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Moore J, Argles A, Cox P. A theory of demographic optimality in forests. Sci Rep 2023; 13:18712. [PMID: 37907540 PMCID: PMC10618179 DOI: 10.1038/s41598-023-44860-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 10/12/2023] [Indexed: 11/02/2023] Open
Abstract
Carbon uptake by the land is a key determinant of future climate change. Unfortunately, Dynamic Global Vegetation Models have many unknown internal parameters which leads to significant uncertainty in projections of the future land carbon sink. By contrast, observed forest inventories in both Amazonia and the USA show strikingly common tree-size distributions, pointing to a simpler modelling paradigm. The curvature of these size-distributions is related to the ratio of mortality to growth in Demographic Equilibrium Theory (DET). We extend DET to include recruitment limited by competitive exclusion from existing trees. From this, we find simultaneous maxima of tree density and biomass in terms of respectively the ratio of mortality to growth and the proportion of primary productivity allocated to reproduction, an idea we call Demographic Optimality (DO). Combining DO with the ratio of mortality to growth common to the US and Amazon forests, results in the prediction that about an eighth of productivity should be allocated to reproduction, which is broadly consistent with observations. Another prediction of the model is that seed mortality should decrease with increasing seed size, such that the advantage of having many small seeds is nullified by the higher seed mortality. Demographic Optimality is therefore consistent with the common shape of tree-size distributions seen in very different forests, and an allocation to reproduction that is independent of seed size.
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Affiliation(s)
- Jon Moore
- Faculty of Environment, Science and Economy, University of Exeter, Exeter, Devon, EX4 4QF, UK
| | - Arthur Argles
- Met Office Hadley Centre, Fitzroy Road, Exeter, EX1 3PB, UK.
| | - Peter Cox
- Faculty of Environment, Science and Economy, University of Exeter, Exeter, Devon, EX4 4QF, UK
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Cox P, Panay N. Non-hormonal treatments for managing vulvovaginal atrophy/genitourinary syndrome of menopause. Climacteric 2023:1-6. [PMID: 37199295 DOI: 10.1080/13697137.2023.2210283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
The demand for non-hormonal therapies for vulvovaginal atrophy (VVA) is increasing due to an increasing number of patients surviving long term post cancer diagnosis, as well as increased public knowledge of the symptoms of menopause and availability of non-hormonal therapies. Treatment options are wide-ranging and encompass different formulations and methods of application. This review summarizes the key characteristics of the main forms of these therapies, as well as considering the current evidence for each of them and where future clinical studies should be directed. Care for VVA may be in primary care, or under gynecology or oncology. Further research requirements include the need for long-term data as well larger randomized controlled trials into alternatives where vaginal estrogen cannot be used as first-line treatment. Widespread education of health-care providers and patients on VVA and the impact on quality of life is urgently needed, as well as increased use of non-hormonal methods in routine clinical practice.
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Affiliation(s)
- P Cox
- Department of Gynaecology, Chelsea and Westminster Hospital, London, UK
| | - N Panay
- Department of Gynaecology, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, UK
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Millington RC, Rogers A, Cox P, Bozec Y, Mumby PJ. Combined direct and indirect impacts of warming on the productivity of coral reef fishes. Ecosphere 2022. [DOI: 10.1002/ecs2.4108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Rebecca C. Millington
- College of Engineering, Mathematics and Physical Science University of Exeter Exeter UK
- Marine Spatial Ecology Lab, School of Biological Sciences The University of Queensland Brisbane Queensland Australia
| | - Alice Rogers
- School of Biological Sciences Victoria University of Wellington Wellington New Zealand
| | - Peter Cox
- College of Engineering, Mathematics and Physical Science University of Exeter Exeter UK
| | - Yves‐Marie Bozec
- Marine Spatial Ecology Lab, School of Biological Sciences The University of Queensland Brisbane Queensland Australia
| | - Peter J. Mumby
- Marine Spatial Ecology Lab, School of Biological Sciences The University of Queensland Brisbane Queensland Australia
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Abstract
Objective: Core outcome sets (COS) are an agreed standardised collection of outcomes created with representation from all key stakeholders (such as patients, clinicians, researchers), which should be reported as a minimum for all trials in that corresponding clinical area. There has been little research investigating the use of core outcomes in Health technology assessments (HTAs) and none in non-oncology HTAs. This study aimed to assess the similarity between COS and HTA outcomes. Methods: Ten COS published between 2015 and 2019 were selected, with patient participation taken as a proxy measure for a high quality COS. The INAHTA database was used as a source to identify relevant HTAs, which were accessed through the hyperlinks provided. Outcomes selected for these assessments were categorised as either a specific, partial or no match compared to the COS. An additional cohort of non-oncology HTAs published between 2019 and 2021 were identified from the NICE website and compared against a relevant COS. Results: Six hundred and fifty-one HTAs were matched to the ten COS areas, of which 119 were reviewed. Of a possible 1318 core outcome matches, there were 562 (43%) matches, 413 (31%) specific and 149 (11%) partial. NICE HTA matches against corresponding COS ranged from 44% to 100%, with a total of 78% (73/94) matches, 57 (61%) specific and 16 (17%) partial. Conclusion: Further work is required to promote the awareness and implementation of COS within HTAs. The degree of matching between COS and NICE HTA outcomes is encouraging, demonstrating acceptance of COS by HTA producers.
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Affiliation(s)
- Peter Cox
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| | - Paula R. Williamson
- Department of Health Data Science, University of Liverpool (a member of Liverpool Health Partners), Liverpool, UK
| | - Susanna Dodd
- Department of Health Data Science, University of Liverpool (a member of Liverpool Health Partners), Liverpool, UK
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Cox P. Cycling and the British: A Modern History by Neil Carter (review). Technol Cult 2022; 63:282-283. [PMID: 35000991 DOI: 10.1353/tech.2022.0034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
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Minshall I, Buckels L, Cox P, Jamroze H, Jeyam T, Newman A, Williams L, Neligan A. UK general practice: Continuing to fail in the care of people with epilepsy? Epilepsy Behav 2021; 124:108354. [PMID: 34628090 DOI: 10.1016/j.yebeh.2021.108354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 09/15/2021] [Accepted: 09/16/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE To review the standard of clinical care of people with epilepsy (PWE) attending UK general practice after epilepsy was removed from the Quality and Outcomes Framework (QOF) in 2014. METHOD The case notes of 324 people were reviewed against standards based on National Institute for Health and Care Excellence (NICE), Drug Safety Unit (DSU), and Medicines and Healthcare products Regulatory Agency (MHRA) guidelines. RESULTS Annual face-to-face review fell significantly (p = 0.021) after the removal of epilepsy from QOF in 2014. Clinical Commissioning Group (CCG) downloaded review rates fell significantly from 95% in 2010 to only 14% in 2016. One hundred and twenty seven (39%) people had seen their GP, and108 (33%) had not seen any doctor, in the past year. One hundred and seventy three (53%) were under specialist care. Forty nine percent not under specialist care had poor control. Two hundred and fifty four (78%) people were on ASM (Anti-Seizure Medication) associated with poor bone health, of these 41 (16%) were prescribed vitamin D. Fourteen women of childbearing age were taking sodium valproate, of whom only 5 (36%) had written confirmation of being counseled of the associated risks. Fifty six (17%) people were non-complaint with prescription collection, of which 66% had documented poor control. There was a discrepancy between actual face-to-face review rates and the review rates the CCG collected. CONCLUSION This study reveals poor annual review rates for PWE in UK primary care, which have fallen further since the removal of epilepsy from QOF. Unmet needs persist for people with poorly controlled epilepsy not under specialist care, bone health, and the care of women of child bearing age. This study, along with previous work, brings into question the concept of shared care for PWE. Clinical Commissioning Groups should consider investing in the training and employment of GPwSIe (GP with Special Interest in epilepsy) and ENS (Epilepsy Nurse Specialists) to work in the community. The Government should examine re-introducing epilepsy back into QOF with measurable clinical targets and adequate remuneration.
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Affiliation(s)
- Ian Minshall
- Fountains Medical Practice, Fountains Health, Delamere Street, Chester CH1 4DS, United Kingdom.
| | - Laura Buckels
- NHS Liverpool Clinical Commissioning Group Levels 4 & 5, The Department, 2 Renshaw Street, L1 2SA, United Kingdom
| | - Peter Cox
- University of Liverpool Medical School, Cedar House, Ashton St, Liverpool L69 3GE, United Kingdom
| | - Humaira Jamroze
- University of Liverpool Medical School, Cedar House, Ashton St, Liverpool L69 3GE, United Kingdom
| | - Tara Jeyam
- University of Liverpool Medical School, Cedar House, Ashton St, Liverpool L69 3GE, United Kingdom
| | - Amelia Newman
- University of Liverpool Medical School, Cedar House, Ashton St, Liverpool L69 3GE, United Kingdom
| | - Lisa Williams
- University of Liverpool Medical School, Cedar House, Ashton St, Liverpool L69 3GE, United Kingdom
| | - Aiden Neligan
- Homerton University Hospital NHS Foundation Trust, and UCL Institute of Neurology, Queen Square, London, United Kingdom
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Abstract
Objective: Core outcome sets (COS) are an agreed standardised collection of outcomes created with representation from all key stakeholders (such as patients, clinicians, researchers), which should be reported as a minimum for all trials in that corresponding clinical area. There has been little research investigating the use of core outcomes in Health technology assessments (HTAs) and none in non-oncology HTAs. This study aimed to assess the similarity between COS and HTA outcomes. Methods: Ten COS published between 2015 and 2019 were selected, with patient participation taken as a proxy measure for a high quality COS. The INAHTA database was used as a source to identify relevant HTAs, which were accessed through the hyperlinks provided. Outcomes selected for these assessments were categorised as either a specific, partial or no match compared to the COS. An additional cohort of non-oncology HTAs published between 2019 and 2021 were identified from the NICE website and compared against a relevant COS. Results: Six hundred and fifty-one HTAs were matched to the ten COS areas, of which 119 were reviewed. Of a possible 1318 core outcome matches, there were 562 (43%) matches, 413 (31%) specific and 149 (11%) partial. NICE HTA matches against corresponding COS ranged from 44% to 100%, with a total of 78% (73/94) matches, 57 (61%) specific and 16 (17%) partial. Conclusion: Further work is required to promote the awareness and implementation of COS within HTAs. The degree of matching between COS and NICE HTA outcomes is encouraging, demonstrating acceptance of COS by HTA producers.
