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Sökning: WFRF:(Fernandes Ricardo M. M.)

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1.
  • Lozano, Rafael, et al. (författare)
  • Measuring progress from 1990 to 2017 and projecting attainment to 2030 of the health-related Sustainable Development Goals for 195 countries and territories: a systematic analysis for the Global Burden of Disease Study 2017
  • 2018
  • Ingår i: The Lancet. - : Elsevier. - 1474-547X .- 0140-6736. ; 392:10159, s. 2091-2138
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Efforts to establish the 2015 baseline and monitor early implementation of the UN Sustainable Development Goals (SDGs) highlight both great potential for and threats to improving health by 2030. To fully deliver on the SDG aim of “leaving no one behind”, it is increasingly important to examine the health-related SDGs beyond national-level estimates. As part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017), we measured progress on 41 of 52 health-related SDG indicators and estimated the health-related SDG index for 195 countries and territories for the period 1990–2017, projected indicators to 2030, and analysed global attainment. Methods: We measured progress on 41 health-related SDG indicators from 1990 to 2017, an increase of four indicators since GBD 2016 (new indicators were health worker density, sexual violence by non-intimate partners, population census status, and prevalence of physical and sexual violence [reported separately]). We also improved the measurement of several previously reported indicators. We constructed national-level estimates and, for a subset of health-related SDGs, examined indicator-level differences by sex and Socio-demographic Index (SDI) quintile. We also did subnational assessments of performance for selected countries. To construct the health-related SDG index, we transformed the value for each indicator on a scale of 0–100, with 0 as the 2·5th percentile and 100 as the 97·5th percentile of 1000 draws calculated from 1990 to 2030, and took the geometric mean of the scaled indicators by target. To generate projections through 2030, we used a forecasting framework that drew estimates from the broader GBD study and used weighted averages of indicator-specific and country-specific annualised rates of change from 1990 to 2017 to inform future estimates. We assessed attainment of indicators with defined targets in two ways: first, using mean values projected for 2030, and then using the probability of attainment in 2030 calculated from 1000 draws. We also did a global attainment analysis of the feasibility of attaining SDG targets on the basis of past trends. Using 2015 global averages of indicators with defined SDG targets, we calculated the global annualised rates of change required from 2015 to 2030 to meet these targets, and then identified in what percentiles the required global annualised rates of change fell in the distribution of country-level rates of change from 1990 to 2015. We took the mean of these global percentile values across indicators and applied the past rate of change at this mean global percentile to all health-related SDG indicators, irrespective of target definition, to estimate the equivalent 2030 global average value and percentage change from 2015 to 2030 for each indicator. Findings: The global median health-related SDG index in 2017 was 59·4 (IQR 35·4–67·3), ranging from a low of 11·6 (95% uncertainty interval 9·6–14·0) to a high of 84·9 (83·1–86·7). SDG index values in countries assessed at the subnational level varied substantially, particularly in China and India, although scores in Japan and the UK were more homogeneous. Indicators also varied by SDI quintile and sex, with males having worse outcomes than females for non-communicable disease (NCD) mortality, alcohol use, and smoking, among others. Most countries were projected to have a higher health-related SDG index in 2030 than in 2017, while country-level probabilities of attainment by 2030 varied widely by indicator. Under-5 mortality, neonatal mortality, maternal mortality ratio, and malaria indicators had the most countries with at least 95% probability of target attainment. Other indicators, including NCD mortality and suicide mortality, had no countries projected to meet corresponding SDG targets on the basis of projected mean values for 2030 but showed some probability of attainment by 2030. For some indicators, including child malnutrition, several infectious diseases, and most violence measures, the annualised rates of change required to meet SDG targets far exceeded the pace of progress achieved by any country in the recent past. We found that applying the mean global annualised rate of change to indicators without defined targets would equate to about 19% and 22% reductions in global smoking and alcohol consumption, respectively; a 47% decline in adolescent birth rates; and a more than 85% increase in health worker density per 1000 population by 2030. Interpretation: The GBD study offers a unique, robust platform for monitoring the health-related SDGs across demographic and geographic dimensions. Our findings underscore the importance of increased collection and analysis of disaggregated data and highlight where more deliberate design or targeting of interventions could accelerate progress in attaining the SDGs. Current projections show that many health-related SDG indicators, NCDs, NCD-related risks, and violence-related indicators will require a concerted shift away from what might have driven past gains—curative interventions in the case of NCDs—towards multisectoral, prevention-oriented policy action and investments to achieve SDG aims. Notably, several targets, if they are to be met by 2030, demand a pace of progress that no country has achieved in the recent past. The future is fundamentally uncertain, and no model can fully predict what breakthroughs or events might alter the course of the SDGs. What is clear is that our actions—or inaction—today will ultimately dictate how close the world, collectively, can get to leaving no one behind by 2030.
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2.
  • Murray, Christopher J. L., et al. (författare)
  • Population and fertility by age and sex for 195 countries and territories, 1950–2017: a systematic analysis for the Global Burden of Disease Study 2017
  • 2018
  • Ingår i: The Lancet. - 1474-547X .- 0140-6736. ; 392:10159, s. 1995-2051
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Population estimates underpin demographic and epidemiological research and are used to track progress on numerous international indicators of health and development. To date, internationally available estimates of population and fertility, although useful, have not been produced with transparent and replicable methods and do not use standardised estimates of mortality. We present single-calendar year and single-year of age estimates of fertility and population by sex with standardised and replicable methods. Methods: We estimated population in 195 locations by single year of age and single calendar year from 1950 to 2017 with standardised and replicable methods. We based the estimates on the demographic balancing equation, with inputs of fertility, mortality, population, and migration data. Fertility data came from 7817 location-years of vital registration data, 429 surveys reporting complete birth histories, and 977 surveys and censuses reporting summary birth histories. We estimated age-specific fertility rates (ASFRs; the annual number of livebirths to women of a specified age group per 1000 women in that age group) by use of spatiotemporal Gaussian process regression and used the ASFRs to estimate total fertility rates (TFRs; the average number of children a woman would bear if she survived through the end of the reproductive age span [age 10–54 years] and experienced at each age a particular set of ASFRs observed in the year of interest). Because of sparse data, fertility at ages 10–14 years and 50–54 years was estimated from data on fertility in women aged 15–19 years and 45–49 years, through use of linear regression. Age-specific mortality data came from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 estimates. Data on population came from 1257 censuses and 761 population registry location-years and were adjusted for underenumeration and age misreporting with standard demographic methods. Migration was estimated with the GBD Bayesian demographic balancing model, after incorporating information about refugee migration into the model prior. Final population estimates used the cohort-component method of population projection, with inputs of fertility, mortality, and migration data. Population uncertainty was estimated by use of out-of-sample predictive validity testing. With these data, we estimated the trends in population by age and sex and in fertility by age between 1950 and 2017 in 195 countries and territories. Findings: From 1950 to 2017, TFRs decreased by 49·4% (95% uncertainty interval [UI] 46·4–52·0). The TFR decreased from 4·7 livebirths (4·5–4·9) to 2·4 livebirths (2·2–2·5), and the ASFR of mothers aged 10–19 years decreased from 37 livebirths (34–40) to 22 livebirths (19–24) per 1000 women. Despite reductions in the TFR, the global population has been increasing by an average of 83·8 million people per year since 1985. The global population increased by 197·2% (193·3–200·8) since 1950, from 2·6 billion (2·5–2·6) to 7·6 billion (7·4–7·9) people in 2017; much of this increase was in the proportion of the global population in south Asia and sub-Saharan Africa. The global annual rate of population growth increased between 1950 and 1964, when it peaked at 2·0%; this rate then remained nearly constant until 1970 and then decreased to 1·1% in 2017. Population growth rates in the southeast Asia, east Asia, and Oceania GBD super-region decreased from 2·5% in 1963 to 0·7% in 2017, whereas in sub-Saharan Africa, population growth rates were almost at the highest reported levels ever in 2017, when they were at 2·7%. The global average age increased from 26·6 years in 1950 to 32·1 years in 2017, and the proportion of the population that is of working age (age 15–64 years) increased from 59·9% to 65·3%. At the national level, the TFR decreased in all countries and territories between 1950 and 2017; in 2017, TFRs ranged from a low of 1·0 livebirths (95% UI 0·9–1·2) in Cyprus to a high of 7·1 livebirths (6·8–7·4) in Niger. The TFR under age 25 years (TFU25; number of livebirths expected by age 25 years for a hypothetical woman who survived the age group and was exposed to current ASFRs) in 2017 ranged from 0·08 livebirths (0·07–0·09) in South Korea to 2·4 livebirths (2·2–2·6) in Niger, and the TFR over age 30 years (TFO30; number of livebirths expected for a hypothetical woman ageing from 30 to 54 years who survived the age group and was exposed to current ASFRs) ranged from a low of 0·3 livebirths (0·3–0·4) in Puerto Rico to a high of 3·1 livebirths (3·0–3·2) in Niger. TFO30 was higher than TFU25 in 145 countries and territories in 2017. 33 countries had a negative population growth rate from 2010 to 2017, most of which were located in central, eastern, and western Europe, whereas population growth rates of more than 2·0% were seen in 33 of 46 countries in sub-Saharan Africa. In 2017, less than 65% of the national population was of working age in 12 of 34 high-income countries, and less than 50% of the national population was of working age in Mali, Chad, and Niger. Interpretation: Population trends create demographic dividends and headwinds (ie, economic benefits and detriments) that affect national economies and determine national planning needs. Although TFRs are decreasing, the global population continues to grow as mortality declines, with diverse patterns at the national level and across age groups. To our knowledge, this is the first study to provide transparent and replicable estimates of population and fertility, which can be used to inform decision making and to monitor progress. Funding: Bill & Melinda Gates Foundation.
