20 research outputs found
TORSION ENHANCEMENT OF REINFORCED SELF-COMPACTING CONCRETE BOX BEAMS USING INTERNAL FRAMED STEEL STIFFENING RIBS
No full textResearches concerning internal torsional strengthening of box beams are very little, since few researchers may study such method of strengthening. This research adopts employing of internal Framed Steel Stiffening Ribs (FSSRs) to strengthen reinforced Self-Compacting Concrete (SCC) box beams subjected to pure torsion. These FSSRs were fabricated to be fully bonded with SCC through using of bolts as shear connectors. Four specimens (the first was a reference one with no strengthening and the other three were strengthened with one, three and five FSSRs, respectively) of reinforced SCC were tested under effect of pure torsion up to failure. All specimens have the same dimensions and reinforcement. The effect of FSSRs presence and their number on torsional capacity was studied. Also, applied torque-angle of twist relation at end, quarter and mid span were studied. Test results show that the ultimate torsional capacity is increased by 45.7 %, 75.5 %, and 122.4 % for specimens strengthened with one, three and five FSSRs, respectively, as compared with reference specimen. Presence of FSSRs tends to reduce deformations where deformations decrease with increasing of FSSRs number. It is concluded that the torsional capacity of a reinforced SCC box beams can be enhanced using internal Transverse FSSRs. The number of used internal FSSRs have main effect on the amount of enhancement
The flexural response of hybrid beams strengthened with fiber polymer rebars
No full textThe current study aimed to examine the value of applying the hybridization approach to study the flexural behavior of hybrid reinforced concrete beams including two different concrete types: normal strength concrete and reactive powder concrete. In addition, carbon fiber-reinforced polymer bars and glass fiber-reinforced polymer bars were bonded in the tension face of the hybrid RC beams utilizing the near-surface-mounted technique. Eight simply supported reinforced concrete beams were tested. The hybridization technique enhanced the flexural behavior and increased the first crack and ultimate loads. Furthermore, the hybrid beams are stiffer than that of a normal beam, and it became even stiffer as the reactive powder concrete layer thickness increased. The hybrid beams that were strengthened with carbon fiber-reinforced polymer bars displayed higher load capacity by about 20% more than those strengthened with glass fiber-reinforced polymer bars
Efficacy of Plastic Waste Strips Towards Enhancement of Shear Capacity of Reinforced Concrete Beams
No full textThe amount of plastic waste produced worldwide has been steadily rising. Manufacturing processes, service industries, and municipal solid waste produce a significant amount of waste plastic. One common construction and industrial waste that could be employed as shear reinforcement in concrete beams for specified purposes is the plastic waste strips, since they have relatively high tensile strength. Such plastic strips are used to tie clay bricks, floor finishing tiles, walkway finishing blocks, curbstones, and so on in different industrial products. This study examines an approach that uses plastic waste strips in place of conventional stirrups to enhance the shear performance of reinforced concrete (RC) beams. A set of shear tests was performed on carefully constructed 150 mm width × 225 mm depth × 1400 mm length beam specimens to evaluate failure mechanisms, modes of failure, crack patterns, and shear strength. All beams have the same flexural requirements, so they were ensured to fail by exceeding their shear strength under the applied load. This study examined five concrete beams that were reinforced internally using plastic waste strips in the shear region, as well as one control beam. The tested beams were reinforced using various strip spacings and configurations. The results of the tests indicated that increasing the plastic waste strips improved the concrete section shear strength. As the number of plastic strips in the section increases, the distance between each strip is drastically reduced, increasing the shear capacity of the beam. The experimental results indicate that the beam with six vertical plastic waste strips in its section has a 75% higher shear strength capacity than the reference beam without any transverse reinforcement. In addition, shear resistance is higher in the beam with plastic strips at 45° and 135° inclined angles than in the beam with vertical plastic strips in the same amount of plastic strips. Based on these findings, reinforced concrete beams can be utilized for specific purposes by employing plastic waste strips as transverse reinforcement to resist internal shear forces
The role of the accused in English and Islamic criminal justice
No full textThis thesis is a comparative study of the role of the accused in the systems of
English and Islamic criminal justice. It seeks to explore the underlying
relationship between the individual and the state through an historical, structural
and contextual analysis of their rules relating to questioning and of confessions.
The analysis of the English system covers the period 1800 to 1984, with
particular reference to developments during the nineteenth century when the
foundations for the modern English state were established. The analysis of the
Islamic system combines traditionally Islamic and modern methods, assessing the
"Islamisation" movement in Malaysia through a religico-structural understanding
of juristic opinion from the four main schools of Sunnite jurisprudence.
The thesis contributes to existing knowledge on a number of levels: first, it
questions and revises the "myth" of "progress" that has dominated observations
of the history of the English criminal justice system; second, it elucidates the
relationship between Islamic law in theory and the law that is applied and
proposed in its name in Muslim states; third, it provides an analytical framework
for drawing comparisons between the underlying values of the systems of English
and Islamic criminal justice.
While acknowledging fundamental differences in terms of outlook and
articulation, the author concludes there are important similarities expressed
through such notions as "suspect" in the English system and "kafir"I"fasiq" in the
Islamic. These act as intermediate constitutional categories to whom the state
owe less protection. But the author notes also that these similarities are not
observed necessarily in the "law" which is implemented or proposed in Muslim
states; exact correspondence depends upon the over-arching political structure
and the institution of Caliphate.
The thesis is divided into six chapters: chapter one sets out the conventional view
of the historical development of English criminal procedure and evidence;
chapter two subjects that to a critique and chapter three offers a revised thesis.
