A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: A systematic analysis for the Global Burden of Disease Study 2010

BACKGROUND Quantification of the disease burden caused by different risks informs prevention by providing an account of health loss different to that provided by a disease-by-disease analysis. No complete revision of global disease burden caused by risk factors has been done since a comparative risk assessment in 2000, and no previous analysis has assessed changes in burden attributable to risk factors over time. METHODS We estimated deaths and disability-adjusted life years (DALYs; sum of years lived with disability [YLD] and years of life lost [YLL]) attributable to the independent effects of 67 risk factors and clusters of risk factors for 21 regions in 1990 and 2010. We estimated exposure distributions for each year, region, sex, and age group, and relative risks per unit of exposure by systematically reviewing and synthesising published and unpublished data. We used these estimates, together with estimates of cause-specific deaths and DALYs from the Global Burden of Disease Study 2010, to calculate the burden attributable to each risk factor exposure compared with the theoretical-minimum-risk exposure. We incorporated uncertainty in disease burden, relative risks, and exposures into our estimates of attributable burden. FINDINGS In 2010, the three leading risk factors for global disease burden were high blood pressure (7·0% [95% uncertainty interval 6·2-7·7] of global DALYs), tobacco smoking including second-hand smoke (6·3% [5·5-7·0]), and alcohol use (5·5% [5·0-5·9]). In 1990, the leading risks were childhood underweight (7·9% [6·8-9·4]), household air pollution from solid fuels (HAP; 7·0% [5·6-8·3]), and tobacco smoking including second-hand smoke (6·1% [5·4-6·8]). Dietary risk factors and physical inactivity collectively accounted for 10·0% (95% UI 9·2-10·8) of global DALYs in 2010, with the most prominent dietary risks being diets low in fruits and those high in sodium. Several risks that primarily affect childhood communicable diseases, including unimproved water and sanitation and childhood micronutrient deficiencies, fell in rank between 1990 and 2010, with unimproved water and sanitation accounting for 0·9% (0·4-1·6) of global DALYs in 2010. However, in most of sub-Saharan Africa childhood underweight, HAP, and non-exclusive and discontinued breastfeeding were the leading risks in 2010, while HAP was the leading risk in south Asia. The leading risk factor in Eastern Europe, most of Latin America, and southern sub-Saharan Africa in 2010 was alcohol use; in most of Asia, North Africa and Middle East, and central Europe it was high blood pressure. Despite declines, tobacco smoking including second-hand smoke remained the leading risk in high-income north America and western Europe. High body-mass index has increased globally and it is the leading risk in Australasia and southern Latin America, and also ranks high in other high-income regions, North Africa and Middle East, and Oceania. INTERPRETATION Worldwide, the contribution of different risk factors to disease burden has changed substantially, with a shift away from risks for communicable diseases in children towards those for non-communicable diseases in adults. These changes are related to the ageing population, decreased mortality among children younger than 5 years, changes in cause-of-death composition, and changes in risk factor exposures. New evidence has led to changes in the magnitude of key risks including unimproved water and sanitation, vitamin A and zinc deficiencies, and ambient particulate matter pollution. The extent to which the epidemiological shift has occurred and what the leading risks currently are varies greatly across regions. In much of sub-Saharan Africa, the leading risks are still those associated with poverty and those that affect children.

Children's literature and the environment

Fiction offers creative and imaginative scenarios and solutions that may stimulate young people to consider their own relationship with the environment. Literature for young people also offers insights into ecocatastrophe, anthropocentrism, sustainability, and other important issues. A further significance of this project is that it aligns with the cross-curriculum priority of the Australian Curriculum, namely ‘sustainability’. The 'Children's Literature and the Environment' project in AustLit includes a variety of bibliographic records (fiction, information books, film, poetry, and multimedia) relevant to children and young adults that deal with the environment in imaginative, scientific, educational, and creative ways, which culminates in an online exhibition. There are a number of components clustered around key concepts and issues, such as sustainability, urban environments, and Indigenous perspectives. This exhibition allows researchers and students to access and engage with bibliographical data on a range of literary and critical texts that provide various environmental perspectives over a significant period of time.