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3.
  • Naghavi, Mohsen, et al. (författare)
  • 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
  • Ingår i: The Lancet. - 1474-547X .- 0140-6736. ; 385:9963, s. 117-171
  • 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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4.
  • Stanaway, Jeffrey D., et al. (författare)
  • Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990-2017: A systematic analysis for the Global Burden of Disease Study 2017
  • 2018
  • Ingår i: The Lancet. - 1474-547X .- 0140-6736. ; 392:10159, s. 1923-1994
  • Tidskriftsartikel (refereegranskat)abstract
    • Background The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 comparative risk assessment (CRA) is a comprehensive approach to risk factor quantification that offers a useful tool for synthesising evidence on risks and risk-outcome associations. With each annual GBD study, we update the GBD CRA to incorporate improved methods, new risks and risk-outcome pairs, and new data on risk exposure levels and risk- outcome associations. Methods We used the CRA framework developed for previous iterations of GBD to estimate levels and trends in exposure, attributable deaths, and attributable disability-adjusted life-years (DALYs), by age group, sex, year, and location for 84 behavioural, environmental and occupational, and metabolic risks or groups of risks from 1990 to 2017. This study included 476 risk-outcome pairs that met the GBD study criteria for convincing or probable evidence of causation. We extracted relative risk and exposure estimates from 46 749 randomised controlled trials, cohort studies, household surveys, census data, satellite data, and other sources. We used statistical models to pool data, adjust for bias, and incorporate covariates. Using the counterfactual scenario of theoretical minimum risk exposure level (TMREL), we estimated the portion of deaths and DALYs that could be attributed to a given risk. We explored the relationship between development and risk exposure by modelling the relationship between the Socio-demographic Index (SDI) and risk-weighted exposure prevalence and estimated expected levels of exposure and risk-attributable burden by SDI. Finally, we explored temporal changes in risk-attributable DALYs by decomposing those changes into six main component drivers of change as follows: (1) population growth; (2) changes in population age structures; (3) changes in exposure to environmental and occupational risks; (4) changes in exposure to behavioural risks; (5) changes in exposure to metabolic risks; and (6) changes due to all other factors, approximated as the risk-deleted death and DALY rates, where the risk-deleted rate is the rate that would be observed had we reduced the exposure levels to the TMREL for all risk factors included in GBD 2017.
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5.
  • Wang, Haidong, et al. (författare)
  • 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
  • Ingår i: The Lancet. - 0140-6736 .- 1474-547X. ; 388:10053, s. 1459-1544
  • 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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7.
  • Kassebaum, Nicholas J., et al. (författare)
  • Global, regional, and national disability-adjusted life-years (DALYs) for 315 diseases and injuries and healthy life expectancy (HALE), 1990-2015 : a systematic analysis for the Global Burden of Disease Study 2015
  • 2016
  • Ingår i: The Lancet. - 0140-6736 .- 1474-547X. ; 388:10053, s. 1603-1658
  • Tidskriftsartikel (refereegranskat)abstract
    • Background Healthy life expectancy (HALE) and disability-adjusted life-years (DALYs) provide summary measures of health across geographies and time that can inform assessments of epidemiological patterns and health system performance, help to prioritise investments in research and development, and monitor progress toward the Sustainable Development Goals (SDGs). We aimed to provide updated HALE and DALYs for geographies worldwide and evaluate how disease burden changes with development. Methods We used results from the Global Burden of Diseases, Injuries, and Risk Factors Study 2015 (GBD 2015) for all-cause mortality, cause-specific mortality, and non-fatal disease burden to derive HALE and DALYs by sex for 195 countries and territories from 1990 to 2015. We calculated DALYs by summing years of life lost (YLLs) and years of life lived with disability (YLDs) for each geography, age group, sex, and year. We estimated HALE using the Sullivan method, which draws from age-specific death rates and YLDs per capita. We then assessed how observed levels of DALYs and HALE differed from expected trends calculated with the Socio-demographic Index (SDI), a composite indicator constructed from measures of income per capita, average years of schooling, and total fertility rate. Findings Total global DALYs remained largely unchanged from 1990 to 2015, with decreases in communicable, neonatal, maternal, and nutritional (Group 1) disease DALYs off set by increased DALYs due to non-communicable diseases (NCDs). Much of this epidemiological transition was caused by changes in population growth and ageing, but it was accelerated by widespread improvements in SDI that also correlated strongly with the increasing importance of NCDs. Both total DALYs and age-standardised DALY rates due to most Group 1 causes significantly decreased by 2015, and although total burden climbed for the majority of NCDs, age-standardised DALY rates due to NCDs declined. Nonetheless, age-standardised DALY rates due to several high-burden NCDs (including osteoarthritis, drug use disorders, depression, diabetes, congenital birth defects, and skin, oral, and sense organ diseases) either increased or remained unchanged, leading to increases in their relative ranking in many geographies. From 2005 to 2015, HALE at birth increased by an average of 2.9 years (95% uncertainty interval 2.9-3.0) for men and 3.5 years (3.4-3.7) for women, while HALE at age 65 years improved by 0.85 years (0.78-0.92) and 1.2 years (1.1-1.3), respectively. Rising SDI was associated with consistently higher HALE and a somewhat smaller proportion of life spent with functional health loss; however, rising SDI was related to increases in total disability. Many countries and territories in central America and eastern sub-Saharan Africa had increasingly lower rates of disease burden than expected given their SDI. At the same time, a subset of geographies recorded a growing gap between observed and expected levels of DALYs, a trend driven mainly by rising burden due to war, interpersonal violence, and various NCDs. Interpretation Health is improving globally, but this means more populations are spending more time with functional health loss, an absolute expansion of morbidity. The proportion of life spent in ill health decreases somewhat with increasing SDI, a relative compression of morbidity, which supports continued efforts to elevate personal income, improve education, and limit fertility. Our analysis of DALYs and HALE and their relationship to SDI represents a robust framework on which to benchmark geography-specific health performance and SDG progress. Country-specific drivers of disease burden, particularly for causes with higher-than-expected DALYs, should inform financial and research investments, prevention efforts, health policies, and health system improvement initiatives for all countries along the development continuum.
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8.
