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.

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.

Work integrated research higher degree studies : experiences, benefits, barriers and coping strategies

Attributed to the changing social, political and economic landscape of the ‘knowledge economy’, Australian universities are under pressure to produce researchers that have a variety of skills which meet the demands of an increasingly diverse job market. As a consequence, the Australian PhD now includes a range of doctoral degrees. This paper reports on the experiences of two PhD students engaged in an informally managed research higher degree program described in this paper as a Work Integrated Research Higher Degree (WIRHD). Their learning process shares the attributes from both the traditional PhD program and professional doctorates. However, because of the blended nature of the learning contexts, what students need to manage within the WIRHD is much more complicated than the established RHD programs. An exploratory case study approach exploring experiences, benefits, barriers and coping strategies was conducted with the view to develop a preliminary integrative framework that attempts to explain the various contexts that influence the learning experience of WIRHD candidates. The paper concludes with some recommended strategies for helping WIRHD candidates to manage the challenges associated with their learning process.

Access to East European and Eurasian culture : publishing, acquisitions, digitization, metadata

Review of the book 'Access to East European and Eurasian culture: publishing, acquisitions, digitization, metadata', edited by Miranda Remnek, published by Haworth Information Press, 2009.

From evidence to action: a shared leadership approach

This paper proposes an organisational effectiveness model that applies the theoretical frameworks of shared leadership, appreciative inquiry, and knowledge creation. Similar to many libraries worldwide, Auraria Library technical services department struggled to establish efficient and effective workflow for electronic resources management. The library purchased an Electronic Resource Management System, as the literature suggests; however, this technology-enabled system did not resolve workflow issues. The Auraria Library case study demonstrates that a technical services division can successfully reorganize personnel, reassign responsibilities, and measure outcomes within an evidencebased shared leadership culture, which invites and enables participants to identify problems and create solutions amidst a dynamically changing electronic resources environment.

Teaching design thinking : Expanding horizons in design education

The term design thinking is increasingly used to mean the human-centred 'open' problem solving process decision makers use to solve real world 'wicked' problems. Claims have been made that design thinking in this sense can radically improve not only product innovation but also decision making in other fields, such as management, public health, and organizations in general. Many design and management schools in North America and elsewhere now include course offerings in design thinking though little is known about how successful these are with students. The lack of such courses in Australia presents an opportunity to design a curriculum for design thinking, employing design thinking's own practices. This paper describes the development of a design thinking course at Swinburne University taught simultaneously in Melbourne and Hong Kong. Following a pilot of the course in Semester 1, 2011 with 90 enrolled students across the two countries, we describe lessons learned to date and future course considerations as it is being taught in its second iteration.

Reorganizing a technical services division using collaborative evidence based information practice at Auraria Library

The article focuses on the evidence-based information practice (EBIP) applied at the Auraria Library in Denver, Colorado during the reorganization of its technical services division. Collaboration processes were established for the technical services division through the reorganization and redefinition of workflows. There are several factors that form part of the redefinition of roles including personal interests, department needs, and library needs. A collaborative EBIP environment was created in the division by addressing issues of workplace hierarchies, by the distribution of problem solving, and by the encouragement of reflective dialogue.

'Information in context' : co-designing workplace structures and systems for organizational learning

With the aim of advancing professional practice through better understanding how to create workplace contexts that cultivate individual and collective learning through situated 'information in context' experiences, this paper presents insights gained from three North American collaborative design (co-design) implementations. In the current project at the Auraria Library in Denver, Colorado, USA, participants use collaborative information practices to redesign face-to-face and technology-enabled communication, decision making, and planning systems. Design processes are described and results-to-date described, within an appreciative framework which values information sharing and enables knowledge creation through shared leadership.

Beyond designing : roles of the designer in complex design projects

Human computer interaction and interaction design have recognised the need for participatory methods of co-design to contribute to designing human-centred interfaces, systems and services. Design thinking has recently developed as a set of strategies for human-centred co-design in product innovation, management and organisational transformation. Both developments place the designer in a new mediator role, requiring new skills than previously evident. This paper presents preliminary findings from a PhD case study of strategy and innovation consultancy Second Road to discuss these emerging roles of design lead, facilitator, teacher and director in action.