Using academagogy to meet the needs of millennial learners: A comparative case study

Higher education institutions across the world are experiencing a new generation of students, known as millennial learners. They are more technologically literate and digitally connected than previous generations of learners. To meet the teaching and learning needs of these learners, we must offer more deliberate and meaningful learning experiences and opportunities, where students can see the connections between new material and their own experiences and real world applications – an academagogic approach. This study compares the implementation of academagogy for two different groups of millennial learners – one a traditional face-to-face undergraduate Engineering unit, and the other a mixed-mode (online and face-to-face) undergraduate Design unit. The units are discussed in terms of their student evaluation results, both qualitative and quantitative, and in terms of their academic outcomes for students. Conclusions are drawn about the applicability of academagogy as a heuristic for improving teaching and learning across disciplines, as well as its strengths and limitations in terms of student results.

A roadmap for interpreting the literature on vision and driving

Over the past several decades there has been a sharp increase in the number of studies focused on the relationship between vision and driving. The intensified attention to this topic has most likely been stimulated by the lack of an evidence basis for determining vision standards for driving licensure and a poor understanding about how vision impairment impacts driver safety and performance. Clinicians depend on the literature on vision and driving to advise visually impaired patients appropriately about driving fitness. Policy makers also depend on the scientific literature in order to develop guidelines that are evidence-based and are thus fair to persons who are visually impaired. Thus it is important for clinicians and policy makers alike to understand how various study designs and measurement methods should be interpreted so that the conclusions and recommendations they make are not overly broad, too narrowly constrained, or even misguided. We offer a methodological framework to guide interpretations of studies on vision and driving that can also serve as a heuristic for researchers in the area. Here, we discuss research designs and general measurement methods for the study of vision as they relate to driver safety, driver performance, and driver-centered (self-reported) outcomes.

Comparative durability study of CFRP strengthened tubular steel members under cold weather

In strengthening systems, the CFRP (Carbon Fibre Reinforced Polymer) materials typically have excellent resistance against environmental conditions; however, the performance of adhesives between CFRP and steel is generally affected by various environmental conditions such as marine environment, cold and hot weather. This paper presents the comparative durability study of CFRP strengthened tubular steel structures by using two different adhesives such as MBrace saturant and Araldite K630 under four-point bending. The program consisted of testing twelve CFRP strengthened specimens having treated with epoxy based adhesion promoter, untreated surface and one unstrengthened specimen and conditioned under cold weather for 3 and 6 months to determine the environmental durability. The beams were then loaded to failure in quasi-static manner under four-point bending. The structural responses of CFRP strengthened tubular steel beams were compared in terms of failure load, stiffness and modes of failure. The research findings show that the cold weather immersion had adversely affected the durability of CFRP strengthened steel members. Design factor is also proposed to address the short-terms durability performance under cold weather.

Wastewater pollution abatement in China: A comparative study of fifteen industrial sectors from 1998 to 2010

This study analyzes the management of wastewater pollutants in a number of Chinese industrial sectors from 1998 to 2010. We use decomposition analysis to calculate changes in wastewater pollutant emissions that result from cleaner production processes, end-of-pipe treatment, structural changes in industry, and changes in the scale of production. We focus on one indicator of water quality and three pollutants: chemical oxygen demand (COD), petroleum, cyanide, and volatile phenols. We find that until 2002, COD emissions were mainly reduced through end-of-pipe treatments. Cleaner production processes didn’t begin contributing to COD emissions reductions until the introduction of a 2003 law that enforced their implementation. Petroleum emissions were primarily lowered through cleaner production mechanisms, which have the added benefit of reducing the input cost of intermediate petroleum. Diverse and effective pollution abatement strategies for cyanide and volatile phenols are emerging among industries in China. It will be important for the government to consider differences between industries should they choose to regulate the emissions of specific chemical substances.

