Research papers

Biology, Diversity, Detection and Management of Fusarium oxysporum f. sp. niveum Causing Vascular Wilt Disease of Watermelon (Citrullus lanatus): A Review

Muhammad Ziaur Rahman, Khairulmazmi Ahmad, Abdulaziz Bashir Kutawa, Yasmeen Siddiqui, Norsazilawati Saad, Tan Geok Hun, Erne…

Fusarium oxysporum f. sp. niveum (Fon) is the causative agent of Fusarium wilt disease of watermelon; it is the most serious soil-borne pathogen around the globe. The yield loss is around 30–80% or even more, and is presently a major hindrance to watermelon cultivation worldwide. Initially, the infected watermelon plant shows symptoms like loss of turgor pressure of the leaves and vines that can be recovered at night. The progress of the disease in contaminated transplants turns into dull green to yellow and finally necrotic. When the fungus continues to colonize the xylem vessel, it usually forms more tyloses, finally limiting water movement and causing wilt. The correct identification of the pathogen is necessary for proper disease control. As such, the selection of a molecular marker could serve as an effective means of screening the pathogen. Additionally, different methods have also been reported for the identification of Fon. Therefore, this review focused on the comprehensive description of the biology, diversity, detection, aggressiveness, mycotoxin production, and eco-friendly management strategies of the Fusarium wilt disease of watermelon.

Attitude of Students Towards the Study of Physics: A Case of Tamale College of Education, Ghana.

Moses Kojo Asare Mabee, Tahiru Zingani Haruna, Abdallah Salifu

The study examined the attitude of third-year science and mathematics students towards the study of Physics in the Tamale College of Education, Ghana. A case study involving a sample of one hundred and thirty–three students was adopted for the study. Using a structured questionnaire, data was collected from the selected sample. The Likert rating scale was adopted to indicate the extent of agreement or disagreement. General findings from the study indicated that the majority of the respondents had a negative perception towards the study of Physics. The research recommended that preferably only students who offered Elective Physics at the Senior High School level should be admitted to study Physics at the College level as this would facilitate the smooth teaching and learning of the subject. It was also suggested that Physics tutors should use innovative strategies to make the teaching and learning of the subject interesting and attractive. Keywords: Physics, attitude, students, tutor, positive, negative.

Physics-informed machine learning

George Em Karniadakis, Ioannis G. Kevrekidis, Lu Lu, Paris Perdikaris, Sifan Wang, Liu Yang

Genome-wide association study of more than 40,000 bipolar disorder cases provides new insights into the underlying biology

Niamh Mullins, Andreas J. Forstner, Kevin S. O’Connell, Brandon J. Coombes, Jonathan R. I. Coleman, Zhen Qiao, Thomas D. Als…

Bipolar disorder is a heritable mental illness with complex etiology. We performed a genome-wide association study of 41,917 bipolar disorder cases and 371,549 controls of European ancestry, which identified 64 associated genomic loci. Bipolar disorder risk alleles were enriched in genes in synaptic signaling pathways and brain-expressed genes, particularly those with high specificity of expression in neurons of the prefrontal cortex and hippocampus. Significant signal enrichment was found in genes encoding targets of antipsychotics, calcium channel blockers, antiepileptics and anesthetics. Integrating expression quantitative trait locus data implicated 15 genes robustly linked to bipolar disorder via gene expression, encoding druggable targets such as HTR6, MCHR1, DCLK3 and FURIN. Analyses of bipolar disorder subtypes indicated high but imperfect genetic correlation between bipolar disorder type I and II and identified additional associated loci. Together, these results advance our understanding of the biological etiology of bipolar disorder, identify novel therapeutic leads and prioritize genes for functional follow-up studies. Genome-wide association analyses of 41,917 bipolar disorder cases and 371,549 controls of European ancestry provide new insights into the etiology of this disorder and identify novel therapeutic leads and potential opportunities for drug repurposing.

