| 1. |
- Naghavi, M., et al.
(författare)
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Global, regional, and national age-sex specific mortality for 264 causes of death, 1980-2016: a systematic analysis for the Global Burden of Disease Study 2016
- 2017
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Ingår i: Lancet. - : Elsevier. - 0140-6736 .- 1474-547X. ; 390:10100, s. 1151-1210
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Tidskriftsartikel (refereegranskat)abstract
- Background Monitoring levels and trends in premature mortality is crucial to understanding how societies can address prominent sources of early death. The Global Burden of Disease 2016 Study (GBD 2016) provides a comprehensive assessment of cause-specific mortality for 264 causes in 195 locations from 1980 to 2016. This assessment includes evaluation of the expected epidemiological transition with changes in development and where local patterns deviate from these trends. Methods We estimated cause-specific deaths and years of life lost (YLLs) by age, sex, geography, and year. YLLs were calculated from the sum of each death multiplied by the standard life expectancy at each age. We used the GBD cause of death database composed of: vital registration (VR) data corrected for under-registration and garbage coding; national and subnational verbal autopsy (VA) studies corrected for garbage coding; and other sources including surveys and surveillance systems for specific causes such as maternal mortality. To facilitate assessment of quality, we reported on the fraction of deaths assigned to GBD Level 1 or Level 2 causes that cannot be underlying causes of death (major garbage codes) by location and year. Based on completeness, garbage coding, cause list detail, and time periods covered, we provided an overall data quality rating for each location with scores ranging from 0 stars (worst) to 5 stars (best). We used robust statistical methods including the Cause of Death Ensemble model (CODEm) to generate estimates for each location, year, age, and sex. We assessed observed and expected levels and trends of cause-specific deaths in relation to the Socio-demographic Index (SDI), a summary indicator derived from measures of average income per capita, educational attainment, and total fertility, with locations grouped into quintiles by SDI. Relative to GBD 2015, we expanded the GBD cause hierarchy by 18 causes of death for GBD 2016. Findings The quality of available data varied by location. Data quality in 25 countries rated in the highest category (5 stars), while 48, 30, 21, and 44 countries were rated at each of the succeeding data quality levels. Vital registration or verbal autopsy data were not available in 27 countries, resulting in the assignment of a zero value for data quality. Deaths from non-communicable diseases (NCDs) represented 72.3% (95% uncertainty interval [UI] 71.2-73.2) of deaths in 2016 with 19.3% (18.5-20.4) of deaths in that year occurring from communicable, maternal, neonatal, and nutritional (CMNN) diseases and a further 8.43% (8.00-8.67) from injuries. Although age-standardised rates of death from NCDs decreased globally between 2006 and 2016, total numbers of these deaths increased; both numbers and age-standardised rates of death from CMNN causes decreased in the decade 2006-16-age-standardised rates of deaths from injuries decreased but total numbers varied little. In 2016, the three leading global causes of death in children under-5 were lower respiratory infections, neonatal preterm birth complications, and neonatal encephalopathy due to birth asphyxia and trauma, combined resulting in 1.80 million deaths (95% UI 1.59 million to 1.89 million). Between 1990 and 2016, a profound shift toward deaths at older ages occurred with a 178% (95% UI 176-181) increase in deaths in ages 90-94 years and a 210% (208-212) increase in deaths older than age 95 years. The ten leading causes by rates of age-standardised YLL significantly decreased from 2006 to 2016 (median annualised rate of change was a decrease of 2.89%); the median annualised rate of change for all other causes was lower (a decrease of 1.59%) during the same interval. Globally, the five leading causes of total YLLs in 2016 were cardiovascular diseases; diarrhoea, lower respiratory infections, and other common infectious diseases; neoplasms; neonatal disorders; and HIV/AIDS and tuberculosis. At a finer level of disaggregation within cause groupings, the ten leading causes of total YLLs in 2016 were ischaemic heart disease, cerebrovascular disease, lower respiratory infections, diarrhoeal diseases, road injuries, malaria, neonatal preterm birth complications, HIV/AIDS, chronic obstructive pulmonary disease, and neonatal encephalopathy due to birth asphyxia and trauma. Ischaemic heart disease was the leading cause of total YLLs in 113 countries for men and 97 countries for women. Comparisons of observed levels of YLLs by countries, relative to the level of YLLs expected on the basis of SDI alone, highlighted distinct regional patterns including the greater than expected level of YLLs from malaria and from HIV/AIDS across sub-Saharan Africa; diabetes mellitus, especially in Oceania; interpersonal violence, notably within Latin America and the Caribbean; and cardiomyopathy and myocarditis, particularly in eastern and central Europe. The level of YLLs from ischaemic heart disease was less than expected in 117 of 195 locations. Other leading causes of YLLs for which YLLs were notably lower than expected included neonatal preterm birth complications in many locations in both south Asia and southeast Asia, and cerebrovascular disease in western Europe. Interpretation The past 37 years have featured declining rates of communicable, maternal, neonatal, and nutritional diseases across all quintiles of SDI, with faster than expected gains for many locations relative to their SDI. A global shift towards deaths at older ages suggests success in reducing many causes of early death. YLLs have increased globally for causes such as diabetes mellitus or some neoplasms, and in some locations for causes such as drug use disorders, and conflict and terrorism. Increasing levels of YLLs might reflect outcomes from conditions that required high levels of care but for which effective treatments remain elusive, potentially increasing costs to health systems. Copyright (C) The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.
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| 4. |
- Naghavi, Mohsen, et al.
