Global, regional, and national incidence and mortality for HIV, tuberculosis, and malaria during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013

BACKGROUND: The Millennium Declaration in 2000 brought special global attention to HIV, tuberculosis, and malaria through the formulation of Millennium Development Goal (MDG) 6. The Global Burden of Disease 2013 study provides a consistent and comprehensive approach to disease estimation for between 1990 and 2013, and an opportunity to assess whether accelerated progress has occured since the Millennium Declaration. METHODS: To estimate incidence and mortality for HIV, we used the UNAIDS Spectrum model appropriately modified based on a systematic review of available studies of mortality with and without antiretroviral therapy (ART). For concentrated epidemics, we calibrated Spectrum models to fit vital registration data corrected for misclassification of HIV deaths. In generalised epidemics, we minimised a loss function to select epidemic curves most consistent with prevalence data and demographic data for all-cause mortality. We analysed counterfactual scenarios for HIV to assess years of life saved through prevention of mother-to-child transmission (PMTCT) and ART. For tuberculosis, we analysed vital registration and verbal autopsy data to estimate mortality using cause of death ensemble modelling. We analysed data for corrected case-notifications, expert opinions on the case-detection rate, prevalence surveys, and estimated cause-specific mortality using Bayesian meta-regression to generate consistent trends in all parameters. We analysed malaria mortality and incidence using an updated cause of death database, a systematic analysis of verbal autopsy validation studies for malaria, and recent studies (2010-13) of incidence, drug resistance, and coverage of insecticide-treated bednets. FINDINGS: Globally in 2013, there were 1·8 million new HIV infections (95% uncertainty interval 1·7 million to 2·1 million), 29·2 million prevalent HIV cases (28·1 to 31·7), and 1·3 million HIV deaths (1·3 to 1·5). At the peak of the epidemic in 2005, HIV caused 1·7 million deaths (1·6 million to 1·9 million). Concentrated epidemics in Latin America and eastern Europe are substantially smaller than previously estimated. Through interventions including PMTCT and ART, 19·1 million life-years (16·6 million to 21·5 million) have been saved, 70·3% (65·4 to 76·1) in developing countries. From 2000 to 2011, the ratio of development assistance for health for HIV to years of life saved through intervention was US$4498 in developing countries. Including in HIV-positive individuals, all-form tuberculosis incidence was 7·5 million (7·4 million to 7·7 million), prevalence was 11·9 million (11·6 million to 12·2 million), and number of deaths was 1·4 million (1·3 million to 1·5 million) in 2013. In the same year and in only individuals who were HIV-negative, all-form tuberculosis incidence was 7·1 million (6·9 million to 7·3 million), prevalence was 11·2 million (10·8 million to 11·6 million), and number of deaths was 1·3 million (1·2 million to 1·4 million). Annualised rates of change (ARC) for incidence, prevalence, and death became negative after 2000. Tuberculosis in HIV-negative individuals disproportionately occurs in men and boys (versus women and girls); 64·0% of cases (63·6 to 64·3) and 64·7% of deaths (60·8 to 70·3). Globally, malaria cases and deaths grew rapidly from 1990 reaching a peak of 232 million cases (143 million to 387 million) in 2003 and 1·2 million deaths (1·1 million to 1·4 million) in 2004. Since 2004, child deaths from malaria in sub-Saharan Africa have decreased by 31·5% (15·7 to 44·1). Outside of Africa, malaria mortality has been steadily decreasing since 1990. INTERPRETATION: Our estimates of the number of people living with HIV are 18·7% smaller than UNAIDS's estimates in 2012. The number of people living with malaria is larger than estimated by WHO. The number of people living with HIV, tuberculosis, or malaria have all decreased since 2000. At the global level, upward trends for malaria and HIV deaths have been reversed and declines in tuberculosis deaths have accelerated. 101 countries (74 of which are developing) still have increasing HIV incidence. Substantial progress since the Millennium Declaration is an encouraging sign of the effect of global action. FUNDING: Bill & Melinda Gates Foundation.

