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- Forouzanfar, Mohammad H, et al.
(författare)
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Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks in 188 countries, 1990-2013 : a systematic analysis for the Global Burden of Disease Study 2013.
- 2015
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Ingår i: The Lancet. - 0140-6736 .- 1474-547X. ; 386:10010, s. 2287-2323
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The Global Burden of Disease, Injuries, and Risk Factor study 2013 (GBD 2013) is the first of a series of annual updates of the GBD. Risk factor quantification, particularly of modifiable risk factors, can help to identify emerging threats to population health and opportunities for prevention. The GBD 2013 provides a timely opportunity to update the comparative risk assessment with new data for exposure, relative risks, and evidence on the appropriate counterfactual risk distribution.METHODS: Attributable deaths, years of life lost, years lived with disability, and disability-adjusted life-years (DALYs) have been estimated for 79 risks or clusters of risks using the GBD 2010 methods. Risk-outcome pairs meeting explicit evidence criteria were assessed for 188 countries for the period 1990-2013 by age and sex using three inputs: risk exposure, relative risks, and the theoretical minimum risk exposure level (TMREL). Risks are organised into a hierarchy with blocks of behavioural, environmental and occupational, and metabolic risks at the first level of the hierarchy. The next level in the hierarchy includes nine clusters of related risks and two individual risks, with more detail provided at levels 3 and 4 of the hierarchy. Compared with GBD 2010, six new risk factors have been added: handwashing practices, occupational exposure to trichloroethylene, childhood wasting, childhood stunting, unsafe sex, and low glomerular filtration rate. For most risks, data for exposure were synthesised with a Bayesian meta-regression method, DisMod-MR 2.0, or spatial-temporal Gaussian process regression. Relative risks were based on meta-regressions of published cohort and intervention studies. Attributable burden for clusters of risks and all risks combined took into account evidence on the mediation of some risks such as high body-mass index (BMI) through other risks such as high systolic blood pressure and high cholesterol.FINDINGS: All risks combined account for 57·2% (95% uncertainty interval [UI] 55·8-58·5) of deaths and 41·6% (40·1-43·0) of DALYs. Risks quantified account for 87·9% (86·5-89·3) of cardiovascular disease DALYs, ranging to a low of 0% for neonatal disorders and neglected tropical diseases and malaria. In terms of global DALYs in 2013, six risks or clusters of risks each caused more than 5% of DALYs: dietary risks accounting for 11·3 million deaths and 241·4 million DALYs, high systolic blood pressure for 10·4 million deaths and 208·1 million DALYs, child and maternal malnutrition for 1·7 million deaths and 176·9 million DALYs, tobacco smoke for 6·1 million deaths and 143·5 million DALYs, air pollution for 5·5 million deaths and 141·5 million DALYs, and high BMI for 4·4 million deaths and 134·0 million DALYs. Risk factor patterns vary across regions and countries and with time. In sub-Saharan Africa, the leading risk factors are child and maternal malnutrition, unsafe sex, and unsafe water, sanitation, and handwashing. In women, in nearly all countries in the Americas, north Africa, and the Middle East, and in many other high-income countries, high BMI is the leading risk factor, with high systolic blood pressure as the leading risk in most of Central and Eastern Europe and south and east Asia. For men, high systolic blood pressure or tobacco use are the leading risks in nearly all high-income countries, in north Africa and the Middle East, Europe, and Asia. For men and women, unsafe sex is the leading risk in a corridor from Kenya to South Africa.INTERPRETATION: Behavioural, environmental and occupational, and metabolic risks can explain half of global mortality and more than one-third of global DALYs providing many opportunities for prevention. Of the larger risks, the attributable burden of high BMI has increased in the past 23 years. In view of the prominence of behavioural risk factors, behavioural and social science research on interventions for these risks should be strengthened. Many prevention and primary care policy options are available now to act on key risks.FUNDING: Bill & Melinda Gates Foundation.
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| 2. |
- Sediva, A, et al.
(författare)
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Europe Immunoglobulin Map
- 2014
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Ingår i: JOURNAL OF CLINICAL IMMUNOLOGY. - : Oxford University Press (OUP). - 0271-9142. ; 178178 Suppl 1, s. 141-143
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)
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| 5. |
- Litaudon, X., et al.
