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Pathways to a zero carbon Oxfordshire
No full textClimate mitigation is a global problem whose solution involves local delivery. The need for coordinated interventions at multiple scales is widely acknowledged, but is hard to achieve in practice. Political commitment through declarations of ‘climate emergencies’ needs to be reflected in action on the ground. Local governments are well placed to convene partnerships, but resources are scarce and the task of scaling up is often hindered by national policy. This paper records the research commissioned by the six relevant local authorities to map pathways to a zero-carbon economy for the county of Oxfordshire (UK). Building on an earlier report (presented at the eceee Summer Study 2015), we summarise recent progress on reducing carbon emissions, showing that Oxfordshire is on track to achieve a 50 % reduction by 2030. However, decarbonisation achievements have been uneven and we highlight the need for urgent action on transport and heat decarbonisation if this trend is to continue. We present three distinct pathways for eliminating carbon emissions in Oxfordshire, with varying levels of individual behaviour change, community leadership, and reliance on technological solutions, and contrast these with a business-as-usual scenario. Finally, we reflect on the ongoing process of engagement with representatives of local government and other stakeholders in trying to steer a path towards zero carbon
Investigating the relationships between unfavourable habitual sleep and metabolomic traits: evidence from multicohort multivariable regression and Mendelian randomization analyses
No full textBackground: Sleep traits are associated with cardiometabolic disease risk, with evidence from Mendelian randomization (MR) suggesting that insomnia symptoms and shorter sleep duration increase coronary artery disease risk. We combined adjusted multivariable regression (AMV) and MR analyses of phenotypes of unfavourable sleep on 113 metabolomic traits to investigate possible biochemical mechanisms linking sleep to cardiovascular disease.
Methods: We used AMV (N = 17,368) combined with two-sample MR (N = 38,618) to examine effects of self-reported insomnia symptoms, total habitual sleep duration, and chronotype on 113 metabolomic traits. The AMV analyses were conducted on data from 10 cohorts of mostly Europeans, adjusted for age, sex, and body mass index. For the MR analyses, we used summary results from published European-ancestry genome-wide association studies of self-
reported sleep traits and of nuclear magnetic resonance (NMR) serum metabolites. We used the inverse-variance weighted (IVW) method and complemented this with sensitivity analyses to assess MR assumptions.
Results: We found consistent evidence from AMV and MR analyses for associations of usual vs. sometimes/rare/never insomnia symptoms with lower citrate (− 0.08 standard deviation (SD)[95% confidence interval (CI) − 0.12, − 0.03] in AMV and − 0.03SD [− 0.07, − 0.003] in MR), higher glycoprotein acetyls (0.08SD [95% CI 0.03, 0.12] in AMV and 0.06SD [0.03, 0.10) in MR]), lower total very large HDL particles (− 0.04SD [− 0.08, 0.00] in AMV and − 0.05SD [− 0.09, − 0.02] in MR), and lower phospholipids in very large HDL particles (− 0.04SD [− 0.08, 0.002] in AMV and − 0.05SD [− 0.08, − 0.02] in MR). Longer total sleep duration associated with higher creatinine concentrations using both methods (0.02SD per 1 h [0.01, 0.03] in AMV and 0.15SD [0.02, 0.29] in MR) and with isoleucine in MR analyses (0.22SD [0.08, 0.35]). No
consistent evidence was observed for effects of chronotype on metabolomic measures.
Conclusions: Whilst our results suggested that unfavourable sleep traits may not cause widespread metabolic disruption, some notable effects were observed. The evidence for possible effects of insomnia symptoms on glycoprotein acetyls and citrate and longer total sleep duration on creatinine and isoleucine might explain some of the effects, found in MR analyses of these sleep traits on coronary heart disease, which warrant further investigation
Lymphovenous anastomoses with three-dimensional digital hybrid visualization: improving ergonomics for supermicrosurgery in lymphedema.
