| 1. |
- Lozano, Rafael, et al.
(författare)
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Measuring progress from 1990 to 2017 and projecting attainment to 2030 of the health-related Sustainable Development Goals for 195 countries and territories: a systematic analysis for the Global Burden of Disease Study 2017
- 2018
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Ingår i: The Lancet. - : Elsevier. - 1474-547X .- 0140-6736. ; 392:10159, s. 2091-2138
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Tidskriftsartikel (refereegranskat)abstract
- Background: Efforts to establish the 2015 baseline and monitor early implementation of the UN Sustainable Development Goals (SDGs) highlight both great potential for and threats to improving health by 2030. To fully deliver on the SDG aim of “leaving no one behind”, it is increasingly important to examine the health-related SDGs beyond national-level estimates. As part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017), we measured progress on 41 of 52 health-related SDG indicators and estimated the health-related SDG index for 195 countries and territories for the period 1990–2017, projected indicators to 2030, and analysed global attainment. Methods: We measured progress on 41 health-related SDG indicators from 1990 to 2017, an increase of four indicators since GBD 2016 (new indicators were health worker density, sexual violence by non-intimate partners, population census status, and prevalence of physical and sexual violence [reported separately]). We also improved the measurement of several previously reported indicators. We constructed national-level estimates and, for a subset of health-related SDGs, examined indicator-level differences by sex and Socio-demographic Index (SDI) quintile. We also did subnational assessments of performance for selected countries. To construct the health-related SDG index, we transformed the value for each indicator on a scale of 0–100, with 0 as the 2·5th percentile and 100 as the 97·5th percentile of 1000 draws calculated from 1990 to 2030, and took the geometric mean of the scaled indicators by target. To generate projections through 2030, we used a forecasting framework that drew estimates from the broader GBD study and used weighted averages of indicator-specific and country-specific annualised rates of change from 1990 to 2017 to inform future estimates. We assessed attainment of indicators with defined targets in two ways: first, using mean values projected for 2030, and then using the probability of attainment in 2030 calculated from 1000 draws. We also did a global attainment analysis of the feasibility of attaining SDG targets on the basis of past trends. Using 2015 global averages of indicators with defined SDG targets, we calculated the global annualised rates of change required from 2015 to 2030 to meet these targets, and then identified in what percentiles the required global annualised rates of change fell in the distribution of country-level rates of change from 1990 to 2015. We took the mean of these global percentile values across indicators and applied the past rate of change at this mean global percentile to all health-related SDG indicators, irrespective of target definition, to estimate the equivalent 2030 global average value and percentage change from 2015 to 2030 for each indicator. Findings: The global median health-related SDG index in 2017 was 59·4 (IQR 35·4–67·3), ranging from a low of 11·6 (95% uncertainty interval 9·6–14·0) to a high of 84·9 (83·1–86·7). SDG index values in countries assessed at the subnational level varied substantially, particularly in China and India, although scores in Japan and the UK were more homogeneous. Indicators also varied by SDI quintile and sex, with males having worse outcomes than females for non-communicable disease (NCD) mortality, alcohol use, and smoking, among others. Most countries were projected to have a higher health-related SDG index in 2030 than in 2017, while country-level probabilities of attainment by 2030 varied widely by indicator. Under-5 mortality, neonatal mortality, maternal mortality ratio, and malaria indicators had the most countries with at least 95% probability of target attainment. Other indicators, including NCD mortality and suicide mortality, had no countries projected to meet corresponding SDG targets on the basis of projected mean values for 2030 but showed some probability of attainment by 2030. For some indicators, including child malnutrition, several infectious diseases, and most violence measures, the annualised rates of change required to meet SDG targets far exceeded the pace of progress achieved by any country in the recent past. We found that applying the mean global annualised rate of change to indicators without defined targets would equate to about 19% and 22% reductions in global smoking and alcohol consumption, respectively; a 47% decline in adolescent birth rates; and a more than 85% increase in health worker density per 1000 population by 2030. Interpretation: The GBD study offers a unique, robust platform for monitoring the health-related SDGs across demographic and geographic dimensions. Our findings underscore the importance of increased collection and analysis of disaggregated data and highlight where more deliberate design or targeting of interventions could accelerate progress in attaining the SDGs. Current projections show that many health-related SDG indicators, NCDs, NCD-related risks, and violence-related indicators will require a concerted shift away from what might have driven past gains—curative interventions in the case of NCDs—towards multisectoral, prevention-oriented policy action and investments to achieve SDG aims. Notably, several targets, if they are to be met by 2030, demand a pace of progress that no country has achieved in the recent past. The future is fundamentally uncertain, and no model can fully predict what breakthroughs or events might alter the course of the SDGs. What is clear is that our actions—or inaction—today will ultimately dictate how close the world, collectively, can get to leaving no one behind by 2030.
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| 4. |
- Stanaway, Jeffrey D., et al.
(författare)
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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
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Ingår i: The Lancet. - 1474-547X .- 0140-6736. ; 392:10159, s. 1923-1994
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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. |
- Kassebaum, Nicholas J., et al.
(författare)
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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
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Ingår i: The Lancet. - 0140-6736 .- 1474-547X. ; 388:10053, s. 1603-1658
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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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| 6. |
- Wang, Haidong, et al.
(författare)
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Estimates of global, regional, and national incidence, prevalence, and mortality of HIV, 1980-2015 : the Global Burden of Disease Study 2015.
- 2016
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Ingår i: The lancet. HIV. - : Elsevier. - 2352-3018. ; 3:8, s. e361-e387
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Timely assessment of the burden of HIV/AIDS is essential for policy setting and programme evaluation. In this report from the Global Burden of Disease Study 2015 (GBD 2015), we provide national estimates of levels and trends of HIV/AIDS incidence, prevalence, coverage of antiretroviral therapy (ART), and mortality for 195 countries and territories from 1980 to 2015.METHODS: For countries without high-quality vital registration data, we estimated prevalence and incidence with data from antenatal care clinics and population-based seroprevalence surveys, and with assumptions by age and sex on initial CD4 distribution at infection, CD4 progression rates (probability of progression from higher to lower CD4 cell-count category), on and off antiretroviral therapy (ART) mortality, and mortality from all other causes. Our estimation strategy links the GBD 2015 assessment of all-cause mortality and estimation of incidence and prevalence so that for each draw from the uncertainty distribution all assumptions used in each step are internally consistent. We estimated incidence, prevalence, and death with GBD versions of the Estimation and Projection Package (EPP) and Spectrum software originally developed by the Joint United Nations Programme on HIV/AIDS (UNAIDS). We used an open-source version of EPP and recoded Spectrum for speed, and used updated assumptions from systematic reviews of the literature and GBD demographic data. For countries with high-quality vital registration data, we developed the cohort incidence bias adjustment model to estimate HIV incidence and prevalence largely from the number of deaths caused by HIV recorded in cause-of-death statistics. We corrected these statistics for garbage coding and HIV misclassification.FINDINGS: Global HIV incidence reached its peak in 1997, at 3·3 million new infections (95% uncertainty interval [UI] 3·1-3·4 million). Annual incidence has stayed relatively constant at about 2·6 million per year (range 2·5-2·8 million) since 2005, after a period of fast decline between 1997 and 2005. The number of people living with HIV/AIDS has been steadily increasing and reached 38·8 million (95% UI 37·6-40·4 million) in 2015. At the same time, HIV/AIDS mortality has been declining at a steady pace, from a peak of 1·8 million deaths (95% UI 1·7-1·9 million) in 2005, to 1·2 million deaths (1·1-1·3 million) in 2015. We recorded substantial heterogeneity in the levels and trends of HIV/AIDS across countries. Although many countries have experienced decreases in HIV/AIDS mortality and in annual new infections, other countries have had slowdowns or increases in rates of change in annual new infections.INTERPRETATION: Scale-up of ART and prevention of mother-to-child transmission has been one of the great successes of global health in the past two decades. However, in the past decade, progress in reducing new infections has been slow, development assistance for health devoted to HIV has stagnated, and resources for health in low-income countries have grown slowly. Achievement of the new ambitious goals for HIV enshrined in Sustainable Development Goal 3 and the 90-90-90 UNAIDS targets will be challenging, and will need continued efforts from governments and international agencies in the next 15 years to end AIDS by 2030.
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| 7. |
- 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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| 8. |
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- 2019
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Tidskriftsartikel (refereegranskat)
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| 9. |
- Alharbi, Khalid Saad, et al.
(författare)
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Nuclear factor-kappa B and its role in inflammatory lung disease
- 2021
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Ingår i: Chemico-Biological Interactions. - : Elsevier. - 0009-2797 .- 1872-7786. ; 345
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Tidskriftsartikel (refereegranskat)abstract
- Nuclear factor-kappa B, involved in inflammation, host immune response, cell adhesion, growth signals, cell proliferation, cell differentiation, and apoptosis defense, is a dimeric transcription factor. Inflammation is a key component of many common respiratory disorders, including asthma, chronic obstructive pulmonary disease (COPD), bronchiectasis, and acute respiratory distress syndrome. Many basic transcription factors are found in NF-xB signaling, which is a member of the Rel protein family. Five members of this family c-REL, NF-xB2 (p100/ p52), RelA (p65), NF-xB1 (p105/p50), RelB, and RelA (p65) produce 5 transcriptionally active molecules. Proinflammatory cytokines, T lymphocyte, and B lymphocyte cell mitogens, lipopolysaccharides, bacteria, viral proteins, viruses, double-stranded RNA, oxidative stress, physical exertion, various chemotherapeutics are the stimulus responsible for NF-xB activation. NF-xB act as a principal component for several common respiratory illnesses, such as asthma, lung cancer, pulmonary fibrosis, COPD as well as infectious diseases like pneumonia, tuberculosis, COVID-19. Inflammatory lung disease, especially COVID-19, can make NF-xB a key target for drug production.
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| 10. |
- Borah, Jintu, et al.
