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sex, and age group, and relative risks per unit of exposure by systematically reviewing and synthesising published and unpublished data.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.

Coming of Age in 9/11 Fiction: Bildungsroman and Loss of Innocence

Directly after the horrific events of September 11, 2001, many Americans were saying the same thing: the world has changed forever. They were overwhelmed with a sense that “the party was over.” It was clear that America had lost its innocence; it now had to “grow up.” Much of the fiction produced since 9/11 and with 9/11 at its core provides evidence of the larger cultural belief that September 11 was a turning point (much like adolescence) from which there is no turning back. In this chapter, I examine how three post-9/11 novels—Lorrie Moore’s A Gate at the Stairs, Joyce Maynard’s The Usual Rules, and John Updike’s Terrorist—position readers to understand September 11 as a moment that changed how young Americans come of age.

Numerical modeling of thin steel roof battens under wind uplift loads

Extreme wind events such as tropical cyclones, tornadoes and storms are more likely to impact the Australian coastal regions due to possible climate changes. Such events can be extremely destructive to building structures, in particular, low-rise buildings with lightweight roofing systems that are commonly made of thin steel roofing sheets and battens. Large wind uplift loads that act on the roofs during high wind events often cause premature roof connection failures. Recent wind damage investigations have shown that roof failures have mostly occurred at the batten to rafter or truss screw connections. In most of these cases, the screw fastener heads pulled through the bottom flanges of thin steel roof battens. This roof connection failure is very critical as both roofing sheets and battens will be lost during the high wind events. Hence, a research study was conducted to investigate this critical pull-through failure using both experimental and numerical methods. This paper presents the details of numerical modeling and the results.

Advance care planning in stroke: Influence of time on engagement in the process

Purpose Individuals who experience stroke have a higher likelihood of subsequent stroke events, making it imperative to plan for future medical care. In the event of a further serious health event, engaging in the process of advanced care planning (ACP) can help family members and health care professionals (HCPs) make medical decisions for individuals who have lost the capacity to do so. Few studies have explored the views and experiences of patients with stroke about discussing their wishes and preferences for future medical events, and the extent to which stroke HCPs engage in conversations around planning for such events. In this study, we sought to understand how the process of ACP unfolded between HCPs and patients post-stroke. Patients and methods Using grounded theory (GT) methodology, we engaged in direct observation of HCP and patient interactions on an acute stroke unit and two stroke rehabilitation units. Using semi-structured interviews, 14 patients and four HCPs were interviewed directly about the ACP process. Results We found that open and continual ACP conversations were not taking place, patients experienced an apparent lack of urgency to engage in ACP, and HCPs were uncomfortable initiating ACP conversations due to the sensitive nature of the topic. Conclusion In this study, we identified lack of engagement in ACP post-stroke, attributable to patient and HCP factors. This encourages us to look further into the process of ACP in order to develop open communication between the patient with stroke, their families, and stroke HCPs.

The legacy of David Unaipon

The historical case of David Unaipon is a good starting point for a wider discussion of Indigenous intellectual property law, practice and reform. His story is a microcosm of larger battles over the cultural appropriation of Indigenous culture, iconography and science. David Unaipon could be seen as a beneficiary of intellectual property law. He is a creator of copyright works; an inventor of patented inventions; and an iconic figure, worthy of personality rights. His creative and scientific work has been an inspiration for others. David Unaipon could also be seen as being disenfranchised by intellectual property law. He lost ownership of his economic rights in respect of literary works; and his moral rights have not been respected under copyright law. His case also highlights the deficiencies of copyright law in respect of its failure to provide comprehensive recognition of communal authorship and ownership of copyright works. While he was a patent applicant, David Unaipon never seemed to have benefitted from the patent system. His experience raises questions about access to justice. The government and commercial use of the persona of David Unaipon raises complex questions about trade mark law, passing off and personality rights. The story of David Unaipon highlights the need for the systematic and holistic reformation of intellectual property law, so that it better serves Indigenous communities and peoples.

