Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015 : a systematic analysis for the Global Burden of Disease Study 2015

Background Improving survival and extending the longevity of life for all populations requires timely, robust evidence on local mortality levels and trends. The Global Burden of Disease 2015 Study (GBD 2015) provides a comprehensive assessment of all-cause and cause-specific mortality for 249 causes in 195 countries and territories from 1980 to 2015. These results informed an in-depth investigation of observed and expected mortality patterns based on sociodemographic measures. Methods We estimated all-cause mortality by age, sex, geography, and year using an improved analytical approach originally developed for GBD 2013 and GBD 2010. Improvements included refinements to the estimation of child and adult mortality and corresponding uncertainty, parameter selection for under-5 mortality synthesis by spatiotemporal Gaussian process regression, and sibling history data processing. We also expanded the database of vital registration, survey, and census data to 14 294 geography-year datapoints. For GBD 2015, eight causes, including Ebola virus disease, were added to the previous GBD cause list for mortality. We used six modelling approaches to assess cause-specific mortality, with the Cause of Death Ensemble Model (CODEm) generating estimates for most causes. We used a series of novel analyses to systematically quantify the drivers of trends in mortality across geographies. First, we assessed observed and expected levels and trends of cause-specific mortality as they relate to the Socio-demographic Index (SDI), a summary indicator derived from measures of income per capita, educational attainment, and fertility. Second, we examined factors affecting total mortality patterns through a series of counterfactual scenarios, testing the magnitude by which population growth, population age structures, and epidemiological changes contributed to shifts in mortality. Finally, we attributed changes in life expectancy to changes in cause of death. We documented each step of the GBD 2015 estimation processes, as well as data sources, in accordance with Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER). Findings Globally, life expectancy from birth increased from 61.7 years (95% uncertainty interval 61.4-61.9) in 1980 to 71.8 years (71.5-72.2) in 2015. Several countries in sub-Saharan Africa had very large gains in life expectancy from 2005 to 2015, rebounding from an era of exceedingly high loss of life due to HIV/AIDS. At the same time, many geographies saw life expectancy stagnate or decline, particularly for men and in countries with rising mortality from war or interpersonal violence. From 2005 to 2015, male life expectancy in Syria dropped by 11.3 years (3.7-17.4), to 62.6 years (56.5-70.2). Total deaths increased by 4.1% (2.6-5.6) from 2005 to 2015, rising to 55.8 million (54.9 million to 56.6 million) in 2015, but age-standardised death rates fell by 17.0% (15.8-18.1) during this time, underscoring changes in population growth and shifts in global age structures. The result was similar for non-communicable diseases (NCDs), with total deaths from these causes increasing by 14.1% (12.6-16.0) to 39.8 million (39.2 million to 40.5 million) in 2015, whereas age-standardised rates decreased by 13.1% (11.9-14.3). Globally, this mortality pattern emerged for several NCDs, including several types of cancer, ischaemic heart disease, cirrhosis, and Alzheimer's disease and other dementias. By contrast, both total deaths and age-standardised death rates due to communicable, maternal, neonatal, and nutritional conditions significantly declined from 2005 to 2015, gains largely attributable to decreases in mortality rates due to HIV/AIDS (42.1%, 39.1-44.6), malaria (43.1%, 34.7-51.8), neonatal preterm birth complications (29.8%, 24.8-34.9), and maternal disorders (29.1%, 19.3-37.1). Progress was slower for several causes, such as lower respiratory infections and nutritional deficiencies, whereas deaths increased for others, including dengue and drug use disorders. Age-standardised death rates due to injuries significantly declined from 2005 to 2015, yet interpersonal violence and war claimed increasingly more lives in some regions, particularly in the Middle East. In 2015, rotaviral enteritis (rotavirus) was the leading cause of under-5 deaths due to diarrhoea (146 000 deaths, 118 000-183 000) and pneumococcal pneumonia was the leading cause of under-5 deaths due to lower respiratory infections (393 000 deaths, 228 000-532 000), although pathogen-specific mortality varied by region. Globally, the effects of population growth, ageing, and changes in age-standardised death rates substantially differed by cause. Our analyses on the expected associations between cause-specific mortality and SDI show the regular shifts in cause of death composition and population age structure with rising SDI. Country patterns of premature mortality (measured as years of life lost [YLLs]) and how they differ from the level expected on the basis of SDI alone revealed distinct but highly heterogeneous patterns by region and country or territory. Ischaemic heart disease, stroke, and diabetes were among the leading causes of YLLs in most regions, but in many cases, intraregional results sharply diverged for ratios of observed and expected YLLs based on SDI. Communicable, maternal, neonatal, and nutritional diseases caused the most YLLs throughout sub-Saharan Africa, with observed YLLs far exceeding expected YLLs for countries in which malaria or HIV/AIDS remained the leading causes of early death. Interpretation At the global scale, age-specific mortality has steadily improved over the past 35 years; this pattern of general progress continued in the past decade. Progress has been faster in most countries than expected on the basis of development measured by the SDI. Against this background of progress, some countries have seen falls in life expectancy, and age-standardised death rates for some causes are increasing. Despite progress in reducing age-standardised death rates, population growth and ageing mean that the number of deaths from most non-communicable causes are increasing in most countries, putting increased demands on health systems. Copyright (C) The Author(s). Published by Elsevier Ltd.Peer reviewe