End-to-End Physics Event Generator

Yasir Alanazi

We apply generative adversarial network (GAN) technology to build an event generator that simulates particle production in electron-proton scattering that is free of theoretical assumptions about underlying particle dynamics. The difficulty of efficiently training a GAN event simulator lies in learning the complicated pat- terns of the distributions of the particles physical properties. We develop a GAN that selects a set of transformed features from particle momenta that can be generated easily by the generator, and uses these to produce a set of augmented features that improve the sensitivity of the discriminator. The new Feature-Augmented and Transformed GAN (FAT-GAN) is able to faithfully reproduce the distribution of final state electron momenta in inclusive electron scattering, without the need for input derived from domain-based theoretical assumptions. The developed technology can play a significant role in boosting the science of the Jefferson Lab 12 GeV program and the future Electron-Ion Collider.

Maternal and Neonatal Morbidity and Mortality Among Pregnant Women With and Without COVID-19 Infection

José Villar, Shabina Ariff, Robert B. Gunier, Ramachandran Thiruvengadam, Stephen Rauch, Kholin A.M. Kholin, Paola Roggero, …

Importance: Detailed information about the association of COVID-19 with outcomes in pregnant individuals compared with not-infected pregnant individuals is much needed. Objective: To evaluate the risks associated with COVID-19 in pregnancy on maternal and neonatal outcomes compared with not-infected, concomitant pregnant individuals. Design, Setting, and Participants: In this cohort study that took place from March to October 2020, involving 43 institutions in 18 countries, 2 unmatched, consecutive, not-infected women were concomitantly enrolled immediately after each infected woman was identified, at any stage of pregnancy or delivery, and at the same level of care to minimize bias. Women and neonates were followed up until hospital discharge. Exposures: COVID-19 in pregnancy determined by laboratory confirmation of COVID-19 and/or radiological pulmonary findings or 2 or more predefined COVID-19 symptoms. Main Outcomes and Measures: The primary outcome measures were indices of (maternal and severe neonatal/perinatal) morbidity and mortality; the individual components of these indices were secondary outcomes. Models for these outcomes were adjusted for country, month entering study, maternal age, and history of morbidity. Results: A total of 706 pregnant women with COVID-19 diagnosis and 1424 pregnant women without COVID-19 diagnosis were enrolled, all with broadly similar demographic characteristics (mean [SD] age, 30.2 [6.1] years). Overweight early in pregnancy occurred in 323 women (48.6%) with COVID-19 diagnosis and 554 women (40.2%) without. Women with COVID-19 diagnosis were at higher risk for preeclampsia/eclampsia (relative risk [RR], 1.76; 95% CI, 1.27-2.43), severe infections (RR, 3.38; 95% CI, 1.63-7.01), intensive care unit admission (RR, 5.04; 95% CI, 3.13-8.10), maternal mortality (RR, 22.3; 95% CI, 2.88-172), preterm birth (RR, 1.59; 95% CI, 1.30-1.94), medically indicated preterm birth (RR, 1.97; 95% CI, 1.56-2.51), severe neonatal morbidity index (RR, 2.66; 95% CI, 1.69-4.18), and severe perinatal morbidity and mortality index (RR, 2.14; 95% CI, 1.66-2.75). Fever and shortness of breath for any duration was associated with increased risk of severe maternal complications (RR, 2.56; 95% CI, 1.92-3.40) and neonatal complications (RR, 4.97; 95% CI, 2.11-11.69). Asymptomatic women with COVID-19 diagnosis remained at higher risk only for maternal morbidity (RR, 1.24; 95% CI, 1.00-1.54) and preeclampsia (RR, 1.63; 95% CI, 1.01-2.63). Among women who tested positive (98.1% by real-time polymerase chain reaction), 54 (13%) of their neonates tested positive. Cesarean delivery (RR, 2.15; 95% CI, 1.18-3.91) but not breastfeeding (RR, 1.10; 95% CI, 0.66-1.85) was associated with increased risk for neonatal test positivity. Conclusions and Relevance: In this multinational cohort study, COVID-19 in pregnancy was associated with consistent and substantial increases in severe maternal morbidity and mortality and neonatal complications when pregnant women with and without COVID-19 diagnosis were compared. The findings should alert pregnant individuals and clinicians to implement strictly all the recommended COVID-19 preventive measures.

performance: An R Package for Assessment, Comparison and Testing of Statistical Models

Daniel Lüdecke, Mattan S. Ben‐Shachar, Indrajeet Patil, Philip Waggoner, Dominique Makowski

A crucial part of statistical analysis is evaluating a model's quality and fit, or performance. During analysis, especially with regression models, investigating the fit of models to data also often involves selecting the best fitting model amongst many competing models. Upon investigation, fit indices should also be reported both visually and numerically to bring readers in on the investigative effort.

