The Relation between Awareness of Cancer Diagnosis and Spiritual Health among Cancer Patients

Introduction: Disclosure of cancer diagnosis is one the main challenges in caring of patients with cancer since it may have negative effects on the spiritual health of patients. No study has ever been performed in Iran to investigate the relationship between awareness of cancer diagnosis and spiritual health in cancer patients. Therefore, the present study aimed to review the effects of awareness of cancer on spiritual health in patients with cancer. Methods: This was a descriptive-comparative study conducted in Shahid Ghazi Tabatabaei University Hospital in 2009. The subjects included 150 patients aware of their cancer diagnosis and 150 unaware patients. The patients were selected through convenient sampling method. Using a questionnaire, the patient's spiritual health was assessed. Data analysis was conducted in SPSS17 using descriptive and inferential statistics. Results: Results showed the mean (SD) of spiritual health among aware and unaware patients to be 75.1 (3.8) and 75.4 (3.9), respectively. Statistically, there was no significant difference between the spiritual health of the two groups (p = 0.96). Conclusion: These findings showed that awareness of cancer diagnosis had no effects on spiritual health of patients. It is not surprising considering Iranian culture. However, confirmation of this finding requires further studies

A COMPARATIVE STUDY ON THE CYTOTOXIC EFFECT OF DIFFERENT CONCENTRATIONS OF HYDROGEN PEROXIDE AND CARBAMIDE PEROXIDE ON THE SURVIVAL OF HUMAN DENTAL PULP STEM CELLS IN VITRO

Abstract. Background: Tooth discoloration due to different causes (systemic or acquired) is one of the major issues that has involved the dentists to itself. up to now, dental bleaching has been reported as the most conservative method of treating teeth discoloration. In most bleaching methods, hydrogen peroxide and carbamide peroxide derivatives are used at different concentrations. Considering that these materials are oxidative materials, in this study, we are trying to evaluate and compare the toxicity of different concentrations of these two materials on dental pulp stem cells. Materials andmethods: Human dental pulp stem cells (DPSCs) were extracted and cultured, and they were treated with 50, 100, 180, 250 and 300 μM concentrations of hydrogen peroxide and 1.9, 0.95, 0.71, 0.47 and 0.24 mg/ml concentrations of carbamide peroxide. Metabolic activity of the cells was evaluated by MTT test. Objective: The purpose of this study was to evaluate and compare the cytotoxic effects of various concentrations of hydrogen peroxide and carbamide peroxide on the survival of human dental pulp stem cells. Results: The results showed that viability of treated cells with hydrogen peroxide andcarbamide peroxide has decreased at high concentrations. IC50 was at 180 μM concentration from HP and 1.9 mg concentration of CP, which was statistically significant (P<0.05). Conclusion: The results of our studies showed that these two materials affect the growth of stem cells in a dose-dependent manner. These materials, at low concentrations, cause a esistance to oxidative stress, however, at high concentrations, they have toxic effects on cell growth. The fatal effect of hydrogen peroxide on cells is much more than the effect of carbamide peroxide on the same cell line. It can be concludedthat carbamide peroxide has less side effects than hydrogen peroxide and its use at a lower dose compared to hydrogen peroxide can be a good method for tooth bleaching.Keywords: Stem cells, Dental pulp, Apoptosis, Hydrogen peroxide, Carbamide peroxid

An Efficient Quantile-Based Adaptive Sampling RBDO with Shifting Constraint Strategy

There is an increasing demand for the performance optimization under the reliability constraints in various engineering problems. These problems are commonly known as reliability-based design optimization (RBDO) problems. Among different RBDO frameworks, the decoupled methods are widely accepted for their high efficiency and stability. However, when facing problems with high nonlinearity and nonnormally distributed random variables, they lose their computational performance. In this study, a new efficient decoupled method with two level quantile-based sampling strategy is presented. The strategies introduced for two level sampling followed by information reuse of nearby designs are intended to enhance the sampling from failure region, thus reducing the number of samples to improve the efficiency of sampling-based methods. Compared with the existing methods which decouples RBDO in the design space and thus need to struggle with searching for most probable point (MPP), the proposed method decouples RBDO in the probability space to further make beneficial use of an efficient optimal shifting value search strategy to reach an optimal design in less iterations. By comparing the proposed method with crude MCS and other sampling-based methods through benchmark examples, our proposed method proved to be competitive in dramatically saving the computational cost