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Affiliation(s)
- Peter Cox
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| | - Paula R. Williamson
- Department of Health Data Science, University of Liverpool (a member of Liverpool Health Partners), Liverpool, UK
| | - Susanna Dodd
- Department of Health Data Science, University of Liverpool (a member of Liverpool Health Partners), Liverpool, UK
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Cox P, Gupta S, Zhao SS, Hughes DM. The incidence and prevalence of cardiovascular diseases in gout: a systematic review and meta-analysis. Rheumatol Int 2021; 41:1209-1219. [PMID: 33987709 PMCID: PMC8164620 DOI: 10.1007/s00296-021-04876-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 04/21/2021] [Indexed: 02/07/2023]
Abstract
The aims of this systematic review and meta-analysis were to describe prevalence of cardiovascular disease in gout, compare these results with non-gout controls and consider whether there were differences according to geography. PubMed, Scopus and Web of Science were systematically searched for studies reporting prevalence of any cardiovascular disease in a gout population. Studies with non-representative sampling, where a cohort had been used in another study, small sample size (< 100) and where gout could not be distinguished from other rheumatic conditions were excluded, as were reviews, editorials and comments. Where possible meta-analysis was performed using random-effect models. Twenty-six studies comprising 949,773 gout patients were included in the review. Pooled prevalence estimates were calculated for five cardiovascular diseases: myocardial infarction (2.8%; 95% confidence interval (CI)s 1.6, 5.0), heart failure (8.7%; 95% CI 2.9, 23.8), venous thromboembolism (2.1%; 95% CI 1.2, 3.4), cerebrovascular accident (4.3%; 95% CI 1.8, 9.7) and hypertension (63.9%; 95% CI 24.5, 90.6). Sixteen studies reported comparisons with non-gout controls, illustrating an increased risk in the gout group across all cardiovascular diseases. There were no identifiable reliable patterns when analysing the results by country. Cardiovascular diseases are more prevalent in patients with gout and should prompt vigilance from clinicians to the need to assess and stratify cardiovascular risk. Future research is needed to investigate the link between gout, hyperuricaemia and increased cardiovascular risk and also to establish a more thorough picture of prevalence for less common cardiovascular diseases.
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Affiliation(s)
- Peter Cox
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Biosciences Building, Crown Street, Liverpool, L69 7BE, UK.
| | - Sonal Gupta
- School of Medicine, University of Liverpool, Liverpool, UK
| | - Sizheng Steven Zhao
- Musculoskeletal Biology, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - David M Hughes
- Department of Health Data Science, University of Liverpool, Liverpool, UK
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Cox P, Gupta S, Zhao SS, Hughes D. POS1131 THE INCIDENCE AND PREVALENCE OF CARDIOVASCULAR DISEASES IN GOUT: A SYSTEMATIC REVIEW AND META-ANALYSIS. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.1425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Gout is an inflammatory crystal arthropathy characterised by hyperuricaemia and sodium urate crystal deposition. Both gout and subclinical hyperuricaemia are associated with adverse cardiovascular outcomes. Several studies have found gout to cause an increased risk of cardiovascular disease, but the evidence is not unanimous. The conflicting evidence has made it difficult to establish the extent of the cardiovascular risk to patients with gout.Objectives:To describe the incidence and prevalence of cardiovascular disease in gout, compare these results with non-gout controls.Methods:PubMed, Scopus and Web of Science were systematically searched in January 2021 for studies reporting prevalence of any cardiovascular disease in a gout population. Studies with non-representative sampling, where a cohort had been used in another study, small sample size (< 100) and where gout could not be distinguished from other rheumatic conditions were excluded. Sample size, prevalence of the investigated cardiovascular disease, definition of gout and cardiovascular disease, demographic data, data source and any comparisons with non-gout controls were extracted from each study. Where prevalence data was reported in ≥3 cohorts meta-analysis was performed using random-effect models.Results:Of the 6164 titles identified, 105 full texts were assessed for eligibility with 30 included in the review, producing a gout population of 1,125,988. Pooled prevalence estimates were calculated for six cardiovascular diseases: heart failure (8.73%; 95% confidence interval (CI), 2.85 – 23.76), cerebrovascular accident (4.27%; 95% CI, 1.83 – 9.67), myocardial infarction (2.82%; 95% CI, 1.58 – 5.01), venous thromboembolism (2.05%; 95% CI, 1.22 – 3.43), hypertension (63.94%; 95% CI, 24.51 – 90.64) and cardiovascular mortality (4.75%; 95% CI, 3.56 – 6.31). Twenty studies reported comparisons with non-gout controls, illustrating an increased risk in the gout group across all cardiovascular diseases, particularly for myocardial infarction.Conclusion:Cardiovascular diseases are more prevalent in patients with gout and should prompt vigilance from clinicians to the need to assess and stratify cardiovascular risk. These results are in line with other studies which have shown an increased cardiovascular risk for sufferers of hyperuricaemia, highlighting the need for future research to explain this finding. There are limited studies in the literature investigating less common cardiovascular conditions, illustrating the need for future work if a more thorough picture of prevalence is to be established.Figure 1.Forest plots of pooled prevalence of: (A) 8.73% for heart failure, (B) 4.27% for cerebrovascular accident, (C) 2.82% for myocardial infarction, (D) 2.05% for venous thromboembolism, (E) 63.94% for hypertension and (F) 4.75% for cardiovascular mortality.Disclosure of Interests:None declared.
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10
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Hu J, Lloyd M, Hobbs C, Cox P, Burke K, Pearce G, Streicker MA, Gao Q, Frankos V. Absence of genotoxicity of purified Aloe vera whole leaf dry juice as assessed by an in vitro mouse lymphoma tk assay and an in vivo comet assay in male F344 rats. Toxicol Rep 2021; 8:511-519. [PMID: 33747796 PMCID: PMC7973126 DOI: 10.1016/j.toxrep.2021.03.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 03/05/2021] [Accepted: 03/06/2021] [Indexed: 02/07/2023] Open
Abstract
Hydroxyanthracene derivatives (HAD) are naturally present in the latex layer of Aloe vera leaf, predominantly as aloins A, B and aloe-emodin. HAD are typically removed from commercial ingestible aloe products through activated charcoal filtration (decolorization). Current research aimed to evaluate genotoxic potential of a purified aloe whole leaf dry juice containing 0.3 ppm of total aloins and non-detectable aloe-emodin (LOD =0.01 ppm) in the L5178Y mouse lymphoma assay (MLA; OECD 490) and in vivo comet assay (OECD 489). No marked increases in mutant frequency at the tk locus were observed in the MLA at concentrations up to 5000 μg/mL for 3 h and 24 h (-S9), and up to a precipitating concentration of 3000 μg/mL for 3 h (+S9) compared to concurrent vehicle control. Relative total growth at the highest analyzable concentrations at 3 h (±S9) and 24 h (-S9) ranged from 64 to 133 %. In the comet assay, no statistically significant increases in DNA strand breaks were detected in the colon or kidney following oral gavage of 500, 1000 or 2000 mg/kg/day in male F344 rats for 2 days compared to concurrent vehicle control. Overall, these findings demonstrated the test article containing minimal HAD is not genotoxic under the described experimental conditions.
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Affiliation(s)
- Jiang Hu
- Herbalife Nutrition, Torrance, CA, 90502, United States
| | - Mel Lloyd
- Covance Laboratories Ltd., Harrogate, United Kingdom
| | - Cheryl Hobbs
- Integrated Laboratory Systems, LLC, Morrisville, NC, 27560, United States
| | - Peter Cox
- Covance Laboratories Ltd., Harrogate, United Kingdom
| | - Keith Burke
- Integrated Laboratory Systems, LLC, Morrisville, NC, 27560, United States
| | - Gareth Pearce
- Covance Laboratories Ltd., Harrogate, United Kingdom
| | | | - Quanyin Gao
- Herbalife Nutrition, Torrance, CA, 90502, United States
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Munot P, McCrea N, Torelli S, Manzur A, Sewry C, Chambers D, Feng L, Ala P, Zaharieva I, Ragge N, Roper H, Marton T, Cox P, Milev M, Sacher M, Liang W, Maruyama S, Nishino I, Phadke R, Muntoni F. CONGENITAL MUSCULAR DYSTROPHIES. Neuromuscul Disord 2020. [DOI: 10.1016/j.nmd.2020.08.200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Gulati N, Mackie FL, Cox P, Marton T, Heazell A, Morris RK, Kilby MD. Cause of intrauterine and neonatal death in twin pregnancies (CoDiT): development of a novel classification system. BJOG 2020; 127:1507-1515. [PMID: 32359214 DOI: 10.1111/1471-0528.16291] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Twin pregnancies have a significantly higher perinatal mortality than singleton pregnancies. Current classification systems for perinatal death lack twin-specific categories, potentially leading to loss of important information regarding cause of death. We introduce and test a classification system designed to assign a cause of death in twin pregnancies (CoDiT). DESIGN Retrospective cross-sectional study. SETTING Tertiary maternity unit in England with a perinatal pathology service. POPULATION Twin pregnancies in the West Midlands affected by fetal or neonatal demise of one or both twins between 1 January 2005 and 31 December 2016 in which postmortem examination was undertaken. METHODS A multidisciplinary panel designed CoDiT by adapting the most appropriate elements of singleton classification systems. The system was tested by assigning cause of death in 265 fetal and neonatal deaths from 144 twin pregnancies. Cause of death was validated by another obstetrician blinded to the original classification. MAIN OUTCOME MEASURES Inter-rater, intra-rater, inter-disciplinary agreement and cause of death. RESULTS Cohen's Kappa demonstrated 'strong' (>0.8) inter-rater, intra-rater and inter-disciplinary agreement (95% CI 0.70-0.91). The commonest cause of death irrespective of chorionicity was the placenta; twin-to-twin transfusion syndrome (TTTS) was the commonest placental cause in monochorionic twins and acute chorioamnionitis in dichorionic twins. CONCLUSIONS This novel classification system records causes of death in twin pregnancies from postmortem reports with high inter-user agreement. We highlight differences in aetiology of death between monochorionic and dichorionic twins. TWEETABLE ABSTRACT New classification system for #twin cause of death 'CoDiT' shows high rater agreement.