(författare)
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Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013
- 2015
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Ingår i: The Lancet. - 1474-547X .- 0140-6736. ; 385:9963, s. 117-171
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Tidskriftsartikel (refereegranskat)abstract
- Background Up-to-date evidence on levels and trends for age-sex-specifi c all-cause and cause-specifi c mortality is essential for the formation of global, regional, and national health policies. In the Global Burden of Disease Study 2013 (GBD 2013) we estimated yearly deaths for 188 countries between 1990, and 2013. We used the results to assess whether there is epidemiological convergence across countries. Methods We estimated age-sex-specifi c all-cause mortality using the GBD 2010 methods with some refinements to improve accuracy applied to an updated database of vital registration, survey, and census data. We generally estimated cause of death as in the GBD 2010. Key improvements included the addition of more recent vital registration data for 72 countries, an updated verbal autopsy literature review, two new and detailed data systems for China, and more detail for Mexico, UK, Turkey, and Russia. We improved statistical models for garbage code redistribution. We used six different modelling strategies across the 240 causes; cause of death ensemble modelling (CODEm) was the dominant strategy for causes with sufficient information. Trends for Alzheimer's disease and other dementias were informed by meta-regression of prevalence studies. For pathogen-specifi c causes of diarrhoea and lower respiratory infections we used a counterfactual approach. We computed two measures of convergence (inequality) across countries: the average relative difference across all pairs of countries (Gini coefficient) and the average absolute difference across countries. To summarise broad findings, we used multiple decrement life-tables to decompose probabilities of death from birth to exact age 15 years, from exact age 15 years to exact age 50 years, and from exact age 50 years to exact age 75 years, and life expectancy at birth into major causes. For all quantities reported, we computed 95% uncertainty intervals (UIs). We constrained cause-specific fractions within each age-sex-country-year group to sum to all-cause mortality based on draws from the uncertainty distributions. Findings Global life expectancy for both sexes increased from 65.3 years (UI 65.0-65.6) in 1990, to 71.5 years (UI 71.0-71.9) in 2013, while the number of deaths increased from 47.5 million (UI 46.8-48.2) to 54.9 million (UI 53.6-56.3) over the same interval. Global progress masked variation by age and sex: for children, average absolute diff erences between countries decreased but relative diff erences increased. For women aged 25-39 years and older than 75 years and for men aged 20-49 years and 65 years and older, both absolute and relative diff erences increased. Decomposition of global and regional life expectancy showed the prominent role of reductions in age-standardised death rates for cardiovascular diseases and cancers in high-income regions, and reductions in child deaths from diarrhoea, lower respiratory infections, and neonatal causes in low-income regions. HIV/AIDS reduced life expectancy in southern sub-Saharan Africa. For most communicable causes of death both numbers of deaths and age-standardised death rates fell whereas for most non-communicable causes, demographic shifts have increased numbers of deaths but decreased age-standardised death rates. Global deaths from injury increased by 10.7%, from 4.3 million deaths in 1990 to 4.8 million in 2013; but age-standardised rates declined over the same period by 21%. For some causes of more than 100 000 deaths per year in 2013, age-standardised death rates increased between 1990 and 2013, including HIV/AIDS, pancreatic cancer, atrial fibrillation and flutter, drug use disorders, diabetes, chronic kidney disease, and sickle-cell anaemias. Diarrhoeal diseases, lower respiratory infections, neonatal causes, and malaria are still in the top five causes of death in children younger than 5 years. The most important pathogens are rotavirus for diarrhoea and pneumococcus for lower respiratory infections. Country-specific probabilities of death over three phases of life were substantially varied between and within regions. Interpretation For most countries, the general pattern of reductions in age-sex specifi c mortality has been associated with a progressive shift towards a larger share of the remaining deaths caused by non-communicable disease and injuries. Assessing epidemiological convergence across countries depends on whether an absolute or relative measure of inequality is used. Nevertheless, age-standardised death rates for seven substantial causes are increasing, suggesting the potential for reversals in some countries. Important gaps exist in the empirical data for cause of death estimates for some countries; for example, no national data for India are available for the past decade.
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| 5. |
- Sheena, B. S., et al.
(författare)
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Global, regional, and national burden of hepatitis B, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019
- 2022
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Ingår i: Lancet Gastroenterology & Hepatology. - : Elsevier BV. - 2468-1253. ; 7:9, s. 796-829
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Tidskriftsartikel (refereegranskat)abstract
- Background Combating viral hepatitis is part of the UN Sustainable Development Goals (SDGs), and WHO has put forth hepatitis B elimination targets in its Global Health Sector Strategy on Viral Hepatitis (WHO-GHSS) and Interim Guidance for Country Validation of Viral Hepatitis Elimination (WHO Interim Guidance). We estimated the global, regional, and national prevalence of hepatitis B virus (HBV), as well as mortality and disability-adjusted life-years (DALYs) due to HBV, as part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019. This included estimates for 194 WHO member states, for which we compared our estimates to WHO elimination targets. Methods The primary data sources were population-based serosurveys, claims and hospital discharges, cancer registries, vital registration systems, and published case series. We estimated chronic HBV infection and the burden of HBV-related diseases, defined as an aggregate of cirrhosis due to hepatitis B, liver cancer due to hepatitis B, and acute hepatitis B. We used DisMod-MR 2.1, a Bayesian mixed-effects meta-regression tool, to estimate the prevalence of chronic HBV infection, cirrhosis, and aetiological proportions of cirrhosis. We used mortality-to-incidence ratios modelled with spatiotemporal Gaussian process regression to estimate the incidence of liver cancer. We used the Cause of Death Ensemble modelling (CODEm) model, a tool that selects models and covariates on the basis of out-ofsample performance, to estimate mortality due to cirrhosis, liver cancer, and acute hepatitis B. Findings In 2019, the estimated global, all-age prevalence of chronic HBV infection was 4 center dot 1% (95% uncertainty interval [UI] 3 center dot 7 to 4 center dot 5), corresponding to 316 million (284 to 351) infected people. There was a 31 center dot 3% (29 center dot 0 to 33 center dot 9) decline in all-age prevalence between 1990 and 2019, with a more marked decline of 76 center dot 8% (76 center dot 2 to 77 center dot 5) in prevalence in children younger than 5 years. HBV-related diseases resulted in 555 000 global deaths (487 000 to 630 000) in 2019. The number of HBV-related deaths increased between 1990 and 2019 (by 5 center dot 9% [-5 center dot 6 to 19 center dot 2]) and between 2015 and 2019 (by 2 center dot 9% [-5 center dot 9 to 11 center dot 3]). By contrast, all-age and age-standardised death rates due to HBV-related diseases decreased during these periods. We compared estimates for 2019 in 194 WHO locations to WHO-GHSS 2020 targets, and found that four countries achieved a 10% reduction in deaths, 15 countries achieved a 30% reduction in new cases, and 147 countries achieved a 1% prevalence in children younger than 5 years. As of 2019, 68 of 194 countries had already achieved the 2030 target proposed in WHO Interim Guidance of an all-age HBV-related death rate of four per 100 000. Interpretation The prevalence of chronic HBV infection declined over time, particularly in children younger than 5 years, since the introduction of hepatitis B vaccination. HBV-related death rates also decreased, but HBV-related death counts increased as a result of population growth, ageing, and cohort effects. By 2019, many countries had met the interim seroprevalence target for children younger than 5 years, but few countries had met the WHO-GHSS interim targets for deaths and new cases. Progress according to all indicators must be accelerated to meet 2030 targets, and there are marked disparities in burden and progress across the world. HBV interventions, such as vaccination, testing, and treatment, must be strategically supported and scaled up to achieve elimination.
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| 6. |
- Wang, Haidong, et al.