  • Stephens, Lucas, et al. (författare)
  • Archaeological assessment reveals Earth’s early transformation through land use
  • 2019
  • Ingår i: Science. - : American Association for the Advancement of Science. - 0036-8075 .- 1095-9203. ; 365:6456, s. 897-902
  • Tidskriftsartikel (refereegranskat)abstract
    • Humans began to leave lasting impacts on Earth’s surface starting 10,000 to 8000 years ago. Through a synthetic collaboration with archaeologists around the globe, Stephens et al. compiled a comprehensive picture of the trajectory of human land use worldwide during the Holocene (see the Perspective by Roberts). Hunter-gatherers, farmers, and pastoralists transformed the face of Earth earlier and to a greater extent than has been widely appreciated, a transformation that was essentially global by 3000 years before the present.Science, this issue p. 897; see also p. 865Environmentally transformative human use of land accelerated with the emergence of agriculture, but the extent, trajectory, and implications of these early changes are not well understood. An empirical global assessment of land use from 10,000 years before the present (yr B.P.) to 1850 CE reveals a planet largely transformed by hunter-gatherers, farmers, and pastoralists by 3000 years ago, considerably earlier than the dates in the land-use reconstructions commonly used by Earth scientists. Synthesis of knowledge contributed by more than 250 archaeologists highlighted gaps in archaeological expertise and data quality, which peaked for 2000 yr B.P. and in traditionally studied and wealthier regions. Archaeological reconstruction of global land-use history illuminates the deep roots of Earth’s transformation and challenges the emerging Anthropocene paradigm that large-scale anthropogenic global environmental change is mostly a recent phenomenon.
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9.
  • Poorter, Lourens, et al. (författare)
  • Wet and dry tropical forests show opposite successional pathways in wood density but converge over time
  • 2019
  • Ingår i: Nature Ecology & Evolution. - : Nature Publishing Group. - 2397-334X. ; 3:6, s. 928-934
  • Tidskriftsartikel (refereegranskat)abstract
    • Tropical forests are converted at an alarming rate for agricultural use and pastureland, but also regrow naturally through secondary succession. For successful forest restoration, it is essential to understand the mechanisms of secondary succession. These mechanisms may vary across forest types, but analyses across broad spatial scales are lacking. Here, we analyse forest recovery using 1,403 plots that differ in age since agricultural abandonment from 50 sites across the Neotropics. We analyse changes in community composition using species-specific stem wood density (WD), which is a key trait for plant growth, survival and forest carbon storage. In wet forest, succession proceeds from low towards high community WD (acquisitive towards conservative trait values), in line with standard successional theory. However, in dry forest, succession proceeds from high towards low community WD (conservative towards acquisitive trait values), probably because high WD reflects drought tolerance in harsh early successional environments. Dry season intensity drives WD recovery by influencing the start and trajectory of succession, resulting in convergence of the community WD over time as vegetation cover builds up. These ecological insights can be used to improve species selection for reforestation. Reforestation species selected to establish a first protective canopy layer should, among other criteria, ideally have a similar WD to the early successional communities that dominate under the prevailing macroclimatic conditions.
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10.
  • Beal, Jacob, et al. (författare)
  • Robust estimation of bacterial cell count from optical density
  • 2020
  • Ingår i: Communications Biology. - : Springer Science and Business Media LLC. - 2399-3642. ; 3:1
  • Tidskriftsartikel (refereegranskat)abstract
    • Optical density (OD) is widely used to estimate the density of cells in liquid culture, but cannot be compared between instruments without a standardized calibration protocol and is challenging to relate to actual cell count. We address this with an interlaboratory study comparing three simple, low-cost, and highly accessible OD calibration protocols across 244 laboratories, applied to eight strains of constitutive GFP-expressing E. coli. Based on our results, we recommend calibrating OD to estimated cell count using serial dilution of silica microspheres, which produces highly precise calibration (95.5% of residuals <1.2-fold), is easily assessed for quality control, also assesses instrument effective linear range, and can be combined with fluorescence calibration to obtain units of Molecules of Equivalent Fluorescein (MEFL) per cell, allowing direct comparison and data fusion with flow cytometry measurements: in our study, fluorescence per cell measurements showed only a 1.07-fold mean difference between plate reader and flow cytometry data.
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11.
  • Gei, Maga, et al. (författare)
  • Legume abundance along successional and rainfall gradients in Neotropical forests
  • 2018
  • Ingår i: Nature Ecology & Evolution. - : Springer Science and Business Media LLC. - 2397-334X. ; 2:7
  • Tidskriftsartikel (refereegranskat)abstract
    • The nutrient demands of regrowing tropical forests are partly satisfied by nitrogen-fixing legume trees, but our understanding of the abundance of those species is biased towards wet tropical regions. Here we show how the abundance of Leguminosae is affected by both recovery from disturbance and large-scale rainfall gradients through a synthesis of forest inventory plots from a network of 42 Neotropical forest chronosequences. During the first three decades of natural forest regeneration, legume basal area is twice as high in dry compared with wet secondary forests. The tremendous ecological success of legumes in recently disturbed, water-limited forests is likely to be related to both their reduced leaflet size and ability to fix N2, which together enhance legume drought tolerance and water-use efficiency. Earth system models should incorporate these large-scale successional and climatic patterns of legume dominance to provide more accurate estimates of the maximum potential for natural nitrogen fixation across tropical forests.
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12.
  • Poorter, Lourens, et al. (författare)
  • Functional recovery of secondary tropical forests
  • 2021
  • Ingår i: Proceedings of the National Academy of Sciences of the United States of America. - : Proceedings of the National Academy of Sciences (PNAS). - 0027-8424 .- 1091-6490. ; 118:49, s. e2003405118-e2003405118
  • Tidskriftsartikel (refereegranskat)abstract
    • One-third of all Neotropical forests are secondary forests that regrow naturally after agricultural use through secondary succession. We need to understand better how and why succession varies across environmental gradients and broad geographic scales. Here, we analyze functional recovery using community data on seven plant characteristics (traits) of 1,016 forest plots from 30 chronosequence sites across the Neotropics. By analyzing communities in terms of their traits, we enhance understanding of the mechanisms of succession, assess ecosystem recovery, and use these insights to propose successful forest restoration strategies. Wet and dry forests diverged markedly for several traits that increase growth rate in wet forests but come at the expense of reduced drought tolerance, delay, or avoidance, which is important in seasonally dry forests. Dry and wet forests showed different successional pathways for several traits. In dry forests, species turnover is driven by drought tolerance traits that are important early in succession and in wet forests by shade tolerance traits that are important later in succession. In both forests, deciduous and compound-leaved trees decreased with forest age, probably because microclimatic conditions became less hot and dry. Our results suggest that climatic water availability drives functional recovery by influencing the start and trajectory of succession, resulting in a convergence of community trait values with forest age when vegetation cover builds up. Within plots, the range in functional trait values increased with age. Based on the observed successional trait changes, we indicate the consequences for carbon and nutrient cycling and propose an ecologically sound strategy to improve forest restoration success.
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13.
