Prevalence of Cardiovascular Conditions After Traumatic Brain Injury: A Comparison Between the Traumatic Brain Injury Model Systems and the National Health and Nutrition Examination Survey

BACKGROUND: The purpose of this study is to compare the prevalence of self-reported cardiovascular conditions among individuals with moderate to severe traumatic brain injury (TBI) to a propensity-matched control cohort. METHODS AND RESULTS: A cross-sectional study described self-reported cardiovascular conditions (hypertension, congestive heart failure [CHF], myocardial infarction [MI], and stroke) from participants who completed interviews between January 2015 and March 2020 in 2 harmonized large cohort studies, the TBI Model Systems and the National Health and Nutrition Examination Survey. Mixed-effect logistic regression models were used to compare the prevalence of cardiovascular conditions after 1:1 propensity-score matching based on age, sex, race, ethnicity, body mass index, education level, and smoking status. The final sample was 4690 matched pairs. Individuals with TBI were more likely to report hypertension (odds ratio [OR], 1.18 [95% CI, 1.08-1.28]) and stroke (OR, 1.70 [95% CI, 1.56-1.98]) but less likely to report CHF (OR, 0.81 [95% CI, 0.67-0.99]) or MI (OR, 0.66 [95% CI, 0.55-0.79]). There was no difference in rate of CHF or MI for those ≤50 years old; however, rates of CHF and MI were lower in the TBI group for individuals \u3e50 years old. Over 65% of individuals who died before the first follow-up interview at 1 year post-TBI were \u3e50 years old, and those \u3e50 years old were more likely to die of heart disease than those ≤50 years old (17.6% versus 8.6%). CONCLUSIONS: Individuals with moderate to severe TBI had an increased rate of self-reported hypertension and stroke but lower rate of MI and CHF than uninjured adults, which may be due to survival bias

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

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

Surface effects on the electro-mechanical properties of silicon nano-ribbons and nano-wires

The need for developing simple and generic characterization tools to deform freestanding silicon beams down to the nanometre scale, sufficiently equipped to investigate both the mechanical properties and the carrier transport under large strains, has been met in this research through the design of a versatile lab-on-chip. The Young’s modulus was observed to unexpectedly decrease from a bulk value of 169 GPa down to 96 GPa when varying the thickness of silicon from 200 down to 30 nm. The fracture strain increases when decreasing the volume of the test specimen starting from 0.2 % for a bulk silicon wafer, to reach 5% in the smallest SiNWs. In order to proceed with characterizing its electro-mechanical properties, it is necessary to understand the influence of surface state charge distributions on SiNW transport characteristics. The removal of the oxide at the surface of SiNWs by a HF treatment results in a drop in conductance up to six orders of magnitude. This effect is from a surface depletion of holes in the SiNW induced by positive surface charges deposited from the HF treatment. However, it is observed that this charge density is transient and is dissipated with the re-growth of an oxide layer. Additionally, atomic layer deposited Al203 can be used to control the surface potential of p-type SiNWs from depletion to accumulation. In summary, the SiNW conductance can be reproducibly controlled up to several orders of magnitude, while playing with four common surface conditions: with a native oxide, deposited Al203, thermal oxide and HF induced H-terminations. Finally, the piezo-resistance of SiNWs has been investigated under large uniaxial tension up to fracture using an original on-chip tensile testing technique. The piezo-resistance coefficient (π) was found to increase by a factor of 6, when decreasing the dopant concentration from Na ~ 1 x 1019 cm-3 down to ~ Na ~ 5 x 1017 cm-3. Reduction of resistance up to a factor of 5.8, higher than theoretical prediction of 4.5 is reported for Na ~ 5 x 1017 cm-3 under a stress of 1.7 GPa, without any sign of saturation.(FSA 3) -- UCL, 201

