Universiti Brunei Darussalam

IMPORTANCE: The Global Burden of Diseases, Injuries, and Risk Factors Study 2019 (GBD 2019) provided systematic estimates of incidence, morbidity, and mortality to inform local and international efforts toward reducing cancer burden. OBJECTIVE: To estimate cancer burden and trends globally for 204 countries and territories and by Sociodemographic Index (SDI) quintiles from 2010 to 2019. EVIDENCE REVIEW: The GBD 2019 estimation methods were used to describe cancer incidence, mortality, years lived with disability, years of life lost, and disability-adjusted life years (DALYs) in 2019 and over the past decade. Estimates are also provided by quintiles of the SDI, a composite measure of educational attainment, income per capita, and total fertility rate for those younger than 25 years. Estimates include 95% uncertainty intervals (UIs). FINDINGS: In 2019, there were an estimated 23.6 million (95% UI, 22.2-24.9 million) new cancer cases (17.2 million when excluding nonmelanoma skin cancer) and 10.0 million (95% UI, 9.36-10.6 million) cancer deaths globally, with an estimated 250 million (235-264 million) DALYs due to cancer. Since 2010, these represented a 26.3% (95% UI, 20.3%-32.3%) increase in new cases, a 20.9% (95% UI, 14.2%-27.6%) increase in deaths, and a 16.0% (95% UI, 9.3%-22.8%) increase in DALYs. Among 22 groups of diseases and injuries in the GBD 2019 study, cancer was second only to cardiovascular diseases for the number of deaths, years of life lost, and DALYs globally in 2019. Cancer burden differed across SDI quintiles. The proportion of years lived with disability that contributed to DALYs increased with SDI, ranging from 1.4% (1.1%-1.8%) in the low SDI quintile to 5.7% (4.2%-7.1%) in the high SDI quintile. While the high SDI quintile had the highest number of new cases in 2019, the middle SDI quintile had the highest number of cancer deaths and DALYs. From 2010 to 2019, the largest percentage increase in the numbers of cases and deaths occurred in the low and low-middle SDI quintiles. CONCLUSIONS AND RELEVANCE: The results of this systematic analysis suggest that the global burden of cancer is substantial and growing, with burden differing by SDI. These results provide comprehensive and comparable estimates that can potentially inform efforts toward equitable cancer control around the world.

The use of renewable energy resources, such as solar, wind, and biomass will not diminish their availability. Sunlight being a constant source of energy is used to meet the ever-increasing energy need. This review discusses the world's energy needs, renewable energy technologies for domestic use, and highlights public opinions on renewable energy. A systematic review of the literature was conducted from 2009 to 2018. During this process, more than 300 articles were classified and 42 papers were filtered for critical review. The literature analysis showed that despite serious efforts at all levels to reduce reliance on fossil fuels by promoting renewable energy as its alternative, fossil fuels continue to contribute 73.5% to the worldwide electricity production in 2017. Conversely, renewable sources contributed only 26.5%. Furthermore, this study highlights that the lack of public awareness is a major barrier to the acceptance of renewable energy technologies. The results of this study show that worldwide energy crises can be managed by integrating renewable energy sources in the power generation. Moreover, in order to facilitate the development of renewable energy technologies, this systematic review has highlighted the importance of public opinion and performed a real-time analysis of public tweets. This example of tweet analysis is a relatively novel initiative in a review study that will seek to direct the attention of future researchers and policymakers toward public opinion and recommend the implications to both academia and industries.

<p>Ammonia, a molecule that is gaining more interest as a fueling vector, has been considered as a candidate to power transport, produce energy, and support heating applications for decades. However, the particular characteristics of the molecule always made it a chemical with low, if any, benefit once compared to conventional fossil fuels. Still, the current need to decarbonize our economy makes the search of new methods crucial to use chemicals, such as ammonia, that can be produced and employed without incurring in the emission of carbon oxides. Therefore, current efforts in this field are leading scientists, industries, and governments to seriously invest efforts in the development of holistic solutions capable of making ammonia a viable fuel for the transition toward a clean future. On that basis, this review has approached the subject gathering inputs from scientists actively working on the topic. The review starts from the importance of ammonia as an energy vector, moving through all of the steps in the production, distribution, utilization, safety, legal considerations, and economic aspects of the use of such a molecule to support the future energy mix. Fundamentals of combustion and practical cases for the recovery of energy of ammonia are also addressed, thus providing a complete view of what potentially could become a vector of crucial importance to the mitigation of carbon emissions. Different from other works, this review seeks to provide a holistic perspective of ammonia as a chemical that presents benefits and constraints for storing energy from sustainable sources. State-of-the-art knowledge provided by academics actively engaged with the topic at various fronts also enables a clear vision of the progress in each of the branches of ammonia as an energy carrier. Further, the fundamental boundaries of the use of the molecule are expanded to real technical issues for all potential technologies capable of using it for energy purposes, legal barriers that will be faced to achieve its deployment, safety and environmental considerations that impose a critical aspect for acceptance and wellbeing, and economic implications for the use of ammonia across all aspects approached for the production and implementation of this chemical as a fueling source. Herein, this work sets the principles, research, practicalities, and future views of a transition toward a future where ammonia will be a major energy player. </p>

