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.

Structure of 5'-O-acetyl-2',3'-O-isopropylideneuridine, C14H18N2O7

M r = 326.3, monoclinic, P21, a --= 6.510 (2), b=8.432 (2), c= 15.114 (2),a, /~= 101.42 (3) ° , Z = 2, V= 813.15 A 3, D x = 1-33 Mg m -3, F(000) = 172, 2(Cu Ka) = 1.5418/~,, g(Cu Ka) = 0.906 mm -~, final R = 6.4% for 1924 observed counter reflections. The conformation about the glycosidic bond is syn [torsion angle C(6)-N(1)-C(1')-O(4')=-103.9(3)°]. The sugar pucker is C(2')-exo,C(3')-endo (3Tz). The conformation about the C(4')-C(5') bond is gauche-trans. An uncommon intermolecular hydrogen bond involving the ribose-ring oxygen O(1') and the base-nitrogen N(3) stabilizes the crystal structure.

para-Nitrophenoxyacetamide

CsHsN204, M r = 197.2, monoclinic, P21/e , a= 7.818 (2), b= 7.589 (2), e= 14.790 (2)A, t= 98.43 (2) °, V= 868.02/k 3, Z = 4, D m = 1.506 (3), Dx= 1.501Mgm -3, MoKa, 2=0.7107/~, #= 0-79 mm -1, F(000) = 408, T= 426 (1) K, final R = 0.0507 for 798 observed reflections [I_> 2e(/)]. The molecules are hydrogen bonded: N-H...O = 2.886 (3), N--H = 0.97 (7), H--O = 1.92 (6) A, N-- H...O angle = 175.5 (8) °.

Patterns of Transcendence : Classical Myth in Marina Tsvetaeva's Poetry of the 1920s

This study examines the position and meaning of Classical mythological plots, themes and characters in the oeuvre of the Russian Modernist poet Marina Tsvetaeva (1892-1941). The material consists of lyric poems from the collection Posle Rossii (1928) and two longer lyrical tragedies, Ariadna (1924) and Fedra (1927). These works are examined in the context of Russian Modernism and Tsvetaeva s own poetic development, also taking into account the author s biography, namely, her correspondence with Boris Pasternak. Tsvetaeva s appropriations of the myths enter into a dialogue with the Classical tradition and with the earlier Russian and Western literary manifestations of the source material. Her Classical texts are inextricably linked with her own authorial myth, they are used to project both her ideas about poetry as well as the authored self of her poems. An important context for Tsvetaeva s application of the Classical myths is the concept of the Platonic ladder of Eros. This plot evokes the process of transcendence of the mortal subject into the immaterial realm and is applied by the author as an extended metaphor of the poet s birth. Emphasizing the dialectical movement between the earthly and the divine, Tsvetaeva s Classical personae foreground various positions of the individual between these two realms. By means of kaleidoscopic reformulations of similar metaphors and concepts, Tsvetaeva s mythological poems illustrate the poet s position between the material and the immaterial and the various consequences of this dichotomy on the creative mission. At the heart of Tsvetaeva s appropriation of the Sibyl, Phaedra, Eurydice and Ariadne is the tension between the body and disembodiment. The two lyrical tragedies develop the dichotomous worldview further, nevertheless emphasizing the dual perspective of the divine and the earthly realms: immaterial existence is often evaluated from a material perspective and vice versa. The Platonic subtext is central for Ariadna, focussing on Theseus development from an earthly hero to a spiritual one. Fedra concentrates on Phaedra s divinely induced physical passion, which is nevertheless evoked in a creative light.

