Glucose levels in first 3 days and neurodevelopmental outcome at 1 year in low birth weight infants: A cohort study

Background: Definition of neonatal hypoglycemia is still controversial. Objective: To find the effect of blood glucose (BG) levelsin the first 3 days of life, on developmental outcome at 1 year in low birth weight neonates <2000 g. Methods: A prospective cohortstudy was conducted in tertiary level neonatal intensive care unit and follow-up clinic in south India. Intramural neonates admittedfrom September 2009 to August 2010 were enrolled. Perinatal and neonatal variables were recorded. Respiratory support, fluids,and feeding management were based on the standard protocols. BG was measured within 2 h, then 6 hourly for 72 h by glucometerand BG <50 mg% was analyzed by hexokinase method. Infants were followed until 1 year corrected age and development age(DA) assessed by Developmental Assessment Scales for Indian Infants (DASII). Motor and mental DA at various BG levelswere compared. Composite outcome of motor or mental developmental delay; or cerebral palsy or hearing impairment or visualimpairment was analyzed, and logistic regression analysis was performed. Results: The mean birth weight and gestation of the studygroup (n=129) was 1493 g and 32.5 weeks. The 10th centile of BG in the first 72 h was 51 mg%. BG below 10th centile was seen in60 infants. The mean motor and mental DA of the infants by DASII assessment at 1 year was 11.3 and 11.5 months, respectively.The motor DA and mental DA were significantly higher until 50 mg% lowest BG level, and positive correlation was seen (r=0.26motor, 0.2 mental DA). Mean BG level, the presence of symptoms; number of episodes or small for gestation did not influence theDA. The adjusted odds for poor composite outcome when BG was below 51 mg% is 2.83 (0.65-12.3). Conclusion: Even thoughhigh-risk neonates with BG <51 mg% have a lower motor DA and mental DA at 1 year, than neonates with BG >50 mg%; othermorbidities do determine their composite outcome

Burden of disease scenarios for 204 countries and territories, 2022–2050: a forecasting analysis for the Global Burden of Disease Study 2021