No full textThe conventional approach of looking down a microscope to perform microsurgical procedures is associated with occupational injuries, anti-ergonomic postures, and increased tremor and fatigue, all of which predispose microsurgeons to early retirement. Recently, three-dimensional (3D) visualization of real-time microscope magnification has been developed as an alternative. Despite its commercial availability, no supermicrosurgical procedures have been reported using this technology to date. Lymphovenous anastomoses (LVAs) often require suturing vessels with diameters of 0.2–0.8 mm, thus representing the ultimate microsurgical challenge. After performing the first documented LVA procedure using 3D-augmented visualization in our unit and gaining experience with this technique, we conducted an anonymized in-house survey among microsurgeons who had used this approach. The participants considered that 3D visualization for supermicrosurgery was equivalent in terms of handling, optical detail, depth resolution, and safety to conventional binocular magnification. This survey revealed that team communication, resident education, and ergonomics were superior using 3D digital hybrid visualization. Postoperative muscle fatigue, tremor, and pain were also reduced. The major drawbacks of the 3D visualization microscopic systems are the associated costs, required space, and difficulty of visualizing the lymphatic contrast used
Normalising comparative effectiveness trials as clinical practice
No full textThere is a lack of high-quality evidence underpinning many contemporary clinical practice guidelines embedded in the healthcare systems, leading to treatment uncertainty and practice variation in most medical disciplines. Comparative effectiveness trials (CETs) represent a diverse range of research that focuses on optimising health outcomes by comparing currently approved interventions to generate high-quality evidence to inform decision makers. Yet, despite their ability to produce real-world evidence that addresses the key priorities of patients and health systems, many implementation challenges exist within the healthcare environment.This manuscript aims to highlight common barriers to conducting CETs and describes potential solutions to normalise their conduct as part of a learning healthcare system
A capability approach to smart local energy systems: aiming for ‘smart and fair’
No full textThis paper describes early experience of using a conceptual framework of “capabilities” to understand the propensity of actors (households, businesses, flexibility providers) and communities to participate in and benefit from a Smart Local Energy System (SLES).
Having outlined some basic features of capability theory and examples of its application, we offer a description of the SLES concept, then outline how a ‘capability lens’ can be applied as an analytic tool in designing policies and actions that are sensitive to issues of energy equity. We do this through applying an elaboration of the capability lens developed by the Centre for Sustainable Energy to two smart grid opportunities under consideration in “Project LEO” a major demonstration of prototype SLES mechanisms and market arrangements underway in Oxfordshire, UK: Vehicle-to-Grid charging and domestic Demand Side Response from small scale applications (e.g. heat pumps, smart appliances) connected at the grid edge.
There is a discussion of how capability to adopt these systems has implications for differential access to markets for flexibility and therefore impacts on energy equity. We then argue that a capability lens can be applied not only to individuals, households or organisations, but to communities and systems and considers how inequity might be addressed in terms of actor, community and system capability
Using neural network and random forest algorithmic approaches to predicting particulate emissions from a highly boosted GDI engine
No full textParticulate emissions from gasoline direct injection (GDI) engines continue to be a topic of substantial research interest. Forthcoming regulation both in the USA and the EU will further reduce their emission and drive innovation. Substantial research effort is spent undertaking experiments to understand, characterize, and research particle number (PN) emissions from engines and vehicles. Recent advances in computing power, data storage, and understanding of artificial intelligence algorithms now mean that these are becoming an important tool in engine research. In this work artificial neural network (ANN) and random forest (RF) algorithms for the prediction of PN emissions from a highly boosted (up to 32 bar BMEP) GDI engine are used. Particle size, concentration and the accumulation mode geometric standard deviation (GSD) are all predicted by the two models. The ANN and RF results are compared, and an in depth study on parameter importance is carried out. The Random Forest algorithm is used as an estimator and the various engine parameters are ranked with a permutation feature importance technique using mean squared error as a performance metric. The results show that from 158 input parameters, only between 13 and 31 (depending on which output is of interest) are needed to characterize the concentration, size, and GSD of the particle spectrums to within 95% of the cumulative mean squared error. Overall, both models show good agreement to the experimental data
Shortening the Edinburgh postnatal depression scale using optimal test assembly methods: Development of the EPDS-Dep-5
No full textAims:
This study used a large database to develop a reliable and valid shortened form of the Edinburgh Postnatal Depression Scale (EPDS), a self‐report questionnaire used for depression screening in pregnancy and postpartum, based on objective criteria.
Methods:
Item responses from the 10‐item EPDS were obtained from 5157 participants (765 major depression cases) from 22 primary screening accuracy studies that compared the EPDS to the Structured Clinical Interview for DSM (SCID). Unidimensionality of the EPDS latent construct was verified using confirmatory factor analysis, and an item response theory model was fit. Optimal test assembly (OTA) methods identified a maximally informative shortened form for each possible scale length between 1 and 9 items. The final shortened form was selected based on pre‐specified validity and reliability criteria and non‐inferiority of screening accuracy of the EPDS as compared to the SCID.
