Global, regional, and national burden of colorectal cancer and its risk factors, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Funding: F Carvalho and E Fernandes acknowledge support from Fundação para a Ciência e a Tecnologia, I.P. (FCT), in the scope of the project UIDP/04378/2020 and UIDB/04378/2020 of the Research Unit on Applied Molecular Biosciences UCIBIO and the project LA/P/0140/2020 of the Associate Laboratory Institute for Health and Bioeconomy i4HB; FCT/MCTES through the project UIDB/50006/2020. J Conde acknowledges the European Research Council Starting Grant (ERC-StG-2019-848325). V M Costa acknowledges the grant SFRH/BHD/110001/2015, received by Portuguese national funds through Fundação para a Ciência e Tecnologia (FCT), IP, under the Norma Transitória DL57/2016/CP1334/CT0006.proofepub_ahead_of_prin

The global burden of adolescent and young adult cancer in 2019 : a systematic analysis for the Global Burden of Disease Study 2019

Background In estimating the global burden of cancer, adolescents and young adults with cancer are often overlooked, despite being a distinct subgroup with unique epidemiology, clinical care needs, and societal impact. Comprehensive estimates of the global cancer burden in adolescents and young adults (aged 15-39 years) are lacking. To address this gap, we analysed results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, with a focus on the outcome of disability-adjusted life-years (DALYs), to inform global cancer control measures in adolescents and young adults. Methods Using the GBD 2019 methodology, international mortality data were collected from vital registration systems, verbal autopsies, and population-based cancer registry inputs modelled with mortality-to-incidence ratios (MIRs). Incidence was computed with mortality estimates and corresponding MIRs. Prevalence estimates were calculated using modelled survival and multiplied by disability weights to obtain years lived with disability (YLDs). Years of life lost (YLLs) were calculated as age-specific cancer deaths multiplied by the standard life expectancy at the age of death. The main outcome was DALYs (the sum of YLLs and YLDs). Estimates were presented globally and by Socio-demographic Index (SDI) quintiles (countries ranked and divided into five equal SDI groups), and all estimates were presented with corresponding 95% uncertainty intervals (UIs). For this analysis, we used the age range of 15-39 years to define adolescents and young adults. Findings There were 1.19 million (95% UI 1.11-1.28) incident cancer cases and 396 000 (370 000-425 000) deaths due to cancer among people aged 15-39 years worldwide in 2019. The highest age-standardised incidence rates occurred in high SDI (59.6 [54.5-65.7] per 100 000 person-years) and high-middle SDI countries (53.2 [48.8-57.9] per 100 000 person-years), while the highest age-standardised mortality rates were in low-middle SDI (14.2 [12.9-15.6] per 100 000 person-years) and middle SDI (13.6 [12.6-14.8] per 100 000 person-years) countries. In 2019, adolescent and young adult cancers contributed 23.5 million (21.9-25.2) DALYs to the global burden of disease, of which 2.7% (1.9-3.6) came from YLDs and 97.3% (96.4-98.1) from YLLs. Cancer was the fourth leading cause of death and tenth leading cause of DALYs in adolescents and young adults globally. Interpretation Adolescent and young adult cancers contributed substantially to the overall adolescent and young adult disease burden globally in 2019. These results provide new insights into the distribution and magnitude of the adolescent and young adult cancer burden around the world. With notable differences observed across SDI settings, these estimates can inform global and country-level cancer control efforts. Copyright (C) 2021 The Author(s). Published by Elsevier Ltd.Peer reviewe

The global burden of cancer attributable to risk factors, 2010-19 : a systematic analysis for the Global Burden of Disease Study 2019

