Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Background: In an era of shifting global agendas and expanded emphasis on non-communicable diseases and injuries along with communicable diseases, sound evidence on trends by cause at the national level is essential. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic scientific assessment of published, publicly available, and contributed data on incidence, prevalence, and mortality for a mutually exclusive and collectively exhaustive list of diseases and injuries. Methods: GBD estimates incidence, prevalence, mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) due to 369 diseases and injuries, for two sexes, and for 204 countries and territories. Input data were extracted from censuses, household surveys, civil registration and vital statistics, disease registries, health service use, air pollution monitors, satellite imaging, disease notifications, and other sources. Cause-specific death rates and cause fractions were calculated using the Cause of Death Ensemble model and spatiotemporal Gaussian process regression. Cause-specific deaths were adjusted to match the total all-cause deaths calculated as part of the GBD population, fertility, and mortality estimates. Deaths were multiplied by standard life expectancy at each age to calculate YLLs. A Bayesian meta-regression modelling tool, DisMod-MR 2.1, was used to ensure consistency between incidence, prevalence, remission, excess mortality, and cause-specific mortality for most causes. Prevalence estimates were multiplied by disability weights for mutually exclusive sequelae of diseases and injuries to calculate YLDs. We considered results in the context of the Socio-demographic Index (SDI), a composite indicator of income per capita, years of schooling, and fertility rate in females younger than 25 years. Uncertainty intervals (UIs) were generated for every metric using the 25th and 975th ordered 1000 draw values of the posterior distribution. Findings: Global health has steadily improved over the past 30 years as measured by age-standardised DALY rates. After taking into account population growth and ageing, the absolute number of DALYs has remained stable. Since 2010, the pace of decline in global age-standardised DALY rates has accelerated in age groups younger than 50 years compared with the 1990–2010 time period, with the greatest annualised rate of decline occurring in the 0–9-year age group. Six infectious diseases were among the top ten causes of DALYs in children younger than 10 years in 2019: lower respiratory infections (ranked second), diarrhoeal diseases (third), malaria (fifth), meningitis (sixth), whooping cough (ninth), and sexually transmitted infections (which, in this age group, is fully accounted for by congenital syphilis; ranked tenth). In adolescents aged 10–24 years, three injury causes were among the top causes of DALYs: road injuries (ranked first), self-harm (third), and interpersonal violence (fifth). Five of the causes that were in the top ten for ages 10–24 years were also in the top ten in the 25–49-year age group: road injuries (ranked first), HIV/AIDS (second), low back pain (fourth), headache disorders (fifth), and depressive disorders (sixth). In 2019, ischaemic heart disease and stroke were the top-ranked causes of DALYs in both the 50–74-year and 75-years-and-older age groups. Since 1990, there has been a marked shift towards a greater proportion of burden due to YLDs from non-communicable diseases and injuries. In 2019, there were 11 countries where non-communicable disease and injury YLDs constituted more than half of all disease burden. Decreases in age-standardised DALY rates have accelerated over the past decade in countries at the lower end of the SDI range, while improvements have started to stagnate or even reverse in countries with higher SDI. Interpretation: As disability becomes an increasingly large component of disease burden and a larger component of health expenditure, greater research and developm nt investment is needed to identify new, more effective intervention strategies. With a rapidly ageing global population, the demands on health services to deal with disabling outcomes, which increase with age, will require policy makers to anticipate these changes. The mix of universal and more geographically specific influences on health reinforces the need for regular reporting on population health in detail and by underlying cause to help decision makers to identify success stories of disease control to emulate, as well as opportunities to improve. Funding: Bill & Melinda Gates Foundation. © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licens

Corrosion and odor management in sewer systems

Sewers emit hydrogen sulfide and various volatile organic sulfur and carbon compounds, which require control and mitigation. In the last 5–10 years, extensive research was conducted to optimize existing sulfide abatement technologies based on newly developed in-depth understanding of the in-sewer processes. Recent advances have also led to low-cost novel solutions targeting sewer biofilms. Online control has been demonstrated to greatly reduce the chemical usage. Dynamic models for both the water, air and solid (concrete) phases have been developed and used for the planning and maintenance of sewer systems. Existing technologies primarily focused on ‘hotspots’ in sewers. Future research should aim to achieve network-wide corrosion and emission control and management of sewers as an integrated component of an urban water system

Development of a model for assessing methane formation in rising main sewers

Significant methane formation in sewers has been reported recently, which may contribute significantly to the overall greenhouse gas emission from wastewater systems. The understanding of the biological conversions occurring in sewers, particularly the competition between methanogenic and sulfate-reducing populations for electron donors, is an essential step for minimising methane emissions from sewers. This work proposes an extensionto the current state-of-the-art models characterising biological and physicochemical processes in sewers. This extended model includes the competitive interactions of sulfate-reducing bacteria and methanogenic archaea in sewers for various substrates available. The most relevant parameters of the model were calibrated with lab-scale experimental data. The calibrated model described field data reasonably well. The model was then used to investigate the effect of several key sewer design and operational parameters on methane formation. The simulation results showed that methane production was highly correlated with the hydraulic residence time (HRT) and pipe area to volume (A/V) ratio showing higher methane concentrations at a long HRT or a larger A/V ratio. ª 2009 Elsevier Ltd. All rights reserved

