Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Background: In an era of shifting global agendas and expanded emphasis on non-communicable diseases and injuries along with communicable diseases, sound evidence on trends by cause at the national level is essential. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic scientific assessment of published, publicly available, and contributed data on incidence, prevalence, and mortality for a mutually exclusive and collectively exhaustive list of diseases and injuries. Methods: GBD estimates incidence, prevalence, mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) due to 369 diseases and injuries, for two sexes, and for 204 countries and territories. Input data were extracted from censuses, household surveys, civil registration and vital statistics, disease registries, health service use, air pollution monitors, satellite imaging, disease notifications, and other sources. Cause-specific death rates and cause fractions were calculated using the Cause of Death Ensemble model and spatiotemporal Gaussian process regression. Cause-specific deaths were adjusted to match the total all-cause deaths calculated as part of the GBD population, fertility, and mortality estimates. Deaths were multiplied by standard life expectancy at each age to calculate YLLs. A Bayesian meta-regression modelling tool, DisMod-MR 2.1, was used to ensure consistency between incidence, prevalence, remission, excess mortality, and cause-specific mortality for most causes. Prevalence estimates were multiplied by disability weights for mutually exclusive sequelae of diseases and injuries to calculate YLDs. We considered results in the context of the Socio-demographic Index (SDI), a composite indicator of income per capita, years of schooling, and fertility rate in females younger than 25 years. Uncertainty intervals (UIs) were generated for every metric using the 25th and 975th ordered 1000 draw values of the posterior distribution. Findings: Global health has steadily improved over the past 30 years as measured by age-standardised DALY rates. After taking into account population growth and ageing, the absolute number of DALYs has remained stable. Since 2010, the pace of decline in global age-standardised DALY rates has accelerated in age groups younger than 50 years compared with the 1990–2010 time period, with the greatest annualised rate of decline occurring in the 0–9-year age group. Six infectious diseases were among the top ten causes of DALYs in children younger than 10 years in 2019: lower respiratory infections (ranked second), diarrhoeal diseases (third), malaria (fifth), meningitis (sixth), whooping cough (ninth), and sexually transmitted infections (which, in this age group, is fully accounted for by congenital syphilis; ranked tenth). In adolescents aged 10–24 years, three injury causes were among the top causes of DALYs: road injuries (ranked first), self-harm (third), and interpersonal violence (fifth). Five of the causes that were in the top ten for ages 10–24 years were also in the top ten in the 25–49-year age group: road injuries (ranked first), HIV/AIDS (second), low back pain (fourth), headache disorders (fifth), and depressive disorders (sixth). In 2019, ischaemic heart disease and stroke were the top-ranked causes of DALYs in both the 50–74-year and 75-years-and-older age groups. Since 1990, there has been a marked shift towards a greater proportion of burden due to YLDs from non-communicable diseases and injuries. In 2019, there were 11 countries where non-communicable disease and injury YLDs constituted more than half of all disease burden. Decreases in age-standardised DALY rates have accelerated over the past decade in countries at the lower end of the SDI range, while improvements have started to stagnate or even reverse in countries with higher SDI. Interpretation: As disability becomes an increasingly large component of disease burden and a larger component of health expenditure, greater research and developm nt investment is needed to identify new, more effective intervention strategies. With a rapidly ageing global population, the demands on health services to deal with disabling outcomes, which increase with age, will require policy makers to anticipate these changes. The mix of universal and more geographically specific influences on health reinforces the need for regular reporting on population health in detail and by underlying cause to help decision makers to identify success stories of disease control to emulate, as well as opportunities to improve. 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 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

