High genetic diversity of measles virus, World Health Organization European region, 2005-2006

During 2005-2006, nine measles virus (MV) genotypes were identified throughout the World Health Organization European Region. All major epidemics were associated with genotypes D4, D6, and B3. Other genotypes (B2, D5, D8, D9, G2, and H1) were only found in limited numbers of cases after importation from other continents. The genetic diversity of endemic D6 strains was low; genotypes C2 and D7, circulating in Europe until recent years, were no longer identified. The transmission chains of several indigenous MV strains may thus have been interrupted by enhanced vaccination. However, multiple importations from Africa and Asia and virus introduction into highly mobile and unvaccinated communities caused a massive spread of D4 and B3 strains throughout much of the region. Thus, despite the reduction of endemic MV circulation, importation of MV from other continents caused prolonged circulation and large outbreaks after their introduction into unvaccinated and highly mobile communities

Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations. METHODS The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model-a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates-with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality-which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration cause-of-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds. FINDINGS The leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2-100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading five causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1-290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1-211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4-48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3-37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7-9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles. INTERPRETATION Long-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere. FUNDING Bill & Melinda Gates Foundation

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Features of the Macro-, Micro-, and Fine Structure of the Nickel Superalloy Product Material Formed by the Method of Electron Beam Additive Manufacturing

In the present work, the products in the form of vertical walls were made of heat-resistant nickel-based superalloy ZhS32 via the method of electron beam additive technology. Unidirectional printing strategy was applied. The effect of heat input and 3D printing strategy on the macrostructure, dimensions, and morphology of microstructure elements was established. It was shown that the additive product material has a directed macrostructure. The only exclusion was the final layer with a thickness of no more than 3.5 mm. The directed macrostructure consisted of dendrites oriented predominantly along the crystallographic direction {001} of the primary dendrite arms. The misorientation of the dendrite axes did not exceed 9 degrees. The angle between the predominant dendrite growth direction and the normal to the substrate was 23 degrees. The average primary dendrite arms’ spacing increased monotonically from 16 µm at 5 mm from the substrate to 23 µm in the final layers of the product material (the overall height was 41 mm). It was found that the average size of γ’ (Ni3Al)-phase precipitations in the form of nanoscale and submicrocrystalline cuboids varied in the range of 76 to 163 nm depending on the distance from the substrate. The size of γ’-phase precipitations reached a maximum at about 30 mm from the substrate, while in the final layers of the product material, the average cuboid size did not exceed 135 nm. Extreme dependence of the size of γ’-phase precipitations on the height of the product followed from a combination of a given monotonic decrease in heat input and heat accumulation in the product material as it formed, as did additional heat removal by means of radiation during formation of the final layer of the product without re-melting. Chemical elements of the austenitic steel substrate material were not detected in the product material more than 8 mm from the substrate. There were no macrodefects, such as voids, in the entire volume of the product material

On the Control of Elemental Composition, Macro-, and Microstructure of Directionally Solidified Additive Products from Nickel-Based Alloy

The present work establishes the influence of heat input and methods of heat removal at the wire-feed electron beam additive manufacturing (EBAM) process on the structure of an additive product made of a nickel-based alloy. The following printing approaches are considered: changes in heat input, 3D printing strategy, and heat removal conditions due to (1) heating of the substrate, (2) partial suppression of radiative heat dissipation, and (3) thermal insulation of the substrate. It is shown that epitaxial growth of dendrites occurs in each case. However, in the case of an increase in speed and a change in the 3D printing strategy, the directed dendritic growth is interrupted. Preheating of the substrate and subsequent maintenance of the temperature reached during the EBAM process, as well as partial suppression of the radiative component of heat removal, allow to obtain the most uniform directional structure

Features of the Macro-, Micro-, and Fine Structure of the Nickel Superalloy Product Material Formed by the Method of Electron Beam Additive Manufacturing

In the present work, the products in the form of vertical walls were made of heat-resistant nickel-based superalloy ZhS32 via the method of electron beam additive technology. Unidirectional printing strategy was applied. The effect of heat input and 3D printing strategy on the macrostructure, dimensions, and morphology of microstructure elements was established. It was shown that the additive product material has a directed macrostructure. The only exclusion was the final layer with a thickness of no more than 3.5 mm. The directed macrostructure consisted of dendrites oriented predominantly along the crystallographic direction {001} of the primary dendrite arms. The misorientation of the dendrite axes did not exceed 9 degrees. The angle between the predominant dendrite growth direction and the normal to the substrate was 23 degrees. The average primary dendrite arms’ spacing increased monotonically from 16 µm at 5 mm from the substrate to 23 µm in the final layers of the product material (the overall height was 41 mm). It was found that the average size of γ’ (Ni3Al)-phase precipitations in the form of nanoscale and submicrocrystalline cuboids varied in the range of 76 to 163 nm depending on the distance from the substrate. The size of γ’-phase precipitations reached a maximum at about 30 mm from the substrate, while in the final layers of the product material, the average cuboid size did not exceed 135 nm. Extreme dependence of the size of γ’-phase precipitations on the height of the product followed from a combination of a given monotonic decrease in heat input and heat accumulation in the product material as it formed, as did additional heat removal by means of radiation during formation of the final layer of the product without re-melting. Chemical elements of the austenitic steel substrate material were not detected in the product material more than 8 mm from the substrate. There were no macrodefects, such as voids, in the entire volume of the product material

The Effect of Strain Rate on Hydrogen-Assisted Deformation Behavior and Microstructure in AISI 316L Austenitic Stainless Steel

The influence of strain rate in the interval of (10−5–10−3) 1/s on room temperature tensile behavior, dislocation arrangement, deformation mechanisms, and fracture of austenitic stainless steel AISI 316L electrochemically charged with hydrogen was investigated. Independently on strain rate, hydrogen charging provides the increase in the yield strength of the specimens due to a solid solution hardening of austenite, but it slightly influences deformation behavior and strain hardening of the steel. Simultaneously, hydrogen charging assists surface embrittlement of the specimens during straining and reduces an elongation to failure, which both are strain rate-dependent parameters. Hydrogen embrittlement index decreases with increase in strain rate, which testifies the importance of hydrogen transport with dislocations during plastic deformation. The stress–relaxation tests directly confirm the hydrogen-enhanced increase in the dislocation dynamics at low strain rates. The interaction of the hydrogen atoms with dislocations and hydrogen-associated plastic flow are discussed

Assessment of Structure and Properties Homogeneity after Repairing of a Nickel-Based Superalloy Product by the Electron Beam Additive Technology

Repairing damaged products made of nickel-based superalloys is an urgent task because replacing them with new products is a costly and time-consuming process. The present work considers the method of electron-beam additive manufacturing as an approach to the repair process. First of all, the initial product was produced by layer-by-layer deposition. Hereon, a part of the surface was removed, and then several more layers were deposited. Thus, three areas were considered in the work: initial, transitional, and repaired areas. Each of the formed regions was defect-free. It was found that the transition region was difficult to identify since it did not differ in structural-phase composition from the initial and repaired regions. It is shown that the complex thermal history consisting of periodic thermal exposure and repeated melting of the newly crystallized layers does not lead to the formation of defects and undesirable phases. Moreover, in all three regions, there is a redistribution of the chemical element content of the γ′ and γ phases towards an increase in the mismatch of their lattice parameters. The mechanical properties of the transition and repaired regions are not significantly different from the initial area