Chapter four, explores methods for interpreting and explaining Islam; chapter
five sets out rules relating to confessions and questioning according to the four
Sunni schools; chapter six puts them into "context" through an examination of
the "Islamisation" process in Malaysia
Exploring the cost-effectiveness of high versus low perioperative fraction of inspired oxygen in the prevention of surgical site infections among abdominal surgery patients in three low- and middle-income countries
No full textBackground: This study assessed the potential cost-effectiveness of high (80–100%) vs low (21–35%) fraction of inspired oxygen (FiO2) at preventing surgical site infections (SSIs) after abdominal surgery in Nigeria, India, and South Africa. Methods: Decision-analytic models were constructed using best available evidence sourced from unbundled data of an ongoing pilot trial assessing the effectiveness of high FiO2, published literature, and a cost survey in Nigeria, India, and South Africa. Effectiveness was measured as percentage of SSIs at 30 days after surgery, a healthcare perspective was adopted, and costs were reported in US dollars (216 compared with 6 (95% confidence interval [CI]: −1) difference in costs. In India, the average cost for high FiO2 was 195 for low FiO2 leading to a −15 to −1164 compared with 93 (95% CI: −65) difference in costs. The high FiO2 arm had few SSIs, 7.33% compared with 8.38% for low FiO2, leading to a −1.05 (95% CI: −1.14 to −0.90) percentage point reduction in SSIs. Conclusion: High FiO2 could be cost-effective at preventing SSIs in the three countries but further data from large clinical trials are required to confirm this. © 2023 The Author
Global fertility in 204 countries and territories, 1950–2021, with forecasts to 2100 : a comprehensive demographic analysis for the Global Burden of Disease Study 2021
No full textNatalia V Bhattacharjee, Austin E Schumacher, Amirali Aali, Yohannes Habtegiorgis Abate, Rouzbeh Abbasgholizadeh, Mohammadreza Abbasian, Mohsen Abbasi-Kangevari, Hedayat Abbastabar, Samar Abd ElHafeez, Sherief Abd-Elsalam, Mohammad Abdollahi, Mohammad-Amin Abdollahifar, Meriem Abdoun, Auwal Abdullahi, Mesfin Abebe, Samrawit Shawel Abebe, Olumide Abiodun, Hassan Abolhassani, Meysam Abolmaali, Mohamed Abouzid, Girma Beressa Aboye, Lucas Guimarães Abreu, Woldu Aberhe Abrha, Michael R M Abrigo, Dariush Abtahi, Hasan Abualruz, Bilyaminu Abubakar, Eman Abu-Gharbieh, Niveen ME Abu-Rmeileh, Tadele Girum Girum Adal, Mesafint Molla Adane, Oluwafemi Atanda Adeagbo Adeagbo, Rufus Adesoji Adedoyin, Victor Adekanmbi, Bashir Aden, Abiola Victor Adepoju, Olatunji O Adetokunboh, Juliana Bunmi Adetunji, Daniel Adedayo Adeyinka, Olorunsola Israel Adeyomoye, Qorinah Estiningtyas Sakilah Adnani, Saryia Adra, Rotimi Felix Afolabi, Shadi Afyouni, Muhammad Sohail Afzal, Saira Afzal, Shahin Aghamiri, Antonella Agodi, Williams Agyemang-Duah, Bright Opoku Ahinkorah, Austin J Ahlstrom, Aqeel Ahmad, Danish Ahmad, Firdos Ahmad, Muayyad M Ahmad, Sajjad Ahmad, Tauseef Ahmad, Ali Ahmed, Ayman Ahmed, Haroon Ahmed, Luai A Ahmed, Meqdad Saleh Ahmed, Syed Anees Ahmed, Marjan Ajami, Budi Aji, Gizachew Taddesse Akalu, Hossein Akbarialiabad, Rufus Olusola Akinyemi, Mohammed Ahmed Akkaif, Sreelatha Akkala, Hanadi Al Hamad, Syed Mahfuz Al Hasan, Mohammad Al Qadire, Tareq Mohammed Ali AL-Ahdal, Samer O Alalalmeh, Tariq A Alalwan, Ziyad Al-Aly, Khurshid Alam, Rasmieh Mustafa Al-amer, Fahad Mashhour Alanezi, Turki M Alanzi, Almaza Albakri, Mohammed Albashtawy, Mohammad T AlBataineh, Hediyeh Alemi, Sharifullah Alemi, Yihun Mulugeta Alemu, Ayman Al-Eyadhy, Adel Ali Saeed Al-Gheethi, Khalid F Alhabib, Noora Alhajri, Fadwa Alhalaiqa Naji Alhalaiqa, Robert Kaba Alhassan, Abid Ali, Beriwan Abdulqadir Ali, Liaqat Ali, Mohammed Usman Ali, Rafat Ali, Syed Shujait Shujait Ali, Sheikh Mohammad Alif, Mohammad Aligol, Mehran Alijanzadeh, Mohammad A M Aljasir, Syed Mohamed Aljunid, Sabah Al-Marwani, Joseph Uy Almazan, Hesham M Al-Mekhlafi, Omar Almidani, Mahmoud A Alomari, Basem Al-Omari, Jaber S Alqahtani, Ahmed Yaseen Alqutaibi, Rajaa M Al-Raddadi, Salman Khalifah Al-Sabah, Awais Altaf, Jaffar A Al-Tawfiq, Khalid A Altirkawi, Deborah Oyine Aluh, Farrukh Jawad Alvi, Nelson Alvis-Guzman, Hassan Alwafi, Yaser Mohammed Al-Worafi, Hany Aly, Safwat Aly, Karem H Alzoubi, Edward Kwabena Ameyaw, Tarek Tawfik Amin, Alireza Amindarolzarbi, Mostafa Amini-Rarani, Sohrab Amiri, Irene Gyamfuah Ampomah, Dickson A Amugsi, Ganiyu Adeniyi Amusa, Robert Ancuceanu, Deanna Anderlini, Pedro Prata Andrade, Catalina Liliana Andrei, Tudorel Andrei, Abhishek Anil, Sneha Anil, Adnan Ansar, Alireza Ansari-Moghaddam, Catherine M Antony, Ernoiz Antriyandarti, Saeid Anvari, SALEHA ANWAR, Razique Anwer, Anayochukwu Edward Anyasodor, Jalal Arabloo, Razman Arabzadeh Bahri, Elshaimaa A Arafa, Mosab Arafat, Ana Margarida Araújo, Aleksandr Y Aravkin, Abdulfatai Aremu, Timur Aripov, Mesay Arkew, Benedetta Armocida, Johan Ärnlöv, Mahwish Arooj, Anton A Artamonov, Judie Arulappan, Raphael Taiwo Aruleba, Ashokan Arumugam, Mohsen Asadi-Lari, Zatollah Asemi, Saeed Asgary, Mona Asghariahmadabad, Mohammad Asghari-Jafarabadi, Mubarek Yesse Ashemo, Muhammad Ashraf, Tahira Ashraf, Marvellous O Asika, Seyyed Shamsadin Athari, Maha Moh'd Wahbi Atout, Alok Atreya, Avinash Aujayeb, Marcel Ausloos, Abolfazl Avan, Amlaku Mulat Aweke, Getnet Melaku Ayele, Seyed Mohammad Ayyoubzadeh, Sina Azadnajafabad, Rui M S Azevedo, Ahmed Y Azzam, Muhammad Badar, Ashish D Badiye, Soroush Baghdadi, Nasser Bagheri, Sara Bagherieh, Najmeh Bahmanziari, Ruhai Bai, Atif Amin Baig, Jennifer L Baker, Abdulaziz T Bako, Ravleen Kaur Bakshi, Madhan Balasubramanian, Ovidiu Constantin Baltatu, Kiran Bam, Maciej Banach, Soham Bandyopadhyay, Biswajit Banik, Palash Chandra Banik, Hansi Bansal, Mehmet Firat Baran, Martina Barchitta, Mainak Bardhan, Erfan Bardideh, Suzanne