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  • 2019
  • Journal article (peer-reviewed)
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3.
  • Wang, Haidong, et al. (author)
  • 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
  • In: The Lancet. - 0140-6736 .- 1474-547X. ; 388:10053, s. 1459-1544
  • Journal article (peer-reviewed)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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  • Lozano, Rafael, et al. (author)
  • 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
  • In: The Lancet. - : Elsevier. - 1474-547X .- 0140-6736. ; 392:10159, s. 2091-2138
  • Journal article (peer-reviewed)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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6.
  • Stanaway, Jeffrey D., et al. (author)
  • 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
  • In: The Lancet. - 1474-547X .- 0140-6736. ; 392:10159, s. 1923-1994
  • Journal article (peer-reviewed)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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  • Kassebaum, Nicholas J., et al. (author)
  • 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
  • In: The Lancet. - 0140-6736 .- 1474-547X. ; 388:10053, s. 1603-1658
  • Journal article (peer-reviewed)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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  • Hudson, Lawrence N, et al. (author)
  • The database of the PREDICTS (Projecting Responses of Ecological Diversity In Changing Terrestrial Systems) project
  • 2017
  • In: Ecology and Evolution. - : John Wiley & Sons. - 2045-7758. ; 7:1, s. 145-188
  • Journal article (peer-reviewed)abstract
    • The PREDICTS project-Projecting Responses of Ecological Diversity In Changing Terrestrial Systems (www.predicts.org.uk)-has collated from published studies a large, reasonably representative database of comparable samples of biodiversity from multiple sites that differ in the nature or intensity of human impacts relating to land use. We have used this evidence base to develop global and regional statistical models of how local biodiversity responds to these measures. We describe and make freely available this 2016 release of the database, containing more than 3.2 million records sampled at over 26,000 locations and representing over 47,000 species. We outline how the database can help in answering a range of questions in ecology and conservation biology. To our knowledge, this is the largest and most geographically and taxonomically representative database of spatial comparisons of biodiversity that has been collated to date; it will be useful to researchers and international efforts wishing to model and understand the global status of biodiversity.
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  • Murray, Christopher J. L., et al. (author)
  • Population and fertility by age and sex for 195 countries and territories, 1950–2017: a systematic analysis for the Global Burden of Disease Study 2017
  • 2018
  • In: The Lancet. - 1474-547X .- 0140-6736. ; 392:10159, s. 1995-2051
  • Journal article (peer-reviewed)abstract
    • Background: Population estimates underpin demographic and epidemiological research and are used to track progress on numerous international indicators of health and development. To date, internationally available estimates of population and fertility, although useful, have not been produced with transparent and replicable methods and do not use standardised estimates of mortality. We present single-calendar year and single-year of age estimates of fertility and population by sex with standardised and replicable methods. Methods: We estimated population in 195 locations by single year of age and single calendar year from 1950 to 2017 with standardised and replicable methods. We based the estimates on the demographic balancing equation, with inputs of fertility, mortality, population, and migration data. Fertility data came from 7817 location-years of vital registration data, 429 surveys reporting complete birth histories, and 977 surveys and censuses reporting summary birth histories. We estimated age-specific fertility rates (ASFRs; the annual number of livebirths to women of a specified age group per 1000 women in that age group) by use of spatiotemporal Gaussian process regression and used the ASFRs to estimate total fertility rates (TFRs; the average number of children a woman would bear if she survived through the end of the reproductive age span [age 10–54 years] and experienced at each age a particular set of ASFRs observed in the year of interest). Because of sparse data, fertility at ages 10–14 years and 50–54 years was estimated from data on fertility in women aged 15–19 years and 45–49 years, through use of linear regression. Age-specific mortality data came from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 estimates. Data on population came from 1257 censuses and 761 population registry location-years and were adjusted for underenumeration and age misreporting with standard demographic methods. Migration was estimated with the GBD Bayesian demographic balancing model, after incorporating information about refugee migration into the model prior. Final population estimates used the cohort-component method of population projection, with inputs of fertility, mortality, and migration data. Population uncertainty was estimated by use of out-of-sample predictive validity testing. With these data, we estimated the trends in population by age and sex and in fertility by age between 1950 and 2017 in 195 countries and territories. Findings: From 1950 to 2017, TFRs decreased by 49·4% (95% uncertainty interval [UI] 46·4–52·0). The TFR decreased from 4·7 livebirths (4·5–4·9) to 2·4 livebirths (2·2–2·5), and the ASFR of mothers aged 10–19 years decreased from 37 livebirths (34–40) to 22 livebirths (19–24) per 1000 women. Despite reductions in the TFR, the global population has been increasing by an average of 83·8 million people per year since 1985. The global population increased by 197·2% (193·3–200·8) since 1950, from 2·6 billion (2·5–2·6) to 7·6 billion (7·4–7·9) people in 2017; much of this increase was in the proportion of the global population in south Asia and sub-Saharan Africa. The global annual rate of population growth increased between 1950 and 1964, when it peaked at 2·0%; this rate then remained nearly constant until 1970 and then decreased to 1·1% in 2017. Population growth rates in the southeast Asia, east Asia, and Oceania GBD super-region decreased from 2·5% in 1963 to 0·7% in 2017, whereas in sub-Saharan Africa, population growth rates were almost at the highest reported levels ever in 2017, when they were at 2·7%. The global average age increased from 26·6 years in 1950 to 32·1 years in 2017, and the proportion of the population that is of working age (age 15–64 years) increased from 59·9% to 65·3%. At the national level, the TFR decreased in all countries and territories between 1950 and 2017; in 2017, TFRs ranged from a low of 1·0 livebirths (95% UI 0·9–1·2) in Cyprus to a high of 7·1 livebirths (6·8–7·4) in Niger. The TFR under age 25 years (TFU25; number of livebirths expected by age 25 years for a hypothetical woman who survived the age group and was exposed to current ASFRs) in 2017 ranged from 0·08 livebirths (0·07–0·09) in South Korea to 2·4 livebirths (2·2–2·6) in Niger, and the TFR over age 30 years (TFO30; number of livebirths expected for a hypothetical woman ageing from 30 to 54 years who survived the age group and was exposed to current ASFRs) ranged from a low of 0·3 livebirths (0·3–0·4) in Puerto Rico to a high of 3·1 livebirths (3·0–3·2) in Niger. TFO30 was higher than TFU25 in 145 countries and territories in 2017. 33 countries had a negative population growth rate from 2010 to 2017, most of which were located in central, eastern, and western Europe, whereas population growth rates of more than 2·0% were seen in 33 of 46 countries in sub-Saharan Africa. In 2017, less than 65% of the national population was of working age in 12 of 34 high-income countries, and less than 50% of the national population was of working age in Mali, Chad, and Niger. Interpretation: Population trends create demographic dividends and headwinds (ie, economic benefits and detriments) that affect national economies and determine national planning needs. Although TFRs are decreasing, the global population continues to grow as mortality declines, with diverse patterns at the national level and across age groups. To our knowledge, this is the first study to provide transparent and replicable estimates of population and fertility, which can be used to inform decision making and to monitor progress. Funding: Bill & Melinda Gates Foundation.