(författare)
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AiCareBreath : IoT Enabled Location Invariant Novel Unified Model for Predicting Air Pollutants to Avoid Related Respiratory Disease
- 2024
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Ingår i: IEEE Internet of Things Journal. - : IEEE. - 2327-4662. ; 11:8, s. 14625-14633
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Tidskriftsartikel (refereegranskat)abstract
- This article presents a location-invariant air pollution prediction model with good geographic generalizability. The model uses a Light GBR as part of a machine-learning framework to capture the spatial identification of air contaminants. Given the dynamic nature of air pollution, the model also uses a Random Forest to capture temporal dependencies in the data. Our model uses a transfer learning strategy to deal with location variability. The algorithm can learn concentration patterns because it has been trained on a vast dataset of air quality measurements from various locations. The trained model is then improved using information from a particular target site, customizing it to the features of the target area. Experiments are carried out on a comprehensive dataset containing air pollution measurements from various places to assess the efficacy of the proposed model. The recommended method performs better than standard models at forecasting air pollution levels, proving its dependability in various geographical settings. An interpretability analysis is also performed to learn about the variables affecting air pollution levels. We identify the geographical patterns associated with high pollutant concentrations by visualizing the learned representations within the model, giving important information for environmental planning and mitigation methods. The observations show that the model outperforms state-of-the-art forecasting based on RNNs and transformer-based models. The suggested methodology for forecasting air contaminants has the potential to improve air quality management and aid in decision-making across numerous regions. This helps safeguard the environment and public health by creating more precise and dependable air pollution forecast systems.
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| 11. |
- Forouzanfar, Mohammad H, et al.
(författare)
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Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks in 188 countries, 1990-2013 : a systematic analysis for the Global Burden of Disease Study 2013.
- 2015
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Ingår i: The Lancet. - 0140-6736 .- 1474-547X. ; 386:10010, s. 2287-2323
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The Global Burden of Disease, Injuries, and Risk Factor study 2013 (GBD 2013) is the first of a series of annual updates of the GBD. Risk factor quantification, particularly of modifiable risk factors, can help to identify emerging threats to population health and opportunities for prevention. The GBD 2013 provides a timely opportunity to update the comparative risk assessment with new data for exposure, relative risks, and evidence on the appropriate counterfactual risk distribution.METHODS: Attributable deaths, years of life lost, years lived with disability, and disability-adjusted life-years (DALYs) have been estimated for 79 risks or clusters of risks using the GBD 2010 methods. Risk-outcome pairs meeting explicit evidence criteria were assessed for 188 countries for the period 1990-2013 by age and sex using three inputs: risk exposure, relative risks, and the theoretical minimum risk exposure level (TMREL). Risks are organised into a hierarchy with blocks of behavioural, environmental and occupational, and metabolic risks at the first level of the hierarchy. The next level in the hierarchy includes nine clusters of related risks and two individual risks, with more detail provided at levels 3 and 4 of the hierarchy. Compared with GBD 2010, six new risk factors have been added: handwashing practices, occupational exposure to trichloroethylene, childhood wasting, childhood stunting, unsafe sex, and low glomerular filtration rate. For most risks, data for exposure were synthesised with a Bayesian meta-regression method, DisMod-MR 2.0, or spatial-temporal Gaussian process regression. Relative risks were based on meta-regressions of published cohort and intervention studies. Attributable burden for clusters of risks and all risks combined took into account evidence on the mediation of some risks such as high body-mass index (BMI) through other risks such as high systolic blood pressure and high cholesterol.FINDINGS: All risks combined account for 57·2% (95% uncertainty interval [UI] 55·8-58·5) of deaths and 41·6% (40·1-43·0) of DALYs. Risks quantified account for 87·9% (86·5-89·3) of cardiovascular disease DALYs, ranging to a low of 0% for neonatal disorders and neglected tropical diseases and malaria. In terms of global DALYs in 2013, six risks or clusters of risks each caused more than 5% of DALYs: dietary risks accounting for 11·3 million deaths and 241·4 million DALYs, high systolic blood pressure for 10·4 million deaths and 208·1 million DALYs, child and maternal malnutrition for 1·7 million deaths and 176·9 million DALYs, tobacco smoke for 6·1 million deaths and 143·5 million DALYs, air pollution for 5·5 million deaths and 141·5 million DALYs, and high BMI for 4·4 million deaths and 134·0 million DALYs. Risk factor patterns vary across regions and countries and with time. In sub-Saharan Africa, the leading risk factors are child and maternal malnutrition, unsafe sex, and unsafe water, sanitation, and handwashing. In women, in nearly all countries in the Americas, north Africa, and the Middle East, and in many other high-income countries, high BMI is the leading risk factor, with high systolic blood pressure as the leading risk in most of Central and Eastern Europe and south and east Asia. For men, high systolic blood pressure or tobacco use are the leading risks in nearly all high-income countries, in north Africa and the Middle East, Europe, and Asia. For men and women, unsafe sex is the leading risk in a corridor from Kenya to South Africa.INTERPRETATION: Behavioural, environmental and occupational, and metabolic risks can explain half of global mortality and more than one-third of global DALYs providing many opportunities for prevention. Of the larger risks, the attributable burden of high BMI has increased in the past 23 years. In view of the prominence of behavioural risk factors, behavioural and social science research on interventions for these risks should be strengthened. Many prevention and primary care policy options are available now to act on key risks.FUNDING: Bill & Melinda Gates Foundation.
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| 12. |
- 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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| 13. |
- Reitsma, Marissa B., et al.
(författare)
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Smoking prevalence and attributable disease burden in 195 countries and territories, 1990-2015 : a systematic analysis from the Global Burden of Disease Study 2015
- 2017
-
Ingår i: The Lancet. - : Elsevier. - 0140-6736 .- 1474-547X. ; 389:10082, s. 1885-1906
-
Tidskriftsartikel (refereegranskat)abstract
- Background The scale-up of tobacco control, especially after the adoption of the Framework Convention for Tobacco Control, is a major public health success story. Nonetheless, smoking remains a leading risk for early death and disability worldwide, and therefore continues to require sustained political commitment. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) offers a robust platform through which global, regional, and national progress toward achieving smoking-related targets can be assessed. Methods We synthesised 2818 data sources with spatiotemporal Gaussian process regression and produced estimates of daily smoking prevalence by sex, age group, and year for 195 countries and territories from 1990 to 2015. We analysed 38 risk-outcome pairs to generate estimates of smoking-attributable mortality and disease burden, as measured by disability-adjusted life-years (DALYs). We then performed a cohort analysis of smoking prevalence by birth-year cohort to better understand temporal age patterns in smoking. We also did a decomposition analysis, in which we parsed out changes in all-cause smoking-attributable DALYs due to changes in population growth, population ageing, smoking prevalence, and risk-deleted DALY rates. Finally, we explored results by level of development using the Socio-demographic Index (SDI). Findings Worldwide, the age-standardised prevalence of daily smoking was 25.0% (95% uncertainty interval [UI] 24.2-25.7) for men and 5.4% (5.1-5.7) for women, representing 28.4% (25.8-31.1) and 34.4% (29.4-38.6) reductions, respectively, since 1990. A greater percentage of countries and territories achieved significant annualised rates of decline in smoking prevalence from 1990 to 2005 than in between 2005 and 2015; however, only four countries had significant annualised increases in smoking prevalence between 2005 and 2015 (Congo [Brazzaville] and Azerbaijan for men and Kuwait and Timor-Leste for women). In 2015, 11.5% of global deaths (6.4 million [95% UI 5.7-7.0 million]) were attributable to smoking worldwide, of which 52.2% took place in four countries (China, India, the USA, and Russia). Smoking was ranked among the five leading risk factors by DALYs in 109 countries and territories in 2015, rising from 88 geographies in 1990. In terms of birth cohorts, male smoking prevalence followed similar age patterns across levels of SDI, whereas much more heterogeneity was found in age patterns for female smokers by level of development. While smoking prevalence and risk-deleted DALY rates mostly decreased by sex and SDI quintile, population growth, population ageing, or a combination of both, drove rises in overall smoking-attributable DALYs in low-SDI to middle-SDI geographies between 2005 and 2015. Interpretation The pace of progress in reducing smoking prevalence has been heterogeneous across geographies, development status, and sex, and as highlighted by more recent trends, maintaining past rates of decline should not be taken for granted, especially in women and in low-SDI to middle-SDI countries. Beyond the effect of the tobacco industry and societal mores, a crucial challenge facing tobacco control initiatives is that demographic forces are poised to heighten smoking's global toll, unless progress in preventing initiation and promoting cessation can be substantially accelerated. Greater success in tobacco control is possible but requires effective, comprehensive, and adequately implemented and enforced policies, which might in turn require global and national levels of political commitment beyond what has been achieved during the past 25 years.
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| 14. |
- Vos, Theo, et al.
(författare)
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Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013
- 2015
-
Ingår i: The Lancet. - 1474-547X .- 0140-6736. ; 386:9995, s. 743-800
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Tidskriftsartikel (refereegranskat)abstract
- Background Up-to-date evidence about levels and trends in disease and injury incidence, prevalence, and years lived with disability (YLDs) is an essential input into global, regional, and national health policies. In the Global Burden of Disease Study 2013 (GBD 2013), we estimated these quantities for acute and chronic diseases and injuries for 188 countries between 1990 and 2013. Methods Estimates were calculated for disease and injury incidence, prevalence, and YLDs using GBD 2010 methods with some important refinements. Results for incidence of acute disorders and prevalence of chronic disorders are new additions to the analysis. Key improvements include expansion to the cause and sequelae list, updated systematic reviews, use of detailed injury codes, improvements to the Bayesian meta-regression method (DisMod-MR), and use of severity splits for various causes. An index of data representativeness, showing data availability, was calculated for each cause and impairment during three periods globally and at the country level for 2013. In total, 35 620 distinct sources of data were used and documented to calculated estimates for 301 diseases and injuries and 2337 sequelae. The comorbidity simulation provides estimates for the number of sequelae, concurrently, by individuals by country, year, age, and sex. Disability weights were updated with the addition of new population-based survey data from four countries. Findings Disease and injury were highly prevalent; only a small fraction of individuals had no sequelae. Comorbidity rose substantially with age and in absolute terms from 1990 to 2013. Incidence of acute sequelae were predominantly infectious diseases and short-term injuries, with over 2 billion cases of upper respiratory infections and diarrhoeal disease episodes in 2013, with the notable exception of tooth pain due to permanent caries with more than 200 million incident cases in 2013. Conversely, leading chronic sequelae were largely attributable to non-communicable diseases, with prevalence estimates for asymptomatic permanent caries and tension-type headache of 2.4 billion and 1.6 billion, respectively. The distribution of the number of sequelae in populations varied widely across regions, with an expected relation between age and disease prevalence. YLDs for both sexes increased from 537.6 million in 1990 to 764.8 million in 2013 due to population growth and ageing, whereas the age-standardised rate decreased little from 114.87 per 1000 people to 110.31 per 1000 people between 1990 and 2013. Leading causes of YLDs included low back pain and major depressive disorder among the top ten causes of YLDs in every country. YLD rates per person, by major cause groups, indicated the main drivers of increases were due to musculoskeletal, mental, and substance use disorders, neurological disorders, and chronic respiratory diseases; however HIV/AIDS was a notable driver of increasing YLDs in sub-Saharan Africa. Also, the proportion of disability-adjusted life years due to YLDs increased globally from 21.1% in 1990 to 31.2% in 2013. Interpretation Ageing of the world's population is leading to a substantial increase in the numbers of individuals with sequelae of diseases and injuries. Rates of YLDs are declining much more slowly than mortality rates. The non-fatal dimensions of disease and injury will require more and more attention from health systems. The transition to non-fatal outcomes as the dominant source of burden of disease is occurring rapidly outside of sub-Saharan Africa. Our results can guide future health initiatives through examination of epidemiological trends and a better understanding of variation across countries.
