Duke Kunshan University

Importance: Elevated systolic blood (SBP) pressure is a leading global health risk. Quantifying the levels of SBP is important to guide prevention policies and interventions. Objective: To estimate the association between SBP of at least 110 to 115 mm Hg and SBP of 140 mm Hg or higher and the burden of different causes of death and disability by age and sex for 195 countries and territories, 1990-2015. Design: A comparative risk assessment of health loss related to SBP. Estimated distribution of SBP was based on 844 studies from 154 countries (published 1980-2015) of 8.69 million participants. Spatiotemporal Gaussian process regression was used to generate estimates of mean SBP and adjusted variance for each age, sex, country, and year. Diseases with sufficient evidence for a causal relationship with high SBP (eg, ischemic heart disease, ischemic stroke, and hemorrhagic stroke) were included in the primary analysis. Main Outcomes and Measures: Mean SBP level, cause-specific deaths, and health burden related to SBP (≥110-115 mm Hg and also ≥140 mm Hg) by age, sex, country, and year. Results: Between 1990-2015, the rate of SBP of at least 110 to 115 mm Hg increased from 73 119 (95% uncertainty interval [UI], 67 949-78 241) to 81 373 (95% UI, 76 814-85 770) per 100 000, and SBP of 140 mm Hg or higher increased from 17 307 (95% UI, 17 117-17 492) to 20 526 (95% UI, 20 283-20 746) per 100 000. The estimated annual death rate per 100 000 associated with SBP of at least 110 to 115 mm Hg increased from 135.6 (95% UI, 122.4-148.1) to 145.2 (95% UI 130.3-159.9) and the rate for SBP of 140 mm Hg or higher increased from 97.9 (95% UI, 87.5-108.1) to 106.3 (95% UI, 94.6-118.1). For loss of DALYs associated with systolic blood pressure of 140 mm Hg or higher, the loss increased from 95.9 million (95% uncertainty interval [UI], 87.0-104.9 million) to 143.0 million (95% UI, 130.2-157.0 million) [corrected], and for SBP of 140 mm Hg or higher, the loss increased from 5.2 million (95% UI, 4.6-5.7 million) to 7.8 million (95% UI, 7.0-8.7 million). The largest numbers of SBP-related deaths were caused by ischemic heart disease (4.9 million [95% UI, 4.0-5.7 million]; 54.5%), hemorrhagic stroke (2.0 million [95% UI, 1.6-2.3 million]; 58.3%), and ischemic stroke (1.5 million [95% UI, 1.2-1.8 million]; 50.0%). In 2015, China, India, Russia, Indonesia, and the United States accounted for more than half of the global DALYs related to SBP of at least 110 to 115 mm Hg. Conclusions and Relevance: In international surveys, although there is uncertainty in some estimates, the rate of elevated SBP (≥110-115 and ≥140 mm Hg) increased substantially between 1990 and 2015, and DALYs and deaths associated with elevated SBP also increased. Projections based on this sample suggest that in 2015, an estimated 3.5 billion adults had SBP of at least 110 to 115 mm Hg and 874 million adults had SBP of 140 mm Hg or higher.

Abstract Recent years have seen a tremendous growth in Artificial Intelligence (AI)-based methodological development in a broad range of domains. In this rapidly evolving field, large number of methods are being reported using machine learning (ML) and Deep Learning (DL) models. Majority of these models are inherently complex and lacks explanations of the decision making process causing these models to be termed as 'Black-Box'. One of the major bottlenecks to adopt such models in mission-critical application domains, such as banking, e-commerce, healthcare, and public services and safety, is the difficulty in interpreting them. Due to the rapid proleferation of these AI models, explaining their learning and decision making process are getting harder which require transparency and easy predictability. Aiming to collate the current state-of-the-art in interpreting the black-box models, this study provides a comprehensive analysis of the explainable AI (XAI) models. To reduce false negative and false positive outcomes of these back-box models, finding flaws in them is still difficult and inefficient. In this paper, the development of XAI is reviewed meticulously through careful selection and analysis of the current state-of-the-art of XAI research. It also provides a comprehensive and in-depth evaluation of the XAI frameworks and their efficacy to serve as a starting point of XAI for applied and theoretical researchers. Towards the end, it highlights emerging and critical issues pertaining to XAI research to showcase major, model-specific trends for better explanation, enhanced transparency, and improved prediction accuracy.

BACKGROUND: From 2003 to 2005, standardised 5-year cancer survival in China was much lower than in developed countries and varied substantially by geographical area. Monitoring population-level cancer survival is crucial to the understanding of the overall effectiveness of cancer care. We therefore aimed to investigate survival statistics for people with cancer in China between 2003 and 2015. METHODS: We used population-based data from 17 cancer registries in China. Data for the study population was submitted by the end of July 31, 2016, with follow-up data on vital status obtained on Dec 31, 2015. We used anonymised, individual cancer registration records of patients (aged 0-99 years) diagnosed with primary, invasive cancers from 2003 to 2013. Patients eligible for inclusion had data for demographic characteristics, date of diagnosis, anatomical site, morphology, behaviour code, vital status, and last date of contact. We analysed 5-year relative survival by sex, age, and geographical area, for all cancers combined and 26 different cancer types, between 2003 and 2015. We stratified survival estimates by calendar period (2003-05, 2006-08, 2009-11, and 2012-15). FINDINGS: There were 678 842 records of patients with invasive cancer who were diagnosed between 2003 and 2013. Of these records, 659 732 (97·2%) were eligible for inclusion in the final analyses. From 2003-05 to 2012-15, age-standardised 5-year relative survival increased substantially for all cancers combined, for both male and female patients, from 30·9% (95% CI 30·6-31·2) to 40·5% (40·3-40·7). Age-standardised 5-year relative survival also increased for most cancer types, including cancers of the uterus (average change per calendar period 5·5% [95% CI 2·5-8·5]), thyroid (5·4% [3·2-7·6]), cervix (4·5% [2·9-6·2]), and bone (3·2% [2·1-4·4]). In 2012-15, age-standardised 5-year survival for all patients with cancer was higher in urban areas (46·7%, 95% CI 46·5-47·0) than in rural areas (33·6%, 33·3-33·9), except for patients with oesophageal or cervical cancer; but improvements in survival were greater for patients residing in rural areas than in urban areas. Relative survival decreased with increasing age. The increasing trends in survival were consistent with the upward trends of medical expenditure of the country during the period studied. INTERPRETATION: There was a marked overall increase in cancer survival from 2003 to 2015 in the population covered by these cancer registries in China, possibly reflecting advances in the quality of cancer care in these areas. The survival gap between urban and rural areas narrowed over time, although geographical differences in cancer survival remained. Insight into these trends will help prioritise areas that need increased cancer care. FUNDING: National Key R&D Program of China, PUMC Youth Fund and the Fundamental Research Funds for the Central Universities, and Major State Basic Innovation Program of the Chinese Academy of Medical Sciences.

