Securing land rights under rapid population growth: The feasibility of institutional land rights protection in Africa

The paper examines the claim that a virtuous cycle of more secure land rights, more land-saving investments, and denser populations requires the development of institutions that regulate competition over land. We construct a contest model that links the tenure-security-investment relationship to the efforts of land users to enhance land rights themselves and the role of institutional protection. We study the effect of population growth on a close-to-subsistence economy, including the possibility that it weakens institutional protection. We derive sufficient conditions for a positive effect on land investment, but also show that population growth can push the economy into a low-productivity trap

Diagnostic performance of transthyretin measurement in fat tissue of patients with ATTR amyloidosis

In this article, the diagnostic performance of a transthyretin (TTR) ELISA for detection and characterization of transthyretin-derived (ATTR) amyloid in abdominal subcutaneous fat tissue was studied. Fat tissue specimens were analyzed of 38 patients with ATTR amyloidosis, 70 controls, and 17 carriers of a TTR mutation. Amyloid amount was graded semi-quantitatively in Congo red-stained specimens (0-4+). Amyloid was extracted from tissue in guanidine, and the TTR concentration was measured using a sandwich TTR-ELISA. The TTR concentration of patients with ATTR amyloidosis (mean 0.84 ng/mg fat tissue) was significantly higher than controls (p<0.001). With a TTR concentration of 0.13 ng/mg fat tissue as cut-off value, 32 of the 38 ATTR patients were identified resulting in a sensitivity of 84%. Sixty-seven of the 70 controls had values below the cut-off value resulting in a specificity of 96%. Thus, measuring TTR in fat tissue is useful for detecting ATTR amyloidosis and for characterizing amyloid as ATTR type

Burden of injury along the development spectrum: Associations between the socio-demographic Index and disability-adjusted life year estimates from the global burden of disease study 2017

Background: The epidemiological transition of non-communicable diseases replacing infectious diseases as the main contributors to disease burden has been well documented in global health literature. Less focus, however, has been given to the relationship between sociodemographic changes and injury. The aim of this study was to examine the association between disability-adjusted life years (DALYs) from injury for 195 countries and territories at different levels along the development spectrum between 1990 and 2017 based on the Global Burden of Disease (GBD) 2017 estimates.Methods: Injury mortality was estimated using the GBD mortality database, corrections for garbage coding and CODEm-the cause of death ensemble modelling tool. Morbidity estimation was based on surveys and inpatient and outpatient data sets for 30 cause-of-injury with 47 nature-of-injury categories each. The Socio-demographic Index (SDI) is a composite indicator that includes lagged income per capita, average educational attainment over age 15 years and total fertility rate.Results: For many causes of injury, age-standardised DALY rates declined with increasing SDI, although road injury, interpersonal violence and self-harm did not follow this pattern. Particularly for self-harm opposing patterns were observed in regions with similar SDI levels. For road injuries, this effect was less pronounced.Conclusions: The overall global pattern is that of declining injury burden with increasing SDI. However, not all injuries follow this pattern, which suggests multiple underlying mechanisms influencing injury DALYs. There is a need for a detailed understanding of these patterns to help to inform national and global efforts to address injury-related health outcomes across the development spectrum

Does conversion to reduced tillage really increase soil organic carbon stocks in organic arable farming?

Aggravation of weather extremes increases awareness of climate change consequences. Mitigation options are in demand that aim to reduce the atmospheric concentration of greenhouse gases. Amongst others, the conversion from ploughing to reduced tillage is argued to increase soil organic carbon (SOC) stocks as an accumulation of SOC in topsoil layers is commonly reported. Yet, reviews and meta-analyses describe various results from significant increases to just a redistribution of SOC in the soil profile. Reasons can be found in different sampling depths, SOC and bulk density measurement procedure, and stock calculation (equivalent soil mass vs. equal sampling depth). Furthermore, few studies evaluated the impact of organic farming systems. In nine long-term experiments on tillage systems in temperate Europe (France, Germany, Netherlands, and Switzerland), a common soil sampling campaign took place in spring and autumn 2017, and spring 2018. All trials represent common mixed organic farming systems of the respective region and contain plots with conventional and reduced tillage practices. While climatic conditions are similar, soil types vary from sandy to clayey soils. We took three undisturbed soil cores with driving hammer probes (8 cm in diameter) in each plot (minimum 3 plots per treatment) to a maximum depth of 100 cm and divided the cores in the increments 0-30, 30-50, 50-70, and 70-100 cm. The topsoil (0-30 cm) was further divided into the different tillage depths of the respective trial. We determined bulk density and organic carbon concentration as main variables and soil texture and pH as co-variates for each sample and collected C-inputs for each plot in all trails on a yearly basis. Multivariate statistics will enable the comprehensive evaluation of tillage effects on SOC stocks up to a depth of 100 cm in organic long-term trials. Texture, trial age, and the co-variate C-input will be decisive for the development of SOC stocks and enable the evaluation of carbon sequestration potentials of agricultural soils through improved tillage practices

