Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013

Background: Up-to-date evidence on levels and trends for age-sex-specific all-cause and cause-specific mortality is essential for the formation of global, regional, and national health policies. In the Global Burden of Disease Study 2013 (GBD 2013) we estimated yearly deaths for 188 countries between 1990, and 2013. We used the results to assess whether there is epidemiological convergence across countries. Methods We estimated age-sex-specific all-cause mortality using the GBD 2010 methods with some refinements to improve accuracy applied to an updated database of vital registration, survey, and census data. We generally estimated cause of death as in the GBD 2010. Key improvements included the addition of more recent vital registration data for 72 countries, an updated verbal autopsy literature review, two new and detailed data systems for China, and more detail for Mexico, UK, Turkey, and Russia. We improved statistical models for garbage code redistribution. We used six different modelling strategies across the 240 causes; cause of death ensemble modelling (CODEm) was the dominant strategy for causes with sufficient information. Trends for Alzheimer's disease and other dementias were informed by meta-regression of prevalence studies. For pathogen-specific causes of diarrhoea and lower respiratory infections we used a counterfactual approach. We computed two measures of convergence (inequality) across countries: the average relative difference across all pairs of countries (Gini coefficient) and the average absolute difference across countries. To summarise broad findings, we used multiple decrement life-tables to decompose probabilities of death from birth to exact age 15 years, from exact age 15 years to exact age 50 years, and from exact age 50 years to exact age 75 years, and life expectancy at birth into major causes. For all quantities reported, we computed 95% uncertainty intervals (UIs). We constrained cause-specific fractions within each age-sex-country-year group to sum to all-cause mortality based on draws from the uncertainty distributions. Findings Global life expectancy for both sexes increased from 65·3 years (UI 65·0-65·6) in 1990, to 71·5 years (UI 71·0-71·9) in 2013, while the number of deaths increased from 47·5 million (UI 46·8-48·2) to 54·9 million (UI 53·6-56·3) over the same interval. Global progress masked variation by age and sex: for children, average absolute differences between countries decreased but relative differences increased.For women aged 25-39 years and older than 75 years and for men aged 20-49 years and 65 years and older, both absolute and relative differences increased. Decomposition of global and regional life expectancy showed the prominent role of reductions in age-standardised death rates for cardiovascular diseases and cancers in high-income regions, and reductions in child deaths from diarrhoea, lower respiratory infections, and neonatal causes in low-income regions. HIV/AIDS reduced life expectancy in southern sub-Saharan Africa. For most communicable causes of death both numbers of deaths and age-standardised death rates fell whereas for most non-communicable causes, demographic shifts have increased numbers of deaths but decreased age-standardised death rates. Global deaths from injury increased by 10·7%, from 4·3 million deaths in 1990 to 4·8 million in 2013; but age-standardised rates declined over the same period by 21%. For some causes of more than 100 000 deaths per year in 2013, age-standardised death rates increased between 1990 and 2013, including HIV/AIDS, pancreatic cancer, atrial fibrillation and flutter, drug use disorders, diabetes, chronic kidney disease, and sickle-cell anaemias. Diarrhoeal diseases, lower respiratory infections, neonatal causes, and malaria are still in the top five causes of death in children younger than 5 years. The most important pathogens are rotavirus for diarrhoea and pneumococcus for lower respiratory infections. Country-specific probabilities of death over three phases of life were substantially varied between and within regions. Interpretation For most countries, the general pattern of reductions in age-sex specific mortality has been associated with a progressive shift towards a larger share of the remaining deaths caused by non-communicable disease and injuries. Assessing epidemiological convergence across countries depends on whether an absolute or relative measure of inequality is used. Nevertheless, age-standardised death rates for seven substantial causes are increasing, suggesting the potential for reversals in some countries. Important gaps exist in the empirical data for cause of death estimates for some countries; for example, no national data for India are available for the past decade.