The PRISMA 2020 statement: an updated guideline for reporting systematic reviews

Matthew J. Page, Joanne E. McKenzie, Patrick M. Bossuyt, Isabelle Boutron, Tammy Hoffmann, Cynthia D. Mulrow, Larissa Shamse…

The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement, published in 2009, was designed to help systematic reviewers transparently report why the review was done, what the authors did, and what they found. Over the past decade, advances in systematic review methodology and terminology have necessitated an update to the guideline. The PRISMA 2020 statement replaces the 2009 statement and includes new reporting guidance that reflects advances in methods to identify, select, appraise, and synthesise studies. The structure and presentation of the items have been modified to facilitate implementation. In this article, we present the PRISMA 2020 27-item checklist, an expanded checklist that details reporting recommendations for each item, the PRISMA 2020 abstract checklist, and the revised flow diagrams for original and updated reviews.

Professional image of nursing and midwifery in East Africa: an exploratory analysis

Eunice Ndirangu‐Mugo, Ahmed M. Sarki, Columba Mbekenga, Grace Edwards

BACKGROUND: Evidence suggests that there is a negative image of nursing and midwifery that does not promote these professions as attractive career options. Furthermore, there is a paucity of studies documenting how nursing and midwifery is perceived in East Africa and where such studies exist they are country-specific. The aim of this study was to explore views regarding the image of nursing and midwifery among nurses and midwives in three East African countries, Kenya, Tanzania and Uganda. METHODS: An exploratory descriptive cross-sectional study administered online using Survey Monkey Questionnaires assessed the views and perceptions of nurses and midwives regarding the image of nursing and midwifery professions. Descriptive statistics and Pearson's Chi square tests were used to analyse the data. The semi-structured questions were analysed using content analysis. RESULTS: A total of 551 participants took part in the study. The majority were females (61.8%), registered nurses/midwives (45.8%), and aged 30-39 years (34.2%). Most of the respondents were from Kenya (39.7%) and Uganda (32.9%). About two-thirds of the nurses and midwives in this study perceived nursing/midwifery as both trusted and respected professions and expressed having a level of control over how their image was portrayed. Conversely, the nurses and midwives were conscious that the public had mixed responses about the nursing/midwifery professions specifically, some members of the public described nurses/midwives as professionals, knowledgeable and caring, others perceived nurses/midwives to be rude, cruel, unkind, lazy, unkempt, and maids. CONCLUSION: This study offers an interesting insight about the image of nursing/midwifery in East Africa. Findings from this study will inform policy makers and educators about key concepts that affect the image of nursing and midwifery in East Africa. The findings will be used to design marketing materials to help improve the image of nursing and midwifery in the region and other African countries.

A Call to the CMS: Mandate Adequate Professional Nurse Staffing in Nursing Homes

Ann Kolanowski, Tara Cortes, Christine Mueller, Barbara J. Bowers, Marie Boltz, Debra Bakerjian, Charlene Harrington, Lori P…

Editor's note: This article is by 22 nursing gerontology experts who are all advocates of nursing home reform. They are listed at the end of this article.

The Lancet Global Health Commission on Global Eye Health: vision beyond 2020

Matthew J. Burton, Jacqueline Ramke, Ana Patrícia Marques, Rupert Bourne, Nathan Congdon, Iain Jones, Brandon A M Ah Tong, S…

There is extensive evidence showing that improving eye health contributes directly and indirectly to achieving many Sustainable Development Goals, including reducing poverty and improving work productivity, general and mental health, and education and equity. Improving eye health is a practical and cost-effective way of unlocking human potential. Eye health needs to be reframed as an enabling, cross-cutting issue within the sustainable development framework.