ABSTRACT We develop a method that identifies the attention paid by earnings call participants to firms' climate change exposures. The method adapts a machine learning keyword discovery algorithm and captures exposures related to opportunity, physical, and regulatory shocks associated with climate change. The measures are available for more than 10,000 firms from 34 countries between 2002 and 2020. We show that the measures are useful in predicting important real outcomes related to the net‐zero transition, in particular, job creation in disruptive green technologies and green patenting, and that they contain information that is priced in options and equity markets.

Abstract Understanding the particle size distribution in the air and patterns of environmental contamination of SARS-CoV-2 is essential for infection prevention policies. Here we screen surface and air samples from hospital rooms of COVID-19 patients for SARS-CoV-2 RNA. Environmental sampling is conducted in three airborne infection isolation rooms (AIIRs) in the ICU and 27 AIIRs in the general ward. 245 surface samples are collected. 56.7% of rooms have at least one environmental surface contaminated. High touch surface contamination is shown in ten (66.7%) out of 15 patients in the first week of illness, and three (20%) beyond the first week of illness ( p = 0.01, χ 2 test). Air sampling is performed in three of the 27 AIIRs in the general ward, and detects SARS-CoV-2 PCR-positive particles of sizes >4 µm and 1–4 µm in two rooms, despite these rooms having 12 air changes per hour. This warrants further study of the airborne transmission potential of SARS-CoV-2.

Oxides of nitrogen (NOx) and volatile organic compounds (VOCs) released into the atmosphere can react in the presence of solar irradiation, leading to ozone formation in the troposphere. Historically before clean air regulations were implemented to control NOx and VOCs, ozone concentrations were high enough to exert acute effects such as eye and nose irritation, respiratory disease emergencies, and lung function impairment. At or above current regulatory standards, day-to-day variations in ozone concentrations have been positively associated with asthma incidence and daily non-accidental mortality rate. Emerging evidence has shown that both short-term and long-term exposures to ozone, at concentrations below the current regulatory standards, were associated with increased mortality due to respiratory and cardiovascular diseases. The pathophysiology to support the epidemiologic associations between mortality and morbidity and ozone centers at the chemical and toxicological property of ozone as a strong oxidant, being able to induce oxidative damages to cells and the lining fluids of the airways, and immune-inflammatory responses within and beyond the lung. These new findings add substantially to the existing challenges in controlling ozone pollution. For example, in the United States in 2016, 90% of noncompliance to the national ambient air quality standards was due to ozone whereas only 10% was due to particulate matter and other regulated pollutants. Climate change, through creating atmospheric conditions favoring ozone formation, has been and will continue to increase ozone concentrations in many parts of world. Worldwide, ozone is responsible for several hundreds of thousands premature deaths and tens of million asthma-related emergency room visits annually. To combat ozone pollution globally, more aggressive reductions in fossil fuel consumption are needed to cut NOx and VOCs as well as greenhouse gas emissions. Meanwhile, preventive and therapeutic strategies are needed to alleviate the detrimental effects of ozone especially in more susceptible individuals. Interventional trials in humans are needed to evaluate the efficacy of antioxidants and ozone-scavenging compounds that have shown promising results in animal studies.

BACKGROUND: Salt substitutes with reduced sodium levels and increased potassium levels have been shown to lower blood pressure, but their effects on cardiovascular and safety outcomes are uncertain. METHODS: We conducted an open-label, cluster-randomized trial involving persons from 600 villages in rural China. The participants had a history of stroke or were 60 years of age or older and had high blood pressure. The villages were randomly assigned in a 1:1 ratio to the intervention group, in which the participants used a salt substitute (75% sodium chloride and 25% potassium chloride by mass), or to the control group, in which the participants continued to use regular salt (100% sodium chloride). The primary outcome was stroke, the secondary outcomes were major adverse cardiovascular events and death from any cause, and the safety outcome was clinical hyperkalemia. RESULTS: A total of 20,995 persons were enrolled in the trial. The mean age of the participants was 65.4 years, and 49.5% were female, 72.6% had a history of stroke, and 88.4% a history of hypertension. The mean duration of follow-up was 4.74 years. The rate of stroke was lower with the salt substitute than with regular salt (29.14 events vs. 33.65 events per 1000 person-years; rate ratio, 0.86; 95% confidence interval [CI], 0.77 to 0.96; P = 0.006), as were the rates of major cardiovascular events (49.09 events vs. 56.29 events per 1000 person-years; rate ratio, 0.87; 95% CI, 0.80 to 0.94; P<0.001) and death (39.28 events vs. 44.61 events per 1000 person-years; rate ratio, 0.88; 95% CI, 0.82 to 0.95; P<0.001). The rate of serious adverse events attributed to hyperkalemia was not significantly higher with the salt substitute than with regular salt (3.35 events vs. 3.30 events per 1000 person-years; rate ratio, 1.04; 95% CI, 0.80 to 1.37; P = 0.76). CONCLUSIONS: Among persons who had a history of stroke or were 60 years of age or older and had high blood pressure, the rates of stroke, major cardiovascular events, and death from any cause were lower with the salt substitute than with regular salt. (Funded by the National Health and Medical Research Council of Australia; SSaSS ClinicalTrials.gov number, NCT02092090.).

