The coastal zones of Small Island States are hotspots of human habitation and economic endeavour. In the Pacific region, as elsewhere, there are large gaps in understandings of the exposure and ...vulnerability of people in coastal zones. The 22 Pacific Countries and Territories (PICTs) are poorly represented in global analyses of vulnerability to seaward risks. We combine several data sources to estimate populations to zones 1, 5 and 10 km from the coastline in each of the PICTs. Regional patterns in the proximity of Pacific people to the coast are dominated by Papua New Guinea. Overall, ca. half the population of the Pacific resides within 10 km of the coast but this jumps to 97% when Papua New Guinea is excluded. A quarter of Pacific people live within 1 km of the coast, but without PNG this increases to slightly more than half. Excluding PNG, 90% of Pacific Islanders live within 5 km of the coast. All of the population in the coral atoll nations of Tokelau and Tuvalu live within a km of the ocean. Results using two global datasets, the SEDAC-CIESIN Gridded Population of the World v4 (GPWv4) and the Oak Ridge National Laboratory Landscan differed: Landscan under-dispersed population, overestimating numbers in urban centres and underestimating population in rural areas and GPWv4 over-dispersed the population. In addition to errors introduced by the allocation models of the two methods, errors were introduced as artefacts of allocating households to 1 km x 1 km grid cell data (30 arc-seconds) to polygons. The limited utility of LandScan and GPWv4 in advancing this analysis may be overcome with more spatially resolved census data and the inclusion of elevation above sea level as an important dimension of vulnerability.
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Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Summary Background Familial hypercholesterolaemia is a common autosomal-dominant disorder caused by mutations in three known genes. DNA-based cascade testing is recommended by UK guidelines to ...identify affected relatives; however, about 60% of patients are mutation-negative. We assessed the hypothesis that familial hypercholesterolaemia can also be caused by an accumulation of common small-effect LDL-C-raising alleles. Methods In November, 2011, we assembled a sample of patients with familial hypercholesterolaemia from three UK-based sources and compared them with a healthy control sample from the UK Whitehall II (WHII) study. We also studied patients from a Belgian lipid clinic (Hôpital de Jolimont, Haine St-Paul, Belgium) for validation analyses. We genotyped participants for 12 common LDL-C-raising alleles identified by the Global Lipid Genetics Consortium and constructed a weighted LDL-C-raising gene score. We compared the gene score distribution among patients with familial hypercholesterolaemia with no confirmed mutation, those with an identified mutation, and controls from WHII. Findings We recruited 321 mutation-negative UK patients (451 Belgian), 319 mutation-positive UK patients (273 Belgian), and 3020 controls from WHII. The mean weighted LDL-C gene score of the WHII participants (0·90 SD 0·23) was strongly associated with LDL-C concentration (p=1·4 × 10−77 ; R2 =0·11). Mutation-negative UK patients had a significantly higher mean weighted LDL-C score (1·0 SD 0·21) than did WHII controls (p=4·5 × 10−16 ), as did the mutation-negative Belgian patients (0·99 0·19; p=5·2 × 10−20 ). The score was also higher in UK (0·95 0·20; p=1·6 × 10−5 ) and Belgian (0·92 0·20; p=0·04) mutation-positive patients than in WHII controls. 167 (52%) of 321 mutation-negative UK patients had a score within the top three deciles of the WHII weighted LDL-C gene score distribution, and only 35 (11%) fell within the lowest three deciles. Interpretation In a substantial proportion of patients with familial hypercholesterolaemia without a known mutation, their raised LDL-C concentrations might have a polygenic cause, which could compromise the efficiency of cascade testing. In patients with a detected mutation, a substantial polygenic contribution might add to the variable penetrance of the disease. Funding British Heart Foundation, Pfizer, AstraZeneca, Schering-Plough, National Institute for Health Research, Medical Research Council, Health and Safety Executive, Department of Health, National Heart Lung and Blood Institute, National Institute on Aging, Agency for Health Care Policy Research, John D and Catherine T MacArthur Foundation Research Networks on Successful Midlife Development and Socio-economic Status and Health, Unilever, and Departments of Health and Trade and Industry.