A QoE centric distributed caching approach for vehicular video streaming in cellular networks

Distributed caching-empowered wireless networks can greatly improve the efficiency of data storage and transmission and thereby the users' quality of experience (QoE). However, how this technology can alleviate the network access pressure while ensuring the consistency of content delivery is still an open question, especially in the case where the users are in fast motion. Therefore, in this paper, we investigate the caching issue emerging from a forthcoming scenario where vehicular video streaming is performed under cellular networks. Specifically, a QoE centric distributed caching approach is proposed to fulfill as many users' requests as possible, considering the limited caching space of base stations and basic user experience guarantee. Firstly, a QoE evaluation model is established using verified empirical data. Also, the mathematic relationship between the streaming bit rate and actual storage space is developed. Then, the distributed caching management for vehicular video streaming is formulated as a constrained optimization problem and solved with the generalized-reduced gradient method. Simulation results indicate that our approach can improve the users' satisfaction ratio by up to 40%.

Responsibility for racism in the everyday talk of secondary students

This article examines the attributions of responsibility for racism in the everyday talk of secondary school students. It draws on focus groups with a cross section of students from different ethnic backgrounds in three, very different, secondary schools. In these focus groups, students deploy six different, sometimes contradictory, racialised discourses. Each discourse attributes responsibility for racism in very different ways that testify to the immanence of the past in the present and students’ positioning in specific social and political conditions. In all but one instance, these discourses work to dismiss, deny and/or deflect responsibility for racism by averting responsibility from the self to other individuals, groups or entities. The empirical data, it is argued, show that the individualisation of responsibility for racism has not seeped its way into students’ race-thinking. This testifies to the persistence of race-thinking, the difficult challenge of finding non-racist ways of being in the world, and cautions against assuming that responsibilisation is a universal descriptor of all contemporary social relations.

Support for assessment practice: developing the assessment design decisions framework

There are many excellent publications outlining features of assessment and feedback design in higher education. However, university educators often find these ideas challenging to realise in practice, as much of the literature focuses on institutional change rather than supporting academics. This paper describes the conceptual development of a practical framework designed to stimulate educators’ thinking when creating or modifying assessments. We explain the concepts that underpin this practical support, including the notions of ‘assessment decisions’ and ‘assessment design phases’, as informed by relevant literature and empirical data. We also present the outcome of this work. The Assessment Design Decisions Framework. This provides key considerations in six categories: purposes, contexts, tasks, interactions, feedback processes and learning outcomes. By tracing the development of the Framework, we highlight complex ways of thinking about assessment that are relevant to those who design and deliver assessment to tertiary students.

An Aboriginal obligation to Country: challenging the status quo

Australian Aboriginal Traditional Owner ancestral responsibilities to Country involves listening and exercising vested responsibilities and duties of care, passed down from generation to generation through clan and familial connections. Traditional Owners is a term used to describe today’s descendants of the original Aboriginal inhabitants and have ongoing cultural and spiritual connections to land and water where their ancestors lived. The incorporation of Traditional Owner relationships to Country and the need to engage with Traditional Owners in Western planning regimes are often expressed positively; that Aboriginal needs and aspirations need to be recognized in the urban landscape. However in practice, decisions involving the address of Aboriginal aspirations are usually made in a generic context rather than a Country and knowledge specific context. This can have adverse effects on obligations to Country stewardship, and Custodial perceptions are being ignored and negated. Improving our understanding of how Traditional ancestral obligations to Country are expressed and embodied within the context of generic Western planning instruments, is critical as cities expand and increase the pressures and threats on Traditional Owners Country, their resources, their cultural heritage, their knowledge and their histories. This paper contributes to this understanding by focusing upon Traditional Owner communities in the Brisbane metropolitan region who are attempting to address their responsibility to Country through Western State and local planning instruments. This paper draws on empirical data collected through interviews and observations between 2013-2015 with the Quandamooka communities and a content analysis of current planning instruments. The paper reports on their obligations of and to Country and the consequences that engagement within Western planning instruments has had upon their Traditional Ownership well-being and landscape health. Lessons learned from this case study are discussed to offer future planning policy initiatives that could better meet the needs of Traditional Owners in Australian cities.

