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.

Background: Stroke incidence rises with age. A stroke can severely affect walking ability, requiring therapy. Robot-assisted walking therapy (ROB) has been advocated as one form of walking rehabilitation in stroke patients. However, its comparative efficacy remains controversial and three-group comparisons are scant. We compared the effects of ROB, walking training therapy without a robot (WTT) and standard treatment therapy (STT) on clinical and mobility outcomes in acute ischemic stroke patients. Methods: Individuals (n = 45, 71 % males, age 64.4y ±6.34), who have recently experienced an ischemic stroke, were randomized to ROB, WTT or STT. Clinical and mobility outcomes were assessed before and after each intervention (3 weeks, 5 sessions/week) and after 5 weeks of no-intervention follow-up. Results: Outcomes did not differ between groups at baseline (p > 0.05). Modified Rankin Scale (primary outcome), improved (p < 0.05) after ROB and WTT vs. STT. These improvements were retained relative to baseline (p < 0.05) after follow-up. Barthel index, Berg Balance Scale, 10-m walking speed, the distance while walking with and without the robot for six minutes, and center pressure velocity in standing improved most after ROB (all p < 0.001), exceeding the changes after WTT which in turn were greater than the changes after STT (p ≤ 0.040). Conclusion: Older adults shortly after an ischemic stroke can quickly learn to walk with a soft robot and retain substantial clinical and mobility improvements at follow-up.

The dynamic study of the Supercritical Carbon Dioxide (SCO2) Brayton cycle has received extensive attention from the industry in recent years. While various dynamic operating conditions occur intermittently within the system, some commonly used control methods are unable to adapt effectively to those situations. In this study, a dynamic model of the SCO2 Brayton cycle coupled with a printed circuit heat exchanger with embedded PCM, a storage tank, and a proportional-integral-derivative (PID) controller was developed and validated with the model, and then the control effects of the various control models were compared in terms of their control effectiveness under three typical variable operating conditions (periodic temperature fluctuation, load reduction and recovery, and reduced flow rate). In addition, the stability assessment of the SCO2 Brayton cycle was modeled. Compared to the basic SCO2 Brayton cycle, the PCM-PCHE reduces the amplitude of the total efficiency fluctuations by 44.8 %, and the integrated layout covering the printed circuit heat exchanger with embedded PCM, storage tank, and PID controller shows the best stability. Controlling the extraction ratio with a PID controller contributes more to the stability of the SCO2 Brayton cycle than controlling the condensate flow rate with a PID controller. In contrast, the printed circuit heat exchanger with an embedded PCM contributes more to the stability of the SCO2 Brayton cycle concerning the storage tank. Overall, the total control layout reduced the instability by about 40 % compared to the initial recompression layout, indicating that the PCM, storage tank, and PID controller greatly improved the stability of the SCO2 Brayton cycle.

We focus on the infinite-temperature dynamical spin structure factor of the asymmetric Hatsugai-Kohmoto model, a relative of the asymmetric Hubbard model. It is characterized by distinct single-particle energies for the two spin species, which interact with each other through a contact interaction in momentum space. We evaluate its spin structure factor exactly and follow the evolution of its excitation spectrum for all fillings and interactions, identifying signatures of the Mott transition and fingerprints of the asymmetric hoppings. The longitudinal spin structure factor exhibits soundlike and interaction-induced gapped excitations, whose number gets doubled in the presence of hopping asymmetry. The transverse response displays the competition of interaction- and asymmetry-induced gaps and results in a quadratic excitation branch at their transition. The complete asymmetric case features a momentum-independent dynamical structure factor, characteristic of transitions involving a flat band.