(författare)
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Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015 : a systematic analysis for the Global Burden of Disease Study 2015
- 2016
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Ingår i: The Lancet. - 0140-6736 .- 1474-547X. ; 388:10053, s. 1459-1544
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Improving survival and extending the longevity of life for all populations requires timely, robust evidence on local mortality levels and trends. The Global Burden of Disease 2015 Study (GBD 2015) provides a comprehensive assessment of all-cause and cause-specific mortality for 249 causes in 195 countries and territories from 1980 to 2015. These results informed an in-depth investigation of observed and expected mortality patterns based on sociodemographic measures.METHODS: We estimated all-cause mortality by age, sex, geography, and year using an improved analytical approach originally developed for GBD 2013 and GBD 2010. Improvements included refinements to the estimation of child and adult mortality and corresponding uncertainty, parameter selection for under-5 mortality synthesis by spatiotemporal Gaussian process regression, and sibling history data processing. We also expanded the database of vital registration, survey, and census data to 14 294 geography-year datapoints. For GBD 2015, eight causes, including Ebola virus disease, were added to the previous GBD cause list for mortality. We used six modelling approaches to assess cause-specific mortality, with the Cause of Death Ensemble Model (CODEm) generating estimates for most causes. We used a series of novel analyses to systematically quantify the drivers of trends in mortality across geographies. First, we assessed observed and expected levels and trends of cause-specific mortality as they relate to the Socio-demographic Index (SDI), a summary indicator derived from measures of income per capita, educational attainment, and fertility. Second, we examined factors affecting total mortality patterns through a series of counterfactual scenarios, testing the magnitude by which population growth, population age structures, and epidemiological changes contributed to shifts in mortality. Finally, we attributed changes in life expectancy to changes in cause of death. We documented each step of the GBD 2015 estimation processes, as well as data sources, in accordance with Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER).FINDINGS: Globally, life expectancy from birth increased from 61·7 years (95% uncertainty interval 61·4-61·9) in 1980 to 71·8 years (71·5-72·2) in 2015. Several countries in sub-Saharan Africa had very large gains in life expectancy from 2005 to 2015, rebounding from an era of exceedingly high loss of life due to HIV/AIDS. At the same time, many geographies saw life expectancy stagnate or decline, particularly for men and in countries with rising mortality from war or interpersonal violence. From 2005 to 2015, male life expectancy in Syria dropped by 11·3 years (3·7-17·4), to 62·6 years (56·5-70·2). Total deaths increased by 4·1% (2·6-5·6) from 2005 to 2015, rising to 55·8 million (54·9 million to 56·6 million) in 2015, but age-standardised death rates fell by 17·0% (15·8-18·1) during this time, underscoring changes in population growth and shifts in global age structures. The result was similar for non-communicable diseases (NCDs), with total deaths from these causes increasing by 14·1% (12·6-16·0) to 39·8 million (39·2 million to 40·5 million) in 2015, whereas age-standardised rates decreased by 13·1% (11·9-14·3). Globally, this mortality pattern emerged for several NCDs, including several types of cancer, ischaemic heart disease, cirrhosis, and Alzheimer's disease and other dementias. By contrast, both total deaths and age-standardised death rates due to communicable, maternal, neonatal, and nutritional conditions significantly declined from 2005 to 2015, gains largely attributable to decreases in mortality rates due to HIV/AIDS (42·1%, 39·1-44·6), malaria (43·1%, 34·7-51·8), neonatal preterm birth complications (29·8%, 24·8-34·9), and maternal disorders (29·1%, 19·3-37·1). Progress was slower for several causes, such as lower respiratory infections and nutritional deficiencies, whereas deaths increased for others, including dengue and drug use disorders. Age-standardised death rates due to injuries significantly declined from 2005 to 2015, yet interpersonal violence and war claimed increasingly more lives in some regions, particularly in the Middle East. In 2015, rotaviral enteritis (rotavirus) was the leading cause of under-5 deaths due to diarrhoea (146 000 deaths, 118 000-183 000) and pneumococcal pneumonia was the leading cause of under-5 deaths due to lower respiratory infections (393 000 deaths, 228 000-532 000), although pathogen-specific mortality varied by region. Globally, the effects of population growth, ageing, and changes in age-standardised death rates substantially differed by cause. Our analyses on the expected associations between cause-specific mortality and SDI show the regular shifts in cause of death composition and population age structure with rising SDI. Country patterns of premature mortality (measured as years of life lost [YLLs]) and how they differ from the level expected on the basis of SDI alone revealed distinct but highly heterogeneous patterns by region and country or territory. Ischaemic heart disease, stroke, and diabetes were among the leading causes of YLLs in most regions, but in many cases, intraregional results sharply diverged for ratios of observed and expected YLLs based on SDI. Communicable, maternal, neonatal, and nutritional diseases caused the most YLLs throughout sub-Saharan Africa, with observed YLLs far exceeding expected YLLs for countries in which malaria or HIV/AIDS remained the leading causes of early death.INTERPRETATION: At the global scale, age-specific mortality has steadily improved over the past 35 years; this pattern of general progress continued in the past decade. Progress has been faster in most countries than expected on the basis of development measured by the SDI. Against this background of progress, some countries have seen falls in life expectancy, and age-standardised death rates for some causes are increasing. Despite progress in reducing age-standardised death rates, population growth and ageing mean that the number of deaths from most non-communicable causes are increasing in most countries, putting increased demands on health systems.
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| 12. |
- Fitzmaurice, C., et al.
(författare)
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Global, Regional, and National Cancer Incidence, Mortality, Years of Life Lost, Years Lived With Disability, and Disability-Adjusted Life-years for 32 Cancer Groups, 1990 to 2015. A Systematic Analysis for the Global Burden of Disease Study
- 2017
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Ingår i: Jama Oncology. - : American Medical Association (AMA). - 2374-2445 .- 2374-2437. ; 3:4, s. 524-548
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Tidskriftsartikel (refereegranskat)abstract
- IMPORTANCE Cancer is the second leading cause of death worldwide. Current estimates on the burden of cancer are needed for cancer control planning. OBJECTIVE To estimate mortality, incidence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs) for 32 cancers in 195 countries and territories from 1990 to 2015. EVIDENCE REVIEW Cancer mortality was estimated using vital registration system data, cancer registry incidence data (transformed to mortality estimates using separately estimated mortality to incidence [MI] ratios), and verbal autopsy data. Cancer incidence was calculated by dividing mortality estimates through the modeled MI ratios. To calculate cancer prevalence, MI ratios were used to model survival. To calculate YLDs, prevalence estimates were multiplied by disability weights. The YLLs were estimated by multiplying age-specific cancer deaths by the reference life expectancy. DALYs were estimated as the sum of YLDs and YLLs. A sociodemographic index (SDI) was created for each location based on income per capita, educational attainment, and fertility. Countries were categorized by SDI quintiles to summarize results. FINDINGS In 2015, there were 17.5 million cancer cases worldwide and 8.7 million deaths. Between 2005 and 2015, cancer cases increased by 33%, with population aging contributing 16%, population growth 13%, and changes in age-specific rates contributing 4%. For men, the most common cancer globallywas prostate cancer (1.6 million cases). Tracheal, bronchus, and lung cancerwas the leading cause of cancer deaths and DALYs in men (1.2 million deaths and 25.9 million DALYs). For women, the most common cancerwas breast cancer (2.4 million cases). Breast cancerwas also the leading cause of cancer deaths and DALYs forwomen (523000 deaths and 15.1 million DALYs). Overall, cancer caused 208.3 million DALYs worldwide in 2015 for both sexes combined. Between 2005 and 2015, age-standardized incidence rates for all cancers combined increased in 174 of 195 countries or territories. Age-standardized death rates (ASDRs) for all cancers combined decreased within that timeframe in 140 of 195 countries or territories. Countries with an increase in the ASDR due to all cancers were largely located on the African continent. Of all cancers, deaths between 2005 and 2015 decreased significantly for Hodgkin lymphoma (-6.1%[95% uncertainty interval (UI), -10.6% to -1.3%]). The number of deaths also decreased for esophageal cancer, stomach cancer, and chronic myeloid leukemia, although these results were not statistically significant. CONCLUSION AND RELEVANCE As part of the epidemiological transition, cancer incidence is expected to increase in the future, further straining limited health care resources. Appropriate allocation of resources for cancer prevention, early diagnosis, and curative and palliative care requires detailed knowledge of the local burden of cancer. The GBD 2015 study results demonstrate that progress is possible in the war against cancer. However, the major findings also highlight an unmet need for cancer prevention efforts, including tobacco control, vaccination, and the promotion of physical activity and a healthy diet.
