention following total hip arthroplasty in Australia : a cost-effectiveness analysis

Background: Surgical site infection (SSI) is associated with substantial costs for health services, reduced quality of life, and functional outcomes. The aim of this study was to evaluate the cost-effectiveness of strategies claiming to reduce the risk of SSI in hip arthroplasty in Australia. Methods: Baseline use of antibiotic prophylaxis (AP) was compared with no antibiotic prophylaxis (no AP), antibiotic-impregnated cement (AP þ ABC), and laminar air operating rooms (AP þ LOR). A Markov model was used to simulate long-term health and cost outcomes of a hypothetical cohort of 30,000 total hip arthroplasty patients from a health services perspective. Model parameters were informed by the best available evidence. Uncertainty was explored in probabilistic sensitivity and scenario analyses. Results: Stopping the routine use of AP resulted in over Australian dollars (AUD) $1.5 million extra costs and a loss of 163 quality-adjusted life years (QALYs). Using antibiotic cement in addition to AP (AP þ ABC)generated an extra 32 QALYs while saving over AUD $123,000. The use of laminar air operating rooms combined with routine AP (AP þ LOR) resulted in an AUD $4.59 million cost increase and 127 QALYs lost compared with the baseline comparator. Conclusion: Preventing deep SSI with antibiotic prophylaxis and antibiotic-impregnated cement has shown to improve health outcomes among hospitalized patients, save lives, and enhance resource allocation. Based on this evidence, the use of laminar air operating rooms is not recommended.

Meta-regulation approach to CSR

The convergence of corporate social responsibility and corporate governance has changed the mechanism of corporate accountability, which has developed "corporate self-regulation...

New governance and CSR

New governance (NG) denotes a new approach in the governance strategies. This approach comes with a conceptual background explaining how the hardcore corporate decision-making and people-friendly business strategies have started to converge, relying on executive fiduciary duties, stakeholder engagement, and economic analysis of management incentives. It also addresses how companies incorporate stakeholder-friendly business strategies, examines the role of shareholder and board activism in pushing for social responsibility, and provides quantitative assessments of reporting practices, indexes, and ratings that link governance with responsibility (Kolk 2008; Statman 2005; Deegan 2002). It suggests models for pursuing this emerging frontier through greater involvement on behalf of the board of directors and utilizes a comparative approach to cross the border between the traditional ...

Core principles of CSR approaches

CSR is increasingly an essential issue for business enterprises. It is a company and multidimensional organizational ...