Global, regional, and national levels and causes of maternal mortality during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013

BACKGROUND: The fifth Millennium Development Goal (MDG 5) established the goal of a 75% reduction in the maternal mortality ratio (MMR; number of maternal deaths per 100,000 livebirths) between 1990 and 2015. We aimed to measure levels and track trends in maternal mortality, the key causes contributing to maternal death, and timing of maternal death with respect to delivery. METHODS: We used robust statistical methods including the Cause of Death Ensemble model (CODEm) to analyse a database of data for 7065 site-years and estimate the number of maternal deaths from all causes in 188 countries between 1990 and 2013. We estimated the number of pregnancy-related deaths caused by HIV on the basis of a systematic review of the relative risk of dying during pregnancy for HIV-positive women compared with HIV-negative women. We also estimated the fraction of these deaths aggravated by pregnancy on the basis of a systematic review. To estimate the numbers of maternal deaths due to nine different causes, we identified 61 sources from a systematic review and 943 site-years of vital registration data. We also did a systematic review of reports about the timing of maternal death, identifying 142 sources to use in our analysis. We developed estimates for each country for 1990-2013 using Bayesian meta-regression. We estimated 95% uncertainty intervals (UIs) for all values. FINDINGS: 292,982 (95% UI 261,017-327,792) maternal deaths occurred in 2013, compared with 376,034 (343,483-407,574) in 1990. The global annual rate of change in the MMR was -0·3% (-1·1 to 0·6) from 1990 to 2003, and -2·7% (-3·9 to -1·5) from 2003 to 2013, with evidence of continued acceleration. MMRs reduced consistently in south, east, and southeast Asia between 1990 and 2013, but maternal deaths increased in much of sub-Saharan Africa during the 1990s. 2070 (1290-2866) maternal deaths were related to HIV in 2013, 0·4% (0·2-0·6) of the global total. MMR was highest in the oldest age groups in both 1990 and 2013. In 2013, most deaths occurred intrapartum or postpartum. Causes varied by region and between 1990 and 2013. We recorded substantial variation in the MMR by country in 2013, from 956·8 (685·1-1262·8) in South Sudan to 2·4 (1·6-3·6) in Iceland. INTERPRETATION: Global rates of change suggest that only 16 countries will achieve the MDG 5 target by 2015. Accelerated reductions since the Millennium Declaration in 2000 coincide with increased development assistance for maternal, newborn, and child health. Setting of targets and associated interventions for after 2015 will need careful consideration of regions that are making slow progress, such as west and central Africa. FUNDING: Bill & Melinda Gates Foundation.

The strategy of global branding and brand equity

This book offers a way to predict which brand a buyer will purchase. It looks at brandperformance within a product category and tests it in different countries with verydifferent cultures. Following the Predictive Brand Choice (PBC) model, this book seeks to predict a consumer’s loyalty and choice. Results have shown that PBC can achieve a high level of predictive accuracy, in excess of 70% in mature markets. This accuracy holds even in the face of price competition from a less preferred brand.PBC uses a prospective predicting method which does not have to rely on a brand’spast performance or a customer’s purchase history for prediction. Choice data isgathered in the retail setting – at the point of sale. The Strategy of Global Brandingand Brand Equity presents survey data and quantitative analyses that prove themethod described to be practical, useful and implementable for both researchers and practitioners of commercial brand strategies.

A comprehensive analytical subdomain model and its field solutions for surface-mounted permanent magnet machines

This paper presents a comprehensive analytical subdomain model together with its field solutions for predicting the magnetic field distributions in surface-mounted permanent magnet (PM) machines. The tooth tips and slotting effects during open-circuit, armature reaction, and on-load conditions are considered when deriving the model and developing its solutions. The model derivations and field solutions are extended from a previous model, and can be applied to PM machines with any combinations of slot and pole numbers and any magnetization patterns in the magnets. This model is initially formulated according to Laplace's and Poisson's equations in 2-D polar coordinates by the separation of variables technique in four subdomains, such as magnet, airgap, winding slots, and slot-openings. The field solution of each subdomain is obtained applying the appropriate boundary conditions and interface conditions between every two subdomains, respectively, which can precisely account for the mutual influence between slots. Finite element analysis (FEA) is later deployed to validate the analytical results in a surface-mounted PM machine that has nonoverlapping winding arrangement. For validation purposes, PM machines having 3-slot/2-pole with parallel magnetization and 12-slot/10-pole with either parallel or radial magnetizations are used for comparisons. Computation of global quantities for the motor which include the phase back-EMF and cogging torque is also included. The results indicate that the proposed analytical model can accurately predict the magnetic field distributions in each subdomain and the motor's global quantities, which are in good agreement with those obtained from the FEA.

