Global burden and strength of evidence for 88 risk factors in 204 countries and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

Background: Understanding the health consequences associated with exposure to risk factors is necessary to inform public health policy and practice. To systematically quantify the contributions of risk factor exposures to specific health outcomes, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 aims to provide comprehensive estimates of exposure levels, relative health risks, and attributable burden of disease for 88 risk factors in 204 countries and territories and 811 subnational locations, from 1990 to 2021. Methods: The GBD 2021 risk factor analysis used data from 54 561 total distinct sources to produce epidemiological estimates for 88 risk factors and their associated health outcomes for a total of 631 risk–outcome pairs. Pairs were included on the basis of data-driven determination of a risk–outcome association. Age-sex-location-year-specific estimates were generated at global, regional, and national levels. Our approach followed the comparative risk assessment framework predicated on a causal web of hierarchically organised, potentially combinative, modifiable risks. Relative risks (RRs) of a given outcome occurring as a function of risk factor exposure were estimated separately for each risk–outcome pair, and summary exposure values (SEVs), representing risk-weighted exposure prevalence, and theoretical minimum risk exposure levels (TMRELs) were estimated for each risk factor. These estimates were used to calculate the population attributable fraction (PAF; ie, the proportional change in health risk that would occur if exposure to a risk factor were reduced to the TMREL). The product of PAFs and disease burden associated with a given outcome, measured in disability-adjusted life-years (DALYs), yielded measures of attributable burden (ie, the proportion of total disease burden attributable to a particular risk factor or combination of risk factors). Adjustments for mediation were applied to account for relationships involving risk factors that act indirectly on outcomes via intermediate risks. Attributable burden estimates were stratified by Socio-demographic Index (SDI) quintile and presented as counts, age-standardised rates, and rankings. To complement estimates of RR and attributable burden, newly developed burden of proof risk function (BPRF) methods were applied to yield supplementary, conservative interpretations of risk–outcome associations based on the consistency of underlying evidence, accounting for unexplained heterogeneity between input data from different studies. Estimates reported represent the mean value across 500 draws from the estimate's distribution, with 95% uncertainty intervals (UIs) calculated as the 2·5th and 97·5th percentile values across the draws. Findings: Among the specific risk factors analysed for this study, particulate matter air pollution was the leading contributor to the global disease burden in 2021, contributing 8·0% (95% UI 6·7–9·4) of total DALYs, followed by high systolic blood pressure (SBP; 7·8% [6·4–9·2]), smoking (5·7% [4·7–6·8]), low birthweight and short gestation (5·6% [4·8–6·3]), and high fasting plasma glucose (FPG; 5·4% [4·8–6·0]). For younger demographics (ie, those aged 0–4 years and 5–14 years), risks such as low birthweight and short gestation and unsafe water, sanitation, and handwashing (WaSH) were among the leading risk factors, while for older age groups, metabolic risks such as high SBP, high body-mass index (BMI), high FPG, and high LDL cholesterol had a greater impact. From 2000 to 2021, there was an observable shift in global health challenges, marked by a decline in the number of all-age DALYs broadly attributable to behavioural risks (decrease of 20·7% [13·9–27·7]) and environmental and occupational risks (decrease of 22·0% [15·5–28·8]), coupled with a 49·4% (42·3–56·9) increase in DALYs attributable to metabolic risks, all reflecting ageing populations and changing lifestyles on a global scale. Age-standardised global DALY rates attributable to high BMI and high FPG rose considerably (15·7% [9·9–21·7] for high BMI and 7·9% [3·3–12·9] for high FPG) over this period, with exposure to these risks increasing annually at rates of 1·8% (1·6–1·9) for high BMI and 1·3% (1·1–1·5) for high FPG. By contrast, the global risk-attributable burden and exposure to many other risk factors declined, notably for risks such as child growth failure and unsafe water source, with age-standardised attributable DALYs decreasing by 71·5% (64·4–78·8) for child growth failure and 66·3% (60·2–72·0) for unsafe water source. We separated risk factors into three groups according to trajectory over time: those with a decreasing attributable burden, due largely to declining risk exposure (eg, diet high in trans-fat and household air pollution) but also to proportionally smaller child and youth populations (eg, child and maternal malnutrition); those for which the burden increased moderately in spite of declining risk exposure, due largely to population ageing (eg, smoking); and those for which the burden increased considerably due to both increasing risk exposure and population ageing (eg, ambient particulate matter air pollution, high BMI, high FPG, and high SBP). Interpretation: Substantial progress has been made in reducing the global disease burden attributable to a range of risk factors, particularly those related to maternal and child health, WaSH, and household air pollution. Maintaining efforts to minimise the impact of these risk factors, especially in low SDI locations, is necessary to sustain progress. Successes in moderating the smoking-related burden by reducing risk exposure highlight the need to advance policies that reduce exposure to other leading risk factors such as ambient particulate matter air pollution and high SBP. Troubling increases in high FPG, high BMI, and other risk factors related to obesity and metabolic syndrome indicate an urgent need to identify and implement interventions. Funding: Bill & Melinda Gates Foundation

