Trends and forecasts in cause-specific mortality

Mortality forecasting models are typically limited in that they pertain only to national death rates, predict only all-cause mortality, or do not capture and utilize the correlation among diseases. I have developed a novel Bayesian hierarchical model that jointly forecasts cause- specific death rates for geographic subunits. I examined the model’s effectiveness by applying it to United States vital statistics data from 1982 to 2011 that I prepared using a new cause of death reassignment algorithm. I found that the model not only generated coherent forecasts for mutually exclusive causes of death, but it also exhibited lower out-of-sample error than alternative commonly-used models for forecasting mortality. I then used the model to produce forecasts of US cause-specific mortality through 2025 and analysed the resulting trends. I found that total death rates in the US were likely to continue their decline, but at a slower rate of improvement than has been observed for the past several decades. While death rates due to major causes of death like ischaemic heart disease, stroke, and lung cancer were projected to continue trending downward, increases in causes such as unintentional injuries and mental and neurological conditions offset many of these gains. These findings suggest that the US health system will need to adapt to a changing cause composition of disease burden as its population ages in the coming decade. Forecasting research should continue to consider how to best incorporate and balance the many dimensions of mortality when producing projections.Open Acces

Design of a Heat Pump Assisted Solar Thermal System

This paper outlines the design of an active solar thermal loop system that will be integrated with an air source heat pump hot water heater to provide highly efficient heating of a water/propylene glycol mixture. This system design uses solar energy when available, but reverts to the heat pump at night or during cloudy weather. This new design will be used for hydronic heating in the Applied Energy Laboratory, a teaching laboratory at Purdue University, but it is more generally applicable for a residential scale system that could be used for both hydronic heating and hot water production. This combined system should provide efficient heating at a fraction of the operating costs of competing electric, gas, or even heat pump water heaters. The initial cost of installing a similar system is currently relatively high, but it should be noted that the design is still in the prototype stage. The price should reduce dramatically when the system is commercialized. There are multiple applications where the production of heated fluid by a combined solar/heat pump hydronic system can be much more attractive than conventional heating methods. Construction and implementation of this proposed design will take place summer of 2014 and data collection will be pursued afterwards

Cardiorespiratory Responses during Aquatic Treadmill Exercise and Land Treadmill Exercise in Adults with Diabetes

The purpose of this study was to compare the effect of aquatic treadmill (ATM) exercise to land treadmill (LTM) exercise in adults with type 2 diabetes. Five participants with type 2 diabetes (T2D group; 4 females, 1 male; age = 51±6 years; height = 170±7 cm; weight = 96±24 kg; body fat = 31.6±2.2%) and five participants without type 2 diabetes (control group; 4 females, 1 male; age = 51±6 years; height = 170±6 cm; weight = 71±15 kg; body fat = 26.8±4.6%) completed the study. Protocols for both ATM exercise and LTM exercise began at 2 mph with 0% grade and increased by 1 mph after 5 minutes at each stage. Termination occurred after participants completed the protocol or reached 85% of heart rate reserve. Heart rate, absolute and relative VO2, and systolic and diastolic blood pressure were measured at rest and during steady-state exercise at each intensity. Mean arterial pressure (MAP) was calculated. A 2 x 2 x 3 Mixed Factorial ANOVA and Bonferroni post hoc test with a significance level of .0125 were used. There was a significant difference (p2 of the two groups at 4 mph while performing the land treadmill exercise (T2D: 14.1±1.4 ml/kg/min vs. control: 18.4±1.6 ml/kg/min, p2 between participant groups or modes of exercise. Those with type 2 diabetes had an increased MAP versus those without type 2 diabetes while performing the land treadmill exercise at 2 mph (T2D: 93±3 mmHg vs. control: 81±5 mmHg, p2, and MAP respond similarly in both groups during ATM and LTM exercise at most treadmill speeds

