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.

Perylene-based profluorescent nitroxides for the rapid monitoring of polyester degradation upon weathering: An assessment

A profluorescent nitroxide possessing an isoindoline nitroxide moiety linked to a perylene fluorophore was developed to monitor radical mediated degradation of melamine-formaldehyde crosslinked polyester coil coatings in an industry standard accelerated weathering tester. Trapping of polyester-derived radicals (most likely C-radicals) that are generated during polymer degradation leads to fluorescent closed-shell alkoxy amines, which was used to obtain time-dependent degradation profiles to assess the relative stability of different polyesters towards weathering. The nitroxide probe couples excellent thermal stability and satisfactory photostability with high sensitivity and enables detection of free radical damage in polyesters under conditions that mimic exposure to the environment on a time scale of hours rather than months or years required by other testing methods. There are indications that the profluorescent nitroxide undergoes partial photo-degradation in the absence of polymer-derived radicals. Unexpectedly, it was also found that UV-induced fragmentation of the NO–C bond in closed-shell alkoxy amines leads to regeneration of the profluorescent nitroxide and the respective C-radical. The maximum fluorescence intensity that could be achieved with a given probe concentration is therefore not only determined by the amount of polyester radicals formed during accelerated weathering, but also by the light-driven side reactions of the profluorescent nitroxide and the corresponding alkoxy amine radical trapping products. Studies to determine the optimum probe concentration in the polymer matrix revealed that aggregation and re-absorption effects lowered the fluorescence intensity at higher concentrations of the profluorescent nitroxide, but too low probe concentrations, where these effects would be avoided, were not sufficient to trap the amount of polyester radicals formed upon weathering. The optimized experimental conditions were used to assess the impact of temperature and UV irradiance on polymer degradation during accelerated weathering.

Urban Revitalization: Remaking Cities in a Changing World

Following decades of neglect and decline, many US cities have undergone a dramatic renaissance. From New York to Nashville and Pittsburgh to Portland governments have implemented innovative redevelopment strategies to adapt to a globally integrated, post-industrial economy and cope with declining industries, tax bases, and populations - but the urban comeback has been highly uneven. Urban Revitalization integrates academic and policy research with professional knowledge and techniques. Written in an accessible style and with a thoughtful structure, it will provide graduate and upper-level undergraduate students with a comprehensive resource while also serving as a reference for professionals.

Neighborhood diversity, economic health and the role of the arts

Policymakers pursue a range of strategies aimed at diversifying neighborhoods despite research indicating the complicated and potentially damaging results of these efforts. One increasingly common approach is to incorporate the arts into planning efforts in the hope of enhancing diversity and catalyzing positive neighborhood change. Using data from the Cultural Data Project, we determine where newly established New York City art organizations locate in terms of neighborhood racial, income and industry diversity. We then analyze how diverse contexts interact with an arts presence to impact neighborhood economic health over time. We find that neighborhoods with high levels of racial diversity and low levels of income and industry diversity benefit most from an arts presence. However, the arts are attracted predominately to neighborhoods with moderate levels of racial diversity and high levels of income and industry diversity. This complicates the use of the arts as a tool in urban revitalization policy.

Kuluttaminen ja ylhäisaatelin elämäntapa 1700-luvun Ruotsissa

Consumption and the lifestyle of the high nobility in eighteenth-century Sweden This monograph is an analysis of the lifestyle, consumption and private finances of the Swedish high nobility during the eighteenth century (ca 1730 1795). It describes the lifestyle of one noble house, the House of Fersen. The Fersen family represents the leading political, economic and cultural elite in eighteenth-century Sweden. The analysis concentrates on Count Carl von Fersen (1716 1786) and his brother Count Axel von Fersen (1719 1794), their spouses and children. Carl von Fersen was a courtier whilst Axel von Fersen was an officer and one of the leaders of the Francophile Hat party. His son, Axel von Fersen the younger, was in his time an officer and a favourite of Gustavus III, King of Sweden, as well as a favourite and trusted confidant of Marie-Antoinette, Queen of France. The research is based upon the Fersen family s private archives, the Counts personal account books, probate inventories, letters and diaries. The study discusses the Fersens landed property and investments in ironworks and manufacturing, the indebtedness of the high nobility, high offices in civil administration, the militia and at court, as well as marriages as the foundations of noble wealth and power. It analyses the Count von Fersens revenue and expenditure, their career options and personal expenses, their involvement in the building and decorating of palaces, and the servants in service of the Fersen family as well as the ideal nobleman and his consumption. Central themes are inheritance, children s education, marriages and ladies preparing their trousseaux, the nobility ordering luxury goods from France, the consumption of Counts and Countesses before and after marrying and having children, the pleasures of a noble life as well as the criticism of luxury and sumptuousness. The study contributes to the large body of research on consumption and nobility in the eighteenth century by connecting the lifestyle, consumption and private finances of the Swedish high nobility to their European context. Key words: nobility, Fersen, lifestyle, consumption, private finances, Sweden, eighteenth century