Colorectal cancer (CRC) is the second most deadly cancer. Global incidence and mortality are likely to be increased in the coming decades. Although the deaths associated with CRC are very high in high-income countries, the incidence and fatalities related to CRC are growing in developing countries too. CRC detected early is entirely curable by surgery and subsequent medications. However, the recurrence rate is high, and cancer drug resistance increases the treatment failure rate. Access to early diagnosis and treatment of CRC for survival is somewhat possible in developed countries. However, these facilities are rarely available in developing countries. Highlighting the current status of CRC, its development, risk factors, and management is crucial in creating public awareness. Therefore, in this review, we have comprehensively discussed the current global epidemiology, drug resistance, challenges, risk factors, and preventive and treatment strategies of CRC. Additionally, there is a brief discussion on the CRC development pathways and recommendations for preventing and treating CRC.

Abstract Thermal performance curves ( TPC s), which quantify how an ectotherm's body temperature ( T b ) affects its performance or fitness, are often used in an attempt to predict organismal responses to climate change. Here, we examine the key – but often biologically unreasonable – assumptions underlying this approach; for example, that physiology and thermal regimes are invariant over ontogeny, space and time, and also that TPC s are independent of previously experienced T b. We show how a critical consideration of these assumptions can lead to biologically useful hypotheses and experimental designs. For example, rather than assuming that TPC s are fixed during ontogeny, one can measure TPC s for each major life stage and incorporate these into stage‐specific ecological models to reveal the life stage most likely to be vulnerable to climate change. Our overall goal is to explicitly examine the assumptions underlying the integration of TPC s with T b , to develop a framework within which empiricists can place their work within these limitations, and to facilitate the application of thermal physiology to understanding the biological implications of climate change.

This paper aims to provide a basis for the improvement of software estimation research through a systematic review of previous work. The review identifies 304 software cost estimation papers in 76 journals and classifies the papers according to research topic, estimation approach, research approach, study context and data set. A web-based library of these cost estimation papers is provided to ease the identification of relevant estimation research results. The review results combined with other knowledge provide support for recommendations for future software cost estimation research, including: 1) Increase the breadth of the search for relevant studies, 2) Search manually for relevant papers within a carefully selected set of journals when completeness is essential, 3) Conduct more studies on estimation methods commonly used by the software industry, and, 4) Increase the awareness of how properties of the data sets impact the results when evaluating estimation methods.

We combined two existing datasets of vegetation aboveground biomass (AGB) (Proceedings of the National Academy of Sciences of the United States of America, 108, 2011, 9899; Nature Climate Change, 2, 2012, 182) into a pan-tropical AGB map at 1-km resolution using an independent reference dataset of field observations and locally calibrated high-resolution biomass maps, harmonized and upscaled to 14 477 1-km AGB estimates. Our data fusion approach uses bias removal and weighted linear averaging that incorporates and spatializes the biomass patterns indicated by the reference data. The method was applied independently in areas (strata) with homogeneous error patterns of the input (Saatchi and Baccini) maps, which were estimated from the reference data and additional covariates. Based on the fused map, we estimated AGB stock for the tropics (23.4 N-23.4 S) of 375 Pg dry mass, 9-18% lower than the Saatchi and Baccini estimates. The fused map also showed differing spatial patterns of AGB over large areas, with higher AGB density in the dense forest areas in the Congo basin, Eastern Amazon and South-East Asia, and lower values in Central America and in most dry vegetation areas of Africa than either of the input maps. The validation exercise, based on 2118 estimates from the reference dataset not used in the fusion process, showed that the fused map had a RMSE 15-21% lower than that of the input maps and, most importantly, nearly unbiased estimates (mean bias 5 Mg dry mass ha(-1) vs. 21 and 28 Mg ha(-1) for the input maps). The fusion method can be applied at any scale including the policy-relevant national level, where it can provide improved biomass estimates by integrating existing regional biomass maps as input maps and additional, country-specific reference datasets.