Importance: Accurate and up-to-date estimates on incidence, prevalence, mortality, and disability-adjusted life-years (burden) of neurological disorders are the backbone of evidence-based health care planning and resource allocation for these disorders. It appears that no such estimates have been reported at the state level for the US. Objective: To present burden estimates of major neurological disorders in the US states by age and sex from 1990 to 2017. Design, Setting, and Participants: This is a systematic analysis of the Global Burden of Disease (GBD) 2017 study. Data on incidence, prevalence, mortality, and disability-adjusted life-years (DALYs) of major neurological disorders were derived from the GBD 2017 study of the 48 contiguous US states, Alaska, and Hawaii. Fourteen major neurological disorders were analyzed: stroke, Alzheimer disease and other dementias, Parkinson disease, epilepsy, multiple sclerosis, motor neuron disease, migraine, tension-type headache, traumatic brain injury, spinal cord injuries, brain and other nervous system cancers, meningitis, encephalitis, and tetanus. Exposures: Any of the 14 listed neurological diseases. Main Outcome and Measure: Absolute numbers in detail by age and sex and age-standardized rates (with 95% uncertainty intervals) were calculated. Results: The 3 most burdensome neurological disorders in the US in terms of absolute number of DALYs were stroke (3.58 [95% uncertainty interval [UI], 3.25-3.92] million DALYs), Alzheimer disease and other dementias (2.55 [95% UI, 2.43-2.68] million DALYs), and migraine (2.40 [95% UI, 1.53-3.44] million DALYs). The burden of almost all neurological disorders (in terms of absolute number of incident, prevalent, and fatal cases, as well as DALYs) increased from 1990 to 2017, largely because of the aging of the population. Exceptions for this trend included traumatic brain injury incidence (-29.1% [95% UI, -32.4% to -25.8%]); spinal cord injury prevalence (-38.5% [95% UI, -43.1% to -34.0%]); meningitis prevalence (-44.8% [95% UI, -47.3% to -42.3%]), deaths (-64.4% [95% UI, -67.7% to -50.3%]), and DALYs (-66.9% [95% UI, -70.1% to -55.9%]); and encephalitis DALYs (-25.8% [95% UI, -30.7% to -5.8%]). The different metrics of age-standardized rates varied between the US states from a 1.2-fold difference for tension-type headache to 7.5-fold for tetanus; southeastern states and Arkansas had a relatively higher burden for stroke, while northern states had a relatively higher burden of multiple sclerosis and eastern states had higher rates of Parkinson disease, idiopathic epilepsy, migraine and tension-type headache, and meningitis, encephalitis, and tetanus. Conclusions and Relevance: There is a large and increasing burden of noncommunicable neurological disorders in the US, with up to a 5-fold variation in the burden of and trends in particular neurological disorders across the US states. The information reported in this article can be used by health care professionals and policy makers at the national and state levels to advance their health care planning and resource allocation to prevent and reduce the burden of neurological disorders.

As public health teams respond to the pandemic of coronavirus disease 2019 (COVID-19), containment and understanding of the modes of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission is of utmost importance for policy making. During this time, governmental agencies have been instructing the community on handwashing and physical distancing measures. However, there is no agreement on the role of aerosol transmission for SARS-CoV-2. To this end, we aimed to review the evidence of aerosol transmission of SARS-CoV-2. Several studies support that aerosol transmission of SARS-CoV-2 is plausible, and the plausibility score (weight of combined evidence) is 8 out of 9. Precautionary control strategies should consider aerosol transmission for effective mitigation of SARS-CoV-2.

The electronic band structure of a semiconductor photocatalyst intrinsically controls its level of conduction band (CB) and valence band (VB) and, thus, influences its activity for different photocatalytic reactions. Here, we report a simple bottom-up strategy to rationally tune the band structure of graphitic carbon nitride (g-C3N4). By incorporating electron-deficient pyromellitic dianhydride (PMDA) monomer into the network of g-C3N4, the VB position can be largely decreased and, thus, gives a strong photooxidation capability. Consequently, the modified photocatalyst shows preferential activity for water oxidation over water reduction in comparison with g-C3N4. More strikingly, the active species involved in the photodegradation of methyl orange switches from photogenerated electrons to holes after band structure engineering. This work may provide guidance on designing efficient polymer photocatalysts with the desirable electronic structure for specific photoreactions.

BackgroundLong-term exposure to pollution can lead to an increase in the rate of decline of lung function, especially in older individuals and in those with chronic obstructive pulmonary disease (COPD), whereas shorter-term exposure at higher pollution levels has been implicated in causing excess deaths from ischaemic heart disease and exacerbations of COPD. We aimed to assess the effects on respiratory and cardiovascular responses of walking down a busy street with high levels of pollution compared with walking in a traffic-free area with lower pollution levels in older adults.MethodsIn this randomised, crossover study, we recruited men and women aged 60 years and older with angiographically proven stable ischaemic heart disease or stage 2 Global initiative for Obstructive Lung Disease (GOLD) COPD who had been clinically stable for 6 months, and age-matched healthy volunteers. Individuals with ischaemic heart disease or COPD were recruited from existing databases or outpatient respiratory and cardiology clinics at the Royal Brompton & Harefield NHS Foundation Trust and age-matched healthy volunteers using advertising and existing databases. All participants had abstained from smoking for at least 12 months and medications were taken as recommended by participants' doctors during the study. Participants were randomly assigned by drawing numbered disks at random from a bag to do a 2 h walk either along a commercial street in London (Oxford Street) or in an urban park (Hyde Park). Baseline measurements of participants were taken before the walk in the hospital laboratory. During each walk session, black carbon, particulate matter (PM) concentrations, ultrafine particles, and nitrogen dioxide (NO2) concentrations were measured.FindingsBetween October, 2012, and June, 2014, we screened 135 participants, of whom 40 healthy volunteers, 40 individuals with COPD, and 39 with ischaemic heart disease were recruited. Concentrations of black carbon, NO2, PM10, PM2.5, and ultrafine particles were higher on Oxford Street than in Hyde Park. Participants with COPD reported more cough (odds ratio [OR] 1·95, 95% CI 0·96–3·95; p<0·1), sputum (3·15, 1·39–7·13; p<0·05), shortness of breath (1·86, 0·97–3·57; p<0·1), and wheeze (4·00, 1·52–10·50; p<0·05) after walking down Oxford Street compared with Hyde Park. In all participants, irrespective of their disease status, walking in Hyde Park led to an increase in lung function (forced expiratory volume in the first second [FEV1] and forced vital capacity [FVC]) and a decrease in pulse wave velocity (PWV) and augmentation index up to 26 h after the walk. By contrast, these beneficial responses were attenuated after walking on Oxford Street. In participants with COPD, a reduction in FEV1 and FVC, and an increase in R5–20 were associated with an increase in during-walk exposure to NO2, ultrafine particles and PM2.5, and an increase in PWV and augmentation index with NO2 and ultrafine particles. In healthy volunteers, PWV and augmentation index were associated both with black carbon and ultrafine particles.InterpretationShort-term exposure to traffic pollution prevents the beneficial cardiopulmonary effects of walking in people with COPD, ischaemic heart disease, and those free from chronic cardiopulmonary diseases. Medication use might reduce the adverse effects of air pollution in individuals with ischaemic heart disease. Policies should aim to control ambient levels of air pollution along busy streets in view of these negative health effects.FundingBritish Heart Foundation.