A Framework for Identifying Material sustainability Criteria in the Exchange Industry Using Fuzzy AHP Method

Considering the important role of the exchange industry in the optimal allocation of resources and economic growth, as well as promoting a culture of attention to sustainability issues, the purpose of this study is to provide a comprehensive framework of material sustainability criteria in the exchange industry for integration into strategies, performance measurement, evaluation and reporting. In order to identify material sustainability criteria in the Iranian exchange industry, the findings of Ahmadi et al research  (1401) which include 33 criteria and 352 sub-criteria have been used as a basis. In order to formulate a local framework, the participation of 21 industry experts was used to modify the criteria identified in the Ahmadi et al, according to the culture of Iran. Finally, after finalizing sustainability framework of the Iranian exchange industry, in order to evaluate materiality and prioritize the main criteria, the Fuzzy AHP method has been used. Considering the extensive effects of exchanges from the perspective of financing economic enterprises and the government (through transaction fee tax and issuing bonds), the findings of this study indicate the priority of economic dimension over other sustainability dimensions. Macroeconomics, government and other regulators and trust and confidence have the greatest relative importance among all other criteria. On the other hand, due to the low emissions of exchanges, the relative importance of environment dimension criteria is less than other dimensions in the industry. IntroductionThe number of countries that have organized capital markets has increased greatly in recent decades and investors' interest in capital markets have experienced unprecedented growth in recent years. As a result of the increased attention of society towards investing in capital markets, their awareness of sustainability issues has also increased. As a result, in such a situation, the necessity of proper management and sustainable performance of exchanges and issuing sustainability reports is more important than before. Sustainability reporting deals with how a company can report its sustainability performance in the form of a formal report, taking into account its responsibilities regarding positive and negative economic, social and environmental impacts (Hahn & Michael, 2013).In the current situation of Iranian exchanges and the volatility of stock prices and indices, the attention of a wide range of domestic stakeholders has been drawn to the performance of the exchanges. Therefore in the current situation, it is very important to achieve sustainable performance and be responsible to stakeholders. Therefore, the aim of this study is to answer the question that paying attention to what factors will guarantee the sustainable performance of exchanges and as a result economic development in the long term. Methods and material In order to identify the important sustainability criteria of the Iranian exchange industry in the present study, the results of Ahmadi et al were used as a basis. They presented a comprehensive international framework of sustainability. In order to confirm and modify their proposed model in domestic exchanges, the method of interviewing 21 experts has been used. Then, the fuzzy AHP method has been used to prioritize the sustainability criteria. The results of this process is providing a framework of the most important sustainability issues, considering the priority coefficients of each criterion.The paradigm of the current research is an interpretive paradigm, and in order to extract the sustainability criteria, an inductive approach has been used. From the perspective of research strategy, this study can be classified in the field of documentary and survey studies. Also, due to the use of quantitative and qualitative approaches to answer the research questions, this study used mixed method. On the other hand, due to the fact that this study was conducted at a specific point in time, this study is classified