This paper aims to provide a basis for the improvement of software-estimation research through a systematic review of previous work. The review identifies 304 software cost estimation papers in 76 journals and classifies the papers according to research topic, estimation approach, research approach, study context and data set. A Web-based library of these cost estimation papers is provided to ease the identification of relevant estimation research results. The review results combined with other knowledge provide support for recommendations for future software cost estimation research, including: 1) increase the breadth of the search for relevant studies, 2) search manually for relevant papers within a carefully selected set of journals when completeness is essential, 3) conduct more studies on estimation methods commonly used by the software industry, and 4) increase the awareness of how properties of the data sets impact the results when evaluating estimation methods

The extraordinary abundance of ants in tropical rainforest canopies has led to speculation that numerous arboreal ant taxa feed principally as "herbivores" of plant and insect exudates. Based on nitrogen (N) isotope ratios of plants, known herbivores, arthropod predators, and ants from Amazonia and Borneo, we find that many arboreal ant species obtain little N through predation and scavenging. Microsymbionts of ants and their hemipteran trophobionts might play key roles in the nutrition of taxa specializing on N-poor exudates. For plants, the combined costs of biotic defenses and herbivory by ants and tended Hemiptera are substantial, and forest losses to insect herbivores vastly exceed current estimates.

Energy level diagrams for undoped and N-doped TiO ₂ for visible light induced photocatalytic application.

This note is concerned with a new controller design problem for networked systems with random communication delays. Two kinds of random delays are simultaneously considered: i) from the controller to the plant, and ii) from the sensor to the controller, via a limited bandwidth communication channel. The random delays are modeled as a linear function of the stochastic variable satisfying Bernoulli random binary distribution. The observer-based controller is designed to exponentially stabilize the networked system in the sense of mean square, and also achieve the prescribed H/sub /spl infin// disturbance attenuation level. The addressed controller design problem is transformed to an auxiliary convex optimization problem, which can be solved by a linear matrix inequality (LMI) approach. An illustrative example is provided to show the applicability of the proposed method.

Metal oxides are of great technological importance in environmental remediation and electronics because of their capability to generate charge carriers when stimulated with required amount of energy. The promising arrangement of electronic structure, light absorption properties, and charge transport characteristics of most of the metal oxides has made possible its application as photocatalyst. In this article definition of metal oxides as photocatalyst, structural characteristics, requirements of the photocatalyst, classification of photocatalysts and the mechanism of the photocatalytic process are discussed.

In this study, pure ZnO, CeO2 and ZnO/CeO2 nanocomposites were synthesized using a thermal decomposition method and subsequently characterized using different standard techniques. High-resolution X-ray photoelectron spectroscopy measurements confirmed the oxidation states and presence of Zn(2+), Ce(4+), Ce(3+) and different bonded oxygen species in the nanocomposites. The prepared pure ZnO and CeO2 as well as the ZnO/CeO2 nanocomposites with various proportions of ZnO and CeO2 were tested for photocatalytic degradation of methyl orange, methylene blue and phenol under visible-light irradiation. The optimized and highly efficient ZnO/CeO2 (90:10) nanocomposite exhibited enhanced photocatalytic degradation performance for the degradation of methyl orange, methylene blue, and phenol as well as industrial textile effluent compared to ZnO, CeO2 and the other investigated nanocomposites. Moreover, the recycling results demonstrate that the ZnO/CeO2 (90:10) nanocomposite exhibited good stability and long-term durability. Furthermore, the prepared ZnO/CeO2 nanocomposites were used for the electrochemical detection of uric acid and ascorbic acid. The ZnO/CeO2 (90:10) nanocomposite also demonstrated the best detection, sensitivity and performance among the investigated materials in this application. These findings suggest that the synthesized ZnO/CeO2 (90:10) nanocomposite could be effectively used in various applications.

Global change is impacting forests worldwide, threatening biodiversity and ecosystem services including climate regulation. Understanding how forests respond is critical to forest conservation and climate protection. This review describes an international network of 59 long-term forest dynamics research sites (CTFS-ForestGEO) useful for characterizing forest responses to global change. Within very large plots (median size 25 ha), all stems ≥ 1 cm diameter are identified to species, mapped, and regularly recensused according to standardized protocols. CTFS-ForestGEO spans 25 °S-61 °N latitude, is generally representative of the range of bioclimatic, edaphic, and topographic conditions experienced by forests worldwide, and is the only forest monitoring network that applies a standardized protocol to each of the world's major forest biomes. Supplementary standardized measurements at subsets of the sites provide additional information on plants, animals, and ecosystem and environmental variables. CTFS-ForestGEO sites are experiencing multifaceted anthropogenic global change pressures including warming (average 0.61 °C), changes in precipitation (up to ± 30% change), atmospheric deposition of nitrogen and sulfur compounds (up to 3.8 g N m(-2) yr(-1) and 3.1 g S m(-2) yr(-1)), and forest fragmentation in the surrounding landscape (up to 88% reduced tree cover within 5 km). The broad suite of measurements made at CTFS-ForestGEO sites makes it possible to investigate the complex ways in which global change is impacting forest dynamics. Ongoing research across the CTFS-ForestGEO network is yielding insights into how and why the forests are changing, and continued monitoring will provide vital contributions to understanding worldwide forest diversity and dynamics in an era of global change.

