The global, regional, and national burden of cirrhosis by cause in 195 countries and territories, 1990-2017 : a systematic analysis for the Global Burden of Disease Study 2017

Background Cirrhosis and other chronic liver diseases (collectively referred to as cirrhosis in this paper) are a major cause of morbidity and mortality globally, although the burden and underlying causes differ across locations and demographic groups. We report on results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 on the burden of cirrhosis and its trends since 1990, by cause, sex, and age, for 195 countries and territories. Methods We used data from vital registrations, vital registration samples, and verbal autopsies to estimate mortality. We modelled prevalence of total, compensated, and decompensated cirrhosis on the basis of hospital and claims data. Disability-adjusted life-years (DALYs) were calculated as the sum of years of life lost due to premature death and years lived with disability. Estimates are presented as numbers and age-standardised or age-specific rates per 100 000 population, with 95% uncertainty intervals (UIs). All estimates are presented for five causes of cirrhosis: hepatitis B, hepatitis C, alcohol-related liver disease, non-alcoholic steatohepatitis (NASH), and other causes. We compared mortality, prevalence, and DALY estimates with those expected according to the Socio-demographic Index (SDI) as a proxy for the development status of regions and countries. Findings In 2017, cirrhosis caused more than 1.32 million (95% UI 1.27-1.45) deaths (440000 [416 000-518 000; 33.3%] in females and 883 000 [838 000-967 000; 66.7%] in males) globally, compared with less than 899 000 (829 000-948 000) deaths in 1990. Deaths due to cirrhosis constituted 2.4% (2.3-2.6) of total deaths globally in 2017 compared with 1.9% (1.8-2.0) in 1990. Despite an increase in the number of deaths, the age-standardised death rate decreased from 21.0 (19.2-22.3) per 100 000 population in 1990 to 16.5 (15.8-18-1) per 100 000 population in 2017. Sub-Saharan Africa had the highest age-standardised death rate among GBD super-regions for all years of the study period (32.2 [25.8-38.6] deaths per 100 000 population in 2017), and the high-income super-region had the lowest (10.1 [9.8-10-5] deaths per 100 000 population in 2017). The age-standardised death rate decreased or remained constant from 1990 to 2017 in all GBD regions except eastern Europe and central Asia, where the age-standardised death rate increased, primarily due to increases in alcohol-related liver disease prevalence. At the national level, the age-standardised death rate of cirrhosis was lowest in Singapore in 2017 (3.7 [3.3-4.0] per 100 000 in 2017) and highest in Egypt in all years since 1990 (103.3 [64.4-133.4] per 100 000 in 2017). There were 10.6 million (10.3-10.9) prevalent cases of decompensated cirrhosis and 112 million (107-119) prevalent cases of compensated cirrhosis globally in 2017. There was a significant increase in age-standardised prevalence rate of decompensated cirrhosis between 1990 and 2017. Cirrhosis caused by NASH had a steady age-standardised death rate throughout the study period, whereas the other four causes showed declines in age-standardised death rate. The age-standardised prevalence of compensated and decompensated cirrhosis due to NASH increased more than for any other cause of cirrhosis (by 33.2% for compensated cirrhosis and 54.8% for decompensated cirrhosis) over the study period. From 1990 to 2017, the number of prevalent cases snore than doubled for compensated cirrhosis due to NASH and more than tripled for decompensated cirrhosis due to NASH. In 2017, age-standardised death and DALY rates were lower among countries and territories with higher SDI. Interpretation Cirrhosis imposes a substantial health burden on many countries and this burden has increased at the global level since 1990, partly due to population growth and ageing. Although the age-standardised death and DALY rates of cirrhosis decreased from 1990 to 2017, numbers of deaths and DALYs and the proportion of all global deaths due to cirrhosis increased. Despite the availability of effective interventions for the prevention and treatment of hepatitis B and C, they were still the main causes of cirrhosis burden worldwide, particularly in low-income countries. The impact of hepatitis B and C is expected to be attenuated and overtaken by that of NASH in the near future. Cost-effective interventions are required to continue the prevention and treatment of viral hepatitis, and to achieve early diagnosis and prevention of cirrhosis due to alcohol-related liver disease and NASH. Copyright (C) 2020 The Author(s). Published by Elsevier Ltd.Peer reviewe

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

Les périmètres de l’intercommunalité : entre simplicité juridique et cohérence administrative

International audienc

Lupa. Revalorisation de la vallée de la Louve, nouvelle promenade urbaine et activateur social, Lausanne (CH)

