Global mortality associated with 33 bacterial pathogens in 2019: a systematic analysis for the Global Burden of Disease Study 2019

Background Reducing the burden of death due to infection is an urgent global public health priority. Previous studies have estimated the number of deaths associated with drug-resistant infections and sepsis and found that infections remain a leading cause of death globally. Understanding the global burden of common bacterial pathogens (both susceptible and resistant to antimicrobials) is essential to identify the greatest threats to public health. To our knowledge, this is the first study to present global comprehensive estimates of deaths associated with 33 bacterial pathogens across 11 major infectious syndromes.Methods We estimated deaths associated with 33 bacterial genera or species across 11 infectious syndromes in 2019 using methods from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, in addition to a subset of the input data described in the Global Burden of Antimicrobial Resistance 2019 study. This study included 343 million individual records or isolates covering 11 361 study-location-years. We used three modelling steps to estimate the number of deaths associated with each pathogen: deaths in which infection had a role, the fraction of deaths due to infection that are attributable to a given infectious syndrome, and the fraction of deaths due to an infectious syndrome that are attributable to a given pathogen. Estimates were produced for all ages and for males and females across 204 countries and territories in 2019. 95% uncertainty intervals (UIs) were calculated for final estimates of deaths and infections associated with the 33 bacterial pathogens following standard GBD methods by taking the 2.5th and 97.5th percentiles across 1000 posterior draws for each quantity of interest.Findings From an estimated 13.7 million (95% UI 10.9-17.1) infection-related deaths in 2019, there were 7.7 million deaths (5.7-10.2) associated with the 33 bacterial pathogens (both resistant and susceptible to antimicrobials) across the 11 infectious syndromes estimated in this study. We estimated deaths associated with the 33 bacterial pathogens to comprise 13.6% (10.2-18.1) of all global deaths and 56.2% (52.1-60.1) of all sepsis-related deaths in 2019. Five leading pathogens-Staphylococcus aureus, Escherichia coli, Streptococcus pneumoniae, Klebsiella pneumoniae, and Pseudomonas aeruginosa-were responsible for 54.9% (52.9-56.9) of deaths among the investigated bacteria. The deadliest infectious syndromes and pathogens varied by location and age. The age-standardised mortality rate associated with these bacterial pathogens was highest in the sub-Saharan Africa super-region, with 230 deaths (185-285) per 100 000 population, and lowest in the high-income super-region, with 52.2 deaths (37.4-71.5) per 100 000 population. S aureus was the leading bacterial cause of death in 135 countries and was also associated with the most deaths in individuals older than 15 years, globally. Among children younger than 5 years, S pneumoniae was the pathogen associated with the most deaths. In 2019, more than 6 million deaths occurred as a result of three bacterial infectious syndromes, with lower respiratory infections and bloodstream infections each causing more than 2 million deaths and peritoneal and intra-abdominal infections causing more than 1 million deaths.Interpretation The 33 bacterial pathogens that we investigated in this study are a substantial source of health loss globally, with considerable variation in their distribution across infectious syndromes and locations. Compared with GBD Level 3 underlying causes of death, deaths associated with these bacteria would rank as the second leading cause of death globally in 2019; hence, they should be considered an urgent priority for intervention within the global health community. Strategies to address the burden of bacterial infections include infection prevention, optimised use of antibiotics, improved capacity for microbiological analysis, vaccine development, and improved and more pervasive use of available vaccines. These estimates can be used to help set priorities for vaccine need, demand, and development. Copyright (c) 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license

Regulatory Barriers to Litigation in India

The legal profession in India does not seem to have any significant entry barriers as are prevalent in other sectors in India. Yet litigation fails to attract talented law graduates, except those who have a parental/family background in litigation. Litigation in India is marked by the presence of small and middle-size family-run law firms who employ law graduates as juniors and may fall short of world class corporate culture. On the other hand, it is rare for a fresh law graduate to become an entrepreneur-style practitioner on their own, right after college. This is in contrast with other sectors where graduates with degrees can take a bank loan and can start an enterprise. This paper reviews the regulatory framework of how legal barriers with noble intentions makes the sustainability of new entrants almost impossible in the legal profession and thus discourage new entrants from choosing litigation as a career after college. These barriers, though not entry barriers in a strict sense, are operational barriers and include: a) restrictions on the legal form of a law firm; b) a ban on advertising; c) a ban on charging a contingent fee; d) a ban on moonlighting. The paper also looks at moral hazard associated with self-regulatory bodies viz. the Bar Council of India and the State Bar Councils. Finally, the paper makes a case for reforms in the form of doing away with restrictions to lay down a level-playing field for all practitioners and foster competition

Time for Manushi-II

Frequent strikes, trade unions, meter tampering and poor service are some of the prominent features of auto rickshaw service in Delhi.' On the other hand, drivers usually complain that fare rate is not sufficient2 and Government and bureaucracy are.3 always eager to 'discipline' the errant rickshaws by providing SMS complaint service4 imposing very expensive Global Positioning System device (GPS) on drivers introducing smart card identification scheme5, heavy penaltieS6 and many others. Nothing has worked so far. What seems like a cultural problem or a jinx is not really difficult to understand, rather an obvious legal cum socio-economic problem. But this paper does not claim the obvious facts that all these problems are directly or indirectly the outcome of cap on the number of auto-rickshaws in the city. 7 This has already been reiterated in number of media reports and reports of Government Committees. Using these facts and a comparative approach, this paper argues that Auto-rickshaw sector too deserves economic liberalization like cycle-rickshaw sector. The only difference between the auto-rickshaw sector and cycle rickshaw sector is that while judicial activism led to liberalization of cycle-rickshaw sector, it led to permit system in the case of the latter