as a cross-sectional study. FindingsBased on the research findings, the most important sustainability criteria of the exchange industry can be classified in four economic, social, environmental, and corporate governance dimensions. After summarizing Ahmadi et al. (under publication) findings with the results of the interview coding process regarding the most important sustainability criteria of the Iranian exchange industry, 6 main criteria under the environmental dimension, 6 criteria under the social dimension, 11 criteria under the economic dimension and 13 criteria under the corporate governance dimension has been classified. Based on the findings of this study, the criteria of the economic dimension are the most important and the criteria of the environmental dimension are the least important in the Iranian exchange industry. Table 1: The relative and ultimate priority of sustainability framework criteria of Iran's exchange industryDimensionCriteriaRelative Importance of CriteriaUltimate Importance of CriteriaRelative Priority of CriteriaUltimate Priority of CriteriaEconomicMacroeconomics0.1400.07211EconomicGovernment and Other Regulators0.1290.06622EconomicTrust and Confidence0.1280.06533EconomicOperational Excellence0.1060.05444EconomicDiversified Products and Services0.0980.05055EconomicInnovation and Technology0.0930.04866EconomicListed Companies0.0830.04277Corporate GovernanceBoard of Directors0.1320.04018EconomicTransparency0.0740.03889Corporate GovernanceSelf-Regulation and Independence0.1250.037210EconomicDisclosure and Reporting0.0720.037911Corporate GovernanceMarket Regulation and Surveillance0.1190.036312EconomicFinancial and Economic Performance0.0670.0341013Corporate GovernanceRisk Management0.1060.032414Corporate GovernanceFinancial Crimes0.1050.031515SocialHuman Capital0.2250.027116Corporate GovernanceResponsibility and Accountability0.0840.025617SocialEducation and Training0.1850.022218SocialSupport for Startups and SMEs0.1830.022319SocialHuman Rights0.1780.022420Corporate GovernanceConflict of Interest Management0.0700.021721Corporate GovernanceStakeholder Management0.0660.020822SocialDiversity and Equality0.1630.020523Corporate GovernanceAudit and Assurance0.0610.018924Corporate GovernanceEthics0.0510.0151025EnvironmentalEnergy and Resource Management0.1960.014126EnvironmentalAwareness Raising and Participation in The Environment0.1930.013227EnvironmentalDesigning Environmental Instruments0.1790.012328EnvironmentalEnvironmental Requirements for Listing0.1780.012429Corporate GovernanceValues ​​and Culture0.0390.0121130Corporate GovernanceVision0.0380.0111231EnvironmentalCarbon Footprint and Greenhouse Gas Emissions0.1500.010532SocialImproving the Living Standards0.0660.008633EnvironmentalCompliance with Environmental Rules0.1030.007634EconomicSupply Chain Management0.0110.0051135Corporate GovernanceWhistleblowing0.0040.0011336Total 1  Conclusion & ResultsAccording to the survey conducted by Wfe in 2016, the most important sustainability issues for exchanges include ethics and corruption, board of directors composition and remuneration, health and safety, risk management, labor standards, water use and recycling, pollution (air, water and waste), climate change and energy, supply chain, human rights and diversity. The findings of the survey conducted by Wfe are limited to 11 criteria, while in the present study a comprehensive approach has been used to identify the most important sustainability criteria and prioritize them. Findings include 36 main criteria and include all the provided criteria in the Wfe survey. The findings of this study will help exchanges to identify the most important issues that help to create shared value. The findings of this study can be used to develop sustainable strategies as well as the findings can also help providers of sustainability reports to choose the most important sustainability issues to report. In addition, due to the similarity of the mechanisms of the financial industry to the exchange industry, financial industry professionals can also use the findings of this research in their sustainability decisions

