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- Díaz, S, et al.
(författare)
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Assessing nature's contributions to people
- 2018
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Ingår i: Science. - : American Association for the Advancement of Science (AAAS). - 0036-8075 .- 1095-9203. ; 359:6373, s. 270-272
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Tidskriftsartikel (refereegranskat)abstract
- A major challenge today and into the future is to maintain or enhance beneficial contributions of nature to a good quality of life for all people. This is among the key motivations of the Intergovernmental Science-Policy Platform on Biodiversity and Ecosystem Services (IPBES), a joint global effort by governments, academia, and civil society to assess and promote knowledge of Earth's biodiversity and ecosystems and their contribution to human societies in order to inform policy formulation. One of the more recent key elements of the IPBES conceptual framework is the notion of nature's contributions to people (NCP), which builds on the ecosystem service concept popularized by the Millennium Ecosystem Assessment. But as we detail below, NCP as defined and put into practice in IPBES differs from earlier work in several important ways. First, the NCP approach recognizes the central and pervasive role that culture plays in defining all links between people and nature. Second, use of NCP elevates, emphasizes, and operationalizes the role of indigenous and local knowledge in understanding nature's contribution to people. The broad remit of IPBES requires it to engage a wide range of stakeholders, spanning from natural, social, humanistic, and engineering sciences to indigenous peoples and local communities in whose territories lie much of the world's biodiversity. Being an intergovernmental body, such inclusiveness is essential not only for advancing knowledge but also for the political legitimacy of assessment findings.
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- Sandercock, P, et al.
(författare)
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Update on the third international stroke trial (IST-3) of thrombolysis for acute ischaemic stroke and baseline features of the 3035 patients recruited
- 2011
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Ingår i: Trials. - : Springer Science and Business Media LLC. - 1745-6215. ; 12, s. 252-
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND:Intravenous recombinant tissue plasminogen activator (rtPA) is approved in Europe for use in patients with acute ischaemic stroke who meet strictly defined criteria. IST-3 sought to improve the external validity and prediction of the estimates of the overall treatment effects (efficacy and safety) of rtPA in acute ischaemic stroke, and to determine whether a wider range of patients might benefit.DESIGN:International, multi-centre, prospective, randomized, open, blinded endpoint (PROBE) trial of intravenous rtPA in acute ischaemic stroke. Suitable patients had to be assessed and able to start treatment within 6 hours of developing symptoms, and brain imaging must have excluded intracranial haemorrhage and stroke mimics.RESULTS:The initial pilot phase was double blind and then, on 01/08/2003, changed to an open design. Recruitment began on 05/05/2000 and closed on 31/07/2011, by which time 3035 patients had been included, only 61 (2%) of whom met the criteria for the 2003 European approval for thrombolysis. 1617 patients were aged over 80 years at trial entry. The analysis plan will be finalised, without reference to the unblinded data, and published before the trial data are unblinded in early 2012. The main trial results will be presented at the European Stroke Conference in Lisbon in May 2012 with the aim to publish simultaneously in a peer-reviewed journal. The trial result will be presented in the context of an updated Cochrane systematic review. We also intend to include the trial data in an individual patient data meta-analysis of all the relevant randomised trials.CONCLUSION:The data from the trial will: improve the external validity and prediction of the estimates of the overall treatment effects (efficacy and safety) of iv rtPA in acute ischaemic stroke; provide: new evidence on the balance of risk and benefit of intravenous rtPA among types of patients who do not clearly meet the terms of the current EU approval; and, provide the first large-scale randomised evidence on effects in patients over 80, an age group which had largely been excluded from previous acute stroke trials. Trial registration ISRCTN25765518.
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- Sandercock, P, et al.
(författare)
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EPITHET--where next?
- 2008
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Ingår i: The Lancet. Neurology. - 1474-4422. ; 7:7, s. 570-571
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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- Hacke, W, et al.
