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National levels of personal health-care access and quality can be approximated by measuring mortality rates from causes that should not be fatal in the presence of effective medical care (ie, amenable mortality). Previous analyses of mortality amenable to health care only focused on high-income countries and faced several methodological challenges. In the present analysis, we use the highly standardised cause of death and risk factor estimates generated through the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) to improve and expand the quantification of personal health-care access and quality for 195 countries and territories from 1990 to 2015. We mapped the most widely used list of causes amenable to personal health care developed by Nolte and McKee to 32 GBD causes. We accounted for variations in cause of death certification and misclassifications through the extensive data standardisation processes and redistribution algorithms developed for GBD. To isolate the effects of personal health-care access and quality, we risk-standardised cause-specific mortality rates for each geography-year by removing the joint effects of local environmental and behavioural risks, and adding back the global levels of risk exposure as estimated for GBD 2015. We employed principal component analysis to create a single, interpretable summary measure–the Healthcare Quality and Access (HAQ) Index–on a scale of 0 to 100. The HAQ Index showed strong convergence validity as compared with other health-system indicators, including health expenditure per capita (r=0·88), an index of 11 universal health coverage interventions (r=0·83), and human resources for health per 1000 (r=0·77). We used free disposal hull analysis with bootstrapping to produce a frontier based on the relationship between the HAQ Index and the Socio-demographic Index (SDI), a measure of overall development consisting of income per capita, average years of education, and total fertility rates. This frontier allowed us to better quantify the maximum levels of personal health-care access and quality achieved across the development spectrum, and pinpoint geographies where gaps between observed and potential levels have narrowed or widened over time. Between 1990 and 2015, nearly all countries and territories saw their HAQ Index values improve; nonetheless, the difference between the highest and lowest observed HAQ Index was larger in 2015 than in 1990, ranging from 28·6 to 94·6. Of 195 geographies, 167 had statistically significant increases in HAQ Index levels since 1990, with South Korea, Turkey, Peru, China, and the Maldives recording among the largest gains by 2015. Performance on the HAQ Index and individual causes showed distinct patterns by region and level of development, yet substantial heterogeneities emerged for several causes, including cancers in highest-SDI countries; chronic kidney disease, diabetes, diarrhoeal diseases, and lower respiratory infections among middle-SDI countries; and measles and tetanus among lowest-SDI countries. While the global HAQ Index average rose from 40·7 (95% uncertainty interval, 39·0–42·8) in 1990 to 53·7 (52·2–55·4) in 2015, far less progress occurred in narrowing the gap between observed HAQ Index values and maximum levels achieved; at the global level, the difference between the observed and frontier HAQ Index only decreased from 21·2 in 1990 to 20·1 in 2015. If every country and territory had achieved the highest observed HAQ Index by their corresponding level of SDI, the global average would have been 73·8 in 2015. Several countries, particularly in eastern and western sub-Saharan Africa, reached HAQ Index values similar to or beyond their development levels, whereas others, namely in southern sub-Saharan Africa, the Middle East, and south Asia, lagged behind what geographies of similar development attained between 1990 and 2015. This novel extension of the GBD Study shows the untapped potential for personal health-care access and quality improvement across the development spectrum. Amid substantive advances in personal health care at the national level, heterogeneous patterns for individual causes in given countries or territories suggest that few places have consistently achieved optimal health-care access and quality across health-system functions and therapeutic areas. This is especially evident in middle-SDI countries, many of which have recently undergone or are currently experiencing epidemiological transitions. The HAQ Index, if paired with other measures of health-system characteristics such as intervention coverage, could provide a robust avenue for tracking progress on universal health coverage and identifying local priorities for strengthening personal health-care quality and access throughout the world. Bill & Melinda Gates Foundation.