Background: Cardiovascular disease is the leading cause of death among women worldwide, yet, women have historically been underrepresented in cardiovascular trials. Methods: We systematically assessed the participation of women in completed cardiovascular trials registered in ClinicalTrials.gov between 2010 and 2017, and extracted publicly available information including disease type, sponsor type, country, trial size, intervention type, and the demographic characteristics of trial participants. We calculated the female-to-male ratio for each trial and determined the prevalence-adjusted estimates for participation of women by dividing the percentage of women among trial participants by the percentage of women in the disease population (participation prevalence ratio; a ratio of 0.8 to 1.2 suggests comparable prevalence and good representation). Results: We identified 740 completed cardiovascular trials including a total of 862 652 adults, of whom 38.2% were women. The median female-to-male ratio of each trial was 0.51 (25th quartile, 0.32; 75th quartile, 0.90) overall and varied by age group (1.02 in ≤55 year old group versus 0.40 in the 61- to 65-year-old group), type of intervention (0.44 for procedural trials versus 0.78 for lifestyle intervention trials), disease type (0.34 for acute coronary syndrome versus 3.20 for pulmonary hypertension), region (0.45 for Western Pacific versus 0.55 for the Americas), funding/sponsor type (0.14 for government-funded versus 0.73 for multiple sponsors), and trial size (0.56 for smaller [n≤47] versus 0.49 for larger [n≥399] trials). Relative to their prevalence in the disease population, participation prevalence ratio was higher than 0.8 for hypertension, pulmonary arterial hypertension and lower (participation prevalence ratio 0.48 to 0.78) for arrhythmia, coronary heart disease, acute coronary syndrome, and heart failure trials. The most recent time period (2013 to 2017) saw significant increases in participation prevalence ratios for stroke ( P =0.007) and heart failure ( P =0.01) trials compared with previous periods. Conclusions: Among cardiovascular trials in the current decade, men still predominate overall, but the representation of women varies with disease and trial characteristics, and has improved in stroke and heart failure trials.

Individuals take preventive measures to avoid costly air pollution exposure. This paper provides new empirical evidence of pollution avoidance that Chinese urban residents purchase particulate-filtering facemasks to protect against ambient air pollution. The analysis is conducted with detailed and comprehensive data available on daily facemask purchases and air quality that became available only very recently. We find that this transitory air pollution avoidance behavior exhibits dynamics and nonlinearities, with significant increases of facemask purchases during extreme pollution episodes. The daily model shows that a 100-point increase in Air Quality Index (AQI) increases the consumption of all masks by 54.5 percent and anti-PM2.5 masks by 70.6 percent. The estimates from the aggregated model with flexible pollution levels are used to simulate the benefit of air quality improvement. If 10 percent of heavy pollution days (AQI ≥201) were eliminated, the total savings on facemasks alone would be approximately 187 million USD in China. This result suggests that reducing the occurrence of “airpocalypse” events represents a signifi1cant opportunity to improve social welfare. Nevertheless, our estimates are likely only a small part of the benefit of clean air because facemasks can only partially reduce the negative health effects of air pollution and the costs of other avoidance behaviors are not included.