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Affiliation(s)
- N Gulati
- Institute of Metabolism & Systems Research, College of Medical & Dental Sciences, University of Birmingham, Birmingham, UK.,Fetal Medicine Centre, Birmingham Women's & Children's Foundation Trust, Birmingham, UK
| | - F L Mackie
- Institute of Metabolism & Systems Research, College of Medical & Dental Sciences, University of Birmingham, Birmingham, UK.,Fetal Medicine Centre, Birmingham Women's & Children's Foundation Trust, Birmingham, UK
| | - P Cox
- Cellular Pathology Department, Birmingham Women's Hospital, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - T Marton
- Cellular Pathology Department, Birmingham Women's Hospital, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Aep Heazell
- Maternal and Fetal Health Research Centre, University of Manchester, Manchester, UK.,St Mary's Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - R K Morris
- Fetal Medicine Centre, Birmingham Women's & Children's Foundation Trust, Birmingham, UK.,Institute of Applied Health Research, College of Medical & Dental Sciences, University of Birmingham, Birmingham, UK
| | - M D Kilby
- Institute of Metabolism & Systems Research, College of Medical & Dental Sciences, University of Birmingham, Birmingham, UK.,Fetal Medicine Centre, Birmingham Women's & Children's Foundation Trust, Birmingham, UK
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Rapson R, Marsden J, Jeffery R, Cox P, Morris C, King T. What is the effect of increased standing time in non-ambulant children with cerebral palsy? a feasibility study. Physiotherapy 2020. [DOI: 10.1016/j.physio.2020.03.098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Curtin D, Drewes M, McCullough M, Meade P, Mohapatra RN, Shelton J, Shuve B, Accomando E, Alpigiani C, Antusch S, Carlos Arteaga-Velázquez J, Batell B, Bauer M, Blinov N, Salomé Caballero-Mora K, Hyeok Chang J, Chun EJ, Co RT, Cohen T, Cox P, Craig N, Csáki C, Cui Y, D'Eramo F, Delle Rose L, Bhupal Dev PS, Dienes KR, Dror JA, Essig R, Evans JA, Evans JL, Fernández Tellez A, Fischer O, Flacke T, Fradette A, Frugiuele C, Fuchs E, Gherghetta T, Giudice GF, Gorbunov D, Gupta RS, Hagedorn C, Hall LJ, Harris P, Carlos Helo J, Hirsch M, Hochberg Y, Hook A, Ibarra A, Ipek S, Jung S, Knapen S, Kuflik E, Liu Z, Lombardo S, Lubatti HJ, McKeen D, Molinaro E, Moretti S, Nagata N, Neubert M, Miguel No J, Olaiya E, Perez G, Peskin ME, Pinner D, Pospelov M, Reece M, Robinson DJ, Rodríguez Cahuantzi M, Santonico R, Schlaffer M, Shepherd-Themistocleous CH, Spray A, Stolarski D, Subieta Vasquez MA, Sundrum R, Thamm A, Thomas B, Tsai Y, Tweedie B, West SM, Young C, Yu F, Zaldivar B, Zhang Y, Zurek K, Zurita J. Long-lived particles at the energy frontier: the MATHUSLA physics case. Rep Prog Phys 2019; 82:116201. [PMID: 31185458 DOI: 10.1088/1361-6633/ab28d6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
We examine the theoretical motivations for long-lived particle (LLP) signals at the LHC in a comprehensive survey of standard model (SM) extensions. LLPs are a common prediction of a wide range of theories that address unsolved fundamental mysteries such as naturalness, dark matter, baryogenesis and neutrino masses, and represent a natural and generic possibility for physics beyond the SM (BSM). In most cases the LLP lifetime can be treated as a free parameter from the [Formula: see text]m scale up to the Big Bang Nucleosynthesis limit of [Formula: see text] m. Neutral LLPs with lifetimes above [Formula: see text]100 m are particularly difficult to probe, as the sensitivity of the LHC main detectors is limited by challenging backgrounds, triggers, and small acceptances. MATHUSLA is a proposal for a minimally instrumented, large-volume surface detector near ATLAS or CMS. It would search for neutral LLPs produced in HL-LHC collisions by reconstructing displaced vertices (DVs) in a low-background environment, extending the sensitivity of the main detectors by orders of magnitude in the long-lifetime regime. We study the LLP physics opportunities afforded by a MATHUSLA-like detector at the HL-LHC, assuming backgrounds can be rejected as expected. We develop a model-independent approach to describe the sensitivity of MATHUSLA to BSM LLP signals, and compare it to DV and missing energy searches at ATLAS or CMS. We then explore the BSM motivations for LLPs in considerable detail, presenting a large number of new sensitivity studies. While our discussion is especially oriented towards the long-lifetime regime at MATHUSLA, this survey underlines the importance of a varied LLP search program at the LHC in general. By synthesizing these results into a general discussion of the top-down and bottom-up motivations for LLP searches, it is our aim to demonstrate the exceptional strength and breadth of the physics case for the construction of the MATHUSLA detector.
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Affiliation(s)
- David Curtin
- Department of Physics, University of Toronto, Toronto, ON M5S 1A7, Canada
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Affiliation(s)
- P. Cox
- Department of Gynaecology, Queen Charlotte’s and Chelsea Hospital, London, UK
| | - N. Panay
- Department of Gynaecology, Queen Charlotte’s and Chelsea Hospital, London, UK
- Department of Gynaecology, Chelsea and Westminster Hospital, London, UK
- Department of Gynaecology, Imperial College London, London, UK
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Eller CB, Rowland L, Oliveira RS, Bittencourt PRL, Barros FV, da Costa ACL, Meir P, Friend AD, Mencuccini M, Sitch S, Cox P. Modelling tropical forest responses to drought and El Niño with a stomatal optimization model based on xylem hydraulics. Philos Trans R Soc Lond B Biol Sci 2018; 373:20170315. [PMID: 30297470 PMCID: PMC6178424 DOI: 10.1098/rstb.2017.0315] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2018] [Indexed: 11/12/2022] Open
Abstract
The current generation of dynamic global vegetation models (DGVMs) lacks a mechanistic representation of vegetation responses to soil drought, impairing their ability to accurately predict Earth system responses to future climate scenarios and climatic anomalies, such as El Niño events. We propose a simple numerical approach to model plant responses to drought coupling stomatal optimality theory and plant hydraulics that can be used in dynamic global vegetation models (DGVMs). The model is validated against stand-scale forest transpiration (E) observations from a long-term soil drought experiment and used to predict the response of three Amazonian forest sites to climatic anomalies during the twentieth century. We show that our stomatal optimization model produces realistic stomatal responses to environmental conditions and can accurately simulate how tropical forest E responds to seasonal, and even long-term soil drought. Our model predicts a stronger cumulative effect of climatic anomalies in Amazon forest sites exposed to soil drought during El Niño years than can be captured by alternative empirical drought representation schemes. The contrasting responses between our model and empirical drought factors highlight the utility of hydraulically-based stomatal optimization models to represent vegetation responses to drought and climatic anomalies in DGVMs.This article is part of a discussion meeting issue 'The impact of the 2015/2016 El Niño on the terrestrial tropical carbon cycle: patterns, mechanisms and implications'.
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Affiliation(s)
- Cleiton B Eller
- College of Life and Environmental Sciences, University of Exeter, Exeter, UK
| | - Lucy Rowland
- College of Life and Environmental Sciences, University of Exeter, Exeter, UK
| | - Rafael S Oliveira
- Department of Plant Biology, Institute of Biology, UNICAMP, Campinas, Brazil
| | - Paulo R L Bittencourt
- College of Life and Environmental Sciences, University of Exeter, Exeter, UK
- Department of Plant Biology, Institute of Biology, UNICAMP, Campinas, Brazil
| | - Fernanda V Barros
- Department of Plant Biology, Institute of Biology, UNICAMP, Campinas, Brazil
| | | | - Patrick Meir
- Research School of Biology, Australian National University, Canberra, Australia
- School of GeoSciences, University of Edinburgh, Edinburgh, UK
| | - Andrew D Friend
- Department of Geography, University of Cambridge, Cambridge, UK
| | | | - Stephen Sitch
- College of Life and Environmental Sciences, University of Exeter, Exeter, UK
| | - Peter Cox
- College of Engineering, Mathematics and Physical Sciences, University of Exeter, Exeter, UK
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Hewitt NA, Cox P. Recurrent Subanesthetic Ketamine Infusions for Complex Regional Pain Syndrome Leading to Biliary Dilation, Jaundice, and Cholangitis: A Case Report. A A Pract 2018; 10:168-170. [PMID: 29135531 DOI: 10.1213/xaa.0000000000000650] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Complex regional pain syndrome is a chronic pain condition that may be resistant to many treatment modalities. Ketamine infusions have demonstrated some promising results, though their use may be associated with a number of adverse effects limiting their widespread applicability. Hepatotoxicity and cholangiopathy have been described in chronic ketamine abuse, though rarely in therapeutic use. We report the impact of recurrent short subanesthetic ketamine infusions for the treatment of complex regional pain syndrome resulting in biliary dilation, jaundice, and cholangitis. We recommend that prescribing physicians consider this and monitor liver function tests throughout the treatment period to minimize morbidity.