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  • Abbafati, Cristiana, et al. (author)
  • 2020
  • Journal article (peer-reviewed)
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11.
  • Feigin, Valery L., et al. (author)
  • Global, regional, and national burden of neurological disorders, 1990–2016 : a systematic analysis for the Global Burden of Disease Study 2016
  • 2019
  • In: Lancet Neurology. - : Elsevier. - 1474-4422 .- 1474-4465. ; 18:5, s. 459-480
  • Journal article (peer-reviewed)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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12.
  • Santangelo, James S., et al. (author)
  • Global urban environmental change drives adaptation in white clover
  • 2022
  • In: Science. - : American Association for the Advancement of Science (AAAS). - 0036-8075 .- 1095-9203. ; 375
  • Journal article (peer-reviewed)abstract
    • Urbanization transforms environments in ways that alter biological evolution. We examined whether urban environmental change drives parallel evolution by sampling 110,019 white clover plants from 6169 populations in 160 cities globally. Plants were assayed for a Mendelian antiherbivore defense that also affects tolerance to abiotic stressors. Urban-rural gradients were associated with the evolution of clines in defense in 47% of cities throughout the world. Variation in the strength of clines was explained by environmental changes in drought stress and vegetation cover that varied among cities. Sequencing 2074 genomes from 26 cities revealed that the evolution of urban-rural dines was best explained by adaptive evolution, but the degree of parallel adaptation varied among cities. Our results demonstrate that urbanization leads to adaptation at a global scale.
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13.
  • Wang, Haidong, et al. (author)
  • Estimates of global, regional, and national incidence, prevalence, and mortality of HIV, 1980-2015 : the Global Burden of Disease Study 2015.
  • 2016
  • In: The lancet. HIV. - : Elsevier. - 2352-3018. ; 3:8, s. e361-e387
  • Journal article (peer-reviewed)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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14.
  • Sartelli, Massimo, et al. (author)
  • Ten golden rules for optimal antibiotic use in hospital settings: the WARNING call to action
  • 2023
  • In: WORLD JOURNAL OF EMERGENCY SURGERY. - 1749-7922. ; 18:1
  • Research review (peer-reviewed)abstract
    • Antibiotics are recognized widely for their benefits when used appropriately. However, they are often used inappropriately despite the importance of responsible use within good clinical practice. Effective antibiotic treatment is an essential component of universal healthcare, and it is a global responsibility to ensure appropriate use. Currently, pharmaceutical companies have little incentive to develop new antibiotics due to scientific, regulatory, and financial barriers, further emphasizing the importance of appropriate antibiotic use. To address this issue, the Global Alliance for Infections in Surgery established an international multidisciplinary task force of 295 experts from 115 countries with different backgrounds. The task force developed a position statement called WARNING (Worldwide Antimicrobial Resistance National/International Network Group) aimed at raising awareness of antimicrobial resistance and improving antibiotic prescribing practices worldwide. The statement outlined is 10 axioms, or "golden rules," for the appropriate use of antibiotics that all healthcare workers should consistently adhere in clinical practice.
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15.
  • Afshin, Ashkan, et al. (author)
  • Health effects of dietary risks in 195 countries, 1990-2017 : a systematic analysis for the Global Burden of Disease Study 2017
  • 2019
  • In: The Lancet. - : Elsevier. - 0140-6736 .- 1474-547X. ; 393:10184, s. 1958-1972
  • Journal article (peer-reviewed)abstract
    • Background: Suboptimal diet is an important preventable risk factor for non-communicable diseases (NCDs); however, its impact on the burden of NCDs has not been systematically evaluated. This study aimed to evaluate the consumption of major foods and nutrients across 195 countries and to quantify the impact of their suboptimal intake on NCD mortality and morbidity.Methods: By use of a comparative risk assessment approach, we estimated the proportion of disease-specific burden attributable to each dietary risk factor (also referred to as population attributable fraction) among adults aged 25 years or older. The main inputs to this analysis included the intake of each dietary factor, the effect size of the dietary factor on disease endpoint, and the level of intake associated with the lowest risk of mortality. Then, by use of diseasespecific population attributable fractions, mortality, and disability-adjusted life-years (DALYs), we calculated the number of deaths and DALYs attributable to diet for each disease outcome.Findings: In 2017, 11 million (95% uncertainty interval [UI] 10-12) deaths and 255 million (234-274) DALYs were attributable to dietary risk factors. High intake of sodium (3 million [1-5] deaths and 70 million [34-118] DALYs), low intake of whole grains (3 million [2-4] deaths and 82 million [59-109] DALYs), and low intake of fruits (2 million [1-4] deaths and 65 million [41-92] DALYs) were the leading dietary risk factors for deaths and DALYs globally and in many countries. Dietary data were from mixed sources and were not available for all countries, increasing the statistical uncertainty of our estimates.Interpretation: This study provides a comprehensive picture of the potential impact of suboptimal diet on NCD mortality and morbidity, highlighting the need for improving diet across nations. Our findings will inform implementation of evidence-based dietary interventions and provide a platform for evaluation of their impact on human health annually.
  •  
16.
  • Bousquet, Jean, et al. (author)
  • ARIA digital anamorphosis : Digital transformation of health and care in airway diseases from research to practice
  • 2021
  • In: Allergy. European Journal of Allergy and Clinical Immunology. - : John Wiley & Sons. - 0105-4538 .- 1398-9995. ; 76:1, s. 168-190
  • Research review (peer-reviewed)abstract
    • Digital anamorphosis is used to define a distorted image of health and care that may be viewed correctly using digital tools and strategies. MASK digital anamorphosis represents the process used by MASK to develop the digital transformation of health and care in rhinitis. It strengthens the ARIA change management strategy in the prevention and management of airway disease. The MASK strategy is based on validated digital tools. Using the MASK digital tool and the CARAT online enhanced clinical framework, solutions for practical steps of digital enhancement of care are proposed.
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17.
  • Nguyen, Thanh N, et al. (author)
  • Global Impact of the COVID-19 Pandemic on Stroke Volumes and Cerebrovascular Events: A 1-Year Follow-up.