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| 13. |
- Fitzmaurice, C., et al.
(författare)
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The Global Burden of Cancer 2013
- 2015
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Ingår i: JAMA Oncology. - : American Medical Association (AMA). - 2374-2437 .- 2374-2445. ; 1:4, s. 505-527
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Tidskriftsartikel (refereegranskat)abstract
- IMPORTANCE: Cancer is among the leading causes of death worldwide. Current estimates of cancer burden in individual countries and regions are necessary to inform local cancer control strategies. OBJECTIVE: To estimate mortality, incidence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs) for 28 cancers in 188 countries by sex from 1990 to 2013. EVIDENCE REVIEW: The general methodology of the Global Burden of Disease (GBD) 2013 study was used. Cancer registries were the source for cancer incidence data as well as mortality incidence (MI) ratios. Sources for cause of death data include vital registration system data, verbal autopsy studies, and other sources. The MI ratios were used to transform incidence data to mortality estimates and cause of death estimates to incidence estimates. Cancer prevalence was estimated using MI ratios as surrogates for survival data; YLDs were calculated by multiplying prevalence estimates with disability weights, which were derived from population-based surveys; YLLs were computed by multiplying the number of estimated cancer deaths at each age with a reference life expectancy; and DALYs were calculated as the sum of YLDs and YLLs. FINDINGS: In 2013 there were 14.9 million incident cancer cases, 8.2 million deaths, and 196.3 million DALYs. Prostate cancer was the leading cause for cancer incidence (1.4 million) for men and breast cancer for women (1.8 million). Tracheal, bronchus, and lung (TBL) cancer was the leading cause for cancer death in men and women, with 1.6 million deaths. For men, TBL cancer was the leading cause of DALYs (24.9 million). For women, breast cancer was the leading cause of DALYs (13.1 million). Age-standardized incidence rates (ASIRs) per 100 000 and age-standardized death rates (ASDRs) per 100 000 for both sexes in 2013 were higher in developing vs developed countries for stomach cancer (ASIR, 17 vs 14; ASDR, 15 vs 11), liver cancer (ASIR, 15 vs 7; ASDR, 16 vs 7), esophageal cancer (ASIR, 9 vs 4; ASDR, 9 vs 4), cervical cancer (ASIR, 8 vs 5; ASDR, 4 vs 2), lip and oral cavity cancer (ASIR, 7 vs 6; ASDR, 2 vs 2), and nasopharyngeal cancer (ASIR, 1.5 vs 0.4; ASDR, 1.2 vs 0.3). Between 1990 and 2013, ASIRs for all cancers combined (except nonmelanoma skin cancer and Kaposi sarcoma) increased by more than 10% in 113 countries and decreased by more than 10% in 12 of 188 countries. CONCLUSIONS AND RELEVANCE: Cancer poses a major threat to public health worldwide, and incidence rates have increased in most countries since 1990. The trend is a particular threat to developing nations with health systems that are ill-equipped to deal with complex and expensive cancer treatments. The annual update on the Global Burden of Cancer will provide all stakeholders with timely estimates to guide policy efforts in cancer prevention, screening, treatment, and palliation. Copyright 2015 American Medical Association. All rights reserved.
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- Pelkmans, L., et al.
(författare)
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Monitoring the Impact of Sustainability Certification in Relation to Biomass Use for Energy
- 2012
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Ingår i: EUBCE 2012 proceedings. - 9788889407547 ; , s. 2013-2018
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Since the public has expressed concern about unintended consequences associated with potentially unsustainable biomass production and use for energy (or biofuels), producers of biomass feedstocks in the private sector as well as governmental and non-governmental organisations have initiated many generally unlinked efforts to define 'sustainable' bioenergy production and supply chains. These 'sustainability' standards may be implemented through certification systems involving 3rd party audit, and influence production systems and trade of bioenergy products from producers to consumers of ‘green' energy. At present numerous biomass and biofuel sustainability certification systems are being developed or implemented by a variety of private and public organisations. Systems are applicable to different feedstock production sectors (forests, agricultural crops), different bioenergy products (relatively unprocessed forest residues, ethanol, biodiesel, electricity), and whole or segments of supply chains (production system, chain of custody from growers to energy consumers). It is expected that such a wide range of systems, developed largely without coordination among the organisations involved, could be problematic for all stakeholders along the supply chain in individual sectors and for those involved in deployment of bioenergy systems globally. These are individual feedstock producers, companies and commodity sectors that must comply with these systems either to maintain market access and share or to comply with legislative mandates, and also consumers who prefer to purchase certified green energy, and regulatory agencies and local to national governments that may be involved in enforcing sustainability standards. The potential for confusion among the actors, depression of markets, and unnecessary restrictions on sustainable trade seems high. Within IEA Bioenergy a strategic study was initiated between Task 40, Task 43 and Task 38 to monitor the actual implementation process of sustainability certification of bioenergy, evaluate how stakeholders are affected by certification initiatives, quantify the anticipated impact on worldwide bioenergy trade, assess the level of coordination among schemes, and make recommendations to remove barriers which may depress markets and reduce sustainable trade. Interaction with different stakeholder groups is one of the main objectives of this study, so we anticipate the recommendations being representative of the whole bioenergy certification sector and therefore having high potential to improve an otherwise uncoordinated interest in ensuring bioenergy trade is sustainable.
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| 18. |
- Cowie, A. L., et al.
(författare)
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Applying a science-based systems perspective to dispel misconceptions about climate effects of forest bioenergy
- 2021
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Ingår i: Global Change Biology Bioenergy. - : John Wiley and Sons Inc. - 1757-1693 .- 1757-1707. ; 13:8, s. 1210-1231
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Tidskriftsartikel (refereegranskat)abstract
- The scientific literature contains contrasting findings about the climate effects of forest bioenergy, partly due to the wide diversity of bioenergy systems and associated contexts, but also due to differences in assessment methods. The climate effects of bioenergy must be accurately assessed to inform policy-making, but the complexity of bioenergy systems and associated land, industry and energy systems raises challenges for assessment. We examine misconceptions about climate effects of forest bioenergy and discuss important considerations in assessing these effects and devising measures to incentivize sustainable bioenergy as a component of climate policy. The temporal and spatial system boundary and the reference (counterfactual) scenarios are key methodology choices that strongly influence results. Focussing on carbon balances of individual forest stands and comparing emissions at the point of combustion neglect system-level interactions that influence the climate effects of forest bioenergy. We highlight the need for a systems approach, in assessing options and developing policy for forest bioenergy that: (1) considers the whole life cycle of bioenergy systems, including effects of the associated forest management and harvesting on landscape carbon balances; (2) identifies how forest bioenergy can best be deployed to support energy system transformation required to achieve climate goals; and (3) incentivizes those forest bioenergy systems that augment the mitigation value of the forest sector as a whole. Emphasis on short-term emissions reduction targets can lead to decisions that make medium- to long-term climate goals more difficult to achieve. The most important climate change mitigation measure is the transformation of energy, industry and transport systems so that fossil carbon remains underground. Narrow perspectives obscure the significant role that bioenergy can play by displacing fossil fuels now, and supporting energy system transition. Greater transparency and consistency is needed in greenhouse gas reporting and accounting related to bioenergy.