BACKGROUND: Mobile health (mHealth) app use is a major concern because of the possible dissemination of misinformation that could harm the users. Particularly, it can be difficult for health care professionals to recommend a suitable app for coronavirus disease (COVID-19) education and self-monitoring purposes. OBJECTIVE: This study aims to analyze and evaluate the contents as well as features of COVID-19 mobile apps. The findings are instrumental in helping health care professionals to identify suitable mobile apps for COVID-19 self-monitoring and education. The results of the mobile apps' assessment could potentially help mobile app developers improve or modify their existing mobile app designs to achieve optimal outcomes. METHODS: The search for the mHealth apps available in the android-based Play Store and the iOS-based App Store was conducted between April 18 and May 5, 2020. The region of the App Store where we performed the search was the United States, and a virtual private network app was used to locate and access COVID-19 mobile apps from all countries on the Google Play Store. The inclusion criteria were apps that are related to COVID-19 with no restriction in language type. The basic features assessment criteria used for comparison were the requirement for free subscription, internet connection, education or advisory content, size of the app, ability to export data, and automated data entry. The functionality of the apps was assessed according to knowledge (information on COVID-19), tracing or mapping of COVID-19 cases, home monitoring surveillance, online consultation with a health authority, and official apps run by health authorities. RESULTS: Of the 223 COVID-19-related mobile apps, only 30 (19.9%) found in the App Store and 28 (44.4%) in the Play Store matched the inclusion criteria. In the basic features assessment, most App Store (10/30, 33.3%) and Play Store (10/28, 35.7%) apps scored 4 out of 7 points. Meanwhile, the outcome of the functionality assessment for most App Store apps (13/30, 43.3%) was a score of 3 compared to android-based apps (10/28, 35.7%), which scored 2 (out of the maximum 5 points). Evaluation of the basic functions showed that 75.0% (n=36) of the 48 included mobile apps do not require a subscription, 56.3% (n=27) provide symptom advice, and 41.7% (n=20) have educational content. In terms of the specific functions, more than half of the included mobile apps are official mobile apps maintained by a health authority for COVID-19 information provision. Around 37.5% (n=18) and 31.3% (n=15) of the mobile apps have tracing or mapping and home monitoring surveillance functions, respectively, with only 17% (n=8) of the mobile apps equipped with an online consultation function. CONCLUSIONS: Most iOS-based apps incorporate infographic mapping of COVID-19 cases, while most android-based apps incorporate home monitoring surveillance features instead of providing focused educational content on COVID-19. It is important to evaluate the contents and features of COVID-19 mobile apps to guide users in choosing a suitable mobile app based on their requirements.

Agriculture and development transform forest ecosystems to human-modified landscapes. Decades of research in ecology have generated myriad concepts for the appropriate management of these landscapes. Yet, these concepts are often contradictory and apply at different spatial scales, making the design of biodiversity-friendly landscapes challenging. Here, we combine concepts with empirical support to design optimal landscape scenarios for forest-dwelling species. The supported concepts indicate that appropriately sized landscapes should contain ≥ 40% forest cover, although higher percentages are likely needed in the tropics. Forest cover should be configured with c. 10% in a very large forest patch, and the remaining 30% in many evenly dispersed smaller patches and semi-natural treed elements (e.g. vegetation corridors). Importantly, the patches should be embedded in a high-quality matrix. The proposed landscape scenarios represent an optimal compromise between delivery of goods and services to humans and preserving most forest wildlife, and can therefore guide forest preservation and restoration strategies.

