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.

Photocatalytic and Thermal Degradation of Poly(methyl methacrylate), Poly(butyl acrylate), and Their Copolymers

The photocatalytic and thermal degradations of poly(methyl methacrylate), poly(butyl acrylate), and their copolymers of different compositions were studied. The photocatalytic degradation was investigated in o-dichlorobenzene in the presence of two different catalysts, namely, Degussa P-25 and combustion synthesized nanotitania (CSN-TiO2). The samples were analyzed by using gel permeation chromatography (GPC) to obtain the molecular weight distributions (MWDs) as a function of reaction time. Experimental data indicated that the photodegradation of these polymers occurs by both random and chain end scission. A continuous distribution kinetic model was used to determine the degradation rate coefficients by fitting the experimental data with the model. Both the random and specific rate coefficients of the copolymers decreased with increasing percentage of butyl acrylate (BA). Thermal degradation of the copolymers was investigated by thermo-gravimetry. The normalized weight loss profiles for the copolymers showed that the thermal stability of the copolymers increased with mole percentage of BA in the copolymer (PMMABA). The Czawa method was used to determine the activation energies at different conversions. At low acrylate content in the copolymer, the activation energy depends on conversion, indicating multiple degradation mechanisms. At high acrylate content in the copolymer, the activation energy is independent of conversion, indicating degradation by a one-step mechanism.

CMC simulations of lifted turbulent jet flame in a vitiated coflow

Lifted turbulent jet diffusion flame is simulated using Conditional Moment Closure (CMC). Specifically, the burner configuration of Cabra et al. [R. Cabra, T. Myhrvold, J.Y. Chen. R.W. Dibble, A.N. Karpetis, R.S. Barlow, Proc. Combust. Inst. 29 (2002) 1881-1887] is chosen to investigate H-2/N-2 jet flame supported by a vitiated coflow of products of lean H-2/air combustion. A 2D, axisymmetric flow-model fully coupled with the scalar fields, is employed. A detailed chemical kinetic scheme is included, and first order CIVIC is applied. Simulations are carried out for different jet velocities and coflow temperatures (T-c) The predicted liftoff generally agrees with experimental data, as well as joint-PDF results. Profiles of mean scalar fluxes in the mixture fraction space, for T-c = 1025 and 1080 K reveal that (1) Inside the flame zone, the chemical term balances the molecular diffusion term, and hence the Structure is of a diffusion flamelet for both cases. (2) In the pre-flame zone, the structure depends on the coflow temperature: for the 1025 K case, the chemical term being small, the advective term balances the axial turbulent diffusion term. However, for the 1080 K case. the chemical term is large and balances the advective term, the axial turbulent diffusion term being small. It is concluded that, lift-off is controlled (a) by turbulent premixed flame propagation for low coflow temperature while (b) by autoignition for high coflow temperature. (C) 2009 The Combustion Institute. Published by Elsevier Inc. All rights reserved.

Rossijskaja Karelija i karely v imperskoi politike Rossii, 1905-1917

Russian Karelians were one of the small peasant nations of the Russian Empire that began to identify themselves as nations during the late imperial period. At that historical moment Russian Karelia fell between an economically undeveloped empire and the rapidly modernizing borderland of Finland. The economic and cultural lure of Finland drew Karelians into the Finnish camp. This attraction was seen as a challenge to Russia and influenced the straggle between Russia and Finland for the Karelians. This struggle was waged from 1905 to 1917. This work is focused on the beginning stage of the struggle, its various phases, and their results. The confrontation extended into different dimensions (economic, political, ideological, church and cultural politics) and occurred on two levels: central and regional. Countermeasures against local nationalisms developed much earlier both in Russia and in other empires for use were also used in the Russian Karelian case. Economic policies were deployed to try to make relations with Russia more alluring for Karelians and to improve their economic condition. However, these efforts produced only minimal results due to the economic weakness of the empire and a lack of finances. Fear of the economic integration of the Karelians and Finns, which would have stimulated the economy of the Karelia, also hindered these attempts. The further development of the Orthodox Church, the schools and the zemstvos in Karelia yielded fewer results than expected due to the economic underdevelopment of the region and the avoidance of the Finnish language. Policizing measures were the most successfull, as all activities in Russian Karelia by the Finns were entirely halted in practice. However, the aspiration of Russian Karelians to integrate their home districts with Finland remained a latent force that just waited for an opportunity to push to the surface again. Such a chance materialized with the Russian revolution. The Karelian question was also a part of Russian domestic political confrontation. At the and of the 1800s, the Russian nationalist right had grown strong and increasingly gained the favor of the autocracy. The right political forces exploited the Karelian question in its anti-Finnish ideology and in its general resistance to the national emancipation of the minority peoples of Russia. A separate ideology was developed, focusing on the closeness of Karelians to the "great Russian people." Simultaneously, this concept found a place in the ultramonarchist myth of the particularly close connection between the people and tsar that was prominent in the era of Nicholas II. This myth assigned the Karelians a place amongst the "simple people" faithful to the tsar.