Cyber sisters: Buddhist women’s online activism and practice

While the churches are emptying, other virtual religious places as the religious websites seem to be filling up. The researcher focusing on religion and internet or digital religion as an object of study must seek answers to a number of questions. Is computer-mediated religious communication a particular communication process whose object is what we conventionally call religion? Or is it a modern, independent form of religious expressiveness that finds its new-born status in the web and its particular language? To examine the questions above, and others, the book collects more empirical data, claiming that the Internet will have a specific or novel impact on how religious traditions are interpreted. The blurring of previous boundaries (offline/online, virtual/local, illegitimate/legitimate religion) is another theme common to all the contributions in this volume.

Landscape properties mediate the homogenization of bird assemblages during climatic extremes

Extreme weather events, such as drought, have marked impacts on biotic communities. In many regions, a predicted increase in occurrence of such events will be imposed on landscapes already heavily modified by human land use. There is an urgency, therefore, to understand the way in which the effects of such events may be exacerbated, or moderated, by different patterns of landscape change. We used empirical data on woodlanddependent birds in southeast Australia, collected during and after a severe drought, to document temporal change in the composition of bird assemblages in 24 landscapes (each 100 km2) representing a gradient in the cover of native wooded vegetation (from 60% to <2%). We examined (a) whether drought caused region-wide homogenization of the composition of landscape bird assemblages, and (b) whether landscape properties influenced the way assemblages changed in response to drought. To quantify change, we used pairwise indices of assemblage dissimilarity, partitioned into components that represented change in the richness of assemblages and change in the identity of constituent species (turnover). There was widespread loss of woodland birds in response to drought, with only partial recovery following drought-breaking rains. Region-wide, the composition of landscape assemblages became more different over time, primarily caused by turnover-related differentiation. The response of bird assemblages to drought varied between landscapes and was strongly associated with landscape properties. The extent of wooded vegetation had the greatest influence on assemblage change: landscapes with more native vegetation had more stable bird assemblages over time. However, for the component processes of richness- and turnoverrelated compositional change, measures of landscape productivity had a stronger effect. For example, landscapes with more riparian vegetation maintained more stable assemblages in terms of richness. These results emphasize the importance of the total extent of native vegetation, both overall cover and that occurring in productive parts of the landscape, for maintaining bird communities whose composition is resistant to severe drought. While extreme climatic events cannot be prevented, their effects can be ameliorated by managing the pattern of native vegetation in anthropogenic landscapes, with associated benefits for maintaining ecological processes and human well-being.

L’étendue effective de pratique des infirmières oeuvrant en santé mentale et le niveau de formation

L’importance du rôle de l’infirmière dans le système de santé autant au niveau de l’accessibilité que la qualité et la sécurité des soins et services donnés à la population est reconnue. Pour être en mesure d’exercer pleinement ce rôle, les infirmières doivent être en mesure d’exercer à leur pleine étendue de pratique. Les infirmières œuvrant dans le domaine de la santé mentale n’y font pas exception. Or, les recherches démontrent que les infirmières ne parviennent pas à mettre en oeuvre l’ensemble des activités pour lesquelles elles détiennent la formation et l’expérience. Cette recherche vise à mesurer l’étendue de pratique effective des infirmières oeuvrant en santé mentale ainsi qu’à identifier l’influence du niveau de formation sur cette étendue de pratique. Cette étude prend appui sur le SCOP model de Déry et al. (2015) qui mentionne que certaines caractéristiques de l’environnement et individuelles, telles que le niveau de formation, peuvent influencer l’étendue effective de la pratique des infirmières. Le déploiement de cette étendue de pratique a le potentiel d’influencer à son tour la satisfaction professionnelle des infirmières (Déry et al., 2013), la qualité des soins aux patients ainsi que d’autres variables organisationnelles telles que l’accessibilité, les durées moyennes de séjours et les coûts. Un devis corrélationnel descriptif a été retenu pour cette étude. Un questionnaire de type Likert a été complété par les infirmières (n=80) d’un Institut universitaire en santé mentale du Québec. Des analyses de la variance ont été utilisées pour comparer les moyennes d’étendue de pratique selon les ni-veaux de formation. Les résultats démontrent un déploiement sous-optimal de l’étendue de la pratique des infirmières (4,24/6; E.T.= 0,63). Cette étendue de pratique est tout de même supérieure à l’étendue de pratique des infirmières d’autres milieux qui a été mesurée à l’aide du questionnaire de l’étendue de la pratique infirmière (QÉPI). Les analyses effectuées concernant l’influence du niveau de formation sur l’étendue de pratique n’ont révélées aucune différence significative entre les niveaux de formation F (3, 77) = 0,707, p = 0,551. Le niveau de formation des infirmières, la présence d’un biais de représentation, le manque de puissance statistique et certaines caractéristiques de l’emploi peuvent expliquer ces résultats. Les résultats de cette étude semblent constituer une recherche empirique initiale puisqu'il s’agit à ce jour de l’unique recherche à avoir mesuré l’étendue de pratique des infirmières œuvrant en santé mentale à l’aide du QÉPI et à avoir tenté de connaître l’influence que pouvait avoir le niveau de formation sur l’étendue de leur pratique.