Abstract. Tropical tree height-diameter (H:D) relationships may vary by forest type and region making large-scale estimates of above-ground biomass subject to bias if they ignore these differences in stem allometry. We have therefore developed a new global tropical forest database consisting of 39 955 concurrent H and D measurements encompassing 283 sites in 22 tropical countries. Utilising this database, our objectives were: 1. to determine if H:D relationships differ by geographic region and forest type (wet to dry forests, including zones of tension where forest and savanna overlap). 2. to ascertain if the H:D relationship is modulated by climate and/or forest structural characteristics (e.g. stand-level basal area, A). 3. to develop H:D allometric equations and evaluate biases to reduce error in future local-to-global estimates of tropical forest biomass. Annual precipitation coefficient of variation (PV), dry season length (SD), and mean annual air temperature (TA) emerged as key drivers of variation in H:D relationships at the pantropical and region scales. Vegetation structure also played a role with trees in forests of a high A being, on average, taller at any given D. After the effects of environment and forest structure are taken into account, two main regional groups can be identified. Forests in Asia, Africa and the Guyana Shield all have, on average, similar H:D relationships, but with trees in the forests of much of the Amazon Basin and tropical Australia typically being shorter at any given D than their counterparts elsewhere. The region-environment-structure model with the lowest Akaike's information criterion and lowest deviation estimated stand-level H across all plots to within amedian −2.7 to 0.9% of the true value. Some of the plot-to-plot variability in H:D relationships not accounted for by this model could be attributed to variations in soil physical conditions. Other things being equal, trees tend to be more slender in the absence of soil physical constraints, especially at smaller D. Pantropical and continental-level models provided less robust estimates of H, especially when the roles of climate and stand structure in modulating H:D allometry were not simultaneously taken into account.