The DC resistivity method is a common tool in periglacial research because it can delineate zones of large resistivities, which are often associated with frozen water. The interpretation can be ambiguous, however, because large resistivities may also have other causes, like solid dry rock. One possibility to reduce the ambiguity is to measure the frequency-dependent resistivity. At low frequencies (< 100 Hz) the corresponding method is called induced polarization, which has also been used in periglacial environments. For the detection and possibly quantification of water ice, a higher frequency range, between 100 Hz and 100 kHz, may be particularly interesting because in that range, the electrical properties of water ice exhibit a characteristic behaviour. In addition, the large frequencies allow a capacitive coupling of the electrodes, which may have logistical advantages. The capacitively coupled resistivity (CCR) method tries to combine these logistical advantages with the potential scientific benefit of reduced ambiguity. In this paper, we discuss CCR data obtained at two field sites with cryospheric influence: the Schilthorn massif in the Swiss Alps and the frozen Lake Prestvannet in the northern part of Norway. One objective is to add examples to the literature where the method is assessed in different conditions. Our results agree reasonably well with known subsurface structure: at the Prestvannet site, the transition from a frozen lake to the land is clearly visible in the inversion results, whereas at the Schilthorn site, the boundary between a snow cover and the bedrock below can be nicely delineated. In both cases, the electrical parameters are consistent with those expected from literature. The second objective is to discuss useful methodological advancements: first, we investigate the effect of capacitive sensor height above the surface and corroborate the assumption that it is negligible for highly resistive conditions. For the inversion of the data, we modified an existing 2-D inversion code originally developed for low-frequency induced polarization data by including a parametrization of electrical permittivity. The new inversion code allows the extraction of electrical parameters that may be directly compared with literature values, which was previously not possible.

The most dramatic effects of global climate change are predicted for the Arctic, and there is a raising concern about the lack of baseline information on microalgal biodiversity. The present study was motivated by the general lack of information on species distribution of Arctic benthic diatoms and particularly studies providing photographs to facilitate morphological species identification. Diatoms were studied in samples collected from Ny Ålesund, Spitsbergen, Svalbard, during summer 2006 and spring 2008. Two types of samples were examined: diatoms scraped from ceramic tiles, immersed at 0.5 m depth (2006), and diatoms extracted from surface sediment, collected at 0.5 to 3 m depth (2008). A total number of 75 taxa belonging to 45 genera were encountered. Sixty-eight species were found in the sediment samples and 48 on the ceramic tiles, of which 41 species were found on both substrata. Common species of the tile assemblages were Fragilariopsis spp., Licmophora spp., Odontella aurita , Synedropsis hyperborea and Trachyneis aspera , while Thalassiosira spp., Diploneis spp. and Navicula spp. were common in the sediment samples. Twenty-five percent of the observed diatom species belonged to freshwater taxa brought to the fjord from surrounding meltwater and river discharges.

This study presents the results of dendrochronological and dendroclimatological research of from four sites in northern Norway (Kvaløya Island, Tromsøya Island and Storelva Valley), which provided a 193-year chronology. Our results highlight the importance of the site selection in dendroclimatological studies. We demonstrated that activity of geomorphic processes connected with local topography could led to reduced strength of climatic signal embedded in tree-ring data. Negative pointer years, triggered mainly by unfavourable climatic conditions and insect outbreaks, were common for all site chronologies in 1945, 1955, 1965, 1975, 1986, 2004. However, some site-specific differences were also distinguished. Response function analysis confirmed that June, July and August temperatures were positively correlated with tree-ring widths. This climate-growth relationship was stable throughout the years 1925–2000. From summer temperature reconstruction back to AD 1820, two colder ( 1835–1850 and 1890–1920) and two warmer ( 1825–1835 and 1920–1940) periods were identified. The tree-ring record from the Tromsø Region, well correlated between series, sites and climate variables, is an important element of a large-scale reconstruction of pre-instrumental climate variation in the northeastern part of the Atlantic Ocean. Our dendroclimatic reconstruction corresponds well with other climate proxy data, like fluctuations of mountain glaciers in Scandinavia or sea ice extent.

Carotid plaques can be characterised by ultrasound by size and echogenicity. Both size and echogenicity are predictors of cardiovascular events. The aim of this study was to examine whether traditional risk factors and markers of inflammation and oxidation were associated with plaque size and echogenicity. Computerised analysis of carotid plaque size and echogenicity (grey scale median, GSM) were performed by ultrasound in a population-based health survey in 1,016 subjects aged 70 years (PIVUS study). Information on cardiovascular risk factors was collected, together with markers of inflammation and oxidation. Increased Framingham risk score, systolic blood pressure, higher BMI and decreased HDL, lower glutathione levels were related to echolucent plaques. Previous or present smoking was common with significantly more pack-years related to the echorich plaques. Plaque size was associated with increased Framingham risk score, systolic blood pressure, blood glucose levels, smoking, ApoB/A1 ratio, OxLDL, TNF alpha, HOMA insulin resistance, leucocyte count, decreased BCD-LDL and low levels of l-selectin. Low HDL, increased BMI and decreased glutathione levels were associated with the echolucency of carotid plaques, implying metabolic factors to play a role for plaque composition. Markers of inflammation were related to plaque size alone, implying inflammation to be predominantly associated with the amount of atherosclerosis. These results suggest that plaque size and echogenicity are influenced by different risk factors.

