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- Ademuyiwa, Adesoji O., et al.
(författare)
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Determinants of morbidity and mortality following emergency abdominal surgery in children in low-income and middle-income countries
- 2016
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Ingår i: BMJ Global Health. - : BMJ Publishing Group Ltd. - 2059-7908. ; 1:4
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Tidskriftsartikel (refereegranskat)abstract
- Background: Child health is a key priority on the global health agenda, yet the provision of essential and emergency surgery in children is patchy in resource-poor regions. This study was aimed to determine the mortality risk for emergency abdominal paediatric surgery in low-income countries globally.Methods: Multicentre, international, prospective, cohort study. Self-selected surgical units performing emergency abdominal surgery submitted prespecified data for consecutive children aged <16 years during a 2-week period between July and December 2014. The United Nation's Human Development Index (HDI) was used to stratify countries. The main outcome measure was 30-day postoperative mortality, analysed by multilevel logistic regression.Results: This study included 1409 patients from 253 centres in 43 countries; 282 children were under 2 years of age. Among them, 265 (18.8%) were from low-HDI, 450 (31.9%) from middle-HDI and 694 (49.3%) from high-HDI countries. The most common operations performed were appendectomy, small bowel resection, pyloromyotomy and correction of intussusception. After adjustment for patient and hospital risk factors, child mortality at 30 days was significantly higher in low-HDI (adjusted OR 7.14 (95% CI 2.52 to 20.23), p<0.001) and middle-HDI (4.42 (1.44 to 13.56), p=0.009) countries compared with high-HDI countries, translating to 40 excess deaths per 1000 procedures performed.Conclusions: Adjusted mortality in children following emergency abdominal surgery may be as high as 7 times greater in low-HDI and middle-HDI countries compared with high-HDI countries. Effective provision of emergency essential surgery should be a key priority for global child health agendas.
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| 2. |
- Bixby, H., et al.
(författare)
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Rising rural body-mass index is the main driver of the global obesity epidemic in adults
- 2019
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Ingår i: Nature. - : Springer Science and Business Media LLC. - 0028-0836 .- 1476-4687. ; 569:7755, s. 260-4
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Tidskriftsartikel (refereegranskat)abstract
- Body-mass index (BMI) has increased steadily in most countries in parallel with a rise in the proportion of the population who live in cities(.)(1,2) This has led to a widely reported view that urbanization is one of the most important drivers of the global rise in obesity(3-6). Here we use 2,009 population-based studies, with measurements of height and weight in more than 112 million adults, to report national, regional and global trends in mean BMI segregated by place of residence (a rural or urban area) from 1985 to 2017. We show that, contrary to the dominant paradigm, more than 55% of the global rise in mean BMI from 1985 to 2017-and more than 80% in some low- and middle-income regions-was due to increases in BMI in rural areas. This large contribution stems from the fact that, with the exception of women in sub-Saharan Africa, BMI is increasing at the same rate or faster in rural areas than in cities in low- and middle-income regions. These trends have in turn resulted in a closing-and in some countries reversal-of the gap in BMI between urban and rural areas in low- and middle-income countries, especially for women. In high-income and industrialized countries, we noted a persistently higher rural BMI, especially for women. There is an urgent need for an integrated approach to rural nutrition that enhances financial and physical access to healthy foods, to avoid replacing the rural undernutrition disadvantage in poor countries with a more general malnutrition disadvantage that entails excessive consumption of low-quality calories.
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| 3. |
- Campbell, PJ, et al.
(författare)
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Pan-cancer analysis of whole genomes
- 2020
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Ingår i: Nature. - : Springer Science and Business Media LLC. - 1476-4687 .- 0028-0836. ; 578:7793, s. 82-
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Tidskriftsartikel (refereegranskat)abstract
- Cancer is driven by genetic change, and the advent of massively parallel sequencing has enabled systematic documentation of this variation at the whole-genome scale1–3. Here we report the integrative analysis of 2,658 whole-cancer genomes and their matching normal tissues across 38 tumour types from the Pan-Cancer Analysis of Whole Genomes (PCAWG) Consortium of the International Cancer Genome Consortium (ICGC) and The Cancer Genome Atlas (TCGA). We describe the generation of the PCAWG resource, facilitated by international data sharing using compute clouds. On average, cancer genomes contained 4–5 driver mutations when combining coding and non-coding genomic elements; however, in around 5% of cases no drivers were identified, suggesting that cancer driver discovery is not yet complete. Chromothripsis, in which many clustered structural variants arise in a single catastrophic event, is frequently an early event in tumour evolution; in acral melanoma, for example, these events precede most somatic point mutations and affect several cancer-associated genes simultaneously. Cancers with abnormal telomere maintenance often originate from tissues with low replicative activity and show several mechanisms of preventing telomere attrition to critical levels. Common and rare germline variants affect patterns of somatic mutation, including point mutations, structural variants and somatic retrotransposition. A collection of papers from the PCAWG Consortium describes non-coding mutations that drive cancer beyond those in the TERT promoter4; identifies new signatures of mutational processes that cause base substitutions, small insertions and deletions and structural variation5,6; analyses timings and patterns of tumour evolution7; describes the diverse transcriptional consequences of somatic mutation on splicing, expression levels, fusion genes and promoter activity8,9; and evaluates a range of more-specialized features of cancer genomes8,10–18.