Controlling Parameters for Plasmonic Photothermal Ablation of a Tumor

This paper investigates the controllable therapeutic parameters for plasmonic photothermal ablation of a tumor with an objective to specify the parameters (irradiation intensity, irradiation duration, nanoparticle concentration) based on spatial distribution and accumulation of nanoparticles within a tumor. In this study, a melanoma surrounded by healthy tissue is analyzed. Monte Carlo method, Beer's law, and Pennes' bioheat equation are used to compute spatiotemporal thermal ablation zones. Results show that depending on spatial extent of nanoparticle loaded region of a tumor as well as nanoparticle concentration, different ablation zones are attained within tumor. It is shown that a nanoparticle concentration of 0.0001% embedded within 2-3-mm thick tumor periphery, along with irradiation intensity of 1 W/cm2 for duration of 110 s, is required to attain thermal ablation for the considered tumor sizes of 20-40 mm diameter. For lesser extent of nanoparticle loaded region, it is not possible to attain thermal ablation even with higher nanoparticle concentrations. Further it is shown that, for future clinical application of such therapy, through intravenous delivery of nanoparticles, a tumor must possess a certain spatial extent of vascularized region to facilitate the accumulation of nanoparticles in desired concentration for thermal ablation

Implementation of motion transfer in robotic surgery

Minimally invasive surgery is a modern surgical technique in which the operating tools are inserted into the patient through small incisions. Robotic applications in general surgery have evolved from simple surgical assist devices, to more sophisticated systems capable of enhancing surgical performance. The primary class of robots used in general surgery today, are 'master-slave' machines, where the robot mimics the movement of the surgeon. A major drawback with the master-slave robotic systems is the motion coordination between the two. The paper discusses the techniques of motion transfer from master to slave and to implement force feedback from slave to master. Motion is transferred from master surgeon handle to the robotic arm depending on the encoder pulses from master configuration. The pulses from the encoder are processed and fed to the slave, which mimics the hand motion of master configuration. A two channel encoder with DC motor is used in master-slave configuration. The proposed configuration with force feedback capability enables the exact motion coordination between surgeon and robotic surgical system. This technique has a wide application, with accuracy, efficiency, safety and overall user experience that provide superior performance and reliability in master-slave robot-assisted interventions

In vitro Evaluation of Fungicides, Botanicals and Bio-agents against Phomopsis vexans, the Causal Agent of Fruit Rot of Brinjal

Fruit rot (Phomopsis vexans) of brinjal is an important disease of Northern dry zone of Karnataka resulting into heavy losses. Recently the production of brinjal has been drastically reduced due to incidence of fruit rot disease caused by a fungus Phomopsis vexans. An investigation was carried out to test the efficacy of fungicides, botanicals and bio-agents in vitro. Among fungicides tested carbendazim, tebuconazole and hexaconazole at 0.25, 0.5, 0.75 and 1.00 per cent concentration showed high inhibition of 100 per cent of mycelial growth of the pathogen. The least mycelial inhibition was observed in case of captaf (63.33%).The results of botanicles tested in vitro revealed that highest inhibition of mycelial growth of Phomopsis vexans was observed in 5 and 10 per cent of garlic extract, kokum extract and onion extract. The results of dual culture technique revealed that fungal bio agents were better than bacterial bioagents in inhibiting the growth of fruit rot pathogen. Phomopsis vexans was effectively inhibited by T. harzianum-p

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Line × tester analysis for growth and biomass characteristics of Salix

Line × tester analysis was carried out in willows (Salix spp.) to determine the genetic interaction in the expression of various quantitative characters related to productivity. Combining ability revealed that the estimates of GCA variance (σ2 GCA) were more than the SCA variance (σ2 SCA) for all the characters studied. Later the gene action study revealed that additive variance was observed more than the dominance variance for all the parameters studied. The proportional contribution of lines were higher than individual contribution of testers or line × tester interaction except for fresh root weight, dry shoot weight, dry root weight and total dry weight where the contribution of interactions was more. Line PN 227 and tester Austree and J 795 were found to be good general combiners and thus appeared to be worthy of exploiting in Salix improvement through breeding and recurrent selection followed by cloning for developing commercial superior clones. On the basis of mean performance and significant desirable SCA effects, the combinations PN 227 × Austree, PN 227 × NZ 1140 and J 799 × Austree were found to be the most promising families for growth and biomass characters and are recommended for within family selections followed by heterotic breeding