A laboratory assessment of the impact of brewery wastewater discharge on sulfide and methane production in a sewer

The impact of brewery wastewater discharge on sulfide and methane production in a sewer was assessed. Experiments were carried out on laboratory scale sewer reactors consisting of both an experimental and a control reactor. The control reactor was intermittently fed with real fresh sewage while the experimental reactor was fed with a mixture of brewery and domestic wastewater at two different proportions (10 and 25% v/v). 10% v/v discharge of brewery wastewater increased the H2S and CH4 production rates in the sewer reactor by 40% and 30%, respectively. When the brewery wastewater fraction was increased to 25% v/v, the H2S production rate of the experimental reactor decreased to the level of the control reactor. In contrast, the CH4 production rate maintained at a level that was 30% higher than that in the control reactor. These results indicate that the discharge of brewery wastewater into sewers can give negative impacts in relation to odour and corrosion management of the systems and will increase the greenhouse gas emissions from sewers. The study also reveals that the impact of trade waste on the biological reactions in sewers is complex, and requires careful experimental assessment in each case

Iron salts dosage for sulfide control in sewers induces chemical phosphorus removal during wastewater treatment

Chemical phosphorus (P) removal during aerobic wastewater treatment induced by iron salt addition in sewer systems for sulfide control is investigated. Aerobic batch tests with activated sludge fed with wastewater containing iron sulfide precipitates showed that iron sulfide was rapidly reoxidised in aerobic conditions, resulting in phosphate precipitation. The amount of P removed was proportional to the amount of iron salts added, and for the sludge used, ratios of 0.44 and 0.37 mgP/mgFe were obtained for ferric and ferrous dosages, respectively. The hydraulic retention time (HRT) of iron sulfide in sewers was found to have a crucial impact on the settling of iron sulfide precipitates during primary settling, with a shorter HRT resulting in a higher concentration of iron sulfide in the primary effluent and thus enabling higher P removal. A mathematical model was developed to describe iron sulfide oxidation in aerated activated sludge and the subsequent iron phosphate precipitation. The model was used to optimise FeCl(3) dosing in a real wastewater collection and treatment system. Simulation studies revealed that, by moving FeCl(3) dosing from the WWTP, which is the current practice, to a sewer location upstream of the plant, both sulfide control and phosphate removal could be achieved with the current ferric salt consumption. This work highlights the importance of integrated management of sewer networks and wastewater treatment plants. (C) 2010 Elsevier Ltd. All rights reserved

Effect of incorporation of walnut cake (Juglans regia) in concentrate mixture on degradation of dry matter, organic matter and production of microbial biomass in vitro in goat

Aim: This study was carried out to investigate the effect of incorporation of different level of walnut cake in concentrate mixture on in vitro dry matter degradation in order to determine its level of supplementation in ruminant ration. Materials and Methods: Walnut cake was used @ 0, 10, 15, 20, 25 and 30% level to formulate an iso-nitrogenous concentrate mixtures and designated as T1, T2, T3, T4, T5 and T6 respectively. The different formulae of concentrate mixtures were used for in vitro gas production studies using goat rumen liquor with wheat straw in 40:60 ratio. Proximate composition, fiber fractionation and calcium and phosphrous content of walnut cake were estimated. Result: The per cent IVDMD value of T1 and T2 diets was 68.42 ± 1.20 and 67.25 ± 1.37 respectively which was found highest (P<0.05) T3, T4, T5 and T6. Similar trend was also found for TDOM and MBP. Inclusion of walnut cake at 10% level in the concentrate mixture does not affect in vitro dry matter digestibility (IVDMD), truly degradable organic matter (TDOM, mg/200 mg DM), total gas production, microbial biomass production (MBP) and efficiency of microbial biomass production (EMP). Conclusion: It is concluded that walnut cake incorporation up to 10% level in the iso -nitrogenous concentrate mixture has no any negative effect on in vitro digestibility of dry matter (DM), TDOM, MBP, EMP and total gas production in goat

SCORe-CT: A new method for testing effectiveness of sulfide-control chemicals used in sewer systems

A new method for testing the effectiveness of chemical products for sulfide control in sewers is reported. The method, called SCORe-CT (Sewer Corrosion and Odour Research - Chemical Testing), consists of two specially designed laboratory-scale systems that mimic sulfide production in real rising main sewers, and a multi-phase and multi-facet testing protocol. The monitoring tools/methods include both routine chemical analysis of various sulfurous and carbonaceous compounds in liquid and their on-line monitoring using advanced sensors. Molecular methods and microelectrodes can also be employed to examine the microbial structure and activity of sewer biofilms. The SCORe-CT method is not proposed to replace field trials but to screen chemicals prior to their often costly trials/applications in field conditions. For effective chemicals the method helps to reveal the mechanisms involved, and assists with the design of optimal dosage strategies, which would significantly reduce application costs. In this paper, the method is explained in detail and demonstrated with several case studies