L’étendue effective de pratique des infirmières oeuvrant en santé mentale et le niveau de formation

L’importance du rôle de l’infirmière dans le système de santé autant au niveau de l’accessibilité que la qualité et la sécurité des soins et services donnés à la population est reconnue. Pour être en mesure d’exercer pleinement ce rôle, les infirmières doivent être en mesure d’exercer à leur pleine étendue de pratique. Les infirmières œuvrant dans le domaine de la santé mentale n’y font pas exception. Or, les recherches démontrent que les infirmières ne parviennent pas à mettre en oeuvre l’ensemble des activités pour lesquelles elles détiennent la formation et l’expérience. Cette recherche vise à mesurer l’étendue de pratique effective des infirmières oeuvrant en santé mentale ainsi qu’à identifier l’influence du niveau de formation sur cette étendue de pratique. Cette étude prend appui sur le SCOP model de Déry et al. (2015) qui mentionne que certaines caractéristiques de l’environnement et individuelles, telles que le niveau de formation, peuvent influencer l’étendue effective de la pratique des infirmières. Le déploiement de cette étendue de pratique a le potentiel d’influencer à son tour la satisfaction professionnelle des infirmières (Déry et al., 2013), la qualité des soins aux patients ainsi que d’autres variables organisationnelles telles que l’accessibilité, les durées moyennes de séjours et les coûts. Un devis corrélationnel descriptif a été retenu pour cette étude. Un questionnaire de type Likert a été complété par les infirmières (n=80) d’un Institut universitaire en santé mentale du Québec. Des analyses de la variance ont été utilisées pour comparer les moyennes d’étendue de pratique selon les ni-veaux de formation. Les résultats démontrent un déploiement sous-optimal de l’étendue de la pratique des infirmières (4,24/6; E.T.= 0,63). Cette étendue de pratique est tout de même supérieure à l’étendue de pratique des infirmières d’autres milieux qui a été mesurée à l’aide du questionnaire de l’étendue de la pratique infirmière (QÉPI). Les analyses effectuées concernant l’influence du niveau de formation sur l’étendue de pratique n’ont révélées aucune différence significative entre les niveaux de formation F (3, 77) = 0,707, p = 0,551. Le niveau de formation des infirmières, la présence d’un biais de représentation, le manque de puissance statistique et certaines caractéristiques de l’emploi peuvent expliquer ces résultats. Les résultats de cette étude semblent constituer une recherche empirique initiale puisqu'il s’agit à ce jour de l’unique recherche à avoir mesuré l’étendue de pratique des infirmières œuvrant en santé mentale à l’aide du QÉPI et à avoir tenté de connaître l’influence que pouvait avoir le niveau de formation sur l’étendue de leur pratique.

Development of an intervention to support medication management in patients with multimorbidity in primary care

