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

The global burden of cancer attributable to risk factors, 2010-19 : a systematic analysis for the Global Burden of Disease Study 2019

Background Understanding the magnitude of cancer burden attributable to potentially modifiable risk factors is crucial for development of effective prevention and mitigation strategies. We analysed results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 to inform cancer control planning efforts globally. Methods The GBD 2019 comparative risk assessment framework was used to estimate cancer burden attributable to behavioural, environmental and occupational, and metabolic risk factors. A total of 82 risk-outcome pairs were included on the basis of the World Cancer Research Fund criteria. Estimated cancer deaths and disability-adjusted life-years (DALYs) in 2019 and change in these measures between 2010 and 2019 are presented. Findings Globally, in 2019, the risk factors included in this analysis accounted for 4.45 million (95% uncertainty interval 4.01-4.94) deaths and 105 million (95.0-116) DALYs for both sexes combined, representing 44.4% (41.3-48.4) of all cancer deaths and 42.0% (39.1-45.6) of all DALYs. There were 2.88 million (2.60-3.18) risk-attributable cancer deaths in males (50.6% [47.8-54.1] of all male cancer deaths) and 1.58 million (1.36-1.84) risk-attributable cancer deaths in females (36.3% [32.5-41.3] of all female cancer deaths). The leading risk factors at the most detailed level globally for risk-attributable cancer deaths and DALYs in 2019 for both sexes combined were smoking, followed by alcohol use and high BMI. Risk-attributable cancer burden varied by world region and Socio-demographic Index (SDI), with smoking, unsafe sex, and alcohol use being the three leading risk factors for risk-attributable cancer DALYs in low SDI locations in 2019, whereas DALYs in high SDI locations mirrored the top three global risk factor rankings. From 2010 to 2019, global risk-attributable cancer deaths increased by 20.4% (12.6-28.4) and DALYs by 16.8% (8.8-25.0), with the greatest percentage increase in metabolic risks (34.7% [27.9-42.8] and 33.3% [25.8-42.0]). Interpretation The leading risk factors contributing to global cancer burden in 2019 were behavioural, whereas metabolic risk factors saw the largest increases between 2010 and 2019. Reducing exposure to these modifiable risk factors would decrease cancer mortality and DALY rates worldwide, and policies should be tailored appropriately to local cancer risk factor burden. Copyright (C) 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.Peer reviewe

Global, regional, and national burden of disorders affecting the nervous system, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BackgroundDisorders affecting the nervous system are diverse and include neurodevelopmental disorders, late-life neurodegeneration, and newly emergent conditions, such as cognitive impairment following COVID-19. Previous publications from the Global Burden of Disease, Injuries, and Risk Factor Study estimated the burden of 15 neurological conditions in 2015 and 2016, but these analyses did not include neurodevelopmental disorders, as defined by the International Classification of Diseases (ICD)-11, or a subset of cases of congenital, neonatal, and infectious conditions that cause neurological damage. Here, we estimate nervous system health loss caused by 37 unique conditions and their associated risk factors globally, regionally, and nationally from 1990 to 2021.MethodsWe estimated mortality, prevalence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs), with corresponding 95% uncertainty intervals (UIs), by age and sex in 204 countries and territories, from 1990 to 2021. We included morbidity and deaths due to neurological conditions, for which health loss is directly due to damage to the CNS or peripheral nervous system. We also isolated neurological health loss from conditions for which nervous system morbidity is a consequence, but not the primary feature, including a subset of congenital conditions (ie, chromosomal anomalies and congenital birth defects), neonatal conditions (ie, jaundice, preterm birth, and sepsis), infectious diseases (ie, COVID-19, cystic echinococcosis, malaria, syphilis, and Zika virus disease), and diabetic neuropathy. By conducting a sequela-level analysis of the health outcomes for these conditions, only cases where nervous system damage occurred were included, and YLDs were recalculated to isolate the non-fatal burden directly attributable to nervous system health loss. A comorbidity correction was used to calculate total prevalence of all conditions that affect the nervous system combined.FindingsGlobally, the 37 conditions affecting the nervous system were collectively ranked as the leading group cause of DALYs in 2021 (443 million, 95% UI 378–521), affecting 3·40 billion (3·20–3·62) individuals (43·1%, 40·5–45·9 of the global population); global DALY counts attributed to these conditions increased by 18·2% (8·7–26·7) between 1990 and 2021. Age-standardised rates of deaths per 100 000 people attributed to these conditions decreased from 1990 to 2021 by 33·6% (27·6–38·8), and age-standardised rates of DALYs attributed to these conditions decreased by 27·0% (21·5–32·4). Age-standardised prevalence was almost stable, with a change of 1·5% (0·7–2·4). The ten conditions with the highest age-standardised DALYs in 2021 were stroke, neonatal encephalopathy, migraine, Alzheimer's disease and other dementias, diabetic neuropathy, meningitis, epilepsy, neurological complications due to preterm birth, autism spectrum disorder, and nervous system cancer.InterpretationAs the leading cause of overall disease burden in the world, with increasing global DALY counts, effective prevention, treatment, and rehabilitation strategies for disorders affecting the nervous system are needed

Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations. METHODS The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model-a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates-with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality-which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration cause-of-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds. FINDINGS The leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2-100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading five causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1-290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1-211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4-48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3-37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7-9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles. INTERPRETATION Long-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere. FUNDING Bill & Melinda Gates Foundation

Accumulation and Toxicity of Polycyclic Aromatic Hydrocarbons in Long-Term Soil Irrigated with Treated Wastewater

Our study focuses on examining the effects of treated wastewater irrigation (TWWI) on agricultural soils in water-scarce regions, with a specific emphasis on the presence and accumulation of polycyclic aromatic hydrocarbons (PAHs). This issue is particularly significant due to its potential threats to environmental security. During our research, we discovered the existence of 16 different PAHs in these soils, which are known to have harmful impacts on ecosystems and human health. The concentration of total PAHs ranged from 163.9 ng g−1 to 9177.4 ng g−1, with 4- and 5-ring PAHs being the most dominant contributors. The PAHs Fluoranthene and Pyrene were found to be the most prevalent in all soil samples. Comparing the PAH concentrations in our research area to those reported in other studies, we observed that the agricultural areas in our study were more contaminated. Through positive matrix factorization (PMF) and diagnostic ratios (DRs) analyses, we identified petroleum combustion, vehicular emissions, as well as coal, grass, or wood combustion as the primary sources of PAH contamination. We also noted a negative correlation between clay, silt, pH, and PAH concentrations, while a significant positive relationship was observed between total organic carbon (TOC), sand, and PAHs. Based on the computed environmental risk index value, the presence of PAHs in the area poses a moderate to high level of ecological risk. TWWI was identified as the main contributor to PAHs in the agricultural soils we studied. Therefore, it is crucial to establish and enforce standards for wastewater reuse in agricultural fields before irrigation takes place

Influence of Surface Coating towards the Controlled Toxicity of ZnO Nanoparticles In Vitro

The uncertainties in ZnO-mediated toxicity and particle stability in a biological system remain a challenge and mitigate against deployment as next-generation nanoparticles (NPs), especially in biomedical applications. With that perspective, the present study investigates the surface chemical properties of ZnO NPs coated with three different surfactant biomolecules, namely polyethylene glycol (PEG), cetyltrimethylammonium bromide (CTAB), and sodium dodecyl sulfate (SDS) to control the toxicity-induced potentials. On the testing of the surface-functionalized ZnO NPs, notable changes in the particle sizes, morphology, zeta potential, and hydrodynamic size compared to the pure ZnO NPs are observed. In addition, FTIR spectroscopy, TGA, XRD, XPS, and HRTEM analysis showed significant changes in the surface structures and surface functional groups of the three different ZnO NPs on surface functionalization. Following the physical characterization, the cell viability of rat liver BRL-3A-treated ZnO–PEG, ZnO–CTAB, and ZnO–SDS compared to pure ZnO NPs ( ZnO–CTAB > ZnO–PEG, i.e., anionic > cationic > non-ionic. Overall from the analysis, the study stresses the importance of having a suitable surface ligand for the ZnO NPs so as to use them in the biomedical sector

Characterization and optimization of abrasive water jet machining parameters of aluminium/silicon carbide composites

Due to the complexity of high temperature and cutting tool wear, most machined components are still facing problems in terms of harder functional fillers that reinforce aluminium matrix composites. Conversely, abrasive water jet machining (AWJM) incredibly useful for the cutting of anisotropic and non-homogeneous metal matrix composites. In this research article, silicon carbide (SiC) particulates were utilized as reinforcement in the AA6026 matrix material (AA6026/SiC) and machined using AWJM under different process parameters namely SiC loading, traverse speed and stand-off distance. Two different compositions of SiC (4, and 8 wt%) were considered to fabricate AA6026 composites using the stir casting. In addition, outputs have been examined, e.g., surface roughness, material removal rate, and kerf angle. An optical microscope, scanning electron microscope, Brinell hardness tester and universal testing machine have been used to characterize the matrix material AA6026 and its composites. Microstructural analysis revealed that the inclusion of SiC particulates in AA6026 affects the very fine grain size of the composite. Furthermore, the 8 wt% composite exhibits the evolution of the Al-Si eutectic phase during solidification. Processing of these composites was performed using the L _27 orthogonal geometry, successfully improving the parameters of the abrasive water jet process. The output response shows that reducing the SiC load improves the surface roughness under the key parameters of traverse speed and stand-off distance. However, increasing the SiC loading increases the material removal rate and kerf angle under the key parameters, namely traverse speed, and stand-off distance

