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

Background: 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

A fast algorithm for modeling multiple bubbles dynamics

10.1016/j.jcp.2005.12.009Journal of Computational Physics2162430-453JCTP

Workshops as a research method: Guidelines for designing and evaluating artifacts through workshops

Workshops are often used in the information systems (IS) and design fields to evaluate artifacts or to co-create business innovations. However, the evaluation of workshops is often conducted in a rather unsystematic and heterogenous way. This paper introduces a set of guidelines for designing or evaluating artifacts through workshops. These guidelines include five evaluation principles and a framework that outlines appropriate evaluation methods for different research goals. The relevant constructs and principles were identified based on related literature. The derived evaluation matrix was then revised based on ratings of five experts who independently assigned appropriate research methods for different evaluation foci. The framework's applicability was evaluated by comparing it with ten papers from the IS and design fields. The proposed guidelines can support researchers with conducting workshop evaluations in a comparable and replicable way, which will help to improve research rigor in the future.</p

The idea arc: Designing a visual canvas for fuzzy ideas

At the fuzzy front end of innovation emerging ideas are often fuzzy as well. This may lead to premature rejection of those early ideas and hence result in missed business opportunities. This paper introduces the Idea Arc-a canvas-based innovation tool that facilitates team-based discussions, elaboration and refinement of an idea, identification of missing parts, detection and correction of inconsistencies, finding fit between elements, and preparation for prototyping. We developed the canvas based on expert interviews and tested it in two workshops. As a result, this paper contributes to the existing research on the fuzzy front end of innovation and also informs the emerging research on visual innovation tools.</p

Assessing and changing an organization's innovation culture with the workspace catalyst Canvas

The design of the workspace can be an indicator for an organization's innovation culture. This paper introduces a canvas-based collaboration tool that facilitates both, team-based analysis of existing workspaces regarding the expressed culture, and co-creating spatial design ideas with the goal to instigate a cultural change. This two-way approach is also reflected in the canvas design. We describe the development process of the canvas and its evaluation through a workshop. As a result, the contribution of this paper is twofold: (1) It informs practitioners about the relevance of spatial workspace design for cultural change, and (2) it provides insights on an atypical canvas design.</p

Erratum: Decrease in Incidence of Bronchopulmonary Dysplasia with Erythropoietin Administration in Preterm Infants: A Retrospective Study

<b><i>Background:</i></b> Despite advances in clinical care, the incidence of bronchopulmonary dysplasia (BPD) remains high in premature infants. Erythropoietin (EPO) is used for the treatment of anemia of prematurity (AOP) to decrease blood transfusion needs. EPO has been shown to mobilize circulating endothelial progenitor cells and to enhance lung repair in animal models. <b><i>Objective:</i></b> To determine whether EPO treatment for AOP was associated with a reduced incidence of BPD in premature infants. <b><i>Methods:</i></b> This retrospective study was performed on all live-born neonates with birth weights from 500 to 1,500 g and gestational age (GA) from 22 to 32 weeks admitted from 1994 to 2002. Infants who received EPO and those who did not receive EPO were compared for incidence of BPD and other morbidities. <b><i>Results:</i></b> Of<b> </b>478 patients, 297 received EPO before 36 weeks’ postmenstrual age (group 1) and 181 did not receive EPO (group 2). Group 1 was of similar birth weight but lower GA than group 2. The incidence of BPD was lower in group 1 than group 2 (26 vs. 36%, p = 0.03); after adjusting for significant risk factors, the adjusted odds ratio for BPD was 0.50 (95% CI 0.32, 0.79), p = 0.0028. The BPD rate was much lower when EPO was initiated before 4 weeks of age (16%) as compared to later initiation (44%). <b><i>Conclusions:</i></b> This study shows an association between EPO treatment and reduced incidence of BPD in preterm infants, particularly when EPO treatment was initiated within the first 4 weeks of life

Literature & Video Games

Nelson, ScottEnglishISBN for the ePub is 978-0-9887134-0-6. ISBN for the PDF is 978-0-9887134-1-3

Understanding prediction systems for HLA-binding peptides and t-cell epitope identification

Peptide binding to HLA molecules is a critical step in induction and regulation of T-cell mediated immune responses. Because of combinatorial complexity of immune responses, systematic studies require combination of computational methods and experimentation. Most of available computational predictions are based on discriminating binders from non-binders based on use of suitable prediction thresholds. We compared four state-of-the-art binding affinity prediction models and found that nonlinear models show better performance than linear models. A comprehensive analysis of HLA binders (A*0101, A*0201, A*0301, A*1101, A*2402, B*0702, B*0801 and B*1501) showed that non-linear predictors predict peptide binding affinity with high accuracy. The analysis of known T-cell epitopes of survivin and known HIV T-cell epitopes showed lack of correlation between binding affinity and immunogenicity of HLA-presented peptides. T-cell epitopes, therefore, can not be directly determined from binding affinities by simple selection of the highest affinity binders