| 1. |
- Kinyoki, DK, et al.
(författare)
-
Mapping child growth failure across low- and middle-income countries
- 2020
-
Ingår i: Nature. - : Springer Science and Business Media LLC. - 1476-4687 .- 0028-0836. ; 577:7789, s. 231-
-
Tidskriftsartikel (refereegranskat)abstract
- Childhood malnutrition is associated with high morbidity and mortality globally1. Undernourished children are more likely to experience cognitive, physical, and metabolic developmental impairments that can lead to later cardiovascular disease, reduced intellectual ability and school attainment, and reduced economic productivity in adulthood2. Child growth failure (CGF), expressed as stunting, wasting, and underweight in children under five years of age (0–59 months), is a specific subset of undernutrition characterized by insufficient height or weight against age-specific growth reference standards3–5. The prevalence of stunting, wasting, or underweight in children under five is the proportion of children with a height-for-age, weight-for-height, or weight-for-age z-score, respectively, that is more than two standard deviations below the World Health Organization’s median growth reference standards for a healthy population6. Subnational estimates of CGF report substantial heterogeneity within countries, but are available primarily at the first administrative level (for example, states or provinces)7; the uneven geographical distribution of CGF has motivated further calls for assessments that can match the local scale of many public health programmes8. Building from our previous work mapping CGF in Africa9, here we provide the first, to our knowledge, mapped high-spatial-resolution estimates of CGF indicators from 2000 to 2017 across 105 low- and middle-income countries (LMICs), where 99% of affected children live1, aggregated to policy-relevant first and second (for example, districts or counties) administrative-level units and national levels. Despite remarkable declines over the study period, many LMICs remain far from the ambitious World Health Organization Global Nutrition Targets to reduce stunting by 40% and wasting to less than 5% by 2025. Large disparities in prevalence and progress exist across and within countries; our maps identify high-prevalence areas even within nations otherwise succeeding in reducing overall CGF prevalence. By highlighting where the highest-need populations reside, these geospatial estimates can support policy-makers in planning interventions that are adapted locally and in efficiently directing resources towards reducing CGF and its health implications.
|
|
| 2. |
- Jonkman, Nini H., et al.
(författare)
-
Do self-management interventions work in patients with heart failure? An individual patient data meta-analysis
- 2016
-
Ingår i: Circulation. - : Lippincott Williams & Wilkins. - 0009-7322 .- 1524-4539. ; 133:12, s. 1189-1198
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: -Self-management interventions are widely implemented in care for patients with heart failure (HF). Trials however show inconsistent results and whether specific patient groups respond differently is unknown. This individual patient data meta-analysis assessed the effectiveness of self-management interventions in HF patients and whether subgroups of patients respond differently.METHODS AND RESULTS: -Systematic literature search identified randomized trials of self-management interventions. Data of twenty studies, representing 5624 patients, were included and analyzed using mixed effects models and Cox proportional-hazard models including interaction terms. Self-management interventions reduced risk of time to the combined endpoint HF-related hospitalization or all-cause death (hazard ratio [HR], 0.80; 95% confidence interval [CI], 0.71-0.89), time to HF-related hospitalization (HR, 0.80; 95%CI, 0.69-0.92), and improved 12-month HF-related quality of life (standardized mean difference 0.15; 95%CI, 0.00-0.30). Subgroup analysis revealed a protective effect of self-management on number of HF-related hospital days in patients <65 years (mean number of days 0.70 days vs. 5.35 days; interaction p=0.03). Patients without depression did not show an effect of self-management on survival (HR for all-cause mortality, 0.86; 95%CI, 0.69-1.06), while in patients with moderate/severe depression self-management reduced survival (HR, 1.39; 95%CI, 1.06-1.83, interaction p=0.01).CONCLUSIONS: -This study shows that self-management interventions had a beneficial effect on time to HF-related hospitalization or all-cause death, HF-related hospitalization alone, and elicited a small increase in HF-related quality of life. The findings do not endorse limiting self-management interventions to subgroups of HF patients, but increased mortality in depressed patients warrants caution in applying self-management strategies in these patients.
|
|
| 3. |
- Jonkman, Nini H., et al.
(författare)
-
What Are Effective Program Characteristics of Self-Management Interventions in Patients With Heart Failure? : An Individual Patient Data Meta-analysis
- 2016
-
Ingår i: Journal of Cardiac Failure. - : Elsevier BV. - 1071-9164 .- 1532-8414. ; 22:11, s. 861-871
-
Tidskriftsartikel (refereegranskat)abstract
- Background To identify those characteristics of self-management interventions in patients with heart failure (HF) that are effective in influencing health-related quality of life, mortality, and hospitalizations.Methods and Results Randomized trials on self-management interventions conducted between January 1985 and June 2013 were identified and individual patient data were requested for meta-analysis. Generalized mixed effects models and Cox proportional hazard models including frailty terms were used to assess the relation between characteristics of interventions and health-related outcomes. Twenty randomized trials (5624 patients) were included. Longer intervention duration reduced mortality risk (hazard ratio 0.99, 95% confidence interval [CI] 0.97–0.999 per month increase in duration), risk of HF-related hospitalization (hazard ratio 0.98, 95% CI 0.96–0.99), and HF-related hospitalization at 6 months (risk ratio 0.96, 95% CI 0.92–0.995). Although results were not consistent across outcomes, interventions comprising standardized training of interventionists, peer contact, log keeping, or goal-setting skills appeared less effective than interventions without these characteristics.Conclusion No specific program characteristics were consistently associated with better effects of self-management interventions, but longer duration seemed to improve the effect of self-management interventions on several outcomes. Future research using factorial trial designs and process evaluations is needed to understand the working mechanism of specific program characteristics of self-management interventions in HF patients.
|
|
| 4. |
- Ross, Owen A., et al.
