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- Ademuyiwa, Adesoji O., et al.
(författare)
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Determinants of morbidity and mortality following emergency abdominal surgery in children in low-income and middle-income countries
- 2016
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Ingår i: BMJ Global Health. - : BMJ Publishing Group Ltd. - 2059-7908. ; 1:4
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Tidskriftsartikel (refereegranskat)abstract
- Background: Child health is a key priority on the global health agenda, yet the provision of essential and emergency surgery in children is patchy in resource-poor regions. This study was aimed to determine the mortality risk for emergency abdominal paediatric surgery in low-income countries globally.Methods: Multicentre, international, prospective, cohort study. Self-selected surgical units performing emergency abdominal surgery submitted prespecified data for consecutive children aged <16 years during a 2-week period between July and December 2014. The United Nation's Human Development Index (HDI) was used to stratify countries. The main outcome measure was 30-day postoperative mortality, analysed by multilevel logistic regression.Results: This study included 1409 patients from 253 centres in 43 countries; 282 children were under 2 years of age. Among them, 265 (18.8%) were from low-HDI, 450 (31.9%) from middle-HDI and 694 (49.3%) from high-HDI countries. The most common operations performed were appendectomy, small bowel resection, pyloromyotomy and correction of intussusception. After adjustment for patient and hospital risk factors, child mortality at 30 days was significantly higher in low-HDI (adjusted OR 7.14 (95% CI 2.52 to 20.23), p<0.001) and middle-HDI (4.42 (1.44 to 13.56), p=0.009) countries compared with high-HDI countries, translating to 40 excess deaths per 1000 procedures performed.Conclusions: Adjusted mortality in children following emergency abdominal surgery may be as high as 7 times greater in low-HDI and middle-HDI countries compared with high-HDI countries. Effective provision of emergency essential surgery should be a key priority for global child health agendas.
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| 3. |
- van de Vegte, Yordi, et al.
(författare)
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Genetic insights into resting heart rate and its role in cardiovascular disease
- 2023
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Ingår i: Nature Communications. - : Springer Nature. - 2041-1723. ; 14:1
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Tidskriftsartikel (refereegranskat)abstract
- The genetics and clinical consequences of resting heart rate (RHR) remain incompletely understood. Here, the authors discover new genetic variants associated with RHR and find that higher genetically predicted RHR decreases risk of atrial fibrillation and ischemic stroke. Resting heart rate is associated with cardiovascular diseases and mortality in observational and Mendelian randomization studies. The aims of this study are to extend the number of resting heart rate associated genetic variants and to obtain further insights in resting heart rate biology and its clinical consequences. A genome-wide meta-analysis of 100 studies in up to 835,465 individuals reveals 493 independent genetic variants in 352 loci, including 68 genetic variants outside previously identified resting heart rate associated loci. We prioritize 670 genes and in silico annotations point to their enrichment in cardiomyocytes and provide insights in their ECG signature. Two-sample Mendelian randomization analyses indicate that higher genetically predicted resting heart rate increases risk of dilated cardiomyopathy, but decreases risk of developing atrial fibrillation, ischemic stroke, and cardio-embolic stroke. We do not find evidence for a linear or non-linear genetic association between resting heart rate and all-cause mortality in contrast to our previous Mendelian randomization study. Systematic alteration of key differences between the current and previous Mendelian randomization study indicates that the most likely cause of the discrepancy between these studies arises from false positive findings in previous one-sample MR analyses caused by weak-instrument bias at lower P-value thresholds. The results extend our understanding of resting heart rate biology and give additional insights in its role in cardiovascular disease development.
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| 4. |
- Carson, Marcus, et al.
(författare)
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Institutionalising gender equality in disaster risk reduction : DRR challenges and impacts on women and men, girls and boys in the context of a changing climate
- 2013
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- While MSB has many years of experience of implementing environmental and gender perspectives in its humanitarian work; disaster risk reduction (DRR) and climate change adaptation present a different set of opportunities and challenges. Thesefurther emphasise the inclusion of a social change component that overlaps somewhat with more conventional development work. MSB commissioned the Stockholm Environment Institute (SEI) to prepare this report, noting that women and men (as well as girls and boys) are affected differently by: i) the impacts of climate change, ii) efforts related to climate change adaptation (CCA), and iii) disaster risk reduction (DRR).
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| 5. |
- Prusakov, Pavel, et al.