Cardiovascular prevention model from Kenyan slums to migrants in the Netherlands

Cardiovascular diseases (CVD) are the main cause of morbidity and mortality worldwide. As prevention and treatment of CVD often requires active screening and lifelong follow up it is a challenge for health systems both in high-income and low and middle-income countries to deliver adequate care to those in need, with efficient use of resources.We developed a health service model for primary prevention of CVD suitable for implementation in the Nairobi slums, based on best practices from public health and the private sectors. The model consists of four key intervention elements focusing on increasing awareness, incentives for promoting access to screening and treatment, and improvement of long-term adherence to prescribed medications. More than 5,000 slum dwellers aged ≥35 years and above have been screened in the study resulting in more than 1000 diagnosed with hypertension and referred to the clinic.Some marginalized groups in high-income countries like African migrants in the Netherlands also have low rates of awareness, treatment and control of hypertension as the slum population in Nairobi. The parallel between both groups is that they have a combination of risky lifestyle, are prone to chronic diseases such as hypertension, have limited knowledge about hypertension and its complications, and a tendency to stay away from clinics partly due to cultural beliefs in alternative forms of treatment, and lack of trust in health providers. Based on these similarities it was suggested by several policymakers that the model from Nairobi can be applied to other vulnerable populations such as African migrants in high-income countries. The model can be contextualized to the local situation by adapting the key steps of the model to the local settings.The involvement and support of African communities' infrastructures and health care staff is crucial, and the most important enabler for successful implementation of the model in migrant communities in high-income countries. Once these stakeholders have expressed their interest, the impact of the adapted intervention can be measured through an implementation research approach including collection of costs from health care providers' perspective and health effects in the target population, similar to the study design for Nairobi.

Medical tourism: A conceptual framework for an innovation in global healthcare provision

© 2015, IGI Global. The purpose of this chapter is to establish a conceptual model that can potentially fill research gaps in the literature about medical tourism as an innovative concept in global healthcare provision by developing emerging economies as they are providing low cost alternatives in medical treatment at internationally accredited medical facilities to treat patients from developed countries. Major databases such as Ebscohost and Emerald have been used to search relevant literature. The literature on medical tourism is reviewed so as to understand the key drivers of medical tourism as well as research gaps in the existing literature. Three major drivers of medical tourism have been identified, namely cost, waiting time, and perceived quality. Further empirical research is needed to test the conceptual model in order to better understand what drives a decision to engage in medical tourism. This chapter makes three major contributions; firstly, the identification of the medical tourism literature from the service marketing and management perspectives; secondly, to propose a conceptual model representing innovation in medical tourism for global healthcare by developing emerging economies; thirdly, the identification of research gaps in the medical tourism literature through which future research can further the knowledge of why people travel to developing countries for medical treatment.

Human threats to sandy beaches: a meta-analysis of ghost crabs illustrates global anthropogenic impacts

Beach and coastal dune systems are increasingly subjected to a broad range of anthropogenic pressures that on many shorelines require significant conservation and mitigation interventions. But these interventions require reliable data on the severity and frequency of adverse ecological impacts. Such evidence is often obtained by measuring the response of 'indicator species'.Ghost crabs are the largest invertebrates inhabiting tropical and subtropical sandy shores and are frequently used to assess human impacts on ocean beaches. Here we present the first global meta-analysis of these impacts, and analyse the design properties and metrics of studies using ghost-crabs in their assessment. This was complemented by a gap analysis to identify thematic areas of anthropogenic pressures on sandy beach ecosystems that are under-represented in the published literature.Our meta-analysis demonstrates a broad geographic reach, encompassing studies on shores of the Pacific, Indian, and Atlantic Oceans, as well as the South China Sea. It also reveals what are, arguably, two major limitations: i) the near-universal use of proxies (i.e. burrow counts to estimate abundance) at the cost of directly measuring biological traits and bio-markers in the organism itself; and ii) descriptive or correlative study designs that rarely extend beyond a simple 'compare and contrast approach', and hence fail to identify the mechanistic cause(s) of observed contrasts.Evidence for a historically narrow range of assessed pressures (i.e., chiefly urbanisation, vehicles, beach nourishment, and recreation) is juxtaposed with rich opportunities for the broader integration of ghost crabs as a model taxon in studies of disturbance and impact assessments on ocean beaches. Tangible advances will most likely occur where ghost crabs provide foci for experiments that test specific hypotheses associated with effects of chemical, light and acoustic pollution, as well as the consequences of climate change (e.g. species range shifts).