Thermal Management Using Graphene and Carbon-Nanotubes

This dissertation investigates the application of graphene and carbon nanotubes (CNTs) for thermal management of high-power batteries and interconnects. The research is focused on three applications: (i) thermal phase change materials (PCMs) with graphene fillers for thermal management of battery packs; (ii) CNTs incorporated in the battery electrodes; (iii) graphene coatings for copper (Cu) interconnects. In this study, lithium-ion (Li-ion) batteries were used for testing the proposed approaches. The graphene solutions for synthesis of graphene PCMs were obtained by the liquid-phase exfoliation. The graphene coatings on Cu films were grown by the chemical vapor deposition (CVD). In the first part of the dissertation, it is demonstrated that thermal management of Li-ion batteries can be drastically improved using PCM with graphene fillers. Incorporation of graphene to the hydrocarbon-based PCM allowed one to increase its thermal conductivity by more than two orders of magnitude while preserving its latent heat storage ability. A combination of the sensible and latent heat storage together with the improved heat conduction outside of the battery pack leads to a significant decrease in the temperature rise inside the Li-ion battery pack. I the second part of the dissertation, it is shown that thermal properties of Li-ion battery electrodes can be improved by incorporation of CNTs. The electrodes were synthesized via an inexpensive scalable filtration method, which can be extended to commercial electrode-active materials. The measurements reveal that the in-plane (cross-plane) thermal conductivity of the cathodes with the highest battery capacity was ~50 W/mK (3 W/mK) at room temperature. These values are up to two-orders-of-magnitude higher than those for conventional electrodes based on carbon black. The highest in-plane thermal conductivity achieved in the carbon-nanotube-enhanced electrodes was ~141 W/mK. In third part of the dissertation, it is demonstrated that graphene coating can strongly increase the thermal conductivity of Cu films as compared to the reference Cu and annealed Cu films. The observed improvement of thermal properties of graphene coated Cu films results primarily from the changes in Cu morphology during graphene CVD rather than from graphene's action as an additional heat conducting channel. The obtained results are important for thermal management of advanced batteries and downscaled computer chips

Toward Lithium Ion Batteries with Enhanced Thermal Conductivity

As batteries become more powerful and utilized in diverse applications, thermal management becomes one of the central problems in their application. We report the results on thermal properties of a set of different Li-ion battery electrodes enhanced with multiwalled carbon nanotubes. Our measurements reveal that the highest in-plane and cross-plane thermal conductivities achieved in the carbon-nanotube-enhanced electrodes reached up to 141 and 3.6 W/mK, respectively. The values for in-plane thermal conductivity are up to 2 orders of magnitude higher than those for conventional electrodes based on carbon black. The electrodes were synthesized via an inexpensive scalable filtration method, and we demonstrate that our approach can be extended to commercial electrode-active materials. The best performing electrodes contained a layer of γ-Fe2O3 nanoparticles on carbon nanotubes sandwiched between two layers of carbon nanotubes and had in-plane and cross-plane thermal conductivities of ∼50 and 3 W/mK, respectively, at room temperature. The obtained results are important for thermal management in Li-ion and other high-power-density batteries.Fil: Koo, Bonil. Argonne National Laboratory; Estados UnidosFil: Goli, Pradyumna. University of California; Estados UnidosFil: Sumant, Anirudha V.. Argonne National Laboratory; Estados UnidosFil: Dos Santos Claro, Paula Cecilia. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico la Plata. Instituto de Investigaciones Fisicoquímicas Teóricas y Aplicadas; Argentina. Argonne National Laboratory; Estados UnidosFil: Rajh, Tijana. Argonne National Laboratory; Estados UnidosFil: Johnson, Christopher S.. Argonne National Laboratory; Estados UnidosFil: Balandin, Alexander A.. University of California; Estados UnidosFil: Shevchenko, Elena V.. Argonne National Laboratory; Estados Unido

Thermal Properties of Graphene–Copper–Graphene Heterogeneous Films

We demonstrated experimentally that graphene–Cu–graphene heterogeneous films reveal strongly enhanced thermal conductivity as compared to the reference Cu and annealed Cu films. Chemical vapor deposition of a single atomic plane of graphene on both sides of 9 μm thick Cu films increases their thermal conductivity by up to 24% near room temperature. Interestingly, the observed improvement of thermal properties of graphene–Cu–graphene heterofilms results primarily from the changes in Cu morphology during graphene deposition rather than from graphene’s action as an additional heat conducting channel. Enhancement of thermal properties of graphene-capped Cu films is important for thermal management of advanced electronic chips and proposed applications of graphene in the hybrid graphene–Cu interconnect hierarchies