Lyn Barker-Collo, Till Winfried Bärnighausen, Francesco Barone-Adesi, Hiba Jawdat Barqawi, Amadou Barrow, Sandra Barteit, Zarrin Basharat, Asma'u I J Bashir, Hameed Akande Bashiru, Afisu Basiru, João Diogo Basso, Sanjay Basu, Abdul-Monim Mohammad Batiha, Kavita Batra, Bernhard T Baune, Mohsen Bayati, Tahmina Begum, Emad Behboudi, Amir Hossein Behnoush, Maryam Beiranvand, Diana Fernanda Bejarano Ramirez, Alehegn Bekele, Sefealem Assefa Belay, Uzma Iqbal Belgaumi, Michelle L Bell, Olorunjuwon Omolaja Bello, Apostolos Beloukas, Isabela M Bensenor, Zombor Berezvai, Alemshet Yirga Berhie, Amiel Nazer C Bermudez, Paulo J G Bettencourt, Akshaya Srikanth Bhagavathula, Nikha Bhardwaj, Pankaj Bhardwaj, Prarthna V Bhardwaj, Sonu Bhaskar, Vivek Bhat, Gurjit Kaur Bhatti, Jasvinder Singh Bhatti, Manpreet S Bhatti, Rajbir Bhatti, Antonio Biondi, Catherine Bisignano, Atanu Biswas, Raaj Kishore Biswas, Veera R Bitra, Tone Bjørge, Elye Bliss, Micheal Kofi Boachie, Anca Vasilica Bobirca, Virginia Bodolica, Aadam Olalekan Bodunrin, Eyob Ketema Bogale, Kassawmar Angaw Bogale, Milad Bonakdar Hashemi, Berrak Bora Basara, Souad Bouaoud, Dejana Braithwaite, Michael Brauer, Nicholas J K Breitborde, Dana Bryazka, Norma B Bulamu, Danilo Buonsenso, Katrin Burkart, Richard A Burns, Yasser Bustanji, Nadeem Shafique Butt, Zahid A Butt, Florentino Luciano Caetano dos Santos, Daniela Calina, Ismael R Campos-Nonato, Fan Cao, Shujin Cao, Angelo Capodici, Giulia Carreras, Andrea Carugno, Carlos A Castañeda-Orjuela, Giulio Castelpietra, Maria Sofia Cattaruzza, Arthur Caye, Luca Cegolon, Francieli Cembranel, Ester Cerin, Joshua Chadwick, Yaacoub Chahine, Chiranjib Chakraborty, Julian Chalek, Jeffrey Shi Kai Chan, Periklis Charalampous, Vijay Kumar Chattu, Sarika Chaturvedi, Malizgani Paul Chavula, An-Tian Chen, Haowei Chen, Simiao Chen, Gerald Chi, Fatemeh Chichagi, Ju-Huei Chien, Patrick R Ching, William C S Cho, Sungchul Choi, Bryan Chong, Hitesh Chopra, Sonali Gajanan Choudhari, Devasahayam J Christopher, Dinh-Toi Chu, Isaac Sunday Chukwu, Eric Chung, Sheng-Chia Chung, Zinhle Cindi, Iolanda Cioffi, Raffaela Ciuffreda, Rafael M Claro, Kaleb Coberly, Alyssa Columbus, Haley Comfort, Joao Conde, Michael H Criqui, Natália Cruz-Martins, Silvia Magali Cuadra-Hernández, Sriharsha Dadana, Omid Dadras, Tukur Dahiru, Zhaoli Dai, Bronte Dalton, Giovanni Damiani, Aso Mohammad Darwesh, Jai K Das, Saswati Das, Mohsen Dashti, Anna Dastiridou, Claudio Alberto Dávila-Cervantes, Kairat Davletov, Aklilu Tamire Debele, Shayom Debopadhaya, Somayeh Delavari, Ivan Delgado-Enciso, Dessalegn Demeke, Berecha Hundessa Demessa, Xinlei Deng, Edgar Denova-Gutiérrez, Kebede Deribe, Nikolaos Dervenis, Hardik Dineshbhai Desai, Rupak Desai, Vinoth Gnana Chellaiyan Devanbu, Arkadeep Dhali, Kuldeep Dhama, Meghnath Dhimal, Vishal R Dhulipala, Diana Dias da Silva, Daniel Diaz, Michael J Diaz, Adriana Dima, Delaney D Ding, M Ashworth Dirac, Thanh Chi Do, Thao Huynh Phuong Do, Camila Bruneli do Prado, Sushil Dohare, Wanyue Dong, Mario D'Oria, Wendel Mombaque dos Santos, Leila Doshmangir, Robert Kokou Dowou, Ashel Chelsea Dsouza, Haneil Larson Dsouza, Viola Dsouza, John Dube, Joe Duprey, Andre Rodrigues Duraes, Senbagam Duraisamy, Oyewole Christopher Durojaiye, Sulagna Dutta, Laura Dwyer-Lindgren, Paulina Agnieszka Dzianach, Arkadiusz Marian Dziedzic, Alireza Ebrahimi, Hisham Atan Edinur, Kristina Edvardsson, Ferry Efendi, Terje Andreas Eikemo, Michael Ekholuenetale, Maha El Tantawi, Noha Mousaad Elemam, Ghada Metwally Tawfik ElGohary, Muhammed Elhadi, Legesse Tesfaye Elilo, Omar Abdelsadek Abdou Elmeligy, Mohamed A Elmonem, Mohammed Elshaer, Ibrahim Elsohaby, Amir Emami Zeydi, Luchuo Engelbert Bain, Sharareh Eskandarieh, Francesco Esposito, Kara Estep, Farshid Etaee, Natalia Fabin, Adeniyi Francis Fagbamigbe, Saman Fahimi, Aliasghar Fakhri-Demeshghieh, Luca Falzone, Ali Faramarzi, MoezAlIslam Ezzat Mahmoud Faris, Sam Farmer, Andre Faro, Abidemi Omolara Fasanmi, Ali Fatehizadeh, Nelsensius Klau Fauk, Pooria Fazeli, Valery L Feigin, Seyed-Mohammad Fereshtehnejad, Abdullah Hamid Feroze, Pietro Ferrara, Nuno Ferreira, Getahun Fetensa, Irina Filip, Florian Fischer, Joanne Flavel, Nataliya A Foigt, Morenike Oluwatoyin Folayan, Artem Alekseevich Fomenkov, Behzad Foroutan, Matteo Foschi, Kayode Raphael Fowobaje, Kate Louise Francis, Alberto Freitas, Takeshi Fukumoto, John E Fuller, Blima Fux, Peter Andras Gaal, Muktar A Gadanya, Abhay Motiramji Gaidhane, Yaseen Galali, Silvano Gallus, Aravind P Gandhi, Balasankar Ganesan, Mohammad Arfat Ganiyani, M.A. Garcia-Gordillo, Naval Garg, Rupesh K Gautam, Federica Gazzelloni, Semiu Olatunde Gbadamosi, Miglas W Gebregergis, Mesfin Gebrehiwot, Tesfay Brhane Gebremariam, Tesfay B B Gebremariam, Teferi Gebru Gebremeskel, Yohannes Fikadu Geda, Simona Roxana Georgescu, Urge Gerema, Habtamu Geremew, Motuma Erena Getachew, Peter W Gething, MohammadReza Ghasemi, Ghazal Ghasempour Dabaghi, Afsaneh Ghasemzadeh, Fariba Ghassemi, Ramy Mohamed Ghazy, Sailaja Ghimire, Asadollah Gholamian, Ali Gholamrezanezhad, Mahsa Ghorbani, Aloke Gopal Ghoshal, Arun Digambarrao Ghuge, Artyom Urievich Gil, Tiffany K Gill, Matteo Giorgi, Alem Girmay, James C Glasbey, Laszlo Göbölös, Amit Goel, Ali Golchin, Mahaveer Golechha, Pouya Goleij, Sameer Vali Gopalani, Houman Goudarzi, Alessandra C Goulart, Anmol Goyal, Simon Matthew Graham, Michal Grivna, Shi-Yang Guan, Giovanni Guarducci, Mohammed Ibrahim Mohialdeen Gubari, Mesay Dechasa Gudeta, Stefano Guicciardi, Snigdha Gulati, David Gulisashvili, Damitha Asanga Gunawardane, Cui Guo, Anish Kumar Gupta, Bhawna Gupta, Manoj Kumar Gupta, Mohak Gupta, Sapna Gupta, Veer Bala Gupta, Vijai Kumar Gupta, Vivek Kumar Gupta, Annie Haakenstad, Farrokh Habibzadeh, Najah R Hadi, Nils Haep, Ramtin Hajibeygi, Sebastian Haller, Rabih Halwani, Randah R Hamadeh, Nadia M Hamdy, Sajid Hameed, Samer Hamidi, Qiuxia