The IUCN Red List of Threatened Species assesses the extinction risk of nearly 100 000 species, including documentation of a range map, habitat, and elevation data for each species.Numerous recent studies have matched these habitat and elevation data with remotely sensed land cover and elevation datasets to map AOH (also known as extent of suitable habitat) within the range of each species.AOH differs from the two spatial metrics used in the IUCN Red List criteria for extinction risk assessment: EOO (minimum convex polygon around all present native occurrences of a species); and AOO (area actually occupied by a species).AOH can be of value in locating target areas for species-specific field surveys, assessing the proportion of a species’ habitat within protected areas, and monitoring habitat loss and fragmentation. The International Union for Conservation of Nature (IUCN) Red List of Threatened Species includes assessment of extinction risk for 98 512 species, plus documentation of their range, habitat, elevation, and other factors. These range, habitat and elevation data can be matched with terrestrial land cover and elevation datasets to map the species’ area of habitat (AOH; also known as extent of suitable habitat; ESH). This differs from the two spatial metrics used for assessing extinction risk in the IUCN Red List criteria: extent of occurrence (EOO) and area of occupancy (AOO). AOH can guide conservation, for example, through targeting areas for field surveys, assessing proportions of species’ habitat within protected areas, and monitoring habitat loss and fragmentation. We recommend that IUCN Red List assessments document AOH wherever practical. The International Union for Conservation of Nature (IUCN) Red List of Threatened Species includes assessment of extinction risk for 98 512 species, plus documentation of their range, habitat, elevation, and other factors. These range, habitat and elevation data can be matched with terrestrial land cover and elevation datasets to map the species’ area of habitat (AOH; also known as extent of suitable habitat; ESH). This differs from the two spatial metrics used for assessing extinction risk in the IUCN Red List criteria: extent of occurrence (EOO) and area of occupancy (AOO). AOH can guide conservation, for example, through targeting areas for field surveys, assessing proportions of species’ habitat within protected areas, and monitoring habitat loss and fragmentation. We recommend that IUCN Red List assessments document AOH wherever practical. The IUCN Red List of Threatened Species [1International Union for Conservation of Nature The IUCN Red List of Threatened Species (Version 2018-1).2018Google Scholar] aspires to assess the extinction risk of the world’s species, and to serve as a ‘barometer of life’ of the state of nature [2Stuart S.N. et al.The barometer of life.Science. 2010; 328: 177Crossref PubMed Scopus (121) Google Scholar]. Of the approximately 2 million named species [3Scheffers B.R. et al.What we know and don’t know about Earth’s missing biodiversity.Trends Ecol. Evol. 2012; 27: 501-510Abstract Full Text Full Text PDF PubMed Scopus (251) Google Scholar], the IUCN Red List has assessed 98 512 species (having increased from fewer than 20 000 in 2002i). The process of assessment classifies species in different categories of extinction risk. It does so through an open, rigorously defined process [4International Union for Conservation of Nature Rules of Procedure for IUCN Red List Assessments 2017–2020 (Version 3.0).2016Google Scholar] that is objective and transparent. Petitioners can challenge decisions made by Red List Authorities. An important use of the IUCN Red List is the assessment of changes in species extinction risk to monitor changes in the status of individual species, classes and other groups of species, and species-level biodiversity overall [5Butchart S.H.M. et al.Measuring global trends in the status of biodiversity: Red List indices for birds.PLoS Biol. 2004; 2e383Crossref PubMed Scopus (334) Google Scholar, 6Rodrigues A.S.L. et al.Spatially explicit trends in the global conservation status of vertebrates.PLoS One. 2014; 9e113934Crossref PubMed Scopus (49) Google Scholar]. These are essential, for example, in reporting on the Aichi Targets [7Secretariat of the Convention on Biological Diversity Global Biodiversity Outlook 4.Convention on Biological Diversity. 2014Google Scholar] and Sustainable Development Goals [8United Nations The Sustainable Development Goals Report 2017. United Nations, 2017Crossref Google Scholar], as well as progress in conserving species [9Hoffmann M. et al.The impact of conservation on the status of the world’s vertebrates.Science. 2010; 330: 1503-1509Crossref PubMed Scopus (971) Google Scholar]. The need for rigour and consensus in assessing extinction risk can potentially bring the process into conflict with those who seek to harness rapidly expanding geographic databases and remote sensing technologies to assess species’ status [10Ocampo-Peñuela N. Pimm S.L. Setting practical conservation priorities for birds in the Western Andes of Colombia.Conserv. Biol. 2014; 28: 1260-1270Crossref PubMed Scopus (28) Google Scholar, 11Ocampo-Peñuela N. et al.Incorporating explicit geospatial data shows more species at risk of extinction than the current Red List.Sci. Adv. 2016; 2e1601367Crossref PubMed Scopus (67) Google Scholar, 12Ramesh V. et al.IUCN greatly underestimates threat levels of endemic birds in the Western Ghats.Biol. Conserv. 2017; 210: 205-221Crossref Scopus (32) Google Scholar]. Numerous publications have illustrated how increasingly sophisticated and high-resolution regional and global remote sensing and spatial datasets or can the Red List criteria et remote sensing to conservation status assessment: of recent on and the endemic Conserv. Scopus Google Scholar, et of the impact of on the extinction risk of terrestrial Biol. 2016; PubMed Scopus Google Scholar]. The in the of these data the with to process has the of for of the of and for terrestrial It is to and how AOH is how to the Red List and of in we that AOH is to extent of occurrence (EOO) to area of occupancy (AOO). the area of the convex polygon around a species’ AOH can be used to the of a species’ AOH is at a 2 2 can be used to the of We by the of of terrestrial species’ area of habitat in conservation, for through targeting areas for field surveys, assessing proportions of species’ habitat within protected areas, monitoring habitat loss and and Red List different criteria are used to assess a species’ extinction risk Union for Conservation of Nature IUCN Red List and (Version Scholar]. for terrestrial species et of extinction risk assessment with the IUCN Red 2016; PubMed Scopus Google Scholar], the is the of plus of at two of or spatial metrics of are defined for of of have that are and Union for Conservation of Nature IUCN Red List and (Version Scholar]. EOO is the area within the that can be to all the current known as well as occurrence and occurrence of a species AOO is the area occupied by a species The of EOO is to the to from are the geographic Union for Conservation of Nature and for the IUCN Red List and (Version Scholar], the of AOO is a of the that within or a or are from explicit Union for Conservation of Nature and for the IUCN Red List and (Version Scholar]. the IUCN Red EOO be as the convex polygon that includes all the occupied areas Union for Conservation of Nature and for the IUCN Red List and (Version Scholar, et of metrics on of extent of occurrence for extinction risk Biol. 2016; PubMed Scopus Google Scholar]. AOO be at a of 2 2 Union for Conservation of Nature and for the IUCN Red List and (Version Scholar, et range to for of to Biol. PubMed Scopus Google Scholar]. The is more of for species with and used of and assessed as the and [1International Union for Conservation of Nature The IUCN Red List of Threatened Species (Version 2018-1).2018Google Scholar]. a species for the EOO is 000 and is of at two of on or more of extent of habitat, of or or or the categories have for and the of The for AOO are of the for for example, for documentation for the IUCN Red List also includes the of a and elevation, and of a range map Union for Conservation of Nature and for IUCN Red List Assessments and Species (Version Scholar]. range has an the range map to the current known of the within native The of are known occurrences of the and of habitat suitable habitat, elevation Union for Conservation of Nature and for IUCN Red List Assessments and Species (Version Scholar] the range and of spatial data to a species’ Union for Conservation of Nature and for IUCN Red List Assessments and Species (Version Scholar] current range from areas the species has The have a in the of regional and global spatial data that are in geographic to the and of of species These global of elevation at et for the Scholar], global a to global land cover from Scopus Google Scholar], and global cover at et global of cover PubMed Scopus Google Scholar, et of of with of Scopus Google Scholar]. species’ habitat as by of the IUCN Red List to these can be with the range map of terrestrial species to the area of habitat within a species’ has used the to et remote sensing to conservation status assessment: of recent on and the endemic Conserv. Scopus Google Scholar, et of the impact of on the extinction risk of terrestrial Biol. 2016; PubMed Scopus Google Scholar, et of metrics on of extent of occurrence for extinction risk Biol. 2016; PubMed Scopus Google Scholar, Union for Conservation of Nature Global for the of Biodiversity (Version International Union for Conservation of Scholar], we the AOH the is a by suitable for the species in area is more than the as in extent of AOH is defined as the habitat to a species, that habitat within in AOH is on range, habitat and the areas to be suitable for the species within to have used to The [10Ocampo-Peñuela N. Pimm S.L. Setting practical conservation priorities for birds in the Western Andes of Colombia.Conserv. Biol. 2014; 28: 1260-1270Crossref PubMed Scopus (28) Google Scholar, 11Ocampo-Peñuela N. et al.Incorporating explicit geospatial data shows more species at risk of extinction than the current Red List.Sci. Adv. 2016; 2e1601367Crossref PubMed Scopus (67) Google Scholar, 12Ramesh V. et al.IUCN greatly underestimates threat levels of endemic birds in the Western Ghats.Biol. Conserv. 