Inter-Office Memorandum from J.F. Cunningham, O.P. to R.L. Pelkington, O.P.

Providence College Department of Theatre, Dance & Film Inter-Office Memorandum from J.F. Cunningham, O.P. to R.L. Pelkington, O.P. regarding the production of Man of La Mancha. March 2, 1973https://digitalcommons.providence.edu/lamancha_commentary/1001/thumbnail.jp

Global age-sex-specific fertility, mortality, healthy life expectancy (HALE), and population estimates in 204 countries and territories, 1950–2019: a comprehensive demographic analysis for the Global Burden of Disease Study 2019

Background: Accurate and up-to-date assessment of demographic metrics is crucial for understanding a wide range of social, economic, and public health issues that affect populations worldwide. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 produced updated and comprehensive demographic assessments of the key indicators of fertility, mortality, migration, and population for 204 countries and territories and selected subnational locations from 1950 to 2019. Methods: 8078 country-years of vital registration and sample registration data, 938 surveys, 349 censuses, and 238 other sources were identified and used to estimate age-specific fertility. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate age-specific fertility rates for 5-year age groups between ages 15 and 49 years. With extensions to age groups 10–14 and 50–54 years, the total fertility rate (TFR) was then aggregated using the estimated age-specific fertility between ages 10 and 54 years. 7417 sources were used for under-5 mortality estimation and 7355 for adult mortality. ST-GPR was used to synthesise data sources after correction for known biases. Adult mortality was measured as the probability of death between ages 15 and 60 years based on vital registration, sample registration, and sibling histories, and was also estimated using ST-GPR. HIV-free life tables were then estimated using estimates of under-5 and adult mortality rates using a relational model life table system created for GBD, which closely tracks observed age-specific mortality rates from complete vital registration when available. Independent estimates of HIV-specific mortality generated by an epidemiological analysis of HIV prevalence surveys and antenatal clinic serosurveillance and other sources were incorporated into the estimates in countries with large epidemics. Annual and single-year age estimates of net migration and population for each country and territory were generated using a Bayesian hierarchical cohort component model that analysed estimated age-specific fertility and mortality rates along with 1250 censuses and 747 population registry years. We classified location-years into seven categories on the basis of the natural rate of increase in population (calculated by subtracting the crude death rate from the crude birth rate) and the net migration rate. We computed healthy life expectancy (HALE) using years lived with disability (YLDs) per capita, life tables, and standard demographic methods. Uncertainty was propagated throughout the demographic estimation process, including fertility, mortality, and population, with 1000 draw-level estimates produced for each metric. Findings: The global TFR decreased from 2•72 (95% uncertainty interval [UI] 2•66–2•79) in 2000 to 2•31 (2•17–2•46) in 2019. Global annual livebirths increased from 134•5 million (131•5–137•8) in 2000 to a peak of 139•6 million (133•0–146•9) in 2016. Global livebirths then declined to 135•3 million (127•2–144•1) in 2019. Of the 204 countries and territories included in this study, in 2019, 102 had a TFR lower than 2•1, which is considered a good approximation of replacement-level fertility. All countries in sub-Saharan Africa had TFRs above replacement level in 2019 and accounted for 27•1% (95% UI 26•4–27•8) of global livebirths. Global life expectancy at birth increased from 67•2 years (95% UI 66•8–67•6) in 2000 to 73•5 years (72•8–74•3) in 2019. The total number of deaths increased from 50•7 million (49•5–51•9) in 2000 to 56•5 million (53•7–59•2) in 2019. Under-5 deaths declined from 9•6 million (9•1–10•3) in 2000 to 5•0 million (4•3–6•0) in 2019. Global population increased by 25•7%, from 6•2 billion (6•0–6•3) in 2000 to 7•7 billion (7•5–8•0) in 2019. In 2019, 34 countries had negative natural rates of increase; in 17 of these, the population declined because immigration was not sufficient to counteract the negative rate of decline. Globally, HALE increased from 58•6 years (56•1–60•8) in 2000 to 63•5 years (60•8–66•1) in 2019. HALE increased in 202 of 204 countries and territories between 2000 and 2019. Interpretation: Over the past 20 years, fertility rates have been dropping steadily and life expectancy has been increasing, with few exceptions. Much of this change follows historical patterns linking social and economic determinants, such as those captured by the GBD Socio-demographic Index, with demographic outcomes. More recently, several countries have experienced a combination of low fertility and stagnating improvement in mortality rates, pushing more populations into the late stages of the demographic transition. Tracking demographic change and the emergence of new patterns will be essential for global health monitoring. Funding: Bill & Melinda Gates Foundation. © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licens