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| 19. |
- Dale, Virginia H., et al.
(författare)
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Status and prospects for renewable energy using wood pellets from the southeastern United States
- 2017
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Ingår i: Global Change Biology Bioenergy. - : Wiley-Blackwell. - 1757-1693 .- 1757-1707. ; 9:8, s. 1296-1305
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Tidskriftsartikel (refereegranskat)abstract
- The ongoing debate about costs and benefits of wood-pellet based bioenergy production in the southeastern United States (SE USA) requires an understanding of the science and context influencing market decisions associated with its sustainability. Production of pellets has garnered much attention as US exports have grown from negligible amounts in the early 2000s to 4.6 million metric tonnes in 2015. Currently, 98% of these pellet exports are shipped to Europe to displace coal in power plants. We ask, 'How is the production of wood pellets in the SE USA affecting forest systems and the ecosystem services they provide?' To address this question, we review current forest conditions and the status of the wood products industry, how pellet production affects ecosystem services and biodiversity, and what methods are in place to monitor changes and protect vulnerable systems. Scientific studies provide evidence that wood pellets in the SE USA are a fraction of total forestry operations and can be produced while maintaining or improving forest ecosystem services. Ecosystem services are protected by the requirement to utilize loggers trained to apply scientifically based best management practices in planning and implementing harvest for the export market. Bioenergy markets supplement incomes to private rural landholders and provide an incentive for forest management practices that simultaneously benefit water quality and wildlife and reduce risk of fire and insect outbreaks. Bioenergy also increases the value of forest land to landowners, thereby decreasing likelihood of conversion to nonforest uses. Monitoring and evaluation are essential to verify that regulations and good practices are achieving goals and to enable timely responses if problems arise. Conducting rigorous research to understand how conditions change in response to management choices requires baseline data, monitoring, and appropriate reference scenarios. Long-term monitoring data on forest conditions should be publicly accessible and utilized to inform adaptive management.
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| 21. |
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| 22. |
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| 23. |
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| 24. |
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| 25. |
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| 26. |
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| 27. |
- Sepanlou, Sadaf G., et al.
(författare)
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The global, regional, and national burden of cirrhosis by cause in 195 countries and territories, 1990-2017 : a systematic analysis for the Global Burden of Disease Study 2017
- 2020
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Ingår i: The Lancet Gastroenterology & Hepatology. - 2468-1253. ; 5:3, s. 245-266
-
Tidskriftsartikel (refereegranskat)abstract
- Background Cirrhosis and other chronic liver diseases (collectively referred to as cirrhosis in this paper) are a major cause of morbidity and mortality globally, although the burden and underlying causes differ across locations and demographic groups. We report on results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 on the burden of cirrhosis and its trends since 1990, by cause, sex, and age, for 195 countries and territories. Methods We used data from vital registrations, vital registration samples, and verbal autopsies to estimate mortality. We modelled prevalence of total, compensated, and decompensated cirrhosis on the basis of hospital and claims data. Disability-adjusted life-years (DALYs) were calculated as the sum of years of life lost due to premature death and years lived with disability. Estimates are presented as numbers and age-standardised or age-specific rates per 100 000 population, with 95% uncertainty intervals (UIs). All estimates are presented for five causes of cirrhosis: hepatitis B, hepatitis C, alcohol-related liver disease, non-alcoholic steatohepatitis (NASH), and other causes. We compared mortality, prevalence, and DALY estimates with those expected according to the Socio-demographic Index (SDI) as a proxy for the development status of regions and countries. Findings In 2017, cirrhosis caused more than 1.32 million (95% UI 1.27-1.45) deaths (440000 [416 000-518 000; 33.3%] in females and 883 000 [838 000-967 000; 66.7%] in males) globally, compared with less than 899 000 (829 000-948 000) deaths in 1990. Deaths due to cirrhosis constituted 2.4% (2.3-2.6) of total deaths globally in 2017 compared with 1.9% (1.8-2.0) in 1990. Despite an increase in the number of deaths, the age-standardised death rate decreased from 21.0 (19.2-22.3) per 100 000 population in 1990 to 16.5 (15.8-18-1) per 100 000 population in 2017. Sub-Saharan Africa had the highest age-standardised death rate among GBD super-regions for all years of the study period (32.2 [25.8-38.6] deaths per 100 000 population in 2017), and the high-income super-region had the lowest (10.1 [9.8-10-5] deaths per 100 000 population in 2017). The age-standardised death rate decreased or remained constant from 1990 to 2017 in all GBD regions except eastern Europe and central Asia, where the age-standardised death rate increased, primarily due to increases in alcohol-related liver disease prevalence. At the national level, the age-standardised death rate of cirrhosis was lowest in Singapore in 2017 (3.7 [3.3-4.0] per 100 000 in 2017) and highest in Egypt in all years since 1990 (103.3 [64.4-133.4] per 100 000 in 2017). There were 10.6 million (10.3-10.9) prevalent cases of decompensated cirrhosis and 112 million (107-119) prevalent cases of compensated cirrhosis globally in 2017. There was a significant increase in age-standardised prevalence rate of decompensated cirrhosis between 1990 and 2017. Cirrhosis caused by NASH had a steady age-standardised death rate throughout the study period, whereas the other four causes showed declines in age-standardised death rate. The age-standardised prevalence of compensated and decompensated cirrhosis due to NASH increased more than for any other cause of cirrhosis (by 33.2% for compensated cirrhosis and 54.8% for decompensated cirrhosis) over the study period. From 1990 to 2017, the number of prevalent cases snore than doubled for compensated cirrhosis due to NASH and more than tripled for decompensated cirrhosis due to NASH. In 2017, age-standardised death and DALY rates were lower among countries and territories with higher SDI. Interpretation Cirrhosis imposes a substantial health burden on many countries and this burden has increased at the global level since 1990, partly due to population growth and ageing. Although the age-standardised death and DALY rates of cirrhosis decreased from 1990 to 2017, numbers of deaths and DALYs and the proportion of all global deaths due to cirrhosis increased. Despite the availability of effective interventions for the prevention and treatment of hepatitis B and C, they were still the main causes of cirrhosis burden worldwide, particularly in low-income countries. The impact of hepatitis B and C is expected to be attenuated and overtaken by that of NASH in the near future. Cost-effective interventions are required to continue the prevention and treatment of viral hepatitis, and to achieve early diagnosis and prevention of cirrhosis due to alcohol-related liver disease and NASH.
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| 28. |
- Swedberg, Karl, 1944, et al.
(författare)
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Successful treatment of heart failure with devices requires collaboration
- 2008
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Ingår i: European Journal of Heart Failure. - : Wiley. - 1388-9842. ; 10:12, s. 1229-35
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Tidskriftsartikel (refereegranskat)abstract
- Implanted biventricular pacemakers (cardiac resynchronisation therapy, CRT) with or without implantable cardioverter defibrillators (ICD) improve survival and morbidity in some patients with chronic heart failure (CHF) who are optimally treated with pharmacologic agents according to current guidelines. Correspondingly, ICDs improve survival. However, there is only limited evidence for device treatment in certain patient subgroups, such as the impact of ICD on outcomes in patients with reduced ejection fraction in New York Heart Association (NYHA) Class I or IV heart failure. Similarly, limited evidence exists for CRT in patients with only modest QRS prolongation or only modestly reduced ejection fraction. Despite evidence for a beneficial effect of device therapy in CHF, only a minority of eligible patients are currently offered these options. Multiple reasons contribute to the underuse of these potentially life-saving therapies. A lack of adherence to guidelines by health care professionals is an important barrier. Clearly, efforts should be made to improve the standard of care and to familiarise all physicians involved in managing CHF patients with the indications and potential efficacy of these devices. Increased collaboration between structured heart failure care and pacemaker clinics as well as between electrophysiologists, heart failure clinicians, and primary care physicians is required. Such team collaborations should lead to improved care with reduced mortality and morbidity and increased cost effectiveness. Treatment strategy should be based on a structured approach tailored to local practice and national priorities.