Nanoporous carbon@CoFe2O4 nanocomposite as a green absorbent for the adsorptive removal of Hg(ii) from aqueous solutions

To address the harmful pollutants found in heavy metals and agricultural waste, researchers have worked on creating various materials that can capture these pollutants. They have experimented with altering the shape, size, structure, surface properties, and bioactive components of these materials. This study aims to improve the effectiveness of materials used for adsorption, focusing on the combination of cobalt spinal ferrite (CoFe2O4) and nanoporous carbon (NC) obtained from discarded palm kernel shells with the aim of Hg(ii) removal. The composite formed by the hydrothermal method was characterized thoroughly with morphological, structural, functional, pore sizes, thermal analysis, and magnetization analysis. Adsorption experiments were conducted under optimal conditions with a mass of 0.3 g, a concentration of 30 mg·L−1 of Hg(ii), and a pH of 3. The aim was to adsorb Hg(ii) ions from aqueous solutions. The analysis of kinetic studies using the Freundlich model revealed that it provided the most accurate fit for the adsorption isotherm. This model indicated a maximum Hg(ii) adsorption efficiency of 232.56 mg·g−1. Additionally, the thermodynamic measurements indicate that the adsorption is a spontaneous, favorable, and endothermic process. Likewise, we assessed how well the NC@CoFe2O4 nanocomposite could absorb Hg(ii) ions in actual condensate samples from the oil and gas industry. The results demonstrated a 93% recovery rate for Hg(ii) ions in wastewater. According to the findings, the NC@CoFe2O4 nanocomposite synthesized appears to be a strong contender for wastewater treatment and, at the same time, the prepared nanocomposite’s effectiveness, affordability, and non-toxic nature support the potential applications

Influence of Ultrasonic Vibration towards the Microstructure Refinement and Particulate Distribution of AA7150-B4C Nanocomposites

Aluminum-based metal matrix composites with single or multiple ceramic reinforcements are finding application in the aerospace and automobile industries. In this research work, novel AA7150-B4C (aluminium7150 alloy–Boron carbide) nanocomposites were successfully fabricated, through the liquid metallurgy route via stir casting method, with the incorporation of B4C nanoparticles with different weight percentages using a novel sequence of a vortex technique and a double stir casting process with ultrasonication. The formed composites have been thoroughly studied for microstructure refinement, nano-particulate distribution, and bonding with the matrix by making use of the optical microscopy (OM) and scanning electron microscopy (SEM) studies (respectively). In addition, the composites were analyzed for the density, porosity, and elemental composition. Further, the composites were tested for the investigation of mechanical properties, like micro-hardness and tensile strength, to investigate the influence of ultrasonic vibration on the arrangement of B4C nano-particulates. The analysis indicated that the mechanical properties of the AA7150-B4C nanocomposites in as-cast condition significantly improved with a gain of 57.7% in strength and 24.5% in hardness compared to the native AA7150 material

Surface-enhanced Carboxyphenyl diazonium functionalized screen-printed carbon electrode for the screening of tuberculosis in sputum samples

Curbing tuberculosis (TB) requires a combination of good strategies, including a proper prevention measure, diagnosis, and treatment. This study proposes an improvised tuberculosis diagnosis based on an amperometry approach for the sensitive detection of MPT64 antigen in clinical samples. An MPT64 aptamer specific to the target antigen was covalently attached to the carboxyphenyl diazonium-functionalized carbon electrode via carbodiimide chemistry. The electrochemical detection assay was adapted from a sandwich assay format to trap the antigen between the immobilized aptamer and horseradish peroxidase (HRP) tagged polyclonal anti-MPT64 antibody. The amperometric current was measured from the catalytic reaction response between HRP, hydrogen peroxide, and hydroquinone, which is used as an electron mediator. From the analysis, the detection limit in the measurement buffer was 1.11 ng mL-1. Additionally, the developed aptasensor exhibited a linear relationship between the current signal and the MPT64 antigen-spiked serum concentration ranging from 10 to 150 ng mL-1 with a 1.38 ng mL-1 detection limit. Finally, an evaluation using the clinical sputum samples from both TB (+) and TB (-) individuals revealed a sensitivity and specificity of 88% and 100%, respectively. Based on the analysis, the developed aptasensor was found to be simple in its fabrication, sensitive, and allowed for the efficient detection and diagnosis of TB in sputum samples