20 research outputs found

    Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015

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    SummaryBackground The Global Burden of Diseases, Injuries, and Risk Factors Study 2015 provides an up-to-date synthesis of the evidence for risk factor exposure and the attributable burden of disease. By providing national and subnational assessments spanning the past 25 years, this study can inform debates on the importance of addressing risks in context. Methods We used the comparative risk assessment framework developed for previous iterations of the Global Burden of Disease Study to estimate attributable deaths, disability-adjusted life-years (DALYs), and trends in exposure by age group, sex, year, and geography for 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks from 1990 to 2015. This study included 388 risk-outcome pairs that met World Cancer Research Fund-defined criteria for convincing or probable evidence. We extracted relative risk and exposure estimates from randomised controlled trials, cohorts, pooled cohorts, household surveys, census data, satellite data, and other sources. We used statistical models to pool data, adjust for bias, and incorporate covariates. We developed a metric that allows comparisons of exposure across risk factors—the summary exposure value. Using the counterfactual scenario of theoretical minimum risk level, we estimated the portion of deaths and DALYs that could be attributed to a given risk. We decomposed trends in attributable burden into contributions from population growth, population age structure, risk exposure, and risk-deleted cause-specific DALY rates. We characterised risk exposure in relation to a Socio-demographic Index (SDI). Findings Between 1990 and 2015, global exposure to unsafe sanitation, household air pollution, childhood underweight, childhood stunting, and smoking each decreased by more than 25%. Global exposure for several occupational risks, high body-mass index (BMI), and drug use increased by more than 25% over the same period. All risks jointly evaluated in 2015 accounted for 57·8% (95% CI 56·6–58·8) of global deaths and 41·2% (39·8–42·8) of DALYs. In 2015, the ten largest contributors to global DALYs among Level 3 risks were high systolic blood pressure (211·8 million [192·7 million to 231·1 million] global DALYs), smoking (148·6 million [134·2 million to 163·1 million]), high fasting plasma glucose (143·1 million [125·1 million to 163·5 million]), high BMI (120·1 million [83·8 million to 158·4 million]), childhood undernutrition (113·3 million [103·9 million to 123·4 million]), ambient particulate matter (103·1 million [90·8 million to 115·1 million]), high total cholesterol (88·7 million [74·6 million to 105·7 million]), household air pollution (85·6 million [66·7 million to 106·1 million]), alcohol use (85·0 million [77·2 million to 93·0 million]), and diets high in sodium (83·0 million [49·3 million to 127·5 million]). From 1990 to 2015, attributable DALYs declined for micronutrient deficiencies, childhood undernutrition, unsafe sanitation and water, and household air pollution; reductions in risk-deleted DALY rates rather than reductions in exposure drove these declines. Rising exposure contributed to notable increases in attributable DALYs from high BMI, high fasting plasma glucose, occupational carcinogens, and drug use. Environmental risks and childhood undernutrition declined steadily with SDI; low physical activity, high BMI, and high fasting plasma glucose increased with SDI. In 119 countries, metabolic risks, such as high BMI and fasting plasma glucose, contributed the most attributable DALYs in 2015. Regionally, smoking still ranked among the leading five risk factors for attributable DALYs in 109 countries; childhood underweight and unsafe sex remained primary drivers of early death and disability in much of sub-Saharan Africa. Interpretation Declines in some key environmental risks have contributed to declines in critical infectious diseases. Some risks appear to be invariant to SDI. Increasing risks, including high BMI, high fasting plasma glucose, drug use, and some occupational exposures, contribute to rising burden from some conditions, but also provide opportunities for intervention. Some highly preventable risks, such as smoking, remain major causes of attributable DALYs, even as exposure is declining. Public policy makers need to pay attention to the risks that are increasingly major contributors to global burden. Funding Bill & Melinda Gates Foundation

    Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017

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    Background: The Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017) includes a comprehensive assessment of incidence, prevalence, and years lived with disability (YLDs) for 354 causes in 195 countries and territories from 1990 to 2017. Previous GBD studies have shown how the decline of mortality rates from 1990 to 2016 has led to an increase in life expectancy, an ageing global population, and an expansion of the non-fatal burden of disease and injury. These studies have also shown how a substantial portion of the world's population experiences non-fatal health loss with considerable heterogeneity among different causes, locations, ages, and sexes. Ongoing objectives of the GBD study include increasing the level of estimation detail, improving analytical strategies, and increasing the amount of high-quality data. Methods: We estimated incidence and prevalence for 354 diseases and injuries and 3484 sequelae. We used an updated and extensive body of literature studies, survey data, surveillance data, inpatient admission records, outpatient visit records, and health insurance claims, and additionally used results from cause of death models to inform estimates using a total of 68 781 data sources. Newly available clinical data from India, Iran, Japan, Jordan, Nepal, China, Brazil, Norway, and Italy were incorporated, as well as updated claims data from the USA and new claims data from Taiwan (province of China) and Singapore. We used DisMod-MR 2.1, a Bayesian meta-regression tool, as the main method of estimation, ensuring consistency between rates of incidence, prevalence, remission, and cause of death for each condition. YLDs were estimated as the product of a prevalence estimate and a disability weight for health states of each mutually exclusive sequela, adjusted for comorbidity. We updated the Socio-demographic Index (SDI), a summary development indicator of income per capita, years of schooling, and total fertility rate. Additionally, we calculated differences between male and female YLDs to identify divergent trends across sexes. GBD 2017 complies with the Guidelines for Accurate and Transparent Health Estimates Reporting. Findings: Globally, for females, the causes with the greatest age-standardised prevalence were oral disorders, headache disorders, and haemoglobinopathies and haemolytic anaemias in both 1990 and 2017. For males, the causes with the greatest age-standardised prevalence were oral disorders, headache disorders, and tuberculosis including latent tuberculosis infection in both 1990 and 2017. In terms of YLDs, low back pain, headache disorders, and dietary iron deficiency were the leading Level 3 causes of YLD counts in 1990, whereas low back pain, headache disorders, and depressive disorders were the leading causes in 2017 for both sexes combined. All-cause age-standardised YLD rates decreased by 3·9% (95% uncertainty interval [UI] 3·1–4·6) from 1990 to 2017; however, the all-age YLD rate increased by 7·2% (6·0–8·4) while the total sum of global YLDs increased from 562 million (421–723) to 853 million (642–1100). The increases for males and females were similar, with increases in all-age YLD rates of 7·9% (6·6–9·2) for males and 6·5% (5·4–7·7) for females. We found significant differences between males and females in terms of age-standardised prevalence estimates for multiple causes. The causes with the greatest relative differences between sexes in 2017 included substance use disorders (3018 cases [95% UI 2782–3252] per 100 000 in males vs s1400 [1279–1524] per 100 000 in females), transport injuries (3322 [3082–3583] vs 2336 [2154–2535]), and self-harm and interpersonal violence (3265 [2943–3630] vs 5643 [5057–6302]). Interpretation: Global all-cause age-standardised YLD rates have improved only slightly over a period spanning nearly three decades. However, the magnitude of the non-fatal disease burden has expanded globally, with increasing numbers of people who have a wide spectrum of conditions. A subset of conditions has remained globally pervasive since 1990, whereas other conditions have displayed more dynamic trends, with different ages, sexes, and geographies across the globe experiencing varying burdens and trends of health loss. This study emphasises how global improvements in premature mortality for select conditions have led to older populations with complex and potentially expensive diseases, yet also highlights global achievements in certain domains of disease and injury