Arkeen pudonnut sibylla : Modernin naisen identiteetin rakentuminen Marja-Liisa Vartion romaanissa Kaikki naiset näkevät unia

A Sibyl fallen into everyday life. The enfolding of the identity of modern woman in Marja- Liisa Vartio s novel Kaikki naiset näkevät unia ( All Women Have Dreams ). --- Marja-Liisa Vartio played a remarkable part in renewing Finnish literature. My thesis examines her novel Kaikki naiset näkevät unia (1960), which describes the life of a middle-aged housewife, Mrs. Pyy ( Mrs. Hazel Hen ). She has moved from country to city and lives now in a suburb, in the Helsinki of the 1950 s. In Finnish literature, the novel is the first significant description of a modern city woman accomplished by modernistic means. My research examines the identity of a woman in the Finland of the 50 s, an epoch marked by the inevitable transition into modernity. My aim is to look into the ways in which the female identity enfolds in Kaikki naiset näkevät unia, how it takes its form, how it is described and commented. The primary method is contextual close reading; the novel is seen in the social, cultural and historical context of the time it was published. Essential elements in this study are literary motifs and images in the novel, and particularly transtextual relations as defined by Gérald Genette. The focus is on hypertextuality, intertextuality and paratextuality. Kaikki naiset näkevät unia emerges as a modern version of Madame Bovary by Gustave Flaubert. A woman s life spent in illusive dreaming is transferred from a 1900th century bourgeois town in France to a middle class Finnish suburb in the 1950 s. Vartio s novel is a variant of an ancient Finnish ballad I, a bird without a nest , making it into a modern narration of transition. The inner, mental journey from country to city is of great length, and the liminal life in a suburb does not make the passage any easier. Like the lyrical voices in the poetry of Edith Södergran, also Mrs. Pyy finds it hard to discover any values of sisterhood or those of ideal femininity in modern times. In earlier studies of Marja-Liisa Vartio s prose, stress has been laid on the discourse of her narrators and characters, as well as on its modern literary form. In this research, however, urgent allusions to paintings, old and new, are taken into account, since Mrs. Pyy mirrors herself against art, both classical and modern. Principal images in this context are Michelangelo s Sibyls in the ceiling of the Sistine Chapel, and a modern painting, which remains unidentified. Mrs. Pyy turns out to be a tragicomic character, who has magnanimous illusions about herself, but is compelled to accept the fact the she is only a mediocre person. She is nothing more than a first generation city dweller; she is not a modern, aloof outsider but a mere dilettante, who desperately tries to live out modern city life. Kaikki naiset näkevät unia is a striking picture of the 1950 s, a picture that is construed in the consciousness of Mrs. Pyy. We are shown everyday life growing more and more modern after the war and woman s role growing more and more subject to increasing pressure for change.

Maaseutuopistoista Yliopistoon : Maatalous- ja metsätieteiden tutkimus- ja opetustoiminnan akatemisoitumisprosessi Helsingin Yliopistossa vuoteen 1945

From Provincial Institutes to the University. The Academisation Process of the Research and Teaching of Agricultural and Forest Sciences at the University of Helsinki before 1945. This study focuses on the teaching and research conducted in the Faculty of Agriculture and Forestry at the University of Helsinki, as well as in its predecessor, the Section of Agriculture and Economics before 1945. The study falls into the field of university history. Its key research question is the academisation process, an example of which is the academisation process of the teaching and research of agricultural and forest sciences in Finland. From a perspective of university history, the study looks at academisation as the beginning of university-level teaching and research in these fields, or their relocation to a university or another institute of university standing. In addition to the above, the academisation process also includes the establishment of the position of the subjects and their acceptance as part of university activity. Academic closure, on the other hand, prevents the academisation of new subjects. In Finland, the preliminary stage of the academisation of the research and teaching of the agriculture and forestry was the Age of Utility, when questions concerning the subjects became part of clerical and civil service training at the Royal Academy of Turku in the mid-18th century. In the mid-19th century, as a result of social and economic development, agricultural and forestry professionals needed more theoretical professional training. At that time, the Imperial Alexander University was focused on traditional professional training and theoretical education, so, because of this academic closure, practical training for agronomists and foresters was organised at first outside the University at the Mustiala Agricultural Institute and the Evo Forest Institute. In the late 19th century, discussion began on the reform of higher agricultural and forestry education. This led, from the 1890s, to the academisation of higher agricultural and forestry education and research at the Alexander University. Academisation was followed by a transitional stage, during which the work of the Section of Agriculture and Economics, which had begun in 1902, became more established in about 1910. The position of the agricultural and forest sciences was, however, largely temporary, because of the planned Agricultural University. A sign of this establishment and of the rise in scientific status of the subjects was the commencement of operations of the Faculty of Agriculture and Forestry in 1924. Furthermore, as a consequence of the development of the subjects and the collapse of the Agricultural University project, agricultural and forest sciences gradually began to be accepted at the University of Helsinki from the end of the 1920s. This led to the allocation of sites for the faculty buildings and research farms, and to the building of ‘Metsätalo’ before the Second World War. Key words: academisation, academisation process, academic closure, university history, University of Helsinki, Faculty of Agriculture and Forestry, agricultural sciences, forest sciences, agronomy training, forestry training