  • 2023
  • In: Neurology. - 1526-632X. ; 100:4
  • Journal article (peer-reviewed)abstract
    • Declines in stroke admission, IV thrombolysis (IVT), and mechanical thrombectomy volumes were reported during the first wave of the COVID-19 pandemic. There is a paucity of data on the longer-term effect of the pandemic on stroke volumes over the course of a year and through the second wave of the pandemic. We sought to measure the effect of the COVID-19 pandemic on the volumes of stroke admissions, intracranial hemorrhage (ICH), IVT, and mechanical thrombectomy over a 1-year period at the onset of the pandemic (March 1, 2020, to February 28, 2021) compared with the immediately preceding year (March 1, 2019, to February 29, 2020).We conducted a longitudinal retrospective study across 6 continents, 56 countries, and 275 stroke centers. We collected volume data for COVID-19 admissions and 4 stroke metrics: ischemic stroke admissions, ICH admissions, IVT treatments, and mechanical thrombectomy procedures. Diagnoses were identified by their ICD-10 codes or classifications in stroke databases.There were 148,895 stroke admissions in the 1 year immediately before compared with 138,453 admissions during the 1-year pandemic, representing a 7% decline (95% CI [95% CI 7.1-6.9]; p < 0.0001). ICH volumes declined from 29,585 to 28,156 (4.8% [5.1-4.6]; p < 0.0001) and IVT volume from 24,584 to 23,077 (6.1% [6.4-5.8]; p < 0.0001). Larger declines were observed at high-volume compared with low-volume centers (all p < 0.0001). There was no significant change in mechanical thrombectomy volumes (0.7% [0.6-0.9]; p = 0.49). Stroke was diagnosed in 1.3% [1.31-1.38] of 406,792 COVID-19 hospitalizations. SARS-CoV-2 infection was present in 2.9% ([2.82-2.97], 5,656/195,539) of all stroke hospitalizations.There was a global decline and shift to lower-volume centers of stroke admission volumes, ICH volumes, and IVT volumes during the 1st year of the COVID-19 pandemic compared with the prior year. Mechanical thrombectomy volumes were preserved. These results suggest preservation in the stroke care of higher severity of disease through the first pandemic year.This study is registered under NCT04934020.
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18.
  • Roth, Gregory A, et al. (author)
  • The Burden of Cardiovascular Diseases Among US States, 1990-2016
  • 2018
  • In: JAMA cardiology. - : American Medical Association (AMA). - 2380-6583 .- 2380-6591. ; 3:5, s. 375-389
  • Journal article (peer-reviewed)abstract
    • Importance: Cardiovascular disease (CVD) is the leading cause of death in the United States, but regional variation within the United States is large. Comparable and consistent state-level measures of total CVD burden and risk factors have not been produced previously.Objective: To quantify and describe levels and trends of lost health due to CVD within the United States from 1990 to 2016 as well as risk factors driving these changes.Design, Setting, and Participants: Using the Global Burden of Disease methodology, cardiovascular disease mortality, nonfatal health outcomes, and associated risk factors were analyzed by age group, sex, and year from 1990 to 2016 for all residents in the United States using standardized approaches for data processing and statistical modeling. Burden of disease was estimated for 10 groupings of CVD, and comparative risk analysis was performed. Data were analyzed from August 2016 to July 2017.Exposures: Residing in the United States.Main Outcomes and Measures: Cardiovascular disease disability-adjusted life-years (DALYs).Results: Between 1990 and 2016, age-standardized CVD DALYs for all states decreased. Several states had large rises in their relative rank ordering for total CVD DALYs among states, including Arkansas, Oklahoma, Alabama, Kentucky, Missouri, Indiana, Kansas, Alaska, and Iowa. The rate of decline varied widely across states, and CVD burden increased for a small number of states in the most recent years. Cardiovascular disease DALYs remained twice as large among men compared with women. Ischemic heart disease was the leading cause of CVD DALYs in all states, but the second most common varied by state. Trends were driven by 12 groups of risk factors, with the largest attributable CVD burden due to dietary risk exposures followed by high systolic blood pressure, high body mass index, high total cholesterol level, high fasting plasma glucose level, tobacco smoking, and low levels of physical activity. Increases in risk-deleted CVD DALY rates between 2006 and 2016 in 16 states suggest additional unmeasured risks beyond these traditional factors.Conclusions and Relevance: Large disparities in total burden of CVD persist between US states despite marked improvements in CVD burden. Differences in CVD burden are largely attributable to modifiable risk exposures.
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19.
  • Tuya, Fernando, et al. (author)
  • Levelling-up rhodolith-bed science to address global-scale conservation challenges
  • 2023
  • In: Science of the Total Environment. - : Elsevier. - 0048-9697 .- 1879-1026. ; 892
  • Journal article (peer-reviewed)abstract
    • Global marine conservation remains fractured by an imbalance in research efforts and policy actions, limiting progression towards sustainability. Rhodolith beds represent a prime example, as they have ecological importance on a global scale, provide a wealth of ecosystem functions and services, including biodiversity provision and potential climate change mitigation, but remain disproportionately understudied, compared to other coastal ecosystems (tropical coral reefs, kelp forests, mangroves, seagrasses). Although rhodolith beds have gained some recognition, as important and sensitive habitats at national/regional levels during the last decade, there is still a notable lack of information and, consequently, specific conservation efforts. We argue that the lack of information about these habitats, and the significant ecosystem services they provide, is hindering the development of effective conservation measures and limiting wider marine conservation success. This is becoming a pressing issue, considering the multiple severe pressures and threats these habitats are exposed to (e.g., pollution, fishing activities, climate change), which may lead to an erosion of their ecological function and ecosystem services. By synthesizing the current knowledge, we provide arguments to highlight the importance and urgency of levelling-up research efforts focused on rhodolith beds, combating rhodolith bed degradation and avoiding the loss of associated biodiversity, thus ensuring the sustainability of future conservation programs.
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20.
  • Cunha, Jose M. V., et al. (author)
  • High-Performance and Industrially Viable Nanostructured SiOx Layers for Interface Passivation in Thin Film Solar Cells
  • 2021
  • In: Solar RRL. - : John Wiley & Sons. - 2367-198X. ; 5:3
  • Journal article (peer-reviewed)abstract
    • Herein, it is demonstrated, by using industrial techniques, that a passivation layer with nanocontacts based on silicon oxide (SiOx) leads to significant improvements in the optoelectronical performance of ultrathin Cu(In,Ga)Se-2 (CIGS) solar cells. Two approaches are applied for contact patterning of the passivation layer: point contacts and line contacts. For two CIGS growth conditions, 550 and 500 degrees C, the SiOx passivation layer demonstrates positive passivation properties, which are supported by electrical simulations. Such positive effects lead to an increase in the light to power conversion efficiency value of 2.6% (absolute value) for passivated devices compared with a nonpassivated reference device. Strikingly, both passivation architectures present similar efficiency values. However, there is a trade-off between passivation effect and charge extraction, as demonstrated by the trade-off between open-circuit voltage (V-oc) and short-circuit current density (J(sc)) compared with fill factor (FF). For the first time, a fully industrial upscalable process combining SiOx as rear passivation layer deposited by chemical vapor deposition, with photolithography for line contacts, yields promising results toward high-performance and low-cost ultrathin CIGS solar cells with champion devices reaching efficiency values of 12%, demonstrating the potential of SiOx as a passivation material for energy conversion devices.
