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.

Konstruktiivisen linjakkuuden perusteita etsimässä : Systemaattinen analyysi John Biggsin esittämistä yliopisto-opetuksen lähtökohdista

The aim of this study is to explore by systematic textual analysis the crucial conceptions of constructive alignment and to reconstruct the concept of constructive alignment and examine the relation between conceptual relationships in John Biggs’s texts. In this study, I have also analyzed the presuppositions of the concept of constructive alignment and its possible implications. The research material includes Biggs’s (1996b; 2003) article entitled Enhancing Teaching through Constructive Alignment and book entitled Teaching for Quality Learning at University. The primary purpose of the systematic textual analysis is to reconstruct concepts and gain access to a new or more profound understanding of the concepts. The main purpose of the constructive alignment is to design a teaching system that supports and encourages students to adopt a deep approach learning. At the center of the constructive alignment are two concepts: constructivism in learning and alignment in teaching. A tension was detected between these concepts. Biggs assumes that students’ learning activities are primed by the teaching. Because of this it is not important what the teacher does. At the same time he emphasizes that teaching interacts with learning. The teacher’s task is to support student’s appropriate learning activities. On the basis of the analysis, I conclude these conceptions are not mutually exclusive. Interaction between teaching and learning has an effect on student’s learning activities. The most essential benefit of the model of constructive alignment is that Biggs brings together and considers teaching at the same level with learning. A weakness of Biggs’s model relates to the theoretical basis and positions of the concept of constructive alignment. There are some conflicts between conceptions of epistemology in Biggs’s texts. In addition, Biggs writes about constructivism also as conceptions of epistemology, but doesn’t consider implications of that position or what follows or doesn’t follow from that commitment. On the basis of the analysis, I suggest that constructivism refers in Biggs’s texts rather to constructivism in learning than philosophical constructivism. In light of this study, constructive alignment doesn´t lead to philosophical constructivism. That’s why constructive alignment stays out of idealism. Biggs’s way of thinking about teachers possibility to confronting students’ misconceptions and evaluate and assess students’ constructions support a realist purpose in terms of philosophical stance. Realism does not drift toward general problems of relativism, like lack of criteria for assessing or evaluate these constructions.

John and Ursula Schlosstein nee Gottschalk with their infant son Ralph. portraits family

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John Ettinger Collection 1941-1946

John Ettinger, 1987.

John and Ursula Schlosstein nee Gottschalk with their infant son Ralph. portraits family

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Phenotyping novel stay-green traits to capture genetic variation in senescence dynamics

Stay-green plants retain green leaves longer after anthesis and can have improved yield, particularly under water limitation. As senescence is a dynamic process, genotypes with different senescence patterns may exhibit similar final normalised difference vegetative index (NDVI). By monitoring NDVI from as early as awn emergence to maturity, we demonstrate that analysing senescence dynamics improves insight into genotypic stay-green variation. A senescence evaluation tool was developed to fit a logistic function to NDVI data and used to analyse data from three environments for a wheat (Triticum aestivum L.) population whose lines contrast for stay-green. Key stay-green traits were estimated including, maximum NDVI, senescence rate and a trait integrating NDVI variation after anthesis, as well as the timing from anthesis to onset, midpoint and conclusion of senescence. The integrative trait and the timing to onset and mid-senescence exhibited high positive correlations with yield and a high heritability in the three studied environments. Senescence rate was correlated with yield in some environments, whereas maximum NDVI was associated with yield in a drought-stressed environment. Where resources preclude frequent measurements, we found that NDVI measurements may be restricted to the period of rapid senescence, but caution is required when dealing with lines of different phenology. In contrast, regular monitoring during the whole period after flowering allows the estimation of senescence dynamics traits that may be reliably compared across genotypes and environments. We anticipate that selection for stay-green traits will enhance genetic progress towards high-yielding, stay-green germplasm.

Contract with John Moore for building house on Mill Street

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Warrant to pay John Moore for building house on Mill Street

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John Searlen teoria tietoisuudesta