Stable and functional solutions of the Klein-Fock-Gordon equation with nonlinear physical phenomena

Md. Nur Alam, Ebenezer Bonyah, Md Fayz-Al-Asad, M.S. Osman, Kholod M. Abualnaja

Abstract The present article uses a modified <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" overflow="scroll"> <mml:mfenced close=")" open="("> <mml:mrow> <mml:mstyle displaystyle="false"> <mml:mfrac> <mml:mrow> <mml:mi>G</mml:mi> <mml:mo accent="false">′</mml:mo> </mml:mrow> <mml:mrow> <mml:mi>G</mml:mi> </mml:mrow> </mml:mfrac> </mml:mstyle> </mml:mrow> </mml:mfenced> </mml:math> -expansion method and the generalized Kudryashov method on Klein-Fock-Gordon (KFG) equation and receives some stable and functional solutions. The obtained results are checked by putting backwards into the physical model and are very beneficial over various existing processes. The diverse variety of stable and functional outcomes such as kink-type shape, bright and dark lump shape, bright and dark singular kinky shape, periodic bright and dark lump shape, multiple bright and dark lump shape, the lump with rough wave shape, the rough wave shape and the kinky shape are taken. The above procedure could also be employed to get stable and functional solutions for other integral and fractional nonlinear models in physics, mathematics, and engineering.

Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries

Hyuna Sung, Adalberto M. Filho, Mathieu Laversanne, Jacques Ferlay, Rebecca L. Siegel, Isabelle Soerjomataram, Ahmedin Jemal…

This article provides an update on the global cancer burden using the GLOBOCAN 2020 estimates of cancer incidence and mortality produced by the International Agency for Research on Cancer. Worldwide, an estimated 19.3 million new cancer cases (18.1 million excluding nonmelanoma skin cancer) and almost 10.0 million cancer deaths (9.9 million excluding nonmelanoma skin cancer) occurred in 2020. Female breast cancer has surpassed lung cancer as the most commonly diagnosed cancer, with an estimated 2.3 million new cases (11.7%), followed by lung (11.4%), colorectal (10.0 %), prostate (7.3%), and stomach (5.6%) cancers. Lung cancer remained the leading cause of cancer death, with an estimated 1.8 million deaths (18%), followed by colorectal (9.4%), liver (8.3%), stomach (7.7%), and female breast (6.9%) cancers. Overall incidence was from 2-fold to 3-fold higher in transitioned versus transitioning countries for both sexes, whereas mortality varied <2-fold for men and little for women. Death rates for female breast and cervical cancers, however, were considerably higher in transitioning versus transitioned countries (15.0 vs 12.8 per 100,000 and 12.4 vs 5.2 per 100,000, respectively). The global cancer burden is expected to be 28.4 million cases in 2040, a 47% rise from 2020, with a larger increase in transitioning (64% to 95%) versus transitioned (32% to 56%) countries due to demographic changes, although this may be further exacerbated by increasing risk factors associated with globalization and a growing economy. Efforts to build a sustainable infrastructure for the dissemination of cancer prevention measures and provision of cancer care in transitioning countries is critical for global cancer control.

The World Federation of ADHD International Consensus Statement: 208 Evidence-based conclusions about the disorder

Stephen V. Faraone, Tobias Banaschewski, David Coghill, Yi Zheng, Joseph Biederman, Mark A. Bellgrove, Jeffrey H. Newcorn, M…

BACKGROUND: Misconceptions about ADHD stigmatize affected people, reduce credibility of providers, and prevent/delay treatment. To challenge misconceptions, we curated findings with strong evidence base. METHODS: We reviewed studies with more than 2000 participants or meta-analyses from five or more studies or 2000 or more participants. We excluded meta-analyses that did not assess publication bias, except for meta-analyses of prevalence. For network meta-analyses we required comparison adjusted funnel plots. We excluded treatment studies with waiting-list or treatment as usual controls. From this literature, we extracted evidence-based assertions about the disorder. RESULTS: We generated 208 empirically supported statements about ADHD. The status of the included statements as empirically supported is approved by 80 authors from 27 countries and 6 continents. The contents of the manuscript are endorsed by 366 people who have read this document and agree with its contents. CONCLUSIONS: Many findings in ADHD are supported by meta-analysis. These allow for firm statements about the nature, course, outcome causes, and treatments for disorders that are useful for reducing misconceptions and stigma.