Achieving the highest efficiency using a BODIPY core decorated with dithiafulvalene wings for small molecule based solution-processed organic solar cells

A novel boron dipyrromethene based dye, coded as BODIPY-DTF, decorated with dithiafulvalene wings has been developed for solar cell application. A very high efficiency of 7.2% has been achieved, which is the highest reported value so far for BODIPY based donors. A remarkable value of about 88.1% of external quantum efficiency has also been observed at 371 nm

Synthesis and Optoelectrical Characterization of Novel Squaraine Dyes Derived from Benzothiophene and Benzofuran

Synthesis and photophysical characterizations of two novel small molecules SQ-BEN-THI and SQ-BEN-FUR with D−A−D molecular structure consisting of squaraine as central unit and benzothiophene and benzofuran as end groups are being reported. Apart from very sharp and intense light absorption by these molecular sensitizers in near-infrared (NIR) wavelength region, their possibility as small molecular organic semiconductor was also explored after fabricating organic field-effect transistors (OFETs). Results obtained from photophysical, electrochemical, and quantum chemical studies were combined to elucidate the structural and optoelectronic properties. Electrical characterization pertaining to the charge-transport properties carried after OFET fabrication exhibited field-effect mobilities of 4.0 × 10−5 and 5.4 × 10−5 cm2 /(V s) for SQ-BEN-THI and SQ-BEN-FUR, respectively. After thermal annealing at 130 °C, the field-effect mobility was found to increase for both squaraine dyes. Relatively facile carrier transport in SQ-BEN-FUR compared to that of SQ-BEN-THI could be attributed to relatively higher backbone planarity as indicated from optimized molecular structure obtained after density functional theory calculations. This work may guide for further molecular design and synthesis of novel squaraine dyes for highperformance OFET applications

Molecular Engineering and Structure-Related Properties of Squaraine Dyes Based on the Core and Wings Concept

Three new squaraine-based functional π-conjugated molecules were synthesized considering the core and wings concept. The molecules, SQ-DICN, SQ-DIEt-RH, and SQ-DICN-RH, were end-capped with three different wings, such as malononitrile, 2-(3-hexyl-4-oxothiazolidin-2-ylidene)­malononitrile, and 3-ethyl-2-thioxothiazolidin-4-one. Among the three dyes, SQ-DICN-RH showed the highest molar extinction coefficient. The photoluminescence of all the dyes showed an opposite trend to that of the absorption maximum. The electrochemical results showed that the lowest unoccupied molecular orbital level of all the dyes ranged from −3.72 to −3.82 eV, whereas the highest occupied molecular orbital ranged from −4.89 to −4.94 eV. Solvatochromism was carried out to observe the effects of the solvent containing the dyes. The electronic structure of the dyes was examined using ab initio simulations. The dyes were characterized theoretically, and the red-shifted absorption of SQ-DICN-RH was explained and correlated with its biradicaloid character and singlet–triplet energy gap

Real world experience with an indigenously manufactured stent Cobal C – A retrospective study

Background: Second generation bare metal stents made of cobalt chromium alloy are superior to first generation stain less steel stents. The thin struts are shown to reduce clinical and angiographic adverse outcomes. Objective: To study the long term clinical and angiographic outcomes in patients who underwent coronary angioplasty with an indigenously made cobalt chromium bare metal stents with thin strut Cobal+C™ (Relisys). Methods: A total of 268 consecutive patients who underwent coronary angioplasty with Cobal+C stents were studied retrospectively. Clinical follow up was done after a minimum period of nine months through telephonic interview and angiographic follow up was done in 80 patients chosen randomly. The end points analyzed included major adverse cardiac events (MACE) at nine months and the rate of binary restenosis at follow up angiogram done between 9 and 15 months post angioplasty. Results: Thirty four percent were diabetic and 33% had acute myocardial infarction. Females constituted 17%. Mean stent diameter was 2.88 ± 0.28 and mean stent length 18.8 ± 4.2. MACE at nine months was 4.5% with TLR 0.3%. The rate of binary restenosis was 21%. Patients with longer stent lengths and non-compliance with medications had significantly higher rates of binary restenosis. Conclusions: The use of Relisys Cobal+C stents was associated with good long term clinical and angiographic outcomes as evidenced by low incidence of MACE and binary restenosis rates for a bare metal stent