Tutkielmassa esitellään ja arvioidaan John Searlen teoriaa tietoisuudesta. Tietoisuus (consciousness) on Searlen mukaan tärkein mielenfilosofinen käsite. Searle ei määrittele käsitettä tarkasti, vaan tyytyy esittämään sitä kuvaavia esimerkkejä ja analogioita. Tietoisuuden keskeisimmiksi ominaisuuksiksi Searlen teoriassa näyttävät muodostuvan intentionaalisuus (intentionality), subjektiivisuus (subjectivity) ja kausaalinen vaikutus käyttäytymiseen (mental causation). Näihin ominaisuuksiin liittyvät myös Searlen painavimmat tietoisuudesta esittämät argumentit. Argumenttien analysointi on tutkielman tärkein tavoite. Searlen yhteysperiaatteen (Connection Principle) mukaan intentionaalisia tiloja voi olla vain olennolla, jolla voi olla tietoisia intentionaalisia tiloja, ja jokainen alitajuinen intentionaalinen tila on ainakin potentiaalisesti tietoinen. Toisin sanoen intentionaalisuuden ja tietoisuuden välillä vallitsee välttämätön yhteys seuraavasti: on loogisesti välttämätöntä, että jokainen intentionaalinen tila voi ainakin periaattessa päästä tietoisuuteen.Tutkielmassa kuitenkin osoitetaan, että yhteysperiaateeseen on syytä suhtautua epäillen. Searlen yhteysperiaatteen puolesta esittämä argumentti näyttää nimittäin sisältävän dilemman. Jos erottelu intrinsiseen ja näennäiseen intentionaalisuuteen tulkitaan Searlen tavoin, syyllistytään sen olettamiseen, mikä pitäisi todistaa; jos taas erottelu tulkitaan toisin kuin Searle, argumentti ei tue yhteysperiaatetta. Searlen mukaan mentaaliset tilat ovat aina jonkun mentaalisia tiloja. Tästä väitteestä Searle pyrkii johtamaan toisen, paljon radikaalimman väitteen: mielen ilmiöt kuuluvat omaan ontologiseen kategoriaansa, subjektiivisten mentaalisten tilojen kategoriaan. Searlen käsitystä tukee Thomas Nagelin esittämä, hyvin samansisältöinen argumentti. Yksimielisyys ei kuitenkaan ole erehtymättömyyden tae, sillä Paul Churchlandin kritiikki näyttää pahasti horjuttavan Searlen subjektiivisuusargumentin uskottavuutta. Churchland väittää Searlen syyllistyvän intensionaaliseen virhepäätelmään. Yksittäisen henkilön episteemisen pääsyn rajoittuneisuudesta ei Churchlandin mukaan voida tehdä mitään ontologisia johtopäätöksiä, koska tiedetyksi tuleminen ei ole objektin aito ominaisuus. Vastaväite näyttää olevan kohtalokas Searlen subjektiivisuusargumentille. Subjektiivisuuden ongelma näyttää olevan perustava metafyysinen vedenjakaja, joka jakaa mielenfilosofiset teoriat toisaalta materialistisiin, toisaalta dualistisiin. Searle uskoo, että mieli-ruumis -ongelma (mind-body problem) on ratkaistavissa ilman, että tarvitsee valita kumpaakaan. Ratkaisu sisältyy kahteen Searlen näennäisesti yhteensopimattomaan teesiin. Ensimmäisen teesin mukaan mentaaliset tilat ovat todellisia ilmiöitä, eikä niitä voida redusoida mihinkään muuhun tai eliminoida määrittelemällä ne uudestaan. Toisen teesin mukaan aivojen operaatiot aiheuttavat mentaaliset tilat ja mentaaliset tilat ovat aivojen piirteitä. Teeseistä jälkimmäinen osoittautuu ongelmalliseksi syistä, jotka Jaegwon Kim on esittänyt. Jos mentaaliset tilat olisivat aivojen ominaisuuksia, ei mielen ja aivojen välinen suhde voisi olla kausaalinen, koska kausaatiossa (causation) on aina kyse kahden erillisen entiteetin tai tapahtuman välisestä relaatiosta, jossa suhteen osapuolien välillä on oltava ajallista etäisyyttä. Toiseksi Searlen vertaus tietoisuuden ja aivojen suhteesta kappaleen kiinteyden ja sen mikrorakenteen suhteeseen epäonnistuu, koska tietoisuus ja kiinteys kuuluvat Searlen teoriassa eri ontologisiin kategorioihin, eikä niitä siten voi ongelmattomasti rinnastaa. Searlen analogia kiinteyteen murtuu myös siksi, että kappaleen mikrorakenne ei yksinkertaisesti aiheuta sen kiinteyttä. Tietoisuus ei siis voi olla samanaikaisesti aivojen ominaisuus ja aivojen kausaalisen toiminnan seuraus. Tutkielmassa päädytään puolustamaan kantaa, että Searlen argumentit eivät ole vakuuttavia ja että Searle ei ole onnistunut eksplikoimaan teoriaa, joka välttäisi dualismiin ja materialismiin liittyvät tunnetut ongelmat. Kysymys mikä on mielen suhde ruumiiseen, jää siten avoimeksi. Avainsanat: intentionaalisuus, mentaalinen, mieli-ruumis -ongelma, Searle, subjektiivisuus, tietoisuus

Untitled (after Steven and John)

'Untitled (after Steven and John)' takes inspiration from Spielbergian tracking shots and Baldessarian collages to create ghostly apparitions that explore the affective power of the cinematic close up. By appropriating and obfuscating this common filmic convention, the work investigates the intersubjective potential of the moving image.

Clathrin-independent carriers form a high capacity endocytic sorting system at the leading edge of migrating cells

Although the importance of clathrin- and caveolin-independent endocytic pathways has recently emerged, key aspects of these routes remain unknown. Using quantitative ultrastructural approaches, we show that clathrin-independent carriers (CLICs) account for approximately three times the volume internalized by the clathrin-mediated endocytic pathway, forming the major pathway involved in uptake of fluid and bulk membrane in fibroblasts. Electron tomographic analysis of the 3D morphology of the earliest carriers shows that they are multidomain organelles that form a complex sorting station as they mature. Proteomic analysis provides direct links between CLICs, cellular adhesion turnover, and migration. Consistent with this, CLIC-mediated endocytosis of key cargo proteins, CD44 and Thy-1, is polarized at the leading edge of migrating fibroblasts, while transient ablation of CLICs impairs their ability to migrate. These studies provide the first quantitative ultrastructural analysis and molecular characterization of the major endocytic pathway in fibroblasts, a pathway that provides rapid membrane turnover at the leading edge of migrating cells.