Showing papers by "University of Leeds published in 2020"
University of Exeter1, École Normale Supérieure2, Norwich Research Park3, Wageningen University and Research Centre4, University of Groningen5, Max Planck Society6, Ludwig Maximilian University of Munich7, Commonwealth Scientific and Industrial Research Organisation8, Université Paris-Saclay9, Stanford University10, National Oceanic and Atmospheric Administration11, National Institute for Space Research12, University of Southampton13, Bermuda Institute of Ocean Sciences14, PSL Research University15, Japan Agency for Marine-Earth Science and Technology16, National Institute for Environmental Studies17, University of Maryland, College Park18, University of Leeds19, International Institute of Minnesota20, Flanders Marine Institute21, ETH Zurich22, University of East Anglia23, German Aerospace Center24, Woods Hole Research Center25, University of Illinois at Urbana–Champaign26, University of Toulouse27, Japan Meteorological Agency28, Plymouth Marine Laboratory29, University of Paris30, Hobart Corporation31, Oeschger Centre for Climate Change Research32, Tsinghua University33, National Center for Atmospheric Research34, Appalachian State University35, University of Colorado Boulder36, University of Washington37, Atlantic Oceanographic and Meteorological Laboratory38, Princeton University39, Met Office40, Leibniz Institute of Marine Sciences41, Auburn University42, University of Tasmania43, VU University Amsterdam44, Oak Ridge National Laboratory45, Sun Yat-sen University46, Nanjing University47
TL;DR: In this paper, the authors describe and synthesize data sets and methodology to quantify the five major components of the global carbon budget and their uncertainties, including emissions from land use and land-use change data and bookkeeping models.
Abstract: Accurate assessment of anthropogenic carbon dioxide (CO2) emissions and their redistribution among the atmosphere, ocean, and terrestrial biosphere in a changing climate – the “global carbon budget” – is important to better understand the global carbon cycle, support the development of climate policies, and project future climate change. Here we describe and synthesize data sets and methodology to quantify the five major components of the global carbon budget and their uncertainties. Fossil CO2 emissions (EFOS) are based on energy statistics and cement production data, while emissions from land-use change (ELUC), mainly deforestation, are based on land use and land-use change data and bookkeeping models. Atmospheric CO2 concentration is measured directly and its growth rate (GATM) is computed from the annual changes in concentration. The ocean CO2 sink (SOCEAN) and terrestrial CO2 sink (SLAND) are estimated with global process models constrained by observations. The resulting carbon budget imbalance (BIM), the difference between the estimated total emissions and the estimated changes in the atmosphere, ocean, and terrestrial biosphere, is a measure of imperfect data and understanding of the contemporary carbon cycle. All uncertainties are reported as ±1σ. For the last decade available (2010–2019), EFOS was 9.6 ± 0.5 GtC yr−1 excluding the cement carbonation sink (9.4 ± 0.5 GtC yr−1 when the cement carbonation sink is included), and ELUC was 1.6 ± 0.7 GtC yr−1. For the same decade, GATM was 5.1 ± 0.02 GtC yr−1 (2.4 ± 0.01 ppm yr−1), SOCEAN 2.5 ± 0.6 GtC yr−1, and SLAND 3.4 ± 0.9 GtC yr−1, with a budget imbalance BIM of −0.1 GtC yr−1 indicating a near balance between estimated sources and sinks over the last decade. For the year 2019 alone, the growth in EFOS was only about 0.1 % with fossil emissions increasing to 9.9 ± 0.5 GtC yr−1 excluding the cement carbonation sink (9.7 ± 0.5 GtC yr−1 when cement carbonation sink is included), and ELUC was 1.8 ± 0.7 GtC yr−1, for total anthropogenic CO2 emissions of 11.5 ± 0.9 GtC yr−1 (42.2 ± 3.3 GtCO2). Also for 2019, GATM was 5.4 ± 0.2 GtC yr−1 (2.5 ± 0.1 ppm yr−1), SOCEAN was 2.6 ± 0.6 GtC yr−1, and SLAND was 3.1 ± 1.2 GtC yr−1, with a BIM of 0.3 GtC. The global atmospheric CO2 concentration reached 409.85 ± 0.1 ppm averaged over 2019. Preliminary data for 2020, accounting for the COVID-19-induced changes in emissions, suggest a decrease in EFOS relative to 2019 of about −7 % (median estimate) based on individual estimates from four studies of −6 %, −7 %, −7 % (−3 % to −11 %), and −13 %. Overall, the mean and trend in the components of the global carbon budget are consistently estimated over the period 1959–2019, but discrepancies of up to 1 GtC yr−1 persist for the representation of semi-decadal variability in CO2 fluxes. Comparison of estimates from diverse approaches and observations shows (1) no consensus in the mean and trend in land-use change emissions over the last decade, (2) a persistent low agreement between the different methods on the magnitude of the land CO2 flux in the northern extra-tropics, and (3) an apparent discrepancy between the different methods for the ocean sink outside the tropics, particularly in the Southern Ocean. This living data update documents changes in the methods and data sets used in this new global carbon budget and the progress in understanding of the global carbon cycle compared with previous publications of this data set (Friedlingstein et al., 2019; Le Quere et al., 2018b, a, 2016, 2015b, a, 2014, 2013). The data presented in this work are available at https://doi.org/10.18160/gcp-2020 (Friedlingstein et al., 2020).
