Global, regional, and national burden of disorders affecting the nervous system, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND: Disorders affecting the nervous system are diverse and include neurodevelopmental disorders, late-life neurodegeneration, and newly emergent conditions, such as cognitive impairment following COVID-19. Previous publications from the Global Burden of Disease, Injuries, and Risk Factor Study estimated the burden of 15 neurological conditions in 2015 and 2016, but these analyses did not include neurodevelopmental disorders, as defined by the International Classification of Diseases (ICD)-11, or a subset of cases of congenital, neonatal, and infectious conditions that cause neurological damage. Here, we estimate nervous system health loss caused by 37 unique conditions and their associated risk factors globally, regionally, and nationally from 1990 to 2021. METHODS: We estimated mortality, prevalence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs), with corresponding 95% uncertainty intervals (UIs), by age and sex in 204 countries and territories, from 1990 to 2021. We included morbidity and deaths due to neurological conditions, for which health loss is directly due to damage to the CNS or peripheral nervous system. We also isolated neurological health loss from conditions for which nervous system morbidity is a consequence, but not the primary feature, including a subset of congenital conditions (ie, chromosomal anomalies and congenital birth defects), neonatal conditions (ie, jaundice, preterm birth, and sepsis), infectious diseases (ie, COVID-19, cystic echinococcosis, malaria, syphilis, and Zika virus disease), and diabetic neuropathy. By conducting a sequela-level analysis of the health outcomes for these conditions, only cases where nervous system damage occurred were included, and YLDs were recalculated to isolate the non-fatal burden directly attributable to nervous system health loss. A comorbidity correction was used to calculate total prevalence of all conditions that affect the nervous system combined. FINDINGS: Globally, the 37 conditions affecting the nervous system were collectively ranked as the leading group cause of DALYs in 2021 (443 million, 95% UI 378–521), affecting 3·40 billion (3·20–3·62) individuals (43·1%, 40·5–45·9 of the global population); global DALY counts attributed to these conditions increased by 18·2% (8·7–26·7) between 1990 and 2021. Age-standardised rates of deaths per 100 000 people attributed to these conditions decreased from 1990 to 2021 by 33·6% (27·6–38·8), and age-standardised rates of DALYs attributed to these conditions decreased by 27·0% (21·5–32·4). Age-standardised prevalence was almost stable, with a change of 1·5% (0·7–2·4). The ten conditions with the highest age-standardised DALYs in 2021 were stroke, neonatal encephalopathy, migraine, Alzheimer's disease and other dementias, diabetic neuropathy, meningitis, epilepsy, neurological complications due to preterm birth, autism spectrum disorder, and nervous system cancer. INTERPRETATION: As the leading cause of overall disease burden in the world, with increasing global DALY counts, effective prevention, treatment, and rehabilitation strategies for disorders affecting the nervous system are needed

Why is mathematics valuable?: a comparison of Turkish and German mathematics teachers

This study was based on the data obtained from "Values in Mathematics Teaching in Turkey and Germany [VMTG]" project which lasted two years. The VMTG project compares German and Turkish mathematics teachers' and their students' values. The purpose of the study is to investigate Turkish and German mathematics teachers' views on why math is valuable, and explore the mathematical values behind their views. The study was undertaken with 9 Turkish and 13 German mathematics teachers. Even though several data collection instruments (i.e. observation sheets, Likert type (multiple choice) questionnaire, and questionnaire consisting of open-ended questions) were used in the project, only the data gathered from semi-structured interviews were the basis for the analysis of the study. Collected data were subjected to constant comparative method. Results revealed that two different major categories emerged: (1) isolated thinking and (2) connected thinking. Discussion, recommendation and further educational implications were provided at the end based on the data