(författare)
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A global point prevalence survey of antimicrobial use in neonatal intensive care units : The no-more-antibiotics and resistance (NO-MAS-R) study
- 2021
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Ingår i: eClinicalMedicine. - : Elsevier. - 2589-5370. ; 32
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Tidskriftsartikel (refereegranskat)abstract
- Background: Global assessment of antimicrobial agents prescribed to infants in the neonatal intensive care unit (NICU) may inform antimicrobial stewardship efforts.Methods: We conducted a one-day global point prevalence study of all antimicrobials provided to NICU infants. Demographic, clinical, and microbiologic data were obtained including NICU level, census, birth weight, gestational/chronologic age, diagnoses, antimicrobial therapy (reason for use; length of therapy), antimicrobial stewardship program (ASP), and 30-day in-hospital mortality.Findings: On July 1, 2019, 26% of infants (580/2,265; range, 0-100%; median gestational age, 33 weeks; median birth weight, 1800 g) in 84 NICUs (51, high-income; 33, low-to-middle income) from 29 countries (14, high-income; 15, low-to-middle income) in five continents received >= 1 antimicrobial agent (92%, antibacterial; 19%, antifungal; 4%, antiviral). The most common reasons for antibiotic therapy were "rule-out" sepsis (32%) and "culture-negative" sepsis (16%) with ampicillin (40%), gentamicin (35%), amikacin (19%), vancomycin (15%), and meropenem (9%) used most frequently. For definitive treatment of presumed/confirmed infection, vancomycin (26%), amikacin (20%), and meropenem (16%) were the most prescribed agents. Length of therapy for culture-positive and "culture-negative" infections was 12 days (median; IQR, 8-14) and 7 days (median; IQR, 5-10), respectively. Mortality was 6% (42%, infection-related). An NICU ASP was associated with lower rate of antibiotic utilization (p = 0.02).Interpretation: Global NICU antibiotic use was frequent and prolonged regardless of culture results. NICU-specific ASPs were associated with lower antibiotic utilization rates, suggesting the need for their implementation worldwide.
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| 8. |
- Röös, Elin, et al.
(författare)
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Risks and opportunities of increasing yields in organic farming. A review
- 2018
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Ingår i: Agronomy for Sustainable Development. - : Springer-Verlag France. - 1774-0746 .- 1773-0155. ; 38:2
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Tidskriftsartikel (refereegranskat)abstract
- Current organic agriculture performs well in several sustainability domains, like animal welfare, farm profitability and low pesticide use, but yields are commonly lower than in conventional farming. There is now a re-vitalized interest in increasing yields in organic agriculture to provide more organic food for a growing, more affluent population and reduce negative impacts per unit produced. However, past yield increases have been accompanied by several negative side-effects. Here, we review risks and opportunities related to a broad range of sustainability domains associated with increasing yields in organic agriculture in the Northern European context. We identify increased N input, weed, disease and pest control, improved livestock feeding, breeding for higher yields and reduced losses as the main measures for yield increases. We review the implications of their implementation for biodiversity, greenhouse gas emissions, nutrient losses, soil fertility, animal health and welfare, human nutrition and health and farm profitability. Our findings from this first-of-its-kind integrated analysis reveal which strategies for increasing yields are unlikely to produce negative side-effects and therefore should be a high priority, and which strategies need to be implemented with great attention to trade-offs. For example, increased N inputs in cropping carry many risks and few opportunities, whereas there are many risk-free opportunities for improved pest control through the management of ecosystem services. For most yield increasing strategies, both risks and opportunities arise, and the actual effect depends on management including active mitigation of side-effects. Our review shows that, to be a driving force for increased food system sustainability, organic agriculture may need to reconsider certain fundamental principles. Novel plant nutrient sources, including increased nutrient recycling in society, and in some cases mineral nitrogen fertilisers from renewable sources, and truly alternative animal production systems may need to be developed and accepted.
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| 9. |
- Schunemann, Holger J., et al.
(författare)
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Methods for Development of the European Commission Initiative on Breast Cancer Guidelines Recommendations in the Era of Guideline Transparency
- 2019
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Ingår i: Annals of Internal Medicine. - : American College of Physicians. - 0003-4819 .- 1539-3704. ; 171:4, s. 273-280
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Tidskriftsartikel (refereegranskat)abstract
- Neither breast cancer prevention and early-detection programs, nor their outcomes, are uniform across Europe. This article describes the rationale, methods, and process for development of the European Commission ( EC) Initiative on Breast Cancer Screening and Diagnosis Guidelines. To be consistent with standards set by the Institute of Medicine and others, the EC followed 6 general principles. First, the EC selected, via an open call, a panel with broad representation of areas of expertise. Second, it ensured that all recommendations were supported by systematic reviews. Third, the EC separately considered important subgroups of women, included patient advocates in the guidelines development group, and focused on good communication to inform women's decisions. Fourth, EC rules on conflicts of interest were followed and the GRADE ( Grading of Recommendations Assessment, Development and Evaluation) Evidence to Decision frameworks were used to structure the process and minimize the influence of competing interests. Fifth, it focused its recommendations on outcomes that matter to women, and certainty of the evidence is rated for each. Sixth, the EC elicited stakeholder feedback to ensure that the recommendations remain up to date and relevant to practice. This article describes the approach and highlights ways of disseminating and adapting the recommendations both within and outside Europe, using innovative information technology tools.