Global burden of 87 risk factors in 204 countries and territories, 1990�2019: a systematic analysis for the Global Burden of Disease Study 2019

Background: Rigorous analysis of levels and trends in exposure to leading risk factors and quantification of their effect on human health are important to identify where public health is making progress and in which cases current efforts are inadequate. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 provides a standardised and comprehensive assessment of the magnitude of risk factor exposure, relative risk, and attributable burden of disease. Methods: GBD 2019 estimated attributable mortality, years of life lost (YLLs), years of life lived with disability (YLDs), and disability-adjusted life-years (DALYs) for 87 risk factors and combinations of risk factors, at the global level, regionally, and for 204 countries and territories. GBD uses a hierarchical list of risk factors so that specific risk factors (eg, sodium intake), and related aggregates (eg, diet quality), are both evaluated. This method has six analytical steps. (1) We included 560 risk�outcome pairs that met criteria for convincing or probable evidence on the basis of research studies. 12 risk�outcome pairs included in GBD 2017 no longer met inclusion criteria and 47 risk�outcome pairs for risks already included in GBD 2017 were added based on new evidence. (2) Relative risks were estimated as a function of exposure based on published systematic reviews, 81 systematic reviews done for GBD 2019, and meta-regression. (3) Levels of exposure in each age-sex-location-year included in the study were estimated based on all available data sources using spatiotemporal Gaussian process regression, DisMod-MR 2.1, a Bayesian meta-regression method, or alternative methods. (4) We determined, from published trials or cohort studies, the level of exposure associated with minimum risk, called the theoretical minimum risk exposure level. (5) Attributable deaths, YLLs, YLDs, and DALYs were computed by multiplying population attributable fractions (PAFs) by the relevant outcome quantity for each age-sex-location-year. (6) PAFs and attributable burden for combinations of risk factors were estimated taking into account mediation of different risk factors through other risk factors. Across all six analytical steps, 30 652 distinct data sources were used in the analysis. Uncertainty in each step of the analysis was propagated into the final estimates of attributable burden. Exposure levels for dichotomous, polytomous, and continuous risk factors were summarised with use of the summary exposure value to facilitate comparisons over time, across location, and across risks. Because the entire time series from 1990 to 2019 has been re-estimated with use of consistent data and methods, these results supersede previously published GBD estimates of attributable burden. Findings: The largest declines in risk exposure from 2010 to 2019 were among a set of risks that are strongly linked to social and economic development, including household air pollution; unsafe water, sanitation, and handwashing; and child growth failure. Global declines also occurred for tobacco smoking and lead exposure. The largest increases in risk exposure were for ambient particulate matter pollution, drug use, high fasting plasma glucose, and high body-mass index. In 2019, the leading Level 2 risk factor globally for attributable deaths was high systolic blood pressure, which accounted for 10·8 million (95 uncertainty interval UI 9·51�12·1) deaths (19·2% 16·9�21·3 of all deaths in 2019), followed by tobacco (smoked, second-hand, and chewing), which accounted for 8·71 million (8·12�9·31) deaths (15·4% 14·6�16·2 of all deaths in 2019). The leading Level 2 risk factor for attributable DALYs globally in 2019 was child and maternal malnutrition, which largely affects health in the youngest age groups and accounted for 295 million (253�350) DALYs (11·6% 10·3�13·1 of all global DALYs that year). The risk factor burden varied considerably in 2019 between age groups and locations. Among children aged 0�9 years, the three leading detailed risk factors for attributable DALYs were all related to malnutrition. Iron deficiency was the leading risk factor for those aged 10�24 years, alcohol use for those aged 25�49 years, and high systolic blood pressure for those aged 50�74 years and 75 years and older. Interpretation: Overall, the record for reducing exposure to harmful risks over the past three decades is poor. Success with reducing smoking and lead exposure through regulatory policy might point the way for a stronger role for public policy on other risks in addition to continued efforts to provide information on risk factor harm to the general public. Funding: Bill & Melinda Gates Foundation. © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licens

Inter-Office Memorandum from J.F. Cunningham, O.P. to R.L. Pelkington, O.P.