Ferroptosis: mechanisms, biology and role in disease

Xuejun Jiang, Brent R. Stockwell, Marcus Conrad

Effect of the 5E Instructional Model on Physics Academic Achievement Based on Gender and Students’ Ability: A Case of Berekum Senior High Schools in Ghana

Eric Appiah-Twumasi, Daniel Nti, Richard Acheampong, Cosmos Eminah

This study examined the effect of the 5E instructional model on Physics students’ academic achievement based on gender and students’ ability. The study employed a quasi-experimental design using the pre-test, post-test and delayed-post administered instruments to the experimental and control groups. The study involved two instructional strategies (5E instructional model and traditional teaching). Instruments known as Physics Students’ Academic Achievement Test (PSAAT) and Delayed Post Test (DPT) were used to gather data for the study. Mean scores, standard deviations and normalized gains were used to analyses data while ANCOVA and independent-sample t-test were used to test the hypothesis at the 0.05 level of significance. A significant difference was found between Physics students instructed with the 5E instructional model and those taught through the traditional classroom. Similarly, a significant difference was found between Physics high-ability student in the 5E instructional group and those in the traditional group. However, a non-significant difference was found between Physics low-ability students in the experimental and the control groups. Similarly, a non-significant different was found among gender concerning pre-test and post-test means scores. However, a significant difference was found among gender in favor for the male students. The study recommended that Physics teachers wanting to improve their students learning outcomes should adopt the 5E instructional model.

Nanomaterial by Sol‐Gel Method: Synthesis and Application

Dmitry Olegovich Bokov, Abduladheem Turki Jalil, Supat Chupradit, Wanich Suksatan, Mohammad Javed Ansari, Iman H. Shewael, G…

The sol‐gel process is a more chemical method (wet chemical method) for the synthesis of various nanostructures, especially metal oxide nanoparticles. In this method, the molecular precursor (usually metal alkoxide) is dissolved in water or alcohol and converted to gel by heating and stirring by hydrolysis/alcoholysis. Since the gel obtained from the hydrolysis/alcoholysis process is wet or damp, it should be dried using appropriate methods depending on the desired properties and application of the gel. For example, if it is an alcoholic solution, the drying process is done by burning alcohol. After the drying stage, the produced gels are powdered and then calcined. The sol‐gel method is a cost‐effective method and due to the low reaction temperature there is good control over the chemical composition of the products. The sol‐gel method can be used in the process of making ceramics as a molding material and can be used as an intermediate between thin films of metal oxides in various applications. The materials obtained from the sol‐gel method are used in various optical, electronic, energy, surface engineering, biosensors, and pharmaceutical and separation technologies (such as chromatography). The sol‐gel method is a conventional and industrial method for the synthesis of nanoparticles with different chemical composition. The basis of the sol‐gel method is the production of a homogeneous sol from the precursors and its conversion into a gel. The solvent in the gel is then removed from the gel structure and the remaining gel is dried. The properties of the dried gel depend significantly on the drying method. In other words, the “removing solvent method” is selected according to the application in which the gel will be used. Dried gels in various ways are used in industries such as surface coating, building insulation, and the production of special clothing. It is worth mentioning that, by grinding the gel by special mills, it is possible to achieve nanoparticles.

