| 1. |
- Lozano, Rafael, et al.
(författare)
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Measuring progress from 1990 to 2017 and projecting attainment to 2030 of the health-related Sustainable Development Goals for 195 countries and territories: a systematic analysis for the Global Burden of Disease Study 2017
- 2018
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Ingår i: The Lancet. - : Elsevier. - 1474-547X .- 0140-6736. ; 392:10159, s. 2091-2138
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Tidskriftsartikel (refereegranskat)abstract
- Background: Efforts to establish the 2015 baseline and monitor early implementation of the UN Sustainable Development Goals (SDGs) highlight both great potential for and threats to improving health by 2030. To fully deliver on the SDG aim of “leaving no one behind”, it is increasingly important to examine the health-related SDGs beyond national-level estimates. As part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017), we measured progress on 41 of 52 health-related SDG indicators and estimated the health-related SDG index for 195 countries and territories for the period 1990–2017, projected indicators to 2030, and analysed global attainment. Methods: We measured progress on 41 health-related SDG indicators from 1990 to 2017, an increase of four indicators since GBD 2016 (new indicators were health worker density, sexual violence by non-intimate partners, population census status, and prevalence of physical and sexual violence [reported separately]). We also improved the measurement of several previously reported indicators. We constructed national-level estimates and, for a subset of health-related SDGs, examined indicator-level differences by sex and Socio-demographic Index (SDI) quintile. We also did subnational assessments of performance for selected countries. To construct the health-related SDG index, we transformed the value for each indicator on a scale of 0–100, with 0 as the 2·5th percentile and 100 as the 97·5th percentile of 1000 draws calculated from 1990 to 2030, and took the geometric mean of the scaled indicators by target. To generate projections through 2030, we used a forecasting framework that drew estimates from the broader GBD study and used weighted averages of indicator-specific and country-specific annualised rates of change from 1990 to 2017 to inform future estimates. We assessed attainment of indicators with defined targets in two ways: first, using mean values projected for 2030, and then using the probability of attainment in 2030 calculated from 1000 draws. We also did a global attainment analysis of the feasibility of attaining SDG targets on the basis of past trends. Using 2015 global averages of indicators with defined SDG targets, we calculated the global annualised rates of change required from 2015 to 2030 to meet these targets, and then identified in what percentiles the required global annualised rates of change fell in the distribution of country-level rates of change from 1990 to 2015. We took the mean of these global percentile values across indicators and applied the past rate of change at this mean global percentile to all health-related SDG indicators, irrespective of target definition, to estimate the equivalent 2030 global average value and percentage change from 2015 to 2030 for each indicator. Findings: The global median health-related SDG index in 2017 was 59·4 (IQR 35·4–67·3), ranging from a low of 11·6 (95% uncertainty interval 9·6–14·0) to a high of 84·9 (83·1–86·7). SDG index values in countries assessed at the subnational level varied substantially, particularly in China and India, although scores in Japan and the UK were more homogeneous. Indicators also varied by SDI quintile and sex, with males having worse outcomes than females for non-communicable disease (NCD) mortality, alcohol use, and smoking, among others. Most countries were projected to have a higher health-related SDG index in 2030 than in 2017, while country-level probabilities of attainment by 2030 varied widely by indicator. Under-5 mortality, neonatal mortality, maternal mortality ratio, and malaria indicators had the most countries with at least 95% probability of target attainment. Other indicators, including NCD mortality and suicide mortality, had no countries projected to meet corresponding SDG targets on the basis of projected mean values for 2030 but showed some probability of attainment by 2030. For some indicators, including child malnutrition, several infectious diseases, and most violence measures, the annualised rates of change required to meet SDG targets far exceeded the pace of progress achieved by any country in the recent past. We found that applying the mean global annualised rate of change to indicators without defined targets would equate to about 19% and 22% reductions in global smoking and alcohol consumption, respectively; a 47% decline in adolescent birth rates; and a more than 85% increase in health worker density per 1000 population by 2030. Interpretation: The GBD study offers a unique, robust platform for monitoring the health-related SDGs across demographic and geographic dimensions. Our findings underscore the importance of increased collection and analysis of disaggregated data and highlight where more deliberate design or targeting of interventions could accelerate progress in attaining the SDGs. Current projections show that many health-related SDG indicators, NCDs, NCD-related risks, and violence-related indicators will require a concerted shift away from what might have driven past gains—curative interventions in the case of NCDs—towards multisectoral, prevention-oriented policy action and investments to achieve SDG aims. Notably, several targets, if they are to be met by 2030, demand a pace of progress that no country has achieved in the recent past. The future is fundamentally uncertain, and no model can fully predict what breakthroughs or events might alter the course of the SDGs. What is clear is that our actions—or inaction—today will ultimately dictate how close the world, collectively, can get to leaving no one behind by 2030.
