Trends in premature avertable mortality from non-communicable diseases for 195 countries and territories, 1990–2017: A population-based study

Background: The reduction by a third of premature non-communicable disease (NCD) mortality by 2030 is the ambitious target of Sustainable Development Goal (SDG) 3.4. However, the indicator is narrowly defined, including only four major NCDs (cardiovascular diseases, cancer, diabetes, and chronic respiratory diseases) and only for people aged 30–70 years. This study focuses on premature avertable mortality from NCDs—premature deaths caused by NCDs that could be prevented through effective public policies and health interventions or amenable to high-quality health care—to assess trends at global, regional, and national levels using estimates from the Global Burden of Disease, Injuries, and Risk Factors Study (GBD) 2017. Methods: We reviewed existing lists of NCD causes of death that are either preventable through public health policies and interventions or amenable to health care to create a list of avertable NCD causes of death, which was mapped to the GBD cause list. We estimated age-standardised years of life lost (YLL) per 100 000 population due to premature avertable mortality from NCDs, avertable NCD cause clusters, and non-avertable NCD causes by sex, location, and year and reported their 95% uncertainty intervals (UIs). We examined trends in age-standardised YLL due to avertable and non-avertable NCDs, assessed the progress of premature avertable mortality from NCDs in achieving SDG 3.4, and explored specific avertable NCD cause clusters that could make a substantial contribution to overall trends in premature mortality. Findings: Globally, premature avertable mortality from NCDs for both sexes combined declined −1·3% (95% UI −1·4 to −1·2) per year, from 12 855 years (11 809 to 14 051) in 1990 to 9008 years (8329 to 9756) in 2017. However, the absolute number of avertable NCD deaths increased 49·3% (95% UI 47·3 to 52·2) from 23·1 million (22·0–24·1) deaths in 1990 to 34·5 million (33·4 to 35·6) in 2017. Premature avertable mortality from NCDs reduced in every WHO region and in most countries and territories between 1990 and 2017. Despite these reductions, only the Western Pacific and European regions and 25 countries (most of which are high-income countries) are on track to achieve SDG target 3.4. Since 2017, there has been a global slowdown in the reduction of premature avertable mortality from NCDs. In 2017, high premature avertable mortality from NCDs was clustered in low-income and middle-income countries, mainly in the South-East Asia region, Eastern Mediterranean region, and African region. Most countries with large annual reductions in such mortality between 1990 and 2017 had achieved low levels of premature avertable mortality from NCDs by 2017. Some countries, the most populous examples being Afghanistan, the Central African Republic, Uzbekistan, Haiti, Mongolia, Turkmenistan, Pakistan, Ukraine, Laos, and Egypt, reported both an upward trend and high levels of premature avertable mortality from NCDs. Cardiovascular diseases, cancers, and chronic respiratory diseases have been the main drivers of the global and regional reduction in premature avertable mortality from NCDs, whereas premature mortality from substance use disorders, chronic kidney disease and acute glomerulonephritis, and diabetes have been increasing. Interpretation: Worldwide, there has been a substantial reduction in premature avertable mortality from NCDs, but progress has been uneven across populations. Countries vary substantially in current levels and trends and, hence, the extent to which they are on track to achieve SDG 3.4. By accounting for premature avertable mortality while avoiding arbitrary age cutoffs, premature avertable mortality from NCDs is a robust, comprehensive, and actionable indicator for quantifying and monitoring global and national progress towards NCD prevention and control. Funding: None

Implementation of SHAPES Case Studies (Artifact)

Our main paper presents {SHAPES}, a language extension which offers developers fine-grained control over the placement of data in memory, whilst retaining both memory safety and object abstraction via pooling and clustering. As part of the development of {SHAPES}, we wanted to investigate the usefulness of the concepts {SHAPES} brings to the table. To that extent, we implemented five such case studies. This publication provides the corresponding code and instructions on how to run these case studies and derive the results we provide

Tracking rates of ecotone migration due to salt-water encroachment using fossil mollusks in coastal South Florida