2017; 210: 205-221Crossref Scopus (32) Google Scholar, et remote sensing to conservation status assessment: of recent on and the endemic Conserv. Scopus Google Scholar, et of the impact of on the extinction risk of terrestrial Biol. 2016; PubMed Scopus Google Scholar, et of metrics on of extent of occurrence for extinction risk Biol. 2016; PubMed Scopus Google Scholar, et the of species’ range and in the protected area Conserv. Scopus Google Scholar, et sensed data Red List and conservation priorities in One. 2016; Google Scholar, et the of protected areas and birds in Conserv. Scopus (67) Google Scholar, et al.Incorporating into conservation in Scopus Google Scholar, et areas for a global assessment for birds.PLoS One. PubMed Scopus Google Scholar, S.H.M. et and for and global conservation area Scopus Google Scholar, et the world’s a assessment of all and One. PubMed Scopus Google Scholar, Pimm S.L. and extinction risk in Biol. PubMed Scopus Google Scholar, Pimm S.L. endemic the of the Biol. 2016; PubMed Scopus Google Scholar, et and the in conservation for Biol. Scopus Google Scholar, et of in the more species than the current Red One. PubMed Scopus Google Scholar, et global biodiversity 2016; Scopus Google Scholar] has to use geographic to those areas in a map that within the range of a terrestrial within the of the of the species’ and that map to the known habitat of the have the to as suitable or of by of or have also for a et habitat of terrestrial PubMed Scopus Google Scholar, et the world’s a assessment of all and One. PubMed Scopus Google et et habitat of terrestrial PubMed Scopus Google Scholar] and et et for and extinction a global Scopus Google Scholar] used a different the habitat of all classes of areas and as or on the to habitat and a for of to habitat or for classes in more for species is to within a to all areas than from as used all from remote sensing and Global et the of species’ range and in the protected area Conserv. Scopus Google Scholar, et the world’s a assessment of all and One. PubMed Scopus Google Scholar, Pimm S.L. and extinction risk in Biol. PubMed Scopus Google Scholar] and et habitat of terrestrial PubMed Scopus Google Scholar, et for and extinction a global Scopus Google Scholar]. the classes of these are matched to habitat for from in the by these to to of AOH these is increasingly as AOH for the and so from to species or Species and Scopus Google Scholar, et and Google Scholar], as and et and the in conservation for Biol. Scopus Google Scholar]. these areas than the of a species S.L. et of to et Biol. 2017; PubMed Scopus Google Scholar], and so be than AOH for conservation can be of a species current for example, in Union for Conservation of Nature and for the IUCN Red List and (Version Scholar]. of the area a value of or on the of the be on the of the of of the or on and Union for Conservation of Nature and for the IUCN Red List and (Version Scholar, et species for data and to Ecol. Scopus Google Scholar]. to species also into et process for Ecol. Evol. Scopus Google Scholar, et range of Ecol. Evol. 2016; Full Text Full Text PDF PubMed Scopus Google Scholar, et a to assess the and conservation status of the 2017; Scopus (28) Google Scholar]. have used to The [10Ocampo-Peñuela N. Pimm S.L. Setting practical conservation priorities for birds in the Western Andes of Colombia.Conserv. Biol. 2014; 28: 1260-1270Crossref PubMed Scopus (28) Google Scholar, 11Ocampo-Peñuela N. et al.Incorporating explicit geospatial data shows more species at risk of extinction than the current Red List.Sci. Adv. 2016; 2e1601367Crossref PubMed Scopus (67) Google Scholar, 12Ramesh V. et al.IUCN greatly underestimates threat levels of endemic birds in the Western Ghats.Biol. Conserv. 2017; 210: 205-221Crossref Scopus (32) Google Scholar, et remote sensing to conservation status assessment: of recent on and the endemic Conserv. Scopus Google Scholar, et of the impact of on the extinction risk of terrestrial Biol. 2016; PubMed Scopus Google Scholar, et of metrics on of extent of occurrence for extinction risk Biol. 2016; PubMed Scopus Google Scholar, et the of species’ range and in the protected area Conserv. Scopus Google Scholar, et sensed data Red List and conservation priorities in One. 2016; Google Scholar, et the of protected areas and birds in Conserv. Scopus (67) Google Scholar, et al.Incorporating into conservation in Scopus Google Scholar, et areas for a global assessment for birds.PLoS One. PubMed Scopus Google Scholar, S.H.M. et and for and global conservation area Scopus Google Scholar, et the world’s a assessment of all and One. PubMed Scopus Google Scholar, Pimm S.L. and extinction risk in Biol. PubMed Scopus Google Scholar, Pimm S.L. endemic the of the Biol. 2016; PubMed Scopus Google Scholar, et and the in conservation for Biol. Scopus Google Scholar, et of in the more species than the current Red One. PubMed Scopus Google Scholar, et global biodiversity 2016; Scopus Google Scholar] has to use geographic to those areas in a map that within the range of a terrestrial within the of the of the species’ and that map to the known habitat of the have the to as suitable or of by of or have also for a et habitat of terrestrial PubMed Scopus Google Scholar, et the world’s a assessment of all and One. PubMed Scopus Google Scholar]. et et habitat of terrestrial PubMed Scopus Google Scholar] and et et for and extinction a global Scopus Google Scholar] used a different the habitat of all classes of areas and as or on the to habitat and a for of to habitat or for classes in more for species is to within a to all areas than from as The used all from remote sensing and Global et the of species’ range and in the protected area Conserv. Scopus Google Scholar, et the world’s a assessment of all and One. PubMed Scopus Google Scholar, Pimm S.L. and extinction risk in Biol. PubMed Scopus Google Scholar] and et habitat of terrestrial PubMed Scopus Google Scholar, et for and extinction a global Scopus Google Scholar]. the classes of these are matched to habitat for from in the by these to to of AOH these is increasingly as We AOH for the and so from to species or Species and Scopus Google Scholar, et and Google Scholar], as and et and the in conservation for Biol. Scopus Google Scholar]. these areas than the of a species S.L. et of to et Biol. 2017; PubMed Scopus Google Scholar], and so be than AOH for conservation can be of a species current for example, in Union for Conservation of Nature and for the IUCN Red List and (Version Scholar]. of the area a value of or on the of the be on the of the of of the or on and Union for Conservation of Nature and for the IUCN Red List and (Version Scholar, et species for data and to Ecol. Scopus Google Scholar]. to species also into et process for Ecol. Evol. Scopus Google Scholar, et range of Ecol. Evol. 2016; Full Text Full Text PDF PubMed Scopus Google Scholar, et a to assess the and conservation status of the 2017; Scopus (28) Google Scholar]. for the International IUCN Red List for a species endemic to in the the EOO is as and the range as the AOH is to be is known for the It is of species for the AOH of the range N. et al.Incorporating explicit geospatial data shows more species at risk of extinction than the current Red List.Sci. Adv. 2016; 2e1601367Crossref PubMed Scopus (67) Google Scholar]. et et the of species’ range and in the protected area Conserv. Scopus Google Scholar] a of for species of et et habitat of terrestrial PubMed Scopus Google Scholar] to be for terrestrial species, et et sensed data Red List and conservation priorities in One. 2016; Google Scholar] of for for and for The of et et of the impact of on the extinction risk of terrestrial Biol. 2016; PubMed Scopus Google Scholar] AOH of range species, species and the and range of and of AOH within range to to different and to the used for habitat for each for species assessed as the can be of the range N. et al.Incorporating explicit geospatial data shows