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21.
  • Jeusfeld, Manfred A., et al. (author)
  • Deductive reconstruction of MLT* for multi-level modeling
  • 2020
  • In: MODELS '20. - New York : Association for Computing Machinery (ACM). - 9781450381352
  • Conference paper (peer-reviewed)abstract
    • In the last two decades, about a dozen proposals were made to extend object-oriented modeling by multiple abstraction levels. One group of proposals designates explicit levels to objects and classes. The second group uses the powertype pattern to implicitly establish levels. From this group, we consider two proposals, DeepTelos and MLT*. Both have been defined via axioms and both give a central role to the powertype pattern. In this paper, we reconstruct MLT* with the deductive axiomatization style used for DeepTelos. The resulting specification is executed in a deductive database to check MLT* multi-level models for errors and complete them with derived facts that do not have to be explicitly asserted by modelers. This leverages the rich rules of MLT* with the deductive approach underlying DeepTelos. The effort also allows us to clearly establish the relation between DeepTelos and MLT*, in an attempt to clarify the relations between approaches in this research domain. As a byproduct, we supply MLT-Telos as a fully operational deductive implementation of MLT* to the research community.
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22.
  • Tavares, Julia, et al. (author)
  • Basin-wide variation in tree hydraulic safety margins predicts the carbon balance of Amazon forests
  • 2023
  • In: Nature. - : Springer Nature. - 0028-0836 .- 1476-4687. ; 617:7959, s. 111-117
  • Journal article (peer-reviewed)abstract
    • Tropical forests face increasing climate risk(1,2), yet our ability to predict their response to climate change is limited by poor understanding of their resistance to water stress. Although xylem embolism resistance thresholds (for example, ?(50)) and hydraulic safety margins (for example, HSM50) are important predictors of drought-induced mortality risk(3-5), little is known about how these vary across Earth's largest tropical forest. Here, we present a pan-Amazon, fully standardized hydraulic traits dataset and use it to assess regional variation in drought sensitivity and hydraulic trait ability to predict species distributions and long-term forest biomass accumulation. Parameters ?(50) and HSM50 vary markedly across the Amazon and are related to average long-term rainfall characteristics. Both ?(50) and HSM50 influence the biogeographical distribution of Amazon tree species. However, HSM50 was the only significant predictor of observed decadal-scale changes in forest biomass. Old-growth forests with wide HSM50 are gaining more biomass than are low HSM(50 )forests. We propose that this may be associated with a growth-mortality trade-off whereby trees in forests consisting of fast-growing species take greater hydraulic risks and face greater mortality risk. Moreover, in regions of more pronounced climatic change, we find evidence that forests are losing biomass, suggesting that species in these regions may be operating beyond their hydraulic limits. Continued climate change is likely to further reduce HSM50 in the Amazon(6,7), with strong implications for the Amazon carbon sink.
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23.
  • Alberto, Helena, V, et al. (author)
  • Characterization of the Interfacial Defect Layer in Chalcopyrite Solar Cells by Depth-Resolved Muon Spin Spectroscopy
  • 2022
  • In: Advanced Materials Interfaces. - : John Wiley & Sons. - 2196-7350. ; 9:19
  • Journal article (peer-reviewed)abstract
    • As devices become smaller and more complex, the interfaces between adjacent materials become increasingly important and are often critical to device performance. An important research goal is to improve the interface between the absorber and the window layer by inserting buffer layers to adjust the transition. Depth-resolved studies are key for a fundamental understanding of the interface. In the present experiment, the interface between the chalcopyrite Cu(In,Ga)Se-2 absorber and various buffer layers are investigated using low-energy muon spin rotation (mu SR) spectroscopy. Depth resolution in the nm range is achieved by implanting the muons with different energies so that they stop at different depths in the sample. Near the interface, a region about 50 nm wide is detected where the lattice is more distorted than further inside the absorber. The distortion is attributed to the long-range strain field caused by defects. These measurements allow a quantification of the corresponding passivation effect of the buffer layer. Bath-deposited cadmium sulfide provides the best defect passivation in the near interface region, in contrast to the dry-deposited oxides, which have a much smaller effect. The experiment demonstrates the great potential of low energy mu SR spectroscopy for microscopic interfacial studies of multilayer systems.
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24.
  • de Souza, Claudio M. D., et al. (author)
  • Interaction of forsterite-91 with distilled water and artificial seawater : a prebiotic chemistry experiment
  • 2013
  • In: International Journal of Astrobiology. - 1473-5504 .- 1475-3006. ; 12:2, s. 135-143
  • Journal article (peer-reviewed)abstract
    • In the present work, the interactions between forsterite-91 with distilled water and forsterite-91 with artificial seawater were studied at two pHs (2.0 and 8.0) using different techniques. A large increase in pH was observed for samples incubated at an initially acidic pH (2.0) due to the dissolution of forsterite-91 in distilled water and artificial seawater. Thus, in acidic hydrothermal vents, an increase in the amount of hydrocarbons and magnetite should be expected due to the release of Fe(II). The pH(PZC) decreased and the pH(IEP) increased when forsterite-91 was treated with distilled water and artificial seawater. The ions from the artificial seawater had an effect on zeta potential. Scanning electron microscopy (SEM) images and X-ray diffractograms showed halite in the samples of forsterite-91 mixed with artificial seawater. The presence of halite or adsorption of ions on the surface of forsterite-91 could affect the synthesis of magnetite and hydrocarbons in hydrothermal vents, due to a decrease in the dissolution rates of forsterite-91. The dissolution of forsterite-91 yields low concentrations of Fe(III) and Mn(II) as detected by electron paramagnetic resonance (EPR) spectroscopy. Microanalysis of forsterite-91 showed a higher amount of Mn, with an oxidation that was likely not + II, as Mn in supernatant solutions was only detected by EPR spectroscopy after mixing with artificial seawater at pH 2.0. As Fe(III) and Mn(II) are catalyst constituents of magnetite and manganese oxide, respectively, their presence is important for synthesis in hydrothermal vents. Etch pits were observed only in the forsterite-91 sample mixed with distilled water at pH 8.0. Na, Cl, S, Ca and K were detected in the samples mixed with artificial seawater by SEM-EDS. Si, Mg, Fe and Al were detected in almost all supernatant samples due to forsterite-91 dissolution. Cr was not dissolved in the experiments, thus Cr in the mineral could serve as an effective catalyst for Fischer Tropsch Types (FTT) reactions in hydrothermal vent systems. X-ray diffractograms of the original forsterite-91 also showed peaks arising from zeolites and clinochlore. After the samples were treated with artificial seawater, X-ray diffractograms showed the dissolution of zeolite. Experiments should be performed in the natural environment to verify the potential for zeolites to act as a catalyst in hydrothermal vents.
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25.