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Affiliation(s)
- Nathan A Hewitt
- From the Anesthetic Department and Pain Management Unit, St George Hospital Sydney, Kogarah, New South Wales, Australia
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20
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Jones AV, Tilley M, Gutteridge A, Hyde C, Nagle M, Ziemek D, Gorman D, Fauman EB, Chen X, Miller MR, Tian C, Hu Y, Hinds DA, Cox P, Scollen S. GWAS of self-reported mosquito bite size, itch intensity and attractiveness to mosquitoes implicates immune-related predisposition loci. Hum Mol Genet 2017; 26:1391-1406. [PMID: 28199695 PMCID: PMC5390679 DOI: 10.1093/hmg/ddx036] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 01/23/2017] [Indexed: 12/31/2022] Open
Abstract
Understanding the interaction between humans and mosquitoes is a critical area of study due to the phenomenal burdens on public health from mosquito-transmitted diseases. In this study, we conducted the first genome-wide association studies (GWAS) of self-reported mosquito bite reaction size (n = 84,724), itchiness caused by bites (n = 69,057), and perceived attractiveness to mosquitoes (n = 16,576). In total, 15 independent significant (P < 5×10−8) associations were identified. These loci were enriched for immunity-related genes that are involved in multiple cytokine signalling pathways. We also detected suggestive enrichment of these loci in enhancer regions that are active in stimulated T-cells, as well as within loci previously identified as controlling central memory T-cell levels. Egger regression analysis between the traits suggests that perception of itchiness and attractiveness to mosquitoes is driven, at least in part, by the genetic determinants of bite reaction size. Our findings illustrate the complex genetic and immunological landscapes underpinning human interactions with mosquitoes.
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Affiliation(s)
- Amy V. Jones
- Pfizer WRD, Human Genetics and Computational Biomedicine, The Portway Building, Granta Park, Cambridge CB21 6GS, UK
| | - Mera Tilley
- Pfizer WRD, Pharmatherapeutics Clinical R&D, Precision Medicine, 300 Technology Square Fl #3, Cambridge, MA 02139, USA
| | - Alex Gutteridge
- Pfizer WRD, Computational Sciences CoE, The Portway Building, Granta Park, Cambridge CB21 6GS, UK
| | - Craig Hyde
- Pfizer WRD, Research Statistics, 558 Eastern Point Rd, Groton, CT 06340, USA
| | - Michael Nagle
- Pfizer WRD, Human Genetics and Computational Biomedicine, 610 Main Street S, Cambridge, MA 02139, USA
| | - Daniel Ziemek
- Pfizer WRD, Computational Sciences CoE, Linkstraße 10, 10785 Berlin, Germany
| | - Donal Gorman
- Pfizer WRD, Research Statistics, The Portway Building, Granta Park, Cambridge CB21 6GS, UK
| | - Eric B. Fauman
- Pfizer WRD, Computational Sciences CoE, 610 Main Street S, Cambridge, MA 02139, USA
| | - Xing Chen
- Pfizer WRD, Research Statistics, 558 Eastern Point Rd, Groton, CT 06340, USA
| | - Melissa R. Miller
- Pfizer WRD, Human Genetics and Computational Biomedicine, 610 Main Street S, Cambridge, MA 02139, USA
| | - Chao Tian
- 23andMe, Inc, 899 W Evelyn Avenue, Mountain View, California, CA 94043, USA
| | - Youna Hu
- 23andMe, Inc, 899 W Evelyn Avenue, Mountain View, California, CA 94043, USA
| | - David A. Hinds
- 23andMe, Inc, 899 W Evelyn Avenue, Mountain View, California, CA 94043, USA
| | - Peter Cox
- Pfizer Ltd, Neuroscience and Pain Research Unit, The Portway Building, Granta Park, Cambridge CB21 6GS, UK
| | - Serena Scollen
- Pfizer WRD, Human Genetics and Computational Biomedicine, The Portway Building, Granta Park, Cambridge CB21 6GS, UK
- To whom correspondence should be addressed at: ELIXIR Hub, Wellcome Genome Campus, Hinxton, Cambridge CB10 1SD, UK. Tel: +44 1223494322; Fax: +44 (0)1223 484696;
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21
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Yusuf E, Loens K, Jans B, Cox P, Ieven M, Goossens H. The first clonal spread of vanA-positive Enterococcus raffinosus in a nursing home. J Hosp Infect 2017; 96:72-74. [PMID: 28377181 DOI: 10.1016/j.jhin.2017.03.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 03/07/2017] [Indexed: 11/29/2022]
Affiliation(s)
- E Yusuf
- Antwerp University Hospital (UZA), Belgian National Reference Centre for Enterococci, University Hospital of Antwerp, Edegem, Belgium.
| | - K Loens
- Antwerp University Hospital (UZA), Belgian National Reference Centre for Enterococci, University Hospital of Antwerp, Edegem, Belgium
| | - B Jans
- Scientific Institute of Public Health (WIV-ISP), Brussels, Belgium
| | - P Cox
- Flemish Agency for Care and Health (Agentschap Zorg en Gezondheid), Leuven, Belgium
| | - M Ieven
- Antwerp University Hospital (UZA), Belgian National Reference Centre for Enterococci, University Hospital of Antwerp, Edegem, Belgium
| | - H Goossens
- Antwerp University Hospital (UZA), Belgian National Reference Centre for Enterococci, University Hospital of Antwerp, Edegem, Belgium
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Watts N, Adger WN, Ayeb-Karlsson S, Bai Y, Byass P, Campbell-Lendrum D, Colbourn T, Cox P, Davies M, Depledge M, Depoux A, Dominguez-Salas P, Drummond P, Ekins P, Flahault A, Grace D, Graham H, Haines A, Hamilton I, Johnson A, Kelman I, Kovats S, Liang L, Lott M, Lowe R, Luo Y, Mace G, Maslin M, Morrissey K, Murray K, Neville T, Nilsson M, Oreszczyn T, Parthemore C, Pencheon D, Robinson E, Schütte S, Shumake-Guillemot J, Vineis P, Wilkinson P, Wheeler N, Xu B, Yang J, Yin Y, Yu C, Gong P, Montgomery H, Costello A. The Lancet Countdown: tracking progress on health and climate change. Lancet 2017; 389:1151-1164. [PMID: 27856085 DOI: 10.1016/s0140-6736(16)32124-9] [Citation(s) in RCA: 182] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Revised: 10/10/2016] [Accepted: 10/19/2016] [Indexed: 11/15/2022]
Abstract
The Lancet Countdown: tracking progress on health and climate change is an international, multidisciplinary research collaboration between academic institutions and practitioners across the world. It follows on from the work of the 2015 Lancet Commission, which concluded that the response to climate change could be "the greatest global health opportunity of the 21st century". The Lancet Countdown aims to track the health impacts of climate hazards; health resilience and adaptation; health co-benefits of climate change mitigation; economics and finance; and political and broader engagement. These focus areas form the five thematic working groups of the Lancet Countdown and represent different aspects of the complex association between health and climate change. These thematic groups will provide indicators for a global overview of health and climate change; national case studies highlighting countries leading the way or going against the trend; and engagement with a range of stakeholders. The Lancet Countdown ultimately aims to report annually on a series of indicators across these five working groups. This paper outlines the potential indicators and indicator domains to be tracked by the collaboration, with suggestions on the methodologies and datasets available to achieve this end. The proposed indicator domains require further refinement, and mark the beginning of an ongoing consultation process-from November, 2016 to early 2017-to develop these domains, identify key areas not currently covered, and change indicators where necessary. This collaboration will actively seek to engage with existing monitoring processes, such as the UN Sustainable Development Goals and WHO's climate and health country profiles. The indicators will also evolve over time through ongoing collaboration with experts and a range of stakeholders, and be dependent on the emergence of new evidence and knowledge. During the course of its work, the Lancet Countdown will adopt a collaborative and iterative process, which aims to complement existing initiatives, welcome engagement with new partners, and be open to developing new research projects on health and climate change.