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| 29. |
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| 30. |
- Anker, S. D., et al.
(författare)
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The importance of patient-reported outcomes: a call for their comprehensive integration in cardiovascular clinical trials
- 2014
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Ingår i: European Heart Journal. - : Oxford University Press (OUP). - 0195-668X .- 1522-9645. ; 35, s. 2001-2009
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Tidskriftsartikel (refereegranskat)abstract
- Patient-reported outcomes (PROs), such as symptoms, health-related quality of life (HRQOL), or patient perceived health status, are reported directly by the patient and are powerful tools to inform patients, clinicians, and policy-makers about morbidity and 'patient suffering', especially in chronic diseases. Patient-reported outcomes provide information on the patient experience and can be the target of therapeutic intervention. Patient-reported outcomes can improve the quality of patient care by creating a holistic approach to clinical decision-making; however, PROs are not routinely used as key outcome measures in major cardiovascular clinical trials. Thus, limited information is available on the impact of cardiovascular therapeutics on PROs to guide patient-level clinical decision-making or policy-level decision-making. Cardiovascular clinical research should shift its focus to include PROs when evaluating the efficacy of therapeutic interventions, and PRO assessments should be scientifically rigorous. The European Society of Cardiology and other professional societies can take action to influence the uptake of PRO data in the research and clinical communities. This process of integrating PRO data into comprehensive efficacy evaluations will ultimately improve the quality of care for patients across the spectrum of cardiovascular disease.
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| 31. |
- Berndes, Göran, 1966, et al.
(författare)
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Bioenergy and Land Use Change-State of the Art
- 2015
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Ingår i: Advances in Bioenergy: The Sustainability Challenge. - Oxford, UK : John Wiley & Sons, Ltd. - 9781118957875 - 9781118957844 ; , s. 249-271
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Bokkapitel (refereegranskat)abstract
- The dedicated production of biomass crops and the collection of residues in agriculture and forestry can lead to undesirable negative impacts and it is crucial that practices are found that ensure that these impacts are avoided or mitigated as far as possible. This chapter concerns the use of biomass for energy and the connection between increased bioenergy use and land use change (LUC). Land use and LUC associated with bioenergy can lead to a multitude of environmental and socioeconomic consequences. The chapter focuses on the question whether greenhouse gas (GHG) emissions associated with LUC could undermine the climate change mitigation benefits of bioenergy. There are, however, several options for mitigating these emissions that can be implemented: development of bioenergy feedstock production systems that integrate with existing agriculture and forestry production, enhancement of land use productivity in agriculture and forestry in general, and legal protection of natural ecosystems.
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| 32. |
- Berndes, Göran, 1966, et al.
(författare)
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Bioenergy and land use change-state of the art
- 2013
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Ingår i: Wiley Interdisciplinary Reviews: Energy and Environment. - : Wiley. - 2041-8396 .- 2041-840X. ; 2:3, s. 282-303
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Forskningsöversikt (refereegranskat)abstract
- Bioenergy projects can lead to direct and indirect land use change (LUC), which can substantially affect greenhouse gas balances with both beneficial and adverse outcomes for bioenergy's contribution to climate change mitigation. The causes behind LUC are multiple, complex, interlinked, and change over time. This makes quantification uncertain and sensitive to many factors that can develop in different directions-including land use productivity, trade patterns, prices and elasticities, and use of by-products associated with biofuels production. Quantifications reported so far vary substantially and do not support the ranking of bioenergy options with regard to LUC and associated emissions. There are however several options for mitigating these emissions, which can be implemented despite the uncertainties. Long-rotation forest management is associated with carbon emissions and sequestration that are not in temporal balance with each other and this leads to mitigation trade-offs between biomass extraction for energy use and the alternative to leave the biomass in the forest. Bioenergy's contribution to climate change mitigation needs to reflect a balance between near-term targets and the long-term objective to hold the increase in global temperature below 2 degrees C (Copenhagen Accord). Although emissions from LUC can be significant in some circumstances, the reality of such emissions is not sufficient reason to exclude bioenergy from the list of worthwhile technologies for climate changemitigation. Policy measures to minimize the negative impacts of LUC should be based on a holistic perspective recognizing the multiple drivers and effects of LUC.
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| 33. |
- Berndes, Göran, 1966, et al.
(författare)
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Forest biomass, carbon neutrality and climate change mitigation. From Science to Policy 3
- 2016
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- The Paris Agreement and the EU Climate and Energy Framework set ambitious but necessary targets. Reducing greenhouse gas (GHG) emissions by phasing out the technologies and infrastructures that cause fossil carbon emissions is one of today’s most important challenges. In the EU, bioenergy is currently the largest renewable energy source used. Most Member States have in absolute terms increased the use of forest biomass for energy to reach their 2020 renewable energy targets.In recent years, the issue of ‘carbon neutrality’ has been debated with regard to the bioenergy products that are produced from forest biomass. There is no clear consensus among scientists on the issue and their messages may even appear contradictory to decision-makers and citizens. Divergence arises because scientists address the issue from different points of view, which can all be valid. It is important to find agreement on some basic principles, to inform policy makers. Guidance is also needed on how the results should be interpreted.This report provides insights into the current scientific debate on forest biomass, carbon neutrality and climate change mitigation. It draws on the science literature to give a balanced and policy-relevant synthesis, from both an EU and global perspective.
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| 34. |
- Both, C., et al.
(författare)
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Large-scale geographical variation confirms that climate change causes birds to lay earlier
- 2004
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Ingår i: Proceedings of the Royal Society of London Series B-Biological Sciences. - : The Royal Society. - 0962-8452 .- 1471-2954. ; 271:1549, s. 1657-1662
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Tidskriftsartikel (refereegranskat)abstract
- Advances in the phenology of organisms are often attributed to climate change, but alternatively, may reflect a publication bias towards advances and may be caused by environmental factors unrelated to climate change. Both factors are investigated using the breeding dates of 25 long-term studied populations of Ficedula flycatchers across Europe. Trends in spring temperature varied markedly between study sites, and across populations the advancement of laying date was stronger in areas where the spring temperatures increased more, giving support to the theory that climate change causally affects breeding date advancement.
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| 35. |
- Both, C., et al.