Comparative analysis reveals loss of the appetite-regulating peptide hormone ghrelin in falcons

Ghrelin and leptin are key peripherally secreted appetite-regulating hormones in vertebrates. Here we consider the ghrelin gene (GHRL) of birds (class Aves), where it has been reported that ghrelin inhibits rather than augments feeding. Thirty-one bird species were compared, revealing that most species harbour a functional copy of GHRL and the coding region for its derived peptides ghrelin and obestatin. We provide evidence for loss of GHRL in saker and peregrine falcons, and this is likely to result from the insertion of an ERVK retrotransposon in intron 0. We hypothesise that the loss of anorexigenic ghrelin is a predatory adaptation that results in increased food-seeking behaviour and feeding in falcons.

Criteria for interpreting kimberlite as coherent: Insights from the Muskox and Jericho kimberlites (Nunavut, Canada)

The Jurassic Muskox and Jericho kimberlites (Northern Slave Province, Nunavut, Canada) contain a variety of facies exhibiting different geometries, contact relationships, internal organisation, country rock abundance and olivine shapes, although many have similar matrix/groundmass mineralogies and textures. Five facies are examined that either have characteristics consistent with coherent rocks in general (i.e. intrusive and extrusive non-fragmental rocks) or are mineralogically and texturally similar to kimberlite described as coherent (or apparent coherent). Three facies are interpreted as coherent on the basis of: (1) geological setting, (2) apparent-porphyritic texture, (3) sharp contacts with fragmental kimberlite, (4) relative abundance of elongate and unbroken olivine crystals and (5) paucity of country rock xenoliths, while the remaining two facies are interpreted as fragmental on the basis of: (1) the gradational contacts with demonstrably fragmental kimberlite, (2) relative abundance and range of sizes of country rock lithic clasts and (3) numerous broken olivine crystals. Comparisons are made with coherent and apparent-coherent kimberlite from the literature. Our three coherent facies are similar to literature reported coherent kimberlite dykes hosted in country rock (CKd) in terms of internal organisation, low abundance of country rock xenoliths, and apparent-porphyritic texture. Conversely, our two fragmental facies share attributes with previously described pipe-filling coherent and apparent-coherent kimberlite (CKpf) in terms of geometry, internal organisation and abundance of country rock xenoliths. We conclude that CKd and most CKpf, although similar in matrix/groundmass mineralogy and texture, can be distinguished on the basis of internal organisation, country rock lithic clast abundance, texture (e.g. apparent-porphyritic texture) and possibly olivine crystal shapes and suggest that fragmental kimberlite is more common than reported.

Positioning as a source of competitive advantage: Benchmarking Rotorua’s position as a domestic short break holiday destination

Travellers are spoilt by holiday choice, and yet will usually only seriously consider a few destinations during the decision process. With thousands of destination marketing organisations (DMOs) competing for attention, places are becoming increasingly substitutable. The study of destination competitiveness is an emerging field, and thesis contributes to an enhanced understanding by addressing three topics that have received relatively little attention in the tourism literature: destination positioning, the context of short break holidays, and domestic travel in New Zealand. A descriptive model of positioning as a source of competitive advantage is developed, and tested through 12 propositions. The destination of interest is Rotorua, which was arguably New Zealand’s first tourist destination. The market of interest is Auckland, which is Rotorua’s largest visitor market. Rotorua’s history is explored to identify factors that may have contributed to the destination’s current image in the Auckland market. A mix of qualitative and quantitative procedures is then utilised to determine Rotorua’s position, relative to a competing set of destinations. Based on an applied research problem, the thesis attempts to bridge the gap between academia and industry by providing useable results and benchmarks for five regional tourism organisations (RTOs). It is proposed that, in New Zealand, the domestic short break market represents a valuable opportunity not explicitly targeted by the competitive set of destinations. Conceptually, the thesis demonstrates the importance of analysing a destination’s competitive position, from the demand perspective, in a travel context; and then the value of comparing this ‘ideal’ position with that projected by the RTO. The thesis concludes Rotorua’s market position in the Auckland short break segment represents a source of comparative advantage, but is not congruent with the current promotional theme, which is being used in all markets. The findings also have implications for destinations beyond the context of the thesis. In particular, a new definition for ‘destination attractiveness’ is proposed, which warrants consideration in the design of future destination positioning analyses.