A new method of detecting changes in corneal health in response to toxic insults

The size and arrangement of stromal collagen fibrils (CFs) influence the optical properties of the cornea and hence its function. The spatial arrangement of the collagen is still questionable in relation to the diameter of collagen fibril. In the present study, we introduce a new parameter, edge-fibrillar distance (EFD) to measure how two collagen fibrils are spaced with respect to their closest edges and their spatial distribution through normalized standard deviation of EFD (NSDEFD) accessed through the application of two commercially available multipurpose solutions (MPS): ReNu and Hippia. The corneal buttons were soaked separately in ReNu and Hippia MPS for five hours, fixed overnight in 2.5% glutaraldehyde containing cuprolinic blue and processed for transmission electron microscopy. The electron micrographs were processed using ImageJ user-coded plugin. Statistical analysis was performed to compare the image processed equivalent diameter (ED), inter-fibrillar distance (IFD), and EFD of the CFs of treated versus normal corneas. The ReNu-soaked cornea resulted in partly degenerated epithelium with loose hemidesmosomes and Bowman’s collagen. In contrast, the epithelium of the cornea soaked in Hippia was degenerated or lost but showed closely packed Bowman’s collagen. Soaking the corneas in both MPS caused a statistically significant decrease in the anterior collagen fibril, ED and a significant change in IFD, and EFD than those of the untreated corneas (p < 0.05, for all comparisons). The introduction of EFD measurement in the study directly provided a sense of gap between periphery of the collagen bundles, their spatial distribution; and in combination with ED, they showed how the corneal collagen bundles are spaced in relation to their diameters. The spatial distribution parameter NSDEFD indicated that ReNu treated cornea fibrils were uniformly distributed spatially, followed by normal and Hippia. The EFD measurement with relatively lower standard deviation and NSDEFD, a characteristic of uniform CFs distribution, can be an additional parameter used in evaluating collagen organization and accessing the effects of various treatments on corneal health and transparency.

The Down Under book and film remind us our copyright law’s still unfair for artists

Australian copyright law is broken, and the Australian Government isn’t moving quickly to fix it. Borrowing, quoting, and homage are fundamental to the creative process. This is how people are inspired to create. Under Australian law, though, most borrowing is copyright infringement, unless it is licensed or falls within particular, narrow categories. This year marks five years since the very real consequences of Australia’s restrictive copyright law for Australian artists were made clear in the controversial litigation over Men at Work’s 1981 hit Down Under. The band lost a court case in 2010 that found that the song’s iconic flute riff copied some of the 1934 children’s song Kookaburra Sits in the Old Gumtree. A new book and documentary tell us more about the story behind the anthem – and the court case. The book, Down Under by Trevor Conomy, and the documentary, You Better Take Cover by Harry Hayes, bring renewed interest and new perspectives on the tragic story.

Rainfall variability drives interannual variation in N2O emissions from a humid, subtropical pasture

Variations in interannual rainfall totals can lead to large uncertainties in annual N2O emission budget estimates from short term field studies. The interannual variation in nitrous oxide (N2O) emissions from a subtropical pasture in Queensland, Australia, was examined using continuous measurements of automated chambers over 2 consecutive years. Nitrous oxide emissions were highest during the summer months and were highly episodic, related more to the size and distribution of rain events than soil water content. Over 48% of the total N2O emitted was lost in just 16% of measurement days. Interannual variation in annual N2O estimates was high, with cumulative emissions increasing with decreasing rainfall. Cumulative emissions averaged 1826.7 ± 199.9 g N2O-N ha−1 yr−1 over the two year period, though emissions from 2008 (2148 ± 273 g N2O-N ha−1 yr−1) were 42% higher than 2007 (1504 ± 126 g N2O-N ha−1 yr−1). This increase in annual emissions coincided with almost half of the summer precipitation from 2007 to 2008. Emissions dynamics were chiefly driven by the distribution and size of rain events which varied on a seasonal and annual basis. Sampling frequency effects on cumulative N2O flux estimation were assessed using a jackknife technique to inform future manual sampling campaigns. Test subsets of the daily measured data were generated for the pasture and two adjacent land-uses (rainforest and lychee orchard) by selecting measured flux values at regular time intervals ranging from 1 to 30 days. Errors associated with weekly sampling were up to 34% of the sub-daily mean and were highly biased towards overestimation if strategically sampled following rain events. Sampling time of day also played a critical role. Morning sampling best represented the 24 hour mean in the pasture, whereas sampling at noon proved the most accurate in the shaded rainforest and lychee orchard.