Prevalence and Risk Factors of Voice Disorders in University Teaching Faculty Members: A Pilot Study

Voice disorder is a multifactorial impairment. Several studies have shown that there is a direct relationship between voice problems and voice-related jobs. Therefore, professional voice users, including teachers, are at high risk of voice disorders, which threatens the employment positions. Also, the investigation of voice impairments among faculty members seems essential. The purpose of this study is to assess the prevalence of voice disorders in faculty members, its impact on the physical, emotional, and functional status of this job group, with and without voice disorders, and the correlation of voice disorders with some risk factors. Methods The participants of this study were 114 university teaching faculty members of Mashhad University of Medical Sciences, with a mean age of 43.95±0.98 years. The current cross-sectional descriptive-analytical study used a demographic questionnaire and Voice Handicap Index (VHI) as the data collection instruments. In the present study, based on VHI test results, participants with a total VHI score greater than 14.5 are considered to have voice disorders. Results The prevalence of voice disorders among university teaching faculty members was 27.19%. There was a significant correlation between allergy and voice disorders (P= 0.04). Significant differences were also found between the two study groups in terms of the total score of the VHI and its subscales (P <0.001). Conclusions Considering the 27.19% prevalence of voice disorders among university teaching faculty members and its effect on the total VHI score, our results confirm that education, prevention, and treatment programs are critical to lessen the frequency of voice disorders related to teaching. However, it has been found that this job group with voice disorders is four times more likely to have allergies than those without voice disorder, which indicates the importance of controlling this problem