  • Erjefält, Jonas S., et al. (author)
  • Diffuse alveolar damage patterns reflect the immunological and molecular heterogeneity in fatal COVID-19
  • 2022
  • In: EBioMedicine. - : Elsevier BV. - 2352-3964. ; 83
  • Journal article (peer-reviewed)abstract
    • Background: Severe COVID-19 lung disease exhibits a high degree of spatial and temporal heterogeneity, with different histological features coexisting within a single individual. It is important to capture the disease complexity to support patient management and treatment strategies. We provide spatially decoded analyses on the immunopathology of diffuse alveolar damage (DAD) patterns and factors that modulate immune and structural changes in fatal COVID-19. Methods: We spatially quantified the immune and structural cells in exudative, intermediate, and advanced DAD through multiplex immunohistochemistry in autopsy lung tissue of 18 COVID-19 patients. Cytokine profiling, viral, bacteria, and fungi detection, and transcriptome analyses were performed. Findings: Spatial DAD progression was associated with expansion of immune cells, macrophages, CD8+ T cells, fibroblasts, and (lymph)angiogenesis. Viral load correlated positively with exudative DAD and negatively with disease/hospital length. In all cases, enteric bacteria were isolated, and Candida parapsilosis in eight cases. Cytokines correlated mainly with macrophages and CD8+T cells. Pro-coagulation and acute repair were enriched pathways in exudative DAD whereas intermediate/advanced DAD had a molecular profile of elevated humoral and innate immune responses and extracellular matrix production. Interpretation: Unraveling the spatial and molecular immunopathology of COVID-19 cases exposes the responses to SARS-CoV-2-induced exudative DAD and subsequent immune-modulatory and remodeling changes in proliferative/advanced DAD that occur side-by-side together with secondary infections in the lungs. These complex features have important implications for disease management and the development of novel treatments. Funding: CNPq, Bill and Melinda Gates Foundation, HC-Convida, FAPESP, Regeneron Pharmaceuticals, and the Swedish Heart & Lung Foundation.
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26.
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27.
  • Kühne, Thomas, et al. (author)
  • Field Types for Deep Characterization in Multi-Level Modeling
  • 2023
  • In: Proceedings 2023 ACM/IEEE International Conference on Model Driven Engineering Languages and Systems Companion MODELS-C 2023, Västerås, Sweden 1-6 October 2023. - : IEEE. - 9798350324990 - 9798350324983 ; , s. 639-648
  • Conference paper (peer-reviewed)abstract
    • Traditional two-level modeling approaches distinguish between class- and object features. Using UML parlance, classes have attributes which require their instances to have  object slots. Multi-Level Modeling unifies classes and objects to "clabjects", and it has been suggested that attributes and slots can and should be unified to "fields" in a similar way. The notion of deep instantiation for clabjects creates the possibility of "deep fields", i.e., fields that expand on the roles of pure attributes or pure slots. In this paper, we discuss several variants of such a "deep field" notion, pointing out the semantic differences and the various resulting trade-offs. We hope our observations will help clarify the range of options for supporting clabject fields in multi-level modeling and thus aid future MLM development.
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28.
  • Monteiro, Bernardo, et al. (author)
  • Lanthanide-based complexes as efficient physiological temperature sensors
  • 2022
  • In: Materials Chemistry and Physics. - : Elsevier BV. - 0254-0584 .- 1879-3312. ; 277
  • Journal article (peer-reviewed)abstract
    • A new molecular thermometric sensor based on the terbium(III) complex [C(2)mim][Tb(fod)4] (C(2)mim - 1-methyl-3-ethylimidazolium, fod(-) - tetrakis-6,6,7,7,8,8,8-heptafluoro-2,2-dimethyl-3,5-octanedionate),doped with 0.015% of its europium(III) analogue (1, [C(2)mim][Tb(fod)(4)]0.99985:[C(2)mim][Eu(fod)(4)]0.00015), was prepared and its thermochromic behaviour evaluated from ambient temperature up to 75 degrees C, including in the physiological range (35-45 degrees C). It was found that the intensity ratio of the D-5(4)-> F-7(5) (TbIII) and D-5(0)-> F-7(2) (EuIII) transitions is correlated with temperature having three different linear regimes. Visual colorimetry allowed the evaluation of the temperature in different ranges from green at ambient temperature, to yellow and finally red at higher temperatures. The TbIII complex emission intensity is extremely sensitive to small temperature variations, particularly between 25 and 35 degrees C, were it reaches only 40% of the initial intensity. Confinement of the dopped TbIII tetrakis-complex in the organic polymeric matrix poly(methylmethacrylate) (PMMA) induced higher thermal stability in 1, together with a strong temperature dependence of the most intense emissive transition of the TbIII complexes. The photoluminescence quantum yield of polymer-lanthanide hybrid materials increased significantly compared with that of 1. Under 366 nm irradiation, the hybrid material presents a green colour at 25 degrees C that evolves to yellow at 30 degrees C and to a white tone at 35 degrees C.
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29.
  • Nashih, Samuel K., et al. (author)
  • Validation of a Simulation Model for Analysis of Shading Effects on Photovoltaic Panels
  • 2016
  • In: Journal of solar energy engineering. - : ASME International. - 0199-6231 .- 1528-8986. ; 138:4
  • Journal article (peer-reviewed)abstract
    • Numerical simulation results and modeling on the electrical features of concentrating photovoltaic-thermal (PVT) using the free circuit simulation package from linear technology corporation (LTSPICE) are presented. The effects of partial shading of cell strings and temperature are analyzed, showing very good agreement with the results obtained experimentally in lab, at Lisbon University, and under outdoor testing using similar receivers, at the SME Solarus Sunpower AB, a Swedish company whose mission is the development, production, and marketing of concentrated solar technology to the world market. The potential of the used methodology for the design of the solar cell configuration is emphasized as an important tool to optimize PV and PVT performances in the energy conversion process. 
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30.
  • Nehme, Ralda, et al. (author)
  • The 22q11.2 region regulates presynaptic gene-products linked to schizophrenia
  • 2022
  • In: Nature Communications. - : Nature Publishing Group. - 2041-1723. ; 13:1
  • Journal article (peer-reviewed)abstract
    • It is unclear how the 22q11.2 deletion predisposes to psychiatric disease. To study this, we generated induced pluripotent stem cells from deletion carriers and controls and utilized CRISPR/Cas9 to introduce the heterozygous deletion into a control cell line. Here, we show that upon differentiation into neural progenitor cells, the deletion acted in trans to alter the abundance of transcripts associated with risk for neurodevelopmental disorders including autism. In excitatory neurons, altered transcripts encoded presynaptic factors and were associated with genetic risk for schizophrenia, including common and rare variants. To understand how the deletion contributed to these changes, we defined the minimal protein-protein interaction network that best explains gene expression alterations. We found that many genes in 22q11.2 interact in presynaptic, proteasome, and JUN/FOS transcriptional pathways. Our findings suggest that the 22q11.2 deletion impacts genes that may converge with psychiatric risk loci to influence disease manifestation in each deletion carrier.
