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  • Ahmad Kiadaliri, Aliasghar, et al. (författare)
  • Measuring performance on the Healthcare Access and Quality Index for 195 countries and territories and selected subnational locations: A systematic analysis from the Global Burden of Disease Study 2016
  • 2018
  • Ingår i: The Lancet. - 1474-547X .- 0140-6736. ; 391:10136, s. 2236-2271
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: A key component of achieving universal health coverage is ensuring that all populations have access to quality health care. Examining where gains have occurred or progress has faltered across and within countries is crucial to guiding decisions and strategies for future improvement. We used the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) to assess personal health-care access and quality with the Healthcare Access and Quality (HAQ) Index for 195 countries and territories, as well as subnational locations in seven countries, from 1990 to 2016. Methods Drawing from established methods and updated estimates from GBD 2016, we used 32 causes from which death should not occur in the presence of effective care to approximate personal health-care access and quality by location and over time. To better isolate potential effects of personal health-care access and quality from underlying risk factor patterns, we risk-standardised cause-specific deaths due to non-cancers by location-year, replacing the local joint exposure of environmental and behavioural risks with the global level of exposure. Supported by the expansion of cancer registry data in GBD 2016, we used mortality-to-incidence ratios for cancers instead of risk-standardised death rates to provide a stronger signal of the effects of personal health care and access on cancer survival. We transformed each cause to a scale of 0-100, with 0 as the first percentile (worst) observed between 1990 and 2016, and 100 as the 99th percentile (best); we set these thresholds at the country level, and then applied them to subnational locations. We applied a principal components analysis to construct the HAQ Index using all scaled cause values, providing an overall score of 0-100 of personal health-care access and quality by location over time. We then compared HAQ Index levels and trends by quintiles on the Socio-demographic Index (SDI), a summary measure of overall development. As derived from the broader GBD study and other data sources, we examined relationships between national HAQ Index scores and potential correlates of performance, such as total health spending per capita. Findings In 2016, HAQ Index performance spanned from a high of 97·1 (95% UI 95·8-98·1) in Iceland, followed by 96·6 (94·9-97·9) in Norway and 96·1 (94·5-97·3) in the Netherlands, to values as low as 18·6 (13·1-24·4) in the Central African Republic, 19·0 (14·3-23·7) in Somalia, and 23·4 (20·2-26·8) in Guinea-Bissau. The pace of progress achieved between 1990 and 2016 varied, with markedly faster improvements occurring between 2000 and 2016 for many countries in sub-Saharan Africa and southeast Asia, whereas several countries in Latin America and elsewhere saw progress stagnate after experiencing considerable advances in the HAQ Index between 1990 and 2000. Striking subnational disparities emerged in personal health-care access and quality, with China and India having particularly large gaps between locations with the highest and lowest scores in 2016. In China, performance ranged from 91·5 (89·1-93·6) in Beijing to 48·0 (43·4-53·2) in Tibet (a 43·5-point difference), while India saw a 30·8-point disparity, from 64·8 (59·6-68·8) in Goa to 34·0 (30·3-38·1) in Assam. Japan recorded the smallest range in subnational HAQ performance in 2016 (a 4·8-point difference), whereas differences between subnational locations with the highest and lowest HAQ Index values were more than two times as high for the USA and three times as high for England. State-level gaps in the HAQ Index in Mexico somewhat narrowed from 1990 to 2016 (from a 20·9-point to 17·0-point difference), whereas in Brazil, disparities slightly increased across states during this time (a 17·2-point to 20·4-point difference). Performance on the HAQ Index showed strong linkages to overall development, with high and high-middle SDI countries generally having higher scores and faster gains for non-communicable diseases. Nonetheless, countries across the development spectrum saw substantial gains in some key health service areas from 2000 to 2016, most notably vaccine-preventable diseases. Overall, national performance on the HAQ Index was positively associated with higher levels of total health spending per capita, as well as health systems inputs, but these relationships were quite heterogeneous, particularly among low-to-middle SDI countries. Interpretation GBD 2016 provides a more detailed understanding of past success and current challenges in improving personal health-care access and quality worldwide. Despite substantial gains since 2000, many low-SDI and middle- SDI countries face considerable challenges unless heightened policy action and investments focus on advancing access to and quality of health care across key health services, especially non-communicable diseases. Stagnating or minimal improvements experienced by several low-middle to high-middle SDI countries could reflect the complexities of re-orienting both primary and secondary health-care services beyond the more limited foci of the Millennium Development Goals. Alongside initiatives to strengthen public health programmes, the pursuit of universal health coverage hinges upon improving both access and quality worldwide, and thus requires adopting a more comprehensive view-and subsequent provision-of quality health care for all populations.