Outcomes after Complicated and Uncomplicated Mild Traumatic Brain Injury at Three- and Six-Months Post-Injury: Results from the CENTER-TBI Study

The objective of this study was to provide a comprehensive examination of the relation of complicated and uncomplicated mild traumatic brain injury (mTBI) with multidimensional outcomes at three- and six-months after TBI. We analyzed data from the Collaborative European NeuroTrauma Effectiveness Research (CENTER-TBI) research project. Patients after mTBI (Glasgow Coma scale (GCS) score of 13–15) enrolled in the study were differentiated into two groups based on computed tomography (CT) findings: complicated mTBI (presence of any traumatic intracranial injury on first CT) and uncomplicated mTBI (absence of any traumatic intracranial injury on first CT). Multidimensional outcomes were assessed using seven instruments measuring generic and disease-specific health-related quality of life (HRQoL) (SF-36 and QOLIBRI), functional outcome (GOSE), and psycho-social domains including symptoms of post-traumatic stress disorder (PTSD) (PCL-5), depression (PHQ-9), and anxiety (GAD-7). Data were analyzed using a multivariate repeated measures approach (MANOVA-RM), which inspected mTBI groups at three- and six-months post injury. Patients after complicated mTBI had significantly lower GOSE scores, reported lower physical and mental component summary scores based on the SF-36 version 2, and showed significantly lower HRQoL measured by QOLIBRI compared to those after uncomplicated mTBI. There was no difference between mTBI groups when looking at psychological outcomes, however, a slight improvement in PTSD symptoms and depression was observed for the entire sample from three to six months. Patients after complicated mTBI reported lower generic and disease specific HRQoL and worse functional outcome compared to individuals after uncomplicated mTBI at three and six months. Both groups showed a tendency to improve from three to six months after TBI. The complicated mTBI group included more patients with an impaired long-term outcome than the uncomplicated group. Nevertheless, patients, clinicians, researchers, and decisions-makers in health care should take account of the short and long-term impact on outcome for patients after both uncomplicated and complicated mTBI

A systematic review of studies measuring health-related quality of life of general injury populations

Background. It is important to obtain greater insight into health-related quality of life (HRQL) of injury patients in order to document people's pathways to recovery and to quantify the impact of injury on population health over time. We performed a systematic review of studies measuring HRQL in general injury populations with a generic health state measure to summarize existing knowledge. Methods. Injury studies (1995-2009) were identified with main inclusion criteri

Trends in liver transplantation for primary biliary cirrhosis in the Netherlands 1988-2008

Background: A decrease in the need for liver transplantations (LTX) in Primary Biliary Cirrhosis (PBC), possibly related to treatment with ursodeoxycholic acid (UDCA), has been reported in the USA and UK. The aim of this study was to assess LTX require

The effect of comorbidity on health-related quality of life for injury patients in the first year following injury: comparison of three comorbidity adjustment approaches

Background: Three approaches exist to deal with the impact of comorbidity in burden of disease studies - the maximum limit approach, the additive approach, and the multiplicative approach. The aim of this study was to compare the three comorbidity approaches in patients with temporary injury consequences as well as comorbid chronic conditions with nontrivial health impacts.Methods: Disability weights were assessed using data from the EQ-5D instrument developed by the EuroQol Group and derived from a postal survey among 2,295 injury patients at 2.5 and 9 months after being treated at an emergency department. We compared the observed and predicted EQ-5D disability weights in comorbid case

Long-term evidence for ecological intensification as a pathway to sustainable agriculture