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31.
  • Ramos do Prado, Samira Bernardino, 1990-, et al. (author)
  • Chelate-soluble Pectin Fraction From Papaya Pulp Interacts With galectin-3 and Inhibits Colon Cancer Cell Proliferation
  • 2019
  • In: International Journal of Biological Macromolecules. - : Elsevier. - 0141-8130 .- 1879-0003. ; 126, s. 170-178
  • Journal article (peer-reviewed)abstract
    • Colorectal cancer has an overexpression of galectin-3 that is related to cancer progression. A decreased risk of colon cancer can be related to consumption of dietary fibers, but the entire mechanism by which this protection occurs remains unclear. Pectin is a type of dietary fiber that possesses β-galactosides and can bind and inhibit galectin-3–mediated effects. Papaya fruit has a massive cell wall disassembling during ripening that naturally changes its pectin structure. Our work shows that different points in the ripening time of papaya fruit exhibit pectins (chelate-soluble fractions; CSF) that can or cannot inhibit galectin-3. The fraction that inhibits galectin-3 (3CSF) also diminishes the proliferation of colon cancer cell lines, and it is derived from an intermediate point of papaya ripening. Therefore, we related this to a papaya pectin structure-dependent effect, and the papaya fruit seems to have a pectin structure that is promising in decreasing the risk of colon cancer development.
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32.
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33.
  • Torres, João Paulo N., et al. (author)
  • Effect of reflector geometry in the annual received radiation of low concentration photovoltaic systems
  • 2018
  • In: Energies. - : MDPI AG. - 1996-1073. ; 11:7
  • Journal article (peer-reviewed)abstract
    • Solar concentrator photovoltaic collectors are able to deliver energy at higher temperatures for the same irradiances, since they are related to smaller areas for which heat losses occur. However, to ensure the system reliability, adequate collector geometry and appropriate choice of the materials used in these systems will be crucial. The present work focuses on the re-design of the Concentrating Photovoltaic system (C-PV) collector reflector presently manufactured by the company Solarus, together with an analysis based on the annual assessment of the solar irradiance in the collector. An open-source ray tracing code (Soltrace) is used to accomplish the modelling of optical systems in concentrating solar power applications. Symmetric parabolic reflector configurations are seen to improve the PV system performance when compared to the conventional structures currently used by Solarus. The parabolic geometries, using either symmetrically or asymmetrically placed receivers inside the collector, accomplished both the performance and cost-effectiveness goals: for almost the same area or costs, the new proposals for the PV system may be in some cases 70% more effective as far as energy output is concerned.
  •  
34.
  • Torres, João Paulo N., et al. (author)
  • The effect of shading on photovoltaic solar panels
  • 2018
  • In: Energy Systems, Springer Verlag. - : Springer Berlin/Heidelberg. - 1868-3967 .- 1868-3975. ; 9:1, s. 195-208
  • Journal article (peer-reviewed)abstract
    • A modelling description of photovoltaic (PV) modules in a PSPICE environment is presented. To validate the simulation model, a lab prototype is used to create similar conditions as those existing in real photovoltaic systems. The effects of partial shading of solar cell strings and temperature on the performance of various PV modules are analyzed. The simulation results show a very good agreement with those obtained experimentally in similar conditions, either in lab, at Lisbon University, and under outdoor testing in Sweden, using PV solar collectors manufactured by Solarus Sunpower AB. The potential of the simulation analysis is highlighted as a flexible and powerful tool for the design of new and more competitive PV module configurations for the collectors in solar panels.
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35.
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36.
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37.
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38.
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39.
  • Zhang, Guojie, et al. (author)
  • Comparative genomics reveals insights into avian genome evolution and adaptation
  • 2014
  • In: Science. - : American Association for the Advancement of Science (AAAS). - 0036-8075 .- 1095-9203. ; 346:6215, s. 1311-1320
  • Journal article (peer-reviewed)abstract
    • Birds are the most species-rich class of tetrapod vertebrates and have wide relevance across many research fields. We explored bird macroevolution using full genomes from 48 avian species representing all major extant clades. The avian genome is principally characterized by its constrained size, which predominantly arose because of lineage-specific erosion of repetitive elements, large segmental deletions, and gene loss. Avian genomes furthermore show a remarkably high degree of evolutionary stasis at the levels of nucleotide sequence, gene synteny, and chromosomal structure. Despite this pattern of conservation, we detected many non-neutral evolutionary changes in protein-coding genes and noncoding regions. These analyses reveal that pan-avian genomic diversity covaries with adaptations to different lifestyles and convergent evolution of traits.
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40.
  • Bose, Sourav, et al. (author)
  • Optical Lithography Patterning of SiO2 Layers for Interface Passivation of Thin Film Solar Cells
  • 2018
  • In: Solar RRL. - : Wiley. - 2367-198X. ; 2:12
  • Journal article (peer-reviewed)abstract
    • Ultrathin Cu(In,Ga)Se-2 solar cells are a promising way to reduce costs and to increase the electrical performance of thin film solar cells. An optical lithography process that can produce sub-micrometer contacts in a SiO2 passivation layer at the CIGS rear contact is developed in this work. Furthermore, an optimization of the patterning dimensions reveals constrains over the features sizes. High passivation areas of the rear contact are needed to passivate the CIGS interface so that high performing solar cells can be obtained. However, these dimensions should not be achieved by using long distances between the contacts as they lead to poor electrical performance due to poor carrier extraction. This study expands the choice of passivation materials already known for ultrathin solar cells and its fabrication techniques.
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41.
  • Courbis, Anne-Lise, et al. (author)
  • Electronic Clinical Decision Support System for allergic rhinitis management : MASK e-CDSS
  • 2018
  • In: Clinical and Experimental Allergy. - : WILEY. - 0954-7894 .- 1365-2222. ; 48:12, s. 1640-1653
  • Journal article (peer-reviewed)abstract
    • Background: Allergic rhinitis (AR) management has changed in recent years following the switch from the concept of disease severity to the concept of disease control, publication of the AR clinical decision support system (CDSS) and development of mobile health (m-health) tools for patients (eg Allergy Diary). The Allergy Diary Companion app for healthcare providers is currently being developed and will be launched in 2018. It incorporates the AR CDSS to provide evidence-based treatment recommendations, linking all key stakeholders in AR management.Objective: To produce an electronic version of the AR CDSS (e-CDSS) for incorporation into the Allergy Diary Companion, to describe the app interfaces used to collect information necessary to inform the e-CDSS and to summarize some key features of the Allergy Diary Companion.Methods: The steps involved in producing the e-CDSS and incorporating it into the Allergy Diary Companion were (a) generation of treatment management scenarios; (b) expert consensus on treatment recommendations; (c) generation of electronic decisional algorithms to describe all AR CDSS scenarios; (d) digitization of these algorithms to form the e-CDSS; and (e) embedding the e-CDSS into the app to permit easy user e-CDSS interfacing.Results: Key experts in the AR field agreed on the AR CDSS approach to AR management and on specific treatment recommendations provided by Allergy Diary Companion. Based on this consensus, decision processes were developed and programmed into the Allergy Diary Companion using Titanium Appcelerator (JavaScript) for IOS tablets. To our knowledge, this is the first time the development of any m-health tool has been described in this transparent and detailed way, providing confidence, not only in the app, but also in the provided management recommendations.Conclusion: The Allergy Diary Companion for providers provides guideline and expert-endorsed AR management recommendations. [MASK paper No 32].