Coronaviruses are enveloped RNA viruses found in mammals, birds and humans. At present, six coronavirus species are known agents for illnesses in humans. Four viruses—229E, OC43, NL63 and HKU1—are prevalent and can cause respiratory symptoms. The other two—severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV)—are zoonotic in origin and can cause fatalities [1]. SARS-CoV originated in Guangdong Province, China and was responsible for the severe acute respiratory syndrome outbreaks in 2002 and 2003. It rapidly spread across the globe and resulted in 8098 reported cases and 774 deaths (case-fatality rate, 9.6%) in 37 countries. MERS-CoV originated in the Middle East and caused severe respiratory disease outbreaks in 2012. Since 2012, there have been 2494 reported MERS-CoV cases resulting in 858 deaths (case-fatality rate, 34%) in 27 countries. There were also several rapid outbreaks reported, mainly in hospitals in Saudi Arabia, Jordan and South Korea [2]. On 31 December 2019, the World Health Organization (WHO) China office was informed of cases of pneumonia of unknown aetiology detected in Wuhan city in Hubei Province, central China [3]. By 9 January 2020, WHO released a statement on the cluster of cases, which stated that ‘Chinese authorities have made a preliminary determination of a novel (or new) coronavirus, identified in a hospitalized person with pneumonia in Wuhan’ [4]. The virus was initially referred to as 2019-nCoV, but has since been re-named as SARS-CoV-2 by the WHO on 12 February 2020. Early indications are that the overall case-fatality rate is around 2%. An analysis of the first 425 cases provided an estimated mean incubation period of 5.2 days (95% confidence interval [CI] 4.1–7.0) and a basic reproductive number (Ro) of 2.2 (95% CI 1.4–3.9) [1]. It is possible that people with Coronavirus Disease 2019 (COVID-19) may be infectious even before showing significant symptoms [5]. However, based on currently available data, those who have symptoms are causing the majority of virus spread. The WHO declared this disease as a Public Health Emergency of International Concern (PHEIC) on 30 January 2020 [6]. A significant proportion of cases are related to occupational exposure. As this virus is believed to have originated from wildlife and then crossed the species barrier to infect humans, it is not unexpected that the first documented occupational groups at risk were persons working in seafood and wet animal wholesale markets in Wuhan. At the start of the outbreak, workers and visitors to the market comprised 55% of the 47 cases with onset before 1 January 2020, when the wholesale market was closed. In comparison, only 8.5% of the 378 cases with onset of symptoms after 1 January 2020 had a link with exposure at the market [1]. As cases increased and required health care, health care workers (HCWs) were next recognized as another high-risk group to acquire this infection. In a case series of 138 patients treated in a Wuhan hospital, 40 patients (29% of cases) were HCWs. Among the affected HCWs, 31 (77.5%) worked on general wards, 7 (17.5%) in the emergency department, and 2 (5%) in the intensive care unit (ICU). There was apparently a super-spreader patient encountered in the hospital, who presented with abdominal symptoms and was admitted to the surgical department. This patient infected >10 HCWs in the department [7]. China’s Vice-Minister at the National Health Commission said that 1716 health workers had been infected in the country as of Tuesday 11 February 2020, among whom 6 have died [8]. Outside of China, the first confirmed case of COVID-19 infection in Singapore was announced on 23 January 2020 by the Ministry of Health, Singapore (MOH-Sg). The MOH-Sg issues daily press reports to describe case details of confirmed COVID-19 patients. As of 11 February 2020, a total of 47 cases have been confirmed [9]. Among the first 25 locally transmitted cases, 17 cases (68%) were probably related to occupational exposure (Table 1). They included staff in the tourism, retail and hospitality industry, transport and security workers, and construction workers. Probable occupationally acquired COVID-19 among 25 locally transmitted cases in Singapore, 4–11 February 2020 aThe case no. denotes the order of cases according to the time of announcement by the Ministry of Health, Singapore. The first 18 cases were imported cases. bTwo other cases (Cases 52 and 56) were reported from the same worksite 2 days later. Probable occupationally acquired COVID-19 among 25 locally transmitted cases in Singapore, 4–11 February 2020 aThe case no. denotes the order of cases according to the time of announcement by the Ministry of Health, Singapore. The first 18 cases were imported cases. bTwo other cases (Cases 52 and 56) were reported from the same worksite 2 days later. An international business meeting for 109 staff was organized by a multinational company from 20–22 January 2020 in Singapore. At this event, healthy company workers interacted with other infected participants, which resulted in the transmission of the virus to three employees based in Singapore. Besides those infected from Singapore, one employee from Malaysia, two participants from South Korea and one staff member from the UK were also infected. They presented as cases after leaving Singapore. Crew on board cruise ships with infected passengers are also at risk. At least 10 cases have been reported among the 1035 crew on the liner Diamond Princess, which is currently docked in Yokohama with around 3600 people quarantined since 3 February 2020. A Hong Kong man boarded the ship on 20 January in Yokohama at the beginning of a 14-day round trip cruise. The passenger sailed from Yokohama to Hong Kong, where he disembarked on 25 January. The ship continued its journey, until news was received that the passenger tested positive on 1 February 2020. The Diamond Princess returned to Yokohama a day early, and has been quarantined since then, with guests isolated in their cabins and screened [10]. The quarantine period will end on 19 February 2020. Another cruise ship, the Dutch liner Westerdam, sailed out of Hong Kong on 1 February 2020. It was turned away by the Philippines, Taiwan, Korea, Japan, Thailand and the US territory of Guam, because of fears arising from the COVID-19 outbreak—even though there was apparently no confirmed case on board [11]. The ship was finally allowed to dock in Sihanoukville, Cambodia after 13 days at sea. Besides fears of contagion from people on board cruise ships, which have been likened to ‘floating petri dishes’, fears are also widespread on land. There are increasing reports of HCWs being shunned and harassed by a fearful public because of their occupation. A Member of Parliament in Singapore highlighted what he termed as ‘disgraceful actions’ against HCWs stemming from fear and panic [12]. Some examples of behaviour described were: Taxi drivers reluctant to pick up staff in medical uniform. A healthcare professional’s private-hire vehicle cancelled because she was going to a hospital. A nurse in a lift asked why she was not taking the stairs and that she was spreading the virus to others by taking the lift. A nurse scolded for making the Mass Rapid Transit train “dirty” and spreading the virus. An ambulance driver turned away by food stall workers. However, not all the reactions from the public towards HCWs have been negative. There are probably an equal number of stories of public support and encouragement. Members of the public have showed their appreciation for HCWs and have volunteered to help the more vulnerable in society [13]. For example, a ride-hailing transport operator started a new service offering a dedicated 24-h service for HCWs travelling from work. Volunteers have also stepped forward to distribute hand sanitizers and masks to the elderly and vulnerable in their community, while sharing important public health messages. Such reactions are reminiscent of behaviour during the 2003 SARS outbreak, where not only the general public, but even close family members were afraid of being infected by HCWs exposed to the disease. A survey of over 10 000 HCWs in Singapore during the SARS outbreak of 2003 reported that many respondents experienced social stigmatization. Almost half (49%) thought that ‘people avoid me because of my job’ and 31% felt that ‘people avoid my family members because of my job’. For example, some parents of schoolchildren forbade their children to play or be close to children of HCWs. A large number (69%) of HCWs also felt that ‘people close to me are worried they might get infected through me’ [14]. On the other hand, there was also massive public support for HCWs, who were hailed as heroes in the fight against the disease. Most of the HCWs (77%) felt appreciated by society. COVID-19 is the first new occupational disease to be described in this decade. Our experiences in coping with the previous SARS-CoV and MERS-CoV outbreaks have better prepared us to face this new challenge. While the explosive increase in cases in China has overwhelmed the health care system initially, we know that public health measures such as early detection, quarantine and isolation of cases can be effective in containing the outbreak. All health personnel should be alert to the risk of COVID-19 in a wide variety of occupations, and not only HCWs. These occupational groups can be protected by good infection control practices. These at-risk groups should also be given adequate social and mental health support [15], which are needed but which are sometimes overlooked.