  • Munn-Chernoff, M. A., et al. (författare)
  • Shared genetic risk between eating disorder- and substance-use-related phenotypes: Evidence from genome-wide association studies
  • 2020
  • Ingår i: Addiction Biology. - 1355-6215.
  • Tidskriftsartikel (refereegranskat)abstract
    • Eating disorders and substance use disorders frequently co-occur. Twin studies reveal shared genetic variance between liabilities to eating disorders and substance use, with the strongest associations between symptoms of bulimia nervosa and problem alcohol use (genetic correlation [r(g)], twin-based = 0.23-0.53). We estimated the genetic correlation between eating disorder and substance use and disorder phenotypes using data from genome-wide association studies (GWAS). Four eating disorder phenotypes (anorexia nervosa [AN], AN with binge eating, AN without binge eating, and a bulimia nervosa factor score), and eight substance-use-related phenotypes (drinks per week, alcohol use disorder [AUD], smoking initiation, current smoking, cigarettes per day, nicotine dependence, cannabis initiation, and cannabis use disorder) from eight studies were included. Significant genetic correlations were adjusted for variants associated with major depressive disorder and schizophrenia. Total study sample sizes per phenotype ranged from similar to 2400 to similar to 537 000 individuals. We used linkage disequilibrium score regression to calculate single nucleotide polymorphism-based genetic correlations between eating disorder- and substance-use-related phenotypes. Significant positive genetic associations emerged between AUD and AN (r(g) = 0.18; false discovery rate q = 0.0006), cannabis initiation and AN (r(g) = 0.23; q < 0.0001), and cannabis initiation and AN with binge eating (r(g) = 0.27; q = 0.0016). Conversely, significant negative genetic correlations were observed between three nondiagnostic smoking phenotypes (smoking initiation, current smoking, and cigarettes per day) and AN without binge eating (r(gs) = -0.19 to -0.23; qs < 0.04). The genetic correlation between AUD and AN was no longer significant after co-varying for major depressive disorder loci. The patterns of association between eating disorder- and substance-use-related phenotypes highlights the potentially complex and substance-specific relationships among these behaviors.
  • Abbasi, R., et al. (författare)
  • Measurement of the anisotropy of cosmic-ray arrival directions with icecube
  • 2010
  • Ingår i: The Astrophysical Journal Letters. - 2041-8205. ; 718:2, s. L194-L198
  • Tidskriftsartikel (refereegranskat)abstract
    • <p>We report the first observation of an anisotropy in the arrival direction of cosmic rays with energies in the multi-TeV region in the Southern sky using data from the IceCube detector. Between 2007 June and 2008 March, the partially deployed IceCube detector was operated in a configuration with 1320 digital optical sensors distributed over 22 strings at depths between 1450 and 2450 m inside the Antarctic ice. IceCube is a neutrino detector, but the data are dominated by a large background of cosmic-ray muons. Therefore, the background data are suitable for high-statistics studies of cosmic rays in the southern sky. The data include 4.3 billion muons produced by downward-going cosmic-ray interactions in the atmosphere; these events were reconstructed with a median angular resolution of 3 degrees and a median energy of similar to 20 TeV. Their arrival direction distribution exhibits an anisotropy in right ascension with a first-harmonic amplitude of (6.4 +/- 0.2 stat. +/- 0.8 syst.) x 10(-4).</p>
  • Abbasi, R., et al. (författare)
  • Neutrino Analysis of the 2010 September Crab Nebula Flare and Time-Integrated Constraints on Neutrino Emission from the Crab Using Icecube
  • 2012
  • Ingår i: Astrophysical Journal. - 0004-637X .- 1538-4357. ; 745:1, s. 45
  • Tidskriftsartikel (refereegranskat)abstract
    • <p>We present the results of a search for high-energy muon neutrinos with the IceCube detector in coincidence with the Crab Nebula flare reported on 2010 September by various experiments. Due to the unusual flaring state of the otherwise steady source we performed a prompt analysis of the 79-string configuration data to search for neutrinos that might be emitted along with the observed. gamma-rays. We performed two different and complementary data selections of neutrino events in the time window of 10 days around the flare. One event selection is optimized for discovery of E-upsilon(2). neutrino spectrum typical of first-order Fermi acceleration. A similar event selection has also been applied to the 40-string data to derive the time-integrated limits to the neutrino emission from the Crab. The other event selection was optimized for discovery of neutrino spectra with softer spectral index and TeV energy