Eclogites and garnet pyroxenites from the Seve Nappe Complex in the Jamtland area of the Scandinavian Caledonides give Sm-Nd mineral ages (garnet-clinopyroxene-whole rock±orthopyroxene±amphibole) that are identical within error and give a weighted average age of 457.9±4.5 Ma (95% confidence). The age is 50 Ma younger than ages determined from eclogites from the apparently similar Norrbotten terrane, roughly 200 km to the north. Both terranes are correlated with the western margin of Baltica, suggesting that at least two eclogite-facies metamorphic events affected this margin prior to the final closure of Iapetus during the 430-400 Ma Scandian Orogeny. The c. 458 Ma ages are nearly identical to ages determined from the eclogite-bearing Tromso Nappe of the uppermost allochthon. The uppermost allochthon is generally considered part of the Laurentian margin, which, if true, requires that it evolved independently of Baltica until the Scandian Orogeny, when Laurentia and Baltica collided. Thus high-pressure eclogite-facies metamorphism and the introduction of mantle peridotite bodies into the crust appear to have occurred concurrently on opposite sides of Iapetus. We suggest that the HP collision recorded in the Jamtland area be called the \"Jamtlandian Orogeny\" if further studies confirm its Early Ordovician age.

SummaryLess is known about the impact of non-hip non-vertebral fractures (NHNV) on early death. This study demonstrated increased risk of dying following hip and NHNV fractures which was further increased by a subsequent fracture. This highlights the importance of early intervention to prevent both initial and subsequent fractures and improve survival.IntroductionOsteoporotic fractures are a major health concern. Limited evidence exists on their impact on mortality in ageing populations. This study examined the contribution of initial fracture type and subsequent fracture on mortality in a Norwegian population that has one of the highest rates of fractures.MethodsThe Tromsø Study is a prospective population-based cohort in Norway. Women and men aged 50+ years were followed from 1994 to 2010. All incident hip and non-hip non-vertebral (NHNV) fractures were registered. NHNV fractures were classified as either proximal or distal. Information on self-reported co-morbidities, lifestyle factors, general health and education level was collected. Multivariable Cox models were used to quantify mortality risk with incident and subsequent fractures analysed as time-dependent variables.ResultsOf 5214 women and 4620 men, 1549 (30%) and 504 (11%) sustained a fracture, followed by 589 (38%) and 254 (51%) deaths over 10,523 and 2821 person-years, respectively. There were 403 (26%) subsequent fractures in women and 68 (13%) in men. Hip fracture was associated with a two-fold increase in mortality risk (HR 2.05, 95% CI 1.73–2.42 in women and 2.49, 95% CI 2.00–3.11 in men). Proximal NHNV fractures were associated with 49% and 81% increased mortality risk in women and men (HR 1.49, 95% CI 1.21–1.84 and 1.81, 95% CI 1.37–2.41), respectively. Distal NHNV fractures were not associated with mortality. Subsequent fracture was associated with 89% and 77% increased mortality risk in women and men (HR 1.89, 95% CI 1.52–2.35 and 1.77, 95% CI 1.16–2.71), respectively.ConclusionHip, proximal NHNV and subsequent fractures were significantly associated with increased mortality risk in the elderly, highlighting the importance of early intervention.

