| 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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| 2. |
- 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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| 6. |
- Niederberger, C., et al.
(författare)
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Forty years of IVF
- 2018
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Ingår i: Fertility and Sterility. - : Elsevier BV. - 0015-0282. ; 110:2
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Tidskriftsartikel (refereegranskat)abstract
- This monograph, written by the pioneers of IVF and reproductive medicine, celebrates the history, achievements, and medical advancements made over the last 40 years in this rapidly growing field.
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| 7. |
- Farrugia, C. J., et al.
(författare)
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Effects in the Near-Magnetopause Magnetosheath Elicited by Large-Amplitube Alfvenic Fluctuations Terminating in a Field and Flow Discontinuity
- 2018
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Ingår i: Journal of Geophysical Research - Space Physics. - : AMER GEOPHYSICAL UNION. - 2169-9380 .- 2169-9402. ; 123:11, s. 8983-9004
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Tidskriftsartikel (refereegranskat)abstract
- In this paper we report on a sequence of large-amplitude Alfvenic fluctuations terminating in a field and flow discontinuity and their effects on electromagnetic fields and plasmas in the near-magnetopause magnetosheath. An arc-polarized structure in the magnetic field was observed by the Time History of Events and Macroscale Interactions during Substorms-C in the solar wind, indicative of nonlinear Alfven waves. It ends with a combined tangential discontinuity/vortex sheet, which is strongly inclined to the ecliptic plane and at which there is a sharp rise in the density and a drop in temperature. Several effects resulting from this structure were observed by the Magnetospheric Multiscale spacecraft in the magnetosheath close to the subsolar point (11:30 magnetic local time) and somewhat south of the geomagnetic equator (-33 degrees magnetic latitude): (i) kinetic Alfven waves; (ii) a peaking of the electric and magnetic field strengths where E . J becomes strong and negative (-1 nW/m(3)) just prior to an abrupt dropout of the fields; (iii) evolution in the pitch angle distribution of energetic (a few tens of kilo-electron-volts) ions (H+, Hen+, and On+) and electrons inside a high-density region, which we attribute to gyrosounding of the tangential discontinuity/vortex sheet structure passing by the spacecraft; (iv) field-aligned acceleration of ions and electrons that could be associated with localized magnetosheath reconnection inside the high-density region; and (v) variable and strong flow changes, which we argue to be unrelated to reconnection at partial magnetopause crossings and likely result from deflections of magnetosheath flow by a locally deformed, oscillating magnetopause.
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| 8. |
- Kacem, I., et al.
(författare)
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Magnetic Reconnection at a Thin Current Sheet Separating Two Interlaced Flux Tubes at the Earth's Magnetopause
- 2018
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Ingår i: Journal of Geophysical Research - Space Physics. - 2169-9380 .- 2169-9402. ; 123:3, s. 1779-1793
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Tidskriftsartikel (refereegranskat)abstract
- The occurrence of spatially and temporally variable reconnection at the Earth's magnetopause leads to the complex interaction of magnetic fields from the magnetosphere and magnetosheath. Flux transfer events (FTEs) constitute one such type of interaction. Their main characteristics are (1) an enhanced core magnetic field magnitude and (2) a bipolar magnetic field signature in the component normal to the magnetopause, reminiscent of a large-scale helicoidal flux tube magnetic configuration. However, other geometrical configurations which do not fit this classical picture have also been observed. Using high-resolution measurements from the Magnetospheric Multiscale mission, we investigate an event in the vicinity of the Earth's magnetopause on 7 November 2015. Despite signatures that, at first glance, appear consistent with a classic FTE, based on detailed geometrical and dynamical analyses as well as on topological signatures revealed by suprathermal electron properties, we demonstrate that this event is not consistent with a single, homogenous helicoidal structure. Our analysis rather suggests that it consists of the interaction of two separate sets of magnetic field lines with different connectivities. This complex three-dimensional interaction constructively conspires to produce signatures partially consistent with that of an FTE. We also show that, at the interface between the two sets of field lines, where the observed magnetic pileup occurs, a thin and strong current sheet forms with a large ion jet, which may be consistent with magnetic flux dissipation through magnetic reconnection in the interaction region.
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| 9. |
- Argall, M. R., et al.
(författare)
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Electron Dynamics Within the Electron Diffusion Region of Asymmetric Reconnection
- 2018
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Ingår i: Journal of Geophysical Research - Space Physics. - : AMER GEOPHYSICAL UNION. - 2169-9380 .- 2169-9402. ; 123:1, s. 146-162
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Tidskriftsartikel (refereegranskat)abstract
- We investigate the agyrotropic nature of electron distribution functions and their substructure to illuminate electron dynamics in a previously reported electron diffusion region (EDR) event. In particular, agyrotropy is examined as a function of energy to reveal detailed finite Larmor radius effects for the first time. It is shown that the previously reported approximate to 66eV agyrotropic "crescent" population that has been accelerated as a result of reconnection is evanescent in nature because it mixes with a denser, gyrotopic background. Meanwhile, accelerated agyrotropic populations at 250 and 500eV are more prominent because the background plasma at those energies is more tenuous. Agyrotropy at 250 and 500eV is also more persistent than at 66eV because of finite Larmor radius effects; agyrotropy is observed 2.5 ion inertial lengths from the EDR at 500eV, but only in close proximity to the EDR at 66eV. We also observe linearly polarized electrostatic waves leading up to and within the EDR. They have wave normal angles near 90 degrees, and their occurrence and intensity correlate with agyrotropy. Within the EDR, they modulate the flux of 500eV electrons travelling along the current layer. The net electric field intensifies the reconnection current, resulting in a flow of energy from the fields into the plasma. Plain Language Summary The process of reconnection involves an explosive transfer of magnetic energy into particle energy. When energetic particles contact modern technology such as satellites, cell phones, or other electronic devices, they can cause random errors and failures. Exactly how particles are energized via reconnection, however, is still unknown. Fortunately, the Magnetospheric Multiscale mission is finally able to detect and analyze reconnection processes. One recent finding is that energized particles take on a crescent-shaped configuration in the vicinity of reconnection and that this crescent shape is related to the energy conversion process. In our paper, we explain why the crescent shape has not been observed until now and inspect particle motions to determine what impact it has on energy conversion. When reconnection heats the plasma, the crescent shape forms from the cool, tenuous particles. As plasmas from different regions mix, dense, nonheated plasma obscures the crescent shape in our observations. The highest-energy particle population created by reconnection, though, also contains features of the crescent shape that are more persistent but appear less dramatically in the data.
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| 10. |
- Alm, L., et al.
(författare)
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Differing Properties of Two Ion-Scale Magnetopause Flux Ropes
- 2018
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Ingår i: Journal of Geophysical Research - Space Physics. - : AMER GEOPHYSICAL UNION. - 2169-9380 .- 2169-9402. ; 123:1, s. 114-131
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Tidskriftsartikel (refereegranskat)abstract
- In this paper, we present results from the Magnetospheric Multiscale constellation encountering two ion-scale, magnetopause flux ropes. The two flux ropes exhibit very different properties and internal structure. In the first flux rope, there are large differences in the currents observed by different satellites, indicating variations occurring over sub-d(i) spatial scales, and time scales on the order of the ion gyroperiod. In addition, there is intense wave activity and particle energization. The interface between the two flux ropes exhibits oblique whistler wave activity. In contrast, the second flux rope is mostly quiescent, exhibiting little activity throughout the encounter. Changes in the magnetic topology and field line connectivity suggest that we are observing flux rope coalescence.
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