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Background: Adequate nutrient intake is an essential part of athletes’ preparation, which results in more effective training adaptation, recovery, better body composition ratios, and improved sports performance. Inadequate nutrient intake or lack of knowledge can lead to disordered eating and eating disorders, the prevalence of which is higher among athletes than in the general population. In most cases, these unwanted outcomes occur because athletes do not seek the help of a qualified dietitian. According to a 2019 report by the International Olympic Committee, disordered eating and eating disorders’ point prevalence ranges from 6% to 45% in women and 0% to 19% in men. In Hungary, no athlete sample has been tested with screening questionnaires for eating disorders, and the development of reliable measurement tools for identifying this problem is also necessary. Objective: The aim of this study is to present the Hungarian version of the DESA-6 questionnaire (DESA-6H) for screening disordered eating among athletes and to investigate its convergent validity (CV), as well as to evaluate athletes’ nutritional behaviors based on comparative study results. Methods: The DESA-6H questionnaire was tested on elite athletes (n = 131) and recreational athletes (n = 123) aged 14 and older. Kendall’s tau-b correlation was used to establish the CV between the DESA-6H and the total EAT-26 score, as well as between the DESA-6H and the three subscales of the EAT-26. The same method was used to test the potential linear relationship between eating behavior questionnaires and weekly training hours. Chi-square tests were conducted to test the relationships between nominal variables. Differences between groups based on age and sport participation levels were analyzed using Kruskal-Wallis H tests, and post-hoc analyses were conducted using Mann-Whitney U tests. Results: The CV analysis showed a significant positive correlation between the DESA-6H and the total EAT-26 score (τb = 0.49, p < 0.001), the EAT-26 Dieting subscale (τb = 0.53, p < 0.001), and the EAT-26 Bulimia subscale (τb = 0.39, p < 0.001). In the total sample, 20.4% scored above the threshold on the DESA-6H, while 40.1% scored above the threshold on the EAT-26. Among sports categories, the highest prevalence was found in aesthetic, weight-dependent, and endurance sports. A significant difference was observed in the DESA-6H scores based on gender (U = 4948.50, Z = –5.210, p < 0.001) and sports participation level (U = 6847.50, Z = –2.123, p = 0.034), with large (Cohen’s d = 0.68) and small ( Cohen’s d = 0.26) effect sizes. The Mann-Whitney U-test showed no significant difference between the 14–17-year-old and 18+ age groups in terms of DESA-6H scores (U = 6082.00, Z = –1.017, p = 0.309). No statistically significant differences were found between the two age groups on the EAT-26 scores either (U = 6490.00, Z = –0.220, p = 0.826). Overall, the statistical tests consistently supported the convergent validity of the DESA-6H when compared with the EAT-26. Conclusions: Based on the results of our research, it can be concluded that the DESA-6H questionnaire is a reliable tool for screening disordered eating among Hungarian athletes. Its application can help in the early detection and prevention of eating disorders.

Abstract: This study assesses the performance of four nature-inspired optimization algorithms—Dynamic Differential Annealed Optimization (DDAO), Flower Pollination Algorithm (FPA), Firefly Algorithm (FF), and Particle Swarm Optimization (PSO) for achieving optimal space truss design. The aim is to minimize the structural weight of three benchmark trusses (10-bar, 25-bar, and 72-bar) while meeting stress and displacement constraints. The key contribution of this work is the first systematic evaluation of FPA in space truss optimization, demonstrating its greater effectiveness in obtaining optimal or near-optimal solutions with faster convergence and higher stability compared to PSO and FF. The results also highlight the limitations of DDAO in handling constrained engineering problems. Findings confirm that FPA and FF are highly effective for structural optimization, offering robust solutions with minimal computational cost. These insights contribute to advancing metaheuristic-based structural design, supporting the adoption of FPA in large-scale optimization problems.