Providence College Department of Theatre, Dance & Film Inter-Office Memorandum from J.F. Cunningham, O.P. to R.L. Pelkington, O.P. regarding the production of Man of La Mancha. March 2, 1973https://digitalcommons.providence.edu/lamancha_commentary/1001/thumbnail.jp

Substituição do milho por casca de café ou de soja em dietas para vacas leiteiras: consumo, digestibilidade dos nutrientes, produção e composição do leite Replacing corn with coffee hulls or soyhulls in dairy cows diets: intake, nutrient digestibility, and milk production and composition

Objetivou-se avaliar o efeito da substituição do milho por casca de café ou casca de soja na dieta sobre o consumo e a digestibilidade dos nutrientes, a produção e composição do leite, a variação de peso corporal e a mobilização de reserva corporal em vacas leiteiras. Foram utilizadas 12 vacas holandesas, puras e mestiças, distribuídas em três quadrados latinos 4 <FONT FACE=Symbol>&acute;</FONT> 4. As dietas foram isonitrogenadas (14% de PB, na MS) e a dieta controle foi composta de 60% de silagem de milho e 40% de concentrado na MS. Foram avaliadas três dietas à base de cana-de-açúcar e com 60% de concentrado na MS: uma controle (sem casca de soja ou de café), uma com 25% e outra com 50% de substituição do milho pela casca de café e casca de soja, respectivamente. O consumo de MS não foi afetado pelas dietas e apresentou valor médio de 19,39 kg/dia. Apesar das diferenças nos consumos de PB e NDT, as dietas foram suficientes para atender às exigências para produção de leite de 20 kg/dia (corrigida ou não para 3,5% de gordura) e ganho de peso de 0,50 kg/dia, o que explica a ausência de diferenças na produção de leite corrigida (20,54 kg/dia) ou não para 3,5% de gordura (19,68 kg/dia), na variação de peso (0,683 kg/dia) e nos níveis plasmáticos de ácidos graxos não-esterificados (AGNE) (226,99 µeq/L). A composição do leite não foi afetada pelas dietas, à exceção dos teores de lactose e extrato seco desengordurado. Em dietas à base de cana-de-açúcar para vacas com produção de 20 kg de leite/dia, o milho pode ser substituído em 25% pela casca de café ou em 50% pela casca de soja, desde que a participação de concentrado seja de 60%.<br>The objectives of this trial were to evaluate the effect of replacing corn meal with coffee hulls or soyhulls on intake and apparent digestibility of nutrients, milk yield and composition, and body weight (BW) change in lactating dairy cows. Twelve purebred and crossbred Holstein cows were assigned to three replicated 4 <FONT FACE=Symbol>&acute;</FONT> 4 Latin squares. Diets were isonitrogeneous (14% of CP, DM basis) and control diet contained 60% corn silage plus 40%concentrate. Three sugarcane based diets with 60% concentrate were used: control (without coffee hulls or soyhulls), 25% and 50% replacing corn meal by coffee hulls and soyhulls, respective. Dry matter intake did not differ and averaged 19.39 kg/day among diets. Although the intakes of CP and total digestible nutrients differ among treatments, all diets were able to meet the nutrional requirements for milk production, 3.5% fat-corrected milk (FCM), and BW gain because milk yield, FCM, BW change and plasma concentration of non-esterified fatty acids did not differ and averaged 20.54 kg/ day, 19.68 kg/day, 0.683 kg/day, and 226.99 µeq/L across diets, respectively. With the exception of lactose and solids nonfat no other significant differences in milk composition were observed across diets. In sugarcane based diets for cows producing 20 kg of milk/day, the corn can be replacement by 25% of coffee hulls or 50% of soyhulls since the concentrate participation is of 60%