Background Understanding the magnitude of cancer burden attributable to potentially modifiable risk factors is crucial for development of effective prevention and mitigation strategies. We analysed results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 to inform cancer control planning efforts globally. Methods The GBD 2019 comparative risk assessment framework was used to estimate cancer burden attributable to behavioural, environmental and occupational, and metabolic risk factors. A total of 82 risk-outcome pairs were included on the basis of the World Cancer Research Fund criteria. Estimated cancer deaths and disability-adjusted life-years (DALYs) in 2019 and change in these measures between 2010 and 2019 are presented. Findings Globally, in 2019, the risk factors included in this analysis accounted for 4.45 million (95% uncertainty interval 4.01-4.94) deaths and 105 million (95.0-116) DALYs for both sexes combined, representing 44.4% (41.3-48.4) of all cancer deaths and 42.0% (39.1-45.6) of all DALYs. There were 2.88 million (2.60-3.18) risk-attributable cancer deaths in males (50.6% [47.8-54.1] of all male cancer deaths) and 1.58 million (1.36-1.84) risk-attributable cancer deaths in females (36.3% [32.5-41.3] of all female cancer deaths). The leading risk factors at the most detailed level globally for risk-attributable cancer deaths and DALYs in 2019 for both sexes combined were smoking, followed by alcohol use and high BMI. Risk-attributable cancer burden varied by world region and Socio-demographic Index (SDI), with smoking, unsafe sex, and alcohol use being the three leading risk factors for risk-attributable cancer DALYs in low SDI locations in 2019, whereas DALYs in high SDI locations mirrored the top three global risk factor rankings. From 2010 to 2019, global risk-attributable cancer deaths increased by 20.4% (12.6-28.4) and DALYs by 16.8% (8.8-25.0), with the greatest percentage increase in metabolic risks (34.7% [27.9-42.8] and 33.3% [25.8-42.0]). Interpretation The leading risk factors contributing to global cancer burden in 2019 were behavioural, whereas metabolic risk factors saw the largest increases between 2010 and 2019. Reducing exposure to these modifiable risk factors would decrease cancer mortality and DALY rates worldwide, and policies should be tailored appropriately to local cancer risk factor burden. Copyright (C) 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.Peer reviewe

Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations. METHODS The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model-a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates-with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality-which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration cause-of-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds. FINDINGS The leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2-100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading five causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1-290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1-211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4-48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3-37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7-9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles. INTERPRETATION Long-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere. FUNDING Bill & Melinda Gates Foundation

The hydrogeology of the Tabriz area, Iran

The present project area lies in East Azarbijan in the north-west part of Iran, and comprises the Tabriz Plain (about 3000 km2) and part of the surrounding mountain area (about 45(X) km2). Climatically, the Tabriz area has hot and dry summers and cold winters with average precipitation ranging from 2(X)mm in the lowland to 5(X)mm in the higher mountain area. Three main aquifers supply drinking, domestic, industrial and most part of the agricultural water to Tabriz City and its surrounding urban and rural areas. They are (1) the unconfined Sahand Plio-Pleistocene volcanic and volcano-sedimentary Alluvial Tuff aquifer which lies to the south and south-west of Tabriz, (2) the unconfmed alluvial fans that lie in the north and southern parts of the Plain, and(3) the multi-layered aquifer system which" lies in the central part of the Plain. The average thickness of these aquifers are about 2(X)m, 50m and 60m respectively. Long-term declines of ground water level are indicated in some parts of the alluvial fans and reverse flow of ground water, in the heavily pumping area in the south-west of the Plain, has produced saline water intrusion into the fresh water aquifer. Constant-rate and step-drawdown pumping test data available from different parts of the area, have been analysed by analytical as well as numerical methods to determine the aquifer properties and well characteristics. The resultant values of transmissivity for the Plain and alluvial tuff aquifers range from 500 mVd to 35(X) mVd, and 240 mVd to 1000 mVd, respectively. Due to the lack of observation well data, direct values of storage coefficient could not be determined for the Plain aquifer. However, the values deduced from the numerical method for the confined aquifer of this area ranges between 2.2x10-3 and 2.0x10-5. Values for the alluvial tuff aquifer range from 2.7x10-1 to 1.1x10-1. The step-drawdown test data have been analysed by a number of methods. The well loss factor (C) and aquifer loss factor (B) range from 1.0x10-7 to 1.1x10-8 d2m-5 and 4.66x10-3 to 4.14x10-4 dm-2, respectively. With respect to geological conditions and ground water quality, the area was divided into three hydrochemical zones i.e., alluvial tuff, northern part of the Plain, and southern and central parts of the Plain. The values of TDS in the ground water of these zones range from 150 to 5(X) mg/1, 2(X) to 12(X) mg/1, and 1000 to 5(XX) mg/1, respectively. Bicarbonate type water dominates the alluvial tuff aquifer and higher elevation parts of the northern parts of the Plain. The southern and central parts of the Plain represents a chloride type ground water in some places especially around the River Aji Chay and the area between Tabriz and Soufian. The alluvial tuff water is rich in Ca and Na whereas, the northern part of the Plain is rich in Ca and Mg which reflect the differences in water bearing-layers in the area. The total amount of annual recharge to ground water is estimated to be about 782x1