Background: Future trends in disease burden and drivers of health are of great interest to policy makers and the public at large. This information can be used for policy and long-term health investment, planning, and prioritisation. We have expanded and improved upon previous forecasts produced as part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) and provide a reference forecast (the most likely future), and alternative scenarios assessing disease burden trajectories if selected sets of risk factors were eliminated from current levels by 2050. Methods: Using forecasts of major drivers of health such as the Socio-demographic Index (SDI; a composite measure of lag-distributed income per capita, mean years of education, and total fertility under 25 years of age) and the full set of risk factor exposures captured by GBD, we provide cause-specific forecasts of mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) by age and sex from 2022 to 2050 for 204 countries and territories, 21 GBD regions, seven super-regions, and the world. All analyses were done at the cause-specific level so that only risk factors deemed causal by the GBD comparative risk assessment influenced future trajectories of mortality for each disease. Cause-specific mortality was modelled using mixed-effects models with SDI and time as the main covariates, and the combined impact of causal risk factors as an offset in the model. At the all-cause mortality level, we captured unexplained variation by modelling residuals with an autoregressive integrated moving average model with drift attenuation. These all-cause forecasts constrained the cause-specific forecasts at successively deeper levels of the GBD cause hierarchy using cascading mortality models, thus ensuring a robust estimate of cause-specific mortality. For non-fatal measures (eg, low back pain), incidence and prevalence were forecasted from mixed-effects models with SDI as the main covariate, and YLDs were computed from the resulting prevalence forecasts and average disability weights from GBD. Alternative future scenarios were constructed by replacing appropriate reference trajectories for risk factors with hypothetical trajectories of gradual elimination of risk factor exposure from current levels to 2050. The scenarios were constructed from various sets of risk factors: environmental risks (Safer Environment scenario), risks associated with communicable, maternal, neonatal, and nutritional diseases (CMNNs; Improved Childhood Nutrition and Vaccination scenario), risks associated with major non-communicable diseases (NCDs; Improved Behavioural and Metabolic Risks scenario), and the combined effects of these three scenarios. Using the Shared Socioeconomic Pathways climate scenarios SSP2-4.5 as reference and SSP1-1.9 as an optimistic alternative in the Safer Environment scenario, we accounted for climate change impact on health by using the most recent Intergovernmental Panel on Climate Change temperature forecasts and published trajectories of ambient air pollution for the same two scenarios. Life expectancy and healthy life expectancy were computed using standard methods. The forecasting framework includes computing the age-sex-specific future population for each location and separately for each scenario. 95% uncertainty intervals (UIs) for each individual future estimate were derived from the 2·5th and 97·5th percentiles of distributions generated from propagating 500 draws through the multistage computational pipeline. Findings: In the reference scenario forecast, global and super-regional life expectancy increased from 2022 to 2050, but improvement was at a slower pace than in the three decades preceding the COVID-19 pandemic (beginning in 2020). Gains in future life expectancy were forecasted to be greatest in super-regions with comparatively low life expectancies (such as sub-Saharan Africa) compared with super-regions with higher life expectancies (such as the high-income super-region), leading to a trend towards convergence in life expectancy across locations between now and 2050. At the super-region level, forecasted healthy life expectancy patterns were similar to those of life expectancies. Forecasts for the reference scenario found that health will improve in the coming decades, with all-cause age-standardised DALY rates decreasing in every GBD super-region. The total DALY burden measured in counts, however, will increase in every super-region, largely a function of population ageing and growth. We also forecasted that both DALY counts and age-standardised DALY rates will continue to shift from CMNNs to NCDs, with the most pronounced shifts occurring in sub-Saharan Africa (60·1% [95% UI 56·8–63·1] of DALYs were from CMNNs in 2022 compared with 35·8% [31·0–45·0] in 2050) and south Asia (31·7% [29·2–34·1] to 15·5% [13·7–17·5]). This shift is reflected in the leading global causes of DALYs, with the top four causes in 2050 being ischaemic heart disease, stroke, diabetes, and chronic obstructive pulmonary disease, compared with 2022, with ischaemic heart disease, neonatal disorders, stroke, and lower respiratory infections at the top. The global proportion of DALYs due to YLDs likewise increased from 33·8% (27·4–40·3) to 41·1% (33·9–48·1) from 2022 to 2050, demonstrating an important shift in overall disease burden towards morbidity and away from premature death. The largest shift of this kind was forecasted for sub-Saharan Africa, from 20·1% (15·6–25·3) of DALYs due to YLDs in 2022 to 35·6% (26·5–43·0) in 2050. In the assessment of alternative future scenarios, the combined effects of the scenarios (Safer Environment, Improved Childhood Nutrition and Vaccination, and Improved Behavioural and Metabolic Risks scenarios) demonstrated an important decrease in the global burden of DALYs in 2050 of 15·4% (13·5–17·5) compared with the reference scenario, with decreases across super-regions ranging from 10·4% (9·7–11·3) in the high-income super-region to 23·9% (20·7–27·3) in north Africa and the Middle East. The Safer Environment scenario had its largest decrease in sub-Saharan Africa (5·2% [3·5–6·8]), the Improved Behavioural and Metabolic Risks scenario in north Africa and the Middle East (23·2% [20·2–26·5]), and the Improved Nutrition and Vaccination scenario in sub-Saharan Africa (2·0% [–0·6 to 3·6]). Interpretation: Globally, life expectancy and age-standardised disease burden were forecasted to improve between 2022 and 2050, with the majority of the burden continuing to shift from CMNNs to NCDs. That said, continued progress on reducing the CMNN disease burden will be dependent on maintaining investment in and policy emphasis on CMNN disease prevention and treatment. Mostly due to growth and ageing of populations, the number of deaths and DALYs due to all causes combined will generally increase. By constructing alternative future scenarios wherein certain risk exposures are eliminated by 2050, we have shown that opportunities exist to substantially improve health outcomes in the future through concerted efforts to prevent exposure to well established risk factors and to expand access to key health interventions