Depth profile composition studies of thin film CdS: Cu,S solar cells using XPS and AES

Surface composition and depth profile studies of hemiplated thin film CdS:CuzS solar cells have been carried out using x-ray photoelectron spectroscopy (XPS) and Auger electron spectroscopy (AES) techniques. These studies indicate that the junction is fairly diffused in the as-prepared cell. However, heat treatment of the cell at 210°C in air relatively sharpens the junction and improves the cell performance. Using the Cu(2p3p)/S(2p) ratio as well as the Cu(LVV)/(LMM) Auger intensity ratio, it can be inferred that the nominal valency of copper in the layers above the junction is Cut and it is essentially in the CUSS form. Copper signals are observed from layers deep down in the cell. These seem to appear mostly from the grain boundary region. From the observed concentration of Cd, Cu and S in these deeper layers and the Cu(LVV)/(LMM) ratio it appears that the signals from copper essentially originate partly from copper in CuS and partly from Cu2t trapped in the lattice. It is significant to note that the nominal valence state of copper changes rather abruptly from Cut to Cuz+ across the junction.

miR-514a regulates the tumour suppressor NF1 and modulates BRAFi sensitivity in melanoma

To identify ‘melanoma-specific’ microRNAs (miRNAs) we used an unbiased microRNA profiling approach to comprehensively study cutaneous melanoma in relation to other solid malignancies, which revealed 233 differentially expressed (≥ 2 fold, p < 0.05) miRNAs. Among the top 20 most significantly different miRNAs was hsa-miR-514a-3p. miR-514a is a member of a cluster of miRNAs (miR-506-514) involved in initiating melanocyte transformation and promotion of melanoma growth. We found miR-514a was expressed in 38/55 (69%) melanoma cell lines but in only 1/34 (3%) other solid cancers. To identify miR-514a regulated targets we conducted a miR-514a-mRNA ‘pull-down’ experiment, which revealed hundreds of genes, including: CTNNB1, CDK2, MC1R, and NF1, previously associated with melanoma. NF1 was selected for functional validation because of its recent implication inacquired resistance to BRAFV600E-targeted therapy. Luciferase-reporter assays confirmed NF1 as a direct target of miR-514a and over-expression of miR-514a in melanoma cell lines inhibited NF1 expression, which correlated with increased survival of BRAFV600E cells treated with PLX4032. These data provide another mechanism for the dysregulation of the MAPK pathway which may contribute to the profound resistance associated with current RAF-targeted therapies.

The use of animation to promote student learning about the importance of mental well-being for tertiary study success

