| 1. |
- McMahon, Colin J, et al.
(författare)
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Paediatric and adult congenital cardiology education and training in Europe.
- 2022
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Ingår i: Cardiology in the young. - 1467-1107. ; 32:12, s. 1966-1983
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Tidskriftsartikel (refereegranskat)abstract
- Limited data exist on training of European paediatric and adult congenital cardiologists.A structured and approved questionnaire was circulated to national delegates of Association for European Paediatric and Congenital Cardiology in 33 European countries.Delegates from 30 countries (91%) responded. Paediatric cardiology was not recognised as a distinct speciality by the respective ministry of Health in seven countries (23%). Twenty countries (67%) have formally accredited paediatric cardiology training programmes, seven (23%) have substantial informal (not accredited or certified) training, and three (10%) have very limited or no programme. Twenty-two countries have a curriculum. Twelve countries have a national training director. There was one paediatric cardiology centre per 2.66 million population (range 0.87-9.64 million), one cardiac surgical centre per 4.73 million population (range 1.63-10.72 million), and one training centre per 4.29 million population (range 1.63-10.72 million population). The median number of paediatric cardiology fellows per training programme was 4 (range 1-17), and duration of training was 3 years (range 2-5 years). An exit examination in paediatric cardiology was conducted in 16 countries (53%) and certification provided by 20 countries (67%). Paediatric cardiologist number is affected by gross domestic product (R2 = 0.41).Training varies markedly across European countries. Although formal fellowship programmes exist in many countries, several countries have informal training or no training. Only a minority of countries provide both exit examination and certification. Harmonisation of training and standardisation of exit examination and certification could reduce variation in training thereby promoting high-quality care by European congenital cardiologists.
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| 2. |
- Palmer, Nicholette D, et al.
(författare)
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A genome-wide association search for type 2 diabetes genes in African Americans.
- 2012
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Ingår i: PloS one. - San Francisco : Public Library of Science (PLoS). - 1932-6203. ; 7:1, s. e29202-
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Tidskriftsartikel (refereegranskat)abstract
- African Americans are disproportionately affected by type 2 diabetes (T2DM) yet few studies have examined T2DM using genome-wide association approaches in this ethnicity. The aim of this study was to identify genes associated with T2DM in the African American population. We performed a Genome Wide Association Study (GWAS) using the Affymetrix 6.0 array in 965 African-American cases with T2DM and end-stage renal disease (T2DM-ESRD) and 1029 population-based controls. The most significant SNPs (n = 550 independent loci) were genotyped in a replication cohort and 122 SNPs (n = 98 independent loci) were further tested through genotyping three additional validation cohorts followed by meta-analysis in all five cohorts totaling 3,132 cases and 3,317 controls. Twelve SNPs had evidence of association in the GWAS (P<0.0071), were directionally consistent in the Replication cohort and were associated with T2DM in subjects without nephropathy (P<0.05). Meta-analysis in all cases and controls revealed a single SNP reaching genome-wide significance (P<2.5×10(-8)). SNP rs7560163 (P = 7.0×10(-9), OR (95% CI) = 0.75 (0.67-0.84)) is located intergenically between RND3 and RBM43. Four additional loci (rs7542900, rs4659485, rs2722769 and rs7107217) were associated with T2DM (P<0.05) and reached more nominal levels of significance (P<2.5×10(-5)) in the overall analysis and may represent novel loci that contribute to T2DM. We have identified novel T2DM-susceptibility variants in the African-American population. Notably, T2DM risk was associated with the major allele and implies an interesting genetic architecture in this population. These results suggest that multiple loci underlie T2DM susceptibility in the African-American population and that these loci are distinct from those identified in other ethnic populations.
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| 3. |
- Barredo, José I., et al.
(författare)
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Mapping and assessment of forest ecosystems and their services : Applications and guidance for decision making in the framework of MAES
- 2015
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- The aim of this report is to illustrate by means of a series of case studies the implementation of mapping and assessment of forest ecosystem services in different contexts and geographical levels. Methodological aspects, data issues, approaches, limitations, gaps and further steps for improvement are analysed for providing good practices and decision making guidance. The EU initiative on Mappingand Assessment of Ecosystems and their Services (MAES), with the support of all Member States, contributes to improve the knowledge on ecosystem services. MAES is one of the building-block initiatives supporting the EU Biodiversity Strategy to 2020.
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| 4. |
- Brunner, Manuela Irene, et al.