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| 15. |
- Wang, Haidong, et al.
(författare)
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Global, regional, and national levels of neonatal, infant, and under-5 mortality during 1990-2013 : a systematic analysis for the Global Burden of Disease Study 2013
- 2014
-
Ingår i: The Lancet. - 0140-6736 .- 1474-547X. ; 384:9947, s. 957-979
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Remarkable financial and political efforts have been focused on the reduction of child mortality during the past few decades. Timely measurements of levels and trends in under-5 mortality are important to assess progress towards the Millennium Development Goal 4 (MDG 4) target of reduction of child mortality by two thirds from 1990 to 2015, and to identify models of success.METHODS: We generated updated estimates of child mortality in early neonatal (age 0-6 days), late neonatal (7-28 days), postneonatal (29-364 days), childhood (1-4 years), and under-5 (0-4 years) age groups for 188 countries from 1970 to 2013, with more than 29 000 survey, census, vital registration, and sample registration datapoints. We used Gaussian process regression with adjustments for bias and non-sampling error to synthesise the data for under-5 mortality for each country, and a separate model to estimate mortality for more detailed age groups. We used explanatory mixed effects regression models to assess the association between under-5 mortality and income per person, maternal education, HIV child death rates, secular shifts, and other factors. To quantify the contribution of these different factors and birth numbers to the change in numbers of deaths in under-5 age groups from 1990 to 2013, we used Shapley decomposition. We used estimated rates of change between 2000 and 2013 to construct under-5 mortality rate scenarios out to 2030.FINDINGS: We estimated that 6·3 million (95% UI 6·0-6·6) children under-5 died in 2013, a 64% reduction from 17·6 million (17·1-18·1) in 1970. In 2013, child mortality rates ranged from 152·5 per 1000 livebirths (130·6-177·4) in Guinea-Bissau to 2·3 (1·8-2·9) per 1000 in Singapore. The annualised rates of change from 1990 to 2013 ranged from -6·8% to 0·1%. 99 of 188 countries, including 43 of 48 countries in sub-Saharan Africa, had faster decreases in child mortality during 2000-13 than during 1990-2000. In 2013, neonatal deaths accounted for 41·6% of under-5 deaths compared with 37·4% in 1990. Compared with 1990, in 2013, rising numbers of births, especially in sub-Saharan Africa, led to 1·4 million more child deaths, and rising income per person and maternal education led to 0·9 million and 2·2 million fewer deaths, respectively. Changes in secular trends led to 4·2 million fewer deaths. Unexplained factors accounted for only -1% of the change in child deaths. In 30 developing countries, decreases since 2000 have been faster than predicted attributable to income, education, and secular shift alone.INTERPRETATION: Only 27 developing countries are expected to achieve MDG 4. Decreases since 2000 in under-5 mortality rates are accelerating in many developing countries, especially in sub-Saharan Africa. The Millennium Declaration and increased development assistance for health might have been a factor in faster decreases in some developing countries. Without further accelerated progress, many countries in west and central Africa will still have high levels of under-5 mortality in 2030.
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| 16. |
- Bhoi, Bandan Kumar, et al.
(författare)
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Analyzing Design Parameters of Nano-Magnetic Technology Based Converter Circuit
- 2019
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Ingår i: VLSI Design and Test. - Singapore : Springer. - 9789813297661 ; , s. 34-46
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Konferensbidrag (refereegranskat)abstract
- Digital circuits need improvement in computation speed, reducing circuit complexity and power consumption. Emerging Technology NML can be such an architecture at nano-scale and thus emerges as a viable alternative for the digital CMOS VLSI. This technology has the capability to compute the logic as well as storage into the same device, which points out that it great potential for emerging technology. Since Nano-magnetic, technology fast approaches its minimal feature size, high device density and operate at room temperature. NML based circuits synthesis has to opt for novel half subtraction and Binary-to-Gray architecture for achieving minimal complexity and high-speed performance. This manuscript pro-poses area efficient binary half-subtraction and Binary-to-Gray converter architecture. Circuits’ synthesize are performed by MagCAD tool and simulate by Modelsim simulator. The circuit’s performance are estimated over other existing designs. The proposed converter consume 73.73%, and 94.49% less area than the converter designed using QCA and CMOS technique respectively. This is a significant contribution to this paper. Simulation results of converter show that the critical path delay falls within 0.15 µs.
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| 17. |
- Challa, Srinavi, et al.
(författare)
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An efficient ECC-based provably secure three-factor user authentication and key agreement protocol for wireless healthcare sensor networks
- 2017
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Ingår i: Computers & electrical engineering. - : Elsevier. - 0045-7906 .- 1879-0755. ; 69, s. 534-554
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Tidskriftsartikel (refereegranskat)abstract
- We first show the security limitations of a recent user authentication scheme proposed for wireless healthcare sensor networks. We then present a provably secure three-factor user authentication and key agreement protocol for wireless healthcare sensor networks. The proposed scheme supports functionality features, such as dynamic sensor node addition, password as well as biometrics update, smart card revocation along with other usual features required for user authentication in wireless sensor networks. Our scheme is shown to be secure through the rigorous formal security analysis under the Real-Or-Random (ROR) model and broadly-accepted Burrows-Abadi-Needham (BAN) logic. Furthermore, the simulation through the widely-known Automated Validation of Internet Security Protocols and Applications (AVISPA) tool shows that our scheme is also secure. High security, and low communication and computation costs make our scheme more suitable for practical application in healthcare applications as compared to other related existing schemes.
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| 18. |
- Chatterjee, Santanu, et al.
(författare)
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Secure Biometric-Based Authentication Schemeusing Chebyshev Chaotic Map for Multi-Server Environment
- 2018
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Ingår i: IEEE Transactions on Dependable and Secure Computing. - Piscataway, NJ : IEEE. - 1545-5971 .- 1941-0018. ; 15:5, s. 824-839
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Tidskriftsartikel (refereegranskat)abstract
- Multi-server environment is the most common scenario for a large number of enterprise class applications. In this environment, user registration at each server is not recommended. Using multi-server authentication architecture, user can manage authentication to various servers using single identity and password. We introduce a new authentication scheme for multi-server environments using Chebyshev chaotic map. In our scheme, we use the Chebyshev chaotic map and biometric verification along with password verification for authorization and access to various application servers. The proposed scheme is light-weight compared to other related schemes. We only use the Chebyshev chaotic map, cryptographic hash function and symmetric key encryption-decryption in the proposed scheme. Our scheme provides strong authentication, and also supports biometrics & password change phase by a legitimate user at any time locally, and dynamic server addition phase. We perform the formal security verification using the broadly-accepted AVISPA (Automated Validation of Internet Security Protocols and Applications) tool to show that the presented scheme is secure. In addition, we use the formal security analysis using the Burrows-Abadi-Needham (BAN) logic along with random oracle models and prove that our scheme is secure against different known attacks. High security and significantly low computation and communication costs make our scheme is very suitable for multi-server environments as compared to other existing related schemes.
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| 19. |
- Griswold, Max G., et al.
(författare)
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Alcohol use and burden for 195 countries and territories, 1990-2016 : a systematic analysis for the Global Burden of Disease Study 2016
- 2018
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Ingår i: The Lancet. - : Elsevier. - 0140-6736 .- 1474-547X. ; 392:10152, s. 1015-1035
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Tidskriftsartikel (refereegranskat)abstract
- Background: Alcohol use is a leading risk factor for death and disability, but its overall association with health remains complex given the possible protective effects of moderate alcohol consumption on some conditions. With our comprehensive approach to health accounting within the Global Burden of Diseases, Injuries, and Risk Factors Study 2016, we generated improved estimates of alcohol use and alcohol-attributable deaths and disability-adjusted life-years (DALYs) for 195 locations from 1990 to 2016, for both sexes and for 5-year age groups between the ages of 15 years and 95 years and older.Methods: Using 694 data sources of individual and population-level alcohol consumption, along with 592 prospective and retrospective studies on the risk of alcohol use, we produced estimates of the prevalence of current drinking, abstention, the distribution of alcohol consumption among current drinkers in standard drinks daily (defined as 10 g of pure ethyl alcohol), and alcohol-attributable deaths and DALYs. We made several methodological improvements compared with previous estimates: first, we adjusted alcohol sales estimates to take into account tourist and unrecorded consumption; second, we did a new meta-analysis of relative risks for 23 health outcomes associated with alcohol use; and third, we developed a new method to quantify the level of alcohol consumption that minimises the overall risk to individual health.Findings: Globally, alcohol use was the seventh leading risk factor for both deaths and DALYs in 2016, accounting for 2.2% (95% uncertainty interval [UI] 1.5-3.0) of age-standardised female deaths and 6.8% (5.8-8.0) of age-standardised male deaths. Among the population aged 15-49 years, alcohol use was the leading risk factor globally in 2016, with 3.8% (95% UI 3.2-4-3) of female deaths and 12.2% (10.8-13-6) of male deaths attributable to alcohol use. For the population aged 15-49 years, female attributable DALYs were 2.3% (95% UI 2.0-2.6) and male attributable DALYs were 8.9% (7.8-9.9). The three leading causes of attributable deaths in this age group were tuberculosis (1.4% [95% UI 1. 0-1. 7] of total deaths), road injuries (1.2% [0.7-1.9]), and self-harm (1.1% [0.6-1.5]). For populations aged 50 years and older, cancers accounted for a large proportion of total alcohol-attributable deaths in 2016, constituting 27.1% (95% UI 21.2-33.3) of total alcohol-attributable female deaths and 18.9% (15.3-22.6) of male deaths. The level of alcohol consumption that minimised harm across health outcomes was zero (95% UI 0.0-0.8) standard drinks per week.Interpretation: Alcohol use is a leading risk factor for global disease burden and causes substantial health loss. We found that the risk of all-cause mortality, and of cancers specifically, rises with increasing levels of consumption, and the level of consumption that minimises health loss is zero. These results suggest that alcohol control policies might need to be revised worldwide, refocusing on efforts to lower overall population-level consumption.