Effect of nitrification inhibitors (DMPP and 3MP+ TZ) on soil nitrous oxide emissions from a sub-tropical vegetable production system in Queensland, Australia

The use of nitrification inhibitors, in combination with ammonium based fertilisers, has been promoted recently as an effective method to reduce nitrous oxide (N2O) emissions from fertilised agricultural fields, whilst increasing yield and nitrogen use efficiency. Vegetable cropping systems are often characterised by high inputs of nitrogen fertiliser and consequently elevated emissions of nitrous oxide (N2O) can be expected. However, to date only limited data is available on the use of nitrification inhibitors in sub-tropical vegetable systems. A field experiment investigated the effect of the nitrification inhibitors (DMPP & 3MP+TZ) on N2O emissions and yield from a typical vegetable production system in sub-tropical Australia. Soil N2O fluxes were monitored continuously over an entire year with a fully automated system. Measurements were taken from three subplots for each treatment within a randomized complete blocks design. There was a significant inhibition effect of DMPP and 3MP+TZ on N2O emissions and soil mineral N content directly following the application of the fertiliser over the vegetable cropping phase. However this mitigation was offset by elevated N2O emissions from the inhibitor treatments over the post-harvest fallow period. Cumulative annual N2O emissions amounted to 1.22 kg-N/ha, 1.16 kg-N/ha, 1.50 kg-N/ha and 0.86 kg-N/ha in the conventional fertiliser (CONV), the DMPP treatment, the 3MP+TZ treatment and the zero fertiliser (0N) respectively. Corresponding fertiliser induced emission factors (EFs) were low with only 0.09 - 0.20% of the total applied fertiliser lost as N2O. There was no significant effect of the nitrification inhibitors on yield compared to the CONV treatment for the three vegetable crops (green beans, broccoli, lettuce) grown over the experimental period. This study highlights that N2O emissions from such vegetable cropping system are primarily controlled by post-harvest emissions following the incorporation of vegetable crop residues into the soil. It also shows that the use of nitrification inhibitors can lead to elevated N2O emissions by storing N in the soil profile that is available to soil microbes during the decomposition of the vegetable residues over the post-harvest phase. Hence the use of nitrification inhibitors in vegetable systems has to be treated carefully and fertiliser rates need to be adjusted to avoid excess soil nitrogen during the postharvest phase.

The paradox of creative uncertainty in learning and teaching

In an ever-changing and globalised world there is a need for higher education to adapt and evolve its models of learning and teaching. The old industrial model has lost traction, and new patterns of creative engagement are required. These new models potentially increase relevancy and better equip students for the future. Although creativity is recognised as an attribute that can contribute much to the development of these pedagogies, and creativity is valued by universities as a graduate capability, some educators understandably struggle to translate this vision into practice. This paper reports on selected survey findings from a mixed methods research project which aimed to shed light on how creativity can be designed for in higher education learning and teaching settings. A social constructivist epistemology underpinned the research and data was gathered using survey and case study methods. Descriptive statistical methods and informed grounded theory were employed for the analysis reported here. The findings confirm that creativity is valued for its contribution to the development of students’ academic work, employment opportunities and life in general; however, tensions arise between individual educator’s creative pedagogical goals and the provision of institutional support for implementation of those objectives. Designing for creativity becomes, paradoxically, a matter of navigating and limiting complexity and uncertainty, while simultaneously designing for those same states or qualities.

Sport across cultures: Applications of the human capital model in refugee communities

When working with the world’s most vulnerable populations there are questions surrounding the salience of physical activity promotion programs given the multitude of basic needs that must first be met. Indeed, physical activity may be a low priority for individuals seeking safety, reunification with loved ones, and food for their families, as a subsistence lifestyle makes excess weight gain, diabetes, and cardiovascular disease irrelevant. Yet, when working with people from a refugee background for whom these challenges all too frequently apply, opportunities for sport and activity have repeatedly surfaced as desirable and needed, yet are utterly deficient. If we conceptualize physical activity purely as a chronic disease prevention tool, its significance within under-resourced communities is most assuredly lost; however, if we harness the power of physical activity to serve as an agent of positive social change, then it instantly becomes more meaningful and necessary.