    Effectiveness of seismic isolation for cable-stayed bridges

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    This paper investigates the effectiveness of elastomeric and sliding types of isolation systems for the seismic response control of cable-stayed bridges. A simplified two-dimensional lumped-mass finite-element model of the Quincy Bay-view Bridge at Illinois was developed for the investigation. The seismic isolation of cable-stayed bridges is achieved using three different isolators, namely, high damping rubber bearings (HDRB), lead rubber bearings (LRB) and friction pendulum system (FPS). Time history analysis is performed for the bridge with four different earthquake ground motions applied in the longitudinal direction using Newmark's method with linear variation of acceleration over the time interval. The seismic response of the isolated cable-stayed bridge is compared with that of the bridge with no isolation system. The results show that the isolation systems are effective for reducing the absolute acceleration of the deck and the base shear response of the tower. Further, a parametric study is performed by varying the damping ratio, yield strength and friction coefficient of HDRB, LRB and FPS to investigate the influence of these parameters on the seismic response of the bridge. From such a study, optimal values can be found for the isolators for reducing the bridge responses

    Passive hybrid systems for earthquake protection of cable-stayed bridge

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    The performance of passive hybrid control systems for the earthquake protection of a cable-stayed bridge under real earthquake ground motion is presented. A simplified lumped mass finite-element model of the Quincy Bay-view Bridge at Illinois is used for the investigation. A viscous fluid damper (VFD) is used as a passive supplemental energy dissipation device in association with elastomeric and sliding isolation systems to form a passive hybrid control system. The effects of non-linear viscous damping of the VFD on the seismic response of an isolated cable-stayed bridge are examined by taking different values of velocity exponent of the damper. Further, the influence of a variation in viscous damping on the response of the isolated bridge is also investigated. The seismic response of the bridge with passive hybrid systems is compared with the corresponding response of the bridge with only isolation systems, as well as with the uncontrolled bridge. The results of the investigation show that the addition of supplemental damping in the form of a viscous fluid damper significantly reduces the earthquake response of an isolated cable-stayed bridge. The non-linear viscous damping is found to be more effective in controlling the peak isolator displacement of the isolated bridge while simultaneously limiting the base shear in towers.© Elsevie

    Response of an isolated cable-stayed bridge under bi-directional seismic actions

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    This paper investigates the effectiveness and limitations of seismic isolation for the earthquake protection of a cable-stayed bridge under bi-directional seismic actions. A simplified lumped mass finite element model of the Quincy Bay-view Bridge at Illinois is developed for the investigation. The deck of the bridge is isolated from the towers by using elastomeric and sliding isolation systems. For the non-linear isolation systems, the interaction between the restoring forces in two orthogonal horizontal directions is duly considered in the response analysis. The seismic response of the bridge is obtained by solving the governing equations of motion in the incremental form using an iterative step-by-step method. A parametric study is also performed by varying important parameters of the isolation systems. The seismic response of the isolated cable-stayed bridge is compared with the corresponding response of the bridge without isolation systems. The results of the investigation indicate that the peak base shear response of the towers and deck accelerations are significantly reduced by the isolation. The displacement response of the hysteretic isolation systems is found to be increased when the bi-directional interaction of the bearing force is considered in the response analysis. Furthermore, it is also found that the response of the bridge is significantly affected by the variation in the parameters of the isolation systems

    Simplified seismic resistant design of base isolated single pylon cable-stayed bridge

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    © 2018 Springer Science+Business Media B.V., part of Springer Nature The seismic vulnerability of single pylon cable-stayed bridges under strong ground motions in the transverse direction is of great concern to earthquake engineering researchers and bridge engineers. Introduction of base isolation to cable-stayed bridges has been proved very effective in reducing seismic forces in the bridges in previous studies. This paper proposes a direct displacement based seismic design (DDBD) procedure for base isolated cable-stayed bridge under transverse seismic excitation. One of the key aspects of the DDBD is the realization of a uniform transverse target displacement of the deck under seismic excitation, which is achieved by appropriate design of the isolator stiffness at the bottom of the pylon and the ends of the deck. The proposed DDBD procedure is applied in this paper to the seismic design of a single pylon cable-stayed bridge isolated by friction pendulum bearings. The effectiveness and the accuracy of the resulting design are checked by nonlinear time history analyses. The numerical results indicate that the proposed DDBD procedure can predict the deck displacement profile and amplitudes, as well as the base shear within a reasonable degree of accuracy. The case study demonstrates that the proposed DDBD procedure is sufficiently accurate and practical for the seismic design of base isolated single pylon cable-stayed bridges
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