more species at risk of extinction than the current Red List.Sci. Adv. 2016; 2e1601367Crossref PubMed Scopus (67) Google Scholar]. We that AOH is to EOO to AOO N. et al.Incorporating explicit geospatial data shows more species at risk of extinction than the current Red List.Sci. Adv. 2016; 2e1601367Crossref PubMed Scopus (67) Google Scholar, et in different of species occurrence data for use in conservation PubMed Scopus Google Scholar]. as in the IUCN and Union for Conservation of Nature and for the IUCN Red List and (Version Scholar], AOH be to the for EOO or AOO used for the extinction risk of a species on the IUCN Red List example, of AOH with the IUCN Red List EOO the of species potentially each Red List a species’ AOH can to EOO and AOO as The area of the convex polygon convex that includes a species’ AOH within or of an to the of at a 2 2 is an on the of The for example, et et of the impact of on the extinction risk of terrestrial Biol. 2016; PubMed Scopus Google Scholar], who used to extinction risk assessments for and species in AOH to changes are in extent and to changes in land use by and from as well as in as to and of species’ habitat in AOH changes to can be used to of the of Red List et remote sensing to conservation status assessment: of recent on and the endemic Conserv. Scopus Google Scholar, et of the impact of on the extinction risk of terrestrial Biol. 2016; PubMed Scopus Google Scholar, assessment of extinction 2012; PubMed Scopus Google Scholar], trends can of the Red List [5Butchart S.H.M. et al.Measuring global trends in the status of biodiversity: Red List indices for birds.PLoS Biol. 2004; 2e383Crossref PubMed Scopus (334) Google Scholar, S.H.M. et to the Red List One. PubMed Scopus Google Scholar] into the et global biodiversity 2016; Scopus Google Scholar]. are on data from remote these be assessments of than the of from how habitat changes species of for example, global a important of AOH AOH can important into how a terrestrial species’ habitat be M. et of has a global impact on 2017; PubMed Scopus Google Scholar]. has that species in the extent of their habitat and that can be in et of in the more species than the current Red One. PubMed Scopus Google Scholar, et of habitat extinction risk in terrestrial 2017; PubMed Scopus Google Scholar]. does to as defined in the IUCN Red List the has a that to of habitat Union for Conservation of Nature and for the IUCN Red List and (Version Scholar] are a of of in AOH including the the range the range of the species, or areas within the species is the or the range occupied by the species at for species with that the and their for the species or occupied and or their the map a proportion of have in to the classes and habitat the of geographic for habitat for example, of for and the of the geographic and the species’ of the a species use a habitat that is is than the map a species use a of habitat is by et et the of protected areas and birds in Conserv. Scopus (67) Google Scholar] to the of by the and for AOH range data on known occurrences of species in important and biodiversity that AOH more for of species, and for to an in these et et for and extinction a global Scopus Google Scholar] assessed the of AOH for species a of data from the Global Biodiversity that of occurrence within of a as or et et habitat of terrestrial PubMed Scopus Google Scholar] that for terrestrial species with of occurrences within the and for of species, the AOH occurrences than the are important to the of all AOH et to species’ Biol. 2017; Scopus Google Scholar] of AOH for a species does on a area is or is occupied by that from or to the a species does a area be the within the AOH as in habitat the also to assess the of AOH to species terrestrial Species with as and species, to habitat at than those in the IUCN Red List or in remotely sensed the of remotely sensed data for and to habitat The IUCN Red List criteria use changes in habitat to to are with AOH in on elevation, of the changes in the of species with habitat on for example, or species Union for Conservation of Nature and for the IUCN Red List and (Version Scholar] of habitat of changes in land use by or changes in land cover as a of and changes be into AOH global et global terrestrial to in a Google Scholar]. these AOH are into Red List are by on a are for use in IUCN Red List assessments et of the impact of on the extinction risk of terrestrial Biol. 2016; PubMed Scopus Google Scholar, International IUCN Red List for Scholar]. of each species’ AOH map data This is increasingly with the of as and et to species’ Biol. 2017; Scopus Google Scholar], that of these data S.L. et of to et Biol. 2017; PubMed Scopus Google Scholar]. the of the IUCN Red List and in remote sensing has the of data on land cover and and these data are in biodiversity conservation for Conservation from and Google Scholar]. It to these data to guide conservation in and to the of the IUCN Red List and these data are and of known are to use these data are to be species, or need to be and of the AOH is a the of AOH about terrestrial species that is and AOH assessments can be of value for conservation locating target areas for species-specific field to the of biodiversity areas Union for Conservation of Nature Global for the of Biodiversity (Version International Union for Conservation of Scholar] and assessing the proportion of habitat for species that within protected areas Nations Conservation and International Union for Conservation of Nature Scholar]. AOH conservation priorities can serve as into as with the IUCN Red List et risk and conservation PubMed Google Scholar, A.S.L. et al.The value of the IUCN Red List for Ecol. Evol. Full Text Full Text PDF PubMed Scopus Google Scholar]. AOH and Pimm [10Ocampo-Peñuela N. Pimm S.L. Setting practical conservation priorities for birds in the Western Andes of Colombia.Conserv. Biol. 2014; 28: 1260-1270Crossref PubMed Scopus (28) Google Scholar] priorities for conservation in the to on their land The process to on the of the to a of species Pimm S.L. endemic the of the Biol. 2016; PubMed Scopus Google Scholar]. of habitat for species are a to the of databases of conservation areas in of AOH also the of species in et al.The value of the IUCN Red List for Scopus Google Scholar]. of for species and need to be by for species assessed for the IUCN Red more rapidly and with these AOH are with habitat conservation can species changes and areas of habitat loss and conservation is AOH is a to the of species, monitoring habitat and conservation for the IUCN Red List includes a range map as This and IUCN Red List to to map species’ as as we that range and increasingly to as and to map with to for species with known and terrestrial AOH are and with the of to global is to for of AOH in and We recommend that AOH and changes in these be of the in a species’ IUCN Red List assessment wherever are species’ to global and how these changes impact extinction This be global and potentially to of from assessment can AOH be in and This of a global map of areas into categories that can be to the IUCN habitat for and data be used in a to the in elevation data are used for terrestrial the of AOH the of species’ habitat and how does to of the for in the IUCN Red List of the of are the in the of these with habitat and how can these be can AOH be to target to data known for a species, and in species occurrence databases as the Global Biodiversity are species’ to global and how these changes impact extinction This be global and potentially to of from assessment can AOH be in and This of a global map of areas into categories that can be to the IUCN habitat for and data be used in a to the in elevation data are used for terrestrial the of AOH the of species’ habitat and how does to of the for in the IUCN Red List of the of are the in the of these with habitat and how can these be can AOH be to target to data known for a species, and in species occurrence databases as the Global Biodiversity We are to and for their the used in and for data from the IUCN Red and and for on the with habitat to a species, that habitat within known as This is with the of habitat as by and that is by a species’ Union for Conservation of Nature and for the IUCN Red List and (Version Scholar]. is occupied by a of Union for Conservation of Nature IUCN Red List and (Version Scholar], as the occupied of a with the of within the can be to all the or of present occurrence of a of Union for Conservation of Nature IUCN Red List and (Version Scholar], as the convex polygon that includes all native of occurrence of a and of habitat and other Union for Conservation of Nature and for the IUCN Red List and (Version Scholar]. from are of the Union for Conservation of Nature and for the IUCN Red List and (Version Scholar]. of occurrence of a in the of habitat or Union for Conservation of Nature and for the IUCN Red List and (Version Scholar]. the current of of a species, for all or of Union for Conservation of Nature Global for the of Biodiversity (Version International Union for Conservation of Scholar]. species or is known to be Union for Conservation of Nature and for IUCN Red List Assessments and Species (Version Scholar]