Damned to fame: The moral rights of the Beckett estate

The Company B production of Samuel Beckett's Waiting for Godot raises important questions about copyright law, moral rights, and dramatic works. The playwright's nephew and executor, Edward Beckett, threatened to bring a legal action against the Sydney company for breach of contract on the grounds that unauthorised music appeared in the production. The Company B production denied that the contract made any such express provisions. The director Neil Armfield complained: 'In coming here with its narrow prescriptions, its dead controlling hand, the Beckett estate seems to me to be the enemy of art'. In the biography Damned to fame, James Knowlson documents a number of other proceedings taken by Beckett and his agents to control the productions of his work: 'He was often represented as a tyrannical figure, an arch-controller of his work, ready to unleash fiery thunderbolts onto the head of any bold, innovative director, unwilling to follow his text and stage directions to the last counted dot and precisely timed pause.' However, Knowlson notes that Beckett was inconsistent in his willingness to use legal action: 'It made a tremendous difference if he liked and respected the persons involved or if he had been able to listen to their reasons for wanting to attempt something highly innovative or even slightly different'. Famously, in 1988, Beckett brought legal action against a Dutch theatre company, which wanted to stage a production of Waiting for Godot, with women acting all the roles. His lawyer argued that the integrity of the text was violated because actresses were substituted for the male actors asked for in the text. The judge in the Haarlem court ruled that the integrity of the play had not been violated, because the performance showed fidelity to the dialogue and the stage directions of the play. By contrast, in 1992, a French court held a stage director was liable for an infringement of Beckett's moral right of integrity because the director had staged Waiting for Godot with the two lead roles played by women. In 1998, a United States production of Waiting for Godot with a racially mixed cast attracted legal threats amid accusations it had 'injected race into the play'. In the 2000 New York Fringe Festival, a company made light of this ongoing conflict between the Beckett estate and artistic directors. The work was entitled: The complete lost works of Samuel Beckett as found in an envelope (partially burned) in a dustbin in Paris labelled 'Never to be performed. Never. Ever. EVER! Or I'll sue! I'LL SUE FROM THE GRAVE!'. The plot concerned a fight between three producers and the Beckett estate. In the wake of such disputes, Beckett and later his estate sought to tighten production contracts to state that no additions, omissions or alterations should be made to the text of the play or the stage directions and that no music, special effects or other supplements should be added without prior consent.

Reality bites: When copyright law and reality cooking meet, only the lawyers win

There’s nothing new about this recipe for success: toss in high-stress scenarios, flavour generously with competitive chefs, and garnish with a panel of celebrity judges. With all major broadcasters in the country now dishing up some form of reality cooking programme, Australians could be forgiven for having lost any expectation of original TV material. But that didn’t stop Channel Seven from taking Channel Nine to court last week, arguing its copyright in My Kitchen Rules had been infringed with Nine’s latest prime-time effort, The Hotplate. After the first few episodes went to air, Seven asked for an injunction to stop Nine from broadcasting any more episodes of the reality show. So let’s look at some common confusions about copyright law and how it relates to reality television. Because in this context, copyright infringement isn’t about shows sharing major similarities, or about protecting ideas, but rather the expression of these ideas in the final product. Still, stretching copyright law to protect the “vibe” of a work isn’t good for artists, TV producers or viewers: copyright was designed to nurture creativity, not stifle it.

Assessing testamentary capacity – who does it better? Lawyers or doctors?

The effects of mentally disabling conditions on legal capacity are escalating, particularly given the ageing Australian demographic. Wills, enduring powers of attorney, and advance health directives are coming to the fore as a means of ensuring that the wishes of people with regard to their property, finances and health care needs are respected should they become legally incapable of making their own decisions. Assessing when a person has lost legal capacity in this context is an ever-increasing concern facing society as a whole but, in particular, the legal and medical professionals conducting the assessments. Empirical and doctrinal research has been undertaken which canvassed legal and medical opinions about the relationship between members of these professions when assessing legal capacity. This research supports the hypothesis that tensions exist when assessing capacity, especially testamentary capacity. One source of tension is the effect of conflicting evidence about the loss of legal capacity given by legal and medical professionals in court, which raises questions such as: which evidence is, and should be, preferred; and who should be responsible? The exploration of these issues will be conducted with reference to the empirical data collected, and a review of the relevant Australian case law.

The constraints of relevance on prevocational curriculum

This paper reflects on how relevance has been invoked as a curricular principle, both by students and teachers, in curriculum documents and in curriculum theory, to explore its variously conceived parameters and conditions. By posing the questions ‘relevant to whom?’, ‘relevant to what?’, ‘relevant how?’ and ‘relevant when?’ this paper exposes relevance as both a curricular virtue and a curricular constraint. It draws on an empirical project undertaken in the prevocational curriculum offered in Australia’s recently extended compulsory schooling for students in non-academic pathways. Data vignettes offer windows into two settings to exemplify the different ways relevance can be interpreted, stretched or contested. Using Bernstein’s distinction between vertical and horizontal discourses and knowledge structures, the analysis identifies what is gained and what is lost when relevance, variously defined, serves as a principle for curricular selection.