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| 20. |
- Kumar Das, Ashok, et al.
(författare)
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Biometrics-Based Privacy-Preserving User Authentication Scheme for Cloud-Based Industrial Internet of Things Deployment
- 2018
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Ingår i: IEEE Internet of Things Journal. - Piscataway, NJ : IEEE. - 2327-4662. ; 5:6, s. 4900-4913
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Tidskriftsartikel (refereegranskat)abstract
- Due to the widespread popularity of Internet-enabled devices, Industrial Internet of Things (IIoT) becomes popular in recent years. However, as the smart devices share the information with each other using an open channel, i.e., Internet, so security and privacy of the shared information remains a paramount concern. There exist some solutions in the literature for preserving security and privacy in IIoT environment. However, due to their heavy computation and communication overheads, these solutions may not be applicable to wide category of applications in IIoT environment. Hence, in this paper, we propose a new Biometric-based Privacy Preserving User Authentication (BP2UA) scheme for cloud-based IIoT deployment. BP2UA consists of strong authentication between users and smart devices using pre-established key agreement between smart devices and the gateway node. The formal security analysis of BP2UA using the well-known ROR model is provided to prove its session key security. Moreover, an informal security analysis of BP2UA is also given to show its robustness against various types of known attacks. The computation and communication costs of BP2UA in comparison to the other existing schemes of its category demonstrate its effectiveness in the IIoT environment. Finally, the practical demonstration of BP2UA is also done using the NS2 simulation.
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| 21. |
- Pandya, Sharnil, Researcher, 1984-, et al.
(författare)
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COUNTERSAVIOR : AIoMT and IIoT enabled Adaptive Virus Outbreak Discovery Framework for Healthcare Informatics
- 2023
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Ingår i: IEEE Internet of Things Journal. - : IEEE. - 2327-4662 .- 2372-2541. ; 10:4, s. 4202-4212
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Tidskriftsartikel (refereegranskat)abstract
- In the current Pandemic, global issues have caused health issues as well as economic downturns. At the beginning of every novel virus outbreak, lockdown is the best possible weapon to reduce the virus spread and save human life as the medical diagnosis followed by treatment and clinical approval takes significant time. The proposed COUNTERSAVIOR system aims at an Artificial Intelligence of Medical Things (AIoMT), and an edge line computing enabled and Big data analytics supported tracing and tracking approach that consumes GPS spatiotemporal data. COUNTERSAVIOR will be a better scientific tool to handle any virus outbreak. The proposed research discovers the prospect of applying an individual’s mobility to label mobility streams and forecast a virus such as COVID-19 pandemic transmission. The proposed system is the extension of the previously proposed COUNTERACT system. The proposed system can also identify the alternative saviour path concerning the confirmed subject’s cross-path using GPS data to avoid the possibility of infections. In the undertaken study, dynamic meta direct and indirect transmission, meta behaviour, and meta transmission saviour models are presented. In conducted experiments, the machine learning and deep learning methodologies have been used with the recorded historical location data for forecasting the behaviour patterns of confirmed and suspected individuals and a robust comparative analysis is also presented. The proposed system produces a report specifying people that have been exposed to the virus and notifying users about available pandemic saviour paths. In the end, we have represented 3D tracker movements of individuals, 3D contact analysis of COVID-19 and suspected individuals for 24 hours, forecasting and risk classification of COVID-19, suspected and safe individuals.
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| 22. |
- Singh, Prabhjot, et al.
(författare)
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Secure Healthcare Data Dissemination Using Vehicle Relay Networks
- 2018
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Ingår i: IEEE Internet of Things Journal. - Piscataway, NJ : IEEE. - 2327-4662. ; 5:5, s. 3733-3746
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Tidskriftsartikel (refereegranskat)abstract
- In the recent years, vehicular adhoc networks (VANETs) can be an attractive choice for collecting and transferring the healthcare data of the passengers to the remote healthcare centers. In VANETs, some of the intermediate nodes may act as relay nodes in which case, these networks are called as vehicular relay networks (VRNs). However, the transmitted information in VRNs can be captured by intruders during transmission. Moreover, an attacker can launch selective forwarding, blackhole and sinkhole attacks in the network, which may in turn degrade the network performance parameters like high end-to-end delay, low packet delivery ratio and network throughput. Hence, to address these issues, a secure data dissemination scheme using VRNs is proposed. In the proposed scheme, firstly, a secure vehicular medical relay network system is designed for the users belonging to disconnected rural areas. The collected information is filtered at zonal levels before transmission to a nearby road side units (RSUs), which further pass it to the incoming vehicles. Secondly, a secure passenger health monitoring network is designed which continuously monitors health services of the passengers traveling in different vehicles. The information collected through small body sensors installed in the vehicles act as data sets that is forwarded to the on-board monitoring unit within the vehicle. This collected data is then transmitted to centralized healthcare centers for processing by using VRNs. Lastly, a strong Elliptic Curve Cryptography (ECC)-based cryptographic solution is designed for secure communication among different vehicles. The performance of the proposed scheme is evaluated in various network scenarios with respect to different selected parameters, such as throughput, network delay, packet delivery ratio, jitter, transmission and computation overheads, and key distribution overhead. The obtained results indicate that the proposed scheme provides improvement of 52% in average delay and 5% in packet delivery ratio. This further indicates effective message delivery even with high mobility of the vehicles. © 2018 IEEE
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| 23. |
- Teotia, Arun Kumar, et al.
(författare)
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Nano-Hydroxyapatite Bone Substitute Functionalized with Bone Active Molecules for Enhanced Cranial Bone Regeneration
- 2017
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Ingår i: ACS Applied Materials and Interfaces. - : American Chemical Society (ACS). - 1944-8244 .- 1944-8252. ; 9:8, s. 6816-6828
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to synthesize and characterize a nano-hydroxyapatite (nHAP) and calcium sulfate bone substitute (NC) for cranioplasty. The NC was functionalized with low concentrations of bone morphogenetic protein-2 (BMP-2) and zoledronic acid (ZA) and characterized both in vitro and in vivo. In vitro studies included MTT, ALP assays, and fluorescent staining of Saos-2 (human osteoblasts) and MC3T3-E1 (murine preosteoblasts) cells cultured on NC. An in vivo study divided 20 male Wistar rats into four groups: control (defect only), NC, NC + ZA, and NC + ZA + rhBMP-2. The materials were implanted in an 8.5 mm critical size defect in the calvarium for 12 weeks. Micro-CT quantitative analysis was carried out in vivo at 8 weeks and ex vivo after 12 weeks. Mineralization was highest in the NC + ZA + rhBMP-2 group (13.0 ± 2.8 mm3) compared to the NC + ZA group (9.0 ± 3.2 mm3), NC group (6.4 ± 1.9 mm3), and control group (3.4 ± 1.0 mm3) after 12 weeks. Histological and spectroscopic analysis of the defect site provided a qualitative confirmation of neo-bone, which was in agreement with the micro-CT results. In conclusion, NC can be used as a carrier for bioactive molecules, and functionalization with rhBMP-2 and ZA in low doses enhances bone regeneration.
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| 24. |
- Wazid, Mohammad, et al.
(författare)
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A Novel Authentication and Key Agreement Scheme for Implantable Medical Devices Deployment
- 2018
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Ingår i: IEEE journal of biomedical and health informatics. - : Institute of Electrical and Electronics Engineers (IEEE). - 2168-2194 .- 2168-2208. ; 2:4, s. 1299-1309
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Tidskriftsartikel (refereegranskat)abstract
- Implantable medical devices (IMDs) are man-made devices, which can be implanted in the human body to improve the functioning of various organs. The IMDs monitor and treat physiological condition of the human being (for example, monitoring of blood glucose level by insulin pump). The advancement of information and communication technology (ICT) enhances the communication capabilities of IMDs. In healthcare applications, after mutual authentication, a user (for example, doctor) can access the health data from the IMDs implanted in a patient's body. However, in this kind of communication environment, there are always security and privacy issues such as leakage of health data and malfunctioning of IMDs by an unauthorized access.
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| 25. |
- Wazid, Mohammad, et al.
(författare)
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Design and Analysis of Secure Lightweight Remote User Authentication and Key Agreement Scheme in Internet of Drones Deployment
- 2019
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Ingår i: IEEE Internet of Things Journal. - : IEEE. - 2327-4662. ; 6:2, s. 3572-3584
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Tidskriftsartikel (refereegranskat)abstract
- The Internet of Drones (IoD) provides a coordinated access to Unmanned Aerial Vehicles (UAVs) that are referred as drones. The on-going miniaturization of sensors, actuators, and processors with ubiquitous wireless connectivity makes drones to be used in a wide range of applications ranging from military to civilian. Since most of the applications involved in the IoD are real-time based, the users are generally interested in accessing real-time information from drones belonging to a particular fly zone. This happens if we allow users to directly access real-time data from flying drones inside IoD environment and not from the server. This is a serious security breach which may deteriorate performance of any implemented solution in this IoD environment. To address this important issue in IoD, we propose a novel lightweight user authentication scheme in which a user in the IoD environment needs to access data directly from a drone provided that the user is authorized to access the data from that drone. The formal security verification using the broadly-accepted Automated Validation of Internet Security Protocols and Applications (AVISPA) tool along with informal security analysis show that our scheme is secure against several known attacks. The performance comparison demonstrates that our scheme is efficient with respect to various parameters, and it provides better security as compared to those for the related existing schemes. Finally, the practical demonstration of our scheme is done using the widely-accepted NS2 simulation.
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| 26. |
- Wazid, Mohammad, et al.
