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

Optimizing the Schedule of Dispatching Earthmoving Trucks through Genetic Algorithms and Simulation

Most construction projects involve earthmoving operations. Careful management of trucks to perform these operations is considered crucial by earthwork contractors in Taiwan. A mechanism is described that optimizes the management of the truck fleets of earthwork contractors. The proposed model integrates a discrete event simulation technique and genetic algorithms (GAs) to minimize the duration of earthmoving operations. The discrete simulation model is applied to simulate earthmoving operations and generate schedules for dispatching various trucks, and the GAs are used as a filter to screen out schedules that require long trips. Examples prove that the proposed model can determine near-optimal solutions efficiently. In addition, a user-friendly computer program is developed so that earthwork contractors can plan the dispatch schedule of earthmoving trucks easily and effectively. DOI: 10.1061/(ASCE)CF.1943-5509.0000219. (C) 2012 American Society of Civil Engineers

Superior long-term stability of a glucose biosensor based on inserted barrel plating gold electrodes

Disposable one shot usage blood glucose strips are routinely used in the diagnosis and management of diabetes mellitus and their performance can vary greatly. In this paper we critically evaluated the long-term stability of glucose strips made of barrel plating gold electrodes. Compared to other glucose biosensing platforms of vapor deposited palladium and screen printed carbon electrodes, the proposed glucose biosensor was found to show the best stability among the three biosensing platforms in thermal acceleration experiments at 40 degrees C for 6 months with an average bias of 3.4% at glucose concentrations of 5-20 mM. The precision test of this barrel plating gold glucose biosensor also showed the best performance (coefficients of variation in the range of 1.4-2.4%) in thermal acceleration experiments at 40 degrees C, 50 degrees C and 70 degrees C for 27 days. Error grid analysis revealed that all measurements fell in zone A and zone B. Regression analysis showed no significant difference between the proposed biosensor and the reference method at 99% confidence level. The amperometric glucose biosensor fabricated by inserting two barrel plating gold electrodes onto an injection-molding plastic base followed by immobilizing with a bio-reagent layer and membrane was very impressive with a long-term stability up to 2.5 years at 25 degrees C. Overall, these results indicated that the glucose oxidase/barrel plating gold biosensing platform is ideal for long-term accurate glycemic control. (C) 2009 Elsevier B.V. All rights reserved

Estimation of leaf nitrogen content using artificial neural network with cross-learning scheme and significant wavelengths

Reflectance from crops provides spectral information for non-destructive monitoring of their nutrition status. In order to develop a multi-spectral imaging system for remote sensing of the nitrogen content of crops, the significant wavelengths and calibration models were carefully evaluated in this study. The significant wavelengths in full band (4002500 nm) and a selected band (450-950 nm), which is suitable for silicon CCD cameras, were investigated. In this article, significant wavelengths for estimating nitrogen content of cabbage seedling leaves were first determined by SMLR (stepwise multi-linear regression) analysis. A proposed ANN (artificial neural network) model with cross-learning scheme (ANN-CL) was further developed to increase the prediction accuracy. To comply with the design of a practical multi-spectral imaging system using silicon CCD cameras and commercially available bandpass filters, an ANN-CL model with four inputs of spectral absorbance at 490, 570, 600, and 680 nm was developed. The calibration results (rc = 0.93, SEC = 0.873%, and SEV = 0.96001o) reduced the SEVabout 15% when compared with the SMLR method withfour wavelengths (SEV = 1.099%). In addition, the results were comparable to that of SMLR with seven wavelengths (rc = 0.94, SEC = 0.806010, and SEV = 0.993%) in the full band. These results indicated that the ANN model with cross-learning using spectral information at 490, 570, 600, and 680 nm could be used to develop a practical remote sensing system to predict nitrogen content of cabbage seedlings

A reconfigurable low-noise amplifier using a tunable active inductor for multistandard receivers

A reconfigurable low-noise amplifier (LNA) based on a high-value active inductor (AI) is presented in this paper. Instead of using a passive on-chip inductor, a high-value on-chip inductor with a wide tuning range is used in this circuit and results in a decrease in the physical silicon area when compared to a passive inductor-based implementation. The LNA is a common source cascade amplifier with RC feedback. A tunable active inductor is used as the amplifier output load, and for input and output impedance matching, a source follower with an RC network is used to provide a 50 Ω impedance. The amplifier circuit has been designed in 0.18 µm CMOS process and simulated using the Cadence Spectra circuit simulator. The simulation results show a reconfigurable frequency from 0.8 to 2.5 GHz, and tuning of the frequency band is achieved by using a CMOS voltage controlled variable resistor. For a selected 1.5 GHz frequency band, simulation results show S 21 (Gain) of 22 dB, S 11 of −18 dB, S 22 of −16 dB, NF of 3.02 dB, and a minimum NF (NFmin) of 1.7 dB. Power dissipation is 19.6 mW using a 1.8 V dc power supply. The total LNA physical silicon area is (200×150) µm2

Fabrication of a Glucose Biosensor Based on Inserted Barrel Plating Gold Electrodes

We demonstrate here the application of barrel plating gold electrodes for fabricating a new type of disposable amperometric glucose biosensor. It is prepared by inserting two barrel plating gold electrodes onto an injection molding plastic base followed by immobilizing with a bioreagent layer and membrane on the electrode surface. The primary function of barrel plating is to provide an economical way to electroplate manufactured parts. The manufacture procedure is simple and can increase the fabrication precision for automation in mass production. At the two-electrode system, the detection of glucose is linear up to 800 mg/dL (i.e., 44.5 mM, r(2) > 0.99) in pH 7.4 PBS with a sensitivity of 0.71 mu A/mM. Excellent sensor-to-sensor reproducibility shows coefficients of variation of only 0.8-1.4% for the detection of 56.5-561.0 mg/dL glucose. In laboratory trials 176 capillary blood samples with a range of 30-572 mg/dL glucose are used to evaluate the clinical application of the biosensor. A good linear correlation is observed between the measured values of the proposed biosensor and laboratory reference. Error grid analysis verifies that the proposed technique is promising in fabricating biosensor strips on a mass scale. As successfully demonstrated by using whole blood glucose as a model analyte, the fabrication technique can extend into other barrel plating noble metal electrodes for various applications