cutoffs as observed for various Galactic sources in. gamma-rays. The 90% confidence level (CL) best upper limits on the Crab flux during the 10 day flare are 4.73 x 10(-11) cm(-2) s(-1) TeV-1 for an E-upsilon(2). neutrino spectrum and 2.50 x 10(-10) cm(-2) s(-1) TeV-1 for a softer neutrino spectra of E-upsilon(-2.7), as indicated by Fermi measurements during the flare. In this paper, we also illustrate the impact of the time-integrated limit on the Crab neutrino steady emission. The limit obtained using 375.5 days of the 40-string configuration is compared to existing models of neutrino production from the Crab and its impact on astrophysical parameters is discussed. The most optimistic predictions of some models are already rejected by the IceCube neutrino telescope with more than 90% CL.</p>
  • Abbasi, R., et al. (författare)
  • Observation of anisotropy in the arrival directions of galactic cosmic rays at multiple angular scales with IceCube
  • 2011
  • Ingår i: Astrophysical Journal. - 0004-637X .- 1538-4357. ; 740:1, s. 16
  • Tidskriftsartikel (refereegranskat)abstract
    • <p>Between 2009 May and 2010 May, the IceCube neutrino detector at the South Pole recorded 32 billion muons generated in air showers produced by cosmic rays with a median energy of 20 TeV. With a data set of this size, it is possible to probe the southern sky for per-mil anisotropy on all angular scales in the arrival direction distribution of cosmic rays. Applying a power spectrum analysis to the relative intensity map of the cosmic ray flux in the southern hemisphere, we show that the arrival direction distribution is not isotropic, but shows significant structure on several angular scales. In addition to previously reported large-scale structure in the form of a strong dipole and quadrupole, the data show small-scale structure on scales between 15 degrees and 30 degrees. The skymap exhibits several localized regions of significant excess and deficit in cosmic ray intensity. The relative intensity of the smaller-scale structures is about a factor of five weaker than that of the dipole and quadrupole structure. The most significant structure, an excess localized at (right ascension alpha = 122 degrees.4 and declination d = -47 degrees.4), extends over at least 20 degrees in right ascension and has a post-trials significance of 5.3 sigma. The origin of this anisotropy is still unknown.</p>
  • Abbasi, R., et al. (författare)
  • Search for a diffuse flux of astrophysical muon neutrinos with the IceCube 40-string detector
  • 2011
  • Ingår i: Physical Review D. - 1550-7998 .- 1550-2368. ; 84:8, s. 082001
  • Tidskriftsartikel (refereegranskat)abstract
    • <p>The IceCube Neutrino Observatory is a 1 km(3) detector currently taking data at the South Pole. One of the main strategies used to look for astrophysical neutrinos with IceCube is the search for a diffuse flux of high-energy neutrinos from unresolved sources. A hard energy spectrum of neutrinos from isotropically distributed astrophysical sources could manifest itself as a detectable signal that may be differentiated from the atmospheric neutrino background by spectral measurement. This analysis uses data from the IceCube detector collected in its half completed configuration which operated between April 2008 and May 2009 to search for a diffuse flux of astrophysical muon neutrinos. A total of 12 877 upward-going candidate neutrino events have been selected for this analysis. No evidence for a diffuse flux of astrophysical muon neutrinos was found in the data set leading to a 90% C. L. upper limit on the normalization of an E(-2) astrophysical nu(mu) flux of 8.9 x 10(-9) GeV cm(-2) s(-1) sr(-1). The analysis is sensitive in the energy range between 35 TeV and 7 PeV. The 12 877 candidate neutrino events are consistent with atmospheric muon neutrinos measured from 332 GeV to 84 TeV and no evidence for a prompt component to the atmospheric neutrino spectrum is found.</p>
  • Abbasi, R., et al. (författare)
  • Search for relativistic magnetic monopoles with the AMANDA-II neutrino telescope
  • 2010
  • Ingår i: European Physical Journal C. - 1434-6044 .- 1434-6052. ; 69:3-4, s. 361-378
  • Tidskriftsartikel (refereegranskat)abstract
    • <p>We present the search for Cherenkov signatures from relativistic magnetic monopoles in data taken with the AMANDA-II detector, a neutrino telescope deployed in the Antarctic ice cap at the Geographic South Pole. The non-observation of a monopole signal in data collected during the year 2000 improves present experimental limits on the flux of relativistic magnetic monopoles: Our flux limit varies between 3.8x10(-17) cm(-2) s(-1) sr(-1) (for monopoles moving at the vacuum speed of light) and 8.8x10(-16) cm(-2) s(-1) sr(-1) (for monopoles moving at a speed beta=v/c=0.76, just above the Cherenkov threshold in ice). These limits apply to monopoles that are energetic enough to penetrate the Earth and enter the detector from below the horizon. The limit obtained for monopoles reaching the detector from above the horizon is less stringent by roughly an order of magnitude, due to the much larger background from down-going atmospheric muons. This looser limit is however valid for a larger class of magnetic monopoles, since the monopoles are not required to pass through the Earth.</p>