We determined the rate of migration of coastal vegetation zones in response to salt-water encroachment through paleoecological analysis of mollusks in 36 sediment cores taken along transects perpendicular to the coast in a 5.5 km2 band of coastal wetlands in southeast Florida. Five vegetation zones, separated by distinct ecotones, included freshwater swamp forest, freshwater marsh, and dwarf, transitional and fringing mangrove forest. Vegetation composition, soil depth and organic matter content, porewater salinity and the contemporary mollusk community were determined at 226 sites to establish the salinity preferences of the mollusk fauna. Calibration models allowed accurate inference of salinity and vegetation type from fossil mollusk assemblages in chronologically calibrated sediments. Most sediments were shallow (20–130 cm) permitting coarse-scale temporal inferences for three zones: an upper peat layer (zone 1) representing the last 30–70 years, a mixed peat-marl layer (zone 2) representing the previous ca. 150–250 years and a basal section (zone 3) of ranging from 310 to 2990 YBP. Modern peat accretion rates averaged 3.1 mm yr)1 while subsurface marl accreted more slowly at 0.8 mm yr)1. Salinity and vegetation type for zone 1 show a steep gradient with freshwater communities being confined west of a north–south drainage canal constructed in 1960. Inferences for zone 2 (pre-drainage) suggest that freshwater marshes and associated forest units covered 90% of the area, with mangrove forests only present along the peripheral coastline. During the entire pre-drainage history, salinity in the entire area was maintained below a mean of 2 ppt and only small pockets of mangroves were present; currently, salinity averages 13.2 ppt and mangroves occupy 95% of the wetland. Over 3 km2 of freshwater wetland vegetation type have been lost from this basin due to salt-water encroachment, estimated from the mollusk-inferred migration rate of freshwater vegetation of 3.1 m yr)1 for the last 70 years (compared to 0.14 m yr)1 for the pre-drainage period). This rapid rate of encroachment is driven by sea-level rise and freshwater diversion. Plans for rehydrating these basins with freshwater will require high-magnitude re-diversion to counteract locally high rates of sea-level rise

Innate Memory Reprogramming by Gold Nanoparticles Depends on the Microbial Agents That Induce Memory

Inmunidad innata; Agentes microbianos; NanopartículasInnate immunity; Microbial agents; NanoparticlesImmunitat innata; Agents microbians; NanopartículesInnate immune memory, the ability of innate cells to react in a more protective way to secondary challenges, is induced by exposure to infectious and other exogeous and endogenous agents. Engineered nanoparticles are particulate exogenous agents that, as such, could trigger an inflammatory reaction in monocytes and macrophages and could therefore be also able to induce innate memory. Here, we have evaluated the capacity of engineered gold nanoparticles (AuNPs) to induce a memory response or to modulate the memory responses induced by microbial agents. Microbial agents used were in soluble vs. particulate form (MDP and the gram-positive bacteria Staphylococcus aureus; β-glucan and the β-glucan-producing fungi C. albicans), and as whole microrganisms that were either killed (S. aureus, C. albicans) or viable (the gram-negative bacteria Helicobacter pylori). The memory response was assessed in vitro, by exposing human primary monocytes from 2-7 individual donors to microbial agents with or without AuNPs (primary response), then resting them for 6 days to allow return to baseline, and eventually challenging them with LPS (secondary memory response). Primary and memory responses were tested as production of the innate/inflammatory cytokine TNFα and other inflammatory and anti-inflammatory factors. While inactive on the response induced by soluble microbial stimuli (muramyl dipeptide -MDP-, β-glucan), AuNPs partially reduced the primary response induced by whole microorganisms. AuNPs were also unable to directly induce a memory response but could modulate stimulus-induced memory in a circumscribed fashion, limited to some agents and some cytokines. Thus, the MDP-induced tolerance in terms of TNFα production was further exacerbated by co-priming with AuNPs, resulting in a less inflammatory memory response. Conversely, the H. pylori-induced tolerance was downregulated by AuNPs only relative to the anti-inflammatory cytokine IL-10, which would lead to an overall more inflammatory memory response. These effects of AuNPs may depend on a differential interaction/association between the reactive particle surfaces and the microbial components and agents, which may lead to a change in the exposure profiles. As a general observation, however, the donor-to-donor variability in memory response profiles and reactivity to AuNPs was substantial, suggesting that innate memory depends on the individual history of exposures.This work was supported by the EU Commission H2020 projects PANDORA (GA 671881) and ENDONANO (GA 812661), the Italian MIUR InterOmics Flagship projects MEMORAT and MAME, the Italian MIUR/PRIN-20173ZECCM, the Priority program ACBN (Allergy Cancer BioNano Research Centre) of the University of Salzburg, the Cancer Cluster Salzburg, the Research Grant from the University of Salzburg, and the Austrian Science Fund (FWF) Grant Nr. P 29941

Association of diabetes with atrial fibrillation types: a systematic review and meta-analysis