(författare)
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Development of steady-state scenarios compatible with ITER-like wall conditions
- 2007
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Ingår i: Plasma Physics and Controlled Fusion. - 0741-3335 .- 1361-6587. ; 49:12B, s. B529-B550
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Tidskriftsartikel (refereegranskat)abstract
- A key issue for steady-state tokamak operation is to determine the edge conditions that are compatible both with good core confinement and with the power handling and plasma exhaust capabilities of the plasma facing components (PFCs) and divertor systems. A quantitative response to this open question will provide a robust scientific basis for reliable extrapolation of present regimes to an ITER compatible steady-state scenario. In this context, the JET programme addressing steady-state operation is focused on the development of non-inductive, high confinement plasmas with the constraints imposed by the PFCs. A new beryllium main chamber wall and tungsten divertor together with an upgrade of the heating/fuelling capability are currently in preparation at JET. Operation at higher power with this ITER-like wall will impose new constraints on non-inductive scenarios. Recent experiments have focused on the preparation for this new phase of JET operation. In this paper, progress in the development of advanced tokamak (AT) scenarios at JET is reviewed keeping this long-term objective in mind. The approach has consisted of addressing various critical issues separately during the 2006-2007 campaigns with a view to full scenario integration when the JET upgrades are complete. Regimes with internal transport barriers (ITBs) have been developed at q(95) similar to 5 and high triangularity, 3 (relevant to the ITER steady-state demonstration) by applying more than 30 MW of additional heating power reaching beta(N) similar to 2 at B(o) similar to 3.1 T. Operating at higher 6 has allowed the edge pedestal and core densities to be increased pushing the ion temperature closer to that of the electrons. Although not yet fully integrated into a performance enhancing ITB scenario, Neon seeding has been successfully explored to increase the radiated power fraction (up to 60%), providing significant reduction of target tile power fluxes (and hence temperatures) and mitigation of edge localized mode (ELM) activity. At reduced toroidal magnetic field strength, high beta(N) regimes have been achieved and q-profile optimization investigated for use in steady-state scenarios. Values of beta(N) above the 'no-wall magnetohydrodynamic limit' (beta(N) similar to 3.0) have been sustained for a resistive current diffusion time in high-delta configurations (at 1.2 MA/1.8 T). In this scenario, ELM activity has been mitigated by applying magnetic perturbations using error field correction coils to provide ergodization of the magnetic field at the plasma edge. In a highly shaped, quasi-double null X-point configuration, ITBs have been generated on the ion heat transport channel and combined with 'grassy' ELMs with similar to 30 MW of applied heating power (at 1.2 MA/2.7 T, q(95) similar to 7). Advanced algorithms and system identification procedures have been developed with a view to developing simultaneously temperature and q-profile control in real-time. These techniques have so far been applied to the control of the q-profile evolution in JET AT scenarios.
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| 6. |
- Santala, M. I. K., et al.
(författare)
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Proton-triton nuclear reaction in ICRF heated plasmas in JET
- 2006
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Ingår i: Plasma Physics and Controlled Fusion. - : IOP Publishing. - 0741-3335 .- 1361-6587. ; 48:8, s. 1233-1253
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Tidskriftsartikel (refereegranskat)abstract
- Fast protons can react with tritons in an endothermic nuclear reaction which can act as a source of neutrons in magnetically confined fusion plasmas. We have performed an experiment to systematically study this reaction in low tritium concentration (approximate to 1%) plasmas in the Joint European Torus. A linear dependence is found between excess neutron rate and tritium concentration when the DT fusion rate is low. We discuss the properties of the neutron emission, including anisotropy, from the proton-triton reaction in a fusion reactor environment and derive simple models for the calculation of the neutron yield from this reaction in terms of tritium density, fast ion temperature and fast ion energy content.
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| 7. |
- Hermanides, J, et al.
(författare)
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Sensor-augmented pump therapy lowers HbA(1c) in suboptimally controlled Type 1 diabetes; a randomized controlled trial.
- 2011
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Ingår i: Diabetic Medicine: A journal of the British Diabetic Association. - : Wiley. - 1464-5491. ; 28, s. 1158-1167
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Tidskriftsartikel (refereegranskat)abstract
- Aims To investigate the efficacy of sensor-augmented pump therapy vs. multiple daily injection therapy in patients with suboptimally controlled Type 1 diabetes. Methods In this investigator-initiated multi-centre trial (the Eurythmics Trial) in eight outpatient centres in Europe, we randomized 83 patients with Type 1 diabetes (40 women) currently treated with multiple daily injections, age 18-65 years and HbA(1c) ≥ 8.2% (≥ 66 mmol/mol) to 26 weeks of treatment with either a sensor-augmented insulin pump (n = 44) (Paradigm(®) REAL-Time) or continued with multiple daily injections (n = 39). Change in HbA(1c) between baseline and 26 weeks, sensor-derived endpoints and patient-reported outcomes were assessed. Results The trial was completed by 43/44 (98%) patients in the sensor-augmented insulin pump group and 35/39 (90%) patients in the multiple daily injections group. Mean HbA(1c) at baseline and at 26 weeks changed from 8.46% (sd 0.95) (69 mmol/mol) to 7.23% (sd 0.65) (56 mmol/mol) in the sensor-augmented insulin pump group and from 8.59% (sd 0.82) (70 mmol/mol) to 8.46% (sd 1.04) (69 mmol/mol) in the multiple daily injections group. Mean difference in change in HbA(1c) after 26 weeks was -1.21% (95% confidence interval -1.52 to -0.90, P < 0.001) in favour of the sensor-augmented insulin pump group. This was achieved without an increase in percentage of time spent in hypoglycaemia: between-group difference 0.0% (95% confidence interval -1.6 to 1.7, P = 0.96). There were four episodes of severe hypoglycaemia in the sensor-augmented insulin pump group and one episode in the multiple daily injections group (P = 0.21). Problem Areas in Diabetes and Diabetes Treatment Satisfaction Questionnaire scores improved in the sensor-augmented insulin pump group. Conclusions Sensor augmented pump therapy effectively lowers HbA(1c) in patients with Type 1 diabetes suboptimally controlled with multiple daily injections.
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