Psychosocial Assessment of Candidates for Transplantation (PACT) Score Identifies High Risk Patients in Pediatric Renal Transplantation

Background: Currently, there is no standardized approach for determining psychosocial readiness in pediatric transplantation. We examined the utility of the Psychosocial Assessment of Candidates for Transplantation (PACT) to identify pediatric kidney transplant recipients at risk for adverse clinical outcomes.Methods: Kidney transplant patients <21-years-old transplanted at Duke University Medical Center between 2005 and 2015 underwent psychosocial assessment by a social worker with either PACT or unstructured interview, which were used to determine transplant candidacy. PACT assessed candidates on a scale of 0 (poor candidate) to 4 (excellent candidate) in areas of social support, psychological health, lifestyle factors, and understanding. Demographics and clinical outcomes were analyzed by presence or absence of PACT and further characterized by high (≥3) and low (≤2) scores.Results: Of 54 pediatric patients, 25 (46.3%) patients underwent pre-transplant evaluation utilizing PACT, while 29 (53.7%) were not evaluated with PACT. Patients assessed with PACT had a significantly lower percentage of acute rejection (16.0 vs. 55.2%, p = 0.007). After adjusting for HLA mismatch, a pre-transplant PACT score was persistently associated with lower odds of acute rejection (Odds Ratio 0.119, 95% Confidence Interval 0.027–0.52, p = 0.005). In PACT subsection analysis, the lack of family availability (OR 0.08, 95% CI 0.01–0.97, p = 0.047) and risk for psychopathology (OR 0.34, 95% CI 0.13–0.87, p = 0.025) were associated with a low PACT score and post-transplant non-adherence.Conclusions: Our study highlights the importance of standardized psychosocial assessments and the potential use of PACT in risk stratifying pre-transplant candidates

Inflation and Dark Energy from spectroscopy at z > 2

The expansion of the Universe is understood to have accelerated during two epochs: in its very first moments during a period of Inflation and much more recently, at z < 1, when Dark Energy is hypothesized to drive cosmic acceleration. The undiscovered mechanisms behind these two epochs represent some of the most important open problems in fundamental physics. The large cosmological volume at 2 < z < 5, together with the ability to efficiently target high-$z$ galaxies with known techniques, enables large gains in the study of Inflation and Dark Energy. A future spectroscopic survey can test the Gaussianity of the initial conditions up to a factor of ~50 better than our current bounds, crossing the crucial theoretical threshold of $\sigma(f_{NL}^{\rm local})$ of order unity that separates single field and multi-field models. Simultaneously, it can measure the fraction of Dark Energy at the percent level up to $z = 5$, thus serving as an unprecedented test of the standard model and opening up a tremendous discovery space

Global Burden of Multiple Myeloma ASystematic Analysis for the Global Burden of Disease Study 2016

Introduction: Multiple myeloma (MM) is a plasma cell neoplasm with substantial morbidity and mortality. A comprehensive description of the global burden of MM is needed to help direct health policy, resource allocation, research, and patient care.Objective: To describe the burden of MM and the availability of effective therapies for 21 world regions and 195 countries and territories from 1990 to 2016.Design and Setting: We report incidence, mortality, and disability-adjusted life-year (DALY) estimates from the Global Burden of Disease 2016 study. Data sources include vital registration system, cancer registry, drug availability, and survey data for stem cell transplant rates. We analyzed the contribution of aging, population growth, and changes in incidence rates to the overall change in incident cases from 1990 to 2016 globally, by sociodemographic index (SDI) and by region. We collected data on approval of lenalidomide and bortezomib worldwide.Main Outcomes and Measures: Multiple myeloma mortality; incidence; years lived with disabilities; years of life lost; and DALYs by age, sex, country, and year.Results: Worldwide in 2016 there were 138 509 (95% uncertainty interval [UI], 121 000-155 480) incident cases of MM with an age-standardized incidence rate (ASIR) of 2.1 per 100 000 persons (95% UI, 1.8-2.3). Incident cases from 1990 to 2016 increased by 126% globally and by 106% to 192% for all SDI quintiles. The 3 world regions with the highest ASIR of MM were Australasia, North America, and Western Europe. Multiple myeloma caused 2.1 million (95% UI, 1.9-2.3 million) DALYs globally in 2016. Stem cell transplantation is routinely available in higher-income countries but is lacking in sub-Saharan Africa and parts of the Middle East. In 2016, lenalidomide and bortezomib had been approved in 73 and 103 countries, respectively.Conclusions and Relevance: Incidence of MM is highly variable among countries but has increased uniformly since 1990, with the largest increase in middle and low-middle SDI countries. Access to effective care is very limited in many countries of low socioeconomic development, particularly in sub-Saharan Africa. Global health policy priorities for MM are to improve diagnostic and treatment capacity in low and middle income countries and to ensure affordability of effective medications for every patient. Research priorities are to elucidate underlying etiological factors explaining the heterogeneity in myeloma incidence