It is now widely acknowledged that student mental well-being is a critical factor in the tertiary student learning experience and is important to student learning success. The issue of student mental well-being also has implications for effective student transition out of university and into the world of work. It is therefore vital that intentional strategies are adopted by universities both within the formal curriculum, and outside it, to promote student well-being and to work proactively and preventatively to avoid a decline in student psychological well-being. This paper describes how the Queensland University of Technology Law School is using animation to teach students about the importance for their learning success of the protection of their mental well-being. Mayer and Moreno (2002) define an animation as an external representation with three main characteristics: (1) it is a pictorial representation, (2) it depicts apparent movement, and (3) it consists of objects that are artificially created through drawing or some other modelling technique. Research into the effectiveness of animation as a tool for tertiary student learning engagement is relatively new and growing field of enquiry. Nash argues, for example, that animations provide a “rich, immersive environment [that] encourages action and interactivity, which overcome an often dehumanizing learning management system approach” (Nash, 2009, 25). Nicholas states that contemporary millennial students in universities today, have been immersed in animated multimedia since their birth and in fact need multimedia to learn and communicate effectively (2008). However, it has also been established, for example through the work of Lowe (2003, 2004, 2008) that animations can place additional perceptual, attentional, and cognitive demands on students that they are not always equipped to cope with. There are many different genres of animation. The dominant style of animation used in the university learning environment is expository animation. This approach is a useful tool for visualising dynamic processes and is used to support student understanding of subjects and themes that might otherwise be perceived as theoretically difficult and disengaging. It is also a form of animation that can be constructed to avoid any potential negative impact on cognitive load that the animated genre might have. However, the nature of expository animation has limitations for engaging students, and can present as clinical and static. For this reason, the project applied Kombartzky, Ploetzner, Schlag, and Metz’s (2010) cognitive strategy for effective student learning from expository animation, and developed a hybrid form of animation that takes advantage of the best elements of expository animation techniques along with more engaging short narrative techniques. First, the paper examines the existing literature on the use of animation in tertiary educational contexts. Second, the paper describes how animation was used at QUT Law School to teach students about the issue of mental well-being and its importance to their learning success. Finally, the paper analyses the potential of the use of animation, and of the cognitive strategy and animation approach trialled in the project, as a teaching tool for the promotion of student learning about the importance of mental well-being.

Double-Edged Imitation : Theories and Practices of Pastiche in Literature

This study concentrates on the contested concept of pastiche in literary studies. It offers the first detailed examination of the history of the concept from its origins in the seventeenth century to the present, showing how pastiche emerged as a critical concept in interaction with the emerging conception of authorial originality and the copyright laws protecting it. One of the key results of this investigation is the contextualisation of the postmodern debate on pastiche. Even though postmodern critics often emphasise the radical novelty of pastiche, they in fact resuscitate older positions and arguments without necessarily reflecting on their historical conditions. This historical background is then used to analyse the distinction between the primarily French conception of pastiche as the imitation of style and the postmodern notion of it as the compilation of different elements. The latter s vagueness and inclusiveness detracts from its value as a critical concept. The study thus concentrates on the notion of stylistic pastiche, challenging the widespread prejudice that it is merely an indication of lack of talent. Because it is multiply based on repetition, pastiche is in fact a highly ambiguous or double-edged practice that calls into question the distinction between repetition and original, thereby undermining the received notion of individual unique authorship as a fundamental aesthetic value. Pastiche does not, however, constitute a radical upheaval of the basic assumptions on which the present institution of literature relies, since, in order to mark its difference, pastiche always refers to a source outside itself against which its difference is measured. Finally, the theoretical analysis of pastiche is applied to literary works. The pastiches written by Marcel Proust demonstrate how it can become an integral part of a writer s poetics: imitation of style is shown to provide Proust with a way of exploring the role of style as a connecting point between inner vision and reality. The pastiches of the Sherlock Holmes stories by Michael Dibdin, Nicholas Meyer and the duo Adrian Conan Doyle and John Dickson Carr illustrate the functions of pastiche within a genre detective fiction that is itself fundamentally repetitive. A.S. Byatt s Possession and D.M. Thomas s Charlotte use Victorian pastiches to investigate the conditions of literary creation in the age of postmodern suspicion of creativity and individuality. The study thus argues that the concept of pastiche has valuable insights to offer to literary criticism and theory, and that literary pastiches, though often dismissed in reviews and criticism, are a particularly interesting object of study precisely because of their characteristic ambiguity.

Variation in health care-associated infection surveillance practices in Australia

In the absence of a national health care-associated infection surveillance program in Australia, differences between existing state-based programs were explored using an online survey. Only 51% of respondents who undertake surveillance have been trained, fewer than half perform surgical site infection surveillance prospectively, and only 41% indicated they risk adjust surgical site infection data. Wide- spread variation of surveillance methods highlights future challenges when considering the development and implementation of a national program in Australia.