Spatial analysis of Ardabil plain aquifer potable groundwater using fuzzy logic

The purpose of this study is to evaluate the quality of drinking water and qualitative classification of potable water in Ardabil plain aquifer. To determine the chemical properties 58 water samples were collected from wells and analyzed. Distribution of each quality parameter was estimated using data driven techniques of kriging and fuzzy logic modeling. According to the obtained results, the fuzzy model provides better results compared to kriging. Different water quality standards are used for assessment of drinking water. The quantitative limits specified in these standards and also water quality data are associated with uncertainty. To reduce the uncertainty a fuzzy based decision making approach was applied for interpretation of groundwater quality. Final output was presented in the form of a zoning map with three categories as ‘Desirable’, ‘Acceptable’ and ‘Not acceptable’. This map indicates that most parts of the aquifer have acceptable and desirable water quality for drinking; but the groundwater in the Southwest and North of the plain, being in conformity with Miocene formations, is undesirable (Not acceptable). This spatial distribution map can help a lot for groundwater supply and offers a good insight of groundwater qualitative trend in this study area

Using Genetic Algorithm to Estimate Hydraulic Parameters of Unconfined Aquifers

Nowadays, optimization techniques such as Genetic Algorithms (GA) have attracted wide attention among scientists for solving complicated engineering problems. In this article, pumping test data are used to assess the efficiency of GA in estimating unconfined aquifer parameters and a sensitivity analysis is carried out to propose an optimal arrangement of GA. For this purpose, hydraulic parameters of three sets of pumping test data are calculated by GA and they are compared with the results of graphical methods. The results indicate that the GA technique is an efficient, reliable, and powerful method for estimating the hydraulic parameters of unconfined aquifer and, further, that in cases of deficiency in pumping test data, it has a better performance than graphical methods

Vulnerability Assessment of Oshnavieh Plain Aquifer by SINTACS and DRASTIC Models

This study carried out for considering the intrinsic vulnerability of Oshnavieh plain aquifer using from DRASTIC and SINTACS models with respect to increasing groundwater resources contaminations and quality deterioration by agricultural activities, industrial and urban development. Although, cleaning up of groundwater contamination is very costly and long process and often occurs when contamination is detected that decontamination of the aquifer is almost impossible. One of the methods for preventing groundwater pollution, identify areas vulnerable aquifer. For both models, seven hydrological and hydrogeological parameters such as depth to water table, net recharge, aquifer media, soil media, the impact of the unsaturated zone, hydraulic conductivity and topography were used. After preparing the layers of each of the parameters in the GIS, the layers have been combined together and the final map was prepared for the plain vulnerability. For ensuring from results of the vulnerability models nitrate data collected from 25 agricultural wells in September 2015 were used. For models optimization and efficiency, the correlation between each of the parameters with the values of nitrate was considered and according to the correlation results and expertise the model parameters were changed and the weight of each final map was prepared. Corrected DRASTIC and SINTACS models showed 76.3 and 67.56 percent correlation with nitrate values respectively. Vulnerability index obtained for corrected DRASTIC was from 68 to 191 and for the SINTACS from 108 to 224. The results showed that both Corrected DRASTIC and SINTACS models are appropriate to determine the vulnerability of Oshnavieh plain. The corrected DRASTIC and SINTACS model determines the intrinsic vulnerability of the plain better than the corrected SINTACS model. according to  DRASTIC and SINTACS vulnerability models have the highest potential vulnerability of Central Plains and the Southwest and Plains Margin the least amount of potential vulnerability

Analiza porównawcza modeli opartych na logice rozmytej do oceny jakości wód podziemnych na podstawie wskaźników nawadniania