Hydropower Energy Simulation Using Mike 11 Model; A Case Study In South Germany's Small Run-Of-River Hydropower Plants

Renewable energy production is a basic supplement to stabilize rapidly increasing global energy demand and skyrocketing energy price as well as to balance the fluctuation of supply from non-renewable energy sources at electrical grid hubs. The European energy traders, government and private company energy providers and other stakeholders have been, since recently, a major beneficiary, customer and clients of Hydropower simulation solutions. The relationship between rainfall-runoff model outputs and energy productions of hydropower plants has not been clearly studied. In this research, association of rainfall, catchment characteristics, river network and runoff with energy production of a particular hydropower station is examined. The essence of this study is to justify the correspondence between runoff extracted from calibrated catchment and energy production of hydropower plant located at a catchment outlet; to employ a unique technique to convert runoff to energy based on statistical and graphical trend analysis of the two, and to provide environment for energy forecast. For rainfall-runoff model setup and calibration, MIKE 11 NAM model is applied, meanwhile MIKE 11 SO model is used to track, adopt and set a control strategy at hydropower location for runoff-energy correlation. The model is tested at two selected micro run-of-river hydropower plants located in South Germany. Two consecutive calibration is compromised to test the model; one for rainfall-runoff model and other for energy simulation. Calibration results and supporting verification plots of two case studies indicated that simulated discharge and energy production is comparable with the measured discharge and energy production respectively.

Uncertainty Characterization Of A Conceptual Rainfall-Runoff Model By Using Grey Numbers

A procedure for characterizing global uncertainty of a rainfall-runoff simulation model based on using grey numbers is presented. By using the grey numbers technique the uncertainty is characterized by an interval; once the parameters of the rainfall-runoff model have been properly defined as grey numbers, by using the grey mathematics and functions it is possible to obtain simulated discharges in the form of grey numbers whose envelope defines a band which represents the vagueness/uncertainty associated with the simulated variable. The grey numbers representing the model parameters are estimated in such a way that the band obtained from the envelope of simulated grey discharges includes an assigned percentage of observed discharge values and is at the same time as narrow as possible. The approach is applied to a real case study highlighting that a rigorous application of the procedure for direct simulation through the rainfall-runoff model with grey parameters involves long computational times. However, these times can be significantly reduced using a simplified computing procedure with minimal approximations in the quantification of the grey numbers representing the simulated discharges. Relying on this simplified procedure, the conceptual rainfall-runoff grey model is thus calibrated and the uncertainty bands obtained both downstream of the calibration process and downstream of the validation process are compared with those obtained by using a well-established approach, like the GLUE approach, for characterizing uncertainty. The results of the comparison show that the proposed approach may represent a valid tool for characterizing the global uncertainty associable with the output of a rainfall-runoff simulation model.

Uncertainties In Future Projections Of Extreme Rainfall: The Role Of Climate Model, Emission Scenario And Randomness

Climate change has resulted in substantial variations in annual extreme rainfall quantiles in different durations and return periods. Predicting the future changes in extreme rainfall quantiles is essential for various water resources design, assessment, and decision making purposes. Current Predictions of future rainfall extremes, however, exhibit large uncertainties. According to extreme value theory, rainfall extremes are rather random variables, with changing distributions around different return periods; therefore there are uncertainties even under current climate conditions. Regarding future condition, our large-scale knowledge is obtained using global climate models, forced with certain emission scenarios. There are widely known deficiencies with climate models, particularly with respect to precipitation projections. There is also recognition of the limitations of emission scenarios in representing the future global change. Apart from these large-scale uncertainties, the downscaling methods also add uncertainty into estimates of future extreme rainfall when they convert the larger-scale projections into local scale. The aim of this research is to address these uncertainties in future projections of extreme rainfall of different durations and return periods. We plugged 3 emission scenarios with 2 global climate models and used LARS-WG, a well-known weather generator, to stochastically downscale daily climate models’ projections for the city of Saskatoon, Canada, by 2100. The downscaled projections were further disaggregated into hourly resolution using our new stochastic and non-parametric rainfall disaggregator. The extreme rainfall quantiles can be consequently identified for different durations (1-hour, 2-hour, 4-hour, 6-hour, 12-hour, 18-hour and 24-hour) and return periods (2-year, 10-year, 25-year, 50-year, 100-year) using Generalized Extreme Value (GEV) distribution. By providing multiple realizations of future rainfall, we attempt to measure the extent of total predictive uncertainty, which is contributed by climate models, emission scenarios, and downscaling/disaggregation procedures. The results show different proportions of these contributors in different durations and return periods.