The Scandinavian Caledonides contain the record of several high-pressure events reflecting distinct episodes of collision and subduction in the course of the global Caledonian plate reorganization process. In this study, the timing and speed of one of these events in the Tromso Nappe of the Uppermost Allochthon are detailed using multiple U-Pb geochronometers. This unit contains eclogites, the largest of which forms a whole mountain top, whereas many others occur as smaller lenses enclosed within a metamorphosed supracrustal sequence. A minimum age for the sedimentation is provided by a zircon age of 493 +5/-2 Ma for an eclogitized felsic intrusion. Formation of the eclogite, at pressures reaching 2.8 GPa, occurred at 452.1 +/- 1.7 Ma as evidenced by U-Pb in eclogitic zircon. Similar ages of 451-450 Ma are also provided by high-Al titanite in eclogite and titanite in leucosome veins, the latter of which was formed by partial melting during the exhumation of the eclogite. An age of 449 Ma for a rutile porphyroblast in another vein further confirms the rapidity of this high-pressure process. Matrix rutiles in two other eclogites yielded ages of 436 Ma and younger, probably indicating partial resetting during a subsequent metamorphic overprint. Lead isotopic compositions with high 207Pb/ 204Pb ratios are indicative of old crustal sources, thus supporting the previously proposed notion that the Uppermost Allochthon was derived from the Neoproterozoic margin of Laurentia. [PUBLICATION ABSTRACT]

The petrochemistry of carbonatites of three formation types were studied: (1) ultrahigh-pressure garnet-containing carbonatites (UHPC) of the Caledonian sheet (Tromsö, Norway); (2) rocks of the carbonatite—alkaline—ultrabasic Kovdor massif (the Kola Peninsula); and (3) rocks of the carbonatite—alkaline—gabbroid Tikshozero massif (north of Karelia). The samples of carbonatites were examined and tested with a microprobe; the microelements were determined using the ICP—MS technique at the Institute of Microelectronics Technology and High Purity Materials (Chernogolovka). The carbonatites of the Kovdor and Tikshozero massifs are characterized by similar negative REE trends, with a degree of REE enrichment of the Tikshozero carbonatites. The UHPC from Tromsö are different from those of the Kovdor and Tikshozero massifs in the negative trend along with lower concentrations of light REEs. The Tromsö UHPC are similar to the carbonatites of the Kovdor and Tikshozero massifs in the trend and concentrations of heavy REEs. The carbonatites of the Fennoscandian shield of various formation times and types are characterized by the geochemical similarity to those in different regions of the world with the sources associated to mantle plumes. This similarity might be caused by the formation of the mantle carbonated magmas of carbonatite-containing igneous complexes from a mantle source enriched under either mantle metasomatism or plume—lithosphere interaction, with similar mechanisms of formation. The appearance of the formations as such within a wide time interval points to the long-term occurrence of a superplume at the Fennoscandian shield and to permanent activation of the related processes of magma formation.

Background The European Working Group on Sarcopenia in Older People (EWGSOP2) recommends grip strength and chair stand tests to be used as primary defining measures. It is unclear how either test affects prevalence estimates. Methods This cross-sectional study involved 3498 community-dwelling participants (40–84 years) from the 7th Tromsø Study survey (2015–2016). We used grip strength, five-repetition chair stands, four-meter Walk Speed Test, Timed-Up-and-Go (TUG) and Dual-Energy X-ray Absorptiometry measurements. Data were analyzed using multiple linear regression models and ROC-curves. Results Probable and confirmed sarcopenia prevalence was 1.3 and 4.4% based on grip strength and chair stands, respectively. There was very low agreement between grip strength and chair stand cut-offs ( κ  = 0.07), with only 4.3% of participants defined as having probable sarcopenia overlapping in the two criteria. Participants with grip strength-based sarcopenia had lower mean height, weight, waist circumference, and appendicular lean mass relative to body height (ALM height 2 ) than non-sarcopenic participants (all p  < 0.001), after adjusting for multiple covariates. Conversely, participants with chair stand-based sarcopenia had similar height, higher weight, waist circumference and body fat% compared to non-sarcopenic participants (all p  < 0.05). Area-under-curves (AUCs) for TUG-time were significantly larger when using chair stand instead of grip strength cut-offs (0.86, 95% CI 0.84–0.89 vs. 0.75, 95% CI 0.69–0.83). Conclusions Using chair stands instead of grip strength more than doubled probable sarcopenia prevalence across all ages. The two measures defined individuals of contradictory anthropometrics, body composition, and dissimilar physical function to have probable sarcopenia. Researchers should further evaluate the consequences of using different strength measures in the EWGSOP2 definition to classify sarcopenia.