(författare)
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Design of secure key management and user authentication scheme for fog computing services
- 2019
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Ingår i: Future generations computer systems. - : Elsevier. - 0167-739X .- 1872-7115. ; 91, s. 475-492
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Tidskriftsartikel (refereegranskat)abstract
- Fog computing (fog networking) is known as a decentralized computing infrastructure in which data, applications, compute as well as data storage are scattered in the most logical and efficient place among the data source (i.e., smart devices) and the cloud. It gives better services than cloud computing because it has better performance with reasonably low cost. Since the cloud computing has security and privacy issues, and fog computing is an extension of cloud computing, it is therefore obvious that fog computing will inherit those security and privacy issues from cloud computing. In this paper, we design a new secure key management and user authentication scheme for fog computing environment, called SAKA-FC. SAKA-FC is efficient as it only uses the lightweight operations, such as one-way cryptographic hash function and bitwise exclusive-OR (XOR), for the smart devices as they are resource-constrained in nature. SAKA-FC is shown to be secure with the help of the formal security analysis using the broadly accepted Real-Or-Random (ROR) model, the formal security verification using the widely-used Automated Validation of Internet Security Protocols and Applications (AVISPA) tool and also the informal security analysis. In addition, SAKA-FC is implemented for practical demonstration using the widely-used NS2 simulator.
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| 27. |
- Wazid, Mohammad, et al.
(författare)
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Secure Authentication Scheme for Medicine Anti-Counterfeiting System in IoT Environment
- 2017
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Ingår i: IEEE Internet of Things Journal. - : Institute of Electrical and Electronics Engineers (IEEE). - 2327-4662. ; 4:5, s. 1634-1646
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Tidskriftsartikel (refereegranskat)abstract
- A counterfeit drug is a medication or pharmaceutical product which is manufactured and made available on the market to deceptively represent its origin, authenticity and effectiveness, etc., and causes serious threats to the health of a patient. Counterfeited medicines have an adverse effect on the public health and cause revenue loss to the legitimate manufacturing organizations. In this paper, we propose a new authentication scheme for medicine anti-counterfeiting system in the Internet of Things environment which is used for checking the authenticity of pharmaceutical products (dosage forms). The proposed scheme utilizes the near field communication (NFC) and is suitable for mobile environment, which also provides efficient NFC update phase. The security analysis using the widely accepted real-or-random model proves that the proposed scheme provides the session key security. The proposed scheme also protects other known attacks which are analyzed informally. Furthermore, the formal security verification using the broadly accepted automated validation of Internet security protocols and applications tool shows that the proposed scheme is secure. The scheme is efficient with respect to computation and communication costs, and also it provides additional functionality features when compared to other existing schemes. Finally, for demonstration of the practicality of the scheme, we evaluate it using the broadly accepted NS2 simulation
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| 28. |
- Ahmed, Tauheed, et al.
(författare)
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FIMBISAE : A Multimodal Biometric Secured Data Access Framework for Internet of Medical Things Ecosystem
- 2023
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Ingår i: IEEE Internet of Things Journal. - : IEEE. - 2327-4662. ; 10:7, s. 6259-6270
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Tidskriftsartikel (refereegranskat)abstract
- Information from the Internet of Medical Things (IoMT) domain demands building safeguards against illegitimate access and identification. Existing user identification schemes suffer from challenges in detecting impersonation attacks which leave systems vulnerable and susceptible to misuse. Significant advancement has been achieved in the domain of biometrics and health informatics. This can take a step ahead with the usage of multimodal biometrics for the identification of healthcare system users. With this aim, the proposed work explores the fingerprint and iris modality to develop a multimodal biometric data identification and access control system for the healthcare ecosystem. In the proposed approach, minutiae-based fingerprint features and a combination of local and global iris features are considered for identification. Further, an index space based on the dimension of the feature vector is created, which gives a 1-D embedding of the high-dimensional feature set. Next, to minimize the impact of false rejection, the approach considers the possible deviation in each element of the feature vector and then stores the data in possible locations using the predefined threshold. Besides, to reduce the false acceptance rate, linking of the modalities has been done for every individual data. The modality linking thus helps in carrying out an efficient search of the queried data, thereby minimizing the false acceptance and rejection rate. Experiments on a chimeric iris and fingerprint bimodal database resulted in an average of 95% reduction in the search space at a hit rate of 98%. The results suggest that the proposed indexing scheme has the potential to substantially reduce the response time without compromising the accuracy of identification.
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| 29. |
- Aujla, Gagangeet Singh, et al.
(författare)
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Data Offloading in 5G-Enabled Software-Defined Vehicular Networks : A Stackelberg-Game-Based Approach
- 2017
-
Ingår i: IEEE Communications Magazine. - Piscataway, NJ : IEEE. - 0163-6804 .- 1558-1896. ; 55:8, s. 100-108
-
Tidskriftsartikel (refereegranskat)abstract
- Data offloading using vehicles is one of the most challenging tasks to perform due to the high mobility of vehicles. There are many solutions available for this purpose, but due to the inefficient management of data along with the control decisions, these solutions are not adequate to provide data offloading by making use of the available networks. Moreover, with the advent of 5G and related technologies, there is a need to cope with high speed and traffic congestion in the existing infrastructure used for data offloading. Hence, to make intelligent decisions for data offloading, an SDN-based scheme is presented in this article. In the proposed scheme, an SDNbased controller is designed that makes decisions for data offloading by using the priority manager and load balancer. Using these two managers in SDN-based controllers, traffic routing is managed efficiently even with an increase in the size of the network. Moreover, a single-leader multi-follower Stackelberg game for network selection is also used for data offloading. The proposed scheme is evaluated with respect to several parameters where its performance was found to be superior in comparison to the existing schemes. © Copyright 2017 IEEE
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| 30. |
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| 31. |
- Bhambri, Aksheev, et al.
(författare)
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Large scale changes in the transcriptome of Eisenia fetida during regeneration
- 2018
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Ingår i: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 13:9
-
Tidskriftsartikel (refereegranskat)abstract
- Earthworms show a wide spectrum of regenerative potential with certain species like Eisenia fetida capable of regenerating more than two-thirds of their body while other closely related species, such as Paranais litoralis seem to have lost this ability. Earthworms belong to the phylum Annelida, in which the genomes of the marine oligochaete Capitella telata and the freshwater leech Helobdella robusta have been sequenced and studied. Herein, we report the transcriptomic changes in Eisenia fetida (Indian isolate) during regeneration. Following injury, E. fetida regenerates the posterior segments in a time spanning several weeks. We analyzed gene expression changes both in the newly regenerating cells and in the adjacent tissue, at early (15days post amputation), intermediate (20days post amputation) and late (30 days post amputation) by RNAseq based de novo assembly and comparison of transcriptomes. We also generated a draft genome sequence of this terrestrial red worm using short reads and mate-pair reads. An in-depth analysis of the miRNome of the worm showed that many miRNA gene families have undergone extensive duplications. Sox4, a master regulator of TGF-beta mediated epithelial-mesenchymal transition was induced in the newly regenerated tissue. Genes for several proteins such as sialidases and neurotrophins were identified amongst the differentially expressed transcripts. The regeneration of the ventral nerve cord was also accompanied by the induction of nerve growth factor and neurofilament genes. We identified 315 novel differentially expressed transcripts in the transcriptome, that have no homolog in any other species. Surprisingly, 82% of these novel differentially expressed transcripts showed poor potential for coding proteins, suggesting that novel ncRNAs may play a critical role in regeneration of earthworm.
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| 32. |
- Block, Keith I., et al.
(författare)
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Designing a broad-spectrum integrative approach for cancer prevention and treatment
- 2015
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Ingår i: Seminars in Cancer Biology. - : Academic Press. - 1044-579X .- 1096-3650. ; 35, s. S276-S304
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Forskningsöversikt (refereegranskat)abstract
- Targeted therapies and the consequent adoption of "personalized" oncology have achieved notable successes in some cancers; however, significant problems remain with this approach. Many targeted therapies are highly toxic, costs are extremely high, and most patients experience relapse after a few disease-free months. Relapses arise from genetic heterogeneity in tumors, which harbor therapy-resistant immortalized cells that have adopted alternate and compensatory pathways (i.e., pathways that are not reliant upon the same mechanisms as those which have been targeted). To address these limitations, an international task force of 180 scientists was assembled to explore the concept of a low-toxicity "broadspectrum" therapeutic approach that could simultaneously target many key pathways and mechanisms. Using cancer hallmark phenotypes and the tumor microenvironment to account for the various aspects of relevant cancer biology, interdisciplinary teams reviewed each hallmark area and nominated a wide range of high-priority targets (74 in total) that could be modified to improve patient outcomes. For these targets, corresponding low-toxicity therapeutic approaches were then suggested, many of which were phytochemicals. Proposed actions on each target and all of the approaches were further reviewed for known effects on other hallmark areas and the tumor microenvironment Potential contrary or procarcinogenic effects were found for 3.9% of the relationships between targets and hallmarks, and mixed evidence of complementary and contrary relationships was found for 7.1%. Approximately 67% of the relationships revealed potentially complementary effects, and the remainder had no known relationship. Among the approaches, 1.1% had contrary, 2.8% had mixed and 62.1% had complementary relationships. These results suggest that a broad-spectrum approach should be feasible from a safety standpoint. This novel approach has potential to be relatively inexpensive, it should help us address stages and types of cancer that lack conventional treatment, and it may reduce relapse risks. A proposed agenda for future research is offered. (C) 2015 The Authors. Published by Elsevier Ltd.
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| 33. |
- Bonagas, Nadilly, et al.
(författare)
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Pharmacological targeting of MTHFD2 suppresses acute myeloid leukemia by inducing thymidine depletion and replication stress
- 2022
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Ingår i: NATURE CANCER. - : Springer Science and Business Media LLC. - 2662-1347. ; 3:2, s. 156-
-
Tidskriftsartikel (refereegranskat)abstract
- The folate metabolism enzyme MTHFD2 (methylenetetrahydrofolate dehydrogenase/cyclohydrolase) is consistently overexpressed in cancer but its roles are not fully characterized, and current candidate inhibitors have limited potency for clinical development. In the present study, we demonstrate a role for MTHFD2 in DNA replication and genomic stability in cancer cells, and perform a drug screen to identify potent and selective nanomolar MTHFD2 inhibitors; protein cocrystal structures demonstrated binding to the active site of MTHFD2 and target engagement. MTHFD2 inhibitors reduced replication fork speed and induced replication stress followed by S-phase arrest and apoptosis of acute myeloid leukemia cells in vitro and in vivo, with a therapeutic window spanning four orders of magnitude compared with nontumorigenic cells. Mechanistically, MTHFD2 inhibitors prevented thymidine production leading to misincorporation of uracil into DNA and replication stress. Overall, these results demonstrate a functional link between MTHFD2-dependent cancer metabolism and replication stress that can be exploited therapeutically with this new class of inhibitors. Helleday and colleagues describe a nanomolar MTHFD2 inhibitor that causes replication stress and DNA damage accumulation in cancer cells via thymidine depletion, demonstrating a potential therapeutic strategy in AML tumors in vivo.