Le projet se situe au cœur de Lausanne, sur le lit de la rivière de la Louve, entre la butte du parc de l'Hermitage, les coteaux de la cathédrale et les hauteurs du quartier du Valentin. Autrefois frontière naturelle délimitant l’entrée de la cité, la Louve, comblée dans les années 1850, reste un élément fondamental de la topographie de la ville. Un geste: creuser ! Creuser pour revenir aux sources, tant hydrauliques que topographiques, permettant l’émergence d’un espace de vie, la vallée de la Louve. Le bâtiment est positionné de façon à dialoguer avec la rue de la Riponne, axe majeur de la ville, et la place créée en contrebas. Lieu de rassemblements et d'événements, la place est l’aboutissement d’une promenade urbaine parsemée de végétation et d’installations sportives, créant ainsi un poumon vert et un activateur social au cœur de la ville. L’ossature métallique du bâtiment, sur l’extérieur, permet d’obtenir de grands plateaux libres. Ce bâtiment générique est composé d’éléments simples et réguliers : poteaux, poutres, tirants, formant ainsi des portiques qui se répètent sur toute la longueur du bâtiment. Le projet, lieu où deux univers se côtoient, est une métaphore de la société contemporaine. Le hall, espace neutre, offre deux directions : monter pour se diriger vers une hyper-technologie, où la place de l’homme se restreint lors de l’ascension ; ou descendre dans les abîmes, vers un univers des sens et du plaisir. Lupa, la machine dichotomique est née

Difficultés d’émergence d’un cluster en territoire rural : réflexion autour du cluster Bois et Energie du Fumélois, situé en Lot-et-Garonne

National audienc

Img2Mol - Accurate SMILES Recognition from Molecular Graphical Depictions

Automatic recognition of the molecular content of a molecule’s graphical depiction is an extremely challenging problem that remains largely unsolved despite decades of research. Recent advances in neural machine translation enable the auto-encoding of molecular structures in a continuous vector space of fixed size (latent representation) with low reconstruction errors. In this paper, we present a fast and accurate model combining a deep convolutional neural network learning from molecule depictions and a pre-trained decoder that translates the latent representation into the SMILES representation of the molecules. This combination allows to precisely infer a molecular structure from an image. Our rigorous evaluation show that Img2Mol is able to correctly translate up to 88% of the molecular depictions into their SMILES representation. A pretrained version of Img2Mol is made publicly available on GitHub for non-commercial users.</p

Renouveau industriel en territoire rural : De l’innovation technique à l’innovation managériale et sociale – Le cas du Cluster Bois et Energie du Fumélois

Collection "Développement Durable"National audienc

Learning continuous and data-driven molecular descriptors by translating equivalent chemical representations

There has been a recent surge of interest in using machine learning across chemical space in order to predict properties of molecules or design molecules and materials with the desired properties. Most of this work relies on defining clever feature representations, in which the chemical graph structure is encoded in a uniform way such that predictions across chemical space can be made. In this work, we propose to exploit the powerful ability of deep neural networks to learn a feature representation from low-level encodings of a huge corpus of chemical structures. Our model borrows ideas from neural machine translation: it translates between two semantically equivalent but syntactically different representations of molecular structures, compressing the meaningful information both representations have in common in a low-dimensional representation vector. Once the model is trained, this representation can be extracted for any new molecule and utilized as a descriptor. In fair benchmarks with respect to various human-engineered molecular fingerprints and graph-convolution models, our method shows competitive performance in modelling quantitative structure–activity relationships in all analysed datasets. Additionally, we show that our descriptor significantly outperforms all baseline molecular fingerprints in two ligand-based virtual screening tasks. Overall, our descriptors show the most consistent performances in all experiments. The continuity of the descriptor space and the existence of the decoder that permits deducing a chemical structure from an embedding vector allow for exploration of the space and open up new opportunities for compound optimization and idea generation

Difficultés d’émergence d’un cluster en territoire rural : réflexion autour du cluster Bois et Energie du Fumélois, situé en Lot-et-Garonne

National audienc

Le kit de jeu de rôle pédagogique « L'Eau en Têt » : un outil pour éduquer à la participation ?

National audienceSince 2014, a multi-partnership project, involving a french agriculture teaching public organisation, a research team and the french river Têt basin syndicate, achieved the design and edition of "L'Eau en Têt", an educational role-playing game kit dedicated to sustainable water management. This paper introduces this project while summarising the educational and further uses of this game, Finally, we address the effects of such an approach on the learning capabilities of the participants.À partir de 2014, un projet multi-partenarial impliquant un établissement d'enseignement agricole, une équipe de recherche et un syndicat de bassin versant dans les Pyrénées-Orientales a permis de concevoir et éditer « L'eau en Têt », un kit de jeu de rôle consacré à la gestion durable de l'eau. Cet article présente cette initiative, fait un point sur les usages pédagogiques et autres de ce kit de jeu, et aborde finalement la question des effets d'apprentissage de ce type de démarche pour les participants, en particulier du point de vue d’une éducation à la participation