  • Jacome, Cristina, et al. (författare)
  • Monitoring Adherence to Asthma Inhalers Using the InspirerMundi App : Analysis of Real-World, Medium-Term Feasibility Studies
  • 2021
  • Ingår i: Frontiers in Medical Technology. - : Frontiers Media S.A.. - 2673-3129. ; 3
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Poor medication adherence is a major challenge in asthma and objective assessment of inhaler adherence is needed. InspirerMundi app aims to monitor inhaler adherence while turning it into a positive experience through gamification and social support.Objective: We assessed the medium-term feasibility of the InspirerMundi app to monitor inhaler adherence in real-world patients with persistent asthma (treated with daily inhaled medication). In addition, we attempted to identify the characteristics of the patients related to higher app use.Methods: Two real-world multicenter observational studies, with one initial face-to-face visit and a 4-month telephone interview, were conducted in 29 secondary care centers from Portugal. During an initial face-to-face visit, patients were invited to use the app daily to register their asthma medication intakes. A scheduled intake was considered taken when patients took a photo of the medication (inhaler, blister, or others) using the image-based medication detection tool. Medication adherence was calculated as the number of doses taken as a percentage of the number scheduled. Interacting with the app =30 days was used as the cut-off for higher app use.Results: A total of 114 patients {median 20 [percentile 25 to percentile 75 (P25-P75) 16-36] years, 62% adults} were invited, 107 (94%) installed the app and 83 (73%) completed the 4-month interview. Patients interacted with the app for a median of 18 [3-45] days, translated on a median use rate of 15 [3-38]%. Median inhaler adherence assessed through the app was 34 [4-73]% when considering all scheduled inhalations for the study period. Inhaler adherence assessed was not significantly correlated with self-reported estimates. Median adherence for oral and other medication was 41 [6-83]% and 43 [3-73]%, respectively. Patients with higher app use were slightly older (p = 0.012), more frequently taking medication for other health conditions (p = 0.040), and more frequently prescribed long-acting muscarinic antagonists (LAMA, p = 0.024). After 4 months, Control of Allergic Rhinitis and Asthma Test (CARAT) scores improved (p < 0.001), but no differences between patients interacting with the app for 30 days or less were seen.Conclusions: The InspirerMundi app was feasible to monitor inhaler adherence in patients with persistent asthma. The persistent use of this mHealth technology varies widely. A better understanding of characteristics related to higher app use is still needed before effectiveness studies are undertaken.
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14.
  • Nadiv, R., et al. (författare)
  • Polymer nanocomposites : Insights on rheology, percolation and molecular mobility
  • 2018
  • Ingår i: Polymer. - : Elsevier Ltd. - 0032-3861 .- 1873-2291. ; 153, s. 52-60
  • Tidskriftsartikel (refereegranskat)abstract
    • The integration of carbon nanotubes (CNTs) into a polymer matrix strongly affects the rheological behavior that in turn may hamper the overall performance of the resulting composite. Research in this topic has focused on bulk rheological properties, while here we employ NMR diffusion experiments to explore the mobility (diffusivity) of epoxy molecules when loaded with CNTs. Rheology and light microscopy indicate percolation of CNT aggregates. Those aggregates cage a substantial amount of epoxy molecules while small angle X-ray scattering indicates some rearrangement of epoxy molecules in the vicinity of the nanotubes. NMR diffusion experiments distinguish between the slow diffusion of the caged molecules and that of the free ones, and relate the fraction of the former to the macroscopic system viscosity. The demonstrated surface-induced slowing-down of diffusion is attributed to strong intermolecular π-π interactions among the epoxy molecules, and between them and the CNT surface. These findings demonstrate the utility of NMR diffusion experiments as an additional method applied to nanocomposites. 
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15.
  • Sánchez Van Kammen, Mayte, et al. (författare)
  • Characteristics and Outcomes of Patients with Cerebral Venous Sinus Thrombosis in SARS-CoV-2 Vaccine-Induced Immune Thrombotic Thrombocytopenia
  • 2021
  • Ingår i: JAMA Neurology. - : American Medical Association. - 2168-6149 .- 2168-6157. ; 78:11, s. 1314-1323
  • Tidskriftsartikel (refereegranskat)abstract
    • Importance: Thrombosis with thrombocytopenia syndrome (TTS) has been reported after vaccination with the SARS-CoV-2 vaccines ChAdOx1 nCov-19 (Oxford-AstraZeneca) and Ad26.COV2.S (Janssen/Johnson & Johnson).Objective: To describe the clinical characteristics and outcome of patients with cerebral venous sinus thrombosis (CVST) after SARS-CoV-2 vaccination with and without TTS.Design, Setting, and Participants: This cohort study used data from an international registry of consecutive patients with CVST within 28 days of SARS-CoV-2 vaccination included between March 29 and June 18, 2021, from 81 hospitals in 19 countries. For reference, data from patients with CVST between 2015 and 2018 were derived from an existing international registry. Clinical characteristics and mortality rate were described for adults with (1) CVST in the setting of SARS-CoV-2 vaccine-induced immune thrombotic thrombocytopenia, (2) CVST after SARS-CoV-2 vaccination not fulling criteria for TTS, and (3) CVST unrelated to SARS-CoV-2 vaccination.Exposures: Patients were classified as having TTS if they had new-onset thrombocytopenia without recent exposure to heparin, in accordance with the Brighton Collaboration interim criteria.Main Outcomes and Measures: Clinical characteristics and mortality rate.Results: Of 116 patients with postvaccination CVST, 78 (67.2%) had TTS, of whom 76 had been vaccinated with ChAdOx1 nCov-19; 38 (32.8%) had no indication of TTS. The control group included 207 patients with CVST before the COVID-19 pandemic. A total of 63 of 78 (81%), 30 of 38 (79%), and 145 of 207 (70.0%) patients, respectively, were female, and the mean (SD) age was 45 (14), 55 (20), and 42 (16) years, respectively. Concomitant thromboembolism occurred in 25 of 70 patients (36%) in the TTS group, 2 of 35 (6%) in the no TTS group, and 10 of 206 (4.9%) in the control group, and in-hospital mortality rates were 47% (36 of 76; 95% CI, 37-58), 5% (2 of 37; 95% CI, 1-18), and 3.9% (8 of 207; 95% CI, 2.0-7.4), respectively. The mortality rate was 61% (14 of 23) among patients in the TTS group diagnosed before the condition garnered attention in the scientific community and 42% (22 of 53) among patients diagnosed later.Conclusions and Relevance: In this cohort study of patients with CVST, a distinct clinical profile and high mortality rate was observed in patients meeting criteria for TTS after SARS-CoV-2 vaccination..
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16.
  • Bose, Sourav, et al. (författare)
  • Optical Lithography Patterning of SiO2 Layers for Interface Passivation of Thin Film Solar Cells
  • 2018
  • Ingår i: Solar RRL. - : Wiley. - 2367-198X. ; 2:12
  • Tidskriftsartikel (refereegranskat)abstract
    • Ultrathin Cu(In,Ga)Se-2 solar cells are a promising way to reduce costs and to increase the electrical performance of thin film solar cells. An optical lithography process that can produce sub-micrometer contacts in a SiO2 passivation layer at the CIGS rear contact is developed in this work. Furthermore, an optimization of the patterning dimensions reveals constrains over the features sizes. High passivation areas of the rear contact are needed to passivate the CIGS interface so that high performing solar cells can be obtained. However, these dimensions should not be achieved by using long distances between the contacts as they lead to poor electrical performance due to poor carrier extraction. This study expands the choice of passivation materials already known for ultrathin solar cells and its fabrication techniques.
  •  
17.
  • Chaudhary, Himanshu, et al. (författare)
  • Intrinsically disordered protein as carbon nanotube dispersant: How dynamic interactions lead to excellent colloidal stability
  • 2019
  • Ingår i: Journal of Colloid and Interface Science. - : Academic Press. - 0021-9797 .- 1095-7103. ; 556, s. 172-179
  • Tidskriftsartikel (refereegranskat)abstract
    • The rich pool of protein conformations combined with the dimensions and properties of carbon nanotubes create new possibilities in functional materials and nanomedicine. Here, the intrinsically disordered protein α-synuclein is explored as a dispersant of single-walled carbon nanotubes (SWNTs) in water. We use a range of spectroscopic methods to quantify the amount of dispersed SWNT and to elucidate the binding mode of α-synuclein to SWNT. The dispersion ability of α-synuclein is good even with mild sonication and the obtained dispersion is very stable over time. The whole polypeptide chain is involved in the interaction accompanied by a fraction of the chain changing into a helical structure upon binding. Similar to other dispersants, we observe that only a small fraction (15–20%) of α-synuclein is adsorbed on the SWNT surface with an average residence time below 10 ms
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18.
