Global, regional, and national age-sex-specific mortality and life expectancy, 1950–2017: a systematic analysis for the Global Burden of Disease Study 2017

BACKGROUND: Assessments of age-specific mortality and life expectancy have been done by the UN Population Division, Department of Economics and Social Affairs (UNPOP), the United States Census Bureau, WHO, and as part of previous iterations of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD). Previous iterations of the GBD used population estimates from UNPOP, which were not derived in a way that was internally consistent with the estimates of the numbers of deaths in the GBD. The present iteration of the GBD, GBD 2017, improves on previous assessments and provides timely estimates of the mortality experience of populations globally. METHODS: The GBD uses all available data to produce estimates of mortality rates between 1950 and 2017 for 23 age groups, both sexes, and 918 locations, including 195 countries and territories and subnational locations for 16 countries. Data used include vital registration systems, sample registration systems, household surveys (complete birth histories, summary birth histories, sibling histories), censuses (summary birth histories, household deaths), and Demographic Surveillance Sites. In total, this analysis used 8259 data sources. Estimates of the probability of death between birth and the age of 5 years and between ages 15 and 60 years are generated and then input into a model life table system to produce complete life tables for all locations and years. Fatal discontinuities and mortality due to HIV/AIDS are analysed separately and then incorporated into the estimation. We analyse the relationship between age-specific mortality and development status using the Socio-demographic Index, a composite measure based on fertility under the age of 25 years, education, and income. There are four main methodological improvements in GBD 2017 compared with GBD 2016: 622 additional data sources have been incorporated; new estimates of population, generated by the GBD study, are used; statistical methods used in different components of the analysis have been further standardised and improved; and the analysis has been extended backwards in time by two decades to start in 1950. FINDINGS: Globally, 18·7% (95% uncertainty interval 18·4–19·0) of deaths were registered in 1950 and that proportion has been steadily increasing since, with 58·8% (58·2–59·3) of all deaths being registered in 2015. At the global level, between 1950 and 2017, life expectancy increased from 48·1 years (46·5–49·6) to 70·5 years (70·1–70·8) for men and from 52·9 years (51·7–54·0) to 75·6 years (75·3–75·9) for women. Despite this overall progress, there remains substantial variation in life expectancy at birth in 2017, which ranges from 49·1 years (46·5–51·7) for men in the Central African Republic to 87·6 years (86·9–88·1) among women in Singapore. The greatest progress across age groups was for children younger than 5 years; under-5 mortality dropped from 216·0 deaths (196·3–238·1) per 1000 livebirths in 1950 to 38·9 deaths (35·6–42·83) per 1000 livebirths in 2017, with huge reductions across countries. Nevertheless, there were still 5·4 million (5·2–5·6) deaths among children younger than 5 years in the world in 2017. Progress has been less pronounced and more variable for adults, especially for adult males, who had stagnant or increasing mortality rates in several countries. The gap between male and female life expectancy between 1950 and 2017, while relatively stable at the global level, shows distinctive patterns across super-regions and has consistently been the largest in central Europe, eastern Europe, and central Asia, and smallest in south Asia. Performance was also variable across countries and time in observed mortality rates compared with those expected on the basis of development. INTERPRETATION: This analysis of age-sex-specific mortality shows that there are remarkably complex patterns in population mortality across countries. The findings of this study highlight global successes, such as the large decline in under-5 mortality, which reflects significant local, national, and global commitment and investment over several decades. However, they also bring attention to mortality patterns that are a cause for concern, particularly among adult men and, to a lesser extent, women, whose mortality rates have stagnated in many countries over the time period of this study, and in some cases are increasing

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

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

Manufacturing of wollastonite-based glass from cement dust: Physical and mechanical properties

By-pass cement dust is considered as a source of environmental pollution. Wollastonite-based glass foams are made by adding glass waste and SiC to the cement dust. XRD on samples indicated that the main crystalline phase after heat treatment at 850–1,000°C is wollastonite. Empirical models were developed to derive conclusion on the impact of SiC and temperature on the physical and mechanical properties of the products. The optimum sintering temperature was found to be at 900°C for 60 min, at which crushing strength was about 15 MPa and was the best uniform. Such wollastonite-based glass foam could be very attractive for thermal and acoustic applications

التأثير المزدوج لأشعة جاما وبعض العوامل الطبيعية على معدل النمو لبعوضة الكيولكس ببينز

The present work deals with the role of some physical factors, applied separately or combined with gamma radiation on the Fj rate of development of Culex pipiens L. when treated in the pupal stage. The results showed no or slight effect of all treatments on incubation period of eggs. Larval duration was increased when parental pupae were exposed to low temperature (10°C), low humidity (31% R.H.) or when any of the factors was combined with gamma radiation (60 Gy). Larval development was stopped at some mating combinations, when gamma radiation followed exposure to partial vacuum (0.1 torr) or low humidity; Pupal duration at most of the treatments was increased. Percent pupation was significantly reduced at all treatments especially when partial vacuum or temperature was combined with gamma radiation when pupation was inhibited at all mating combinations except controls (NCf x NQ). Generally, adult emergence was decreased at all treatments and inhibited when parental pupae were exposed to partial vacuum, low temperature, or low humidity combined with gamma radiation.يهتم البحث الحالي بدور بعض العوامل الطبيعية منفرده أو مقرونة بأشعة جاما على معدل النمو في الجيل الأول لبعوضة الكيولكس ببينز والمعاملة في طور العذراء الأم . وقد بينت النتائج أنه لا يوجد تأثير محسوس على فترة حضانة البيضة . وقد زادت فترة . نمو اليرقة عندما عرضت العذراء الأم للحرارة المنخفضة (10م) أو الرطوبة المنخفضة (31%) أو عندما استخدم أي من العوامل الطبيعية مقرونة بالإشعاع (60 جراي) ،وقد توقف نمو اليرقات تماما في بعض التزاوجات عندما شععت العذراء بعد تعرضها للتفريغ الجزئي (0.1 تورشيللي) أو الرطوبة المنخفضة . وفي معظم المعاملات ازدادت فترة العذراء . أما نسبة التعذر فقد انخفضت عند جميع المعاملات وخاصة عندما اقترن التشعيع بالتفريغ الجزئي أو الحرارة المنخفضة حيث توقف التعذر تماماً ، وعلى العموم فإن نسبة خروج الحشرات البالغة من الشرنقة قد قلت عند جميع المعاملات وتوقف الخروج عندما اقترنت أشعة جاما بالتفريغ الجزئي أو الحرارة المنخفضة أو الرطوبة المنخفضة