(författare)
-
Mitochondrial DNA damage in lymphocytes : a role in immunosenescence?
- 2002
-
Ingår i: Experimental Gerontology. - : Elsevier. - 0531-5565 .- 1873-6815. ; 37:2-3, s. 329-340
-
Tidskriftsartikel (refereegranskat)abstract
- An age-related increase of DNA damage/mutation has been previously reported in human lymphocytes. The high copy number and mutation rate make the mtDNA genome an ideal candidate for assessing damage and to act as a potential biomarker of ageing. In the present study, two assays were developed to evaluate the level of mtDNA4977 and the accumulation of point mutations with age. A competitive polymerase chain reaction (PCR) methodology incorporating three primers was used to detect and quantify the levels of mtDNA4977 and a novel heteroduplex reference strand conformational analysis (RSCA) technique was used to analyse the accumulation of point mutations. The assays were applied to an in vitro model of T cell ageing and ex vivo DNA samples from an elderly cohort of subjects and a younger control group. The mtDNA4977 was detected in all the DNA samples examined but only a very low concentration was observed and no age-related increase or accumulation was observed. No accumulation of point mutations was identified using RSCA within the T cell clones as they were aged or the ex vivo lymphocytes from the elderly cohort. A higher level of variation was observed within the ex vivo DNA samples, verifying the high resolution of RSCA and its ability to identify different mtDNA species, although no correlation with age was observed. The low level of mtDNA damage observed with respect to the ex vivo lymphocyte DNA samples within this study may be due in part to the high turnover of blood cells/mtDNA, which may inhibit the accumulation of genetically abnormal mtDNA that may play a role in immunosenescence. A similar explanation may also apply to the in vitro model of T cell ageing if the vast majority of the cells are replicating rather than entering senescence.
|
|
| 5. |
- Vinck, Ken, et al.
(författare)
-
Advanced in-situ and laboratory characterisation of the ALPACA chalk research site
- 2022
-
Ingår i: Geotechnique. - : ICE Publishing. - 0016-8505 .- 1751-7656.
-
Tidskriftsartikel (refereegranskat)abstract
- Low-to-medium density chalk at St Nicholas at Wade, UK, is characterised by intensive testing to inform the interpretation of axial and lateral tests on driven piles. The chalk de-structures when taken to large strains, especially under dynamic loading, leading to remarkably high pore pressures beneath penetrating CPT and driven pile tips, weak putty annuli around their shafts and degraded responses in full-displacement pressuremeter tests. Laboratory tests on carefully formed specimens explore the chalk’s unstable structure and markedly time and rate-dependent mechanical behaviour. A clear hierarchy is found between profiles of peak strength with depth of Brazilian tension (BT), drained and undrained triaxial and direct simple shear (DSS) tests conducted from in-situ stress conditions. Highly instrumented triaxial tests reveal the chalk’s unusual effective stress paths, markedly brittle failure behaviour from small strains and the effects of consolidating to higher than in-situ stresses. The chalk’s mainly sub-vertical jointing and micro-fissuring leads to properties depending on specimen scale, with in-situ mass stiffnesses falling significantly below high-quality laboratory measurements and vertical Young’s moduli exceeding horizontal stiffnesses. While compressive strength and stiffness appear relatively insensitive to effective stress levels, consolidation to higher pressures closes micro-fissures, increases stiffness and reduces anisotropy.
|
|
| 6. |
- Ahmadi Naghadeh, Reza, 1982, et al.
(författare)
-
A laboratory characterisation of the response of intact chalk to cyclic loading
- 2022
-
Ingår i: Geotechnique. - : Thomas Telford Ltd.. - 0016-8505 .- 1751-7656. ; In Press
-
Tidskriftsartikel (refereegranskat)abstract
- This paper reports the cyclic behaviour of chalk, which has yet to be studied comprehensively. Multiple undrained high-resolution cyclic triaxial experiments on low- to medium-density intact chalk, along with index and monotonic reference tests, define the conditions under which either thousands of cycles could be applied without any deleterious effect, or failure could be provoked under specified numbers of cycles. Intact chalk's response is shown to differ from that of most saturated soils tested under comparable conditions. While chalk can be reduced to putty by severe two-way displacement-controlled cycling, its behaviour proved stable and nearly linear visco-elastic over much of the one-way, stress-controlled loading space examined, with stiffness improving over thousands of cycles, without loss of undrained shear strength. However, in cases where cyclic failure occurred, the specimens showed little sign of cyclic damage before cracking and movements on discontinuities led to sharp pore pressure reductions, non-uniform displacements and the onset of brittle collapse. Chalk's behaviour resembles the fatigue response of metals, concretes and rocks, where micro-shearing or cracking initiates on imperfections that generate stress concentrations; the experiments identify the key features that must be captured in any representative cyclic loading model.
|
|
| 7. |
- Goodman, Daisy, et al.