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| 34. |
- Chaudhary, Rajat, et al.
(författare)
-
A comprehensive survey on software-defined networking for smart communities
- 2022
-
Ingår i: International Journal of Communication Systems. - : John Wiley & Sons. - 1074-5351 .- 1099-1131.
-
Tidskriftsartikel (refereegranskat)abstract
- The need to provide services closer to the end-user proximity leads to the exchange of a large volume of data generated from the smart devices deployed at different geo-distributed sites. The massive amount of data generated from the smart devices need to be transmitted, analyzed, and processed. This requires seamless data exchanges among geo-separated nodes, which results in a considerable burden on the underlying network infrastructure and can degrade the performance of any implemented solution. Therefore, a dynamic, agile, and programmable network management paradigm is required. To handle the challenges mentioned above, software-defined networking (SDN) gained much attention from academia, researchers, and industrial sectors. Shifting the computational load from forwarding devices to a logically centralized controller is a dream of every network operator who wants to have complete control and global visibility of the network. Also, the concept of network functions virtualization (NFV) in SDN controller is required to increase resource utilization efficiency. Thus, in this paper, a comprehensive survey on SDN for various smart applications is presented. This survey covers the infrastructural details of SDN hardware and OpenFlow switches, controllers, simulation tools, programming languages, open issues, and challenges in SDN implementation with advanced technologies such as 5G and microservices. In addition, the challenges on the control plane and data plane are highlighted in detail, such as fault tolerance, routing, scheduling of flows, and energy consumption on OpenFlow switches. Finally, various open issues and challenges future scope of SDN are discussed and analyzed in the proposal.
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| 35. |
- Chaudhary, Rajat, et al.
(författare)
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SecGreen : Secrecy Ensured Power Optimization Scheme for Software-Defined Connected IoV
- 2023
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Ingår i: IEEE Transactions on Mobile Computing. - : IEEE Computer Society. - 1536-1233 .- 1558-0660. ; 22:4, s. 2370-2386
-
Tidskriftsartikel (refereegranskat)abstract
- Software-Defined Internet of Vehicles (SD-IoV) is an emerging technology that is being used in modern intelligent transportation systems (ITS). The ultimate goal of SD-IoV is to provide seamless connectivity to the end-users with low latency and high-speed data transfer. However, due to the increase in the density of the connected IoV using an open channel, i.e., the Internet, the foremost challenges of high power consumption and secure data transfer are inevitable in such an environment. An external eavesdropper may intercept the transmitted message to access the legitimate information over the public channel, i.e., the Internet. Most of the solutions reported in the literature to tackle these issues may not be applicable in the SD-IoV environment due to high computation and communication costs. Motivated from this, in this paper, the problems of high power consumption and secure data transfer in SD-IoV are formulated using mixed-integer non-linear programming (MINLP) with associated constraints. To solve the aforementioned problem, we propose a joint power optimization and secrecy ensured scheme known as SecGreen. SecGreen has an efficient energy harvesting algorithm using simultaneous wireless information and power transfer (SWIPT) to maximize the energy efficiency. Moreover, to mitigate various security attacks, a resilient lightweight secrecy association protocol is designed between vehicle and trusted gateway node of SD-IoV so that only trusted vehicles can communicate with each other and with the nearest base stations. The secrecy association protocol uses security primitives such as- physically unclonable function (PUF), one-way hash function, and bitwise exclusive OR (XOR) operations which are suitable for energy-constraint sensors in SD-IoV. The performance of the SecGreen is compared with the existing schemes, Stable & Scalable Link Optimization (SSLO), and Secure & Energy-Efficient Blockchain-enabled (SEEB) respectively. The result shows that when the number of packets across the subchannel increases, the energy consumption increases. Also, the result shows that the proposed scheme attains 22.5% and 20.34% better energy efficiency as compared to SSLO and SEEB schemes, respectively. In addition, the SecGreen scheme achieves 37.48% and 32.15% higher throughput as compared to SSLO and SEEB schemes. The results obtained show the superior performance of the proposed SecGreen scheme in comparison to these existing competitive schemes in the literature.
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| 36. |
- Chen, Jinchao, et al.
(författare)
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Global-and-Local Attention-Based Reinforcement Learning for Cooperative Behaviour Control of Multiple UAVs
- 2024
-
Ingår i: IEEE Transactions on Vehicular Technology. - Piscataway : Institute of Electrical and Electronics Engineers (IEEE). - 0018-9545 .- 1939-9359. ; 73:3, s. 4194-4206
-
Tidskriftsartikel (refereegranskat)abstract
- Due to the strong adaptability and high flexibility, unmanned aerial vehicles (UAVs) have been extensively studied and widely applied in both civil and military applications. Although UAVs can achieve significant cost reduction and performance enhancement in large-scale systems by taking full advantage of their cooperation and coordination, they result in a serious cooperative behaviour control problem. Especially in dynamic environments, the cooperative behaviour control problem which has to quickly produce a safe and effective behaviour decision for each UAV to achieve group missions, is NP-hard and difficult to settle. In this work, we design a global-and-local attention-based reinforcement learning algorithm for the cooperative behaviour control problem of UAVs. First, with the motion and coordination models, we analyze the collision avoidance, motion state update, and task execution constraints of multiple UAVs, and abstract the cooperative behaviour control problem as a multi-constraint decision-making one. Then, inspired from the human-learning process where more attention is devoted to the important parts of data, we design a multi-agent reinforcement learning algorithm with a global-and-local attention mechanism to cooperatively control the behaviours of UAVs and achieve the coordination. Simulation experiments in a multi-agent particle environment provided by OpenAI are conducted to verify the effectiveness and efficiency of the proposed approach. Compared with baselines, our approach shows significant advantages in mean reward, training time, and coordination effect. © 2023 IEEE.
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| 37. |
- Chundu, Srikanth, et al.
(författare)
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Parental reported benefits and shortcomings of cochlear implantation : Pilot study findings from Southeast Asia
- 2013
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Ingår i: Cochlear Implants International. - : Maney Publishing. - 1467-0100 .- 1754-7628. ; 14:1, s. 22-27
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Tidskriftsartikel (refereegranskat)abstract
- Objective The aim of the study was to understand the reported benefits and shortcomings by parents of children with cochlear implants and who contribute towards the cost of the implant. Method Thirty parents of children with cochlear implants from a hearing impaired school in Southeast Asia completed open-ended questionnaires and the data were analysed using content analysis. Results A wide range of benefits and shortcomings were reported. However, it is notable that the single most reported shortcoming was related to cost. Discussion The results suggest that, even though, in general, the reports about benefits and shortcomings were similar to previous results from western countries, the emphasis given to various aspects of shortcomings was different. In particular, it appears that parentally reported outcomes could be related to many factors including the hearing healthcare system with the costs involved for the implanted individuals and their families. These findings help us understand the parental perspectives of the success of cochlear implantation and will be useful during parental counselling sessions.
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| 38. |
- Dimopoulos, Meletios A., et al.
(författare)
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All-oral ixazomib, cyclophosphamide, and dexamethasone for transplant-ineligible patients with newly diagnosed multiple myeloma
- 2019
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Ingår i: European Journal of Cancer. - : Elsevier BV. - 0959-8049 .- 1879-0852. ; 106, s. 89-98
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Tidskriftsartikel (refereegranskat)abstract
- Background: Novel efficacious treatments with long-term tolerability are needed for transplant-ineligible, newly diagnosed multiple myeloma (NDMM) patients. This phase 2 study evaluated the safety and efficacy of all-oral ixazomib-cyclophosphamide-dexamethasone (ICd) followed by single-agent ixazomib maintenance. Patients and methods: Patients were randomised (1:1) to receive 4.0 mg of ixazomib, 300 (Arm A) or 400 (Arm B) mg/m2 of cyclophosphamide (days 1, 8, and 15), and 40 mg of dexamethasone (days 1, 8, 15, and 22) as induction (up to 13 × 28-day cycles), followed by single-agent ixazomib maintenance (28-day cycles) until progressive disease, death, or unacceptable toxicity. Primary end-point was complete response (CR) + very good partial response (VGPR) rate for ICd induction. Results: Seventy patients were enrolled (n = 36 Arm A; n = 34 Arm B); median age was 73 years (range, 61–87). At data cut-off, 66% of patients had completed 13 induction cycles followed by ixazomib maintenance. Median overall treatment duration was 19 cycles (range, 1–29); 21% of patients discontinued treatment during induction and 3% during maintenance due to adverse events (AEs). During induction, among 67 response-evaluable patients, CR+VGPR rate was 25%, and overall response rate (ORR) was 73%. Including the maintenance phase, CR+VGPR rate was 33%, and ORR was 76%. Median progression-free survival was 23.5 months (median follow-up: 26.1 months). The most common all-grade AE was neutropenia (31%). Grade ≥3 AEs were reported by 73% of patients. Five on-study deaths occurred (not treatment-related). Conclusions: ICd treatment followed by ixazomib maintenance is tolerable and active in elderly, transplant-ineligible NDMM patients. Trial registration number: NCT02046070.
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| 39. |
- Feigin, Valery L, et al.
(författare)
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Global, Regional, and Country-Specific Lifetime Risks of Stroke, 1990 and 2016.