Global age-sex-specific mortality, life expectancy, and population estimates in 204 countries and territories and 811 subnational locations, 1950–2021, and the impact of the COVID-19 pandemic: a comprehensive demographic analysis for the Global Burden of Disease Study 2021

Background: Estimates of demographic metrics are crucial to assess levels and trends of population health outcomes. The profound impact of the COVID-19 pandemic on populations worldwide has underscored the need for timely estimates to understand this unprecedented event within the context of long-term population health trends. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 provides new demographic estimates for 204 countries and territories and 811 additional subnational locations from 1950 to 2021, with a particular emphasis on changes in mortality and life expectancy that occurred during the 2020–21 COVID-19 pandemic period. Methods: 22 223 data sources from vital registration, sample registration, surveys, censuses, and other sources were used to estimate mortality, with a subset of these sources used exclusively to estimate excess mortality due to the COVID-19 pandemic. 2026 data sources were used for population estimation. Additional sources were used to estimate migration; the effects of the HIV epidemic; and demographic discontinuities due to conflicts, famines, natural disasters, and pandemics, which are used as inputs for estimating mortality and population. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate under-5 mortality rates, which synthesised 30 763 location-years of vital registration and sample registration data, 1365 surveys and censuses, and 80 other sources. ST-GPR was also used to estimate adult mortality (between ages 15 and 59 years) based on information from 31 642 location-years of vital registration and sample registration data, 355 surveys and censuses, and 24 other sources. Estimates of child and adult mortality rates were then used to generate life tables with a relational model life table system. For countries with large HIV epidemics, life tables were adjusted using independent estimates of HIV-specific mortality generated via an epidemiological analysis of HIV prevalence surveys, antenatal clinic serosurveillance, and other data sources. Excess mortality due to the COVID-19 pandemic in 2020 and 2021 was determined by subtracting observed all-cause mortality (adjusted for late registration and mortality anomalies) from the mortality expected in the absence of the pandemic. Expected mortality was calculated based on historical trends using an ensemble of models. In location-years where all-cause mortality data were unavailable, we estimated excess mortality rates using a regression model with covariates pertaining to the pandemic. Population size was computed using a Bayesian hierarchical cohort component model. Life expectancy was calculated using age-specific mortality rates and standard demographic methods. Uncertainty intervals (UIs) were calculated for every metric using the 25th and 975th ordered values from a 1000-draw posterior distribution. Findings: Global all-cause mortality followed two distinct patterns over the study period: age-standardised mortality rates declined between 1950 and 2019 (a 62·8% [95% UI 60·5–65·1] decline), and increased during the COVID-19 pandemic period (2020–21; 5·1% [0·9–9·6] increase). In contrast with the overall reverse in mortality trends during the pandemic period, child mortality continued to decline, with 4·66 million (3·98–5·50) global deaths in children younger than 5 years in 2021 compared with 5·21 million (4·50–6·01) in 2019. An estimated 131 million (126–137) people died globally from all causes in 2020 and 2021 combined, of which 15·9 million (14·7–17·2) were due to the COVID-19 pandemic (measured by excess mortality, which includes deaths directly due to SARS-CoV-2 infection and those indirectly due to other social, economic, or behavioural changes associated with the pandemic). Excess mortality rates exceeded 150 deaths per 100 000 population during at least one year of the pandemic in 80 countries and territories, whereas 20 nations had a negative excess mortality rate in 2020 or 2021, indicating that all-cause mortality in these countries was lower during the pandemic than expected based on historical trends. Between 1950 and 2021, global life expectancy at birth increased by 22·7 years (20·8–24·8), from 49·0 years (46·7–51·3) to 71·7 years (70·9–72·5). Global life expectancy at birth declined by 1·6 years (1·0–2·2) between 2019 and 2021, reversing historical trends. An increase in life expectancy was only observed in 32 (15·7%) of 204 countries and territories between 2019 and 2021. The global population reached 7·89 billion (7·67–8·13) people in 2021, by which time 56 of 204 countries and territories had peaked and subsequently populations have declined. The largest proportion of population growth between 2020 and 2021 was in sub-Saharan Africa (39·5% [28·4–52·7]) and south Asia (26·3% [9·0–44·7]). From 2000 to 2021, the ratio of the population aged 65 years and older to the population aged younger than 15 years increased in 188 (92·2%) of 204 nations. Interpretation: Global adult mortality rates markedly increased during the COVID-19 pandemic in 2020 and 2021, reversing past decreasing trends, while child mortality rates continued to decline, albeit more slowly than in earlier years. Although COVID-19 had a substantial impact on many demographic indicators during the first 2 years of the pandemic, overall global health progress over the 72 years evaluated has been profound, with considerable improvements in mortality and life expectancy. Additionally, we observed a deceleration of global population growth since 2017, despite steady or increasing growth in lower-income countries, combined with a continued global shift of population age structures towards older ages. These demographic changes will likely present future challenges to health systems, economies, and societies. The comprehensive demographic estimates reported here will enable researchers, policy makers, health practitioners, and other key stakeholders to better understand and address the profound changes that have occurred in the global health landscape following the first 2 years of the COVID-19 pandemic, and longer-term trends beyond the pandemic