Ecological intensification (EI) could help return agriculture into a ‘safe operating space’ for humanity. Using a novel application of meta-analysis to data from 30 long-term experiments from Europe and Africa (comprising 25,565 yield records), we investigated how field-scale EI practices interact with each other, and with N fertilizer and tillage, in their effects on long-term crop yields. Here we confirmed that EI practices (specifically, increasing crop diversity and adding fertility crops and organic matter) have generally positive effects on the yield of staple crops. However, we show that EI practices have a largely substitutive interaction with N fertilizer, so that EI practices substantially increase yield at low N fertilizer doses but have minimal or no effect on yield at high N fertilizer doses. EI practices had comparable effects across different tillage intensities, and reducing tillage did not strongly affect yields

Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015

SummaryBackground The Global Burden of Diseases, Injuries, and Risk Factors Study 2015 provides an up-to-date synthesis of the evidence for risk factor exposure and the attributable burden of disease. By providing national and subnational assessments spanning the past 25 years, this study can inform debates on the importance of addressing risks in context. Methods We used the comparative risk assessment framework developed for previous iterations of the Global Burden of Disease Study to estimate attributable deaths, disability-adjusted life-years (DALYs), and trends in exposure by age group, sex, year, and geography for 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks from 1990 to 2015. This study included 388 risk-outcome pairs that met World Cancer Research Fund-defined criteria for convincing or probable evidence. We extracted relative risk and exposure estimates from randomised controlled trials, cohorts, pooled cohorts, household surveys, census data, satellite data, and other sources. We used statistical models to pool data, adjust for bias, and incorporate covariates. We developed a metric that allows comparisons of exposure across risk factors—the summary exposure value. Using the counterfactual scenario of theoretical minimum risk level, we estimated the portion of deaths and DALYs that could be attributed to a given risk. We decomposed trends in attributable burden into contributions from population growth, population age structure, risk exposure, and risk-deleted cause-specific DALY rates. We characterised risk exposure in relation to a Socio-demographic Index (SDI). Findings Between 1990 and 2015, global exposure to unsafe sanitation, household air pollution, childhood underweight, childhood stunting, and smoking each decreased by more than 25%. Global exposure for several occupational risks, high body-mass index (BMI), and drug use increased by more than 25% over the same period. All risks jointly evaluated in 2015 accounted for 57·8% (95% CI 56·6–58·8) of global deaths and 41·2% (39·8–42·8) of DALYs. In 2015, the ten largest contributors to global DALYs among Level 3 risks were high systolic blood pressure (211·8 million [192·7 million to 231·1 million] global DALYs), smoking (148·6 million [134·2 million to 163·1 million]), high fasting plasma glucose (143·1 million [125·1 million to 163·5 million]), high BMI (120·1 million [83·8 million to 158·4 million]), childhood undernutrition (113·3 million [103·9 million to 123·4 million]), ambient particulate matter (103·1 million [90·8 million to 115·1 million]), high total cholesterol (88·7 million [74·6 million to 105·7 million]), household air pollution (85·6 million [66·7 million to 106·1 million]), alcohol use (85·0 million [77·2 million to 93·0 million]), and diets high in sodium (83·0 million [49·3 million to 127·5 million]). From 1990 to 2015, attributable DALYs declined for micronutrient deficiencies, childhood undernutrition, unsafe sanitation and water, and household air pollution; reductions in risk-deleted DALY rates rather than reductions in exposure drove these declines. Rising exposure contributed to notable increases in attributable DALYs from high BMI, high fasting plasma glucose, occupational carcinogens, and drug use. Environmental risks and childhood undernutrition declined steadily with SDI; low physical activity, high BMI, and high fasting plasma glucose increased with SDI. In 119 countries, metabolic risks, such as high BMI and fasting plasma glucose, contributed the most attributable DALYs in 2015. Regionally, smoking still ranked among the leading five risk factors for attributable DALYs in 109 countries; childhood underweight and unsafe sex remained primary drivers of early death and disability in much of sub-Saharan Africa. Interpretation Declines in some key environmental risks have contributed to declines in critical infectious diseases. Some risks appear to be invariant to SDI. Increasing risks, including high BMI, high fasting plasma glucose, drug use, and some occupational exposures, contribute to rising burden from some conditions, but also provide opportunities for intervention. Some highly preventable risks, such as smoking, remain major causes of attributable DALYs, even as exposure is declining. Public policy makers need to pay attention to the risks that are increasingly major contributors to global burden. Funding Bill & Melinda Gates Foundation