(författare)
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Bivariate analysis of floods in climate impact assessments
- 2018
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Ingår i: Science of the Total Environment. - : ELSEVIER SCIENCE BV. - 0048-9697 .- 1879-1026. ; 616-617, s. 1392-1403
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Tidskriftsartikel (refereegranskat)abstract
- Climate impact studies regarding floods usually focus on peak discharges and a bivariate assessment of peak discharges and hydrograph volumes is not commonly included. A joint consideration of peak discharges and hydrograph volumes, however, is crucial when assessing flood risks for current and future climate conditions. Here, we present a methodology to develop synthetic design hydrographs for future climate conditions that jointly consider peak discharges and hydrograph volumes. First, change factors are derived based on a regional climate model and are applied to observed precipitation and temperature time series. Second, the modified time series are fed into a calibrated hydrological model to simulate runoff time series for future conditions. Third, these time series are used to construct synthetic design hydrographs. The bivariate flood frequency analysis used in the construction of synthetic design hydrographs takes into account the dependence between peak discharges and hydrograph volumes, and represents the shape of the hydrograph. The latter is modeled using a probability density function while the dependence between the design variables peak discharge and hydrograph volume is modeled using a copula. We applied this approach to a set of eight mountainous catchments in Switzerland to construct catchment-specific and season-specific design hydrographs for a control and three scenario climates. Our work demonstrates that projected climate changes have an impact not only on peak discharges but also on hydrograph volumes and on hydrograph shapes both at an annual and at a seasonal scale. These changes are not necessarily proportional which implies that climate impact assessments on future floods should consider more flood characteristics than just flood peaks.
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| 5. |
- Brunner, Manuela I., et al.
(författare)
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Flood type specific construction of synthetic design hydrographs
- 2017
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Ingår i: Water resources research. - : AMER GEOPHYSICAL UNION. - 0043-1397 .- 1944-7973. ; 53:2, s. 1390-1406
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Tidskriftsartikel (refereegranskat)abstract
- Accurate estimates of flood peaks, corresponding volumes, and hydrographs are required to design safe and cost-effective hydraulic structures. In this paper, we propose a statistical approach for the estimation of the design variables peak and volume by constructing synthetic design hydrographs for different flood types such as flash-floods, short-rain floods, long-rain floods, and rain-on-snow floods. Our approach relies on the fitting of probability density functions to observed flood hydrographs of a certain flood type and accounts for the dependence between peak discharge and flood volume. It makes use of the statistical information contained in the data and retains the process information of the flood type. The method was tested based on data from 39 mesoscale catchments in Switzerland and provides catchment specific and flood type specific synthetic design hydrographs for all of these catchments. We demonstrate that flood type specific synthetic design hydrographs are meaningful in flood-risk management when combined with knowledge on the seasonality and the frequency of different flood types.
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| 6. |
- Brunner, Manuela I., et al.
(författare)
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Synthetic design hydrographs for ungauged catchments : a comparison of regionalization methods
- 2018
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Ingår i: Stochastic environmental research and risk assessment (Print). - : Springer Science and Business Media LLC. - 1436-3240 .- 1436-3259. ; 32:7, s. 1993-2023
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Tidskriftsartikel (refereegranskat)abstract
- Design flood estimates for a given return period are required in both gauged and ungauged catchments for hydraulic design and risk assessments. Contrary to classical design estimates, synthetic design hydrographs provide not only information on the peak magnitude of events but also on the corresponding hydrograph volumes together with the hydrograph shapes. In this study, we tested different regionalization approaches to transfer parameters of synthetic design hydrographs from gauged to ungauged catchments. These approaches include classical regionalization methods such as linear regression techniques, spatial methods, and methods based on the formation of homogeneous regions. In addition to these classical approaches, we tested nonlinear regression models not commonly used in hydrological regionalization studies, such as random forest, bagging, and boosting. We found that parameters related to the magnitude of the design event can be regionalized well using both linear and nonlinear regression techniques using catchment area, length of the main channel, maximum precipitation intensity, and relief energy as explanatory variables. The hydrograph shape, however, was found to be more difficult to regionalize due to its high variability within a catchment. Such variability might be better represented by looking at flood-type specific synthetic design hydrographs.
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| 7. |
- Engholm, Albin, 1991-, et al.