Algorithms for enhancing public health utility of national causes-of-death data

<p>Abstract</p> <p>Background</p> <p>Coverage and quality of cause-of-death (CoD) data varies across countries and time. Valid, reliable, and comparable assessments of trends in causes of death from even the best systems are limited by three problems: a) changes in the <it>International Statistical Classification of Diseases and Related Health Problems </it>(ICD) over time; b) the use of tabulation lists where substantial detail on causes of death is lost; and c) many deaths assigned to causes that cannot or should not be considered underlying causes of death, often called garbage codes (GCs). The Global Burden of Disease Study and the World Health Organization have developed various methods to enhance comparability of CoD data. In this study, we attempt to build on these approaches to enhance the utility of national cause-of-death data for public health analysis.</p> <p>Methods</p> <p>Based on careful consideration of 4,434 country-years of CoD data from 145 countries from 1901 to 2008, encompassing 743 million deaths in ICD versions 1 to 10 as well as country-specific cause lists, we have developed a public health-oriented cause-of-death list. These 56 causes are organized hierarchically and encompass all deaths. Each cause has been mapped from ICD-6 to ICD-10 and, where possible, they have also been mapped to the <it>International List of Causes of Death </it>1-5. We developed a typology of different classes of GCs. In each ICD revision, GCs have been identified. Target causes to which these GCs should be redistributed have been identified based on certification practice and/or pathophysiology. Proportionate redistribution, statistical models, and expert algorithms have been developed to redistribute GCs to target codes for each age-sex group.</p> <p>Results</p> <p>The fraction of all deaths assigned to GCs varies tremendously across countries and revisions of the ICD. In general, across all country-years of data available, GCs have declined from more than 43% in ICD-7 to 24% in ICD-10. In some regions, such as Australasia, GCs in 2005 are as low as 11%, while in some developing countries, such as Thailand, they are greater than 50%. Across different age groups, the composition of GCs varies tremendously - three classes of GCs steadily increase with age, but ambiguous codes within a particular disease chapter are also common for injuries at younger ages. The impact of redistribution is to change the number of deaths assigned to particular causes for a given age-sex group. These changes alter ranks across countries for any given year by a number of different causes, change time trends, and alter the rank order of causes within a country.</p> <p>Conclusions</p> <p>By mapping CoD through different ICD versions and redistributing GCs, we believe the public health utility of CoD data can be substantially enhanced, leading to an increased demand for higher quality CoD data from health sector decision-makers.</p

Global, regional, and national incidence and mortality for HIV, tuberculosis, and malaria during 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013

The Millennium Declaration in 2000 brought special global attention to HIV, tuberculosis, and malaria through the formulation of Millennium Development Goal (MDG) 6. The Global Burden of Disease 2013 study provides a consistent and comprehensive approach to disease estimation for between 1990 and 2013, and an opportunity to assess whether accelerated progress has occurred since the Millennium Declaration