  • James, John R., et al. (författare)
  • The T Cell Receptor Triggering Apparatus Is Composed of Monovalent or Monomeric Proteins
  • 2011
  • Ingår i: Journal of Biological Chemistry. - : American Society for Biochemistry and Molecular Biology, Inc.. - 0021-9258 .- 1083-351X. ; 286:37, s. 31993-32001
  • Tidskriftsartikel (refereegranskat)abstract
    • Understanding the component stoichiometry of the T cell antigen receptor (TCR) triggering apparatus is essential for building realistic models of signal initiation. Recent studies suggesting that the TCR and other signaling-associated proteins are preclustered on resting T cells relied on measurements of the behavior of membrane proteins at interfaces with functionalized glass surfaces. Using fluorescence recovery after photo-bleaching, we show that, compared with the apical surface, the mobility of TCRs is significantly reduced at Jurkat T cell/glass interfaces, in a signaling-sensitive manner. Using two biophysical approaches that mitigate these effects, bioluminescence resonance energy transfer and two-color coincidence detection microscopy, we show that, within the uncertainty of the methods, the membrane components of the TCR triggering apparatus, i.e. the TCR complex, MHC molecules, CD4/Lck and CD45, are exclusively monovalent or monomeric in human T cell lines, implying that TCR triggering depends only on the kinetics of TCR/pMHC interactions. These analyses also showed that constraining proteins to two dimensions at the cell surface greatly enhances random interactions versus those between the membrane and the cytoplasm. Simulations of TCR-pMHC complex formation based on these findings suggest how unclustered TCR triggering-associated proteins might nevertheless be capable of generating complex signaling outputs via the differential recruitment of cytosolic effectors to the cell membrane.
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19.
  • Lopes, Tomas S., et al. (författare)
  • Rear Optical Reflection and Passivation Using a Nanopatterned Metal/Dielectric Structure in Thin-Film Solar Cells
  • 2019
  • Ingår i: IEEE Journal of Photovoltaics. - : IEEE-INST ELECTRICAL ELECTRONICS ENGINEERS INC. - 2156-3381 .- 2156-3403. ; 9:5, s. 1421-1427
  • Tidskriftsartikel (refereegranskat)abstract
    • Currently, one of the main limitations in ultrathin Cu(In,Ga)Se-2 (CIGS) solar cells are the optical losses, since the absorber layer is thinner than the light optical path. Hence, light management, including rear optical reflection, and light trapping is needed. In this paper, we focus on increasing the rear optical reflection. For this, a novel structure based on having a metal interlayer in between the Mo rear contact and the rear passivation layer is presented. In total, eight different metallic interlayers are compared. For the whole series, the passivation layer is aluminum oxide (Al2O3). The interlayers are used to enhance the reflectivity of the rear contact and thereby increasing the amount of light reflected back into the absorber. In order to understand the effects of the interlayer in the solar cell performance both from optical and/or electrical point of view, optical simulations were performed together with fabrication and electrical measurements. Optical simulations results are compared with current density-voltage (J-V) behavior and external quantum efficiency measurements. A detailed comparison between all the interlayers is done, in order to identify the material with the greatest potential to he used as a rear reflective layer for ultrathin CIGS solar cells and to establish fabrication challenges. The Ti-W alloy is a promising a rear reflective layer since it provides solar cells with light to power conversion efficiency values of 9.9%, which is 2.2% (abs) higher than the passivated ultrathin sample and 3.7% (abs) higher than the unpassivated ultrathin reference sample.
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20.
  • Lotze, Heike K., et al. (författare)
  • Global ensemble projections reveal trophic amplification of ocean biomass declines with climate change
  • 2019
  • Ingår i: Proceedings of the National Academy of Sciences of the United States of America. - : Proceedings of the National Academy of Sciences. - 0027-8424 .- 1091-6490. ; 116:26, s. 12907-12912
  • Tidskriftsartikel (refereegranskat)abstract
    • While the physical dimensions of climate change are now routinely assessed through multimodel intercomparisons, projected impacts on the global ocean ecosystem generally rely on individual models with a specific set of assumptions. To address these single-model limitations, we present standardized ensemble projections from six global marine ecosystem models forced with two Earth system models and four emission scenarios with and without fishing. We derive average biomass trends and associated uncertainties across the marine food web. Without fishing, mean global animal biomass decreased by 5% (+/- 4% SD) under low emissions and 17% (+/- 11% SD) under high emissions by 2100, with an average 5% decline for every 1 degrees C of warming. Projected biomass declines were primarily driven by increasing temperature and decreasing primary production, and were more pronounced at higher trophic levels, a process known as trophic amplification. Fishing did not substantially alter the effects of climate change. Considerable regional variation featured strong biomass increases at high latitudes and decreases at middle to low latitudes, with good model agreement on the direction of change but variable magnitude. Uncertainties due to variations in marine ecosystem and Earth system models were similar. Ensemble projections performed well compared with empirical data, emphasizing the benefits of multimodel inference to project future outcomes. Our results indicate that global ocean animal biomass consistently declines with climate change, and that these impacts are amplified at higher trophic levels. Next steps for model development include dynamic scenarios of fishing, cumulative human impacts, and the effects of management measures on future ocean biomass trends.
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21.
  • Lousada, Cláudio M., et al. (författare)
  • Synthesis of copper hydride (CuH) from CuCO3·Cu(OH)2 – a path to electrically conductive thin films of Cu
  • 2017
  • Ingår i: Dalton Transactions. - : Royal Society of Chemistry. - 1477-9226 .- 1477-9234. ; 46:20, s. 6533-6543
  • Tidskriftsartikel (refereegranskat)abstract
    • The most common synthesis methods for copper hydride (CuH) employ hard ligands that lead to the formation of considerable amounts of metallic Cu as side-product. Here we explore a synthesis method for CuH(s) through the reaction of CuCO3 center dot Cu(OH)(2)(s) with hypophosphorous acid (H3PO2) in solution, via the formation of the intermediate Cu(H2PO2)(2)(aq) complex. The reaction products were characterized with XRD, FTIR and SEM at different reaction times, and the kinetics of the transformation of Cu(H2PO2)(2)(aq) to CuH(s) were followed with NMR and are discussed. We show that our synthesis method provides a simple way for obtaining large amounts of CuH(s) even when the synthesis is performed in air. Compared to the classic Wurtz method, where CuSO4 is used as an initial source of Cu2+, our synthesis produces CuH particles with less metallic Cu side-product. We attribute this to the fact that our reaction medium is free from the hard SO42- ligand that can disproportionate Cu(I). We discuss a mechanism for the reaction based on the known reactivity of the reagents and intermediates involved. We explored the possibility of using CuH(s) for making electrically conductive films. Tests that employed water-dispersed CuH particles show that this compound can be reduced with H3PO2 leading to electrically conductive thin films of Cu. These films were made on regular office paper and were found to be Ohmic conductors even after several weeks of exposure to ambient conditions. The fact that the synthesis reported here produces large amounts of CuH particles in aqueous media, with very little impurities, and the fact that these can then be converted to a stable electrically conductive film can open up new applications for CuH such as for printing electrically conductive films or manufacturing surface coatings.
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22.
  • Amaral, Rita, et al. (författare)
  • Profiling Persistent Asthma Phenotypes in Adolescents : A Longitudinal Diagnostic Evaluation from the INSPIRERS Studies
  • 2021
  • Ingår i: International Journal of Environmental Research and Public Health. - : MDPI. - 1661-7827 .- 1660-4601. ; 18:3
  • Tidskriftsartikel (refereegranskat)abstract
    • We aimed to identify persistent asthma phenotypes among adolescents and to evaluate longitudinally asthma-related outcomes across phenotypes. Adolescents (13-17 years) from the prospective, observational, and multicenter INSPIRERS studies, conducted in Portugal and Spain, were included (n = 162). Latent class analysis was applied to demographic, environmental, and clinical variables, collected at a baseline medical visit. Longitudinal differences in clinical variables were assessed at a 4-month follow-up telephone contact (n = 128). Three classes/phenotypes of persistent asthma were identified. Adolescents in class 1 (n = 87) were highly symptomatic at baseline and presented the highest number of unscheduled healthcare visits per month and exacerbations per month, both at baseline and follow-up. Class 2 (n = 32) was characterized by female predominance, more frequent obesity, and uncontrolled upper/lower airways symptoms at baseline. At follow-up, there was a significant increase in the proportion of controlled lower airway symptoms (p < 0.001). Class 3 (n = 43) included mostly males with controlled lower airways symptoms; at follow-up, while keeping symptom control, there was a significant increase in exacerbations/month (p = 0.015). We have identified distinct phenotypes of persistent asthma in adolescents with different patterns in longitudinal asthma-related outcomes, supporting the importance of profiling asthma phenotypes in predicting disease outcomes that might inform targeted interventions and reduce future risk.