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| 10. |
- Sundberg, Cecilia, et al.
(författare)
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Lönsamhet för småskalig biobränslebaserad kraftvärme : förutsättningar och framtidsutsikter
- 2011
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Combined heat and power (CHP) using biofuels is one possible means to reduce emissions of greenhouse gases and increase the use of renewable energy. Cogeneration is also an efficient way to utilize the energy in biofuels. The aim of the project has been to determine if there are economically viable cogeneration technologies for small-scale use. Three case studies were performed, examining facilities using different technologies and fuels. The studied facilities included one small-scale district heating plant using wood chips, one plant producing heat for farm purposes using straw, and one planned biogas facility with dry fermentation. Steam turbines for cogeneration in larger district heating plants are not economically viable for small-scale use for technological reasons, but there are other possible solutions. Such solutions include combustion engines, stirling engines, ORC technology (similar to steam technologies but using mediums with lower evaporation temperatures), flashbox technology (producing steam through pressure reduction), fuel cells and gas fueled microturbines. Depending on scale, fuel availability and other factors, different technological solutions may be best suited for different applications. Possible biofuels are wood chips, straw, grains, biogas and vegetable oils. The feasibilities of different cogeneration technologies were assessed in each case study, and the examined plants were designed to meet the needs of power and heat. Power production and fuel requirements were calculated through simulations using heat demands and efficiency factors. By summing up results of hour-based simulations, annual values were obtained. The results were then used in financial calculations, where profitability was estimated from revenues and costs. The profitability of cogeneration depends on several factors, which include fixed costs for investments, interests, grid connection fees and green certificate management. Fuel purchases, maintenance and potential cooling are examples of variable costs. Revenues are earned from sales of heat, electricity and green certificates. Furthermore, payment is received from the electricity grid owner as compensation for stabilizing the grid and increasing available power. With the current electricity price it is difficult to achieve profitability for the kinds of small-scale cogeneration that were examined. At the most probable current costs and revenues, there was no profitability in any of the case studies. However, with slightly more optimistic values for service life, investment cost and fuel prices, simulations with current electricity prices achieved profitability in two of the cases. The investment cost was found to be more significant than fuel prices, and if technological development lowers the investment cost, profitability may increase, also if fuel prices rise. Conditions for cogeneration are more favorable if revenues from heat production are obtained all year round. Additional uses for heat during periods of low load should be investigated, to maximize power production. System properties when operating at partial load are very important when determining appropriate cogeneration technology. A constant development of technologies for small-scale cogeneration makes decreased investment costs probable. Thus, there is every reason for the Swedish agricultural industry to monitor future advances in other Nordic countries and in Europe, to acquire up to date knowledge on the state of technological development in this field
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| 14. |
- Östlund, Ruben, 1974, et al.
(författare)
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Filmrummet: ansvar och konsekvens
- 2015
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Ingår i: Filmstudion, Valand Akademien. 8 sept, kl 15.00-16.30. 2015.
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Vad har filmskapare, ansvariga utgivare och konsulenter för ansvar för de bilder som produceras? Vilka begränsningar och påtryckningar utsätts de för och vilka egna överväganden görs? Ett samtal om berättandets etiska och moraliska villkor. Kraven på att nå en allt större publik i många visningsfönster får konsekvenser. Därför krävs en god kunskap om filmens och bildens påverkan på publiken och hur exponeringen påverkar anhöriga och medverkande. Räcker det med att kunna juridiken kring yttrandefrihet för att visa sin film för en större publik? Hur fungerar vår moraliska kompass i en medievärld där gränserna mellan fiktion och verklighet blir allt mer suddiga? Ruben Östlund, regissör och professor på Akademin Valand, inledde med sin syn på en filmares ansvar och hur bilder formar verkligheten. Detta följdes av ett samtal mellan Ingemar Persson programchef dokumentär SVT och Cecilia Lidin, tidigare dokumentärfilmskonsulent på Svenska Filminstitutet, om utgivares och finansiärers ansvar och skyldigheter. NÄR: tisdag 8 september, 15.00 – 16.30 VAR: Filmstudion, Akademin Valand, Storgatan 43 i Göteborg
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