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Affiliation(s)
- Nick Watts
- Institute for Global Health, University College London, London, UK.
| | - W Neil Adger
- Geography, College of Life and Environmental Sciences, University of Exeter, Exeter, UK
| | | | - Yuqi Bai
- Centre for Earth System Science, Tsinghua University, Beijing, China
| | - Peter Byass
- Epidemiology & Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Diarmid Campbell-Lendrum
- Department of Public Health, Environmental and Social Determinants of Health, World Health Organization, Geneva, Switzerland
| | - Tim Colbourn
- Institute for Global Health, University College London, London, UK
| | - Peter Cox
- College of Engineering, Mathematics, and Physical Sciences, University of Exeter, Exeter, UK
| | - Michael Davies
- Institute for Environmental Design and Engineering, University College London, London, UK
| | - Michael Depledge
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Anneliese Depoux
- Centre Virchow-Villermé for Public Health Paris-Berlin, Université Paris Descartes, Paris, France
| | - Paula Dominguez-Salas
- Department of Production and Population Health, Royal Veterinary College, London, UK
| | - Paul Drummond
- Institute for Sustainable Resources, University College London, London, UK
| | - Paul Ekins
- Institute for Sustainable Resources, University College London, London, UK
| | - Antoine Flahault
- Centre Virchow-Villermé for Public Health Paris-Berlin, Université Paris Descartes, Paris, France
| | - Delia Grace
- Food Safety and Zoonoses Program, International Livestock Research Institute, Nairobi, Kenya
| | - Hilary Graham
- Department of Health Sciences, University of York, York, UK
| | - Andy Haines
- NIHR Health Protection Research Unit in Environmental Change and Health and Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Ian Hamilton
- Energy Institute, University College London, London, UK
| | - Anne Johnson
- Institute of Epidemiology and Health Care, University College London, London, UK
| | - Ilan Kelman
- Institute for Global Health and UCL Institute for Risk and Disaster Reduction, University College London, London, UK
| | - Sari Kovats
- NIHR Health Protection Research Unit in Environmental Change and Health and Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Lu Liang
- School of Forestry and Natural Resources, University of Arkansas at Monticello, Monticello, AR, USA
| | - Melissa Lott
- Institute for Sustainable Resources, University College London, London, UK
| | - Robert Lowe
- Energy Institute, University College London, London, UK
| | - Yong Luo
- Centre for Earth System Science, Tsinghua University, Beijing, China
| | - Georgina Mace
- Department of Genetics, Evolution and Environment, University College London, London, UK
| | - Mark Maslin
- Department of Geography, University College London, London, UK
| | - Karyn Morrissey
- European Centre for Environment & Human Health, University of Exeter, Exeter, UK
| | - Kris Murray
- Grantham Institute-Climate Change and the Environment, Imperial College London, London, UK
| | - Tara Neville
- Department of Public Health, Environmental and Social Determinants of Health, World Health Organization, Geneva, Switzerland
| | - Maria Nilsson
- Epidemiology & Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Tadj Oreszczyn
- Bartlett School of Environment, Energy and Resources, RCUK Centre for Energy Epidemiology, University College London, London, UK
| | | | | | - Elizabeth Robinson
- School of Agriculture, Policy and Development, University of Reading, Reading, UK
| | - Stefanie Schütte
- Centre Virchow-Villermé for Public Health Paris-Berlin, Université Paris Descartes, Paris, France
| | - Joy Shumake-Guillemot
- WHO/WMO Joint Climate and Health Office, World Meteorological Organization, Geneva, Switzerland
| | - Paolo Vineis
- MRC/PHE Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - Paul Wilkinson
- NIHR Health Protection Research Unit in Environmental Change and Health and Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Nicola Wheeler
- Institute for Global Health, University College London, London, UK
| | - Bing Xu
- Centre for Earth System Science, Tsinghua University, Beijing, China
| | - Jun Yang
- Centre for Earth System Science, Tsinghua University, Beijing, China
| | - Yongyuan Yin
- Centre for Earth System Science, Tsinghua University, Beijing, China
| | - Chaoqing Yu
- Centre for Earth System Science, Tsinghua University, Beijing, China
| | - Peng Gong
- Centre for Earth System Science, Tsinghua University, Beijing, China
| | - Hugh Montgomery
- Institute for Human Health and Performance, Division of Medicine, University College London, London, UK
| | - Anthony Costello
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland
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Cox P, Marton T, Hargitai B, Coetzee A, Bowen C, Penman D, Evans M, Gannon C, French P, Cohen M, Holden S, Allotey J, Evans C, Murphy A, Turner K, Cullinane C, Stahlschmidt J, Kokai G, Al Adnani M, Marnerides A, Vadgama B, McPartland J. Re: Stillbirth collection by Man et al. Ultrasound Obstet Gynecol 2017; 49:281-282. [PMID: 28169497 DOI: 10.1002/uog.17380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 11/28/2016] [Indexed: 06/06/2023]
Affiliation(s)
- P Cox
- Perinatal Pathology, Birmingham Women's Hospital, Mindelsohn Way, Birmingham, B15 2TG, UK
| | - T Marton
- Perinatal Pathology, Birmingham Women's Hospital, Mindelsohn Way, Birmingham, B15 2TG, UK
| | - B Hargitai
- Perinatal Pathology, Birmingham Women's Hospital, Mindelsohn Way, Birmingham, B15 2TG, UK
| | - A Coetzee
- Perinatal Pathology, Birmingham Women's Hospital, Mindelsohn Way, Birmingham, B15 2TG, UK
| | - C Bowen
- Paediatric Pathology, Queen Elizabeth University Hospital, Glasgow, UK
| | - D Penman
- Paediatric Pathology, Queen Elizabeth University Hospital, Glasgow, UK
| | - M Evans
- Perinatal Pathology, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - C Gannon
- Perinatal Pathologist, Bangor, Northern, Ireland
| | - P French
- Paediatric Pathology, Queen Elizabeth University Hospital, Glasgow, UK
| | - M Cohen
- Pathology, Sheffield Children's Hospital NHS Trust, Sheffield, UK
| | - S Holden
- Paediatric & Perinatal Pathology, Southampton General Hospital, Southampton, UK
| | - J Allotey
- Paediatric Pathology, Queen's Medical Centre, Nottingham, UK
| | - C Evans
- Paediatric Pathology, Queen's Medical Centre, Nottingham, UK
| | - A Murphy
- Paediatric Pathology, Queen's Medical Centre, Nottingham, UK
| | - K Turner
- Paediatric & Perinatal Pathology, St James University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - C Cullinane
- Paediatric & Perinatal Pathology, St James University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - J Stahlschmidt
- Paediatric & Perinatal Pathology, St James University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - G Kokai
- Paediatric Pathology, Alder Hey Children's Hospital, Liverpool, UK
| | - M Al Adnani
- Paediatric & Perinatal Pathology, St Thomas' Hospital, London, UK
| | - A Marnerides
- Paediatric & Perinatal Pathology, St Thomas' Hospital, London, UK
| | - B Vadgama
- Paediatric & Perinatal Pathology, Southampton General Hospital, Southampton, UK
| | - J McPartland
- Paediatric Pathology, Alder Hey Children's Hospital, Liverpool, UK
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Abstract
The authors determine the relationship between seizure duration, etiology, and outcome in a modern intensive care setting and assess the usefulness of computed tomography (CT) and the empiric use of antimicrobial therapy. The design was a retrospective chart review. The setting was a tertiary pediatric critical care unit. Patients included 161 consecutive admissions to the critical care unit at the Hospital for Sick Children, Toronto, with status epilepticus over a 3-year period. There were no interventions. The overall mortality was 5.6%. A further 11% experienced an adverse neurological outcome as determined on hospital discharge. Mean seizure duration was 1.5 ± 2.8 hours in those children with a normal outcome, 1.7 ± 1.2 hours in those survivors with an abnormal neurological outcome ( P > 0.05), and 6.8 ± 12 hours in those who died ( P < 0.05). The CT scan was abnormal in 41% of cases. New findings that directly affected immediate management decisions were found in 20% of CT scans. Both the duration and etiology of status epilepticus affect the outcome. CT scanning should be done without delay, once the patient is stable. Antiviral therapy should be started empirically now that encephalitis is far more common than bacterial meningitis in this group of patients. Studies are lacking that compare the efficacy of drugs available to treat status epilepticus. These studies need to be done, as the findings could affect the duration of status.
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Affiliation(s)
- Simon J. Parsons
- Critical Care Unit, Hospital for Sick Children, Toronto, Ontario, Canada,
| | - Katarina Tomas
- Critical Care Unit, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Peter Cox
- Critical Care Unit, Hospital for Sick Children, Toronto, Ontario, Canada
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26
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King SK, Alfaraj M, Gaiteiro R, O'Brien K, Moraes T, Humpl T, Marcon M, Chiang M, Reyes J, Haliburton B, Ryan G, Cox P, Chiu PPL. Congenital diaphragmatic hernia: Observed/expected lung-to-head ratio as a predictor of long-term morbidity. J Pediatr Surg 2016; 51:699-702. [PMID: 26932249 DOI: 10.1016/j.jpedsurg.2016.02.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2016] [Accepted: 02/07/2016] [Indexed: 02/06/2023]
Abstract
AIM The aim of this study was to investigate the association of observed/expected (O/E) lung-to-head ratio (LHR) with long-term morbidity for isolated fetal congenital diaphragmatic hernia (CDH) patients in a single institution. METHODS We performed a retrospective study of prenatally diagnosed CDH from 18 to 38weeks of gestation (01/2002-04/2010). Two cohorts of O/E LHR were defined (22.6-45%, 45.1-78.3%) based upon previous studies. Survivors with at least 1-year follow-up of prospectively collected long-term morbidity assessments were included. RESULTS O/E LHR was available in 43 survivors (median 40%, range 22.8-78.3%). Follow-up data were available in 41 survivors (M:F=24:17, left CDH=39/41). Median follow-up was 6.5years (1-11years). Height/weight trajectories were similar between the two cohorts, with the majority below the 50th centile. There were no differences between the two cohorts by age 3years for Bayley scales (developmental domains) and/or REEL-3 (language development). In addition, V/Q scans in the two cohorts demonstrated similar degrees of mismatch (mean delta V/Q=35.4 versus 31.3). CONCLUSIONS In fetuses with isolated CDH, a reduction in O/E LHR does not predict a worse outcome in long-term follow-up. There is no association between a lower O/E LHR and a reduction in REEL-3 or Bayley score nor V/Q mismatch.