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| 2. |
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| 3. |
- Buehler, Stefan, et al.
(författare)
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A cloud filtering method for microwave upper tropospheric humidity measurements
- 2007
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Ingår i: Atmospheric Chemistry And Physics. - : Copernicus GmbH. - 1680-7316 .- 1680-7324. ; 7:21, s. 5531-5542
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Tidskriftsartikel (refereegranskat)abstract
- The paper presents a cloud filtering method for upper tropospheric humidity (UTH) measurements at 183.31±1.00 GHz. The method uses two criteria: a viewing angle dependent threshold on the brightness temperature at 183.31±1.00 GHz, and a threshold on the brightness temperature difference between another channel and 183.31±1.00 GHz. Two different alternatives, using 183.31±3.00 GHz or 183.31±7.00 GHz as the other channel, are studied. The robustness of this cloud filtering method is demonstrated by a mid-latitudes winter case study. The paper then studies different biases on UTH climatologies. Clouds are associated with high humidity, therefore the possible dry bias introduced by cloud filtering is discussed and compared to the wet biases introduced by the clouds radiative effect if no filtering is done. This is done by means of a case study, and by means of a stochastic cloud database with representative statistics for midlatitude conditions. Both studied filter alternatives perform nearly equally well, but the alternative using 183.31±3.00 GHz as other channel is preferable, because that channel is less likely to see the Earth's surface than the one at 183.31±7.00 GHz. The consistent result of all case studies and for both filter alternatives is that both cloud wet bias and cloud filtering dry bias are modest for microwave data. The recommended strategy is to use the cloud filtered data as an estimate for the true all-sky UTH value, but retain the unfiltered data to have an estimate of the cloud induced uncertainty. The focus of the paper is on midlatitude data, since atmospheric data to test the filter for that case were readily available. The filter is expected to be applicable also to subtropical and tropical data, but should be further validated with case studies similar to the one presented here for those cases.
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| 4. |
- Buehler, Stefan, et al.
(författare)
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Radiative transfer calculations for a passive microwave satellite sensor : comparing a fast model and a line-by-line model
- 2006
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Ingår i: Journal of Geophysical Research. - 0148-0227 .- 2156-2202. ; 111:20, s. 20304-
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Tidskriftsartikel (refereegranskat)abstract
- A comparison between the fast radiative transfer model Radiative Transfer for the TIROS Operational Vertical Sounder (RTTOV-7) and the physical radiative transfer model Atmospheric Radiative Transfer Simulator ( ARTS) was carried out. Radiances were simulated for the sounding channels of the Advanced Microwave Sounding Unit B (AMSU-B) for the whole globe for a single time of a single day ( 1 January 2000, 0000 UT). Temperature, pressure, and specific humidity profiles from the reanalysis data set ERA-40 of the European Centre for Medium-Range Weather Forecasts (ECMWF) were used as input for both models; geopotential height profiles were also used but only as input for ARTS. The simulations were made for two different surface emissivities, 0.60 and 0.95. The low surface emissivity case exhibits the larger radiance differences. Although the global values of the mean difference and standard deviation are small ( for example, the global mean difference for channel 18 is 0.014 K and the standard deviation is 0.232 K), the examination of the geographical distribution of the differences shows that large positive or negative values are observed over dry regions of high northern and southern latitudes and over dry elevated regions. The origin of these differences was found to be due to errors introduced by the transmittance parametrization used in RTTOV.
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| 5. |
- Buehler, Stefan, et al.
(författare)
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Recent developments in the line-by-line modeling of outgoing longwave radiation
- 2006
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Ingår i: Journal of Quantitative Spectroscopy and Radiative Transfer. - : Elsevier BV. - 0022-4073 .- 1879-1352. ; 98:3, s. 446-457
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Tidskriftsartikel (refereegranskat)abstract
- High frequency resolution radiative transfer model calculations with the Atmospheric Radiative Transfer Simulator (ARTS) were used to simulate the clear-sky outgoing longwave radiative flux (OLR) at the top of the atmosphere. Compared to earlier calculations by Clough and coworkers the model used a spherical atmosphere instead of a plane parallel atmosphere, updated spectroscopic parameters from HITRAN, and updated continuum parameterizations from Mlawer and coworkers. These modifications lead to a reduction in simulated OLR by approximately 4.1%, the largest part, approximately 2.5%, being due to the absence of the plane parallel approximation. As a simple application of the new model, the sensitivity of OLR to changes in humidity, carbon dioxide concentration, and temperature were investigated for different cloud-free atmospheric scenarios. It was found that for the tropical scenario a 20% change in humidity has a larger impact than a doubling of the carbon dioxide concentration. The sensitive altitude region for temperature and humidity changes is the entire free troposphere, including the upper troposphere where humidity data quality is poor.