Deep Learning-Based Intrusion Detection Systems: A Systematic Review

Nowadays, the ever-increasing complication and severity of security attacks on computer networks have inspired security researchers to incorporate different machine learning methods to protect the organizations’ data and reputation. Deep learning is one of the exciting techniques which recently are vastly employed by the IDS or intrusion detection systems to increase their performance in securing the computer networks and hosts. This survey article focuses on the deep learning-based intrusion detection schemes and puts forward an in-depth survey and classification of these schemes. It first presents the primary background concepts about IDS architecture and various deep learning techniques. It then classifies these schemes according to the type of deep learning methods utilized in each of them. It describes how deep learning networks are utilized in the intrusion detection process to recognize intrusions accurately. Finally, a complete analysis of the investigated IDS frameworks is provided, and concluding remarks and future directions are highlighted

The unfinished agenda of communicable diseases among children and adolescents before the COVID-19 pandemic, 1990-2019: a systematic analysis of the Global Burden of Disease Study 2019

BACKGROUND: Communicable disease control has long been a focus of global health policy. There have been substantial reductions in the burden and mortality of communicable diseases among children younger than 5 years, but we know less about this burden in older children and adolescents, and it is unclear whether current programmes and policies remain aligned with targets for intervention. This knowledge is especially important for policy and programmes in the context of the COVID-19 pandemic. We aimed to use the Global Burden of Disease (GBD) Study 2019 to systematically characterise the burden of communicable diseases across childhood and adolescence. METHODS: In this systematic analysis of the GBD study from 1990 to 2019, all communicable diseases and their manifestations as modelled within GBD 2019 were included, categorised as 16 subgroups of common diseases or presentations. Data were reported for absolute count, prevalence, and incidence across measures of cause-specific mortality (deaths and years of life lost), disability (years lived with disability [YLDs]), and disease burden (disability-adjusted life-years [DALYs]) for children and adolescents aged 0-24 years. Data were reported across the Socio-demographic Index (SDI) and across time (1990-2019), and for 204 countries and territories. For HIV, we reported the mortality-to-incidence ratio (MIR) as a measure of health system performance. FINDINGS: In 2019, there were 3·0 million deaths and 30·0 million years of healthy life lost to disability (as measured by YLDs), corresponding to 288·4 million DALYs from communicable diseases among children and adolescents globally (57·3% of total communicable disease burden across all ages). Over time, there has been a shift in communicable disease burden from young children to older children and adolescents (largely driven by the considerable reductions in children younger than 5 years and slower progress elsewhere), although children younger than 5 years still accounted for most of the communicable disease burden in 2019. Disease burden and mortality were predominantly in low-SDI settings, with high and high-middle SDI settings also having an appreciable burden of communicable disease morbidity (4·0 million YLDs in 2019 alone). Three cause groups (enteric infections, lower-respiratory-tract infections, and malaria) accounted for 59·8% of the global communicable disease burden in children and adolescents, with tuberculosis and HIV both emerging as important causes during adolescence. HIV was the only cause for which disease burden increased over time, particularly in children and adolescents older than 5 years, and especially in females. Excess MIRs for HIV were observed for males aged 15-19 years in low-SDI settings. INTERPRETATION: Our analysis supports continued policy focus on enteric infections and lower-respiratory-tract infections, with orientation to children younger than 5 years in settings of low socioeconomic development. However, efforts should also be targeted to other conditions, particularly HIV, given its increased burden in older children and adolescents. Older children and adolescents also experience a large burden of communicable disease, further highlighting the need for efforts to extend beyond the first 5 years of life. Our analysis also identified substantial morbidity caused by communicable diseases affecting child and adolescent health across the world. FUNDING: The Australian National Health and Medical Research Council Centre for Research Excellence for Driving Investment in Global Adolescent Health and the Bill & Melinda Gates Foundation