Background: Cancer is a leading cause of death globally. Accurate cancer burden information is crucial for policy planning, but many countries do not have up-to-date cancer surveillance data. To inform global cancer-control efforts, we used the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023 framework to generate and analyse estimates of cancer burden for 47 cancer types or groupings by age, sex, and 204 countries and territories from 1990 to 2023, cancer burden attributable to selected risk factors from 1990 to 2023, and forecasted cancer burden up to 2050. Methods: Cancer estimation in GBD 2023 used data from population-based cancer registration systems, vital registration systems, and verbal autopsies. Cancer mortality was estimated using ensemble models, with incidence informed by mortality estimates and mortality-to-incidence ratios (MIRs). Prevalence estimates were generated from modelled survival estimates, then multiplied by disability weights to estimate years lived with disability (YLDs). Years of life lost (YLLs) were estimated by multiplying age-specific cancer deaths by the GBD standard life expectancy at the age of death. Disability-adjusted life-years (DALYs) were calculated as the sum of YLLs and YLDs. We used the GBD 2023 comparative risk assessment framework to estimate cancer burden attributable to 44 behavioural, environmental and occupational, and metabolic risk factors. To forecast cancer burden from 2024 to 2050, we used the GBD 2023 forecasting framework, which included forecasts of relevant risk factor exposures and used Socio-demographic Index as a covariate for forecasting the proportion of each cancer not affected by these risk factors. Progress towards the UN Sustainable Development Goal (SDG) target 3.4 aim to reduce non-communicable disease mortality by a third between 2015 and 2030 was estimated for cancer. Findings: In 2023, excluding non-melanoma skin cancers, there were 18·5 million (95% uncertainty interval 16·4 to 20·7) incident cases of cancer and 10·4 million (9·65 to 10·9) deaths, contributing to 271 million (255 to 285) DALYs globally. Of these, 57·9% (56·1 to 59·8) of incident cases and 65·8% (64·3 to 67·6) of cancer deaths occurred in low-income to upper-middle-income countries based on World Bank income group classifications. Cancer was the second leading cause of deaths globally in 2023 after cardiovascular diseases. There were 4·33 million (3·85 to 4·78) risk-attributable cancer deaths globally in 2023, comprising 41·7% (37·8 to 45·4) of all cancer deaths. Risk-attributable cancer deaths increased by 72·3% (57·1 to 86·8) from 1990 to 2023, whereas overall global cancer deaths increased by 74·3% (62·2 to 86·2) over the same period. The reference forecasts (the most likely future) estimate that in 2050 there will be 30·5 million (22·9 to 38·9) cases and 18·6 million (15·6 to 21·5) deaths from cancer globally, 60·7% (41·9 to 80·6) and 74·5% (50·1 to 104·2) increases from 2024, respectively. These forecasted increases in deaths are greater in low-income and middle-income countries (90·6% [61·0 to 127·0]) compared with high-income countries (42·8% [28·3 to 58·6]). Most of these increases are likely due to demographic changes, as age-standardised death rates are forecast to change by –5·6% (–12·8 to 4·6) between 2024 and 2050 globally. Between 2015 and 2030, the probability of dying due to cancer between the ages of 30 years and 70 years was forecasted to have a relative decrease of 6·5% (3·2 to 10·3). Interpretation: Cancer is a major contributor to global disease burden, with increasing numbers of cases and deaths forecasted up to 2050 and a disproportionate growth in burden in countries with scarce resources. The decline in age-standardised mortality rates from cancer is encouraging but insufficient to meet the SDG target set for 2030. Effectively and sustainably addressing cancer burden globally will require comprehensive national and international efforts that consider health systems and context in the development and implementation of cancer-control strategies across the continuum of prevention, diagnosis, and treatment. Funding: Gates Foundation, St Jude Children's Research Hospital, and St Baldrick's Foundation.

This study investigates the effect of annealing heat treatment on polymer composites composed entirely of biodegradable components. Poly(lactic acid) (PLA) was used as the matrix material paired with three different types of commercial lignocellulose fibers of varying sizes. Composites containing 10 wt.% fibers were processed through extrusion followed by injection molding. The amorphous (unannealed) and semi-crystalline (annealed) samples were characterized for their morphological, thermal, mechanical, and water absorption properties. Scanning electron microscopic analysis revealed a homogenous distribution of cellulose fibers within the PLA matrix, even though the composite with the smallest fiber size exhibited slight agglomeration. Differential scanning calorimetric measurements indicated that the annealing heat treatment successfully induced crystallization, with the filler particles capable of increasing the extent of crystallinity formed during the annealing heat treatment from 28% to 36%. Based on the tensile tests, as a result of annealing heat treatment, the composites' strength increased from 48–50 to 53–56 MPa, while their Young's modulus increased from 3.1 GPa to 3.3-3.5 GPa. The Charpy impact tests also revealed an enhanced toughness for the samples exposed to the annealing heat treatment. In terms of water absorption, annealing enhanced the hydrophobic nature of PLA. In addition, the semi-crystalline structure formed during the heat treatment also inhibited the highly hydrophilic cellulose fibers from absorbing as much moisture as they did when incorporated inside amorphous PLA; cellulose fibers embedded in the semi-crystalline PLA matrix consequently exhibited less moisture absorption than the ones in amorphous PLA. Highlights: Through annealing, crystallinity was developed in PLA/lignocellulose composites. Lignocellulose fibers facilitated crystallization by acting as a nucleating agent. Crystallized biocomposites exhibited superior mechanical properties Crystalline segments hindered the water absorption of embedded lignocellulose.