Han, Alexis J Handal, Graeme J Hankey, Md Nuruzzaman Haque, Josep Maria Haro, Ahmed I Hasaballah, Ikramul Hasan, Mohammad Jahid Hasan, S.M. Mahmudul Hasan, Hamidreza Hasani, Md Saquib Hasnain, Amr Hassan, Ikrama Hassan, Soheil Hassanipour, Hadi Hassankhani, Simon I Hay, Jeffrey J Hebert, Omar E Hegazi, Mohammad Heidari, Bartosz Helfer, Mehdi Hemmati, Brenda Yuliana Herrera-Serna, Claudiu Herteliu, Kamran Hessami, Kamal Hezam, Yuta Hiraike, Nguyen Quoc Hoan, Ramesh Holla, Nobuyuki Horita, Md Mahbub Hossain, Mohammad Bellal Hossain Hossain, Hassan Hosseinzadeh, Mehdi Hosseinzadeh, Mihaela Hostiuc, Sorin Hostiuc, Mohamed Hsairi, Vivian Chia-rong Hsieh, Chengxi Hu, Junjie Huang, M Mamun Huda, Ayesha Humayun, Javid Hussain, Nawfal R Hussein, Hong-Han Huynh, Bing-Fang Hwang, Segun Emmanuel Ibitoye, Pulwasha Maria Iftikhar, Olayinka Stephen Ilesanmi, Irena M Ilic, Milena D Ilic, Mustapha Immurana, Leeberk Raja Inbaraj, Afrin Iqbal, Md. Rabiul Islam, Nahlah Elkudssiah Ismail, Hiroyasu Iso, Gaetano Isola, Masao Iwagami, Mahalaxmi Iyer, Linda Merin J, Jalil Jaafari, Louis Jacob, Farhad Jadidi-Niaragh, Khushleen Jaggi, Kasra Jahankhani, Nader Jahanmehr, Haitham Jahrami, Akhil Jain, Nityanand Jain, Ammar Abdulrahman Jairoun, Mihajlo Jakovljevic, Elham Jamshidi, Sabzali Javadov, Tahereh Javaheri, Sathish Kumar Jayapal, Shubha Jayaram, Sun Ha Jee, Jayakumar Jeganathan, Anil K Jha, Ravi Prakash Jha, Heng Jiang, Mohammad Jokar, Jost B Jonas, Tamas Joo, Nitin Joseph, Charity Ehimwenma Joshua, Farahnaz Joukar, Jacek Jerzy Jozwiak, Mikk Jürisson, Vaishali K, Billingsley Kaambwa, Abdulkareem Kabir, Ali Kabir, Hannaneh Kabir, Zubair Kabir, Rizwan Kalani, Leila R Kalankesh, Feroze Kaliyadan, Sanjay Kalra, Rajesh Kamath, Sagarika Kamath, Tanuj Kanchan, Edmund Wedam Kanmiki, Kehinde Kazeem Kanmodi, Suthanthira Kannan S, Sushil Kumar Kansal, Rami S Kantar, Neeti Kapoor, Mehrdad Karajizadeh, Manoochehr Karami, Ibraheem M Karaye, Faizan Zaffar Kashoo, Hengameh Kasraei, Nicholas J Kassebaum, Molly B Kassel, Joonas H Kauppila, Foad Kazemi, sara Kazeminia, John H Kempen, Evie Shoshannah Kendal, Kamyab Keshtkar, Mohammad Keykhaei, Himanshu Khajuria, Amirmohammad Khalaji, Nauman Khalid, Anees Ahmed Khalil, Alireza Khalilian, Faham Khamesipour, Ajmal Khan, Asaduzzaman Khan, Ikramullah Khan, M Nuruzzaman Khan, Maseer Khan, Mohammad Jobair Khan, Moien AB Khan, Young-Ho Khang, Shaghayegh Khanmohammadi, Khaled Khatab, Armin Khavandegar, Hamid Reza Khayat Kashani, Feriha Fatima Khidri, Moein Khormali, Mohammad Ali Khosravi, Mahmood Khosrowjerdi, Wondwosen Teklesilasie Kidane, Zemene Demelash Kifle, Julie Sojin Kim, Min Seo Kim, Ruth W Kimokoti, Kasey E Kinzel, Girmay Tsegay Kiross, Adnan Kisa, Sezer Kisa, Ali-Asghar Kolahi, Farzad Kompani, Gerbrand Koren, Oleksii Korzh, Soewarta Kosen, Sindhura Lakshmi Koulmane Laxminarayana, Kewal Krishan, Varun Krishna, Vijay Krishnamoorthy, Barthelemy Kuate Defo, Connor M Kubeisy, Burcu Kucuk Bicer, Md Abdul Kuddus, Mohammed Kuddus, Ilari Kuitunen, Mukhtar Kulimbet, Harish Kumar, Satyajit Kundu, Kunle Rotimi Kunle, Om P Kurmi, Asep Kusnali, Dian Kusuma, Evans F Kyei, Ilias Kyriopoulos, Carlo La Vecchia, Ben Lacey, Muhammad Awwal Ladan, Lucie Laflamme, Chandrakant Lahariya, Daphne Teck Ching Lai, Dharmesh Kumar Lal, Ratilal Lalloo, Judit Lám, Demetris Lamnisos, Iván Landires, Francesco Lanfranchi, Berthold Langguth, Ariane Laplante-Lévesque, Heidi Jane Larson, Anders O Larsson, Savita Lasrado, Kamaluddin Latief, Kaveh Latifinaibin, Long Khanh Dao Le, Nhi Huu Hanh Le, Trang Diep Thanh Le, Caterina Ledda, Munjae Lee, Paul H Lee, Seung Won Lee, Yo Han Lee, Gebretsadik Kiros Lema, Elvynna Leong, Temesgen L Lerango, An Li, Ming-Chieh Li, Shanshan Li, Wei Li, Xiaopan Li, Virendra S Ligade, Stephen S Lim, Ro-Ting Lin, Paulina A Lindstedt, Stefan Listl, Gang Liu, Jue Liu, Xiaofeng Liu, Xuefeng Liu, Yuewei Liu, Erand Llanaj, Rubén López-Bueno, Platon D Lopukhov, László Lorenzovici, Paulo A Lotufo, Jailos Lubinda, Giancarlo Lucchetti, Alessandra Lugo, Raimundas Lunevicius, Hengliang Lv, Zheng Feei Ma, Kelsey Lynn Maass, Monika Machoy, Áurea M Madureira-Carvalho, Mohammed Magdy Abd El Razek, Azzam A Maghazachi, Soleiman Mahjoub, Mansour Adam Mahmoud, Azeem Majeed, Jeadran N Malagón-Rojas, Elaheh Malakan Rad, Kashish Malhotra, Ahmad Azam Malik, Iram Malik, Deborah Carvalho Malta, Abdullah A Mamun, Yosef Manla, Yasaman Mansoori, Ali Mansour, Borhan Mansouri, Zeinab Mansouri, Mohammad Ali Mansournia, Joemer C Maravilla, Mirko Marino, Abdoljalal Marjani, Gabriel Martinez, Ramon Martinez-Piedra, Francisco Rogerlândio Martins-Melo, Miquel Martorell, Sharmeen Maryam, Roy Rillera Marzo, Alireza Masoudi, Jishanth Mattumpuram, Richard James Maude, Andrea Maugeri, Erin A May, Mahsa Mayeli, Maryam Mazaheri, John J McGrath, Martin McKee, Anna Laura Wensel McKowen, Susan A McLaughlin, Steven M McPhail, Rahul Mehra, Kamran Mehrabani-Zeinabad, Entezar Mehrabi Nasab, Tesfahun Mekene Meto, Max Alberto Mendez Mendez-Lopez, Walter Mendoza, Ritesh G Menezes, George A Mensah, Alexios-Fotios A Mentis, Sultan Ayoub Meo, Mohsen Merati, Atte Meretoja, Tuomo J Meretoja, Abera M Mersha, Tomislav Mestrovic, Pouya Metanat, Kukulege Chamila Dinushi Mettananda, Sachith Mettananda, Adquate Mhlanga, Laurette Mhlanga, Tianyue Mi, Tomasz Miazgowski, Georgia Micha, Irmina Maria Michalek, Ted R Miller, Le Huu Nhat Minh, Mojgan Mirghafourvand, Erkin M Mirrakhimov, Mizan Kiros Mirutse, Moonis Mirza, Roya Mirzaei, Ashim Mishra, Sanjeev Misra, Philip B Mitchell, Chaitanya Mittal, Babak Moazen, Abdalla Z Mohamed, Ahmed Ismail Mohamed, Jama Mohamed, Mouhand F H Mohamed, Nouh Saad Mohamed, Sakineh Mohammad-Alizadeh-Charandabi, Soheil Mohammadi, Abdollah Mohammadian-Hafshejani, Mustapha Mohammed, Salahuddin Mohammed, Shafiu Mohammed, Ali H Mokdad, Peyman Mokhtarzadehazar, Hossein Molavi Vardanjani, Sabrina Molinaro, Lorenzo Monasta, Mohammad Ali Moni, Maryam Moradi, Yousef Moradi, 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Burden of disease scenarios for 204 countries and territories, 2022–2050: a forecasting analysis for the Global Burden of Disease Study 2021