(författare)
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MUST Managing Deep Uncertainty in Planning for Sustainable Transport : Project report: phase 1
- 2024
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- There is a growing recognition that traditional forecasting and decision-making approaches might fall short considering the many uncertainties and complexities facing the development of the transport system. The project Managing deep Uncertainty in planning for Sustainable Transport (MUST), funded by Trafikverket and conducted by KTH ITRL and VTI, aims to explore emerging methods for improving the handling of deep uncertainty in the long-term planning of future transport systems. The core of MUST is to explore, develop, and demonstrate tools and methods grounded in Decision Making under Deep Uncertainty (DMDU) and Exploratory Modeling and Analysis (EMA). These approaches are intended to support a shift towards more robust and adaptable planning methodologies.The project is performed in two phases, with the first phase dedicated to laying a foundational understanding of deep uncertainty in transport planning. This report covers the first phase which has included the following tasks: A literature review on deep uncertainty and existing decision-making and system analysis methods under such conditions, with a focus on transportation. A workshop series with Trafikverket identifying transport planning challenges marked by deep uncertainty.A case study of applying DMDU through a case study on climate policy robustness (primarily reported in other deliverables).The literature review covers how the nature of uncertainty in socio-technical systems can be understood, classified, and analyzed. For policy analysis and decision making, the literature underscores the importance of considering multiple futures in model-based analysis when faced with deep uncertainties. DMDU and EMA methods are reviewed and summarized, and their application to transport are discussed. The literature also summarizes studies on uncertainty in model-based transport planning and policy analysis and concludes that the primary location of deep uncertainty is in the model inputs in the form of “scenario uncertainty”. In the workshop series, uncertainty related to producing the base forecast (Swe: basprognos) and policy analysis for domestic transport climate policy was analyzed. This analysis suggested that scenario uncertainty is a main source of deep uncertainty, but also uncertainty related to the system boundaries where highlighted. Furthermore, potential benefits and drawbacks of EMA and DMDU were discussed. In the case study, it is explored how the Scenario tool can be further leveraged by DMDU. More specifically, MORDM (see Section 2.2.3) is applied to assess to what extent it may allow a broader set of policy options to be explored, and how it can provide a better understanding of the robustness and vulnerabilities of different types of policies. A key takeaway from MUST phase 1 is that DMDU and EMA could provide several potential benefits and that methods and tools for applying them are maturing. However, it is possibly a long way to go before DMDU and EMA can be integrated as a regularly used method during the planning process. This is due to organization and process-related issues, as well as technical issues on how to effectively apply DMDU and EMA to Trafikverket’s national transport models. These technical issues will partly be explored in MUST phase 2.
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| 8. |
- Furthner, Dieter, et al.
(författare)
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Single Point Insulin Sensitivity Estimator in Pediatric Non-Alcoholic Fatty Liver Disease
- 2022
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Ingår i: Frontiers in Endocrinology. - : Frontiers Media S.A.. - 1664-2392. ; 13
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundAttenuated insulin-sensitivity (IS) is a central feature of pediatric non-alcoholic fatty liver disease (NAFLD). We recently developed a new index, single point insulin sensitivity estimator (SPISE), based on triglycerides, high-density-lipoprotein and body-mass-index (BMI), and validated by euglycemic-hyperinsulinemic clamp-test (EHCT) in adolescents. This study aims to assess the performance of SPISE as an estimation of hepatic insulin (in-)sensitivity. Our results introduce SPISE as a novel and inexpensive index of hepatic insulin resistance, superior to established indices in children and adolescents with obesity. Materials and MethodsNinety-nine pubertal subjects with obesity (13.5 +/- 2.0 years, 59.6% males, overall mean BMI-SDS + 2.8 +/- 0.6) were stratified by MRI (magnetic resonance imaging) into a NAFLD (>5% liver-fat-content; male n=41, female n=16) and non-NAFLD (<= 5%; male n=18, female n=24) group. Obesity was defined according to WHO criteria (> 2 BMI-SDS). EHCT were used to determine IS in a subgroup (n=17). Receiver-operating-characteristic (ROC)-curve was performed for diagnostic ability of SPISE, HOMA-IR (homeostatic model assessment for insulin resistance), and HIRI (hepatic insulin resistance index), assuming null hypothesis of no difference in area-under-the-curve (AUC) at 0.5. ResultsSPISE was lower in NAFLD (male: 4.8 +/- 1.2, female: 4.5 +/- 1.1) than in non-NAFLD group (male 6.0 +/- 1.6, female 5.6 +/- 1.5; P< 0.05 {95% confidence interval [CI]: male NAFLD 4.5, 5.2; male non-NAFLD 5.2, 6.8; female NAFLD 4.0, 5.1, female non-NAFLD 5.0, 6.2}). In males, ROC-AUC was 0.71 for SPISE (P=0.006, 95% CI: 0.54, 0.87), 0.68 for HOMA-IR (P=0.038, 95% CI: 0.48, 0.88), and 0.50 for HIRI (P=0.543, 95% CI: 0.27, 0.74). In females, ROC-AUC was 0.74 for SPISE (P=0.006), 0.59 for HOMA-IR (P=0.214), and 0.68 for HIRI (P=0.072). The optimal cutoff-level for SPISE between NAFLD and non-NAFLD patients was 5.18 overall (Youden-index: 0.35; sensitivity 0.68%, specificity 0.67%). ConclusionSPISE is significantly lower in juvenile patients with obesity-associated NAFLD. Our results suggest that SPISE indicates hepatic IR in pediatric NAFLD patients with sensitivity and specificity superior to established indices of hepatic IR.