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| 6. |
- Granholm, Anders, et al.
(författare)
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Dexamethasone 12 mg versus 6 mg for patients with COVID-19 and severe hypoxaemia: a pre-planned, secondary Bayesian analysis of the COVID STEROID 2 trial
- 2022
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Ingår i: Intensive Care Medicine. - : SPRINGER. - 0342-4642 .- 1432-1238. ; 48:1, s. 45-55
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Tidskriftsartikel (refereegranskat)abstract
- Purpose We compared dexamethasone 12 versus 6 mg daily for up to 10 days in patients with coronavirus disease 2019 (COVID-19) and severe hypoxaemia in the international, randomised, blinded COVID STEROID 2 trial. In the primary, conventional analyses, the predefined statistical significance thresholds were not reached. We conducted a pre-planned Bayesian analysis to facilitate probabilistic interpretation. Methods We analysed outcome data within 90 days in the intention-to-treat population (data available in 967 to 982 patients) using Bayesian models with various sensitivity analyses. Results are presented as median posterior probabilities with 95% credible intervals (CrIs) and probabilities of different effect sizes with 12 mg dexamethasone. Results The adjusted mean difference on days alive without life support at day 28 (primary outcome) was 1.3 days (95% CrI -0.3 to 2.9; 94.2% probability of benefit). Adjusted relative risks and probabilities of benefit on serious adverse reactions was 0.85 (0.63 to 1.16; 84.1%) and on mortality 0.87 (0.73 to 1.03; 94.8%) at day 28 and 0.88 (0.75 to 1.02; 95.1%) at day 90. Probabilities of benefit on days alive without life support and days alive out of hospital at day 90 were 85 and 95.7%, respectively. Results were largely consistent across sensitivity analyses, with relatively low probabilities of clinically important harm with 12 mg on all outcomes in all analyses. Conclusion We found high probabilities of benefit and low probabilities of clinically important harm with dexamethasone 12 mg versus 6 mg daily in patients with COVID-19 and severe hypoxaemia on all outcomes up to 90 days.
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| 7. |
- Granholm, Anders, et al.
(författare)
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Higher vs Lower Doses of Dexamethasone in Patients with COVID-19 and Severe Hypoxia (COVID STEROID 2) trial: Protocol for a secondary Bayesian analysis
- 2021
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Ingår i: Acta Anaesthesiologica Scandinavica. - : WILEY. - 0001-5172 .- 1399-6576. ; 65:5, s. 702-710
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Tidskriftsartikel (refereegranskat)abstract
- Background Coronavirus disease 2019 (COVID-19) can lead to severe hypoxic respiratory failure and death. Corticosteroids decrease mortality in severely or critically ill patients with COVID-19. However, the optimal dose remains unresolved. The ongoing randomised COVID STEROID 2 trial investigates the effects of higher vs lower doses of dexamethasone (12 vs 6 mg intravenously daily for up to 10 days) in 1,000 adult patients with COVID-19 and severe hypoxia. Methods This protocol outlines the rationale and statistical methods for a secondary, pre-planned Bayesian analysis of the primary outcome (days alive without life support at day 28) and all secondary outcomes registered up to day 90. We will use hurdle-negative binomial models to estimate the mean number of days alive without life support in each group and present results as mean differences and incidence rate ratios with 95% credibility intervals (CrIs). Additional count outcomes will be analysed similarly and binary outcomes will be analysed using logistic regression models with results presented as probabilities, relative risks and risk differences with 95% CrIs. We will present probabilities of any benefit/harm, clinically important benefit/harm and probabilities of effects smaller than pre-defined clinically minimally important differences for all outcomes analysed. Analyses will be adjusted for stratification variables and conducted using weakly informative priors supplemented by sensitivity analyses using sceptic priors. Discussion This secondary, pre-planned Bayesian analysis will supplement the primary, conventional analysis and may help clinicians, researchers and policymakers interpret the results of the COVID STEROID 2 trial while avoiding arbitrarily dichotomised interpretations of the results. Trial registration ClinicalTrials.gov: NCT04509973; EudraCT: 2020-003363-25.