O global e o contextual no aprendizado gerencial de multinacionais: uma perspectiva brasileira

The major purpose of this thesis is to verify, from a Brazilian perspective, how global and contextual issues influence the management learning in Multinationals. The management learning derived from the interaction of holding and sidiaries/colligates of Multinational corporation is supposed to be subject to convergent and divergent forces, the former related to global and standardized organizational practices, and the latter, is seen as a social practice subject to cultural and organizational singularities. A model was constructed to relate the dichotomy between the universality of the management practices and technologies and the particularity of the contexts where they operate, to the dichotomy between the singularities in organization and national level. This model is composed of the international, global, managerial and inter-organizational dimensions related, respectively, to the cultural and political diversity; to the universal forces of practices and values; to the managerial capabilities and resources in the organization, consolidated as best practices and to the interaction between holding and subsidiaries and the resulted learning. The combined result of these dimensions influences the knowledge flow and the learning derived from it. The field research was constituted of five cases of internationalized Brazilian firms, with a solid experience in their management systems. The main subjects of this study were executives and ofessionals/managers who respond to the management development. The data were first collected in the headquarters and complemented with visits to subsidiaries/joint ventures in other countries, in loco or with expatriated people who return to Brazil. The central supposition was validated. So, the management learning ¿ is driven by the global capitalism practices and by the global culture where they are immersed, reproducing a hegemonic vision and a common language (global dimension); ¿ incorporates the more propagated and dominant managerial values, although there are some variations when they are applied in the subsidiaries/joint ventures; is the product of the assimilation of international recognized and planned managerial practices, with the acculturation power, although not completely; is the result mainly of the managerial practice in work; is impacted not only by cross-cultural and managerial factors, but also by the business environment of the firm; is given according to the capabilities and resources in the organization, guiding the form of assimilation of practices and technologies, with global application or not (managerial dimension); ¿ is affected by the cross-cultural diversity involving the countries of the holding and the subsidiaries/joint ventures where the firm is and is given as a reproduction of the political context of the holding and subsidiaries countries (international dimension); ¿ faces aligned concurrent institutional pressures between corporate or global systems, practices of other subsidiaries/joint ventures and local practices; is more difficult to reach when there is not permeability between organizational cultures and identities of a Multinational firm; is affected by how much the relationship process across these unities is self-referenced; is facilitated by the construction and improvement of the knowledge network (interorganizational dimension). Finally some contributions of this study are exposed, including extensions of the proposed model and suggestions, recommendations for future research.

The Free Trade Area of the Americas : positive outcomes for Brazil and the global community

This document discusses Brazil and the Free Trade Area of the Americas (FTAA). Since the FTAA is only a proposed agreement and trade apparatus at the moment, NAFTA is used as a working model and its influence on and benefit for Mexico and that country’s economy.

Structural challenges in a multipolar and multicultural global legal era : BRICS’ global legal politics beyond cultural and economic partnerships

New emerging international dynamics introduce a global poly-axiological polycentric disorder which undermines the tradition of a unique global legal order in international law. Modern Era was characterized by Western European civilizational model – from which human rights is a byproduct. This consensus had its legitimacy tested by XXst century’s scenario – and the ‘BRICS factor/actor’ is a symptom of this reality. Its empowerment in world politics lead to the rise of distinct groups of States/civilizations provided with different legal, political, economic and social traditions – promoting an unexpected uprise of otherness in international legal order and inviting it to a complete and unforeseeable reframing process. Beyond Washington or Brussels Consensus, other custom-originated discourses (Brasília, Moscow, New Delhi, Peking or Cape Town Consensus, among other unfolded possibilities) will probably henceforth attempt shaping international law in present global legal disorder.

The influence of the global crisis on the slowdown of the emerging markets

A presente dissertação investiga a relação empírica entre a crise financeira de 2007-2009, a crise da dívida soberana de 2010-2012 e a recente desaceleração dos mercados de capitais nos mercados emergentes. A exposição dos mercados emergentes à crise nos desenvolvidos é quantificada através de um modelo de interdependência de factores. Os resultados mostram que estes sofreram, de facto, um choque provocado por ambas as crises. No entanto, este foi um choque de curta duração enquanto os mercados desenvolvidos ainda lutavam com as consequências resultantes das sucessivas crises financeiras. A análise do modelo mostra ainda que após a crise da divida soberana, enquanto os mercados desenvolvidos iniciam a sua recuperação, os emergentes desaceleram o seu crescimento. De forma a completar a análise do modelo foi efectuado um estudo sobre a influência dos fluxos de capitais entre os mercados emergentes e desenvolvidos na direcção do seu crescimento, revelando que existe uma relação entre estes dois eventos.