Anticancer Potential of <i>Moringa oleifera</i> on BRCA-1 Gene: Systems Biology

Toheeb A. Balogun, Kaosarat D. Buliaminu, Onyeka S. Chukwudozie, Zainab Tiamiyu, Taiwo J Idowu

Breast cancer has consistently been a global challenge that is prevalent among women. There is a continuous increase in the high number of women mortality rates because of breast cancer and affecting nations at all modernization levels. Women with high-risk factors, including hereditary, obesity, and menopause, have the possibility of developing breast cancer growth. With the advent of radiotherapy, chemotherapy, hormone therapy, and surgery in breast cancer treatment, breast cancer survivors have increased. Also, the design and development of drugs targeting therapeutic enzymes effectively treat the tumour cells early. However, long-term use of anticancer drugs has been linked to severe side effects. This research aims to develop potential drug candidates from Moringa oleifera, which could serve as anticancer agents. In silico analysis using Schrödinger Molecular Drug Discovery Suite and SWISS ADME was employed to determine the therapeutic potential of phytochemicals from M oleifera against breast cancer via molecular docking, pharmacokinetic parameters, and drug-like properties. The result shows that rutin, vicenin-2, and quercetin-3-O-glucoside have the highest binding energy of −7.522, −6.808, and −6.635 kcal/mol, respectively, in the active site of BRCA-1. The essential amino acids involved in the protein-ligand interaction following active site analysis are ASN 1678, ASN 1774, GLY 1656, LEU 1657, GLN 1779, LYS 1702, SER 1655, PHE 1662, ARG 1699, GLU 1698, and VAL 1654. Thus, we propose that bioactive compounds from M oleifera may be potential novel drug candidates in the treatment of breast cancer.

University students’ knowledge and readiness to practice genomic nursing in Nigeria

Prisca Olabisi Adejumo, Ifeoluwapo Oluwafunke Kolawole, Iyanuoluwa Oreofe Ojo, Rose Ekama Ilesanmi, Olaolorunpo Olorunfemi, …

Genetic nursing education provides knowledge of traits and inherited diseases. This has not been well integrated into nursing practice in Nigeria. This study evaluated university nursing students’ knowledge of genomic concepts and readiness to practice genomic nursing in Nigeria. A cross-sectional study was conducted. Three universities were purposively selected in Nigeria. A total of 136 participants were recruited using convenient sampling technique. A modified Genetic Nursing Concept Inventory questionnaire was distributed to participants in their classrooms. Data were analyzed with SPSS (23); descriptive data were presented in tables and figures with their mean and standard deviations. Chi-square test and multivariate analysis were used to ascertain association between variables at p < 0.05 level of significance. Findings indicated that participants have poor knowledge (89%) and lack readiness (66%) to practice genomic nursing in Nigeria. Their knowledge influenced their readiness (χ2 = 21.033, df = 1, p = 0.001). Institution type was the most consistent predictor of knowledge (χ2 = 48.586, df = 2, p = 0.001) and readiness (OR = 14.817, p = 0.326, C.I. = 3.190, 319.57) as those in federal institution were more knowledgeable and prepared to practice genetic nursing. Participants perceived that poor funding, lack of trained personnel, and social/environmental factors could affect their readiness to practice genetic nursing. The study has brought to the fore that nursing students have low knowledge and were not ready to practice genetic nursing, efforts should be made to look into the adequacy of nursing training on genetic nursing and strategies needed for its integration in education and practice.

Education for Critical Consciousness

Paulo Freiré

Famous for his advocacy of 'critical pedagogy', Paulo Freire was Latin America's foremost educationalist, a thinker and writer whose work and ideas continue to exert enormous influence in education throughout the world today. Education for Critical Consciousness is the main statement of Freire's revolutionary method of education. It takes the life situation of the learner as its starting point and the raising of consciousness and the overcoming of obstacles as its goals. For Freire, man's striving for his own humanity requires the changing of structures which dehumanize both the oppressor and the oppressed. This edition includes a substantial new introduction by Carlos Alberto Torres, Distinguished Professor and Founding Director of the Paulo Freire Institute, UCLA, USA.