Nurses' accountability for stroke quality of care: part one: Review of the literature on nursing-sensitive patient outcomes

Over the past decade, an exciting area of research has emerged that demonstrates strong links between specific nursing care activities and patient outcomes. This body of research has resulted in the identification of a set of "nursing-sensitive outcomes"(NSOs). These NSOs may be interpreted with more meaning when they are linked to evidence-based best practice guidelines, which provide a structured means of ensuring care is consistent among all health care team members, across geographic locations, and across care settings. Uptake of evidence-based best practices at the point of care has been shown to have a measurable positive impact on processes of care and patient outcomes. The purpose of this paper is to present a systematic, narrative review of the literature regarding the clinical effectiveness of nursing management strategies on stroke patient outcomes sensitive to nursing interventions. Subsequent investigation will explore current applications of nursing-sensitive outcomes to patients with stroke, and identify and validate measurable NSOs within stroke care delivery.

Quality of life and caregiver outcomes following decompressive hemicraniectomy for severe stroke: A narrative literature review

AIMS The aim of this narrative review of the literature was to examine the current state of knowledge regarding the impact of aggressive surgical interventions for severe stroke on patient and caregiver quality of life and caregiver outcomes. BACKGROUND Decompressive hemicraniectomy (DHC) is a surgical therapeutic option for treatment of massive middle cerebral artery infarction (MCA), lobar intracerebral hemorrhage (ICH), and severe aneurysmal subarachnoid hemorrhage (aSAH). Decompressive hemicraniectomy has been shown to be effective in reducing mortality in these three life-threatening conditions. Significant functional impairment is an experience common to many severe stroke survivors worldwide and close relatives experience decision-making difficulty when confronted with making life or death choices related to surgical intervention for severe stroke. DATA SOURCES Academic Search Premier, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline, and PsychInfo. REVIEW METHODS A narrative review methodology was utilized in this review of the literature related to long-term outcomes following decompressive hemicraniectomy for stroke. The key words decompressive hemicraniectomy, severe stroke, middle cerebral artery stroke, subarachnoid hemorrhage, lobar ICH, intracerebral hemorrhage, quality of life, and caregivers, literature review were combined to search the databases. RESULTS Good functional outcomes following DHC for life-threatening stroke have been shown to be associated with younger age and few co-morbid conditions. It was also apparent that quality of life was reduced for many stroke survivors, although not assessed routinely in studies. Caregiver burden has not been systematically studied in this population. CONCLUSION Most patients and caregivers in the studies reviewed agreed with the original decision to undergo DHC and would make the same decision again. However, little is known about quality of life for both patients and caregivers and caregiver burden over the long-term post-surgery. Further research is needed to generate information and interventions for the management of ongoing patient and carer recovery following DHC for severe stroke.

Habitus realisation: Negotiating identities through Chinese looks and Chinese language