This trial was conducted to determine whether the reduction in microvascular risk and improved glycemic control that had been observed with medical therapy, as compared with conventional dietary ...treatment, in patients with newly diagnosed type 2 diabetes was sustained during 10 years of follow-up. Despite an early loss of glycemic differences, continued microvascular risk reduction and emergent risk reductions for myocardial infarction and death from any cause were observed.
Despite an early loss of glycemic differences, continued microvascular risk reduction and emergent risk reductions for myocardial infarction and death from any cause were observed.
The United Kingdom Prospective Diabetes Study (UKPDS), a randomized, prospective, multicenter trial, showed that intensive glucose therapy in patients with newly diagnosed type 2 diabetes mellitus was associated with a reduced risk of clinically evident microvascular complications and a nonsignificant reduction of 16% in the relative risk of myocardial infarction (P=0.052).
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In patients whose body weight was more than 120% of their ideal weight
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and who primarily received metformin, reductions in the risk of myocardial infarction of 39% (P=0.01) and of death from any cause of 36% (P=0.01) were observed. The results of the UKPDS, which were published in 1998, . . .
Adolescents with type 1 diabetes received one of four regimens: angiotensin-converting–enzyme (ACE) inhibitor–placebo, statin–placebo, ACE inhibitor–statin, or placebo–placebo. Neither medication ...resulted in a change in albumin excretion over 2 to 4 years.
Abstract Objective Heterozygous familial hypercholesterolaemia (FH) is a common autosomal dominant disorder. The vast majority of affected individuals remain undiagnosed, resulting in lost ...opportunities for preventing premature heart disease. Better use of routine primary care data offers an opportunity to enhance detection. We sought to develop a new predictive algorithm for improving identification of individuals in primary care who could be prioritised for further clinical assessment using established diagnostic criteria. Methods Data were analysed for 2,975,281 patients with total or LDL-cholesterol measurement from 1 Jan 1999 to 31 August 2013 using the Clinical Practice Research Datalink (CPRD). Included in this cohort study were 5050 documented cases of FH. Stepwise logistic regression was used to derive optimal multivariate prediction models. Model performance was assessed by its discriminatory accuracy (area under receiver operating curve AUC). Results The FH prediction model (FAMCAT), consisting of nine diagnostic variables, showed high discrimination (AUC 0.860, 95% CI 0.848–0.871) for distinguishing cases from non-cases. Sensitivity analysis demonstrated no significant drop in discrimination (AUC 0.858, 95% CI 0.845–0.869) after excluding secondary causes of hypercholesterolaemia. Removing family history variables reduced discrimination (AUC 0.820, 95% CI 0.807–0.834), while incorporating more comprehensive family history recording of myocardial infraction significantly improved discrimination (AUC 0.894, 95% CI 0.884–0.904). Conclusion This approach offers the opportunity to enhance detection of FH in primary care by identifying individuals with greatest probability of having the condition. Such cases can be prioritised for further clinical assessment, appropriate referral and treatment to prevent premature heart disease.
A post-trial monitoring study involving follow-up of patients with type 2 diabetes who had been assigned to tight or less-tight blood-pressure control revealed that benefits of previously improved ...control were not sustained when between-group blood-pressure differences equalized. Early improved blood-pressure control in patients with type 2 diabetes and hypertension was associated with a reduced risk of complications, but it must continue for benefits to be sustained.
Follow-up of patients with type 2 diabetes who had been assigned to tight or less-tight blood-pressure control revealed that benefits of previously improved control were not sustained when between-group blood-pressure differences equalized.
The United Kingdom Prospective Diabetes Study (UKPDS) was a randomized, prospective, multicenter trial that indicated that improved glucose control in patients with newly diagnosed type 2 diabetes mellitus reduces the risk of clinically evident microvascular complications, with a relative risk reduction for myocardial infarction of 16% (P=0.052).