Engineering precision nanoparticles for drug delivery

Michael J. Mitchell, Margaret M. Billingsley, Rebecca M. Haley, Marissa E. Wechsler, Nicholas A. Peppas, Róbert Langer

Trends in prevalence of blindness and distance and near vision impairment over 30 years: an analysis for the Global Burden of Disease Study

Rupert Bourne, Jaimie D Steinmetz, Seth Flaxman, Paul Svitil Briant, Hugh R. Taylor, Serge Resnikoff, Robert J. Casson, Amir…

Background To contribute to the WHO initiative, VISION 2020: The Right to Sight, an assessment of global vision impairment in 2020 and temporal change is needed. We aimed to extensively update estimates of global vision loss burden, presenting estimates for 2020, temporal change over three decades between 1990–2020, and forecasts for 2050. Methods We did a systematic review and meta-analysis of population-based surveys of eye disease from January, 1980, to October, 2018. Only studies with samples representative of the population and with clearly defined visual acuity testing protocols were included. We fitted hierarchical models to estimate 2020 prevalence (with 95% uncertainty intervals [UIs]) of mild vision impairment (presenting visual acuity ≥6/18 and <6/12), moderate and severe vision impairment (<6/18 to 3/60), and blindness (<3/60 or less than 10° visual field around central fixation); and vision impairment from uncorrected presbyopia (presenting near vision Findings In 2020, an estimated 43·3 million (95% UI 37·6–48·4) people were blind, of whom 23·9 million (55%; 20·8–26·8) were estimated to be female. We estimated 295 million (267–325) people to have moderate and severe vision impairment, of whom 163 million (55%; 147–179) were female; 258 million (233–285) to have mild vision impairment, of whom 142 million (55%; 128–157) were female; and 510 million (371–667) to have visual impairment from uncorrected presbyopia, of whom 280 million (55%; 205–365) were female. Globally, between 1990 and 2020, among adults aged 50 years or older, age-standardised prevalence of blindness decreased by 28·5% (–29·4 to −27·7) and prevalence of mild vision impairment decreased slightly (–0·3%, −0·8 to −0·2), whereas prevalence of moderate and severe vision impairment increased slightly (2·5%, 1·9 to 3·2; insufficient data were available to calculate this statistic for vision impairment from uncorrected presbyopia). In this period, the number of people who were blind increased by 50·6% (47·8 to 53·4) and the number with moderate and severe vision impairment increased by 91·7% (87·6 to 95·8). By 2050, we predict 61·0 million (52·9 to 69·3) people will be blind, 474 million (428 to 518) will have moderate and severe vision impairment, 360 million (322 to 400) will have mild vision impairment, and 866 million (629 to 1150) will have uncorrected presbyopia. Interpretation Age-adjusted prevalence of blindness has reduced over the past three decades, yet due to population growth, progress is not keeping pace with needs. We face enormous challenges in avoiding vision impairment as the global population grows and ages. Funding Brien Holden Vision Institute, Fondation Thea, Fred Hollows Foundation, Bill & Melinda Gates Foundation, Lions Clubs International Foundation, Sightsavers International, and University of Heidelberg.

Causes of blindness and vision impairment in 2020 and trends over 30 years, and prevalence of avoidable blindness in relation to VISION 2020: the Right to Sight: an analysis for the Global Burden of Disease Study

Jaimie D Steinmetz, Rupert Bourne, Paul Svitil Briant, Seth Flaxman, Hugh R B Taylor, Jost B. Jonas, Amir Abdoli, Woldu Aber…