Mexican Workers in the United States Labour Market: A Contemporary Dilemma

"Ever since the present political boundary separating Mexico and the United States was established in 1848 by the Treaty of Guadalupe Hidalgo and partially amended in 1853 by the Gadsden Purchase, there has been migration of Mexican citizens into the United States. In fact the border between the two nations was completely open until, with the passage of the Immigration Act of 1924, the Border Patrol was established and it became a felony to enter the United States illegally. No quota, however, was applied to immigration from Mexico until 1968. During that year legislation became effective which restricted total annual immigration from all Western Hemisphere nations to 120,000, with a maximum of 40,000 from any one country. Both these figures are regularly exceeded. In 1973, for instance, there were 173,123 legal immigrants from all Western Hemisphere nations, including 70,141 Mexicans. That the real flow exceeds the quotas is explained by the numerous exemptions allowed. With the exception of only three years since 1960, legal immigration from Mexico to the United States has exceeded that of every other nation in the world."

Key participants in the International Peace Conference; Berlin Portraits Groups

Seated second from left Fritjof Nansen; Standing third from left Mme Menard-Dorney?; Seated far right Ludwig Quidde; Seated forefront Ferdinand Buisson

Potential of piperonyl butoxide-synergised pyrethrins against psocids (Psocoptera: Liposcelididae) for stored-grain protection.

BACKGROUND: Piperonyl butoxide (PB)-synergised natural pyrethrins (pyrethrin:PB ratio 1:4) were evaluated both as a grain protectant and a disinfestant against four Liposcelidid psocids: Liposcelis bostrychophila Badonnel, L. entomophila (Enderlein), L. decolor (Pearman) and L. paeta Pearman. These are key storage pests in Australia that are difficult to control with the registered grain protectants and are increasingly being reported as pests of stored products in other countries. Firstly, mortality and reproduction of adults were determined in wheat freshly treated at 0.0, 0.75, 1.5, 3 and 6 mg kg-1 of pyrethrins + PB (1:4) at 301C and 702% RH. Next, wheat treated at 0.0, 1.5, 3 and 6 mg kg-1 of pyrethrins + PB (1:4) was stored at 301C and 702% RH and mortality and reproduction of psocids were assessed after 0, 1.5, 3 and 4.5 months of storage. Finally, the potential of synergised pyrethrins as a disinfestant was assessed by establishing time to endpoint mortality for adult psocids exposed to wheat treated at 3 and 6 mg kg-1 of synergised pyrethrins after 0, 3, 6, 9 and 12 h of exposure. RESULTS: Synergised pyrethrins at 6 mg kg-1 provided 3 months of protection against all four Liposcelis spp., and at this rate complete adult mortality of these psocids can be achieved within 6 h of exposure. CONCLUSION: Piperonyl butoxide-synergised pyrethrins have excellent potential both as a grain protectant and as a disinfestant against Liposcelidid.

Wedding portrait of Kurt Godshaw (Gottschalk) and Edith Godshaw nee Osterer; Quito, Ecuador. Portraits Couples

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Kurt and Edith Godshaw (Gottschalk) nee Osterer during a visit with Maren Matthiesen; Switzerland.

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Outdoor portrait of Peter Molling and Andree Molling nee Baer; Geneva, Switzerland.

Peter Molling (1924-1965) and Andree Mollling born Baer on the occasion of their engagement in Geneva, Switzerland in 1950

Studio portrait of Louis Gottschalk.

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