The overarching aim of this thesis was to develop an intervention to support patient-centred prescribing in the context of multimorbidity in primary care. Methods A range of research methods were used to address different components of the Medical Research Council, UK (MRC) guidance on the development and evaluation of complex interventions in health care. The existing evidence on GPs’ perceptions of the management of multimorbidity was systematically reviewed. In qualitative interviews, chart-stimulated recall was used to explore the challenges experienced by GPs when prescribing for multimorbid patients. In a cross-sectional study, the psychosocial issues that complicate the management of multimorbidity were examined. To develop the complex intervention, the Behaviour Change Wheel (BCW) was used to integrate behavioural theory with the findings of these three studies. A feasibility study of the new intervention was then conducted with GPs. Results The systematic review revealed four domains of clinical practice where GPs experienced difficulties in multimorbidity. The qualitative interview study showed that GPs responded to these difficulties by ‘satisficing’. In multimorbid patients perceived as stable, GPs preferred to ‘maintain the status quo’ rather than actively change medications. In the cross-sectional study, the significant association between multimorbidity and negative psychosocial factors was shown. These findings informed the development of the ‘Multimorbidity Collaborative Medication Review and Decision-making’ (MY COMRADE) intervention. The intervention involves peer support: two GPs review the medications prescribed to a complex multimorbid patient together. In the feasibility study, GPs reported that the intervention was appropriate for the context of general practice; was widely applicable to their patients with multimorbidity; and recommendations for optimising medications arose from all collaborative reviews. Conclusion Applying theory to empirical data has led to an intervention that is implementable in clinical practice, and has the potential to positively change GPs’ behaviour in the management of medications for patients with multimorbidity.

Globala försörjningsbeslut i en industriell kontext

Purpose – The purpose with this study is to investigate which factors that needs to be considered for sourcing decisions to ensure an optimal long-term decision, and which of these factors that can be quantified in a product costing model. To fulfill this purpose two research questions have been proposed: Which factors needs to be considered for a sourcing decision? Which of these factors that needs to be considered can be quantified in a product costing model? Method – A case study was conducted to fulfill the purpose of this study. The case study produced empirical data through interviews and document studies. The empirical data was interpreted and analyzed on the basis of the theoretical framework, created through literature studies. This process produced the result of this study. Findings – Factors to be considered for a sourcing decision have been identified and categorized in four over-arching categories: unit cost, logistical factors, capability factors and risk factors. These factors have been quantified in a product costing model. A preparatory decision model was created to further integrate some risk factors that could not be quantified. Implications – Both the make or buy decision and the manufacturing location decision have been considered in the product costing model presented in this study. The product costing model visualize and take into account hidden costs, rarely considered in sourcing decisions. This further enables optimal long-term sourcing decisions. Limitations – Risk factors remain difficult to quantify. This makes it difficult to determine the cost of risk factors, and as a result of that, to include them in a product costing model. Companies with similar conditions suites the model since the case study was conducted at only one company. Whether the product costing model is true for business in other contexts remain uncertain.

Analys av NIR hårdvaruuppsättning samt metod för fotografering av individer i fordon

Abstract Purpose – To study the possibility of using a NIR hardware solution to photograph individuals in a private vehicle as well as an analysis of its images. Method – A study of existing theories around the NIR-method’s performance in selected conditions and individual tests were performed to examine if the literature statements were valid for this study. Two empirical tests have been carried out, the first was carried out at Kapsch test track and the other outside the test track in a single stationary test. An interview which formed the basis for the assessment on the quality of empirical data with a focus on computer-based detection of the number of individuals in the vehicle. Findings – The results have demonstrated the potential of the NIR method’s performance in a fully automated detection system for the number of individuals inside the vehicle. Empirical data indicates that the method can depict individuals inside vehicles of sufficiently high quality, but it is greatly affected by reflections, weather and light conditions. Implications – Result supports the assumption that the NIR method using an external light source can be used to image the interior through a varying number of weather and lightning conditions. The study originated until the results suggested that a NIR-based hardware setup can create images with high enough quality for the human eye to be able to detect the number of individuals inside the vehicle.If the overall performance into account, it suggests that the main problem with the use of the hardware set is to maintain the quality of the whole sample and that the crucial variables for the method’s performance is the influence of light and reflection conditions. Limitations – The major limitations have been that we limited ourselves to a subjective analysis of the selection and assessment on the image features for computer-based detection of the number of individuals in the vehicle. We were limited to two tests, one in tough conditions where only the driver was in the vehicle and the second stationary test, where the focus was on the number of people in vehicles and light sources impact on the result.