Ajatuksista operaatioiksi : Suomen armeijan hyökkäysoperaatioiden suunnittelu jatkosodassa

In the research on the Continuation War, interest in the events themselves had exceeded the interest in military planning. Careful consideration has not been given to the planning process and the options that were available. This study shows how the planning of these operations was carried out and identifies the persons responsible. Contrary to earlier research this study shows that persons other than Field-Marshal Carl Gustaf Mannerheim and Quartermaster-General Aksel Airo took part in the planning. Furthermore, the plan was to carry out the operations further east than was ultimately done. The operation plans were coordinated by the Operations Department of Headquarters, which had the opportunity to influence on both Mannerheim and Airo. Part of the actual planning was made outside Headquarters, but final decisions were taken at Headquarters. It is worth observing that many times Mannerheim asked President Risto Ryti for his opinion concerning these operations. The Germans tried to influence the Finnish plans, but the Finns took their decisions independently, although they took German requests into account. It is well-known that the attack by the Finnish forces was stopped at the end of the year 1941. It is less well-known that the Finns planned new attacks until the autumn of 1942. At that point the Finns were convinced that the Germans would lose the war. The Finns were thus prepared to keep advancing should the Germans progress in the direction of Leningrad. This study shows that the Finnish military leaders worked for Finland s own plans and their cooperation with the Germans was directed to achieving this goal. In other words, Finland tried expand eastward with the help of the Germans. This purpose was particularly evident in the planning of the operations in the Hanko district and the Karelian Isthmus in the summer and autumn of 1941, in the Sorokka district in the spring of 1942 and around Lake Ladoga in the summer and autumn of 1942. The Finns reduced their activities when Germans took over responsibility for the operations. However, at the same time the Finns tried to support Germans in passive ways. The Finns justified the decrease in their activities with lack of Finnish forces and numerous defeats. Earlier research has shown that Finland was an active operator in the Continuation War and tried to take back the areas lost in the Winter War. In this study that view becomes more precise and clear especially with regard to Field-Marshal Mannerheim and other high military leaders. There is clear indication that the Finns would have attacked much further east had a German success made such an attack possible.