Note: Size effects on the tensile response of top-down fabricated Si nanobeams

The tensile response of top-down fabricated sc-Si nanobeams is inferred from the fitting of stressstrain data obtained under tensile loading conditions over a large range of deformation. The testing is performed using MEMS structures consisting of two connected beams; a highly stressed siliconnitride (SiN) beam connected to a sc-Si specimen beam. The high tensile stress component present upon the deposition of the SiN loads the sc-Si beam once the entire structure is released. The strain and stress values are extracted independently, respectively, by scanning electron microscopy inspection and vibration frequency measurement of the released tensile MEMS structures. The tensile tests are undertaken for six thicknesses to determine the dependence of the elastic response on dimensions. The Young’s modulus shows a variation of 40% for thicknesses ranging from 200 to 30 nm

Piezoresistance of nano-scale silicon up to 2GPa in tension

The piezo-resistance of 100 nm-thick, [110] oriented, p-type, mono-crystalline Si beams has been investigated under large uniaxial tension up to 2 GPa using an original on-chip tensile testing set-up. The piezo-resistance coefficient (π) was found to increase by a factor of 6 compared with ∼1.5 for Si bulk, when decreasing the dopant concentration from Na ∼ 1 × 1019 cm−3 down to Na ∼ 5 × 1017 cm−3. Reduction of resistance by a factor of 5.8, higher than theoretical maximum of 4.5, is reported for Na ∼ 5 × 1017 cm−3 under a stress of 1.7 GPa, without any sign of saturation

Surface states and conductivity of silicon nano-wires

The transport characteristics of low dimensional semiconductors like silicon nano-wires (SiNWs) rarely conform to expectations from geometry and dopant density, exhibiting significant variations as a function of different surface terminations/conditions. The association of these mechanisms with surface states and their exact influence on practical SiNW devices still remains largely unclear. Herein, we report on the influence of surface state charge distributions on SiNW transport characteristics. For this study, p-type SiNW devices with widths of 50, 100, and 2000 nm are fabricated from 25, 50, and 200 nm-thick SOI wafers. A five order difference in effective carrier concentration was observed in the initial SiNWs characteristics, when comparing SiNWs fabricated with and without a thermal oxide. The removal of the surface oxide by a hydrogen fluoride (HF) treatment results in a SiNW conductance drop up to six orders of magnitude. This effect is from a surface depletion of holes in the SiNW induced by positive surface charges deposited as a result of the HF treatment. However, it is observed that this charge density is transient and is dissipated with the re-growth of an oxide layer. In summary, the SiNW conductance is shown to vary by several orders of magnitude, while comparing its characteristics for the three most studied surface conditions: with a native oxide, thermal oxide and HF induced H-terminations. These results emphasize the necessity to interpret the transport characteristics of SiNWs with respect to its surface condition, during future investigations pertaining to the physical properties of SiNWs, like its piezo-resistance. As a sequel, prospects for efficiently sensing an elementary reduction/oxidation chemical process by monitoring the variation of SiNW surface potential, or in practice the SiNW conductance, is demonstrated

Raman analysis of strain in p-type doped silicon nanostructures

In this work, 100 nm-thick boron-doped silicon beams with doping levels between 1 × 1016 and 1 × 1020 cm−3 undergoing uniaxial tensile strain are investigated by Raman spectroscopy. The structures exhibit a noticeable reduction in Young's modulus (∼20%) compared with the value reported for bulk. The traditional Raman shift coefficients used to determine stress and strain in bulk structures are revised, and appropriate corrections are implemented to account for the observed changes in Young's modulus. Interestingly, the Raman shift-strain relation in silicon nanostructures with strain along the [110] direction is found to be independent of size effects and doping. In contrast, the Raman shift-stress relation is found to be highly dependent on size effects. The dependency of the Fano line-shape parameters, used to fit the Raman first order peak in structures with high levels of doping, with strain is also reported. The results are shown to be crucial to accurately determine stress and strain from Raman measurements in doped silicon nanostructures and devices with size effects