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- Naghavi, Mohsen, et al.
(författare)
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Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013
- 2015
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Ingår i: The Lancet. - 1474-547X .- 0140-6736. ; 385:9963, s. 117-171
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Tidskriftsartikel (refereegranskat)abstract
- Background Up-to-date evidence on levels and trends for age-sex-specifi c all-cause and cause-specifi c mortality is essential for the formation of global, regional, and national health policies. In the Global Burden of Disease Study 2013 (GBD 2013) we estimated yearly deaths for 188 countries between 1990, and 2013. We used the results to assess whether there is epidemiological convergence across countries. Methods We estimated age-sex-specifi c all-cause mortality using the GBD 2010 methods with some refinements to improve accuracy applied to an updated database of vital registration, survey, and census data. We generally estimated cause of death as in the GBD 2010. Key improvements included the addition of more recent vital registration data for 72 countries, an updated verbal autopsy literature review, two new and detailed data systems for China, and more detail for Mexico, UK, Turkey, and Russia. We improved statistical models for garbage code redistribution. We used six different modelling strategies across the 240 causes; cause of death ensemble modelling (CODEm) was the dominant strategy for causes with sufficient information. Trends for Alzheimer's disease and other dementias were informed by meta-regression of prevalence studies. For pathogen-specifi c causes of diarrhoea and lower respiratory infections we used a counterfactual approach. We computed two measures of convergence (inequality) across countries: the average relative difference across all pairs of countries (Gini coefficient) and the average absolute difference across countries. To summarise broad findings, we used multiple decrement life-tables to decompose probabilities of death from birth to exact age 15 years, from exact age 15 years to exact age 50 years, and from exact age 50 years to exact age 75 years, and life expectancy at birth into major causes. For all quantities reported, we computed 95% uncertainty intervals (UIs). We constrained cause-specific fractions within each age-sex-country-year group to sum to all-cause mortality based on draws from the uncertainty distributions. Findings Global life expectancy for both sexes increased from 65.3 years (UI 65.0-65.6) in 1990, to 71.5 years (UI 71.0-71.9) in 2013, while the number of deaths increased from 47.5 million (UI 46.8-48.2) to 54.9 million (UI 53.6-56.3) over the same interval. Global progress masked variation by age and sex: for children, average absolute diff erences between countries decreased but relative diff erences increased. For women aged 25-39 years and older than 75 years and for men aged 20-49 years and 65 years and older, both absolute and relative diff erences increased. Decomposition of global and regional life expectancy showed the prominent role of reductions in age-standardised death rates for cardiovascular diseases and cancers in high-income regions, and reductions in child deaths from diarrhoea, lower respiratory infections, and neonatal causes in low-income regions. HIV/AIDS reduced life expectancy in southern sub-Saharan Africa. For most communicable causes of death both numbers of deaths and age-standardised death rates fell whereas for most non-communicable causes, demographic shifts have increased numbers of deaths but decreased age-standardised death rates. Global deaths from injury increased by 10.7%, from 4.3 million deaths in 1990 to 4.8 million in 2013; but age-standardised rates declined over the same period by 21%. For some causes of more than 100 000 deaths per year in 2013, age-standardised death rates increased between 1990 and 2013, including HIV/AIDS, pancreatic cancer, atrial fibrillation and flutter, drug use disorders, diabetes, chronic kidney disease, and sickle-cell anaemias. Diarrhoeal diseases, lower respiratory infections, neonatal causes, and malaria are still in the top five causes of death in children younger than 5 years. The most important pathogens are rotavirus for diarrhoea and pneumococcus for lower respiratory infections. Country-specific probabilities of death over three phases of life were substantially varied between and within regions. Interpretation For most countries, the general pattern of reductions in age-sex specifi c mortality has been associated with a progressive shift towards a larger share of the remaining deaths caused by non-communicable disease and injuries. Assessing epidemiological convergence across countries depends on whether an absolute or relative measure of inequality is used. Nevertheless, age-standardised death rates for seven substantial causes are increasing, suggesting the potential for reversals in some countries. Important gaps exist in the empirical data for cause of death estimates for some countries; for example, no national data for India are available for the past decade.
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| 2. |
- Farinotti, Daniel, et al.