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| 6. |
- Graham, Nicholas A. J., et al.
(författare)
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Climate Warming, Marine Protected Areas and the Ocean-Scale Integrity of Coral Reef Ecosystems
- 2008
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Ingår i: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 3:8, s. e3039-
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Tidskriftsartikel (refereegranskat)abstract
- Coral reefs have emerged as one of the ecosystems most vulnerable to climate variation and change. While the contribution of a warming climate to the loss of live coral cover has been well documented across large spatial and temporal scales, the associated effects on fish have not. Here, we respond to recent and repeated calls to assess the importance of local management in conserving coral reefs in the context of global climate change. Such information is important, as coral reef fish assemblages are the most species dense vertebrate communities on earth, contributing critical ecosystem functions and providing crucial ecosystem services to human societies in tropical countries. Our assessment of the impacts of the 1998 mass bleaching event on coral cover, reef structural complexity, and reef associated fishes spans 7 countries, 66 sites and 26 degrees of latitude in the Indian Ocean. Using Bayesian meta-analysis we show that changes in the size structure, diversity and trophic composition of the reef fish community have followed coral declines. Although the ocean scale integrity of these coral reef ecosystems has been lost, it is positive to see the effects are spatially variable at multiple scales, with impacts and vulnerability affected by geography but not management regime. Existing no-take marine protected areas still support high biomass of fish, however they had no positive affect on the ecosystem response to large-scale disturbance. This suggests a need for future conservation and management efforts to identify and protect regional refugia, which should be integrated into existing management frameworks and combined with policies to improve system-wide resilience to climate variation and change.
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| 7. |
- Graham, Nicholas A. J., et al.
(författare)
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Extinction vulnerability of coral reef fishes
- 2011
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Ingår i: Ecology Letters. - : Wiley. - 1461-023X .- 1461-0248. ; 14:4, s. 341-348
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Tidskriftsartikel (refereegranskat)abstract
- P>With rapidly increasing rates of contemporary extinction, predicting extinction vulnerability and identifying how multiple stressors drive non-random species loss have become key challenges in ecology. These assessments are crucial for avoiding the loss of key functional groups that sustain ecosystem processes and services. We developed a novel predictive framework of species extinction vulnerability and applied it to coral reef fishes. Although relatively few coral reef fishes are at risk of global extinction from climate disturbances, a negative convex relationship between fish species locally vulnerable to climate change vs. fisheries exploitation indicates that the entire community is vulnerable on the many reefs where both stressors co-occur. Fishes involved in maintaining key ecosystem functions are more at risk from fishing than climate disturbances. This finding is encouraging as local and regional commitment to fisheries management action can maintain reef ecosystem functions pending progress towards the more complex global problem of stabilizing the climate.
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| 8. |
- Hudson, Thomas J., et al.
(författare)
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International network of cancer genome projects
- 2010
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Ingår i: Nature. - : Springer Science and Business Media LLC. - 0028-0836 .- 1476-4687. ; 464:7291, s. 993-998
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Tidskriftsartikel (refereegranskat)abstract
- The International Cancer Genome Consortium (ICGC) was launched to coordinate large-scale cancer genome studies in tumours from 50 different cancer types and/or subtypes that are of clinical and societal importance across the globe. Systematic studies of more than 25,000 cancer genomes at the genomic, epigenomic and transcriptomic levels will reveal the repertoire of oncogenic mutations, uncover traces of the mutagenic influences, define clinically relevant subtypes for prognosis and therapeutic management, and enable the development of new cancer therapies.
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| 9. |
- Jennings, Anne E., et al.