Vertical Uplift Resistance of Two Interfering Horizontal Anchors in Clay

The vertical uplift resistance of two interfering rigid strip plate anchors embedded horizontally at the same level in clay has been examined. The lower and upper bound theorems of the limit analysis in combination with finite-elements and linear optimization have been employed to compute the failure load in a bound form. The analysis is meant for an undrained condition and it incorporates the increase of cohesion with depth. For different clear spacing (S) between the anchors, the magnitude of the efficiency factor (eta c gamma) resulting from the combined components of soil cohesion (c) and soil unit weight (gamma), has been computed for different values of embedment ratio (H/B), the rate of linear increase of cohesion with depth (m) and normalized unit weight (gamma H/c). The magnitude of eta c gamma has been found to reduce continuously with a decrease in the spacing between the anchors, and the uplift resistance becomes minimum for S/B=0. It has been noted that the critical spacing between the anchors required to eliminate the interference effect increases continuously with (1) an increase in H/B, and (2) a decrease in m

Seismic stability of a long unsupported circular tunnel

The stability of a long unsupported circular tunnel (opening) in a cohesive frictional soil has been assessed with the inclusion of pseudo-static horizontal earthquake body forces. The analysis has been performed under plane strain conditions by using upper bound finite element limit analysis in combination with a linear optimization procedure. The results have been presented in the form of a non-dimensional stability number (gamma H-max/c); where H = tunnel cover, c refers to soil cohesion and gamma(max) is the maximum unit weight of soil mass which the tunnel can support without collapse. The results have been obtained for various values of H/D (D = diameter of the tunnel), internal friction angle (phi) of soil, and the horizontal earthquake acceleration coefficient (alpha(h)). The computations reveal that the values of the stability numbers (i) decrease quite significantly with an increase in alpha(h), and (ii) become continuously higher for greater values of H/D and phi. As expected, the failure zones around the periphery of the tunnel becomes always asymmetrical with an inclusion of horizontal seismic body forces. (c) 2012 Elsevier Ltd. All rights reserved

Vertical uplift resistance of two horizontal strip anchors with common vertical axis

With an application of the upper bound finite element limit analysis, the vertical pullout capacity of a group of two horizontal strip plate anchors, with the common vertical axis and placed in a cohesive-frictional soil, has been computed. The variation of the uplift factors Fc, Fq and Fy, due to the contributions of soil cohesion, surcharge pressure and unit weight, respectively, has been evaluated for different combinations of S/B and H/B. As compared to single isolated anchor, the group of two anchors generates significantly greater magnitude of Fc for Φ ≤ 20° especially with greater values of H/B and under fully bonded anchor-soil interface condition. The factor Fc attains almost the maximum value when the upper anchor plate is placed midway between ground surface and the lower anchor plate. The factors Fq and Fy, on the other hand, for a group of two anchors are found to remain almost equal to that of a single isolated anchor as long as the levels of the lower plate in the group and the single isolated anchor are kept the same