(författare)
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Pied Flycatchers Ficedula hypoleuca travelling from Africa to breed in Europe: differential effects of winter and migration conditions on breeding date
- 2006
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Ingår i: ARDEA. - 0373-2266 .- 2213-1175. ; 94:3, s. 511-525
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Tidskriftsartikel (refereegranskat)abstract
- In most bird species there is only a short time window available for optimal breeding due to variation in ecological conditions in a seasonal environment. Long-distance migrants must travel before they start breeding, and conditions at the wintering grounds and during migration may affect travelling speed and hence arrival and breeding dates. These effects are to a large extent determined by climate variables such as rainfall and temperature, and need to be identified to predict how well species can adapt to climate change. In this paper we analyse effects of vegetation growth on the wintering grounds and sites en route on the annual timing of breeding of 17 populations of Pied Flycatchers Ficedula hypoleuca studied between 1982–2000. Timing of breeding was largely correlated with local spring temperatures, supplemented by striking effects of African vegetation and NAO. Populations differed in the effects of vegetation growth on the wintering grounds, and on their northern African staging grounds, as well as ecological conditions in Europe as measured by the winter NAO. In general, early breeding populations (low altitude, western European populations) bred earlier in years with more vegetation in the Northern Sahel zone, as well as in Northern Africa. In contrast, late breeding populations (high altitude and northern and eastern populations) advanced their breeding dates when circumstances in Europe were more advanced (high NAO). Thus, timing of breeding in most Pied Flycatcher populations not only depends upon local circumstances, but also on conditions encountered during travelling, and these effects differ across populations dependent on the timing of travelling and breeding.
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| 36. |
- Brandao, Miguel, et al.
(författare)
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On quantifying sources of uncertainty in the carbon footprint of biofuels : crop/feedstock, LCA modelling approach, land-use change, and GHG metrics
- 2022
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Ingår i: Biofuel Research Journal. - : Greenwave Publishing of Canada. - 2292-8782. ; 9:2, s. 1608-1616
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Tidskriftsartikel (refereegranskat)abstract
- Biofuel systems may represent a promising strategy to combat climate change by replacing fossil fuels in electricity generation and transportation. First-generation biofuels from sugar and starch crops for ethanol (a gasoline substitute) and from oilseed crops for biodiesel (a petroleum diesel substitute) have come under increasing levels of scrutiny due to the uncertainty associated with the estimation of climate change impacts of biofuels, such as due to indirect effects on land use. This analysis estimates the magnitude of some uncertainty sources: i) crop/feedstock, ii) life cycle assessment (LCA) modelling approach, iii) land-use change (LUC), and iv) greenhouse gas (GHG) metrics. The metrics used for characterising the different GHGs (global warming potential-GWP and global temperature change potential-GTP at different time horizons) appeared not to play a significant role in explaining the variance in the carbon footprint of biofuels, as opposed to the crop/feedstock used, the inclusion/exclusion of LUC considerations, and the LCA modelling approach (p<0.001). The estimated climate footprint of biofuels is dependent on the latter three parameters and, thus, is context-specific. It is recommended that these parameters be dealt with in a manner consistent with the goal and scope of the study. In particular, it is essential to interpret the results of the carbon footprint of biofuel systems in light of the choices made in each of these sources of uncertainty, and sensitivity analysis is recommended to overcome their influence on the result.
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| 37. |
- Brandao, Miguel, et al.
(författare)
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Quantifying the climate change effects of bioenergy systems : Comparison of 15 impact assessment methods
- 2019
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Ingår i: Global Change Biology Bioenergy. - : Wiley. - 1757-1693 .- 1757-1707. ; 11:5, s. 727-743
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Tidskriftsartikel (refereegranskat)abstract
- Ongoing concern over climate change has led to interest in replacing fossil energy with bioenergy. There are different approaches to quantitatively estimate the climate change effects of bioenergy systems. In the present work, we have focused on a range of published impact assessment methods that vary due to conceptual differences in the treatment of biogenic carbon fluxes, the type of climate change impacts they address and differences in time horizon and time preference. Specifically, this paper reviews fifteen different methods and applies these to three hypothetical bioenergy case studies: (a) woody biomass grown on previously forested land; (b) woody biomass grown on previous pasture land; and (b) annual energy crop grown on previously cropped land. Our analysis shows that the choice of method can have an important influence on the quantification of climate change effects of bioenergy, particularly when a mature forest is converted to bioenergy use as it involves a substantial reduction in biomass carbon stocks. Results are more uniform in other case studies. In general, results are more sensitive to specific impact assessment methods when they involve both emissions and removals at different points in time, such as for forest bioenergy, but have a much smaller influence on agricultural bioenergy systems grown on land previously used for pasture or annual cropping. The development of effective policies for climate change mitigation through renewable energy use requires consistent and accurate approaches to identification of bioenergy systems that can result in climate change mitigation. The use of different methods for the same purpose: estimating the climate change effects of bioenergy systems, can lead to confusing and contradictory conclusions. A full interpretation of the results generated with different methods must be based on an understanding that the different methods focus on different aspects of climate change and represent different time preferences.
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| 38. |
- Brandao, Miguel, et al.
(författare)
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The modelling approach determines the carbon footprint of biofuels: the role of LCA in informing decision makers in government and industry
- 2021
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Ingår i: Cleaner Environmental Systems. - : Elsevier BV. - 2666-7894. ; 2, s. 100027-
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Tidskriftsartikel (refereegranskat)abstract
- Concerns over climate change have led to the promotion of biofuels for transport, particularly biodiesel from oilseed crops and ethanol from sugar and starch crops. However, the climate-change mitigation potential of the various biofuels estimated in published studies tends to vary significantly, questioning the reliability of the methods used to quantify potential impacts. We investigated the values published in the European Commission’s Renewable Energy Directive (RED), and recalculated the climate-change impacts of a range of biofuels using internally-consistent attributional and consequential modelling approaches to enable comparison of these approaches. We conclude that the estimated results are highly dependent on the modelling approach adopted, to the detriment of the perception of the robustness of life cycle assessment as a tool for estimating the climate-change impacts of biofuels. Land use change emissions are a determining parameter which should not be omitted, even if modelling it introduces a large variability in the results and makes interpretation complex. Clearer guidelines and standardization efforts would be helpful in the harmonization of LCA practice, so that the results can be more useful, robust and reproducible.
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| 39. |
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| 40. |
- Cintas Sanchez, Olivia, 1982, et al.
(författare)
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The climate effect of increased forest bioenergy use in Sweden: evaluation at different spatial and temporal scales
- 2016
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Ingår i: Wiley Interdisciplinary Reviews: Energy and Environment. - : Wiley. - 2041-8396 .- 2041-840X. ; 5:3, s. 351-369
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Tidskriftsartikel (refereegranskat)abstract
- Bioenergy from boreal forests managed for productive purposes (e.g., pulp, timber) is commonly held to offer attractive options for climate change mitigation. However, this view has been challenged in recent years. Carbon balances, cumulative radiative forcing, and average global temperature change have been calculated for a variety of bioenergy management regimes in Swedish forests and the results support the view that an increased use of forest biomass for energy in Sweden can contribute to climate change mitigation, although methodological (e.g. spatial scales) and parameter value choices influence the results significantly. We show that the climate effect of forest-based bioenergy depends on the forest ecosystems and management, including biomass extraction for bioenergy and other products, and how this management changes in response to anticipated market demands; and on the energy system effects, which determine the fossil carbon displacement and other greenhouse gas (GHG) mitigation effects of using forest biomass for bioenergy and other purposes. The public and private sectors are advised to consider information from comprehensive analyses that provide insights about energy and forest systems in the context of evolving forest product markets, alternative policy options, and energy technology pathways in their decision-making processes.