(författare)
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Baffin Bay paleoenvironments in the LGM and HS1 : Resolving the ice-shelf question
- 2018
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Ingår i: Marine Geology. - : Elsevier BV. - 0025-3227 .- 1872-6151. ; 402, s. 5-16
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Tidskriftsartikel (refereegranskat)abstract
- Core HU2008029-12PC from the Disko trough mouth fan on the central West Greenland continental slope is used to test whether an ice shelf covered Baffin Bay during the Last Glacial Maximum (LGM) and at the onset of the deglaciation. We use benthic and planktic foraminiferal assemblages, stable isotope analysis of planktic forams, algal biomarkers, ice-rafted detritus (IRD), lithofacies characteristics defined from CT scans, and quantitative mineralogy to reconstruct paleoceanographic conditions, sediment processes and sediment provenance. The chronology is based on radiocarbon dates on planktic foraminifers using a Delta R of 140 +/- 30 C-14 years, supplemented by the varying reservoir estimates of Stern and Lisiecki (2013) that provide an envelope of potential ages. HU2008029-12PC is bioturbated throughout. Sediments between the core base at 11.3 m and 4.6 m (LGM through HS1) comprise thin turbidites, plumites and hemipelagic sediments with Greenlandic provenance consistent with processes active at the Greenland Ice Sheet margin grounded at or near the shelf edge. Abundance spikes of planktic forams coincide with elevated abundance of benthic forams in assemblages indicative of chilled Atlantic Water, meltwater and intermittent marine productivity. IRD and IP25 are rare in this interval, but brassicasterol, an indicator of marine productivity reaches and sustains low levels during the LGM. These biological characteristics are consistent with a sea-ice covered ocean experiencing periods of more open water such as leads or polynyas in the sea ice cover, with chilled Atlantic Water at depth, rather than full iceshelf cover. They do not support the existence of a full Baffin Bay ice shelf cover extending from grounded ice on the Davis Strait. Initial ice retreat from the West Greenland margin is manifested by a pronounced lithofacies shift to bioturbated, diatomaceous mud with rare IRD of Greenlandic origin at 467 cm (16.2 cal ka BP; Delta R = 140 yrs) within HS1. A spike in foraminiferal abundance and ocean warmth indicator benthic forams precedes the initial ice retreat from the shelf edge. At the end of HS1, IP 25 , brassicasterol and benthic forams indicative of sea-ice edge productivity increase, indicating warming interstadial conditions. Within the Bolling/Allerod interstadial a strong rise in IP 25 content and IRD spikes rich in detrital carbonate from northern Baffin Bay indicate that northern Baffin Bay ice streams were retreating and provides evidence for increased open water, advection of Atlantic Water in the West Greenland Current, and formation of an IRD belt along the W. Greenland margin.
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| 10. |
- Jennings, Anne, et al.
(författare)
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Modern and early Holocene ice shelf sediment facies from Petermann Fjord and northern Nares Strait, northwest Greenland
- 2022
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Ingår i: Quaternary Science Reviews. - : Elsevier BV. - 0277-3791 .- 1873-457X. ; 283
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Tidskriftsartikel (refereegranskat)abstract
- Based on sediment cores and geophysical data collected from Petermann Fjord and northern Nares Strait, NW Greenland, an Arctic ice shelf sediment facies is presented that distinguishes sub and pro ice shelf environments. Sediment cores were collected from sites beneath the present day Petermann Ice Tongue (PIT) and in deglacial sediments of northern Nares Strait with a focus on understanding the glacial and oceanographic history over the last 11,000 cal yr BP. The modern sub ice shelf sediment facies in Petermann Fjord is laminated and devoid of coarse clasts (IRD) due to strong basal melting that releases debris (debris filtering) from the basal ice at the grounding zone driven by buoyant subglacial meltwater and entrained Atlantic Water. Laminated sediments in the deep basin proximal to the gounding zone comprise layers of fine mud formed by suspension settling from turbid meltwater plumes (plumites) interrupted by normally graded very fine sand to medium silt layers with sharp basal contacts and rip-up clasts of mud, interpreted as turbidites. An inner fjord sill limits distribution of sediment gravity flows from the grounding zone to the deep inner fjord basin, such that sites on the inner sill and beyond the ice tongue largely only comprise plumites. Bioturbation and foraminiferal abundances increase with distance from the grounding zone. The benthic foraminiferal species, Elphidium clavatum is absent beneath the ice tongue, but dominant in the turbid meltwater influenced environment beyond the ice tongue. The very sparse IRD in sediments beneath the PIT and in the fjord beyond the PIT derives mainly from englacial debris in the ice tongue, side valley glaciers, rock falls from the steep fjord walls and sea ice.We use the modern ice shelf sediment facies characteristics to infer the past presence of ice shelves in northern Nares Strait using analyses of sediment cores from several cruises (OD1507, HLY03, 2001LSSL, RYDER19). On bathymetric highs, bioturbated mud with dispersed IRD overlies a 10–15 m thick, distinctly laminated silt and clay unit with rare coarse clasts and sparse foraminifera which forms a sediment drape of nearly uniform thickness. We interpret these laminated sediments to represent glaciomarine deposition by meltwater plumes emanating from ice streams that terminated in floating ice shelves. IRD layers, shifts in sediment composition (qXRD, MS and XRF) and faunal assemblage changes in the laminated unit document periods of ice-shelf instability sometimes, but not always, coupled with grounding zone retreat. Our deglacial reconstruction, including ice shelves, begins ∼10.7 cal ka BP, with confluent ice streams grounded in Hall Basin fronted by the Robeson Channel ice shelf. Ice shelf breakup and grounding zone retreat to relatively stable grounding zones at Kennedy Channel and the mouth of Petermann Fjord was accomplished by 9.4 cal ka BP when the Hall Basin ice shelf was established. This ice shelf broke up and reformed once prior to the final break up at 8.5 to 8.4 cal ka BP marking ice stream collapse, separation of Greenland and Innuitian ice sheets, and the opening of Nares Strait for Arctic-Atlantic throughflow. The Petermann ice shelf remained in Hall Basin until the Petermann Glacier retreated from the fjord mouth ∼7.1 cal ka BP. The resilience of these northern ice streams to strong early Holocene insolation and subsurface Atlantic Water advection is attributed to their northern aspect, buttressing by narrow passages, and high ice flux from the Greenland Ice Sheet (GIS).
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