Global age-sex-specific mortality, life expectancy, and population estimates in 204 countries and territories and 811 subnational locations, 1950–2021, and the impact of the COVID-19 pandemic: a comprehensive demographic analysis for the Global Burden of Disease Study 2021

Background: Estimates of demographic metrics are crucial to assess levels and trends of population health outcomes. The profound impact of the COVID-19 pandemic on populations worldwide has underscored the need for timely estimates to understand this unprecedented event within the context of long-term population health trends. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 provides new demographic estimates for 204 countries and territories and 811 additional subnational locations from 1950 to 2021, with a particular emphasis on changes in mortality and life expectancy that occurred during the 2020–21 COVID-19 pandemic period. Methods: 22 223 data sources from vital registration, sample registration, surveys, censuses, and other sources were used to estimate mortality, with a subset of these sources used exclusively to estimate excess mortality due to the COVID-19 pandemic. 2026 data sources were used for population estimation. Additional sources were used to estimate migration; the effects of the HIV epidemic; and demographic discontinuities due to conflicts, famines, natural disasters, and pandemics, which are used as inputs for estimating mortality and population. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate under-5 mortality rates, which synthesised 30 763 location-years of vital registration and sample registration data, 1365 surveys and censuses, and 80 other sources. ST-GPR was also used to estimate adult mortality (between ages 15 and 59 years) based on information from 31 642 location-years of vital registration and sample registration data, 355 surveys and censuses, and 24 other sources. Estimates of child and adult mortality rates were then used to generate life tables with a relational model life table system. For countries with large HIV epidemics, life tables were adjusted using independent estimates of HIV-specific mortality generated via an epidemiological analysis of HIV prevalence surveys, antenatal clinic serosurveillance, and other data sources. Excess mortality due to the COVID-19 pandemic in 2020 and 2021 was determined by subtracting observed all-cause mortality (adjusted for late registration and mortality anomalies) from the mortality expected in the absence of the pandemic. Expected mortality was calculated based on historical trends using an ensemble of models. In location-years where all-cause mortality data were unavailable, we estimated excess mortality rates using a regression model with covariates pertaining to the pandemic. Population size was computed using a Bayesian hierarchical cohort component model. Life expectancy was calculated using age-specific mortality rates and standard demographic methods. Uncertainty intervals (UIs) were calculated for every metric using the 25th and 975th ordered values from a 1000-draw posterior distribution. Findings: Global all-cause mortality followed two distinct patterns over the study period: age-standardised mortality rates declined between 1950 and 2019 (a 62·8% [95% UI 60·5–65·1] decline), and increased during the COVID-19 pandemic period (2020–21; 5·1% [0·9–9·6] increase). In contrast with the overall reverse in mortality trends during the pandemic period, child mortality continued to decline, with 4·66 million (3·98–5·50) global deaths in children younger than 5 years in 2021 compared with 5·21 million (4·50–6·01) in 2019. An estimated 131 million (126–137) people died globally from all causes in 2020 and 2021 combined, of which 15·9 million (14·7–17·2) were due to the COVID-19 pandemic (measured by excess mortality, which includes deaths directly due to SARS-CoV-2 infection and those indirectly due to other social, economic, or behavioural changes associated with the pandemic). Excess mortality rates exceeded 150 deaths per 100 000 population during at least one year of the pandemic in 80 countries and territories, whereas 20 nations had a negative excess mortality rate in 2020 or 2021, indicating that all-cause mortality in these countries was lower during the pandemic than expected based on historical trends. Between 1950 and 2021, global life expectancy at birth increased by 22·7 years (20·8–24·8), from 49·0 years (46·7–51·3) to 71·7 years (70·9–72·5). Global life expectancy at birth declined by 1·6 years (1·0–2·2) between 2019 and 2021, reversing historical trends. An increase in life expectancy was only observed in 32 (15·7%) of 204 countries and territories between 2019 and 2021. The global population reached 7·89 billion (7·67–8·13) people in 2021, by which time 56 of 204 countries and territories had peaked and subsequently populations have declined. The largest proportion of population growth between 2020 and 2021 was in sub-Saharan Africa (39·5% [28·4–52·7]) and south Asia (26·3% [9·0–44·7]). From 2000 to 2021, the ratio of the population aged 65 years and older to the population aged younger than 15 years increased in 188 (92·2%) of 204 nations. Interpretation: Global adult mortality rates markedly increased during the COVID-19 pandemic in 2020 and 2021, reversing past decreasing trends, while child mortality rates continued to decline, albeit more slowly than in earlier years. Although COVID-19 had a substantial impact on many demographic indicators during the first 2 years of the pandemic, overall global health progress over the 72 years evaluated has been profound, with considerable improvements in mortality and life expectancy. Additionally, we observed a deceleration of global population growth since 2017, despite steady or increasing growth in lower-income countries, combined with a continued global shift of population age structures towards older ages. These demographic changes will likely present future challenges to health systems, economies, and societies. The comprehensive demographic estimates reported here will enable researchers, policy makers, health practitioners, and other key stakeholders to better understand and address the profound changes that have occurred in the global health landscape following the first 2 years of the COVID-19 pandemic, and longer-term trends beyond the pandemic