REDUCING COMPUTATIONAL EFFORT IN SOLVING GEOMECHANICS PROBLEMS WITH UPPER BOUND FINITE ELEMENTS LIMIT ANALYSIS AND LINEAR OPTIMIZATION

This paper presents a simple technique for reducing the computational effort while solving any geotechnical stability problem by using the upper bound finite element limit analysis and linear optimization. In the proposed method, the problem domain is discretized into a number of different regions in which a particular order (number of sides) of the polygon is chosen to linearize the Mohr-Coulomb yield criterion. A greater order of the polygon needs to be selected only in that region wherein the rate of the plastic strains becomes higher. The computational effort required to solve the problem with this implementation reduces considerably. By using the proposed method, the bearing capacity has been computed for smooth and rough strip footings and the results are found to be quite satisfactory

Upper bound solution for pullout capacity of vertical anchors in sand using finite elements and limit analysis

The horizontal pullout capacity of vertical anchors embedded in sand has been determined by using an upper bound theorem of the limit analysis in combination with finite elements. The numerical results are presented in nondimensional form to determine the pullout resistance for various combinations of embedment ratio of the anchor (H/B), internal friction angle (ϕ) of sand, and the anchor-soil interface friction angle (δ). The pullout resistance increases with increases in the values of embedment ratio, friction angle of sand and anchor-soil interface friction angle. As compared to earlier reported solutions in literature, the present solution provides a better upper bound on the ultimate collapse load

Vertical Uplift Resistance of a Group of Two Coaxial Anchors in Clay

The vertical uplift resistance for a group of two horizontal coaxial rigid strip anchors embedded in clay under undrained condition has been determined by using the upper bound theorem of limit analysis in combination with finite elements. An increase of undrained shear strength of soil mass with depth has been incorporated. The uplift factor F-c gamma has been computed. As compared to a single isolated anchor, a group of two anchors provides greater magnitude of the uplift resistance. For a given embedment ratio, the group of two anchors generates almost the maximum uplift resistance when the upper anchor is located midway between ground surface and the lower anchor. For a given embedment ratio, F-c gamma increases linearly with an increase in the normalized unit weight of soil mass up to a certain value before attaining a certain maximum magnitude; the maximum value of F-c gamma increases with an increase in embedment ratio. DOI: 10.1061/(ASCE)GT.19435606.0000599. (C) 2012 American Society of Civil Engineers

Stability of a circular tunnel in presence of pseudostatic seismic body forces

The stability of a long circular tunnel in a cohesive frictional soil medium has been determined in the presence of horizontal pseudo-static seismic body forces. The tunnel is supported by means of lining and anchorage system which is assumed to exert uniform internal compressive normal pressure on its periphery. The upper bound finite element limit analysis has been performed to compute the magnitude of the internal compressive pressure required to support the tunnel. The results have been presented in terms of normalized compressive normal stress, defined in terms of sigma(i)/c; where sigma(i) is the magnitude of the compressive normal pressure on the periphery of the tunnel and c refers to soil cohesion. The variation of sigma(i)/c with horizontal earthquake acceleration coefficient (alpha(h)) has been established for different combinations of H/D, gamma D/c and phi where (i) H and D refers to tunnel cover and diameter, respectively, and (ii) gamma and phi correspond to unit weight and internal friction angle of soil mass, respectively. Nodal velocity patterns have also been plotted for assessing the zones of significant plastic deformation. The analysis clearly reveals that an increase in the magnitude of the earthquake acceleration leads to a significant increment in the magnitude of internal compressive pressure. (C) 2014 Elsevier Ltd. All rights reserved