(författare)
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Effects of alteplase for acute stroke according to criteria defining the European Union and United States marketing authorizations: Individual-patient-data meta-analysis of randomized trials
- 2018
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Ingår i: International journal of stroke : official journal of the International Stroke Society. - : SAGE Publications. - 1747-4949. ; 13:2, s. 175-189
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Tidskriftsartikel (refereegranskat)abstract
- The recommended maximum age and time window for intravenous alteplase treatment of acute ischemic stroke differs between the Europe Union and United States. Aims We compared the effects of alteplase in cohorts defined by the current Europe Union or United States marketing approval labels, and by hypothetical revisions of the labels that would remove the Europe Union upper age limit or extend the United States treatment time window to 4.5 h. Methods We assessed outcomes in an individual-patient-data meta-analysis of eight randomized trials of intravenous alteplase (0.9 mg/kg) versus control for acute ischemic stroke. Outcomes included: excellent outcome (modified Rankin score 0–1) at 3–6 months, the distribution of modified Rankin score, symptomatic intracerebral hemorrhage, and 90-day mortality. Results Alteplase increased the odds of modified Rankin score 0–1 among 2449/6136 (40%) patients who met the current European Union label and 3491 (57%) patients who met the age-revised label (odds ratio 1.42, 95% CI 1.21−1.68 and 1.43, 1.23−1.65, respectively), but not in those outside the age-revised label (1.06, 0.90−1.26). By 90 days, there was no increased mortality in the current and age-revised cohorts (hazard ratios 0.98, 95% CI 0.76−1.25 and 1.01, 0.86–1.19, respectively) but mortality remained higher outside the age-revised label (1.19, 0.99–1.42). Similarly, alteplase increased the odds of modified Rankin score 0-1 among 1174/6136 (19%) patients who met the current US approval and 3326 (54%) who met a 4.5-h revised approval (odds ratio 1.55, 1.19−2.01 and 1.37, 1.17−1.59, respectively), but not for those outside the 4.5-h revised approval (1.14, 0.97−1.34). By 90 days, no increased mortality remained for the current and 4.5-h revised label cohorts (hazard ratios 0.99, 0.77−1.26 and 1.02, 0.87–1.20, respectively) but mortality remained higher outside the 4.5-h revised approval (1.17, 0.98–1.41). Conclusions An age-revised European Union label or 4.5-h-revised United States label would each increase the number of patients deriving net benefit from alteplase by 90 days after acute ischemic stroke, without excess mortality.
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- Mikityuk, K., et al.
(författare)
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Horizon-2020 ESFR-SMART project on Sodium Fast Reactor Safety: status after 18 months
- 2019
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- To improve the public acceptance of the future nuclear power in Europe we have to demonstrate that the new reactors have significantly higher safety level compared to traditional reactors. The ESFR-SMART project (European Sodium Fast Reactor Safety Measures Assessment and Research Tools) aims at enhancing further the safety of Generation-IV SFRs and in particular of the commercial-size European Sodium Fast Reactor (ESFR) in accordance with the European Sustainable Nuclear Industrial Initiative (ESNII) roadmap and in close cooperation with the Advanced Sodium Technological Reactor for Industrial Demonstration (ASTRID) program. The project aims at 5 specific objectives: 1. Produce new experimental data in order to support calibration and validation of the computational tools for each defence-in-depth level. 2. Test and qualify new instrumentations in order to support their utilization in the reactor protection system. 3. Perform further calibration and validation of the computational tools for each defence-in-depth level in order to support safety assessments of Generation-IV SFRs, using the data produced in the project as well as selected legacy data. 4. Select, implement and assess new safety measures for the commercial-size ESFR, using the GIF methodologies, the FP7 CP-ESFR project legacy, the calibrated and validated codes and being in accordance with the update of the European and international safety frameworks taking into account the Fukushima accident. 5. Strengthen and link together new networks, in particular, the network of the European sodium facilities and the network of the European students working on the SFR technology. By addressing the industry, policy makers and general public, the project is expected to make a meaningful impact on economics, environment, EU policy and society. Selected results and milestones achieved during the first eighteen months of the project will be briefly presented, including − proposal of new safety measures for ESFR; − evaluation of ESFR core performance; − benchmarking of codes; − experimental programs; and − education and training.
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