  •  
42.
  • Franke, Ulrik, 1981- (author)
  • Analysis of enterprise IT service availability : Enterprise architecture modeling for assessment, prediction, and decision-making
  • 2012
  • Doctoral thesis (other academic/artistic)abstract
    • Information technology has become increasingly important to individuals and organizations alike. Not only does IT allow us to do what we always did faster and more effectively, but it also allows us to do new things, organize ourselves differently, and work in ways previously unimaginable. However, these advantages come at a cost: as we become increasingly dependent upon IT services, we also demand that they are continuously and uninterruptedly available for use. Despite advances in reliability engineering, the complexity of today's increasingly integrated systems offers a non-trivial challenge in this respect. How can high availability of enterprise IT services be maintained in the face of constant additions and upgrades, decade-long life-cycles, dependencies upon third-parties and the ever-present business-imposed requirement of flexible and agile IT services?The contribution of this thesis includes (i) an enterprise architecture framework that offers a unique and action-guiding way to analyze service availability, (ii) identification of causal factors that affect the availability of enterprise IT services, (iii) a study of the use of fault trees for enterprise architecture availability analysis, and (iv) principles for how to think about availability management.This thesis is a composite thesis of five papers. Paper 1 offers a framework for thinking about enterprise IT service availability management, highlighting the importance of variance of outage costs. Paper 2 shows how enterprise architecture (EA) frameworks for dependency analysis can be extended with Fault Tree Analysis (FTA) and Bayesian networks (BN) techniques. FTA and BN are proven formal methods for reliability and availability modeling. Paper 3 describes a Bayesian prediction model for systems availability, based on expert elicitation from 50 experts. Paper 4 combines FTA and constructs from the ArchiMate EA language into a method for availability analysis on the enterprise level. The method is validated by five case studies, where annual downtime estimates were always within eight hours from the actual values. Paper 5 extends the Bayesian prediction model from paper 3 and the modeling method from paper 4 into a full-blown enterprise architecture framework, expressed in a probabilistic version of the Object Constraint Language. The resulting modeling framework is tested in nine case studies of enterprise information systems.
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43.
  • Lavall, Rodrigo L., et al. (author)
  • An unprecedented hybrid polyoxometalate based on niobium oligomers: A notable application as redox supercapacitor electrode
  • 2023
  • In: Chemical Engineering Journal. - : ELSEVIER SCIENCE SA. - 1385-8947 .- 1873-3212. ; 455
  • Journal article (peer-reviewed)abstract
    • An unprecedented polyoxoniobate (PONb) oligomer was obtained by addition of a methylene blue (MB) dye solution over the PONb solution formed a blue nanogel that was converted into a stable blue solid through a lyophilization process. The new solid composite, so-called "blue polyoxoniobate" (blue-PONb), presents a two-dimensional (2D) morphology with electrochemical performance that stand out among the materials used in redox supercapacitor technology. This new material was evaluated as supercapacitor electrode showing a high areal specific capacitance and power density that reaches 110.50 mF cm(-2) and 8.49 mW cm(-2). In addition, in this composite the redox additive (MB) and the PONb presented a peculiar electrochemical behavior, the reduction of the niobium species and the transfer of electrons necessary for the accumulation of charge occurring simultaneously. As a result, blue-PONb electrode maintains the cycling performance with high coulombic effi-ciency (similar to 99 %) over the 50,000 cycles evaluated. Here, the origins of the electrochemical stability and the mechanism of operation of the blue-PONb electrode are analyzed and discussed. Finally, this work presents a PONb as a new and promising class of redox-capacitive materials with matrix/redox shuttle synergism.
  •  
44.
  • Lopes, Tomas S., et al. (author)
  • Rear Optical Reflection and Passivation Using a Nanopatterned Metal/Dielectric Structure in Thin-Film Solar Cells
  • 2019
  • In: IEEE Journal of Photovoltaics. - : IEEE-INST ELECTRICAL ELECTRONICS ENGINEERS INC. - 2156-3381 .- 2156-3403. ; 9:5, s. 1421-1427
  • Journal article (peer-reviewed)abstract
    • Currently, one of the main limitations in ultrathin Cu(In,Ga)Se-2 (CIGS) solar cells are the optical losses, since the absorber layer is thinner than the light optical path. Hence, light management, including rear optical reflection, and light trapping is needed. In this paper, we focus on increasing the rear optical reflection. For this, a novel structure based on having a metal interlayer in between the Mo rear contact and the rear passivation layer is presented. In total, eight different metallic interlayers are compared. For the whole series, the passivation layer is aluminum oxide (Al2O3). The interlayers are used to enhance the reflectivity of the rear contact and thereby increasing the amount of light reflected back into the absorber. In order to understand the effects of the interlayer in the solar cell performance both from optical and/or electrical point of view, optical simulations were performed together with fabrication and electrical measurements. Optical simulations results are compared with current density-voltage (J-V) behavior and external quantum efficiency measurements. A detailed comparison between all the interlayers is done, in order to identify the material with the greatest potential to he used as a rear reflective layer for ultrathin CIGS solar cells and to establish fabrication challenges. The Ti-W alloy is a promising a rear reflective layer since it provides solar cells with light to power conversion efficiency values of 9.9%, which is 2.2% (abs) higher than the passivated ultrathin sample and 3.7% (abs) higher than the unpassivated ultrathin reference sample.
  •  
45.
  • Machado, Carla G., et al. (author)
  • Implementation of a knowledge management program and its impact on the management system : Case study at an industrial company
  • 2010
  • Conference paper (peer-reviewed)abstract
    • The business and management environment is influenced by political, organizational, institutional, technological, economic and social phenomena of a global scope. Thus, capturing, registering, organizing and disseminating information and knowledge plays a strategic role in organizations. The objective of this paper is to present a case study of an organization that is developing a Knowledge Management project, analyzing its initiative in order to classify the stage at which the company’s knowledge management cycle is at and to relate this cycle to other management instruments it has. The following instruments were used to raise and collect data: individual interviews and bibliographic study. This paper represents an important contribution to the study of knowledge management, demonstrating new technologies that can leverage organizational change and trigger a new understanding of Knowledge Management.
  •  
46.