No full textFunding: Bill & Melinda Gates Foundation.Peer ReviewedArticle signat per 1420 autors/es. Membres del GBD 2021 Forecasting Collaborators:
Stein Emil Vollset*, Hazim S Ababneh, Yohannes Habtegiorgis Abate, Cristiana Abbafati, Rouzbeh Abbasgholizadeh, Mohammadreza Abbasian, Hedayat Abbastabar, Abdallah H A Abd Al Magied, Samar Abd ElHafeez, Atef Abdelkader, Michael Abdelmasseh, Sherief Abd-Elsalam, Parsa Abdi, Mohammad Abdollahi, Meriem Abdoun, Auwal Abdullahi, Mesfin Abebe, Olumide Abiodun, Richard Gyan Aboagye, Hassan Abolhassani, Mohamed Abouzid, Girma Beressa Aboye, Lucas Guimarães Abreu, Abdorrahim Absalan, Hasan Abualruz, Bilyaminu Abubakar, Hana Jihad Jihad Abukhadijah, Giovanni Addolorato, Victor Adekanmbi, Charles Oluwaseun Adetunji, Juliana Bunmi Adetunji, Temitayo Esther Adeyeoluwa, Rishan Adha, Ripon Kumar Adhikary, Qorinah Estiningtyas Sakilah Adnani, Leticia Akua Adzigbli, Fatemeh Afrashteh, Muhammad Sohail Afzal, Saira Afzal, Faith Agbozo, Antonella Agodi, Anurag Agrawal, Williams Agyemang-Duah, Bright Opoku Ahinkorah, Austin J Ahlstrom, Aqeel Ahmad, Firdos Ahmad, Muayyad M Ahmad, Sajjad Ahmad, Shahzaib 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Rabiul Islam, Sheikh Mohammed Shariful Islam, Faisal Ismail, Nahlah Elkudssiah Ismail, Gaetano Isola, Masao Iwagami, Ihoghosa Osamuyi Iyamu, Louis Jacob, Kathryn H Jacobsen, Morteza Jafarinia, Kasra Jahankhani, Nader Jahanmehr, Nityanand Jain, Ammar Abdulrahman Jairoun, Dr Ruchi Jakhmola Mani, Safayet Jamil, Roland Dominic G Jamora, Abubakar Ibrahim Jatau, Sabzali Javadov, Tahereh Javaheri, Shubha Jayaram, Sun Ha Jee, Jayakumar Jeganathan, Heng Jiang, Mohammad Jokar, Jost B Jonas, Nitin Joseph, Charity Ehimwenma Joshua, Mikk Jürisson, Vaishali K, Ali Kabir, Zubair Kabir, Vidya Kadashetti, Laleh R Kalankesh, Sanjay Kalra, Ashwin Kamath, Rajesh Kamath, Arun Kamireddy, Mona Kanaan, Tanuj Kanchan, Edmund Wedam Kanmiki, Kehinde Kazeem Kanmodi, Sushil Kumar Kansal, Asima Karim, Samad Karkhah, Faizan Zaffar Kashoo, Hengameh Kasraei, Molly B Kassel, Srinivasa Vittal Katikireddi, Joonas H Kauppila, Harkiran Kaur, Gbenga A Kayode, Foad Kazemi, Sina Kazemian, Fassikaw Kebede, Evie Shoshannah Kendal, Emmanuelle Kesse-Guyot, Shahram Khademvatan, Himanshu Khajuria, Amirmohammad Khalaji, Asaad Khalid, Nauman Khalid, Alireza Khalilian, Faham Khamesipour, Fayaz Khan, Mohammad Jobair Khan, Moien AB Khan, Shaghayegh Khanmohammadi, Khaled Khatab, Haitham Khatatbeh, Moawiah Mohammad Khatatbeh, Mahalaqua Nazli Khatib, Hamid Reza Khayat Kashani, Khalid A Kheirallah, Manoj Khokhar, Moein Khormali, Zahra Khorrami, Atulya Aman Khosla, Majid Khosravi, Mahmood Khosrowjerdi, Jagdish Khubchandani, Zemene Demelash Kifle, Grace Kim, Julie Sojin Kim, Min Seo Kim, Yun Jin Kim, Ruth W Kimokoti, Adnan Kisa, Sezer Kisa, Luke D Knibbs, Ann Kristin Skrindo Knudsen, Sonali Kochhar, Ali-Asghar Kolahi, Farzad Kompani, Gerbrand Koren, Oleksii Korzh, Kewal Krishan, Varun Krishna, Vijay Krishnamoorthy, Burcu Kucuk Bicer, Md Abdul Kuddus, Mohammed Kuddus, Ilari Kuitunen, Omar Kujan, Mukhtar Kulimbet, Vishnutheertha Kulkarni, G Anil Kumar, Harish Kumar, Nithin Kumar, Rakesh Kumar, Vijay Kumar, Amartya Kundu, Dian Kusuma, Frank Kyei-Arthur, Ville Kytö, Hmwe Hmwe Kyu, Carlo La Vecchia, Ben Lacey, Muhammad Awwal Ladan, Lucie Laflamme, Chandrakant Lahariya, Daphne Teck Ching Lai, Ratilal Lalloo, Tea Lallukka, Judit Lám, Qing Lan, Tuo Lan, Iván Landires, Francesco Lanfranchi, Berthold Langguth, Van Charles Lansingh, Ariane Laplante-Lévesque, Bagher Larijani, Anders O Larsson, Savita Lasrado, Paolo Lauriola, Hilary R Lawlor, Huu-Hoai Le, Long Khanh Dao Le, Nhi Huu Hanh Le, Thao Thi Thu Le, Trang Diep Thanh Le, Janet L Leasher, Doo Woong Lee, Munjae Lee, Paul H Lee, Sang-woong Lee, Seung Won Lee, Shaun Wen Huey Lee, Yo Han Lee, James Leigh, Elvynna Leong, Ming-Chieh Li, Massimo Libra, Virendra S Ligade, Lee-Ling Lim, Stephen S Lim, Liknaw Workie Limenh, Daniel Lindholm, Paulina A Lindstedt, Stefan Listl, Gang Liu, Shiwei Liu, Shuke Liu, Xiaofeng Liu, Xuefeng Liu, Erand Llanaj, Rubén López-Bueno, José Francisco López-Gil, Arianna Maever Loreche, Paulo A Lotufo, Rafael Lozano, Jailos Lubinda, Giancarlo Lucchetti, Lisha Luo, Jay B Lusk, Lei Lv, Hawraz Ibrahim M Amin, Zheng Feei Ma, Kelsey Lynn Maass, Nikolaos Machairas, Monika Machoy, Áurea M Madureira-Carvalho, Hassan Magdy Abd El Razek, Azzam A Maghazachi, D. R. Mahadeshwara Prasad, Mehrdad Mahalleh, Phetole Walter Mahasha, Mansour Adam Mahmoud, Elham Mahmoudi, Golnaz Mahmoudvand, Maureen Makama, Elaheh Malakan Rad, Kashish Malhotra, Ahmad Azam Malik, Deborah Carvalho Malta, Yosef Manla, Ali Mansour, Mohammad Hadi Mansouri, Pejman Mansouri, Vahid Mansouri, Marjan Mansourian, Mohammad Ali Mansournia, Bishnu P Marasini, Hamid Reza Marateb, Joemer C Maravilla, Parham Mardi, Abdoljalal Marjani, Hamed Markazi Moghadam, Carlos Alberto Marrugo Arnedo, Gabriel Martinez, Ramon Martinez-Piedra, Francisco Rogerlândio Martins-Melo, Miquel Martorell, Wolfgang Marx, Roy Rillera Marzo, Sahar Masoudi, Yasith Mathangasinghe, Alexander G Mathioudakis, Medha Mathur, Navgeet Mathur, Neeta Mathur, Fernanda Penido Matozinhos, Jishanth Mattumpuram, Richard James Maude, Andrea Maugeri, Mahsa Mayeli, Mohsen Mazidi, Antonio Mazzotti, John J McGrath, Martin McKee, Anna Laura W McKowen, Michael A McPhail, Steven M McPhail, Asim Mehmood, Kamran Mehrabani-Zeinabad, Sepideh Mehravar, Tesfahun Mekene Meto, Endalkachew Belayneh Melese, Max Alberto Mendez Mendez-Lopez, Walter Mendoza, Ritesh G Menezes, George A Mensah, Laverne G Mensah, Alexios-Fotios A Mentis, Sultan Ayoub Meo, Atte