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| 41. |
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| 42. |
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| 43. |
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| 44. |
- Cowie, Annette L., et al.
(författare)
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Land in balance : The scientific conceptual framework for Land Degradation Neutrality
- 2018
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Ingår i: Environmental Science and Policy. - : Elsevier BV. - 1462-9011. ; 79, s. 25-35
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Tidskriftsartikel (refereegranskat)abstract
- The health and productivity of global land resources are declining, while demand for those resources is increasing. The aim of land degradation neutrality (LDN) is to maintain or enhance land-based natural capital and its associated ecosystem services. The Scientific Conceptual Framework for Land Degradation Neutrality has been developed to provide a scientific approach to planning, implementing and monitoring LDN. The Science-Policy Interface of the United Nations Convention to Combat Desertification (UNCCD) led the development of the conceptual framework, drawing in expertise from a diverse range of disciplines. The LDN conceptual framework focuses on the supporting processes required to deliver LDN, including biophysical and socio-economic aspects, and their interactions. Neutrality implies no net loss of the land-based natural capital relative to a reference state, or baseline. Planning for neutrality involves projecting the likely cumulative impacts of land use and land management decisions, then counterbalancing anticipated losses with measures to achieve equivalent gains. Counterbalancing should occur only within individual land types, distinguished by land potential, to ensure “like for like” exchanges. Actions to achieve LDN include sustainable land management (SLM) practices that avoid or reduce degradation, coupled with efforts to reverse degradation through restoration or rehabilitation of degraded land. The response hierarchy of Avoid > Reduce > Reverse land degradation articulates the priorities in planning LDN interventions. The implementation of LDN is managed at the landscape level through integrated land use planning, while achievement is assessed at national level. Monitoring LDN status involves quantifying the balance between the area of gains (significant positive changes in LDN indicators) and area of losses (significant negative changes in LDN indicators), within each land type across the landscape. The LDN indicators (and associated metrics) are land cover (physical land cover class), land productivity (net primary productivity, NPP) and carbon stocks (soil organic carbon (SOC) stocks). The LDN conceptual framework comprises five modules: A: Vision of LDN describes the intended outcome of LDN; B: Frame of Reference clarifies the LDN baseline; C: Mechanism for Neutrality explains the counterbalancing mechanism; D: Achieving Neutrality presents the theory of change (logic model) articulating the impact pathway; and E: Monitoring Neutrality presents the LDN indicators. Principles that govern application of the framework provide flexibility while reducing risk of unintended outcomes.
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| 45. |
- Cowie, Annette L., et al.
(författare)
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Policy institutions and forest carbon
- 2016
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Ingår i: Nature Climate Change. - : Springer Science and Business Media LLC. - 1758-6798 .- 1758-678X. ; 6:9, s. 805-805
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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| 46. |
- Cowie, A. L., et al.
(författare)
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Quantifying the climate effects of forest-based bioenergy
- 2018
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Ingår i: Managing Global Warming: An Interface of Technology and Human Issues. - : Elsevier. - 9780128141052 - 9780128141045 ; , s. 399-418
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Bokkapitel (övrigt vetenskapligt/konstnärligt)abstract
- Bioenergy is a key strategy for climate change mitigation in many national and international climate change and renewable energy policies. However, over recent years, claims have been made that forest-based bioenergy can lead to losses in forest carbon (sometimes referred to as "carbon debt") and, thus, their effectiveness at mitigating climate change has been questioned. Climate impacts of forest bioenergy are dependent on a range of case-specific factors, including biophysical features of the biomass-production system and GHG intensity of the energy source it displaces, which are largely determined by the location of the bioenergy project. Estimates of climate impacts are also strongly affected by methodological choices and assumptions, related to reference land use, spatial and temporal system boundary, allocation procedures, time horizon of assessment, metrics applied, and climate forces considered. In this chapter, these key issues are discussed and recommendations are provided for carrying out appropriate and comprehensive assessments of climate impacts of forest bioenergy systems.
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| 47. |
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| 48. |
- Cowie, M. R., et al.
(författare)
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New medicinal products for chronic heart failure: advances in clinical trial design and efficacy assessment
- 2017
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Ingår i: European Journal of Heart Failure. - : Wiley. - 1388-9842. ; 19:6, s. 718-727
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Tidskriftsartikel (refereegranskat)abstract
- Despite the availability of a number of different classes of therapeutic agents with proven efficacy in heart failure, the clinical course of heart failure patients is characterized by a reduction in life expectancy, a progressive decline in health-related quality of life and functional status, as well as a high risk of hospitalization. New approaches are needed to address the unmet medical needs of this patient population. The European Medicines Agency (EMA) is undertaking a revision of its Guideline on Clinical Investigation of Medicinal Products for the Treatment of Chronic Heart Failure. The draft version of the Guideline was released for public consultation in January 2016. The Cardiovascular Round Table of the European Society of Cardiology (ESC), in partnership with the Heart Failure Association of the ESC, convened a dedicated two-day workshop to discuss three main topic areas of major interest in the field and addressed in this draft EMA guideline: (i) assessment of efficacy (i.e. endpoint selection and statistical analysis); (ii) clinical trial design (i.e. issues pertaining to patient population, optimal medical therapy, run-in period); and (iii) research approaches for testing novel therapeutic principles (i.e. cell therapy). This paper summarizes the key outputs from the workshop, reviews areas of expert consensus, and identifies gaps that require further research or discussion. Collaboration between regulators, industry, clinical trialists, cardiologists, health technology assessment bodies, payers, and patient organizations is critical to address the ongoing challenge of heart failure and to ensure the development and market access of new therapeutics in a scientifically robust, practical and safe way.
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| 49. |
- Draper-Joyce, Christopher J., et al.
(författare)
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Positive allosteric mechanisms of adenosine A(1) receptor-mediated analgesia
- 2021
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Ingår i: Nature. - : Springer Nature. - 0028-0836 .- 1476-4687. ; 597:7877, s. 571-576
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Tidskriftsartikel (refereegranskat)abstract
- The adenosine A(1) receptor (A,R) is a promising therapeutic target for non-opioid analgesic agents to treat neuropathic pain(1,2). However, development of analgesic orthosteric A(1)R agonists has failed because of a lack of sufficient on-target selectivity as well as off-tissue adverse effects(3). Here we show that [2-amino-4-(3,5-bis(trifluoromethyl) phenyl)thiophen-3-yl)(4-chlorophenyl)methanone] (MIPS521), a positive allosteric modulator of the A(1)R, exhibits analgesic efficacy in rats in vivo through modulation of the increased levels of endogenous adenosine that occur in the spinal cord of rats with neuropathic pain. We also report the structure of the co-bound to adenosine, MIPS521 and a G(12) heterotrimer, revealing an extrahelicallipid-detergent-facing allosteric binding pocket that involves transmembrane helixes 1, 6 and 7. Molecular dynamics simulations and ligand kinetic binding experiments support a mechanism whereby MIPS521 stabilizes the adenosine-receptor-G protein complex. This study provides proof of concept for structure-based allosteric drug design of non-opioid analgesic agents that are specific to disease contexts.
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| 50. |
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