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23.
  • Fernandes, Juliana Folloni, et al. (författare)
  • Transplantation of Hematopoietic Stem Cells for Primary Immunodeficiencies in Brazil: Challenges in Treating Rare Diseases in Developing Countries.
  • 2018
  • Ingår i: Journal of clinical immunology. - : Springer Science and Business Media LLC. - 1573-2592 .- 0271-9142. ; 38:8, s. 917-926
  • Tidskriftsartikel (refereegranskat)abstract
    • The results of hematopoietic stem cell transplant (HSCT) for primary immunodeficiency diseases (PID) have been improving over time. Unfortunately, developing countries do not experience the same results. This first report of Brazilian experience of HSCT for PID describes the development and results in the field. We included data from transplants in 221 patients, performed at 11 centers which participated in the Brazilian collaborative group, from July 1990 to December 2015. The majority of transplants were concentrated in one center (n=123). The median age at HSCT was 22months, and the most common diseases were severe combined immunodeficiency (SCID) (n=67) and Wiskott-Aldrich syndrome (WAS) (n=67). Only 15 patients received unconditioned transplants. Cumulative incidence of GVHD grades II to IV was 23%, and GVHD grades III to IV was 10%. The 5-year overall survival was 71.6%. WAS patients had better survival compared to other diseases. Most deaths (n=53) occurred in the first year after transplantation mainly due to infection (55%) and GVHD (13%). Although transplant for PID patients in Brazil has evolved since its beginning, we still face some challenges like delayed diagnosis and referral, severe infections before transplant, a limited number of transplant centers with expertise, and resources for more advanced techniques. Measures like newborn screening for SCID may hasten the diagnosis and ameliorate patients' conditions at the moment of transplant.
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24.
  • Fernandes, Ricardo M.F. 1983-, et al. (författare)
  • Assessing Surfactant Binding to Carbon Nanotubes via Competitive Adsorption : Binding strength and critical coverage
  • 2015
  • Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
    • The displacement of a nonionic polymeric dispersant, Pluronic F127, adsorbed at the surface of single-walled carbon nanotubes, by low molecular-weight ionic dispersants (surfactants) is studied in aqueous dispersion. The method applied is diffusion NMR spectroscopy that can accurately measure the fraction of F127 molecules adsorbed at the tube surface because of the slow exchange (over the experimental time scale) of F127 between bulk and surface. In a series of surfactants with varying chain length and headgroups, we find that anionic surfactants replace in general more nonionic F127 than do cationic surfactants. The data collected show a strong correlation with the critical dispersibility concentration of the different surfactants, a parameter that signifies the concentration at which one obtains significant dispersed nanotube concentration by ultrasonication. We posit that this finding indicates the existence of a threshold surface coverage for dispersants that constitutes a necessary condition for de-bundling by ultrasonication. The results are discussed in relation to previous findings in the literature. 
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25.
  • Fernandes, Ricardo M. Ferreira, 1983- (författare)
  • Dispersing Carbon Nanotubes: Towards Molecular Understanding
  • 2015
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • Carbon nanotubes (CNTs) exhibit unique and fascinating intrinsic electrical, optical, thermal or mechanical properties that lead to a plethora of potential applications in composite materials, electronics, energy storage, medicine, among others. However, the manipulation of nanotubes is not trivial and there are significant difficulties to overcome before achieving their full potential in applications. Because of their high aspect ratio and strong tube-to-tube van der Waals interactions, nanotubes form bundles and ropes that are difficult to disperse in liquids. In this thesis, the topic of dispersing carbon nanotubes in water was addressed by several experimental methods such as nuclear magnetic resonance (NMR) diffusometry and light/electron microcopy. The main goal was to obtain molecular information on how the dispersants interact with carbon nanotubes.In dispersions of single-walled carbon nanotubes (SWNTs) in water, only a small fraction of the polymeric dispersant (Pluronic F127) was shown to be adsorbed at the CNT surface. Regarding dynamic features, the residence time of F127 on the SWNT surface was measured to be in the order of hundred milliseconds, and the lateral diffusion coefficient of the polymer along the nanotube surface proved to be an order of magnitude slower than that in the solution. The surface coverage of SWNTs by F127 was also investigated and the competitive adsorption of F127 and the protein bovine serum albumin, BSA, was assessed. F127 was found to bind stronger to the CNT surface than BSA does.Low molecular weight dispersants, viz. surfactants, were also investigated. Using carefully controlled conditions for the sonication and centrifugation steps, reproducible sigmoidal dispersibility curves were obtained, that exhibited an interesting variation with molecular properties of the surfactants. Various metrics that quantify the ability of different surfactants to disperse CNTs were obtained. In particular, the concentration of surfactant required to attain maximal dispersibility depends linearly on alkyl chain length, which indicates that the CNT-surfactant association, although hydrophobic in nature, is different from a micellization process. No correlation between dispersibility and the critical micellization concentration, cmc, of the surfactants was found. For gemini surfactants of the n-s-n type with spacer length s and hydrophobic tail length n, the dispersibility of multiwalled carbon nanotubes (MWNTs) also followed sigmoidal curves that were compared to those obtained with single-tailed homologues. The increase in spacer length caused an increase in the dispersion efficiency. The observations indicate a loose type of monolayer adsorption rather than the formation of micelle-like aggregates on the nanotube surface. With the future goal of embedding nanotubes in liquid crystal (LC) phases and thereby creating nanocomposites, the effect of the spacer length on the thermotropic behavior of the gemini 12-s-12 surfactant was investigated. Different mesophases were observed and a non-monotonic effect of the spacer length was found and rationalized within a model of the surfactant packing in the solid state.The relative binding strength of simple surfactants to CNTs was assessed by the amount of F127 they displace from the CNT surface upon addition. Anionic surfactants were found to replace more F127, which was interpreted as a sign of stronger binding to CNT. The data collected for all surfactants showed a good correlation with their critical dispersibility concentration that suggests the existence of a surface coverage threshold for dispersing nanotubes.On the macroscopic scale, the formation of weakly bound CNT aggregates in homogeneous dispersions was found to be induced by vortex-shaking. These aggregates could quickly and easily be re-dispersed by mild sonication. This counterintuitive behavior was related to the type of dispersant used and of the duration of mechanical agitation and was explained as a result of loose coverage by the dispersant. 
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26.
  • Fernandes, Ricardo M.F. 1983-, et al. (författare)
  • Dispersing Carbon Nanotubes with Ionic Surfactants under Controlled Conditions : Comparisons and Insight
  • 2015
  • Ingår i: Langmuir. - : American Chemical Society (ACS). - 0743-7463 .- 1520-5827. ; 31:40, s. 10955-10965
  • Tidskriftsartikel (refereegranskat)abstract
    • A fundamental understanding of the mechanisms involved in the surfactant-assisted exfoliation and dispersion of carbon nanotubes (CNTs) in water calls for well-controlled experimental methodologies and reliable comparative metrics. We have assessed the ability of several ionic surfactants to disperse single and multiwalled carbon nanotubes, resorting to a stringently controlled sonication-centrifugation method for the preparation of the dispersions. The CNT concentration was accurately measured for a wide range of surfactant concentration, using combined thermogravimetric analysis and UV–vis spectroscopy. The obtained dispersibility curves yield several quantitative parameters, which in turn allow for the effects of nanotube morphology and surfactant properties (aromatic rings, chain length, headgroup charge, andcmc) to be assessed and rationalized, both in terms of dispersed nanotube mass and surface area. The data also indicate that the CNT-surfactant association follows patterns that are markedly different from other equilibrium processes governed by hydrophobicity (such as micellization); in particular, the surfactant concentration needed for maximum dispersibility,cs,max, and the number of surfactant molecules per unit CNT area at cs,max are shown to depend linearly on chain length. The results further suggest that the presence of micelles in the exfoliation process is not a key factor either for starting CNT dispersibility or attaining its saturation value.