Meretoja, Tuomo J Meretoja, Abera M Mersha, Tomislav Mestrovic, Kukulege Chamila Dinushi Mettananda, Sachith Mettananda, Adquate Mhlanga, Laurette Mhlanga, Tomasz Miazgowski, Irmina Maria Michalek, Ana Carolina Micheletti Gomide Nogueira de Sá, Ted R Miller, Le Huu Nhat Minh, Alireza Mirahmadi, Antonio Mirijello, Erkin M Mirrakhimov, Roya Mirzaei, Philip B Mitchell, Chaitanya Mittal, Madeline E Moberg, Atousa Moghadam Fard, Seyedehfatemeh Mohajelin, Ashraf Mohamadkhani, Ahmed Ismail Mohamed, Jama Mohamed, Mouhand F H Mohamed, Nouh Saad Mohamed, Ameen Mosa Mohammad, Soheil Mohammadi, Hussen Mohammed, Mustapha Mohammed, Shafiu Mohammed, Ali H Mokdad, Mariam Molokhia, Shaher Mohammad Momani, Sara Momtazmanesh, Lorenzo Monasta, Stefania Mondello, Mohammad Ali Moni, Fateme Montazeri, AmirAli Moodi Ghalibaf, Maryam Moradi, Yousef Moradi, Paula Moraga, Lidia Morawska, Rafael Silveira Moreira, Negar Morovatdar, Shane Douglas Morrison, Abbas Mosapour, Jonathan F Mosser, Elias Mossialos, Rohith Motappa, Vincent Mougin, Parsa Mousavi, Matías Mrejen, Sumaira Mubarik, Ulrich Otto Mueller, Francesk Mulita, Kavita Munjal, Efrén Murillo-Zamora, Khaled M Musallam, Ana-Maria Musina, Ghulam Mustafa, Woojae Myung, Ayoub Nafei, Ahamarshan Jayaraman Nagarajan, Pirouz Naghavi, Ganesh R Naik, Gurudatta Naik, Firzan Nainu, Soroush Najdaghi, Noureddin Nakhostin Ansari, Vinay Nangia, Sreenivas Narasimha Swamy, Shumaila Nargus, Delaram Narimani Davani, Bruno Ramos Nascimento, Gustavo G Nascimento, Abdallah Y Naser, Abdulqadir J Nashwan, Zuhair S Natto, Javaid Nauman, Samidi N K Navaratna, Muhammad Naveed, Nawsherwan , Biswa Prakash Nayak, Vinod C Nayak, Hadush Negash, Ionut Negoi, Ruxandra Irina Negoi, Seyed Aria Nejadghaderi, Chakib Nejjari, Soroush Nematollahi, Henok Biresaw Netsere, Marie Ng, Georges Nguefack-Tsague, Josephine W Ngunjiri, Anh Hoang Nguyen, Dang H Nguyen, Duc Hoang Nguyen, Hau Thi Hien Nguyen, Nhan Nguyen, Nhien Ngoc Y Nguyen, Phat Tuan Nguyen, QuynhAnh P Nguyen, Van Thanh Nguyen, Duc Nguyen Tran Minh, Robina Khan Niazi, Yeshambel T Nigatu, Mahdieh Niknam, Ali Nikoobar, Amin Reza Nikpoor, Nasrin Nikravangolsefid, Efaq Ali Noman, Shuhei Nomura, Syed Toukir Ahmed Noor, Nafise Noroozi, Mehran Nouri, Majid Nozari, Chisom Adaobi Nri-Ezedi, George Ntaios, Mengistu H Nunemo, Dieta Nurrika, Jerry John Nutor, Chimezie Igwegbe Nzoputam, Ogochukwu Janet Nzoputam, Bogdan Oancea, Kehinde O Obamiro, Ismail A Odetokun, Michael Safo Oduro, Oluwaseun Adeolu Ogundijo, Adesola Adenike Ogunfowokan, Abiola Ogunkoya, Ayodipupo Sikiru Oguntade, In-Hwan Oh, Tolulope R Ojo-Akosile, Hassan Okati-Aliabad, Akinkunmi Paul Okekunle, Osaretin Christabel Okonji, Andrew T Olagunju, Matthew Idowu Olatubi, Gláucia Maria Moraes Oliveira, Bolajoko Olubukunola Olusanya, Jacob Olusegun Olusanya, Yinka Doris Oluwafemi, Hany A Omar, Goran Latif Omer, Sokking Ong, Sandersan Onie, Obinna E Onwujekwe, Abdulahi Opejin Opejin, Michal Ordak, Verner N Orish, Alberto Ortiz, Esteban Ortiz-Prado, Wael M S Osman, Sergej M Ostojic, Samuel M Ostroff, Uchechukwu Levi Osuagwu, Adrian Otoiu, Stanislav S Otstavnov, Amel Ouyahia, Mayowa O Owolabi, Oyetunde T Oyeyemi, Ahmad Ozair, Mahesh Padukudru P A, Alicia Padron-Monedero, Jagadish Rao Padubidri, Pramod Kumar Pal, Tamás Palicz, Feng Pan, Hai-Feng Pan, Songhomitra Panda-Jonas, Anamika Pandey, Victoria Pando-Robles, Helena Ullyartha Pangaribuan, Georgios D Panos, Leonidas D Panos, Ioannis Pantazopoulos, Anca Mihaela Pantea Stoian, Romil R Parikh, Eun-Kee Park, Seoyeon Park, Sungchul Park, Nicholas Parsons, Ashwaghosha Parthasarathi, Maja Pasovic, Roberto Passera, Jay Patel, Aslam Ramjan Pathan, Shankargouda Patil, Dimitrios Patoulias, Shrikant Pawar, Hamidreza Pazoki Toroudi, Spencer A Pease, Amy E Peden, Paolo Pedersini, Umberto Pensato, Veincent Christian Filipino Pepito, Prince Peprah, Marcos Pereira, Maria Odete Pereira, Arokiasamy Perianayagam, Norberto Perico, Simone Perna, Konrad Pesudovs, Fanny Emily Petermann-Rocha, Hoang Tran Pham, Anil K Philip, Michael R Phillips, Manon Pigeolet, Michael A Piradov, Enrico Pisoni, Evgenii Plotnikov, Dimitri Poddighe, Roman V Polibin, Ramesh Poluru, Ville T Ponkilainen, Djordje S Popovic, Maarten J Postma, Ahmad Pour-Rashidi, Disha Prabhu, Sergio I Prada, Jalandhar Pradhan, Pranil Man Singh Pradhan, Akila Prashant, Elton Junio Sady Prates, Tina Priscilla, Hery Purnobasuki, Bharathi M Purohit, Jagadeesh Puvvula, Nameer Hashim Qasim, Ibrahim Qattea, Asma Saleem Qazi, Gangzhen Qian, Mehrdad Rabiee Rad, Venkatraman Radhakrishnan, Hadi Raeisi Shahraki, Quinn Rafferty, Alberto Raggi, Cat Raggi, Nasiru Raheem, Fakher Rahim, Md Jillur Rahim, Sarvenaz Rahimibarghani, Md Mijanur Mijanur Rahman Rahman, Mosiur Rahman, Muhammad Aziz Rahman, Tafhimur Rahman, Amir Masoud Rahmani, Mohammad Rahmanian, Nazanin Rahmanian, Rahem Rahmati, Setyaningrum Rahmawaty, Diego Raimondo, Adarsh Raja, Prashant Rajput, Majed Ramadan, Shakthi Kumaran Ramasamy, Sheena Ramazanu, Pramod W Ramteke, Kritika Rana, Rishabh Kumar Rana, Chhabi Lal Ranabhat, Amey Rane, Chythra R Rao, Mithun Rao, Davide Rasella, Vahid Rashedi, Ahmed Mustafa Rashid, Ashkan Rasouli-Saravani, Prateek Rastogi, Azad Rasul, Devarajan Rathish, Giridhara Rathnaiah Babu, Santosh Kumar Rauniyar, Ramin Ravangard, David Laith Rawaf, Salman Rawaf, Rabail Zehra Raza, Elrashdy Moustafa Mohamed Redwan, Lennart Reifels, Marissa B Reitsma, Giuseppe Remuzzi, Kannan RR Rengasamy, Bhageerathy Reshmi, Serge Resnikoff, Stefano Restaino, Luis Felipe Reyes, Nazila Rezaei, Negar Rezaei, Zahra Sadat Rezaei, Mohsen Rezaeian, Taeho Gregory Rhee, Jennifer Rickard, Toshana Robalik, Hannah Elizabeth Robinson-Oden, Hermano Alexandre Lima Rocha, Mónica Rodrigues, Jefferson Antonio Buendia Rodriguez, Leonardo Roever, Debby Syahru Romadlon, Luca Ronfani, Moustaq Karim Khan Rony, Gholamreza Roshandel, Kunle Rotimi, Himanshu Sekhar Rout, Bedanta