Global, regional, and national burden of disorders affecting the nervous system, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BackgroundDisorders affecting the nervous system are diverse and include neurodevelopmental disorders, late-life neurodegeneration, and newly emergent conditions, such as cognitive impairment following COVID-19. Previous publications from the Global Burden of Disease, Injuries, and Risk Factor Study estimated the burden of 15 neurological conditions in 2015 and 2016, but these analyses did not include neurodevelopmental disorders, as defined by the International Classification of Diseases (ICD)-11, or a subset of cases of congenital, neonatal, and infectious conditions that cause neurological damage. Here, we estimate nervous system health loss caused by 37 unique conditions and their associated risk factors globally, regionally, and nationally from 1990 to 2021.MethodsWe estimated mortality, prevalence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs), with corresponding 95% uncertainty intervals (UIs), by age and sex in 204 countries and territories, from 1990 to 2021. We included morbidity and deaths due to neurological conditions, for which health loss is directly due to damage to the CNS or peripheral nervous system. We also isolated neurological health loss from conditions for which nervous system morbidity is a consequence, but not the primary feature, including a subset of congenital conditions (ie, chromosomal anomalies and congenital birth defects), neonatal conditions (ie, jaundice, preterm birth, and sepsis), infectious diseases (ie, COVID-19, cystic echinococcosis, malaria, syphilis, and Zika virus disease), and diabetic neuropathy. By conducting a sequela-level analysis of the health outcomes for these conditions, only cases where nervous system damage occurred were included, and YLDs were recalculated to isolate the non-fatal burden directly attributable to nervous system health loss. A comorbidity correction was used to calculate total prevalence of all conditions that affect the nervous system combined.FindingsGlobally, the 37 conditions affecting the nervous system were collectively ranked as the leading group cause of DALYs in 2021 (443 million, 95% UI 378–521), affecting 3·40 billion (3·20–3·62) individuals (43·1%, 40·5–45·9 of the global population); global DALY counts attributed to these conditions increased by 18·2% (8·7–26·7) between 1990 and 2021. Age-standardised rates of deaths per 100 000 people attributed to these conditions decreased from 1990 to 2021 by 33·6% (27·6–38·8), and age-standardised rates of DALYs attributed to these conditions decreased by 27·0% (21·5–32·4). Age-standardised prevalence was almost stable, with a change of 1·5% (0·7–2·4). The ten conditions with the highest age-standardised DALYs in 2021 were stroke, neonatal encephalopathy, migraine, Alzheimer's disease and other dementias, diabetic neuropathy, meningitis, epilepsy, neurological complications due to preterm birth, autism spectrum disorder, and nervous system cancer.InterpretationAs the leading cause of overall disease burden in the world, with increasing global DALY counts, effective prevention, treatment, and rehabilitation strategies for disorders affecting the nervous system are needed

Reply to ''Comments on 'Changes to the North Atlantic Subtropical High and Its Role in the Intensification of Summer Rainfall Variability in the Southeastern United States''' WENHONG LI AND LAIFANG LI

ABSTRACT Recently Diem questioned the western ridge movement of the North Atlantic subtropical high (NASH) reported in a 2011 paper of Li et al. This reply shows more analysis that further strengthens the conclusions originally put forth by Li et al. Diem's analysis of the trend in the western ridge of the NASH was based on the data over a 30-yr period , whereas the main conclusions in Li et al. were drawn according to the data over a 60-yr period . Over the last 60 years, the NASH has shown a significant trend of westward movement, the meridional movement of the western ridge of the NASH has enhanced in the recent three decades, and the potential impact of global warming cannot be ruled out in an attempt to explain these changes of the NASH

Who made the world's largest green tide in China?-an integrated study on the initiation and early development of the green tide in Yellow Sea

To discover the original source and clarify development of the world's largest transregional green tides in the Yellow Sea, an integrated investigation covering the Subei Shoal coastal waters and the adjacent regions was carried out during March to June of 2012. The results showed that macroalgal wastes from the connecting ropes of Porphyra aquaculture rafts contributed significantly to the original biomass of free-floating green algae. Approximately 6500t of Ulva prolifera were released into the coastal waters from mid-April to late-May when farmers were cleaning aquaculture facilities. Among the total biomass disposed, about 62.3% floated up to the sea surface, which turned into the original floating patches. The floating U. prolifera, with a high growth rate of 26.3% per day, dominated in the floating algal patches rapidly, moved northward under the hydrodynamic action, and formed a massive free-floating green tide near the south of Shandong peninsula in early June. The optimal sea temperature and sufficient nutrients in the Yellow Sea facilitated the formation of the green tide. No other source contributing substantially to the initial floating biomass was detected in the survey except those from the connecting ropes of rafts. Based on our field data, we concluded that the green tide in Yellow Sea is a transregional disaster stimulated directly by the unhygienic husbandry and maintenance practices of coastal aquaculture