Groundwater quality modelling plays an important role in water resources management decision making processes. Accordingly, models must be developed to account for the inherent uncertainty that arises from the sample measurement stage through to the data interpretation stages. Artificial intelligence models, particularly fuzzy inference systems (FIS), have been shown to be effective in groundwater quality evaluation for complex aquifers. Applying fuzzy set theory to groundwater-quality related decision-making in an agricultural production context, the Mamdani, Sugeno, and Larsen fuzzy logic-based models (MFL, SFL, and LFL, respectively) were used to develop a series of new, generalized, rule-based fuzzy models for water quality evaluation using widely accepted irrigation indices. Rather than drawing upon physiochemical groundwater quality parameters, the present study employed widely accepted agricultural indices (e.g., irrigation criteria) when developing the MFL, SFL and LFL groundwater quality models. These newly-developed models, generated significantly more consistent results than the United States Soil Laboratory (USSL) diagram, addressed the inherent uncertainty in threshold data, and were effective in assessing groundwater quality for agricultural uses. The SFL model is recommended because it had the best performance in terms of accuracy when assessing groundwater quality using irrigation indices.Modelowanie jakości wód podziemnych odgrywa ważną rolę w procesach podejmowania decyzji dotyczących zarządzania zasobami wodnymi. W związku z tym należy opracować modele uwzględniające naturalną niepewność, która pojawia się od etapu pomiaru próbki, aż do interpretacji danych. Wykazano, że modele sztucznej inteligencji, w szczególności systemy wnioskowania rozmytego (FIS), są skuteczne w ocenie jakości wód podziemnych w odniesieniu do złożonych warstw wodonośnych. Zastosowanie teorii zbiorów rozmytych do podejmowania decyzji związanych z jakością wód podziemnych w kontekście produkcji rolnej, modele oparte na logice rozmytej Mamdaniego, Sugeno i Larsena (odpowiednio MFL, SFL i LFL) zostały wykorzystane do opracowania serii nowych, uogólnionych modeli, opartych na regułach rozmytych, do oceny jakości wody z wykorzystaniem powszechnie akceptowanych wskaźników nawadniania. Zamiast czerpać z jakościowych parametrów fizykochemicznych wód gruntowych, w niniejszym badaniu zastosowano powszechnie przyjęte wskaźniki rolne (np. kryteria nawadniania) podczas opracowywania modeli jakości wód podziemnych MFL, SFL i LFL. Za pomocą tych nowo opracowanych modeli, wygenerowano znacznie bardziej spójne wyniki niż z zastosowaniem diagramu Amerykańskiego Laboratorium Gleby (USSL), uwzględniono nieodłączną niepewność danych progowych. Modele te były skuteczne w ocenie jakości wód podziemnych do zastosowań rolniczych. Model SFL jest zalecany, ponieważ miał najlepszą efektywność pod względem dokładności w ocenie jakości wód podziemnych z użyciem wskaźników nawadniania

Mapping groundwater contamination risk of multiple aquifers using multi-model ensemble of machine learning algorithms

Constructing accurate and reliable groundwater risk maps provide scientifically prudent and strategic measures for the protection and management of groundwater. The objectives of this paper are to design and validate machine learning based-risk maps using ensemble-based modelling with an integrative approach. We employ the extreme learning machines (ELM), multivariate regression splines (MARS), M5 Tree and support vector regression (SVR) applied in multiple aquifer systems (e.g.conconfined, semi-confined and confined) in the Marand plain, North West Iran, to encapsulate the merits of individual learning algorithms in a final committee-based ANN model. The DRASTIC Vulnerability Index (VI) ranged from 56.7 to 128.1, categorized with no risk, low and moderate vulnerability thresholds. The correlation coefficient (r) and Willmott's Index (d) between NO3 concentrations and VI were 0.64 and 0.314, respectively. To introduce improvements in the original DRASTIC method, the vulnerability indices were adjusted by NO3 concentrations, termed as the groundwater contamination risk (GCR). Seven DRASTIC parameters utilized as the model inputs and GCR values utilized as the outputs of individual machine learning models were served in the fully optimized committee-based ANN-predictive model. The correlation indicators demonstrated that the ELM and SVR models outperformed the MARS and M5 Tree models, by virtue of a larger d and r value. Subsequently, the r and d metrics for the ANN-committee based multi-model in the testing phase were 0.8889 and 0.7913, respectively; revealing the superiority of the integrated (or ensemble) machine learning models when compared with the original DRASTIC approach. The newly designed multi-model ensemble-based approach can be considered as a pragmatic step for mapping groundwater contamination risks of multiple aquifer systems with multi-model techniques, yielding the high accuracy of the ANN committee-based model