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Affiliation(s)
- Sebastian K King
- Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Malikah Alfaraj
- Fetal Medicine Unit, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Rose Gaiteiro
- Division of Critical Care Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Karel O'Brien
- Division of Neonatology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Theo Moraes
- Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Tilman Humpl
- Division of Cardiology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Margaret Marcon
- Division of Gastroenterology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Monping Chiang
- Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Janette Reyes
- Division of Cardiology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Beth Haliburton
- Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Greg Ryan
- Fetal Medicine Unit, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Peter Cox
- Division of Critical Care Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Priscilla P L Chiu
- Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada.
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Vukosavljev M, Arens P, Voorrips RE, van ‘t Westende WPC, Esselink GD, Bourke PM, Cox P, van de Weg WE, Visser RGF, Maliepaard C, Smulders MJM. High-density SNP-based genetic maps for the parents of an outcrossed and a selfed tetraploid garden rose cross, inferred from admixed progeny using the 68k rose SNP array. Hortic Res 2016; 3:16052. [PMID: 27818777 PMCID: PMC5080978 DOI: 10.1038/hortres.2016.52] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 09/26/2016] [Accepted: 09/30/2016] [Indexed: 05/21/2023]
Abstract
Dense genetic maps create a base for QTL analysis of important traits and future implementation of marker-assisted breeding. In tetraploid rose, the existing linkage maps include <300 markers to cover 28 linkage groups (4 homologous sets of 7 chromosomes). Here we used the 68k WagRhSNP Axiom single-nucleotide polymorphism (SNP) array for rose, in combination with SNP dosage calling at the tetraploid level, to genotype offspring from the garden rose cultivar 'Red New Dawn'. The offspring proved to be not from a single bi-parental cross. In rose breeding, crosses with unintended parents occur regularly. We developed a strategy to separate progeny into putative populations, even while one of the parents was unknown, using principle component analysis on pairwise genetic distances based on sets of selected SNP markers that were homozygous, and therefore uninformative for one parent. One of the inferred populations was consistent with self-fertilization of 'Red New Dawn'. Subsequently, linkage maps were generated for a bi-parental and a self-pollinated population with 'Red New Dawn' as the common maternal parent. The densest map, for the selfed parent, had 1929 SNP markers on 25 linkage groups, covering 1765.5 cM at an average marker distance of 0.9 cM. Synteny with the strawberry (Fragaria vesca) genome was extensive. Rose ICM1 corresponded to F. vesca pseudochromosome 7 (Fv7), ICM4 to Fv4, ICM5 to Fv3, ICM6 to Fv2 and ICM7 to Fv5. Rose ICM2 corresponded to parts of F. vesca pseudochromosomes 1 and 6, whereas ICM3 is syntenic to the remainder of Fv6.
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Affiliation(s)
- Mirjana Vukosavljev
- Wageningen UR Plant Breeding, Wageningen University & Research, NL-6700 AJ Wageningen, The Netherlands
| | - Paul Arens
- Wageningen UR Plant Breeding, Wageningen University & Research, NL-6700 AJ Wageningen, The Netherlands
| | - Roeland E Voorrips
- Wageningen UR Plant Breeding, Wageningen University & Research, NL-6700 AJ Wageningen, The Netherlands
| | - Wendy PC van ‘t Westende
- Wageningen UR Plant Breeding, Wageningen University & Research, NL-6700 AJ Wageningen, The Netherlands
| | - GD Esselink
- Wageningen UR Plant Breeding, Wageningen University & Research, NL-6700 AJ Wageningen, The Netherlands
| | - Peter M Bourke
- Wageningen UR Plant Breeding, Wageningen University & Research, NL-6700 AJ Wageningen, The Netherlands
| | - Peter Cox
- Roath BV, Eindhoven, The Netherlands
| | - W Eric van de Weg
- Wageningen UR Plant Breeding, Wageningen University & Research, NL-6700 AJ Wageningen, The Netherlands
| | - Richard GF Visser
- Wageningen UR Plant Breeding, Wageningen University & Research, NL-6700 AJ Wageningen, The Netherlands
| | - Chris Maliepaard
- Wageningen UR Plant Breeding, Wageningen University & Research, NL-6700 AJ Wageningen, The Netherlands
| | - Marinus JM Smulders
- Wageningen UR Plant Breeding, Wageningen University & Research, NL-6700 AJ Wageningen, The Netherlands
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Girgis S, Ali E, Qureshi R, Cheng L, Gillan G, Walder J, Cox P, Aladangady N. Developing a multidisciplinary tongue-tie service: pitfalls of setting up. Int J Oral Maxillofac Surg 2015. [DOI: 10.1016/j.ijom.2015.08.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Girgis S, Ali E, Cheng L, Gillan G, Qureshi R, Walder J, Cox P, Aladangady N. Multi-disciplinary approach to neonatal ankyloglossia. Int J Oral Maxillofac Surg 2015. [DOI: 10.1016/j.ijom.2015.08.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Boardman H, French S, Bradlow W, Collins S, Ioannou C, Napolitano R, Kenworthy Y, Williamson W, Cox P, Lima E, Leeson P, Mackillop L. 153 Combined Exercise Echocardiography and Cardiopulmonary Exercise Testing During Pregnancy – a Longitudinal Cardiovascular Assessment in the Second Trimester. Heart 2015. [DOI: 10.1136/heartjnl-2015-308066.153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Schimel D, Pavlick R, Fisher JB, Asner GP, Saatchi S, Townsend P, Miller C, Frankenberg C, Hibbard K, Cox P. Observing terrestrial ecosystems and the carbon cycle from space. Glob Chang Biol 2015; 21:1762-76. [PMID: 25472464 DOI: 10.1111/gcb.12822] [Citation(s) in RCA: 133] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Revised: 11/05/2014] [Accepted: 11/08/2014] [Indexed: 05/20/2023]
Abstract
Terrestrial ecosystem and carbon cycle feedbacks will significantly impact future climate, but their responses are highly uncertain. Models and tipping point analyses suggest the tropics and arctic/boreal zone carbon-climate feedbacks could be disproportionately large. In situ observations in those regions are sparse, resulting in high uncertainties in carbon fluxes and fluxes. Key parameters controlling ecosystem carbon responses, such as plant traits, are also sparsely observed in the tropics, with the most diverse biome on the planet treated as a single type in models. We analyzed the spatial distribution of in situ data for carbon fluxes, stocks and plant traits globally and also evaluated the potential of remote sensing to observe these quantities. New satellite data products go beyond indices of greenness and can address spatial sampling gaps for specific ecosystem properties and parameters. Because environmental conditions and access limit in situ observations in tropical and arctic/boreal environments, use of space-based techniques can reduce sampling bias and uncertainty about tipping point feedbacks to climate. To reliably detect change and develop the understanding of ecosystems needed for prediction, significantly, more data are required in critical regions. This need can best be met with a strategic combination of remote and in situ data, with satellite observations providing the dense sampling in space and time required to characterize the heterogeneity of ecosystem structure and function.
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Affiliation(s)
- David Schimel
- Jet Propulsion Laboratory, California Institute of Technology, Pasadena, CA, 91101, USA
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Genzel R, Tacconi LJ, Lutz D, Saintonge A, Berta S, Magnelli B, Combes F, García-Burillo S, Neri R, Bolatto A, Contini T, Lilly S, Boissier J, Boone F, Bouché N, Bournaud F, Burkert A, Carollo M, Colina L, Cooper MC, Cox P, Feruglio C, Förster Schreiber NM, Freundlich J, Gracia-Carpio J, Juneau S, Kovac K, Lippa M, Naab T, Salome P, Renzini A, Sternberg A, Walter F, Weiner B, Weiss A, Wuyts S. COMBINED CO AND DUST SCALING RELATIONS OF DEPLETION TIME AND MOLECULAR GAS FRACTIONS WITH COSMIC TIME, SPECIFIC STAR-FORMATION RATE, AND STELLAR MASS. ACTA ACUST UNITED AC 2015. [DOI: 10.1088/0004-637x/800/1/20] [Citation(s) in RCA: 418] [Impact Index Per Article: 46.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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O’Dwyer E, Ntusi N, Dorrell L, Wainwright E, Holloway C, Piechnik S, Clutton G, Hancock G, Ferrier V, Cox P, Badri M, Karamitos T, Clarke K, Neubauer S. Cardiac MRI demonstrates increased pericardial effusions and subclinical myocardial inflammation, as a potential cause for cardiac dysfunction in a contemporary cohort of patients with HIV. Heart Lung Circ 2015. [DOI: 10.1016/j.hlc.2015.06.506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Vukosavljev M, Esselink GD, van ’t Westende WPC, Cox P, Visser RGF, Arens P, Smulders MJM. Efficient development of highly polymorphic microsatellite markers based on polymorphic repeats in transcriptome sequences of multiple individuals. Mol Ecol Resour 2014; 15:17-27. [DOI: 10.1111/1755-0998.12289] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Revised: 05/29/2014] [Accepted: 05/30/2014] [Indexed: 11/26/2022]
Affiliation(s)
- M. Vukosavljev
- Wageningen UR Plant Breeding; Wageningen University & Research Centre; P.O. Box 386 NL-6700AJ Wageningen the Netherlands
- C.T. de Wit Graduate School for Production Ecology and Resource Conservation (PE&RC); Wageningen the Netherlands
| | - G. D. Esselink
- Wageningen UR Plant Breeding; Wageningen University & Research Centre; P.O. Box 386 NL-6700AJ Wageningen the Netherlands
| | - W. P. C. van ’t Westende
- Wageningen UR Plant Breeding; Wageningen University & Research Centre; P.O. Box 386 NL-6700AJ Wageningen the Netherlands
| | - P. Cox
- Roath BV; Eindhoven the Netherlands
| | - R. G. F. Visser
- Wageningen UR Plant Breeding; Wageningen University & Research Centre; P.O. Box 386 NL-6700AJ Wageningen the Netherlands
| | - P. Arens
- Wageningen UR Plant Breeding; Wageningen University & Research Centre; P.O. Box 386 NL-6700AJ Wageningen the Netherlands
| | - M. J. M. Smulders
- Wageningen UR Plant Breeding; Wageningen University & Research Centre; P.O. Box 386 NL-6700AJ Wageningen the Netherlands
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Wang X, Piao S, Ciais P, Friedlingstein P, Myneni RB, Cox P, Heimann M, Miller J, Peng S, Wang T, Yang H, Chen A. A two-fold increase of carbon cycle sensitivity to tropical temperature variations. Nature 2014; 506:212-5. [PMID: 24463514 DOI: 10.1038/nature12915] [Citation(s) in RCA: 106] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Accepted: 11/27/2013] [Indexed: 11/09/2022]
Abstract
Earth system models project that the tropical land carbon sink will decrease in size in response to an increase in warming and drought during this century, probably causing a positive climate feedback. But available data are too limited at present to test the predicted changes in the tropical carbon balance in response to climate change. Long-term atmospheric carbon dioxide data provide a global record that integrates the interannual variability of the global carbon balance. Multiple lines of evidence demonstrate that most of this variability originates in the terrestrial biosphere. In particular, the year-to-year variations in the atmospheric carbon dioxide growth rate (CGR) are thought to be the result of fluctuations in the carbon fluxes of tropical land areas. Recently, the response of CGR to tropical climate interannual variability was used to put a constraint on the sensitivity of tropical land carbon to climate change. Here we use the long-term CGR record from Mauna Loa and the South Pole to show that the sensitivity of CGR to tropical temperature interannual variability has increased by a factor of 1.9 ± 0.3 in the past five decades. We find that this sensitivity was greater when tropical land regions experienced drier conditions. This suggests that the sensitivity of CGR to interannual temperature variations is regulated by moisture conditions, even though the direct correlation between CGR and tropical precipitation is weak. We also find that present terrestrial carbon cycle models do not capture the observed enhancement in CGR sensitivity in the past five decades. More realistic model predictions of future carbon cycle and climate feedbacks require a better understanding of the processes driving the response of tropical ecosystems to drought and warming.