Roy, Enrico Rubagotti, Guilherme de Andrade Ruela, Susan Fred Rumisha, Tilleye Runghien, Michele Russo, Aly M A Saad, Korosh Saber, Maha Mohamed Saber-Ayad, Cameron John Sabet, Siamak Sabour, Perminder S Sachdev, Adam Saddler, Bashdar Abuzed Sadee, Masoumeh Sadeghi, Mohammad Reza Saeb, Umar Saeed, Sher Zaman Safi, Rajesh Sagar, Alireza Saghafi, Dominic Sagoe, Amirhossein Sahebkar, Pragyan Monalisa Sahoo, Mirza Rizwan Sajid, Nasir Salam, Payman Salamati, Afeez Abolarinwa Salami, Mohamed A Saleh, Leili Salehi, Marwa Rashad Salem, Aanuoluwa James Salemcity, Sohrab Salimi, Hossein Samadi Kafil, Saad Samargandy, Yoseph Leonardo Samodra, Abdallah M Samy, Juan Sanabria, Francesca Sanna, Milena M Santric-Milicevic, Bruno Piassi Sao Jose, Sivan Yegnanarayana Iyer Saraswathy, Aswini Saravanan, Rodrigo Sarmiento-Suárez, Gargi Sachin Sarode, Sachin C Sarode, Benn Sartorius, Maheswar Satpathy, Abu Sayeed, Nikolaos Scarmeas, Benedikt Michael Schaarschmidt, Christophe Schinckus, Art Schuermans, Austin E Schumacher, Aletta Elisabeth Schutte, David C Schwebel, Falk Schwendicke, Siddharthan Selvaraj, Mohammad H Semreen, Sabyasachi Senapati, Pallav Sengupta, Subramanian Senthilkumaran, Dragos Serban, Yashendra Sethi, All
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The burden of bacterial antimicrobial resistance in the WHO Eastern Mediterranean Region 1990–2021: a cross-country systematic analysis with forecasts to 2050
No full textBackgroundAntimicrobial resistance (AMR) is an urgent global crisis and one of the world's most complex challenges. Although there is increasing evidence of its impact on human mortality and morbidity, precise burden estimation has many challenges, and thus far has been elusive for the Eastern Mediterranean Region. Here, we present a comprehensive time-trend analysis of regional and country-level AMR burden estimates in the WHO Eastern Mediterranean Region (EMR), between 1990 and 2021, with forecasts up to 2050. MethodsWe estimated deaths and disability-adjusted life-years (DALYs) attributable to and associated with AMR for 11 infectious syndromes, 22 bacterial pathogens, and 84 pathogen–drug combinations for the WHO EMR and each of its countries from 1990 to 2021. Data were obtained from mortality registries, surveillance systems, hospital records, systematic literature reviews, and other sources. We based our modelling approach on five broad components: the number of deaths in which infection had a role, the proportion of infectious deaths attributable to a given infectious syndrome, the proportion of infectious syndrome deaths attributable to a given pathogen, the percentage of a given pathogen resistant to an antimicrobial drug of interest, and the excess risk of mortality (or duration of an infection) associated with this resistance. These components were then used to estimate the disease burden by using two counterfactual scenarios: deaths and DALYs attributable to AMR (considering an alternative scenario where drug-resistant infections are replaced with susceptible infections), and deaths and DALYs associated with AMR (considering an alternative scenario where infections would not occur at all). Predictive statistical modelling was applied to generate estimates of AMR burden for each country. We also generated AMR burden forecasts up to 2050. We generated 95% uncertainty intervals (UIs) for the final estimates by taking the 2·5th and 97·5th percentiles across 500 draws through the multistage computational pipeline, and models were cross-validated for out-of-sample predictive validity. FindingsWe estimated 380 000 deaths (95% UI 332 000–426 000) associated with bacterial AMR and 92 800 deaths (78 300–111 000) attributable to bacterial AMR in the EMR in 2021. In the past 31 years, there was considerable variation in AMR mortality trends across countries of the region and different age groups. Between 1990 and 2021, associated deaths among children younger than 5 years decreased by 50·0% (38·2–62·0), while those among adults aged 70 and older rose by over 85·7% (95% UI 57·0–115·7). Six pathogens were identified as the primary generators of burden: Streptococcus pneumoniae, Klebsiella pneumoniae, Escherichia coli, Staphylococcus aureus, Acinetobacter baumannii, and Pseudomonas aeruginosa. A substantial increase in the AMR burden due to S aureus was observed between 1990 (28 200 deaths [21 600–34 000]) and 2021 (49 500 deaths [43 100–56 200]); consequently, in 2021, methicillin-resistant S aureus was a leading pathogen–drug combination for most countries in the region for deaths and DALYs attributable to, and associated with AMR. Somalia had the highest age-standardised mortality rates in the region: for deaths attributable to and associated with AMR per 100 000 population in both 1990 and 2021; conversely, the country with the lowest burden in the EMR was Qatar. By 2050, the number of deaths attributable to AMR in region is forecasted to reach 187 000 (157 000–223 000) and deaths associated with AMR were projected to reach 752 000 (629 000–879 000). InterpretationOur study shows that bacterial AMR has been a serious public health threat in the EMR for more than 30 years, with a substantial fatal and non-fatal burden for priority bacterial pathogens and pathogen–drug combinations. The magnitude of this issue, future projects, and the inadequate response capacity in many countries underscore the need for more stringent regional leadership in this field. The insights gained from this study can direct targeted mitigation strategies for individual countries within the region, aiding in resource allocation and funding decisions, and emphasising the need for collaborative multisectoral endeavours among nations to address this issue. FundingWellcome Trust, and the UK Department of Health and Social Care using aid funding managed by the Fleming Fund.
