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

Effects of water temperature and light intensity on the performance of gravity-driven membrane system

The selection of favorable environmental conditions for gravity-driven membrane (GDM) systems is crucial to their widespread application. In this study, GDM systems operated under different light intensities (illuminance levels of 0, 200, and 3000 Lux) and water temperatures (10, 20, and 30 degrees C) were investigated for their performance and fouling layer characteristics. The results showed that indoor light (200 Lux) had limited effects on the performance of the GDM system. However, full daylight (3000 Lux) led to algal growth; these algae increased fouling resistance and deteriorated permeate water by releasing algogenic organic matter, although they could also enhance the heterogeneity of the biofouling layer by increasing the microbial activity. Water temperature rarely influenced the total organic matter removal. The fouling layers had different thicknesses and heterogeneity, but the same level of EPS; therefore, the hydraulic resistances of these fouling layer were almost the same at different water temperatures. These findings suggest that GDM system could be operated at low water temperature and indoor light conditions, and that strong light should be avoided during the operation of GDM systems. (C) 2018 Elsevier Ltd. All rights reserved

Polyamide Thin-Film Composite Janus Membranes Avoiding Direct Contact between Feed Liquid and Hydrophobic Pores for Excellent Wetting Resistance in Membrane Distillation

Hydrophobic membranes are very susceptible to pore wetting when they contact the feed water containing surfactants or low-surface-tension liquids in membrane distillation (MD). Avoiding direct contact between feed water and hydrophobic membrane pores is a potential strategy to control membrane pore wetting. In this study, we successfully fabricated a polyamide thin-film composite (TFC) Janus membrane through interfacial polymerization, with a hydrophobic microporous membrane as the substrate. The fabricated TFC Janus membrane showed a super antiwetting ability when treating the hypersaline water containing surfactants (>0.4 mM sodium dodecyl sulfate) or ethanol (>40% v/v). The optical coherence tomography (OCT) observation revealed that no liquid water was present at the distillate-facing side of the polyamide layer. Therefore, we ascribed the super antiwetting ability to the fact that the polyamide layer could prevent the feed liquid from directly contacting hydrophobic pores. The TFC Janus membrane could also avoid the wetting induced by gypsum scaling because the polyamide layer could act as a barrier to hinder the intrusion of gypsum crystals into hydrophobic pores. In addition to the antiwetting ability, the TFC Janus membrane showed 10–20% increases in vapor flux, despite the existence of a dense polyamide layer. Because interfacial polymerization is the most commonly used method for the fabrication of commercial TFC membranes, this study provides a facile and scalable method to fabricate membranes with robust antiwetting ability

Biofouling in ultrafiltration process for drinking water treatment and its control by chlorinated-water and pure water backwashing

We investigated biofouling in ultrafiltration (UF) for drinking water treatment and its control by backwashing with chlorinated-water or pure water. By using sodium azide to suppress biological growth, the relative contribution of biofouling to total fouling was estimated, and its value (5.3-56.0%) varied with the feed water, and increased with the increases of filtration time and membrane flux. The biofouling layer could partially remove biodegradable organic matter and ammonia (32.9-74.2%). Backwashing using chlorinated-water partly inactivated the microorganisms (23.8%) but increased the content of extracellular polymeric substances (7.7%) in the biofouling layer. In contrast, backwashing using pure water led to a looser and more porous fouling layer according to optical coherence tomography observation. Consequently, the latter was more effective in reducing fouling resistance (33.41% reduction) compared to backwashing by chlorinated-water (8.6%). These findings reveal the critical roles of biofouling in pollutants removal in addition to membrane permeability, which has important implications for addressing seasonal ammonia pollution. (C) 2018 Published by Elsevier B.V

Application of Marine Natural Products against Alzheimer’s Disease: Past, Present and Future

Alzheimer’s disease (AD), a neurodegenerative disease, is one of the most intractable illnesses which affects the elderly. Clinically manifested as various impairments in memory, language, cognition, visuospatial skills, executive function, etc., the symptoms gradually aggravated over time. The drugs currently used clinically can slow down the deterioration of AD and relieve symptoms but cannot completely cure them. The drugs are mainly acetylcholinesterase inhibitors (AChEI) and non-competitive N-methyl-D-aspartate receptor (NDMAR) antagonists. The pathogenesis of AD is inconclusive, but it is often associated with the expression of beta-amyloid. Abnormal deposition of amyloid and hyperphosphorylation of tau protein in the brain have been key targets for past, current, and future drug development for the disease. At present, researchers are paying more and more attention to excavate natural compounds which can be effective against Alzheimer’s disease and other neurodegenerative pathologies. Marine natural products have been demonstrated to be the most prospective candidates of these compounds, and some have presented significant neuroprotection functions. Consequently, we intend to describe the potential effect of bioactive compounds derived from marine organisms, including polysaccharides, carotenoids, polyphenols, sterols and alkaloids as drug candidates, to further discover novel and efficacious drug compounds which are effective against AD