- 2018
-
Ingår i: The New England journal of medicine. - 1533-4406 .- 0028-4793. ; 379:25, s. 2429-2437
-
Tidskriftsartikel (refereegranskat)abstract
- The lifetime risk of stroke has been calculated in a limited number of selected populations. We sought to estimate the lifetime risk of stroke at the regional, country, and global level using data from a comprehensive study of the prevalence of major diseases.We used the Global Burden of Disease (GBD) Study 2016 estimates of stroke incidence and the competing risks of death from any cause other than stroke to calculate the cumulative lifetime risks of first stroke, ischemic stroke, or hemorrhagic stroke among adults 25 years of age or older. Estimates of the lifetime risks in the years 1990 and 2016 were compared. Countries were categorized into quintiles of the sociodemographic index (SDI) used in the GBD Study, and the risks were compared across quintiles. Comparisons were made with the use of point estimates and uncertainty intervals representing the 2.5th and 97.5th percentiles around the estimate.The estimated global lifetime risk of stroke from the age of 25 years onward was 24.9% (95% uncertainty interval, 23.5 to 26.2); the risk among men was 24.7% (95% uncertainty interval, 23.3 to 26.0), and the risk among women was 25.1% (95% uncertainty interval, 23.7 to 26.5). The risk of ischemic stroke was 18.3%, and the risk of hemorrhagic stroke was 8.2%. In high-SDI, high-middle-SDI, and low-SDI countries, the estimated lifetime risk of stroke was 23.5%, 31.1% (highest risk), and 13.2% (lowest risk), respectively; the 95% uncertainty intervals did not overlap between these categories. The highest estimated lifetime risks of stroke according to GBD region were in East Asia (38.8%), Central Europe (31.7%), and Eastern Europe (31.6%), and the lowest risk was in eastern sub-Saharan Africa (11.8%). The mean global lifetime risk of stroke increased from 22.8% in 1990 to 24.9% in 2016, a relative increase of 8.9% (95% uncertainty interval, 6.2 to 11.5); the competing risk of death from any cause other than stroke was considered in this calculation.In 2016, the global lifetime risk of stroke from the age of 25 years onward was approximately 25% among both men and women. There was geographic variation in the lifetime risk of stroke, with the highest risks in East Asia, Central Europe, and Eastern Europe. (Funded by the Bill and Melinda Gates Foundation.).
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| 40. |
- Feigin, Valery L., et al.
(författare)
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Global, regional, and national burden of neurological disorders, 1990–2016 : a systematic analysis for the Global Burden of Disease Study 2016
- 2019
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Ingår i: Lancet Neurology. - : Elsevier. - 1474-4422 .- 1474-4465. ; 18:5, s. 459-480
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Tidskriftsartikel (refereegranskat)abstract
- Background: Neurological disorders are increasingly recognised as major causes of death and disability worldwide. The aim of this analysis from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2016 is to provide the most comprehensive and up-to-date estimates of the global, regional, and national burden from neurological disorders.Methods: We estimated prevalence, incidence, deaths, and disability-adjusted life-years (DALYs; the sum of years of life lost [YLLs] and years lived with disability [YLDs]) by age and sex for 15 neurological disorder categories (tetanus, meningitis, encephalitis, stroke, brain and other CNS cancers, traumatic brain injury, spinal cord injury, Alzheimer's disease and other dementias, Parkinson's disease, multiple sclerosis, motor neuron diseases, idiopathic epilepsy, migraine, tension-type headache, and a residual category for other less common neurological disorders) in 195 countries from 1990 to 2016. DisMod-MR 2.1, a Bayesian meta-regression tool, was the main method of estimation of prevalence and incidence, and the Cause of Death Ensemble model (CODEm) was used for mortality estimation. We quantified the contribution of 84 risks and combinations of risk to the disease estimates for the 15 neurological disorder categories using the GBD comparative risk assessment approach.Findings: Globally, in 2016, neurological disorders were the leading cause of DALYs (276 million [95% UI 247–308]) and second leading cause of deaths (9·0 million [8·8–9·4]). The absolute number of deaths and DALYs from all neurological disorders combined increased (deaths by 39% [34–44] and DALYs by 15% [9–21]) whereas their age-standardised rates decreased (deaths by 28% [26–30] and DALYs by 27% [24–31]) between 1990 and 2016. The only neurological disorders that had a decrease in rates and absolute numbers of deaths and DALYs were tetanus, meningitis, and encephalitis. The four largest contributors of neurological DALYs were stroke (42·2% [38·6–46·1]), migraine (16·3% [11·7–20·8]), Alzheimer's and other dementias (10·4% [9·0–12·1]), and meningitis (7·9% [6·6–10·4]). For the combined neurological disorders, age-standardised DALY rates were significantly higher in males than in females (male-to-female ratio 1·12 [1·05–1·20]), but migraine, multiple sclerosis, and tension-type headache were more common and caused more burden in females, with male-to-female ratios of less than 0·7. The 84 risks quantified in GBD explain less than 10% of neurological disorder DALY burdens, except stroke, for which 88·8% (86·5–90·9) of DALYs are attributable to risk factors, and to a lesser extent Alzheimer's disease and other dementias (22·3% [11·8–35·1] of DALYs are risk attributable) and idiopathic epilepsy (14·1% [10·8–17·5] of DALYs are risk attributable).Interpretation: Globally, the burden of neurological disorders, as measured by the absolute number of DALYs, continues to increase. As populations are growing and ageing, and the prevalence of major disabling neurological disorders steeply increases with age, governments will face increasing demand for treatment, rehabilitation, and support services for neurological disorders. The scarcity of established modifiable risks for most of the neurological burden demonstrates that new knowledge is required to develop effective prevention and treatment strategies.Funding: Bill & Melinda Gates Foundation.
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| 41. |
- Ghayvat, Hemant, et al.
(författare)
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Healthcare-CT : SoLiD PoD and Blockchain-Enabled Cyber Twin Approach for Healthcare 5.0 Ecosystems
- 2024
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Ingår i: IEEE Internet of Things Journal. - : IEEE. - 2327-4662. ; 11:4, s. 6119-6130
-
Tidskriftsartikel (refereegranskat)abstract
- The healthcare personals often use stored healthcare data to make crucial decisions, assess risk, and care for patients. The extraction of the required information from the saved healthcare data needs a healthcare ecosystem that can guarantee reliable data delivery. The reliability of cyber-physical data needs to be cross-examined using several sources of data of overlapping nature. The cross-examined data can be saved on blockchain and SOLID POD (SP) to preserve its reliability and privacy. Once the reliable healthcare data is stored on the blockchain and SP, the patients’ medical history can be delivered to data-operated systems to monitor, diagnose, and detect augmented healthcare anomalies. Cyber twins (CT) combine the specific cyber-physical objects with digital tools portraying their actual settings. The creation of a live model for the delivery of healthcare services presents a novel opportunity in patient care comprising better evaluation of risk and assessment without hampering the activities of daily living. The introduction of blockchain technology can improve the notion of CTs by certifying transparency, decentralized data storage, data irreversibility, and person-to-person industrial communication. The storage and exchange of CT data in the healthcare ecosystem depend on disseminated ledgers and decentralized databases for storing and processing data to avoid single point reliance. The present study develops an owner-centric decentralized sharing technique to fulfil the decentralized distribution of CT data.
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| 42. |
- Gupta, Rajeev Kumar, et al.
(författare)
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Biochar influences nitrogen and phosphorus dynamics in two texturally different soils
- 2024
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Ingår i: Scientific Reports. - : Springer Nature. - 2045-2322. ; 14
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Tidskriftsartikel (refereegranskat)abstract
- Nitrogen (N) and phosphorus (P) are vital for crop growth. However, most agricultural systems have limited inherent ability to supply N and P to crops. Biochars (BCs) are strongly advocated in agrosystems and are known to improve the availability of N and P in crops through different chemical transformations. Herein, a soil-biochar incubation experiment was carried out to investigate the transformations of N and P in two different textured soils, namely clay loam and loamy sand, on mixing with rice straw biochar (RSB) and acacia wood biochar (ACB) at each level (0, 0.5, and 1.0% w/w). Ammonium N (NH4-N) decreased continuously with the increasing incubation period. The ammonium N content disappeared rapidly in both the soils incubated with biochars compared to the unamended soil. RSB increased the nitrate N (NO3–N) content significantly compared to ACB for the entire study period in both texturally divergent soils. The nitrate N content increased with the enhanced biochar addition rate in clay loam soil until 15 days after incubation; however, it was reduced for the biochar addition rate of 1% compared to 0.5% at 30 and 60 days after incubation in loamy sand soil. With ACB, the net increase in nitrate N content with the biochar addition rate of 1% remained higher than the 0.5% rate for 60 days in clay loam and 30 days in loamy sand soil. The phosphorus content remained consistently higher in both the soils amended with two types of biochars till the completion of the experiment.
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| 43. |
- Haslett, Sophie, 1988-, et al.
(författare)
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Nighttime NO emissions strongly suppress chlorine and nitrate radical formation during the winter in Delhi
- 2023
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Ingår i: Atmospheric Chemistry And Physics. - 1680-7316 .- 1680-7324. ; 23:16, s. 9023-9036
-
Tidskriftsartikel (refereegranskat)abstract
- Atmospheric pollution in urban regions is highly influenced by oxidants due to their important role in the formation of secondary organic aerosol (SOA) and smog. These include the nitrate radical (NO3), which is typically considered a nighttime oxidant, and the chlorine radical (Cl), an extremely potent oxidant that can be released in the morning in chloride-rich environments as a result of nocturnal build-up of nitryl chloride (ClNO2). Chloride makes up a higher percentage of particulate matter in Delhi than has been observed anywhere else in the world, which results in Cl having an unusually strong influence in this city. Here, we present observations and model results revealing that atmospheric chemistry in Delhi exhibits an unusual diel cycle that is controlled by high concentrations of NO during the night. As a result of this, the formation of both NO3 and dinitrogen pentoxide (N2O5), a precursor of ClNO2 and thus Cl, are suppressed at night and increase to unusually high levels during the day. Our results indicate that a substantial reduction in nighttime NO has the potential to increase both nocturnal oxidation via NO(3 )and the production of Cl during the day.
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| 44. |
- He, Debiao, et al.
(författare)
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A Provably-Secure Cross-Domain Handshake Scheme with Symptoms-Matching for Mobile Healthcare Social Network
- 2018
-
Ingår i: IEEE Transactions on Dependable and Secure Computing. - Piscataway, NJ : Institute of Electrical and Electronics Engineers (IEEE). - 1545-5971 .- 1941-0018. ; 15:4, s. 633-645
-
Tidskriftsartikel (refereegranskat)abstract
- With rapid developments of sensor, wireless and mobile communication technologies, Mobile Healthcare Social Networks (MHSNs) have emerged as a popular means of communication in healthcare services. Within MHSNs, patients can use their mobile devices to securely share their experiences, broaden their understanding of the illness or symptoms, form a supportive network, and transmit information (e.g. state of health and new symptoms) between users and other stake holders (e.g. medical center). Despite the benefits afforded by MHSNs, there are underlying security and privacy issues (e.g. due to the transmission of messages via a wireless channel). The handshake scheme is an important cryptographic mechanism, which can provide secure communication in MHSNs (e.g. anonymity and mutual authentication between users, such as patients). In this paper, we present a new framework for the handshake scheme in MHSNs, which is based on hierarchical identity-based cryptography. We then construct an efficient Cross-Domain HandShake (CDHS) scheme that allows symptoms-matching within MHSNs. For example, using the proposed CDHS scheme, two patients registered with different healthcare centers can achieve mutual authentication and generate a session key for future secure communications. We then prove the security of the scheme, and a comparative summary demonstrates that the proposed CDHS scheme requires fewer computation and lower communication costs. We also implement the proposed CDHS scheme and three related schemes in a proof of concept Android app to demonstrate utility of the scheme. Findings from the evaluations demonstrate that the proposed CDHS scheme achieves a reduction of 18.14% and 5.41% in computation cost and communication cost, in comparison to three other related handshake schemes. © 2016 IEEE.