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From 1987 to 1991, UKPDS patients with hypertension were, in addition, randomly assigned in a factorial manner to a tight blood-pressure control regimen involving an angiotensin-converting–enzyme (ACE) inhibitor or a beta-blocker or to a less-tight blood-pressure control strategy that excluded these agents.
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For tight as compared with the less-tight control of blood pressure, . . .
Chameleon theories of gravity predict that the gaseous component of isolated dwarf galaxies rotates with a faster velocity than the stellar component. In this paper, we exploit this effect to obtain ...new constraints on the model parameters using the measured rotation curves of six low surface brightness galaxies. For f(R) theories, we rule out values of fR0>10−6. For more general theories, we find that the constraints from Cepheid variable stars are currently more competitive than the bounds we obtain here but we are able to rule out self-screening parameters χc>10−6 for fifth-force strengths (coupling of the scalar to matter) as low as 0.05 the Newtonian force. This region of parameter space has hitherto been inaccessible to astrophysical probes. We discuss the future prospects for improving these bounds.
Abstract
Water worlds have been hypothesized as an alternative to photoevaporation in order to explain the gap in the radius distribution of Kepler exoplanets. We explore water worlds within the ...framework of a joint mass–radius–period distribution of planets fit to a sample of transiting Kepler exoplanets, a subset of which have radial velocity mass measurements. We employ hierarchical Bayesian modeling to create a range of ten mixture models that include multiple compositional subpopulations of exoplanets. We model these subpopulations—including planets with gaseous envelopes, evaporated rocky cores, evaporated icy cores, intrinsically rocky planets, and intrinsically icy planets—in different combinations in order to assess which combinations are most favored by the data. Using cross-validation, we evaluate the support for models that include planets with icy compositions compared to the support for models that do not, finding broad support for both. We find significant population-level degeneracies between subpopulations of water worlds and planets with primordial envelopes. Among models that include one or more icy-core subpopulations, we find a wide range for the fraction of planets with icy compositions, with a rough upper limit of 50%. Improved data sets or alternative modeling approaches may be able to better distinguish between these subpopulations of planets.
Community-based approaches to fisheries management has emerged as a mainstream strategy to govern dispersed, diverse and dynamic small scale fisheries. However, amplifying local community led ...sustainability outcomes remains an enduring challenge. We seek to fill a theoretical gap in the conceptualization of ‘scaling up community-based fisheries management’. We draw on literature of agriculture innovations to provide a framework that takes into account process-driven and structural change occurring across multiple levels of governance, as well as different phases of scaling. We hypothesize that successful scaling requires engagement with all aspects of a governing regime, coalescing a range of actors, and therefore, is an enterprise that is larger than its parts. To demonstrate where the framework offers value, we illustrate the development of community-based fisheries management in Vanuatu according to the framework’s main scaling dimensions.
Anthropogenic global warming has significantly influenced physical and biological processes at global and regional scales. The observed and anticipated changes in global climate present significant ...opportunities and challenges for societies and economies. We compare the vulnerability of 132 national economies to potential climate change impacts on their capture fisheries using an indicator‐based approach. Countries in Central and Western Africa (e.g. Malawi, Guinea, Senegal, and Uganda), Peru and Colombia in north‐western South America, and four tropical Asian countries (Bangladesh, Cambodia, Pakistan, and Yemen) were identified as most vulnerable. This vulnerability was due to the combined effect of predicted warming, the relative importance of fisheries to national economies and diets, and limited societal capacity to adapt to potential impacts and opportunities. Many vulnerable countries were also among the world’s least developed countries whose inhabitants are among the world’s poorest and twice as reliant on fish, which provides 27% of dietary protein compared to 13% in less vulnerable countries. These countries also produce 20% of the world’s fish exports and are in greatest need of adaptation planning to maintain or enhance the contribution that fisheries can make to poverty reduction. Although the precise impacts and direction of climate‐driven change for particular fish stocks and fisheries are uncertain, our analysis suggests they are likely to lead to either increased economic hardship or missed opportunities for development in countries that depend upon fisheries but lack the capacity to adapt.
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