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27.
  • Fernandes, Ricardo M.F. 1983-, et al. (författare)
  • Mechanical Agitation Induces Aggregation of Pre-Dispersed Carbon Nanotubes
  • 2015
  • Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
    • Mechanical agitation is typically used to fragment and disperse insoluble materials in a solvent. We report here an aggregation process that, contrary to expectation, is induced by mechanical agitation: when aqueous dispersions of single-walled carbon nanotubes (SWNTs) are subject to vortex-shaking, weakly bound micron-sized aggregates are formed. The SWNT dispersions are prepared by adding various dispersants employing a sonication followed by centrifugation approach. While surfactant adsorption to the SWNTs during sonication results in stabilized exfoliated tubes and thin bundles, we find that vortex-shaking the fresh dispersions for short periods (10-60 s) results in re-aggregation into flocs in the 1-102 µm range. The aggregation is reversible: if the vortexed dispersions are mildly sonicated, the flocs break down and re-dispersal occurs. Imaging at different resolutions shows that the aggregates consist of loose networks of intertwined tubes and bundles. The data further indicate that the average aggregate size increases logarithmically with vortex time and is critically influenced by dispersant type (ionic or nonionic), centrifugation time (prior to vortexing) and initial concentration of dispersed SWNTs. These results are relevant if stabilization or destabilization of dispersions is sought for, i.e., in drug delivery or sensing applications, and could also be of interest for chiral sorting of SWNTs and percolation conductivity.
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28.
  • Fernandes, Ricardo Madeira F., et al. (författare)
  • Mechanical agitation induces counterintuitive aggregation of pre-dispersed carbon nanotubes
  • 2017
  • Ingår i: Journal of Colloid and Interface Science. - : Academic Press. - 0021-9797 .- 1095-7103. ; 493, s. 398-404
  • Tidskriftsartikel (refereegranskat)abstract
    • Mechanical agitation is commonly used to fragment and disperse insoluble materials in liquids. However, here we show that when pristine single-walled carbon nanotubes pre-dispersed in water are subject to vortex-shaking for very short periods (typically 10–60 s, power density ∼0.002 W mL−1), re-aggregation counterintuitively occurs. The initial dispersions are produced using surfactants as dispersants and powerful tip sonication (∼1 W mL−1) followed by centrifugation. Detailed imaging by light and electron microscopies shows that the vortex-induced aggregates consist of loose networks (1–102 μm in size) of intertwined tubes and thin bundles. The average aggregate size increases with vortexing time in an apparently logarithmic manner and depends on the dispersant used, initial concentration of nanotubes and size distribution of bundles. The aggregation is, nonetheless, reversible: if the vortex-shaken dispersions are mildly bath-sonicated (∼0.03 W mL−1), the flocs break down and re-dispersal occurs. Molecular insight for the mechanism behind this surprising phenomenon is put forth.
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29.
  • Fernandes, Ricardo M.F. 1983-, et al. (författare)
  • Strong Spacer Length Effects on The Thermal Behavior and Mesophase Formation By Gemini Surfactants
  • 2015
  • Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
    • The self-aggregation properties in aqueous solution of gemini surfactants of the type alkanediyl-α,ω-bis(dodecyldimethylammonium bromides), 12-s-12, have been extensively reported and are known to be significantly influenced by the number of methylene groups, s, of the covalent spacer. In contrast, the thermal behavior of the anhydrous compounds as a function of varying s has not been investigated in a similarly systematic way. Herein, we present the thermal phase behavior of eight compounds of the 12-s-12 family (with s = 2-6, 8, 10 and 12), resorting to differential scanning calorimetry (DSC), polarized light microscopy (PLM) and X-ray diffraction (XRD). We find that compounds with either the shortest spacer, s = 2, or the longest ones—8, 10 and 12—form several smectic liquid-crystalline phases prior to isotropization to the liquid phase, with appearance of oily streaks, focal conics, mosaic and fan-shaped birefringent textures. In sharp contrast, gemini compounds with intermediate spacers, s = 3-6, decompose and do not form any disordered, fluid mesophases. Both the DSC thermodynamic parameters for the phase transitions and d00l spacings obtained from XRD show non-monotonic trends with spacer variation, indicating that there are significant differences in solid-state packing and melting process. Plausible molecular packing arrangements in the solid-state are presented, consistent with the XRD information and geometric considerations, and their influence on the phase behavior trends critically discussed.
  •  
30.
  • Fernandes, Ricardo M.F. 1983-, et al. (författare)
  • Surface Coverage and Competitive Adsorption on Carbon Nanotubes
  • 2015
  • Ingår i: The Journal of Physical Chemistry C. - : American Chemical Society (ACS). - 1932-7447 .- 1932-7455. ; 119:38, s. 22190-22197
  • Tidskriftsartikel (refereegranskat)abstract
    • The binding strength of dispersants to the surface of carbon nanotubes is of crucial importance for the efficiency of the dispersion process and for potential applications, yet data are scarce on this subject. Here we present the results of diffusion NMR experiments in dispersions of single-walled carbon nanotubes (SWNTs) prepared by either the polymer Pluronics F127 or the protein bovine serum albumin (BSA). The experiments detect the amount of F127 molecules adsorbed onto the SWNT surface. This quantity is recorded (i) in F127-SWNT dispersions to which BSA molecules are added and (ii) in BSA-SWNT dispersions to which F127 molecules are added. The data clearly show that F127 replaces BSA adsorbed at the SWNT surface, while BSA leaves the adsorbed F127 coverage intact. Consequently, F127 binds to the nanotube surface more strongly than BSA. Hence, we provide a way to categorize dispersants by adsorption strength. We also provide evidence showing that the nanotubes dispersed by BSA form loose aggregates where a large part of the surface is not in direct contact with the surrounding liquid. The results are discussed in relation to previous findings in the literature.
  •  
31.
  • Li, Jun, et al. (författare)
  • ALPPS for Locally Advanced Intrahepatic Cholangiocarcinoma: Did Aggressive Surgery Lead to the Oncological Benefit? An International Multi-center Study
  • 2020
  • Ingår i: Annals of Surgical Oncology. - : SPRINGER. - 1068-9265 .- 1534-4681. ; 27, s. 1372-1384
  • Tidskriftsartikel (refereegranskat)abstract
    • Background ALPPS is found to increase the resectability of primary and secondary liver malignancy at the advanced stage. The aim of the study was to verify the surgical and oncological outcome of ALPPS for intrahepatic cholangiocarcinoma (ICC). Methods The study cohort was based on the ALPPS registry with patients from 31 international centers between August 2009 and January 2018. Propensity score matched patients receiving chemotherapy only were selected from the SEER database as controls for the survival analysis. Results One hundred and two patients undergoing ALPPS were recruited, 99 completed the second stage with median inter-stage duration of 11 days. The median kinetic growth rate was 23 ml/day. R0 resection was achieved in 87 (85%). Initially high rates of morbidity and mortality decreased steadily to a 29% severe complication rate and 7% 90-day morbidity in the last 2 years. Post-hepatectomy liver failure remained the main cause of 90-day mortality. Multivariate analysis revealed insufficient future liver remnant at the stage-2 operation (FLR2) to be the only risk factor for severe complications (OR 2.91, p = 0.02). The propensity score matching analysis showed a superior overall survival in the ALPPS group compared to palliative chemotherapy (median overall survival: 26.4 months vs 14 months; 1-, 2-, and 3-year survival rates: 82.4%, 70.5% and 39.6% vs 51.2%, 21.4% and 11.3%, respectively, p amp;lt; 0.01). The survival benefit, however, was not confirmed in the subgroup analysis for patients with insufficient FLR2 or multifocal ICC. Conclusion ALPPS showed high efficacy in achieving R0 resections in locally advanced ICC. To get the most oncological benefit from this aggressive surgery, ALPPS would be restricted to patients with single lesions and sufficient FLR2.