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Affiliation(s)
- Xuhui Wang
- Sino-French Institute for Earth System Science, College of Urban and Environmental Sciences, Peking University, Beijing 100871, China
| | - Shilong Piao
- 1] Sino-French Institute for Earth System Science, College of Urban and Environmental Sciences, Peking University, Beijing 100871, China [2] Institute of Tibetan Plateau Research, Chinese Academy of Sciences, Beijing 100085, China
| | - Philippe Ciais
- 1] Sino-French Institute for Earth System Science, College of Urban and Environmental Sciences, Peking University, Beijing 100871, China [2] Laboratoire des Sciences du Climat et de l'Environnement, CEA CNRS UVSQ, 91191 Gif-sur-Yvette, France
| | - Pierre Friedlingstein
- College of Engineering, Mathematics, and Physical Sciences, University of Exeter, Exeter EX4 4QF, UK
| | - Ranga B Myneni
- Department of Earth and Environment, Boston University, Boston, Massachusetts 02215, USA
| | - Peter Cox
- College of Engineering, Mathematics, and Physical Sciences, University of Exeter, Exeter EX4 4QF, UK
| | - Martin Heimann
- Max Planck Institute for Biogeochemistry, 07701 Jena, Germany
| | - John Miller
- 1] Global Monitoring Division, Earth System Research Laboratory, National Oceanic and Atmospheric Administration, 325 Broadway, Boulder, Colorado 80305, USA [2] Cooperative Institute for Research in Environmental Sciences, University of Colorado, Boulder, Colorado 80309, USA
| | - Shushi Peng
- Sino-French Institute for Earth System Science, College of Urban and Environmental Sciences, Peking University, Beijing 100871, China
| | - Tao Wang
- 1] Sino-French Institute for Earth System Science, College of Urban and Environmental Sciences, Peking University, Beijing 100871, China [2] Laboratoire des Sciences du Climat et de l'Environnement, CEA CNRS UVSQ, 91191 Gif-sur-Yvette, France
| | - Hui Yang
- Sino-French Institute for Earth System Science, College of Urban and Environmental Sciences, Peking University, Beijing 100871, China
| | - Anping Chen
- Department of Ecology and Evolutionary Biology, Princeton University, Princeton, New Jersey 08544-1003, USA
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Winsor S, Bensimon CM, Sibbald R, Anstey K, Chidwick P, Coughlin K, Cox P, Fowler R, Godkin D, Greenberg RA, Shaul RZ. Identifying prioritization criteria to supplement critical care triage protocols for the allocation of ventilators during a pandemic influenza. Healthc Q 2014; 17:44-51. [PMID: 25191808 DOI: 10.12927/hcq.2014.23833] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
The purpose of this study was to identify supplementary criteria to provide direction when the Ontario Health Plan for an Influenza Pandemic (OHPIP) critical care triage protocol is rendered insufficient by its inability to discriminate among patients assessed as urgent, and there are insufficient critical care resources available to treat those in that category. To accomplish this task, a Supplementary Criteria Task Force for Critical Care Triage was struck at the University of Toronto Joint Centre for Bioethics. The task force reviewed publically available protocols and policies on pandemic flu planning, identified 13 potential triage criteria and determined a set of eight key ethical, legal and practical considerations against which it assessed each criterion. An online questionnaire was distributed to clinical, policy and community stakeholders across Canada to obtain feedback on the 13 potential triage criteria toward selecting those that best met the eight considerations. The task force concluded that the balance of arguments favoured only two of the 13 criteria it had identified for consideration: first come, first served and random selection. The two criteria were chosen in part based on a need to balance the clearly utilitarian approach employed in the OHPIP with equity considerations. These criteria serve as a defensible "fail safe" mechanism for any triage protocol.
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Affiliation(s)
- Shawn Winsor
- Candidate in Health Policy in the Department of Clinical Epidemiology and Biostatistics at McMaster University, in Hamilton, Ontario, and a member of the Joint Centre for Bioethics, University of Toronto, in Toronto, Ontario
| | - Cécile M Bensimon
- Researcher for the Canadian Program of Research on Ethics in a Pandemic (CanPREP), in Toronto, Ontario, and a member of the Joint Centre for Bioethics
| | - Robert Sibbald
- Ethicist at London Health Sciences Centre, in London, Ontario, and a member of the Joint Centre for Bioethics
| | - Kyle Anstey
- Senior bioethicist at the University Health Network, in Toronto, Ontario, assistant professor in the Department of Occupational Science and Occupational Therapy at the University of Toronto, and a member of the Joint Centre for Bioethics
| | - Paula Chidwick
- Director, research and corporate ethics for the William Osler Health System, in Brampton, Ontario, and a member of the Joint Centre for Bioethics
| | - Kevin Coughlin
- Neonatologist at the Children's Hospital - London Health Sciences Centre, associate professor in the Department of Paediatrics at the University of Western Ontario
| | - Peter Cox
- Intensivist at The Hospital for Sick Children, in Toronto, Ontario, and a member of the Joint Centre for Bioethics
| | - Robert Fowler
- Intensivist and senior scientist at Sunnybrook Health Sciences Centre, in Toronto, Ontario, assistant professor in the Department of Medicine at the University of Toronto
| | - Dianne Godkin
- Senior ethicist with Trillium Health Partners, in Mississauga, Ontario, and a member of the Joint Centre for Bioethics
| | - Rebecca A Greenberg
- Ethicist at The Hospital for Sick Children, and a member of the Joint Centre for Bioethics
| | - Randi Zlotnik Shaul
- Bioethicist, Director of the Bioethics Department at The Hospital for Sick Children, and a member of the Joint Centre for Bioethics
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Woodacre T, Carlisle G, Cox P. The results of anterior ultrasound scanning in surveilance of developmental dysplasia of the hip. Int J Surg 2013. [DOI: 10.1016/j.ijsu.2013.06.404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Woodacre T, Dhadwal A, Cox P. The costs of late detection of developmental dysplasia of the hip. Int J Surg 2013. [DOI: 10.1016/j.ijsu.2013.06.474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Tamblyn JA, Lissauer DM, Powell R, Cox P, Kilby MD. The immunological basis of villitis of unknown etiology - review. Placenta 2013; 34:846-55. [PMID: 23891153 DOI: 10.1016/j.placenta.2013.07.002] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Revised: 07/04/2013] [Accepted: 07/05/2013] [Indexed: 01/22/2023]
Abstract
Villitis of unknown etiology (VUE) represents a common placental inflammatory lesion, primarily, but not exclusively, identifiable T lymphocytes at term. Despite considerable evidence to contest that this simply represents a benign pathological finding, VUE remains a significantly undervalued diagnosis. Given its association with adverse pregnancy outcomes; including fetal growth restriction, preterm birth, and recurrent pregnancy loss, an increased awareness amongst clinician obstetricians is certainly warranted. The underlying immunopathogenesis of VUE remains uncertain. Despite initial theories that this represents an infectious placental lesion of undiagnosed pathogenic source, a more complex sequence of events involving the "breakdown" of maternal-fetal tolerance is emerging. Characterization of a unique inflammatory phenomenon in which both maternal and fetal T lymphocytes and Höfbauer cells interact has captivated particular research interest and has generated analogies to both the problems of allograft rejection and graft-versus-host disease (GvHD). Within the context of VUE, this review evaluates how disruption of the multidimensional immunological mechanisms underlying feto-maternal tolerance may permit abnormal lymphocyte infiltration into placental villi. We shall review the existing evidence for these events in VUE and outline areas of certain future interest.