Abstract. Aboveground tropical tree biomass and carbon storage estimates commonly ignore tree height (H). We estimate the effect of incorporating H on tropics-wide forest biomass estimates in 327 plots across four continents using 42 656 H and diameter measurements and harvested trees from 20 sites to answer the following questions: 1. What is the best H-model form and geographic unit to include in biomass models to minimise site-level uncertainty in estimates of destructive biomass? 2. To what extent does including H estimates derived in (1) reduce uncertainty in biomass estimates across all 327 plots? 3. What effect does accounting for H have on plot- and continental-scale forest biomass estimates? The mean relative error in biomass estimates of destructively harvested trees when including H (mean 0.06), was half that when excluding H (mean 0.13). Power- and Weibull-H models provided the greatest reduction in uncertainty, with regional Weibull-H models preferred because they reduce uncertainty in smaller-diameter classes (≤40 cm D) that store about one-third of biomass per hectare in most forests. Propagating the relationships from destructively harvested tree biomass to each of the 327 plots from across the tropics shows that including H reduces errors from 41.8 Mg ha−1 (range 6.6 to 112.4) to 8.0 Mg ha−1 (−2.5 to 23.0). For all plots, aboveground live biomass was −52.2 Mg ha−1 (−82.0 to −20.3 bootstrapped 95% CI), or 13%, lower when including H estimates, with the greatest relative reductions in estimated biomass in forests of the Brazilian Shield, east Africa, and Australia, and relatively little change in the Guiana Shield, central Africa and southeast Asia. Appreciably different stand structure was observed among regions across the tropical continents, with some storing significantly more biomass in small diameter stems, which affects selection of the best height models to reduce uncertainty and biomass reductions due to H. After accounting for variation in H, total biomass per hectare is greatest in Australia, the Guiana Shield, Asia, central and east Africa, and lowest in east-central Amazonia, W. Africa, W. Amazonia, and the Brazilian Shield (descending order). Thus, if tropical forests span 1668 million km2 and store 285 Pg C (estimate including H), then applying our regional relationships implies that carbon storage is overestimated by 35 Pg C (31–39 bootstrapped 95% CI) if H is ignored, assuming that the sampled plots are an unbiased statistical representation of all tropical forest in terms of biomass and height factors. Our results show that tree H is an important allometric factor that needs to be included in future forest biomass estimates to reduce error in estimates of tropical carbon stocks and emissions due to deforestation.

