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

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

Bond properties of sand-coated GFRP bars with fly ash-based geopolymer concrete

Bond behavior is an important subject in the design and performance of reinforced concrete structures. In this research, the bond property between sand-coated glass fiber-reinforced polymer (GFRP) bars, a corrosion-resistant substitute to steel bars, and fly ash-based geopolymer cement (GPC) concrete, a more environmental friendly alternative to ordinary portland cement (OPC) concrete, is investigated. Pullout test specimens containing GFRP bars embedded in GPC and OPC concrete cylinders with 100-mm diameter and 170-mm height were prepared. Three different embedment lengths were tested: three, six, and nine times the bar diameter. Average concrete compressive strengths of approximately 25 and 45 MPa and GFRP bar diameters of 12.7 and 15.9 mm were the other test parameters. For each specimen, the test results include the bond failure mode, the average bond strength, the slip at the loaded and free end, and the bond-slip relationship curves. The test results showed that GFRP-reinforced GPC concrete has similar bond strength as that of GFRP-reinforced OPC concrete. The increase in embedment length resulted in the decrease of the bond strength as well as a change in the failure mode of the specimens. Furthermore, the experimental results were used to generate a constitutive bond-slip law. Finally, finite-element modeling is performed by using the constitutive bond-slip law to investigate strain and bond distribution along the embedment length of the bar

Bond behaviour of GFRP reinforcement in alkali activated cement concrete

Bond plays a key role in the performance of reinforced concrete structures. Glass fiber reinforced polymer (GFRP) reinforcing bar and alkali activated cement (AAC) concrete are promising alternative construction materials for steel bars and Ordinary Portland Cement (OPC) concretes respectively. In this study, the bond behaviour between GFRP bars, and AAC and OPC concretes is investigated by using beam-end test specimens. Sand-coated GFRP bars with 12.7 mm and 15.9 mm diameters and embedment lengths of six and nine times the bar diameter were used. The free end and the loaded end bond slip relationships, the failure mode and the average bond stress were used to analyse each of the specimens. Additionally, the distribution of tensile and bond stress along the embedment length was investigated by installing strain gauges along the embedment length. The results of the study indicate that the tensile and bond stress distribution along the embedment length are nonlinear, and the nonlinearity changes with the load. Finite element analysis was also performed to further study the bond stress distribution along the embedment length of the bar. From the finite element analysis, it was found that the bond stress distribution depends on the embedment length of the specimens; approaching uniform distribution as the embedment length decreases

Bond of spliced GFRP reinforcement bars in alkali activated cement concrete

© 2017 Elsevier Ltd Glass Fibre Reinforced Polymer (GFRP) bars and Alkali Activated Cement (AAC) concrete are promising materials for replacing steel bars and ordinary Portland cement concrete. These materials can provide a solution to the associated corrosion and environmental issues. However, no design recommendations are available on splicing of GFRP bars in AAC concrete. This may be mainly due to insufficient data that would guide such recommendations. In this paper, the results of testing beams with spliced bars are presented mainly from consideration of the bond property between the spliced GFRP bars and the AAC concrete. The effects of splice length, compressive strength of concrete, and stirrup confinement on the bond behaviour are investigated. Ultimate moment capacity, failure modes, cracking pattern, and strain values in the bars have been determined and used in the analysis. A three-dimensional finite element model (FEM) was then developed. The FEM results show that the model accurately reproduces the experimental behaviour of splice tests with regard to load-deflection curves and failure modes. The reported results and numerical analysis are intended for understanding distribution of tensile and bond stresses in GFRP reinforced AAC concrete. These distributions were observed to be dependent on the applied load