Regulatory Barriers to Litigation in India

The legal profession in India does not seem to have any significant entry barriers as are prevalent in other sectors in India. Yet litigation fails to attract talented law graduates, except those who have a parental/family background in litigation. Litigation in India is marked by the presence of small and middle-size family-run law firms who employ law graduates as juniors and may fall short of world class corporate culture. On the other hand, it is rare for a fresh law graduate to become an entrepreneur-style practitioner on their own, right after college. This is in contrast with other sectors where graduates with degrees can take a bank loan and can start an enterprise. This paper reviews the regulatory framework of how legal barriers with noble intentions makes the sustainability of new entrants almost impossible in the legal profession and thus discourage new entrants from choosing litigation as a career after college. These barriers, though not entry barriers in a strict sense, are operational barriers and include: a) restrictions on the legal form of a law firm; b) a ban on advertising; c) a ban on charging a contingent fee; d) a ban on moonlighting. The paper also looks at moral hazard associated with self-regulatory bodies viz. the Bar Council of India and the State Bar Councils. Finally, the paper makes a case for reforms in the form of doing away with restrictions to lay down a level-playing field for all practitioners and foster competition.

Affiliate Marketing

The emergence of internet as a strong medium of communication has led to the emergence of numerous marketing avenues with many companies realizing its potential towards promotion of their products (Liang &amp; Huang, 1998). Online marketing platforms offer various opportunities for directing costumers towards the products through online advertising, affiliate marketing, search engine optimization, direct mailers etc. Affiliate marketing is a performance based marketing and known for its cost effectiveness. we have suggested a framework MECHULUP indicating Mobile Friendliness, E-Commerce, Content Quality, Honesty, Audio/Video, Link Building, Social Media, and Persistence. </jats:p

<b>Progress Report 2020: Implementing the Street Vendors Act</b>

Centre for Civil Society's report for 2019-20 provides a comprehensive analysis of the implementation of the Street Vendors Act across India, drawing on data from the DAY-NULM's Management Information System. The report is divided into three critical sections:State and ULB Progress: It ranks and scores the performance of 28 states and their ULBs, showcasing a spectrum of implementation efficacy, with Andhra Pradesh leading by example in all key areas, while several other states lag significantly behind.Cross-State Legislative Comparison: Through maps and tabulations, the report compares the rules and schemes notified under the Act across states, revealing a diverse range of approaches and highlighting inconsistencies with the Act's mandates.Analysis of Rules and Schemes: The report scrutinizes the rules and schemes of 35 states and union territories, identifying departures from the Act and potential administrative overreach.Key findings indicate mixed progress, with some states showing substantial advancement, while others remain stagnant. The report notes that while some ULBs exemplify best practices, most display significant deviations in their implementation processes. Additionally, the report points out that in many cases, the notified rules and schemes either exceed the Act's intentions or lack clarity, leading to potential misapplication.By shedding light on the disparities in implementation and legislative alignment, the report serves as a valuable benchmark for state authorities to learn from each other and strive for a more uniform and effective application of the Street Vendors Act.</p

<b>Examining the Implementation of Street Vendors Act, 2014: Recommendations to the Parliamentary Standing Committee of Urban Development</b>

Presented by Prashant Narang on behalf of Centre for Civil Society to the Parliamentary Standing Committee on Urban Development on December 28, 2020, this testimony highlights the ongoing challenges in the implementation of the Street Vendors Act, 2014, despite its intent to protect and regulate street vending.Key Issues Identified:Non-functioning of Town Vending Committees (TVCs): TVCs are crucial for incorporating vendor participation in decision-making. However, over 25% of Urban Local Bodies (ULBs) have not established TVCs, and in six states, less than half have done so. Even where TVCs exist, vendor representatives often report a lack of regular meetings, poor communication, and language barriers.Delay in Vendor Identification: The Act tasks TVCs with surveying and issuing certificates of vending (CoVs). Yet, 38% of ULBs have not conducted surveys, and in metropolitan areas like Delhi and Mumbai, most vendors remain unidentified. Furthermore, after surveys, 84% of identified vendors have not received their CoVs, with some states having issued none.Continued Harassment of Vendors: Despite legal protections, vendors face evictions contrary to the Act's stipulations. Centre for Civil Society's study of judicial orders reveals that evictions are a predominant legal contestation, with courts often disregarding the Act's provisions.Inadequate Planning and Arbitrary Zoning: The Act requires local authorities to create a vending plan that designates vending zones. However, planning is often poor, and the demarcation of zones is arbitrary, impacting vendors' rights and livelihoods.The testimony underscores the need for the Parliamentary Standing Committee on Urban Development to address these systemic issues to ensure the Street Vendors Act fulfills its purpose of protecting vendors' rights and livelihoods.</p