(författare)
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Results from the Ice Thickness Models Intercomparison eXperiment Phase 2 (ITMIX2)
- 2021
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Ingår i: Frontiers in Earth Science. - : Frontiers Media S.A.. - 2296-6463. ; 8
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Tidskriftsartikel (refereegranskat)abstract
- Knowing the ice thickness distribution of a glacier is of fundamental importance for a number of applications, ranging from the planning of glaciological fieldwork to the assessments of future sea-level change. Across spatial scales, however, this knowledge is limited by the paucity and discrete character of available thickness observations. To obtain a spatially coherent distribution of the glacier ice thickness, interpolation or numerical models have to be used. Whilst the first phase of the Ice Thickness Models Intercomparison eXperiment (ITMIX) focused on approaches that estimate such spatial information from characteristics of the glacier surface alone, ITMIX2 sought insights for the capability of the models to extract information from a limited number of thickness observations. The analyses were designed around 23 test cases comprising both real-world and synthetic glaciers, with each test case comprising a set of 16 different experiments mimicking possible scenarios of data availability. A total of 13 models participated in the experiments. The results show that the inter-model variability in the calculated local thickness is high, and that for unmeasured locations, deviations of 16% of the mean glacier thickness are typical (median estimate, three-quarters of the deviations within 37% of the mean glacier thickness). This notwithstanding, limited sets of ice thickness observations are shown to be effective in constraining the mean glacier thickness, demonstrating the value of even partial surveys. Whilst the results are only weakly affected by the spatial distribution of the observations, surveys that preferentially sample the lowest glacier elevations are found to cause a systematic underestimation of the thickness in several models. Conversely, a preferential sampling of the thickest glacier parts proves effective in reducing the deviations. The response to the availability of ice thickness observations is characteristic to each approach and varies across models. On average across models, the deviation between modeled and observed thickness increase by 8.5% of the mean ice thickness every time the distance to the closest observation increases by a factor of 10. No single best model emerges from the analyses, confirming the added value of using model ensembles.
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| 3. |
- Fuerst, Johannes J., et al.
(författare)
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The Ice-Free Topography of Svalbard
- 2018
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Ingår i: Geophysical Research Letters. - 0094-8276 .- 1944-8007. ; 45:21, s. 11760-11769
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Tidskriftsartikel (refereegranskat)abstract
- We present a first version of the Svalbard ice-free topography (SVIFT1.0) using a mass conserving approach for mapping glacier ice thickness. SVIFT1.0 is informed by more than 1 million point measurements, totalling more than 8,700 km of thickness profiles. SVIFT1.0 is publicly available and represents the geometric state around the year 2010. Our estimate for the total ice volume is 6,199 km(3), equivalent to 1.5-cm sea level rise. The thickness map suggests that 13% of the glacierized area is grounded below sea level. A complementary map of error estimates comprises uncertainties in the thickness surveys as well as in other input variables. Aggregated error estimates are used to define a likely ice-volume range of 5,200-7,300 km(3). The ice front thickness of marine-terminating glaciers is a key quantity for ice loss attribution because it controls the potential ice discharge by iceberg calving into the ocean. We find a mean ice front thickness of 135 m for the archipelago (likely range 123-158 m). Plain Language Summary Svalbard is an archipelago in the Arctic, north of Norway, which is comparable in size to the New York metropolitan area. Roughly half of it is covered by glacier ice. Yet to this day, the ice volume stored in the many glaciers on Svalbard is not well known. Many attempts have been made to infer a total volume estimate, but results differ substantially. This surprises because of the long research activity in this area. A large record of more than 1 million thickness measurements exists, making Svalbard an ideal study area for the application of a state-of-the-art mapping approach for glacier ice thickness. The mapping approach computes an ice volume that will raise global sea level by more than half an inch if instantaneously melted. If spread over the metropolitan area, New York would be buried beneath a 100-m ice cover. The asset of this approach is that it provides not only a thickness map for each glacier on the archipelago but also an error map that defines the likely local thickness range. Finally, we provide the first well-informed estimate of the ice front thickness of all marine-terminating glaciers that loose icebergs to the ocean. The archipelago-wide mean ice front cliff is 135 m.
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| 4. |
- Godman, Brian, et al.
(författare)
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Dabigatran - a continuing exemplar case history demonstrating the need for comprehensive models to optimize the utilization of new drugs
- 2014
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Ingår i: Frontiers in Pharmacology. - : Frontiers Media SA. - 1663-9812. ; 5
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Forskningsöversikt (refereegranskat)abstract
- Background: There are potential conflicts between authorities and companies to fund new premium priced drugs especially where there are effectiveness, safety and/or budget concerns. Dabigatran, a new oral anticoagulant for the prevention of stroke in patients with non-valvular atrial fibrillation (AF), exemplifies this issue. Whilst new effective treatments are needed, there are issues in the elderly with dabigatran due to variable drug concentrations, no known antidote and dependence on renal elimination. Published studies showed dabigatran to be cost-effective but there are budget concerns given the prevalence of AF. These concerns resulted in extensive activities pre- to post-launch to manage its introduction. Objective: To (i) review authority activities across countries, (ii) use the findings to develop new models to better manage the entry of new drugs, and (iii) review the implications based on post-launch activities. Methodology: (i) Descriptive review and appraisal of activities regarding dabigatran, (ii) development of guidance for key stakeholder groups through an iterative process, (iii) refining guidance following post launch studies. Results: Plethora of activities to manage dabigatran including extensive pre-launch activities, risk sharing arrangements, prescribing restrictions and monitoring of prescribing post launch. Reimbursement has been denied in some countries due to concerns with its budget impact and/or excessive bleeding. Development of a new model and future guidance is proposed to better manage the entry of new drugs, centering on three pillars of pre-, pen-, and post-launch activities. Post-launch activities include increasing use of patient registries to monitor the safety and effectiveness of new drugs in clinical practice. Conclusion: Models for introducing new drugs are essential to optimize their prescribing especially where concerns. Without such models, new drugs may be withdrawn prematurely and/or struggle for funding.
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