Distributing leadership and cultivating dialogue with collaborative EBIP

The purpose of this paper is to demonstrate the efficacy of collaborative evidence based information practice (EBIP) as an organizational effectiveness model. Shared leadership, appreciative inquiry and knowledge creation theoretical frameworks provide the foundation for change toward the implementation of a collaborative EBIP workplace model. Collaborative EBIP reiterates the importance of gathering the best available evidence, but it differs by shifting decision-making authority from "library or employer centric" to "user or employee centric". University of Colorado Denver Auraria Library Technical Services department created a collaborative EBIP environment by flattening workplace hierarchies, distributing problem solving and encouraging reflective dialogue. By doing so, participants are empowered to identify problems, create solutions, and become valued and respected leaders and followers. In an environment where library budgets are in jeopardy, recruitment opportunities are limited and the workplace is in constant flux, the Auraria Library case study offers an approach that maximizes the capability of the current workforce and promotes agile responsiveness to industry and organizational challenges. Collaborative EBIP is an organizational model demonstrating a process focusing first on the individual and moving to the collective to develop a responsive and high performing business unit, and in turn, organization.

Planning for success : repurposing, retooling and reprioritising with results

This paper presents an organisational learning system implemented across a three year period within a multi campus tertiary library. It proposes a three stage system, framed within a reflective evidence based practice process to foster professional engagement and lifelong learning of staff.

From concept to capability : developing design thinking within a professional services firm

Corporate business and management are embracing design thinking for its potential to deliver competitive advantage through helping them be more innovative, differentiate their brands, and bring more customer centric products and services to market (Brown, 2008). As consumers continue to expect more personalisation and customisation from their service providers, the use of design thinking for innovation within organisations is a logical progression. To date however, there is little empirical literature discussing how organisations are setting about integrating design thinking into their culture and innovation practices. This paper is a first step in initiating a scholarly discussion on the integration of design thinking within organisational culture. Deloitte Australia is a large professional services firm employing over 5700 staff in 12 offices across Australia. The company provides a range of services to clients in the areas of audit, tax, financial advisory and consulting. In early 2011 the company made a strategic commitment to introducing design thinking into the organisation’s practices. While it already maintains a strong innovation culture, to date it had largely been operating within an analytical business environment. For Deloitte, design thinking is an opportunity to create better outcomes for the people they serve – both internal and external stakeholders (Brown and Wyatt, 2010). Research was conducted using case study methodology and ethnographic methods from June to September 2011 at the Melbourne Deloitte office. It involved three methods of data collection: semi structured interviews, participant observation and artifact analysis. This paper presents preliminary case study findings of Deloitte’s approach to building awareness and a consistent understanding of design thinking, as well as large scale capability, across the firm. Deloitte’s commitment to transforming its culture to one of design thinking poses significant potential for understanding how design thinking is comprehended, enabled and integrated within a complex organisational environment.

Building knowledge capabilities : an organisational learning approach

The communal nature of knowledge production predicts the importance of creating learning organisations where knowledge arises out of processes that are personal, social, situated and active. It follows that workplaces must provide both formal and informal learning opportunities for interaction with ideas and among individuals. This grounded theory for developing contemporary learning organisations harvests insights from the knowledge management, systems sciences, and educational learning literatures. The resultant hybrid theoretical framework informs practical application, as reported in a case study that harnesses the accelerated information exchange possibilities enabled through web 2.0 social networking and peer production technologies. Through complementary organisational processes, 'meaning making' is negotiated in formal face-to-face meetings supplemented by informal 'boundary spanning' dialogue. The organisational capacity building potential of this participatory and inclusive approach is illustrated through the example of the Dr. Martin Luther King, Jr. Library in San Jose, California, USA. As an outcome of the strategic planning process at this joint city-university library, communication, decision-making, and planning structures, processes, and systems were re-invented. An enterprise- level redesign is presented, which fosters contextualising information interactions for knowledge sharing and community building. Knowledge management within this context envisions organisations as communities where knowledge, identity, and learning are situated. This framework acknowledges the social context of learning - i.e., that knowledge is acquired and understood through action, interaction, and sharing with others. It follows that social networks provide peer-to-peer enculturation through intentional exchange of tacit information made explicit. This, in turn, enables a dynamic process experienced as a continuous spiral that perpetually elevates collective understanding and enables knowledge creation.

Workplace information literacy : cultivation strategies for 'working smarter' in 21st century libraries

This paper presents a hybrid framework of Swedish cultural practices and Australian grounded theory for organizational development and suggests practical strategies for 'working smarter' in 21st Century libraries. Toward that end, reflective evidence-based practices are offered to incrementally build organizational capacity for asking good questions, selecting authoritative sources, evaluating multiple perspectives, organizing emerging insights, and communicating them to inform, educate, and influence. In addition, to ensure the robust information exchange necessary to collective workplace learning, leadership traits are proposed for ensuring inclusive communication, decision making, and planning processes. These findings emerge from action research projects conducted from 2003 to 2008 in two North American libraries.