Background: Atrial fibrillation (AF) is a common arrhythmia classified as paroxysmal and non-paroxysmal. Non-paroxysmal AF is associated with an increased risk of complications. Diabetes contributes to AF initiation, yet its role in AF maintenance is unclear. We conducted a systematic review and meta-analysis to summarize the evidence regarding the association of diabetes with AF types. Methods: We searched 5 databases for observational studies investigating the association of diabetes with the likelihood of an AF type (vs another type) in humans. Study quality was evaluated using the Newcastle-Ottawa Scale. Studies classifying AF types as paroxysmal (reference) and non-paroxysmal were pooled in a meta-analysis using random effects models. Results: Of 1997 articles we identified, 20 were included in our systematic review. The population sample size ranged from 64 to 9816 participants with mean age ranging from 40 to 75 years and percentage of women from 24.8 to 100%. The quality of studies varied from poor (60%) to fair (5%) to good (35%). In the systematic review, 8 studies among patients with AF investigated the cross-sectional association of diabetes with non-paroxysmal AF (vs paroxysmal) of which 6 showed a positive association and 2 showed no association. Fourteen studies investigated the longitudinal association of diabetes with "more sustained" AF types (vs "less sustained") of which 2 showed a positive association and 12 showed no association. In the meta-analysis of cross-sectional studies, patients with AF and diabetes were 1.31-times more likely to have non-paroxysmal AF than those without diabetes [8 studies; pooled OR (95% CI), 1.31 (1.13-1.51), I2 = 82.6%]. The meta-analysis of longitudinal studies showed that for patients with paroxysmal AF, diabetes is associated with 1.32-times increased likelihood of progression to non-paroxysmal AF [five studies; pooled OR (95% CI), 1.32 (1.07-1.62); I2 = 0%]. Conclusions: Our findings suggest that diabetes is associated with an increased likelihood of non-paroxysmal AF rather than paroxysmal AF. However, further high quality studies are needed to replicate these findings, adjust for potential confounders, elucidate mechanisms linking diabetes to non-paroxysmal AF, and assess the impact of antidiabetic medications on AF types. These strategies could eventually help decrease the risk of non-paroxysmal AF among patients with diabetes

Variational techniques for a one-dimensional energy balance model

A one-dimensional climate energy balance model (1D EBM) is a simplified climate model for the zonally averaged global temperature profile, based on the Earth's energy budget. We examine a class of 1D EBMs which emerges as the parabolic equation corresponding to the Euler–Lagrange equations of an associated variational problem, covering spatially inhomogeneous models such as with latitude-dependent albedo. Sufficient conditions are provided for the existence of at least three steady-state solutions in the form of two local minima and one saddle, that is, of coexisting “cold”, “warm” and unstable “intermediate” climates. We also give an interpretation of minimizers as “typical” or “likely” solutions of time-dependent and stochastic 1D EBMs. We then examine connections between the value function, which represents the minimum value (across all temperature profiles) of the objective functional, regarded as a function of greenhouse gas concentration, and the global mean temperature (also as a function of greenhouse gas concentration, i.e. the bifurcation diagram). Specifically, the global mean temperature varies continuously as long as there is a unique minimizing temperature profile, but coexisting minimizers must have different global mean temperatures. Furthermore, global mean temperature is non-decreasing with respect to greenhouse gas concentration, and its jumps must necessarily be upward. Applicability of our findings to more general spatially heterogeneous reaction–diffusion models is also discussed, as are physical interpretations of our results

Liver resection or combined chemoembolization and radiofrequency ablation improve survival in patients with hepatocellular carcinoma

Background/ Aims: To evaluate the long-term outcome of surgical and non-surgical local treatments of patients with hepatocellular carcinoma (HCC). Methods: We stratified a cohort of 278 HCC patients using six independent predictors of survival according to the Vienna survival model for HCC (VISUM- HCC). Results: Prior to therapy, 224 HCC patients presented with VISUM stage 1 (median survival 18 months) while 29 patients were classified as VISUM stage 2 (median survival 4 months) and 25 patients as VISUM stage 3 (median survival 3 months). A highly significant (p < 0.001) improved survival time was observed in VISUM stage 1 patients treated with liver resection ( n = 52; median survival 37 months) or chemoembolization (TACE) and subsequent radiofrequency ablation ( RFA) ( n = 44; median survival 45 months) as compared to patients receiving chemoembolization alone (n = 107; median survival 13 months) or patients treated by tamoxifen only (n = 21; median survival 6 months). Chemoembolization alone significantly (p <= 0.004) improved survival time in VISUM stage 1 - 2 patients but not (p = 0.341) in VISUM stage 3 patients in comparison to those treated by tamoxifen. Conclusion: Both liver resection or combined chemoembolization and RFA improve markedly the survival of patients with HCC

Factors controlling the accelerated expansion of Imja Lake, Mount Everest region, Nepal

This study explores the link between area increase of Imja Tsho (Lake) and changes of Imja Glacier (area ∼25km2) under the influence of climate change using multitemporal satellite imagery and local climate data. Between 1962 and 2013, Imja Lake expanded from 0.03±0.01 to 1.35±0.05 km2 at a rate of 0.026±0.001 km2 a-1. The mean glacier-wide flow velocity was 37±30ma-1 during 1992-93 and 23±15ma-1 during 2013-14, indicating a decreasing velocity. A mean elevation change of -1.29±0.71ma-1 was observed over the lower part of the glacier in the period 2001-14, with a rate of -1.06±0.63ma-1 in 2001-08 and -1.56±0.80ma-1 in 2008-14. We conclude that the decrease in flow velocity is mainly associated with reduced accumulation due to a decrease in precipitation during the last few decades. Furthermore, glacier ablation has increased due to increasing maximum temperatures during the post-monsoon months. Decreased glacier flow velocities and increased mass losses induce the formation and subsequent expansion of glacial lakes under favourable topographic conditions.Publisher PDFPeer reviewe