Burden of disease scenarios for 204 countries and territories, 2022–2050: a forecasting analysis for the Global Burden of Disease Study 2021

Background: Future trends in disease burden and drivers of health are of great interest to policy makers and the public at large. This information can be used for policy and long-term health investment, planning, and prioritisation. We have expanded and improved upon previous forecasts produced as part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) and provide a reference forecast (the most likely future), and alternative scenarios assessing disease burden trajectories if selected sets of risk factors were eliminated from current levels by 2050. Methods: Using forecasts of major drivers of health such as the Socio-demographic Index (SDI; a composite measure of lag-distributed income per capita, mean years of education, and total fertility under 25 years of age) and the full set of risk factor exposures captured by GBD, we provide cause-specific forecasts of mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) by age and sex from 2022 to 2050 for 204 countries and territories, 21 GBD regions, seven super-regions, and the world. All analyses were done at the cause-specific level so that only risk factors deemed causal by the GBD comparative risk assessment influenced future trajectories of mortality for each disease. Cause-specific mortality was modelled using mixed-effects models with SDI and time as the main covariates, and the combined impact of causal risk factors as an offset in the model. At the all-cause mortality level, we captured unexplained variation by modelling residuals with an autoregressive integrated moving average model with drift attenuation. These all-cause forecasts constrained the cause-specific forecasts at successively deeper levels of the GBD cause hierarchy using cascading mortality models, thus ensuring a robust estimate of cause-specific mortality. For non-fatal measures (eg, low back pain), incidence and prevalence were forecasted from mixed-effects models with SDI as the main covariate, and YLDs were computed from the resulting prevalence forecasts and average disability weights from GBD. Alternative future scenarios were constructed by replacing appropriate reference trajectories for risk factors with hypothetical trajectories of gradual elimination of risk factor exposure from current levels to 2050. The scenarios were constructed from various sets of risk factors: environmental risks (Safer Environment scenario), risks associated with communicable, maternal, neonatal, and nutritional diseases (CMNNs; Improved Childhood Nutrition and Vaccination scenario), risks associated with major non-communicable diseases (NCDs; Improved Behavioural and Metabolic Risks scenario), and the combined effects of these three scenarios. Using the Shared Socioeconomic Pathways climate scenarios SSP2-4.5 as reference and SSP1-1.9 as an optimistic alternative in the Safer Environment scenario, we accounted for climate change impact on health by using the most recent Intergovernmental Panel on Climate Change temperature forecasts and published trajectories of ambient air pollution for the same two scenarios. Life expectancy and healthy life expectancy were computed using standard methods. The forecasting framework includes computing the age-sex-specific future population for each location and separately for each scenario. 95% uncertainty intervals (UIs) for each individual future estimate were derived from the 2·5th and 97·5th percentiles of distributions generated from propagating 500 draws through the multistage computational pipeline. Findings: In the reference scenario forecast, global and super-regional life expectancy increased from 2022 to 2050, but improvement was at a slower pace than in the three decades preceding the COVID-19 pandemic (beginning in 2020). Gains in future life expectancy were forecasted to be greatest in super-regions with comparatively low life expectancies (such as sub-Saharan Africa) compared with super-regions with higher life expectancies (such as the high-income super-region), leading to a trend towards convergence in life expectancy across locations between now and 2050. At the super-region level, forecasted healthy life expectancy patterns were similar to those of life expectancies. Forecasts for the reference scenario found that health will improve in the coming decades, with all-cause age-standardised DALY rates decreasing in every GBD super-region. The total DALY burden measured in counts, however, will increase in every super-region, largely a function of population ageing and growth. We also forecasted that both DALY counts and age-standardised DALY rates will continue to shift from CMNNs to NCDs, with the most pronounced shifts occurring in sub-Saharan Africa (60·1% [95% UI 56·8–63·1] of DALYs were from CMNNs in 2022 compared with 35·8% [31·0–45·0] in 2050) and south Asia (31·7% [29·2–34·1] to 15·5% [13·7–17·5]). This shift is reflected in the leading global causes of DALYs, with the top four causes in 2050 being ischaemic heart disease, stroke, diabetes, and chronic obstructive pulmonary disease, compared with 2022, with ischaemic heart disease, neonatal disorders, stroke, and lower respiratory infections at the top. The global proportion of DALYs due to YLDs likewise increased from 33·8% (27·4–40·3) to 41·1% (33·9–48·1) from 2022 to 2050, demonstrating an important shift in overall disease burden towards morbidity and away from premature death. The largest shift of this kind was forecasted for sub-Saharan Africa, from 20·1% (15·6–25·3) of DALYs due to YLDs in 2022 to 35·6% (26·5–43·0) in 2050. In the assessment of alternative future scenarios, the combined effects of the scenarios (Safer Environment, Improved Childhood Nutrition and Vaccination, and Improved Behavioural and Metabolic Risks scenarios) demonstrated an important decrease in the global burden of DALYs in 2050 of 15·4% (13·5–17·5) compared with the reference scenario, with decreases across super-regions ranging from 10·4% (9·7–11·3) in the high-income super-region to 23·9% (20·7–27·3) in north Africa and the Middle East. The Safer Environment scenario had its largest decrease in sub-Saharan Africa (5·2% [3·5–6·8]), the Improved Behavioural and Metabolic Risks scenario in north Africa and the Middle East (23·2% [20·2–26·5]), and the Improved Nutrition and Vaccination scenario in sub-Saharan Africa (2·0% [–0·6 to 3·6]). Interpretation: Globally, life expectancy and age-standardised disease burden were forecasted to improve between 2022 and 2050, with the majority of the burden continuing to shift from CMNNs to NCDs. That said, continued progress on reducing the CMNN disease burden will be dependent on maintaining investment in and policy emphasis on CMNN disease prevention and treatment. Mostly due to growth and ageing of populations, the number of deaths and DALYs due to all causes combined will generally increase. By constructing alternative future scenarios wherein certain risk exposures are eliminated by 2050, we have shown that opportunities exist to substantially improve health outcomes in the future through concerted efforts to prevent exposure to well established risk factors and to expand access to key health interventions