Results:
A 5‐item short form of the EPDS (EPDS‐Dep‐5) was selected. The EPDS‐Dep‐5 had a Cronbach's alpha of 0.82. Sensitivity and specificity of the EPDS‐Dep‐5 for a cutoff of 4 or greater were 0.83 (95% CI, 0.73, 0.89) and 0.86 (95% CI, 0.80, 0.90) and were statistically non‐inferior to the EPDS. The correlation of total scores with the full EPDS was high (r = 0.91).
Conclusion:
The EPDS‐Dep‐5 is a valid short form with minimal loss of information when compared to the full‐length EPDS. The EPDS‐Dep‐5 was developed with OTA methods using objective, pre‐specified criteria, but the approach is data‐driven and exploratory. Thus, there is a need to replicate results of this study in different populations
HIV burden and correlates of infection among transfeminine persons and cisgender men who have sex with men in Nairobi: an observational study
No full textBackground: Globally transgender persons are disproportionately affected by HIV and other sexually transmitted infections (STIs), and culturally competent prevention and treatment services are often unavailable or
inaccessible. Despite recent improvements in national HIV responses for many key populations in East Africa, evidence of transgender sexual health needs to inform effective responses is sparse. We aimed to assess gender identity among men and transgender persons who have sex with men in Nairobi and explore associations with sexual health related outcomes, risk behaviour and uptake of HIV interventions.
Methods: We recruited adult men and transgender persons who reported sex with men through respondent driven sampling during 2017 in Nairobi. We assessed gender identity, sociodemographics, sexual behaviour and HIV prevention and care uptake by self-completed survey. Participants tested for HIV, syphilis, rectal and urethral gonorrhoea and chlamydia. We compared prevalence of sexual health outcomes, risk behaviour and service uptake among transfeminine and cisgender participants using multivariable robust Poisson regression models with gender identity as the independent variable.
Findings: 18 Among 618 recruits, 522 (86.1%) identified as cisgender, 70 (11.5%) transfeminine and 3 (0.7%) transmasculine. Compared to cisgender participants, transfeminine persons were more likely to be HIV positive (41.4% (28/70) v 24.6% (151/521) p=0.00087) and report rectal symptoms consistent with a current STI (16.3% (88/67) v 7.0% (38/518) p=0.014). Transfeminine persons reported higher recent male partner counts and were more likely to report recent condomless anal intercourse (62.1% (43/70) v 38.6% (208/522) p=0.00085), receptive anal intercourse (76.5% (54/70) v 45.5% (252/522) p<0.0001), transactional sex with men (57.5% (42/69) v 41.7% (240/518) p=0.023) and experience of sexual assault during the last year (23.1% (16/69) v 11.3% (65/520) p=0.019). Utilisation of pre- and post-exposure prophylaxis was low.
Interpretation: Transfeminine persons who have sex with men have a higher burden of HIV and associated risk behaviours compared to cisgender MSM in the same context, yet uptake of prevention and care services is poor. Policies should acknowledge the specific needs of transfeminine persons as distinct from men who have sex with men, and support providers to address these
Adjunctive treatments for the management of septic shock – a narrative review of the current evidence
No full textSeptic shock is a leading cause of death and morbidity worldwide. The cornerstones of management include prompt identification of sepsis, early initiation of antibiotic therapy, adequate fluid resuscitation and organ support. Over the past two decades, there have been considerable improvements in our understanding of the pathophysiology of sepsis and the host response, including regulation of inflammation, endothelial disruption and impaired immunity. This has offered opportunities for innovative adjunctive treatments such as vitamin C, corticosteroids and beta‐blockers. Some of these approaches have shown promising results in early phase trials in humans, while others, such as corticosteroids, have been tested in large, international, multicentre randomised controlled trials. Contemporary guidelines make a weak recommendation for the use of corticosteroids to reduce mortality in sepsis and septic shock. Vitamin C, despite showing initial promise in observational studies, has so far not been shown to be clinically effective in randomised trials. Beta‐blocker therapy may have beneficial cardiac and non‐cardiac effects in septic shock, but there is currently insufficient evidence to recommend their use for this condition. The results of ongoing randomised trials are awaited. Crucial to reducing heterogeneity in the trials of new sepsis treatments will be the concept of enrichment, which refers to the purposive selection of patients with clinical and biological characteristics that are likely to be responsive to the intervention being tested