The field of computer vision is experiencing a great-leap-forward development today. This paper aims at providing a comprehensive survey of the recent progress on computer vision algorithms and their corresponding hardware implementations. In particular, the prominent achievements in computer vision tasks such as image classification, object detection and image segmentation brought by deep learning techniques are highlighted. On the other hand, review of techniques for implementing and optimizing deep-learning-based computer vision algorithms on GPU, FPGA and other new generations of hardware accelerators are presented to facilitate real-time and/or energy-efficient operations. Finally, several promising directions for future research are presented to motivate further development in the field.

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.

In this paper, we explore the encoding/pooling layer and loss function in the end-to-end speaker and language recognition system.First, a unified and interpretable end-to-end system for both speaker and language recognition is developed.It accepts variable-length input and produces an utterance level result.In the end-to-end system, the encoding layer plays a role in aggregating the variable-length input sequence into an utterance level representation.Besides the basic temporal average pooling, we introduce a self-attentive pooling layer and a learnable dictionary encoding layer to get the utterance level representation.In terms of loss function for open-set speaker verification, to get more discriminative speaker embedding, center loss and angular softmax loss is introduced in the end-to-end system.Experimental results on Voxceleb and NIST LRE 07 datasets show that the performance of end-to-end learning system could be significantly improved by the proposed encoding layer and loss function.

China has implemented an emission trading system (ETS) to reduce its ever-increasing greenhouse gas emissions while maintaining rapid economic growth. With low carbon prices and infrequent allowance trading, whether China's ETS is an effective approach for climate mitigation has entered the center of the policy and research debate. Utilizing China's regional ETS pilots as a quasi-natural experiment, we provide a comprehensive assessment of the effects of ETS on firm carbon emissions and economic outcomes by means of a matched difference-in-differences (DID) approach. The empirical analysis is based on a unique panel dataset of firm tax records in the manufacturing and public utility sectors during 2009 to 2015. We show unambiguous evidence that the regional ETS pilots are effective in reducing firm emissions, leading to a 16.7% reduction in total emissions and a 9.7% reduction in emission intensity. Regulated firms achieve emission abatement through conserving energy consumption and switching to low-carbon fuels. The economic consequences of the ETS are mixed. On one hand, the ETS has a negative impact on employment and capital input; on the other hand, the ETS incentivizes regulated firms to improve productivity. In the aggregate, the ETS does not exhibit statistically significant effects on output and export. We also find that the ETS displays notable heterogeneity across pilots. Mass-based allowance allocation rules, higher carbon prices, and active allowance trading contribute to more pronounced effects in emission abatement.

The lives lost and economic costs of viral zoonotic pandemics have steadily increased over the past century. Prominent policymakers have promoted plans that argue the best ways to address future pandemic catastrophes should entail, "detecting and containing emerging zoonotic threats." In other words, we should take actions only after humans get sick. We sharply disagree. Humans have extensive contact with wildlife known to harbor vast numbers of viruses, many of which have not yet spilled into humans. We compute the annualized damages from emerging viral zoonoses. We explore three practical actions to minimize the impact of future pandemics: better surveillance of pathogen spillover and development of global databases of virus genomics and serology, better management of wildlife trade, and substantial reduction of deforestation. We find that these primary pandemic prevention actions cost less than 1/20th the value of lives lost each year to emerging viral zoonoses and have substantial cobenefits.

BACKGROUND: During the validation of a highly sensitive panspecies coronavirus (CoV) seminested reverse-transcription polymerase chain reaction (RT-PCR) assay, we found canine CoV (CCoV) RNA in nasopharyngeal swab samples from 8 of 301 patients (2.5%) hospitalized with pneumonia during 2017-2018 in Sarawak, Malaysia. Most patients were children living in rural areas with frequent exposure to domesticated animals and wildlife. METHODS: Specimens were further studied with universal and species-specific CoV and CCoV 1-step RT-PCR assays, and viral isolation was performed in A72 canine cells. Complete genome sequencing was conducted using the Sanger method. RESULTS: Two of 8 specimens contained sufficient amounts of CCoVs as confirmed by less-sensitive single-step RT-PCR assays, and 1 specimen demonstrated cytopathic effects in A72 cells. Complete genome sequencing of the virus causing cytopathic effects identified it as a novel canine-feline recombinant alphacoronavirus (genotype II) that we named CCoV-human pneumonia (HuPn)-2018. Most of the CCoV-HuPn-2018 genome is more closely related to a CCoV TN-449, while its S gene shared significantly higher sequence identity with CCoV-UCD-1 (S1 domain) and a feline CoV WSU 79-1683 (S2 domain). CCoV-HuPn-2018 is unique for a 36-nucleotide (12-amino acid) deletion in the N protein and the presence of full-length and truncated 7b nonstructural protein, which may have clinical relevance. CONCLUSIONS: This is the first report of a novel canine-feline recombinant alphacoronavirus isolated from a human patient with pneumonia. If confirmed as a pathogen, it may represent the eighth unique coronavirus known to cause disease in humans. Our findings underscore the public health threat of animal CoVs and a need to conduct better surveillance for them.