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| 8. |
- Granholm, Anders, et al.
(författare)
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Long-term outcomes of dexamethasone 12 mg versus 6 mg in patients with COVID-19 and severe hypoxaemia
- 2022
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Ingår i: Intensive Care Medicine. - : SPRINGER. - 0342-4642 .- 1432-1238. ; 48, s. 580-589
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Tidskriftsartikel (refereegranskat)abstract
- Purpose We assessed long-term outcomes of dexamethasone 12 mg versus 6 mg given daily for up to 10 days in patients with coronavirus disease 2019 (COVID-19) and severe hypoxaemia. Methods We assessed 180-day mortality and health-related quality of life (HRQoL) using EuroQoL (EQ)-5D-5L index values and EQ visual analogue scale (VAS) in the international, stratified, blinded COVID STEROID 2 trial, which randomised 1000 adults with confirmed COVID-19 receiving at least 10 L/min of oxygen or mechanical ventilation in 26 hospitals in Europe and India. In the HRQoL analyses, higher values indicated better outcomes, and deceased patients were given a score of zero. Results We obtained vital status at 180 days for 963 of 982 patients (98.1%) in the intention-to-treat population, EQ-5D-5L index value data for 922 (93.9%) and EQ VAS data for 924 (94.1%). At 180 days, 164 of 486 patients (33.7%) had died in the 12 mg group versus 184 of 477 (38.6%) in the 6 mg group [adjusted risk difference - 4.3%; 99% confidence interval (CI) - 11.7-3.0; relative risk 0.89; 0.72-1.09; P = 0.13]. The adjusted mean differences between the 12 mg and the 6 mg groups in EQ-5D-5L index values were 0.06 (99% CI - 0.01 to 0.12; P = 0.10) and in EQ VAS scores 4 (- 3 to 10; P = 0.22). Conclusion Among patients with COVID-19 and severe hypoxaemia, dexamethasone 12 mg compared with 6 mg did not result in statistically significant improvements in mortality or HRQoL at 180 days, but the results were most compatible with benefit from the higher dose.
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| 9. |
- John, Viju Oommen, et al.
(författare)
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A cautionary note on the use of Gaussian statistics in satellite-based UTH climatologies
- 2006
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Ingår i: IEEE Geoscience and Remote Sensing Letters. - 1545-598X .- 1558-0571. ; 3:1, s. 130-134
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Tidskriftsartikel (refereegranskat)abstract
- This letter presents a cautionary note on the assumption of Gaussian behavior for upper tropospheric humidity (UTH) derived from satellite data in climatological studies, which can introduce a wet bias in the climatology. An example study using European Centre for Medium-Range Weather Forecasts reanalysis data shows that this wet bias can reach up to 6 %RH, which is significant for climatological applications. A simple Monte Carlo approach demonstrates that these differences and their link to the variability of brightness temperatures are due to a log-normal distribution of the UTH. This problem can be solved by using robust estimators such as the median instead of the arithmetic mean.
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| 10. |
- John, Viju Oommen, et al.
(författare)
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Understanding the variability of clear-sky outgoing long-wave radiation based on ship-based temperature and water vapour measurements
- 2006
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Ingår i: Quarterly Journal of the Royal Meteorological Society. - : Wiley. - 0035-9009 .- 1477-870X. ; 132:621, s. 2675-2691
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Tidskriftsartikel (refereegranskat)abstract
- High-resolution radiative transfer model calculations with the Atmospheric Radiative Transfer Simulator (ARTS) were used to simulate the clear-sky outgoing long-wave radiative flux (OLR) at the top of the atmosphere. The unique set of radiosonde data collected by the research vessel Polarstern of the Alfred Wegener Institute for Polar and Marine Research during 27 expeditions in the years 1982 to 2003 was used to investigate the sources of clear-sky OLR variability for ocean areas in different climate zones and seasons. For this dataset, tropospheric temperature variations contribute approximately 33 W m(-2) OLR variability. tropospheric relative humidity variations 8.5 W m(-2), and vertical structure 2.3-3.4 W m(-2). Of these, 0.3-1.0 W m(-2) are due to structures on a vertical scale smaller than 4 km, which cannot be resolved by conventional remote-sensing instruments. It was also found that the poor absolute accuracy of current humidity data in the upper troposphere, approximately 40% relative error in relative humidity, leads to a significant uncertainty in OLR of about 3.8 W m(-2) (for a midlatitude summer atmosphere), which should be put in the context of the double CO2 effect of only 2.6 W m(-2) (for the same atmosphere).
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