This work was supported by the Wellcome Trust (A126042) and the UK Department of Health and Social Care using UK aid funding managed by the Fleming Fund (R52354 CN001)
Global, regional, and national sepsis incidence and mortality, 1990–2021: a systematic analysis
No full textBACKGROUND: The global burden of sepsis, a life-threatening dysregulated host response to infection leading to organ dysfunction, remains challenging to quantify. We aimed to comprehensively estimate the global, regional, and national burden of sepsis, including the impact of the COVID-19 pandemic and underlying causes of sepsis-related deaths with co-occurring infectious syndromes. METHODS: We used multiple cause-of-death, hospital, minimally invasive tissue sampling, and linked death certificate and hospital record data representing 149 million deaths, covering 4290 location-years with mortality estimates from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 to capture explicit and implicit sepsis cases and deaths. We estimated age-location-sex-specific fractions of sepsis-related deaths from 195 underlying causes of death and 22 infectious syndromes from 1990 to 2021 using binomial logistic regression models, and estimated sepsis-related deaths using GBD cause-specific mortality estimates. Using 250 million hospital admissions and 7·82 million deaths from hospital data, representing 1310 location-years, we modelled case fatality rates by use of binomial logistic regression, applied to sepsis death estimates to estimate sepsis incidence by age, location, and year. FINDINGS: In 2021, we estimated 166 million (95% uncertainty interval 135-201) sepsis cases and 21·4 million (20·3-22·5) all-cause sepsis-related deaths globally, representing 31·5% of total global deaths. Sepsis-related deaths decreased between 1990 and 2019, followed by a surge in 2020 and 2021. As of 2021, individuals aged 15 years and older experienced increases across incidence (230%) and mortality (26·3%) since 1990. Those aged 70 years and older had the highest sepsis-related mortality in 2021 (9·28 million [8·74-9·86] deaths). Sepsis-related deaths from infectious underlying causes decreased from 11·8 million (11·1-12·5) in 1990 to 8·34 million (7·72-9·01) in 2019, then increased by 86·4% to 15·5 million (14·7-16·4) in 2021. Sepsis-related mortality due to non-infectious underlying causes of death increased from 4·69 million (4·35-5·05) in 1990 to 5·81 million (5·40-6·25) in 2021; the leading non-infectious underlying causes of death with sepsis were stroke, chronic obstructive pulmonary disease, and cirrhosis. In 2021, bloodstream infections inclusive of HIV and malaria (3·08 million [2·83-3·35]) and lower respiratory infections inclusive of COVID-19 (11·33 million [1·20-1·47]) were the most prominent infectious syndromes complicating sepsis-related deaths from non-infectious underlying causes, representing a consistent trend since 1990. INTERPRETATION: The global burden of sepsis increased in 2020 and 2021, reversing progress from 1990. Sepsis incidence and mortality increased in people aged 15 years and older, especially those aged 70 years and older, and as a complication of non-infectious underlying causes of death such as stroke, primarily through bloodstream infections and lower respiratory infections. The global burden of sepsis is substantial, and sepsis is increasingly a complication of non-infectious causes of death. FUNDING: Gates Foundation, Wellcome Trust, and Department of Health and Social Care using UK aid funding managed by the Fleming Fund
Global, regional, and national age-sex-specific burden of diarrhoeal diseases, their risk factors, and aetiologies, 1990–2021, for 204 countries and territories: a systematic analysis for the Global Burden of Disease Study 2021
No full textBackgroundDiarrhoeal diseases claim more than 1 million lives annually and are a leading cause of death in children younger than 5 years. Comprehensive global estimates of the diarrhoeal disease burden for specific age groups of children younger than 5 years are scarce, and the burden in children older than 5 years and in adults is also understudied. We used results from the Global Burden of Diseases, Injuries, and Risk Factors Study 2021 to assess the burden of, and trends in, diarrhoeal diseases overall and attributable to 13 pathogens, as well as the contributions of associated risk factors, in children and adults in 204 countries and territories from 1990 to 2021. MethodsWe used the Cause of Death Ensemble modelling strategy to analyse vital registration data, verbal autopsy data, mortality surveillance data, and minimally invasive tissue sampling data. We used DisMod-MR (version 2.1), a Bayesian meta-regression tool, to analyse incidence and prevalence data identified via systematic reviews, population-based surveys, and claims and inpatient data. We calculated diarrhoeal disability-adjusted life-years (DALYs) as the sum of years of life lost (YLLs) and years lived with disability (YLDs) for each location, year, and age–sex group. For aetiology estimation, we used a counterfactual approach to quantify population-attributable fractions (PAFs). Additionally, we estimated the diarrhoeal disease burden attributable to the independent effects of risk factors using the comparative risk assessment framework. FindingsIn 2021, diarrhoeal diseases caused an estimated 1·17 million (95% uncertainty interval 0·793–1·62) deaths globally, representing a 60·3% (50·6–69·0) decrease since 1990 (2·93 million [2·31–3·73] deaths). The most pronounced decline was in children younger than 5 years, with a 79·2% (72·4–84·6) decrease in diarrhoeal deaths. Global YLLs also decreased substantially, from 186 million (147–221) in 1990 to 51·4 million (39·9–65·9) in 2021. In 2021, an estimated 59·0 million (47·2–73·2) DALYs were attributable to diarrhoeal diseases globally, with 30·9 million (23·1–42·0) of these affecting children younger than 5 years. Leading risk factors for diarrhoeal DALYs included low birthweight and short gestation in the neonatal age groups, child growth failure in children aged between 1–5 months and 2–4 years, and unsafe water and poor sanitation in older children and adults. We estimated that the removal of all evaluated diarrhoeal risk factors would reduce global DALYs from 59·0 million (47·2–73·2) to 4·99 million (1·99–10·0) among all ages combined. Globally in 2021, rotavirus was the predominant cause of diarrhoeal deaths across all ages, with a PAF of 15·2% (11·4–20·1), followed by norovirus at 10·6% (2·3–17·0) and Cryptosporidium spp at 10·2% (7·03–14·3). In children younger than 5 years, the fatal PAF of rotavirus was 35·2% (28·7–43·0), followed by Shigella spp at 24·0% (15·2–37·9) and adenovirus at 23·8% (14·8–36·3). Other pathogens with a fatal PAF greater than 10% in children younger than 5 years included Cryptosporidium spp, typical enteropathogenicEscherichia coli, and enterotoxigenic E coli producing heat-stable toxin. InterpretationThe substantial decline in the global burden of diarrhoeal diseases since 1990, particularly in children younger than 5 years, supports the effectiveness of health interventions such as oral rehydration therapy, enhanced water, sanitation, and hygiene (WASH) infrastructure, and the introduction and scale-up of rotavirus vaccination. Targeted interventions and preventive measures against key risk factors and pathogens could further reduce this burden. Continued investment in the development and distribution of vaccines for leading pathogens remains crucial. FundingBill & Melinda Gates Foundation.Bill and Melinda Gates Foundatio