Significant Attributes and Challenges Related to Cross-Functional Team Communications

Purpose The purpose of the research work is to investigate the importance of the communication in the cross-functional teams and in what which communicational tools provide better convenience of communication in cross-functional team members. Methodology An empirical study including the data collection from the interviews conducted from the participants working in cross-functional teams. Qualitative approach has been adopted to understand the communicational attributes in the cross-functional teams. For the analysis both deductive and abductive approach has been used. With the help of theoretical framework and empirical data, conclusions drown for better understanding of the concept. Findings The author has divided the search in two main segments, communicational effects on cross-functional team performance and effectiveness of particular communicational tools used by team members and team leaders. Empirical findings shows that without proper communication, cross-functional team are less tend to perform well to achieve set goals as well as face to face communications are more effective than other communicational tools.  Research limitations The research work is limited to Scandinavian countries. Organizational communicational structures are not studied due to time factor. Other limitation of this research work is effect of cultural differences on communication. Implications The research work provides deep understanding of the different communicational effects on cross-functional team performance. The choice of communicational tool and proportional importance for the team members will help managers while selecting the tools of communication with the team members. Originality / value During the literature studies, author determined that there is potential of research for the communicational tools used in cross-functional team communications. The social media is taking over the traditional communicational tools which provide value for findings. 

Samhällskunskapens dimensioner : Tio lärare ramar in sitt ämne

Denna samhällskunskapsdidaktiska studies syfte är att undersöka vad samhällskunskapslärare själva upplever som de viktigaste påverkansfaktorerna för transformeringen av samhällskunskap som skolämne till samhällskunskap som undervisning utifrån didaktiska frågor som Vad?, Hur? och Varför?, samt hur detta upplevs förändrats över en tidsperiod om cirka tjugo år eller mer. Studien bygger på hermeneutisk-fenomenologisk livsvärldsansats där fenomenologisk beskrivning och hermeneutisk tolkning är centralt. Empirin utgörs av intervjuer med tio samhällskunskapslärare med lång yrkeserfarenhet från högstadium, gymnasium eller vuxenutbildning. Resultatet tematiseras utifrån inspiration från ramfaktorteoretiska utgångspunkteri fyra dimensioner av påverkansfaktorer, vilka är Den personliga dimensionen, Den didaktiska dimensionen, Den styrande dimensionen och Den samhälleliga dimensionen. Var och en av dessa dimensioner delas upp i ett antal variationer. Dimensionerna är konstruerade utifrån principen om det personligt nära till det samhälleligt distanserade. Utöver dessa dimensioner har en aspekt på dessa lagts till. Det är Den elevnära aspekten vars innehåll utgörs av eleverna som påverkansfaktor för hur undervisningen blir. Lärarna i studien pratar aldrig om eleverna som påverkansfaktor utan att koppla detta till någon av de fyra dimensionerna. Slutsatser som dras i studien är att de tio lärarna alla har mycket olika berättelserom vad de uppfattar som viktigaste påverkansfaktorer. Några lägger mest fokus på sin personliga bakgrund eller personliga intressen. Andra fokuserar mer på didaktiska idéer, på styrdokument eller på organisatoriska ramar. Studien visar också att lärarna alla har en eller ett par dominerande dimensioner som dels syns mest i berättelsen, dels också påverkar hur de pratar om de andra dimensionerna. Lärarnas berättelser visar även att de upplever att undervisningen och vad som påverkar denna påtagligt förändras över tid. Studiens viktigaste bidrag är kanske att den exemplifierar teoretiska perspektiv. Inte minst genom att belysa att vad som påverkar undervisningen i ett ämne är så komplext att den ramfaktorteoretiska byggnadsställningen måste anpassas efter den specifika undersökningen med dess frågeställningar och undersökningsmaterial.

Academic governance in the contemporary university: perspectives from Anglophone nations

This book addresses three central questions in contemporary university governance: (1) How and why has academic governance in Anglophone nations changed in recent years and what impact have these changes had on current practices? (2) How do power relations within universities affect decisions about teaching and research and what are the implications for academic voices? (3) How can those involved in university governance and management improve academic governance processes and outcomes and why is it important that they do so? The book explores these issues in clear, concise and accessible language that will appeal to higher education researchers and governance practitioners alike. It draws on extensive empirical data from key national systems in the Anglophone world but goes beyond the simply descriptive to analyse and explain.