  • Abbasi, R., et al. (författare)
  • Background studies for acoustic neutrino detection at the South Pole
  • 2012
  • Ingår i: Astroparticle physics. - 0927-6505 .- 1873-2852. ; 35:6, s. 312-324
  • Tidskriftsartikel (refereegranskat)abstract
    • <p>The detection of acoustic signals from ultra-high energy neutrino interactions is a promising method to measure the flux of cosmogenic neutrinos expected on Earth. The energy threshold for this process depends strongly on the absolute noise level in the target material. The South Pole Acoustic Test Setup (SPATS), deployed in the upper part of four boreholes of the IceCube Neutrino Observatory, has monitored the noise in Antarctic ice at the geographic South Pole for more than two years down to 500 m depth. The noise is very stable and Gaussian distributed. Lacking an in situ calibration up to now, laboratory measurements have been used to estimate the absolute noise level in the 10-50 kHz frequency range to be smaller than 20 mPa. Using a threshold trigger, sensors of the South Pole Acoustic Test Setup registered acoustic events in the IceCube detector volume and its vicinity. Acoustic signals from refreezing IceCube holes and from anthropogenic sources have been used to test the localization of acoustic events. An upper limit on the neutrino flux at energies E-v&gt;10(11) GeV is derived from acoustic data taken over eight months. (C) 2011 Elsevier B.V. All rights reserved.</p>
  • Abbasi, R., et al. (författare)
  • Constraints on high-energy neutrino emission from SN 2008D
  • 2011
  • Ingår i: Astronomy and Astrophysics. - 0004-6361 .- 1432-0746. ; 527:4, s. A28
  • Tidskriftsartikel (refereegranskat)abstract
    • <p>SN 2008D, a core collapse supernova at a distance of 27 Mpc, was serendipitously discovered by the Swift satellite through an associated X-ray flash. Core collapse supernovae have been observed in association with long gamma-ray bursts and X-ray flashes and a physical connection is widely assumed. This connection could imply that some core collapse supernovae possess mildly relativistic jets in which high-energy neutrinos are produced through proton-proton collisions. The predicted neutrino spectra would be detectable by Cherenkov neutrino detectors like IceCube. A search for a neutrino signal in temporal and spatial correlation with the observed X-ray flash of SN 2008D was conducted using data taken in 2007-2008 with 22 strings of the IceCube detector. Events were selected based on a boosted decision tree classifier trained with simulated signal and experimental background data. The classifier was optimized to the position and a "soft jet" neutrino spectrum assumed for SN 2008D. Using three search windows placed around the X-ray peak, emission time scales from 100-10 000 s were probed. No events passing the cuts were observed in agreement with the signal expectation of 0.13 events. Upper limits on the muon neutrino flux from core collapse supernovae were derived for different emission time scales and the principal model parameters were constrained. While no meaningful limits can be given in the case of an isotropic neutrino emission, the parameter space for a jetted emission can be constrained. Future analyses with the full 86 string IceCube detector could detect up to similar to 100 events for a core-collapse supernova at 10 Mpc according to the soft jet model.</p>
  • Abbasi, R., et al. (författare)
  • Constraints on the extremely-high energy cosmic neutrino flux with the IceCube 2008-2009 data
  • 2011
  • Ingår i: Physical Review D - Particles, Fields, Gravitation and Cosmology. - 1550-7998. ; 83:9, s. 092003
  • Tidskriftsartikel (refereegranskat)abstract
    • <p>We report on a search for extremely-high energy neutrinos with energies greater than 10(6) GeV using the data taken with the IceCube detector at the South Pole. The data was collected between April 2008 and May 2009 with the half-completed IceCube array. The absence of signal candidate events in the sample of 333.5 days of live time significantly improves model-independent limits from previous searches and allows to place a limit on the diffuse flux of cosmic neutrinos with an E-2 spectrum in the energy range 2.0 x 10(6) - 6.3 x 10(9) GeV to a level of E-2 phi &lt;= 3.6 x 10(-8) GeV cm(-2) sec(-1) sr(-1).</p>
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