Suomalaiset antisankarit : Suomalaisuusdiskurssi kolmessa 1980-luvun elokuvassa

Tutkimuksen aiheena on suomalaisuusdiskurssi elokuvissa Täältä tullaan, elämä! (1980, ohjaus Tapio Suominen), Ajolähtö (1982, ohjaus Mikko Niskanen) ja Arvottomat (1982, ohjaus Mika Kaurismäki). Tutkimuksen kohteena ovat elokuvien sisältö ja aikalaisten lehdistöarviot elokuvista. Elokuvia analysoidaan kahdella tasolla: pintatasolla jossa tutkitaan elokuvien kerrontaa ja tyyliä ja syvemmällä tasolla, jossa tutkitaan elokuvien merkitysrakenteita semiotiikan ja analyyttisen psykologian keinoin. Elokuvatekstien pintatason tutkimuksessa käytän päälähteenä David Bordwellin ja Kirstin Thompsonin kirjaa Film Art: An Introduction (1990, 3. ed.). Merkitysrakenteiden analyysissa käytän Algirdas Julien Greimasin semanttista neliötä ja aktanttikaavaa ja Ronald Barthesin teorioita kirjasta Mytologioita (1957/1994). Elokuvien sankaruuden tutkimisessa sovelletaan Carl Gustav Jungin teorioita kollektiivisesta alitajunnasta ja sankarin arkkityypistä. Suomalaisuusdiskurssin analyysissa käytän pohjana Michel Foucaultin teosta The Archaeology of knowledge (1972/1985) ja samaa teokseen teoreettisesti paljolti pohjautuvaa Päivi Rantasen teosta Suolatut säkeet. Suomen ja suomalaisten diskursiivinen muotoutuminen 1600-luvulta Topeliukseen (1997). Rantasen teos tuo tutkittavien elokuvien suomalaisuusdiskurssin analyysiin historiallista perspektiiviä. Kontekstina elokuva-analyyseille tarkastelen myös elokuvateollisuuden rakennemuutoksia 1980-luvulla ja elokuva-arvosteluja. Suomalaisuusdiskurssi korostuu elokuvien sovittamattomissa ristiriidoissa. Elokuvien kerronnan ja tyylin, narratiivisen merkitysrakenteen ja jungilaisen analyysin tutkimustuloksina on, että elokuvien sisäisistä ristiriidoista voi havaita suomalaisuusdiskurssin pyrkimystä muutokseen. Elokuvien realistisuus sitoo elokuvia perinteiseen topeliaanis-runebergiläiseen suomalaisuuteen, mutta elokuvissa on myös uudenlaisia suomalaisuustulkintoja jotka tulevat ilmi päähenkilöiden toiminnan kautta. Elokuvien analyysi osoittaa, että elokuvien suomalaisuusdiskurssi ei ole vielä valmis täysin sisäistämään muun muassa kansainvälistymistä (Ajolähtö) ja yksilöllisempää suomalaisuutta (Täältä tullaan, elämä! ja Arvottomat). Tarve uudenlaiseen suomalaisuuden määrittelyyn kuitenkin näkyy sekä elokuvateksteissä että elokuva-arvosteluissa. Tutkimusta voisi jatkaa analysoimalla eri aikakausien elokuvia ja vertailemalla niiden suomalaisuusdiskurssia toisiinsa.

How Jung's concept of the wounded healer can guide learning and teaching in social work and human services

The concept of the “wounded healer” has been used to explain why those with adverse childhood histories often enter helping professions such as social work and human services (SWHS). Psychotherapist Carl Jung (1875–1961) believed wounded healers developed insight and resilience from their own experiences, enabling transformative interventions to occur with clients. Concerns exist that students with adverse childhood histories in SWHS may display unresolved emotional issues. This journal article explores how Jung’s interpretation of the wounded healer can be critically applied to understanding the learning needs of SWHS students with histories of abuse, neglect or other childhood adversity. The relevance of the wounded healer to SWHS education is explored in three key areas: - 1) the increased possibility of the occurrence of countertransference; - 2) the potential for vicarious traumatisation and burnout, and; - 3) personal and professional resilience displayed by SWHS students with a history of childhood adversity. The wounded healer metaphor allows for a more nuanced understanding of SWHS students with these histories. It also provides insight into the pedagogical considerations associated with teaching this student cohort.

Freddy Godshaw (Gottschalk) with his friend Peter Zander celebrating their shared birthday; Cellerina, Switzerland.

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Portrait of Elly Schoenbeck; Cologne, Germany.

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Studio portrait of Fritz Gottschalk as a young man; Hannover, Germany.

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Liederkranz trip to Hundseck Portraits Groups

Liederkranzausflug nach Hundseck; Standing l-r; Sidi Ullmann, Ehepaar, Alfred und Toni Hirschland, Willi Ullmann, Lisel Suess, Lene Hesse-Sinzheimer, Julius Suess, ?, Hermann Boehm, Eugen Hirsch, Dr. Carl Kahn, Frau von Michael Rothschild (Ella?), Max Sinzheimer, Grete Hirschland and Alfred Liebmann ; Seated l-r: Adele Boehm, Michael Rothschild, rosel Suess, Louis Kahn (Junior), Ehepaar Dr. Gustav Hecht, Paula Hirsch and Marianne Kahn

Maximising Revenue within the NT Mud Crab Fishery by Enhancing Post-Harvest Survival of Mud Crabs

Identifying the stress factors imposed on mud crab to develop stress minimisation practices for improving survival, hence increasing revenue for the industry.