  •  
32.
  • Pertl, Leonhard, et al. (författare)
  • Exports and Productivity : Comparable Evidence for 14 Countries
  • 2007
  • Ingår i: Policy Research Working Papers. - New York : World Bank. - 1813-9450.
  • Rapport (refereegranskat)abstract
    • The authors use comparable micro level panel data for 14 countries and a set of identically specified empirical models to investigate the relationship between exports and productivity. The overall results are in line with the big picture that is by now familiar from the literature: Exporters are more productive than non-exporters when observed and unobserved heterogeneity are controlled for, and these exporter productivity premia tend to increase with the share of exports in total sales; there is strong evidence in favour of self-selection of more productive firms into export markets, but nearly no evidence in favour of the learning-by-exporting hypothesis. The authors document that the exporter premia differ considerably across countries in identically specified empirical models. In a meta-analysis of their results the authors find that countries that are more open and have more effective government report higher productivity premia. However, the level of development per se does not appear to be an explanation for the observed cross-country differences.
  •  
33.
  • Rocha, Jessica, et al. (författare)
  • Gemini Surfactants as Dispersants of Multiwalled Carbon Nanotubes : a Systematic Study on the Role of Molecular Structure
  • 2015
  • Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
    • Surfactants have been widely used as non-covalent dispersants of carbon nanotubes and yet a deeper and systematic understanding of the role of their molecular properties on dispersibility still awaits consensus. Herein, we report on the dispersibility of multiwalled carbon nanotubes (MWNTs) using a set of dicationic gemini surfactants of the n-s-n type, where both the length of the covalent spacer (s) that bridges the two cationic headgroups and the length of the tails (n) are systematically varied. Thus, 12-s-12 gemini with s = 2, 6, and 12 are studied together with 16-s-16 (s = 2 and 12). In addition, the single-tailed homologues dodecyltrimethylammonium bromide, DTAB (n = 12), and cetyltrimethylammonium bromide, CTAB (n = 16), are employed for comparisons. High precision dispersion curves (dispersed NT vs. surfactant concentration) are presented, obtained through a well-controlled sonication/centrifugation procedure combined with an accurate determination of MWNT concentration. The gemini amphiphiles, despite being double-tailed and double-charged, are found to be less effective dispersants than CTAB and roughly as effective as DTAB. Among the gemini, the following pattern emerges as concerning dispersion behavior. (i) The tail length, n, is less influential than spacer length, s, in dispersing ability, implying that the spacer hydrophobicity rather than that of the tail may govern the affinity for the nanotube surface. (ii) In the 12-s-12 series, the surfactant concentration needed for maximum MWNT dispersibility depends linearly on s, while it is known that the neat cmc depends non-monotonically on s. (iii) Similarly to single-tailed ionic surfactants, the presence of micelles has no direct effect on the dispersion behavior. In combination, these observations also point to an adsorption mechanism that does not involve the formation of micelle-like aggregates on the nanotube surface but rather coverage by individual dispersant molecules.
  •  
34.
  • Soncin, Silvia, et al. (författare)
  • High-resolution dietary reconstruction of victims of the 79 CE Vesuvius eruption at Herculaneum by compound-specific isotope analysis
  • 2021
  • Ingår i: Science Advances. - : American Association for the Advancement of Science (AAAS). - 2375-2548. ; 7:35
  • Tidskriftsartikel (refereegranskat)abstract
    • The remains of those who perished at Herculaneum in 79 CE offer a unique opportunity to examine lifeways across an ancient community who lived and died together. Historical sources often allude to differential access to foodstuffs across Roman society but provide no direct or quantitative information. By determining the stable isotope values of amino acids from bone collagen and deploying Bayesian models that incorporate knowledge of protein synthesis, we were able to reconstruct the diets of 17 adults from Herculaneum with unprecedented resolution. Significant differences in the proportions of marine and terrestrial foods consumed were observed between males and females, implying that access to food was differentiated according to gender. The approach also provided dietary data of sufficient precision for comparison with assessments of food supply to modern populations, opening up the possibility of benchmarking ancient diets against contemporary settings where the consequences for health are better understood.
  •  
35.
  • Zacarias, Iulisloi, 1985-, et al. (författare)
  • Combining Software-Defined and Delay-Tolerant Approaches in Last-Mile Tactical Edge Networking
  • 2017
  • Ingår i: IEEE Communications Magazine. - Piscataway : Institute of Electrical and Electronics Engineers (IEEE). - 0163-6804 .- 1558-1896. ; 55:10, s. 22-29
  • Tidskriftsartikel (refereegranskat)abstract
    • Network-centric warfare is a no-way-back trend in modern military operations. The application of this concept ranges from upper-level decision making echelons to troop guidance on the battlefield, and many studies have been carried out in this area. However, most of these are concerned with either the higher-level strategic networks, that is, the networks linking the higher echelons with abundant resources, satellite communications, or even a whole network infrastructure, or high-end TEN, representing resource-rich troops in the field, with military aircraft, battleships, or ground vehicles equipped with powerful wireless communication devices and (almost) unrestricted energy resources for communication. However, these studies fail to take into account the "last-mile TEN," which comprises resource constrained communication devices carried by troopers, equipping sensor nodes deployed in the field or small unmanned aerial vehicles. In an attempt to fill this gap in the studies on battlefield networking, this article seeks to combine software-defined and delay-tolerant approaches to support the diverse range of strict requirements for applications in the last-mile TEN. © 2017 IEEE.
  •  
36.
  • Zacarias, Iulisloi, 1985-, et al. (författare)
  • Employing SDN to control video streaming applications in military mobile networks
  • 2017
  • Ingår i: 2017 IEEE 16th International Symposium on Network Computing and Applications (NCA). - New York : IEEE. - 9781538614655 - 9781538614648 ; , s. 1-4
  • Konferensbidrag (refereegranskat)abstract
    • Video streaming is an important service provided by surveillance systems to enhance situation awareness. However, in military systems, data acquisition heavily depends on the network infrastructure. In this application domain, units are spread and the distance between the sources of data and the decision makers may be very large. In the case of video streaming, the demand for high network throughput poses some extra requirements on the network. Considering the mobility patterns of the military units and the diversity of the new generations of sensors, especially those used by Unmanned Aerial Vehicles (UAV), the configuration and the management of the network must be so dynamic and so sensitive to data flow parameters that manual configuration is not acceptable. For this reason, the capability of the network to configure itself to offer the necessary Quality of Service is a must. Using principles of Software Defined Networks (SDN), this paper presents an analysis of video streaming for military surveillance in which multiple UAVs are employed as data providers through an SDN-enabled network, with promising results. ©2017 by IEEE
  •  
37.
  • Zacarias, Iulisloi, 1985-, et al. (författare)
  • Enhancing Mobile Military Surveillance Based on Video Streaming by Employing Software Defined Networks
  • 2018
  • Ingår i: Wireless Communications & Mobile Computing. - Oxford : John Wiley & Sons. - 1530-8669 .- 1530-8677. ; 2018, s. 1-12
  • Tidskriftsartikel (refereegranskat)abstract
    • Situation awareness in surveillance systems benefits from high-quality video streaming service. This is even more important considering military systems, in which delays in image transmission may have a significant impact on the decision-making process. However, in order to deliver high-quality video streaming service, the required network infrastructure may be prohibitively complex, or even completely impossible to deploy, if mobile data providers are considered. Moreover, the demand for high network throughput poses extra requirements on the network. Considering this context, this paper addresses the problem of highly mobile networks composed of unmanned aerial vehicles (UAVs) as data providers of a military surveillance system. The proposed approach to tackle the problem is based on a Software Defined Networking (SDN) approach aiming at providing the best routes to deliver the data, enhancing the end-user quality of experience. An extensive experimental campaign was performed by means of simulations and the acquired results provide solid evidence of the usefulness of this proposal.© 2018 Iulisloi Zacarias et al.
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