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| 9. |
- Gamero, Anna, et al.
(författare)
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Tracking Progress Toward EU Biodiversity Strategy Targets : EU Policy Effects in Preserving its Common Farmland Birds
- 2017
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Ingår i: Conservation Letters. - : Wiley. - 1755-263X. ; 10:4, s. 395-402
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Tidskriftsartikel (refereegranskat)abstract
- Maximizing the area under biodiversity-related conservation measures is a main target of the European Union (EU) Biodiversity Strategy to 2020. We analyzed whether agrienvironmental schemes (AES) within EU common agricultural policy, special protected areas for birds (SPAs), and Annex I designation within EU Birds Directive had an effect on bird population changes using monitoring data from 39 farmland bird species from 1981 to 2012 at EU scale. Populations of resident and short-distance migrants were larger with increasing SPAs and AES coverage, while Annex I species had higher population growth rates with increasing SPAs, indicating that SPAs may contribute to the protection of mainly target species and species spending most of their life cycle in the EU. Because farmland birds are in decline and the negative relationship of agricultural intensification with their population growth rates was evident during the implementation of AES and SPAs, EU policies seem to generally attenuate the declines of farmland bird populations, but not to reverse them.
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| 10. |
- Hageman, Steven H. J., et al.
(författare)
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Prediction of individual lifetime cardiovascular risk and potential treatment benefit: development and recalibration of the LIFE-CVD2 model to four European risk regions
- 2024
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Ingår i: EUROPEAN JOURNAL OF PREVENTIVE CARDIOLOGY. - 2047-4873 .- 2047-4881.
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Tidskriftsartikel (refereegranskat)abstract
- Aims The 2021 European Society of Cardiology prevention guidelines recommend the use of (lifetime) risk prediction models to aid decisions regarding initiation of prevention. We aimed to update and systematically recalibrate the LIFEtime-perspective CardioVascular Disease (LIFE-CVD) model to four European risk regions for the estimation of lifetime CVD risk for apparently healthy individuals.Methods and results The updated LIFE-CVD (i.e. LIFE-CVD2) models were derived using individual participant data from 44 cohorts in 13 countries (687 135 individuals without established CVD, 30 939 CVD events in median 10.7 years of follow-up). LIFE-CVD2 uses sex-specific functions to estimate the lifetime risk of fatal and non-fatal CVD events with adjustment for the competing risk of non-CVD death and is systematically recalibrated to four distinct European risk regions. The updated models showed good discrimination in external validation among 1 657 707 individuals (61 311 CVD events) from eight additional European cohorts in seven countries, with a pooled C-index of 0.795 (95% confidence interval 0.767-0.822). Predicted and observed CVD event risks were well calibrated in population-wide electronic health records data in the UK (Clinical Practice Research Datalink) and the Netherlands (Extramural LUMC Academic Network). When using LIFE-CVD2 to estimate potential gain in CVD-free life expectancy from preventive therapy, projections varied by risk region reflecting important regional differences in absolute lifetime risk. For example, a 50-year-old smoking woman with a systolic blood pressure (SBP) of 140 mmHg was estimated to gain 0.9 years in the low-risk region vs. 1.6 years in the very high-risk region from lifelong 10 mmHg SBP reduction. The benefit of smoking cessation for this individual ranged from 3.6 years in the low-risk region to 4.8 years in the very high-risk region.Conclusion By taking into account geographical differences in CVD incidence using contemporary representative data sources, the recalibrated LIFE-CVD2 model provides a more accurate tool for the prediction of lifetime risk and CVD-free life expectancy for individuals without previous CVD, facilitating shared decision-making for cardiovascular prevention as recommended by 2021 European guidelines. The study introduces LIFE-CVD2, a new tool that helps predict the risk of heart disease over a person's lifetime, and highlights how where you live in Europe can affect this risk. Using health information from over 687 000 people, LIFE-CVD2 looks at things like blood pressure and whether someone smokes to figure out their chance of having heart problems later in life. Health information from another 1.6 million people in seven different European countries was used to show that it did a good job of predicting who might develop heart disease.Knowing your heart disease risk over your whole life helps doctors give you the best advice to keep your heart healthy. Let us say there is a 50-year-old woman who smokes and has a bit high blood pressure. Right now, she might not look like she is in danger. But with the LIFE-CVD2 tool, doctors can show her how making changes today, like lowering her blood pressure or stopping smoking, could mean many more years without heart problems. These healthy changes can make a big difference over many years.
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