Phytoextraction: a review on enhanced metal availability and plant accumulation Fitoextração: uma revisão sobre disponibilidade induzida e acumulação de metais em plantas

Phytoextraction has emerged as a novel approach to clean up metal-polluted soils in which plants are used to transfer toxic metals from soils to shoots. This review provides a synthesis of current knowledge on phytoextraction of metals from soils and their accumulation in plants. The objective is to integrate soil-related (root exudates and chemical amendments) and biological advances to suggest research needs and future directions. As far as can be deduced from the literature, it will be some time before phytoextraction may be established as a commercial technology. For chemically-assisted phytoextraction, research has not shown easily biodegradable compounds to overcome the risks associated with the use of EDTA for poorly available metals in soils. On the other hand, significant progress has been made on the physiological and molecular aspects regarding tolerance and phytoaccumulation of metals in plants. A multidisciplinary approach is warranted to make phytoextraction a feasible commercial technology to remediate metal-polluted soils.<br>A fitoextração é uma tecnologia emergente para despoluição de solos contaminados por metais pesados que usa plantas para transferir metais do solo para a parte aérea, a qual pode ser removida da área poluída. Esta revisão apresenta uma síntese do atual conhecimento sobre fitoextração de metais pesados do solo e sua acumulação em plantas. O objetivo é integrar em uma mesma discussão os avanços relacionados à química do solo (exsudação radicular e adição de agentes quelantes para aumentar a absorção) e à biologia (tolerância a metais e melhoramento genético) visando sugerir futuras pesquisas na área. Embora promissor, o atual estado de desenvolvimento da fitoextração ainda não permite estabelecê-la como uma tecnologia comercial. A pesquisa ainda não encontrou agentes quelantes facilmente biodegradáveis que possam substituir o EDTA na solubilização de metais pouco disponíveis em solos. Entretanto, significativos progressos têm sido feitos no entendimento dos mecanismos fisiológicos e moleculares de tolerância e acumulação de metais em plantas. Uma abordagem multidisciplinar dos vários aspectos que envolvem a fitoextração poderá tornar essa tecnologia econômica e ambientalmente viável a médio prazo

Vorapaxar in the secondary prevention of atherothrombotic events

Item does not contain fulltextBACKGROUND: Thrombin potently activates platelets through the protease-activated receptor PAR-1. Vorapaxar is a novel antiplatelet agent that selectively inhibits the cellular actions of thrombin through antagonism of PAR-1. METHODS: We randomly assigned 26,449 patients who had a history of myocardial infarction, ischemic stroke, or peripheral arterial disease to receive vorapaxar (2.5 mg daily) or matching placebo and followed them for a median of 30 months. The primary efficacy end point was the composite of death from cardiovascular causes, myocardial infarction, or stroke. After 2 years, the data and safety monitoring board recommended discontinuation of the study treatment in patients with a history of stroke owing to the risk of intracranial hemorrhage. RESULTS: At 3 years, the primary end point had occurred in 1028 patients (9.3%) in the vorapaxar group and in 1176 patients (10.5%) in the placebo group (hazard ratio for the vorapaxar group, 0.87; 95% confidence interval [CI], 0.80 to 0.94; P<0.001). Cardiovascular death, myocardial infarction, stroke, or recurrent ischemia leading to revascularization occurred in 1259 patients (11.2%) in the vorapaxar group and 1417 patients (12.4%) in the placebo group (hazard ratio, 0.88; 95% CI, 0.82 to 0.95; P=0.001). Moderate or severe bleeding occurred in 4.2% of patients who received vorapaxar and 2.5% of those who received placebo (hazard ratio, 1.66; 95% CI, 1.43 to 1.93; P<0.001). There was an increase in the rate of intracranial hemorrhage in the vorapaxar group (1.0%, vs. 0.5% in the placebo group; P<0.001). CONCLUSIONS: Inhibition of PAR-1 with vorapaxar reduced the risk of cardiovascular death or ischemic events in patients with stable atherosclerosis who were receiving standard therapy. However, it increased the risk of moderate or severe bleeding, including intracranial hemorrhage. (Funded by Merck; TRA 2P-TIMI 50 ClinicalTrials.gov number, NCT00526474.)