Odour Emissions from Tunnel Ventilated Poultry Housing

In Australia, factors such as local planning processes, urban encroachment into rural areas and intensification of the poultry industry have increased the potential for odour and dust nuisance. At present, accurate estimates of odour emissions from mechanically ventilated poultry housing systems do not exist for Australian conditions. This has made the poultry industry vulnerable to unsubstantiated criticism. Recently, the Australian poultry industry have made a significant investment in research to obtain accurate estimates of odour, dust and volatile chemical emission rates from typical poultry housing systems. This paper describes the measurement of odour emissions from tunnel ventilated poultry housing systems in different climatic zones in Queensland and Victoria, Australia (humid sub-tropical and Mediterranean respectively) during two seasons (summer and winter). Samples were collected at defined intervals over typical batch production cycles to define the odour emission profiles. These samples were analysed using dynamic olfactometry according to the Australian Standard 4323.3 to derive the odour concentration values. Ventilation rates were measured concurrently, allowing the calculation of odour emission rates. Odour concentration and emission rates were assessed in terms of ventilation rate, ambient and shed air temperature and relative humidity and litter moisture status. Odour emission rates varied with bird age. Seasonal differences in odour emission rate were also observed.

An overview of integrated pest management (IPM) in north-eastern Australian grain farming systems: Past, present and future prospects

The authors overview integrated pest management (IPM) in grain crops in north-eastern Australia, which is defined as the area north of latitude 32°S. Major grain crops in this region include the coarse grains (winter and summer cereals), oilseeds and pulses. IPM in these systems is complicated by the diversity of crops, pests, market requirements and cropping environments. In general, the pulse crops are at greatest risk, followed by oilseeds and then by cereal grains. Insecticides remain a key grain pest management tool in north-eastern Australia. IPM in grain crops has benefited considerably through the increased adoption of new, more selective insecticides and biopesticides for many caterpillar pests, in particular Helicoverpa spp. and loopers, and the identification of pest-crop scenarios where spraying is unnecessary (e.g. for most Creontiades spp. populations in soybeans). This has favoured the conservation of natural enemies in north-eastern Australia grain crops, and has arguably assisted in the management of silverleaf whitefly in soybeans in coastal Queensland. However, control of sucking pests and podborers such as Maruca vitrata remains a major challenge for IPM in summer pulses. Because these crops have very low pest-damage tolerances and thresholds, intervention with disruptive insecticides is frequently required, particularly during podfill. The threat posed by silverleaf whitefly demands ongoing multi-pest IPM research, development and extension as this pest can flare under favourable seasonal conditions, especially where disruptive insecticides are used injudiciously. The strong links between researchers and industry have facilitated the adoption of IPM practices in north-eastern Australia and augers well for future pest challenges and for the development and promotion of new and improved IPM tactics.

Understanding the determinants of Australian hospital nurses' hand hygiene decisions following the implementation of a national hand hygiene initiative

Hand hygiene is the primary measure in hospitals to reduce the spread of infections, with nurses experiencing the greatest frequency of patient contact. The ‘5 critical moments’ of hand hygiene initiative has been implemented in hospitals across Australia, accompanied by awareness-raising, staff training and auditing. The aim of this study was to understand the determinants of nurses’ hand hygiene decisions, using an extension of a common health decision-making model, the theory of planned behaviour (TPB), to inform future health education strategies to increase compliance. Nurses from 50 Australian hospitals (n = 2378) completed standard TPB measures (attitude, subjective norm, perceived behavioural control [PBC], intention) and the extended variables of group norm, risk perceptions (susceptibility, severity) and knowledge (subjective, objective) at Time 1, while a sub-sample (n = 797) reported their hand hygiene behaviour 2 weeks later. Regression analyses identified subjective norm, PBC, group norm, subjective knowledge and risk susceptibility as the significant predictors of nurses’ hand hygiene intentions, with intention and PBC predicting their compliance behaviour. Rather than targeting attitudes which are already very favourable among nurses, health education strategies should focus on normative influences and perceptions of control and risk in efforts to encourage hand hygiene adherence.