  • Marinho, Marco A. M., 1986-, et al. (author)
  • Antenna Array Based Localization Scheme for Vehicular Networks
  • 2017
  • In: 2017 IEEE International Conference on Computer and Information Technology (CIT). - Los Alamitos : IEEE Computer Society. - 9781538609583 - 9781538609590 ; , s. 142-146
  • Conference paper (peer-reviewed)abstract
    • Vehicular ad hoc networks (VANETs) are emerging as the possible solution for multiple concerns in road traffic such as mobility and safety. One of the main concerns present in VANETs is the localization and tracking of vehicles. This work presents a passive vehicle localization and tracking method based on direction of arrival (DOA) estimation. The proposed method does not rely on external sources of information such as Global Navigation Satellite Systems (GNSS) and can be used to mitigate the possibility of spoofing or to provide a second independent source of position estimation for integrity purposes. The proposed algorithm uses array signal processing techniques to estimate not only the position but also the direction of other vehicles in network. Furthermore, it is a fully passive method and can alleviate the network load since it does not require any location based data exchange and can be performed by any listening vehicle using the signal of any data transmission. A set of numerical simulations is used to validate the proposed method and the results are shown to be more precise than the average accuracy of Global Position System (GPS) receivers. © Copyright 2017 IEEE
  •  
47.
  • Marinho, Marco A. M., et al. (author)
  • Array interpolation based on multivariate adaptive regression splines
  • 2016
  • In: 2016 IEEE Sensor Array and Multichannel Signal Processing Workshop (SAM). - Piscataway, NJ : Institute of Electrical and Electronics Engineers (IEEE).
  • Conference paper (peer-reviewed)abstract
    • Many important signal processing techniques such as Spatial Smoothing, Forward Backward Averaging and Root-MUSIC, rely on antenna arrays with specific and precise structures. Arrays with such ideal structures, such as a centro-hermitian structure, are often hard to build in practice. Array interpolation is used to enable the usage of these techniques with imperfect (not having a centro-hermitian structure) arrays. Most interpolation methods rely on methods based on least squares (LS) to map the output of a perfect virtual array based on the real array. In this work, the usage of Multivariate Adaptive Regression Splines (MARS) is proposed instead of the traditional LS to interpolate arrays with responses largely different from the ideal.
  •  
48.
  • Marinho, Marco A. M., 1986-, et al. (author)
  • Performance Assessment for Distributed Broadband Radio Localization
  • 2018
  • In: 2018 52nd Asilomar Conference on Signals, Systems, and Computers. - Washington, DC : IEEE. - 9781538692189 - 9781538692165 - 9781538692172 - 9781538692196 ; , s. 20-23
  • Conference paper (peer-reviewed)abstract
    • Various emerging technologies, such as autonomous vehicles and fully autonomous flying, require precision positioning. This work presents a localization and tracking method based on joint direction of arrival (DOA), time delay, and range estimation using the SAGE algorithm. The proposed method does not rely on external sources of information such as global navigation satellite systems (GNSS). The method is opportunistic and does not require any location-based data exchange. A set of numerical simulations is presented to assess the performance of the proposed method.
  •  
49.
  • Marisa, Ferreira, 1992-, et al. (author)
  • Using endogenous saccades to characterize fatigue in multiple sclerosis
  • 2017
  • In: Multiple Sclerosis and Related Disorders. - : Elsevier. - 2211-0348 .- 2211-0356. ; 14, s. 16-22
  • Journal article (peer-reviewed)abstract
    • PurposeMultiple Sclerosis (MS) is likely to cause dysfunction of neural circuits between brain regions increasing brain working load or a subjective overestimation of such working load leading to fatigue symptoms. The aim of this study was to investigate if saccades can reveal the effect of fatigue in patients with MS.MethodsPatients diagnosed with MS (EDSS<=3) and age matched controls were recruited. Eye movements were monitored using an infrared eyetracker. Each participant performed 40 trials in an endogenous generated saccade paradigm (valid and invalid trials). The fatigue severity scale (FSS) was used to assess the severity of fatigue. FSS scores were used to define two subgroups, the MS fatigue group (score above normal range) and the MS non-fatigue. Differences between groups were tested using linear mixed models.ResultsThirty-one MS patients and equal number of controls participated in this study. FSS scores were above the normal range in 11 patients. Differences in saccade latency were found according to group (p<0.001) and trial validity (p=0.023). Differences were 16.9 ms, between MS fatigue and MS non-fatigue, 15.5 ms between MS fatigue and control. The mean difference between valid and invalid trials was 7.5 ms. Differences in saccade peak velocity were found according to group (p<0.001), the difference between MS fatigue and control was 22.3°/s and between MS fatigue and non-fatigue was 12.3°/s. Group was a statistically significant predictor for amplitude (p<0.001). FSS scores were correlated with peak velocity (p=0.028) and amplitude (p=0.019).ConclusionConsistent with the initial hypothesis, our study revealed altered saccade latency, peak velocity and amplitude in patients with fatigue symptoms. Eye movement testing can complement the standard inventories when investigating fatigue because they do not share similar limitations. Our findings contribute to the understanding of functional changes induced by MS and might be useful for clinical trials and treatment decisions.
  •  
50.
  • Pozdniakova, Tatiana A., et al. (author)
  • Optimization of a hybrid bacterial/Arabidopsis thaliana fatty acid synthase system II in Saccharomyces cerevisiae
  • 2023
  • In: Metabolic Engineering Communications. - 2214-0301. ; 17
  • Journal article (peer-reviewed)abstract
    • Fatty acids are produced by eukaryotes like baker's yeast Saccharomyces cerevisiae mainly using a large multifunctional type I fatty acid synthase (FASI) where seven catalytic steps and a carrier domain are shared between one or two protein subunits. While this system may offer efficiency in catalysis, only a narrow range of fatty acids are produced. Prokaryotes, chloroplasts and mitochondria rely instead on a FAS type II (FASII) where each catalytic step is carried out by a monofunctional enzyme encoded by a separate gene. FASII is more flexible and capable of producing a wider range of fatty acid structures, such as the direct production of unsaturated fatty acids. An efficient FASII in the preferred industrial organism S. cerevisiae could provide a platform for developing sustainable production of specialized fatty acids. We functionally replaced either yeast FASI genes (FAS1 or FAS2) with a FASII consisting of nine genes from Escherichia coli (acpP, acpS and fab -A, -B, -D, -F, -G, -H, -Z) as well as three from Arabidopsis thaliana (MOD1, FATA1 and FATB). The genes were expressed from an autonomously replicating multicopy vector assembled using the Yeast Pathway Kit for in-vivo assembly in yeast. Two rounds of adaptation led to a strain with a maximum growth rate (μmax) of 0.19 h−1 without exogenous fatty acids, twice the growth rate previously reported for a comparable strain. Additional copies of the MOD1 or fabH genes resulted in cultures with higher final cell densities and three times higher lipid content compared to the control.
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