The increasing linguistic and cultural diversity of our contemporary world points to the salience of maintaining and developing Heritage Language of ethnic minority groups. The mutually constitutive effect between Heritage Language learning and ethnic identity construction has been well documented in the literature. Classical social psychological work often quantitatively structures this phenomenon in a predictable linear relationship. In contrast, poststructural scholarship draws on qualitative approaches to claim the malleable and multiple dynamics behind the phenomenon. The two schools oppose but complement each other. Nevertheless, both schools struggle to capture the detailed and nuanced construction of ethnic identity through Heritage Language learning. Different from the extant research, we make an attempt to ethno-methodologically unearth the nuisances and predicaments embedded in the reflexive, subtle, and multi-layered identity constructions through nuanced, inter-nested language practices. Drawing on data from the qualitative phase of a large project, we highlight some small but powerful moments abstracted from the interview accounts of five Chinese Australian young people. Firstly, we zoom in on the life politics behind the ‘seen but unnoticed’ stereotype that looking Chinese means being able to speak Chinese. Secondly, we speculate the power relations between the speaker and the listener through the momentary and inadvertent breaches of the taken-for-granted stereotype. Next, we unveil how learning Chinese has become an accountably rational priority for these young Chinese Australians. Finally, we argue that the normalised stereotype becomes visible and hence stable when it is breached – a practical accomplishment that we term ‘habitus realisation’.

Early onset dementia: A narrative review of the literature

Over the past forty years, significant research has been conducted on the epidemiology of late onset dementia. Less is known however, about the prevalence, incidence and burden of illness of early onset dementia (occurring prior to 65 years of age). The purpose of this narrative review is to examine existing literature regarding the experiences and implications of living with early onset dementia for patients, caregivers, and family members. The following questions were addressed: (1) What is the impact of early onset dementia on patients, families and carers? and; (2) What are the needs of patients with early onset dementia and their family and carers? Key findings form this review are presented.

The trajectory of minor stroke recovery for men and their female spousal caregivers: Literature review

Title The trajectory of minor stroke recovery for men and their female spousal caregivers: literature review Aim This paper is a report of a narrative review to examine the current state of knowledge regarding the impact of minor stroke on male patients and their female spousal caregivers’ recovery trajectory and quality of life. Background Minor stroke survivors are often discharged early in the recovery process. The perception of the healthcare community that these patients and their female spousal caregivers will experience an uneventful recovery may lead to inadequate preparation for the postdischarge period. Methods A range of databases was searched to identify papers addressing ‘minor stroke’, ‘transitions’, ‘quality of life’, ‘chronic disease’, ‘caregivers’ and ‘spouse caregivers’, including AARP Ageline, AMED, CINAHL, Evidence Based Medicine Reviews, MEDLINE and PsychInfo. Papers published in English from 1990 to December 2006 were included. Thirty-four papers were in the final data set. Results Minor stroke survivors and their female spousal caregivers may experience major challenges in adaptations postdischarge. The trajectory of minor stroke recovery may necessitate a re-evaluation of life plans, rethinking of priorities and integration of resulting disabilities into current and emerging life situations for both stroke survivors and their female spousal caregivers. In many cases these adaptations are compounded by transitions associated with the normal ageing process. Conclusion While there is extensive literature on stroke recovery and the role of caregivers in general, there is little available describing the recovery of minor stroke survivors in relation to the normal ageing process. Further research is needed examining recovery from a transitional perspective, to support nurses and other health professionals discharge planning.

Importance of literature profiling: An archival analysis with illustrative examples for IS researchers

The importance of a thorough and systematic literature review has long been recognised across academic domains as critical to the foundation of new knowledge and theory evolution. Driven by an exponentially growing body of knowledge in the IS discipline, there has been a recent influx of guidance on how to conduct a literature review. As literature reviews are emerging as a standalone research method in itself, increasingly these method focused guidelines are of great interest, receiving acceptance at top tier IS publication outlets. Nevertheless, the finer details which offer justification for the selected content, and the effective presentation of supporting data has not been widely discussed in these method papers to date. This paper addresses this gap by exploring the concept of ‘literature profiling’ while arguing that it is a key aspect of a comprehensive literature review. The study establishes the importance of profiling for managing aspects such as quality assurance, transparency and the mitigation of selection bias. And then discusses how profiling can provide a valid basis for data analysis based on the attributes of selected literature. In essence, this study has conducted an archival analysis of literature (predominately from the IS domain) to present its main argument; the value for literature profiling, with supporting exemplary illustrations.