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Affiliation(s)
- J A Tamblyn
- Theme of Reproduction, Genes and Development, School of Clinical and Experimental Medicine, University of Birmingham, Birmingham B15 2TG, UK.
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Tamblyn JA, Morris RK, Cox P, Hargitai B, Kilby MD. The role of ultrasound in fetal congenital myopathy detection: a novel case of fetal-onset cap myopathy. Prenat Diagn 2013; 33:1102-4. [DOI: 10.1002/pd.4184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Revised: 05/23/2013] [Accepted: 06/20/2013] [Indexed: 11/09/2022]
Affiliation(s)
- J. A. Tamblyn
- Division of Reproduction, Genes and Development, School of Clinical and Experimental Medicine; University of Birmingham; Birmingham UK
| | - R. K. Morris
- Division of Reproduction, Genes and Development, School of Clinical and Experimental Medicine; University of Birmingham; Birmingham UK
- Fetal Medicine Centre; Birmingham Women's NHS Foundation Trust; Birmingham UK
| | - P. Cox
- Department of Perinatal Pathology; Birmingham Women's NHS Foundation Trust; Birmingham UK
| | - B. Hargitai
- Department of Perinatal Pathology; Birmingham Women's NHS Foundation Trust; Birmingham UK
| | - M. D. Kilby
- Division of Reproduction, Genes and Development, School of Clinical and Experimental Medicine; University of Birmingham; Birmingham UK
- Fetal Medicine Centre; Birmingham Women's NHS Foundation Trust; Birmingham UK
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Rider OJ, Cox P, Tyler D, Clarke K, Neubauer S. Myocardial substrate metabolism in obesity. Int J Obes (Lond) 2013; 37:972-9. [PMID: 23069666 DOI: 10.1038/ijo.2012.170] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Revised: 08/29/2012] [Accepted: 09/02/2012] [Indexed: 12/28/2022]
Abstract
Obesity is linked to a wide variety of cardiac changes, from subclinical diastolic dysfunction to end-stage systolic heart failure. Obesity causes changes in cardiac metabolism, which make ATP production and utilization less efficient, producing functional consequences that are linked to the increased rate of heart failure in this population. As a result of the increases in circulating fatty acids and insulin resistance that accompanies excess fat storage, several of the proteins and genes that are responsible for fatty acid uptake and metabolism are upregulated, and the metabolic machinery responsible for glucose utilization and oxidation are inhibited. The resultant increase in fatty acid metabolism, and the inherent alterations in the proteins of the electron transport chain used to create the gradient needed to drive mitochondrial ATP production, results in a decrease in efficiency of cardiac work and a relative increase in oxygen usage. These changes in cardiac mitochondrial metabolism are potential therapeutic targets for the treatment and prevention of obesity-related heart failure.
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Affiliation(s)
- O J Rider
- Department of Cardiovascular Medicine, Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, John Radcliffe Hospital, Oxford, UK
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Swinkels JM, Cox P, Schukken YH, Lam TJGM. Efficacy of extended cefquinome treatment of clinical Staphylococcus aureus mastitis. J Dairy Sci 2013; 96:4983-92. [PMID: 23706485 DOI: 10.3168/jds.2012-6197] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Accepted: 02/07/2013] [Indexed: 11/19/2022]
Abstract
Clinical Staphylococcus aureus mastitis is difficult to cure. Extended antimicrobial treatment is often advocated as a practical approach to improve cure rates; however, scientific evidence of this hypothesis is lacking. A multi-centered, nonblinded, randomized, positive-controlled clinical trial was conducted in 5 European countries-France, Hungary, Italy, the Netherlands, and the United Kingdom-to study the efficacy of an extended intramammary cefquinome treatment (5 d) compared with a standard intramammary cefquinome treatment (1.5 d) of Staph. aureus clinical mastitis. Least squares means estimates of bacteriological cure during lactation were 34% [standard error (SE)=9.9%] for the standard treatment group and 27% (SE=8.4%) for the extended treatment group. In the final model, extended therapy was not significantly better. The only factor predicting bacteriological cure was pretreatment cow somatic cell count (SCC). Cows with >250,000 cells/mL in milk before treatment were less likely to cure. Least squares means of clinical cure during lactation was 60% (SE=19%) for the standard treatment group and 82% (SE=12%) for the extended treatment group. In the final model, clinical cure after extended treatment was significantly better. Pretreatment cow udder firmness predicted clinical cure. Firm udders were less likely to cure clinically. Irrespective of treatment regimen, new infection rates with pathogens other than Staph. aureus were higher (42%) after bacteriological cure than after nonbacteriological cure (22%) and cured cows had a significantly lower SCC. In conclusion, independent of the treatment protocol, cows with an SCC <250,000 cells/mL before treatment showed a higher probability of bacteriological cure. It appears that successful treatment of clinical Staph. aureus mastitis with cefquinome is associated with an increased number of new infections with coagulase-negative staphylococci. Extended treatment improved clinical, but not bacteriological, cure rates compared with the standard treatment. These results indicate that extending treatment of clinical Staph. aureus mastitis with cefquinome should not be recommended.
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Affiliation(s)
- J M Swinkels
- MSD Animal Health, Global Ruminants Business Unit, Boxmeer, the Netherlands.
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Sipka A, Gurjar A, Klaessig S, Duhamel GE, Skidmore A, Swinkels J, Cox P, Schukken Y. Prednisolone and cefapirin act synergistically in resolving experimental Escherichia coli mastitis. J Dairy Sci 2013; 96:4406-18. [PMID: 23684040 DOI: 10.3168/jds.2012-6455] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Accepted: 04/02/2013] [Indexed: 01/22/2023]
Abstract
Mastitis in dairy cows is typically treated with intramammary antibiotics. The combination of antibiotics with corticosteroids tends to have a large market share where these products are registered. Our objective was to investigate the effect of prednisolone in combination with cefapirin on the inflammatory response of experimentally induced Escherichia coli mastitis. Six midlactating Holstein-Friesian cows were challenged in 3 quarters with E. coli and treated at 4, 12, 24, and 36 h postinfection with 300 mg of cefapirin in 1 quarter and a combination of 300 mg of cefapirin and 20mg of prednisolone in another quarter. At 24h (n=3) or 48 h (n=3) postinfection cows were euthanized for tissue sampling. Clinical scores, somatic cell count, and California mastitis test scores, as well as IL-1β, IFN-γ, IL-4, and IL-10 levels and bacterial growth in milk, were measured every 6h. Experimental inoculation caused a moderate clinical mastitis in all cows in challenged, untreated quarters. The E. coli challenge strain was recovered from all infected quarters and confirmed by PCR-based fingerprinting. Challenged, untreated control quarters showed increased concentrations of all measured cytokines together with recruitment of polymorphonuclear neutrophilic leukocytes at 24 and 48 h postchallenge. Both treatments reduced udder swelling and sensitivity with no statistically significant difference between treatment groups. Administration of cefapirin alone or in combination with prednisolone resulted in significantly lower concentrations of IFN-γ, IL-1β, and IL-10 compared with challenged, untreated quarters. Treated quarters did show IL-4 production, but concentrations were significantly decreased compared with untreated, challenged quarters. Quarters treated with the combination of cefapirin and prednisolone showed a significantly lower concentration of IL-4 compared with cefapirin-only treatment. At both 24 and 48 h postinoculation, the level of polymorphonuclear neutrophilic leukocyte recruitment was lowest in challenged quarters treated with a combination of cefapirin and prednisolone, followed by cefapirin alone. Taken together, treatment with cefapirin alone inhibited bacterial growth in milk and reduced the host inflammatory responses. Addition of prednisolone to cefapirin had a synergistic effect, resulting in a lower density of leukocytes in tissue and milk and a quicker restoration of milk quality.
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Affiliation(s)
- Anja Sipka
- Department of Population Medicine and Diagnostic Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY 14853, USA.
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Gassas A, Craig-Barnes H, Dell SD, Cox P, Schechter T, Doyle J, Sung L, Egeler M, Palaniyar N. Severe lung injury and lung biopsy in children post-hematopoietic stem cell transplantation: The differences between allogeneic and autologous transplantation. Pediatr Transplant 2013; 17:278-84. [PMID: 23461864 DOI: 10.1111/petr.12060] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/24/2013] [Indexed: 11/30/2022]
Abstract
To review outcome of children post-allogeneic (allo) and autologous (auto) SCT with severe lung injury who had lung biopsy and to determine whether the diagnoses provided by lung biopsy had an impact on outcome. Retrospective study was carried out from January 2000 to June 2010. Nine hundred and eighteen children (0-18 yr) received SCT (allo 476, auto 442), and 59 biopsies were performed in 48 patients. Most common result of lung biopsy was non-infectious inflammation and recurrent disease in allo- and autorecipients, respectively. In a multivariate analysis, survival of allorecipients who had management change was inferior (p = 0.002; HR: 3.12). These patients were extremely sick, and management change was the last attempt to stabilize their respiratory status. There was a trend toward superior survival for children who had biopsy after 100 days following SCT (p = 0.09; HR: 0.55) and a trend toward inferior survival for those with proven infections within two wk of biopsy (p = 0.07; HR: 2.14). Only 31% of allorecipients and 25% of autorecipients survived. There were no biopsy-related complications. Lung biopsy itself appears to be well tolerated, although requiring a biopsy seems to carry a poor prognosis; this seems to be due to different causes, auto (relapse), allo (non-infectious inflammation).
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Affiliation(s)
- Adam Gassas
- Division of Haematology/Oncology/BMT, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
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Santos-murphy S, Cox P, Higgs S. The effect of ice cream formulation on palatability and rate of eating. Appetite 2012. [DOI: 10.1016/j.appet.2012.05.099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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