Comparison of odour emission rates measured from various sources using two sampling devices

Two commonly used sampling devices (a wind tunnel and the US EPA dynamic emission chamber), were used to collect paired samples of odorous air from a number of agricultural odour sources. The odour samples were assessed using triangular, forced-choice dynamic olfactometry. The odour concentration data was combined with the flushing rate data to calculate odour emission rates for both devices on all sources. Odour concentrations were consistently higher in samples collected with a flux chamber (ratio ranging from 10:7 to 5:1, relative to wind tunnel samples), whereas odour emission rates were consistently larger when derived from wind tunnels (ratio ranging from 60:1 to 240:1, relative to flux chamber values). A complex relationship existed between emission rate estimates derived from each device, apparently influenced by the nature of the emitting surface. These results have great significance for users of odour dispersion models, for which an odour emission rate is a key input parameter.

Normative values for corneal nerve morphology assessed using corneal confocal microscopy: A multinational normative data set

OBJECTIVE Corneal confocal microscopy is a novel diagnostic technique for the detection of nerve damage and repair in a range of peripheral neuropathies, in particular diabetic neuropathy. Normative reference values are required to enable clinical translation and wider use of this technique. We have therefore undertaken a multicenter collaboration to provide worldwide age-adjusted normative values of corneal nerve fiber parameters. RESEARCH DESIGN AND METHODS A total of 1,965 corneal nerve images from 343 healthy volunteers were pooled from six clinical academic centers. All subjects underwent examination with the Heidelberg Retina Tomograph corneal confocal microscope. Images of the central corneal subbasal nerve plexus were acquired by each center using a standard protocol and analyzed by three trained examiners using manual tracing and semiautomated software (CCMetrics). Age trends were established using simple linear regression, and normative corneal nerve fiber density (CNFD), corneal nerve fiber branch density (CNBD), corneal nerve fiber length (CNFL), and corneal nerve fiber tortuosity (CNFT) reference values were calculated using quantile regression analysis. RESULTS There was a significant linear age-dependent decrease in CNFD (-0.164 no./mm(2) per year for men, P < 0.01, and -0.161 no./mm(2) per year for women, P < 0.01). There was no change with age in CNBD (0.192 no./mm(2) per year for men, P = 0.26, and -0.050 no./mm(2) per year for women, P = 0.78). CNFL decreased in men (-0.045 mm/mm(2) per year, P = 0.07) and women (-0.060 mm/mm(2) per year, P = 0.02). CNFT increased with age in men (0.044 per year, P < 0.01) and women (0.046 per year, P < 0.01). Height, weight, and BMI did not influence the 5th percentile normative values for any corneal nerve parameter. CONCLUSIONS This study provides robust worldwide normative reference values for corneal nerve parameters to be used in research and clinical practice in the study of diabetic and other peripheral neuropathies.

Corneal confocal microscopy predicts 4-year incident peripheral neuropathy in Type 1 diabetes

OBJECTIVE This study determined if deficits in corneal nerve fiber length (CNFL) assessed using corneal confocal microscopy (CCM) can predict future onset of diabetic peripheral neuropathy (DPN). RESEARCH DESIGN AND METHODS CNFL and a range of other baseline measures were compared between 90 nonneuropathic patients with type 1 diabetes who did or did not develop DPN after 4 years. The receiver operator characteristic (ROC) curve was used to determine the capability of single and combined measures of neuropathy to predict DPN. RESULTS DPN developed in 16 participants (18%) after 4 years. Factors predictive of 4-year incident DPN were lower CNFL (P = 0.041); longer duration of diabetes (P = 0.002); higher triglycerides (P = 0.023); retinopathy (higher on the Early Treatment of Diabetic Retinopathy Study scale) (P = 0.008); nephropathy (higher albumin-to-creatinine ratio) (P = 0.001); higher neuropathy disability score (P = 0.037); lower cold sensation (P = 0.001) and cold pain (P = 0.027) thresholds; higher warm sensation (P = 0.008), warm pain (P = 0.024), and vibration (P = 0.003) thresholds; impaired monofilament response (P = 0.003); and slower peroneal (P = 0.013) and sural (P = 0.002) nerve conduction velocity. CCM could predict the 4-year incident DPN with 63% sensitivity and 74% specificity for a CNFL threshold cutoff of 14.1 mm/mm2 (area under ROC curve = 0.66, P = 0.041). Combining neuropathy measures did not improve predictive capability. CONCLUSIONS DPN can be predicted by various demographic, metabolic, and conventional neuropathy measures. The ability of CCM to predict DPN broadens the already impressive diagnostic capabilities of this novel ophthalmic marker.