(författare)
-
Explanation and elaboration of the SQUIRE (Standards for Quality Improvement Reporting Excellence) Guidelines, V.2.0 : Examples of SQUIRE elements in the healthcare improvement literature
- 2016
-
Ingår i: BMJ Quality and Safety. - : BMJ. - 2044-5415 .- 2044-5423. ; 25:12
-
Tidskriftsartikel (refereegranskat)abstract
- Since its publication in 2008, SQUIRE (Standards for Quality Improvement Reporting Excellence) has contributed to the completeness and transparency of reporting of quality improvement work, providing guidance to authors and reviewers of reports on healthcare improvement work. In the interim, enormous growth has occurred in understanding factors that influence the success, and failure, of healthcare improvement efforts. Progress has been particularly strong in three areas: the understanding of the theoretical basis for improvement work; the impact of contextual factors on outcomes; and the development of methodologies for studying improvement work. Consequently, there is now a need to revise the original publication guidelines. To reflect the breadth of knowledge and experience in the field, we solicited input from a wide variety of authors, editors and improvement professionals during the guideline revision process. This Explanation and Elaboration document (E&E) is a companion to the revised SQUIRE guidelines, SQUIRE 2.0. The product of collaboration by an international and interprofessional group of authors, this document provides examples from the published literature, and an explanation of how each reflects the intent of a specific item in SQUIRE. The purpose of the guidelines is to assist authors in writing clearly, precisely and completely about systematic efforts to improve the quality, safety and value of healthcare services. Authors can explore the SQUIRE statement, this E&E and related documents in detail at http://www.squire-statement.org.
|
|
| 8. |
- Liu, Tingfa, et al.
(författare)
-
Cyclic Characterisation of Low-to-Medium Density Chalk for Offshore Driven Pile Design
- 2023
-
Konferensbidrag (refereegranskat)abstract
- Project-specific advanced laboratory testing is employed increasingly frequently in site investigations for major offshore projects. Such testing needs to focus on characterising properties under in-situ conditions, while also catering for the effects of foundation installation and subsequent service conditions, including cyclic loading. Low-to-medium density chalk, a variable soft biomicrite, can be de-structured to soft paste under dynamic percussion or large-strain repetitive shearing, posing significant challenges and uncertainties for driven pile design. This paper draws on key outcomes from undrained cyclic triaxial test programmes on both intact chalk and dynamically de-structured (putty) chalk. The cyclic response of intact chalk resembles the fatigue behaviour of hard rocks and develops little sign of damage before sharp pore pressure reductions and brittle collapse occurs. In contrast, fully de-structured chalk develops both contractive and dilative phases, as seen with silts. The associated effective stress reductions vary systematically with the number of cycles and cyclic stress ratio. A laboratory-based global axial cyclic predictive method is proposed from the experiments and employed to predict the outcomes of field axial cyclic loading pile tests. The research provides then basis for robust cyclic design guidance for piles driven in low-to-medium density chalk.
|
|
| 9. |
- Liu, Tingfa, et al.
(författare)
-
Laboratory investigation of the cyclic loading behaviour of intact and de-structured chalk
- 2024
-
Ingår i: Proceedings of the 8th International Symposium on Deformation Characteristics of Geomaterials (IS-PORTO 2023). - : EDP Sciences.
-
Konferensbidrag (refereegranskat)abstract
- Chalk is a soft biomicrite composed of silt-sized crushable CaCO3 aggregates. Chalk’s response to cyclic loading depends critically on its sensitive micro fabric and state, which may be altered significantly by high-pressure compression, dynamic impact or prior large-strain repetitive shearing. This paper reports high-resolution undrained cyclic triaxial experiments on low- to medium-density intact chalk and chalk de-structured by dynamic compaction to model the effects of percussive pile driving. The intact chalk manifested stable and nearly linear visco-elastic response under a wide range of the one-way, stress-controlled cyclic loading conditions imposed. However, high level cycling led to sudden failures that resembled the fatigue response of metals, concretes and rocks, with little sign of cyclic damage before sharp pore pressure reductions, non-uniform displacements and finally brittle collapses. However, the de-structured chalk’s response to high-level undrained cycling resembles that of silts, developing both contractive and dilative phases that led to pore pressure build-up, leftward effective stress-path drift, permanent strain accumulation, cyclic stiffness losses and increasing damping ratios. Results from exemplar tests are presented to illustrate these key features and demonstrate how chalk’s undrained cyclic shearing characteristics depend also on effective stress level. The experimental outcomes provide significant scope for developing constitutive and empirical relationships or predictive tools to enable the interpretation and design of driven pile foundations in chalk and other chalk-structure interaction related problems under cyclic loading.
|
|