BACKGROUND: For more than three decades, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) has provided a framework to quantify health loss due to diseases, injuries, and associated risk factors. This paper presents GBD 2023 findings on disease and injury burden and risk-attributable health loss, offering a global audit of the state of world health to inform public health priorities. This work captures the evolving landscape of health metrics across age groups, sexes, and locations, while reflecting on the remaining post-COVID-19 challenges to achieving our collective global health ambitions. METHODS: The GBD 2023 combined analysis estimated years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs) for 375 diseases and injuries, and risk-attributable burden associated with 88 modifiable risk factors. Of the more than 310 000 total data sources used for all GBD 2023 (about 30% of which were new to this estimation round), more than 120 000 sources were used for estimation of disease and injury burden and 59 000 for risk factor estimation, and included vital registration systems, surveys, disease registries, and published scientific literature. Data were analysed using previously established modelling approaches, such as disease modelling meta-regression version 2.1 (DisMod-MR 2.1) and comparative risk assessment methods. Diseases and injuries were categorised into four levels on the basis of the established GBD cause hierarchy, as were risk factors using the GBD risk hierarchy. Estimates stratified by age, sex, location, and year from 1990 to 2023 were focused on disease-specific time trends over the 2010-23 period and presented as counts (to three significant figures) and age-standardised rates per 100 000 person-years (to one decimal place). For each measure, 95% uncertainty intervals [UIs] were calculated with the 2·5th and 97·5th percentile ordered values from a 250-draw distribution. FINDINGS: Total numbers of global DALYs grew 6·1% (95% UI 4·0-8·1), from 2·64 billion (2·46-2·86) in 2010 to 2·80 billion (2·57-3·08) in 2023, but age-standardised DALY rates, which account for population growth and ageing, decreased by 12·6% (11·0-14·1), revealing large long-term health improvements. Non-communicable diseases (NCDs) contributed 1·45 billion (1·31-1·61) global DALYs in 2010, increasing to 1·80 billion (1·63-2·03) in 2023, alongside a concurrent 4·1% (1·9-6·3) reduction in age-standardised rates. Based on DALY counts, the leading level 3 NCDs in 2023 were ischaemic heart disease (193 million [176-209] DALYs), stroke (157 million [141-172]), and diabetes (90·2 million [75·2-107]), with the largest increases in age-standardised rates since 2010 occurring for anxiety disorders (62·8% [34·0-107·5]), depressive disorders (26·3% [11·6-42·9]), and diabetes (14·9% [7·5-25·6]). Remarkable health gains were made for communicable, maternal, neonatal, and nutritional (CMNN) diseases, with DALYs falling from 874 million (837-917) in 2010 to 681 million (642-736) in 2023, and a 25·8% (22·6-28·7) reduction in age-standardised DALY rates. During the COVID-19 pandemic, DALYs due to CMNN diseases rose but returned to pre-pandemic levels by 2023. From 2010 to 2023, decreases in age-standardised rates for CMNN diseases were led by rate decreases of 49·1% (32·7-61·0) for diarrhoeal diseases, 42·9% (38·0-48·0) for HIV/AIDS, and 42·2% (23·6-56·6) for tuberculosis. Neonatal disorders and lower respiratory infections remained the leading level 3 CMNN causes globally in 2023, although both showed notable rate decreases from 2010, declining by 16·5% (10·6-22·0) and 24·8% (7·4-36·7), respectively. Injury-related age-standardised DALY rates decreased by 15·6% (10·7-19·8) over the same period. Differences in burden due to NCDs, CMNN diseases, and injuries persisted across age, sex, time, and location. Based on our risk analysis, nearly 50% (1·27 billion [1·18-1·38]) of the roughly 2·80 billion total global DALYs in 2023 were attributable to the 88 risk factors analysed in GBD. Globally, the five level 3 risk factors contributing the highest proportion of risk-attributable DALYs were high systolic blood pressure (SBP), particulate matter pollution, high fasting plasma glucose (FPG), smoking, and low birthweight and short gestation-with high SBP accounting for 8·4% (6·9-10·0) of total DALYs. Of the three overarching level 1 GBD risk factor categories-behavioural, metabolic, and environmental and occupational-risk-attributable DALYs rose between 2010 and 2023 only for metabolic risks, increasing by 30·7% (24·8-37·3); however, age-standardised DALY rates attributable to metabolic risks decreased by 6·7% (2·0-11·0) over the same period. For all but three of the 25 leading level 3 risk factors, age-standardised rates dropped between 2010 and 2023-eg, declining by 54·4% (38·7-65·3) for unsafe sanitation, 50·5% (33·3-63·1) for unsafe water source, and 45·2% (25·6-72·0) for no access to handwashing facility, and by 44·9% (37·3-53·5) for child growth failure. The three leading level 3 risk factors for which age-standardised attributable DALY rates rose were high BMI (10·5% [0·1 to 20·9]), drug use (8·4% [2·6 to 15·3]), and high FPG (6·2% [-2·7 to 15·6]; non-significant). INTERPRETATION: Our findings underscore the complex and dynamic nature of global health challenges. Since 2010, there have been large decreases in burden due to CMNN diseases and many environmental and behavioural risk factors, juxtaposed with sizeable increases in DALYs attributable to metabolic risk factors and NCDs in growing and ageing populations. This long-observed consequence of the global epidemiological transition was only temporarily interrupted by the COVID-19 pandemic. The substantially decreasing CMNN disease burden, despite the 2008 global financial crisis and pandemic-related disruptions, is one of the greatest collective public health successes known. However, these achievements are at risk of being reversed due to major cuts to development assistance for health globally, the effects of which will hit low-income countries with high burden the hardest. Without sustained investment in evidence-based interventions and policies, progress could stall or reverse, leading to widespread human costs and geopolitical instability. Moreover, the rising NCD burden necessitates intensified efforts to mitigate exposure to leading risk factors-eg, air pollution, smoking, and metabolic risks, such as high SBP, BMI, and FPG-including policies that promote food security, healthier diets, physical activity, and equitable and expanded access to potential treatments, such as GLP-1 receptor agonists. Decisive, coordinated action is needed to address long-standing yet growing health challenges, including depressive and anxiety disorders. Yet this can be only part of the solution. Our response to the NCD syndemic-the complex interaction of multiple health risks, social determinants, and systemic challenges-will define the future landscape of global health. To ensure human wellbeing, economic stability, and social equity, global action to sustain and advance health gains must prioritise reducing disparities by addressing socioeconomic and demographic determinants, ensuring equitable health-care access, tackling malnutrition, strengthening health systems, and improving vaccination coverage. We live in times of great opportunity. FUNDING: Gates Foundation and Bloomberg Philanthropies.