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| 45. |
- He, Debiao, et al.
(författare)
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Efficient and Privacy-Preserving Data Aggregation Scheme for Smart Grid against Internal Adversaries
- 2017
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Ingår i: IEEE Transactions on Smart Grid. - Piscataway, NJ : IEEE. - 1949-3053 .- 1949-3061. ; 8:5, s. 2411-2419
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Tidskriftsartikel (refereegranskat)abstract
- Privacy-Preserving Data Aggregation (P2DA) is an important basic building block that can protect consumer’s privacy in the smart grid environment because it could be used to prevent the extraction of the electricity consumption information of a specific consumer. Due to this important function, the P2DA scheme for the smart grid has attracted a lot of attention from both academic and industry researchers who have proposed many P2DA schemes for the smart grid in recent years. However, most of these P2DA schemes are not secure against internal attackers or cannot provide data integrity. Besides, their computation costs are not satisfactory because the bilinear pairing operation or the hash-to-point operation is performed at the smart meter’s side. To address the deficiencies of previous schemes, we propose a new P2DA scheme against internal attackers using Boneh-Goh-Nissim public key cryptography. The proposed P2DA scheme does not use bilinear pairing or hash-to-point operations making it more computationally efficient than previous P2DA schemes. We also show that the proposed P2DA scheme is provably secure and can meet various security requirements. © Copyright 2017 IEEE
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| 46. |
- Jain, Neeraj, et al.
(författare)
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Targetable genetic alterations of TCF4 (E2-2) drive immunoglobulin expression in diffuse large B cell lymphoma
- 2019
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Ingår i: Science Translational Medicine. - : American Association for the Advancement of Science (AAAS). - 1946-6234 .- 1946-6242. ; 11:497
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Tidskriftsartikel (refereegranskat)abstract
- The activated B cell (ABC-like) subtype of diffuse large B cell lymphoma (DLBCL) is characterized by chronic activation of signaling initiated by immunoglobulin m (IgM). By analyzing the DNA copy number profiles of 1000 DLBCL tumors, we identified gains of 18q21.2 as the most frequent genetic alteration in ABC-like DLBCL. Using integrative analysis of matched gene expression profiling data, we found that the TCF4 (E2-2) transcription factor gene was the target of these alterations. Overexpression of TCF4 in ABC-like DLBCL cell lines led to its occupancy on immunoglobulin (IGHM) and MYC gene enhancers and increased expression of these genes at the transcript and protein levels. Inhibition of TCF4 activity with dominant-negative constructs was synthetically lethal to ABC-like DLBCL cell lines harboring TCF4 DNA copy gains, highlighting these gains as an attractive potential therapeutic target. Furthermore, the TCF4 gene was one of the top BRD4-regulated genes in DLBCL cell lines. BET proteolysistargeting chimera (PROTAC) ARV771 extinguished TCF4, MYC, and IgM expression and killed ABC-like DLBCL cells in vitro. In DLBCL xenograft models, ARV771 treatment reduced tumor growth and prolonged survival. This work highlights a genetic mechanism for promoting immunoglobulin signaling in ABC-like DLBCL and provides a functional rationale for the use of BET inhibitors in this disease.
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| 47. |
- Jindal, Anish, et al.
(författare)
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An efficient fuzzy rule-based big data analytics scheme for providing healthcare-as-a-service
- 2017
-
Ingår i: IEEE International Conference on Communications. - Piscataway, NJ : Institute of Electrical and Electronics Engineers (IEEE). - 9781467389990
-
Konferensbidrag (refereegranskat)abstract
- With advancements in information and communication technology (ICT), there is an increase in the number of users availing remote healthcare applications. The data collected about the patients in these applications varies with respect to volume, velocity, variety, veracity, and value. To process such a large collection of heterogeneous data is one of the biggest challenges that needs a specialized approach. To address this issue, a new fuzzy rule-based classifier for big data handling using cloud-based infrastructure is presented in this paper, with an aim to provide Healthcare-as-a-Service (HaaS) to the users located at remote locations. The proposed scheme is based upon the cluster formation using the modified Expectation-Maximization (EM) algorithm and processing of the big data on the cloud environment. Then, a fuzzy rule-based classifier is designed for an efficient decision making about the data classification in the proposed scheme. The proposed scheme is evaluated with respect to different evaluation metrics such as classification time, response time, accuracy and false positive rate. The results obtained are compared with the standard techniques to confirm the effectiveness of the proposed scheme.
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| 48. |
- Kaur, Kuljeet, et al.
(författare)
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A Novel Resource Reservation Scheme for Mobile PHEVs in V2G Environment using Game Theoretical Approach
- 2015
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Ingår i: IEEE Transactions on Vehicular Technology. - Piscataway, NJ : IEEE Press. - 0018-9545 .- 1939-9359. ; 64:12, s. 5653-5666
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Tidskriftsartikel (refereegranskat)abstract
- With the widespread penetration of plug-in hybrid electric vehicles (PHEVs), the overall demand on micro-grids (MGs) may increase manifold in the near future. Unregulated power demands from PHEVs may increase the demand-supply gap at MG. Thus, in order to keep MGs stabilize, and cater the ever growing energy demands, there is a requirement of an intelligent solution to regulate, and manage PHEVs in vehicle-togrid (V2G) environment. Keeping in view the above issues, this paper proposes a novel scheme which aims to regulate PHEVs? charging, and discharging activities based on MGs? day-ahead load curves. These load curves are obtained by utilizing the existing load forecasting techniques such as-fuzzy logic (FL), and artificial neural networks (ANN). Efficient utilization of PHEVs according to these curves may play a vital role in flattening MG?s load profile. Thus, the proposed scheme works by reserving resources such as-time slots, and charging points for PHEVs during peak shaving, and valley filling. Different algorithms pertaining to resource reservation for PHEVs have also been designed. These algorithms employ the concepts of game theory, and 0/1 knapsack problem for supporting peak shaving, and valley filling respectively. Moreover, PHEVs are also utilized when there are transitions from valley filling to peak shaving areas in the load curves, and vice-versa. PHEVs involved in this process have both charging, and discharging capabilities, and are referred as dual-mode PHEVs. The proposed scheme has been tested with respect to various parameters, and its performance was found satisfactory. © 2015 IEEE
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| 49. |
- Khalil, Ibrahim, et al.
(författare)
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Burden of Diarrhea in the Eastern Mediterranean Region, 1990-2013 : Findings from the Global Burden of Disease Study 2013
- 2016
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Ingår i: American Journal of Tropical Medicine and Hygiene. - : American Society of Tropical Medicine and Hygiene. - 1476-1645 .- 0002-9637. ; 95:6, s. 1319-1329
-
Tidskriftsartikel (refereegranskat)abstract
- Diarrheal diseases (DD) are leading causes of disease burden, death, and disability, especially in children in low-income settings. DD can also impact a child's potential livelihood through stunted physical growth, cognitive impairment, and other sequelae. As part of the Global Burden of Disease Study, we estimated DD burden, and the burden attributable to specific risk factors and particular etiologies, in the Eastern Mediterranean Region (EMR) between 1990 and 2013. For both sexes and all ages, we calculated disability-adjusted life years (DALYs), which are the sum of years of life lost and years lived with disability. We estimate that over 125,000 deaths (3.6% of total deaths) were due to DD in the EMR in 2013, with a greater burden of DD in low- and middle-income countries. Diarrhea deaths per 100,000 children under 5 years of age ranged from one (95% uncertainty interval [UI] = 0-1) in Bahrain and Oman to 471 (95% UI = 245-763) in Somalia. The pattern for diarrhea DALYs among those under 5 years of age closely followed that for diarrheal deaths. DALYs per 100,000 ranged from 739 (95% UI = 520-989) in Syria to 40,869 (95% UI = 21,540-65,823) in Somalia. Our results highlighted a highly inequitable burden of DD in EMR, mainly driven by the lack of access to proper resources such as water and sanitation. Our findings will guide preventive and treatment interventions which are based on evidence and which follow the ultimate goal of reducing the DD burden.
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| 50. |
- Kumar, Dhirender, et al.
(författare)
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Population Dynamics of Juniperus macropoda Bossier Forest Ecosystem in Relation to Soil Physico-Chemical Characteristics in the Cold Desert of North-Western Himalaya
- 2022
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Ingår i: Forests. - : MDPI. - 1999-4907. ; 13:10
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Tidskriftsartikel (refereegranskat)abstract
- Juniperus macropoda is the only tree species of a cold desert ecosystem that is experiencing high anthropogenic pressure and has a poor regeneration status due to harsh environmental conditions. Due to the limited distribution of Juniperus macropoda in this region, the species have remained largely unexplored in terms of understanding the distribution pattern along the elevation and soil fertility gradients. Therefore, the current research was carried out along the elevational gradient, starting from the base line at 3000 m above sea level (m asl) asl with an elevational plot distance of 180 m. The study revealed that the average density of J. macropoda declined gradually from the first elevation range, i.e., 3000–3180 m asl onward, and extended up to the elevation range of 3900–4080 m asl. However, the average seedling and sapling densities were highest at mid-elevation and extended up to an elevation range of 4080–4260 m asl. The J. macropoda population formed a reverse J-shaped structure only up to 3540–3720 m asl. The maximum total biomass and carbon density were recorded in the lowest elevational range, and decreased subsequently. The primary soil nutrients under study decreased sharply along the elevational gradient. Seedling, sapling and tree distributions had a significantly positive relationship (p < 0.05) with available N, P, K, SOC, silt and clay contents and were negatively correlated (p < 0.05) with sand contents. The outcome of the study will form the basis for devising a plan for the management and conservation of J. macropoda forests.
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