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

Study on mechanical properties of dredged silt stabilized with cement and reinforced with alginate fibers

Based on the qualities of environmental protection and metal adsorption, alginate fibers were utilized as new curing agents to reinforce cement stabilized dredged silt. The influences of fiber content (0%, 0.3%, 0.6%, and 0.9% by weight of wet soil), cement content (6%, 9%, and 12% by weight of wet soil), and curing time (7, 14, 28and 60 days) on compressive strength were investigated by unconfined compressive strength test, and the reinforcement mechanism of alginate fibers was analyzed. A modified model by considering the parameters including moisture content of soil, curing time, content and length of alginate fibers, and cement content for predicting compressive strength were established. The experimental results revealed that the failure mode of alginate fibers reinforced cement stabilized soil changed from brittle failure to ductile failure with the increasing content and length of alginate fibers. Moreover, the unconfined compressive strength of the sample was improved with the increasing content and length of alginate fibers. However, the content of alginate fibers is 0.6%, length is 3 mm, which can be used as the optimum content and length determined by analyzing the strength growth rate for alginate fibers reinforced cement stabilized soil. Finally, the strength values of modified model were compared with the measured strength values, it was found that the calculated results of this model were within 20% of the measured results, which can be used for engineering strength prediction

Further Evidence That N2pc Reflects Target Enhancement Rather Than Distracter Suppression

The N2-posterior-contralateral (N2pc) component is an index in the domain of event-related potentials for exploring the underlying mechanism of visual-spatial attention. It has been disputed whether the attentional selection reflected by N2pc is primarily due to distracter suppression or target enhancement processes. We addressed this controversy by combining the pop-out item and the target feature, and instructed participants whether the pop-out item included the target feature. Thus, in a visual search task, bilateral visual stimuli including a pop-out item and three distractors were displayed simultaneously. The pop-out detection was analyzed under varying two factors: (a) pop-out item as a target or non-target (b) the distractors containing a target feature or non-target feature. Although all conditions had a salient effect on behavioral performance, the reliable difference of N2pc existed only between the target condition and the non-target condition. These results provided strong support for the hypothesis of target enhancement processes

The Role of Subjective Wellbeing in Mediating Social Trust to the Mental Health of Health Workers

Mental health problems of health workers are attracting increasing concerns in China and the world. A trustful relationship between health workers and patients is the foundation of quality patient care, which is currently under serious threat. This study aimed to determine the associations of social trust on subjective wellbeing and mental health of health workers. Using the survey data of 262 health workers extracted from the 2018 Chinese Family Panel Studies, a structural equation model with partial least square approach was established. The results showed that social trust was linked to both subjective wellbeing (β = 0.251, p p < 0.01). The effect of social trust on mental health was partially mediated by subjective wellbeing (51.87%). The association between social trust and subjective wellbeing was moderated by socioeconomic status: social trust has a stronger effect on subjective wellbeing in those with higher socioeconomic status. Erosion of social trust may present a serious risk to mental health and subjective wellbeing of health workers. High socioeconomic status can amplify the effect of social trust

Interfacial Strengthening and Self-Monitoring in Carbon Fiber-Reinforced Composites via Carbon Nanotube-Based Damage Sensors

Carbon fiber-reinforced polymers are important constituents of aerospace materials. However, due to the inert surface of CFs, their interfacial property is relatively weak, which severely hinders their practical applications. Here, we deposited multi-walled carbon nanotubes (MWCNTs) along with a coupling agent on the surface of carbon fiber to improve the interfacial properties of the carbon fiber/resin. Via a simple dip-coating method, the MWCNTs were uniformly distributed on the CF surface with the assistance of the pre-coated coupling agent. The interfacial shear strength between the fiber and the matrix was significant enhanceed when the CF was loaded with the coupling agent and the MWCNTs. In addition, the MWCNTs were used as sensors to in-situ monitor the interfacial state in order to elucidate the interfacial strengthening mechanism. It revealed that the collaborative contribution of the coupling agent and the MWCNTs in the interphase region is the key to the high interfacial strength

<i>In Situ</i> Thermal Ablation Repair of Delamination in Carbon Fiber-Reinforced Thermosetting Composites

Repairing delamination damage is critical to guarantee the structural safety of carbon fiber-reinforced thermosetting composites. The popular repair approaches, scarf repair and injection repair, can significantly restore the in-plane mechanical performance. However, the out-of-plane properties become worse due to the sacrifice of fiber continuity in these repairing processes, leading to the materials being susceptible under service loads. Here, we propose a novel in situ delamination repair approach of controllable thermal ablation in damage removal, achieving a high repair efficiency without impairing the fiber continuity in carbon fiber/epoxy panels. The epoxy resin in the delaminated region was eliminated under the carbonization temperature in a few minutes, allowing the carbon fiber frame to retain its structural integrity. The healing agent, refilled in the damaged region, was cured by the Joule heating of designed electrodes for 30 min at 80 °C, yielding the whole repair process to be accomplished within one hour. For the delaminated carbon fiber/epoxy panels with thicknesses from 2.5 to 6.8 mm, the in-plane compression-after-impact strength after repair could recover to 90.5% of the pristine one, and still retain 74.9% after three successive repair cycles of the 6.8 mm-thick sample. The simplicity and cost-saving advantages of this repair method offer great potential for practical applications of prolonging the service life of carbon fiber-reinforced thermosetting composites