BACKGROUND: Many causes of vision impairment can be prevented or treated. With an ageing global population, the demands for eye health services are increasing. We estimated the prevalence and relative contribution of avoidable causes of blindness and vision impairment globally from 1990 to 2020. We aimed to compare the results with the World Health Assembly Global Action Plan (WHA GAP) target of a 25% global reduction from 2010 to 2019 in avoidable vision impairment, defined as cataract and undercorrected refractive error. METHODS: We did a systematic review and meta-analysis of population-based surveys of eye disease from January, 1980, to October, 2018. We fitted hierarchical models to estimate prevalence (with 95% uncertainty intervals [UIs]) of moderate and severe vision impairment (MSVI; presenting visual acuity from <6/18 to 3/60) and blindness (<3/60 or less than 10° visual field around central fixation) by cause, age, region, and year. Because of data sparsity at younger ages, our analysis focused on adults aged 50 years and older. FINDINGS: Global crude prevalence of avoidable vision impairment and blindness in adults aged 50 years and older did not change between 2010 and 2019 (percentage change -0·2% [95% UI -1·5 to 1·0]; 2019 prevalence 9·58 cases per 1000 people [95% IU 8·51 to 10·8], 2010 prevalence 96·0 cases per 1000 people [86·0 to 107·0]). Age-standardised prevalence of avoidable blindness decreased by -15·4% [-16·8 to -14·3], while avoidable MSVI showed no change (0·5% [-0·8 to 1·6]). However, the number of cases increased for both avoidable blindness (10·8% [8·9 to 12·4]) and MSVI (31·5% [30·0 to 33·1]). The leading global causes of blindness in those aged 50 years and older in 2020 were cataract (15·2 million cases [9% IU 12·7-18·0]), followed by glaucoma (3·6 million cases [2·8-4·4]), undercorrected refractive error (2·3 million cases [1·8-2·8]), age-related macular degeneration (1·8 million cases [1·3-2·4]), and diabetic retinopathy (0·86 million cases [0·59-1·23]). Leading causes of MSVI were undercorrected refractive error (86·1 million cases [74·2-101·0]) and cataract (78·8 million cases [67·2-91·4]). INTERPRETATION: Results suggest eye care services contributed to the observed reduction of age-standardised rates of avoidable blindness but not of MSVI, and that the target in an ageing global population was not reached. FUNDING: Brien Holden Vision Institute, Fondation Théa, The Fred Hollows Foundation, Bill & Melinda Gates Foundation, Lions Clubs International Foundation, Sightsavers International, and University of Heidelberg.

Global Burden of Cardiovascular Diseases and Risk Factors, 1990–2019

Gregory A. Roth, George A. Mensah, Catherine O. Johnson, Giovanni Addolorato, Enrico Ammirati, Larry M. Baddour, Noël C. Bar…

Cardiovascular diseases (CVDs), principally ischemic heart disease (IHD) and stroke, are the leading cause of global mortality and a major contributor to disability. This paper reviews the magnitude of total CVD burden, including 13 underlying causes of cardiovascular death and 9 related risk factors, using estimates from the Global Burden of Disease (GBD) Study 2019. GBD, an ongoing multinational collaboration to provide comparable and consistent estimates of population health over time, used all available population-level data sources on incidence, prevalence, case fatality, mortality, and health risks to produce estimates for 204 countries and territories from 1990 to 2019. Prevalent cases of total CVD nearly doubled from 271 million (95% uncertainty interval [UI]: 257 to 285 million) in 1990 to 523 million (95% UI: 497 to 550 million) in 2019, and the number of CVD deaths steadily increased from 12.1 million (95% UI:11.4 to 12.6 million) in 1990, reaching 18.6 million (95% UI: 17.1 to 19.7 million) in 2019. The global trends for disability-adjusted life years (DALYs) and years of life lost also increased significantly, and years lived with disability doubled from 17.7 million (95% UI: 12.9 to 22.5 million) to 34.4 million (95% UI:24.9 to 43.6 million) over that period. The total number of DALYs due to IHD has risen steadily since 1990, reaching 182 million (95% UI: 170 to 194 million) DALYs, 9.14 million (95% UI: 8.40 to 9.74 million) deaths in the year 2019, and 197 million (95% UI: 178 to 220 million) prevalent cases of IHD in 2019. The total number of DALYs due to stroke has risen steadily since 1990, reaching 143 million (95% UI: 133 to 153 million) DALYs, 6.55 million (95% UI: 6.00 to 7.02 million) deaths in the year 2019, and 101 million (95% UI: 93.2 to 111 million) prevalent cases of stroke in 2019. Cardiovascular diseases remain the leading cause of disease burden in the world. CVD burden continues its decades-long rise for almost all countries outside high-income countries, and alarmingly, the age-standardized rate of CVD has begun to rise in some locations where it was previously declining in high-income countries. There is an urgent need to focus on implementing existing cost-effective policies and interventions if the world is to meet the targets for Sustainable Development Goal 3 and achieve a 30% reduction in premature mortality due to noncommunicable diseases.