1,764 citations
TL;DR: The flagship paper of the ICGC/TCGA Pan-Cancer Analysis of Whole Genomes Consortium describes the generation of the integrative analyses of 2,658 whole-cancer genomes and their matching normal tissues across 38 tumour types, the structures for international data sharing and standardized analyses, and the main scientific findings from across the consortium studies.
Abstract: Cancer is driven by genetic change, and the advent of massively parallel sequencing has enabled systematic documentation of this variation at the whole-genome scale1,2,3. Here we report the integrative analysis of 2,658 whole-cancer genomes and their matching normal tissues across 38 tumour types from the Pan-Cancer Analysis of Whole Genomes (PCAWG) Consortium of the International Cancer Genome Consortium (ICGC) and The Cancer Genome Atlas (TCGA). We describe the generation of the PCAWG resource, facilitated by international data sharing using compute clouds. On average, cancer genomes contained 4–5 driver mutations when combining coding and non-coding genomic elements; however, in around 5% of cases no drivers were identified, suggesting that cancer driver discovery is not yet complete. Chromothripsis, in which many clustered structural variants arise in a single catastrophic event, is frequently an early event in tumour evolution; in acral melanoma, for example, these events precede most somatic point mutations and affect several cancer-associated genes simultaneously. Cancers with abnormal telomere maintenance often originate from tissues with low replicative activity and show several mechanisms of preventing telomere attrition to critical levels. Common and rare germline variants affect patterns of somatic mutation, including point mutations, structural variants and somatic retrotransposition. A collection of papers from the PCAWG Consortium describes non-coding mutations that drive cancer beyond those in the TERT promoter4; identifies new signatures of mutational processes that cause base substitutions, small insertions and deletions and structural variation5,6; analyses timings and patterns of tumour evolution7; describes the diverse transcriptional consequences of somatic mutation on splicing, expression levels, fusion genes and promoter activity8,9; and evaluates a range of more-specialized features of cancer genomes8,10,11,12,13,14,15,16,17,18.
1,600 citations
TL;DR: A review summarizes the progress over the past 20 years, highlighting the critical role of ACE2 as the novel SARS-CoV-2 receptor and as the negative regulator of the renin-angiotensin system, together with implications for the coronavirus disease 2019 pandemic and associated cardiovascular diseases.
Abstract: ACE2 (angiotensin-converting enzyme 2) has a multiplicity of physiological roles that revolve around its trivalent function: a negative regulator of the renin-angiotensin system, facilitator of ami...
1,328 citations
TL;DR: A model for the classification of MAS is provided to stratify the MAS-like presentation in COVID-19 pneumonia and the complexities of discerning ARDS from MAS are explored.
1,284 citations
Queensland University of Technology1, University of Leicester2, Pennsylvania State University3, Delft University of Technology4, University of Cassino5, Chinese Academy of Sciences6, Edinburgh Napier University7, University of Cambridge8, ICM Partners9, Lund University10, Cooperative Institute for Research in Environmental Sciences11, Tallinn University of Technology12, University of Hong Kong13, Eindhoven University of Technology14, University of New South Wales15, Virginia Tech16, Polytechnic University of Milan17, Technical University of Denmark18, University of Colorado Boulder19, University of Maryland, College Park20, University of California, Berkeley21, Aalborg University22, University of Leeds23, Yale University24, Spanish National Research Council25, National University of Singapore26, Aalto University27, McGill University28, Peking University29
TL;DR: It is argued that existing evidence is sufficiently strong to warrant engineering controls targeting airborne transmission as part of an overall strategy to limit infection risk indoors, and that the use of engineering controls in public buildings would be an additional important measure globally to reduce the likelihood of transmission.
924 citations
TL;DR: The extent of the trait data compiled in TRY is evaluated and emerging patterns of data coverage and representativeness are analyzed to conclude that reducing data gaps and biases in the TRY database remains a key challenge and requires a coordinated approach to data mobilization and trait measurements.
Abstract: Plant traits-the morphological, anatomical, physiological, biochemical and phenological characteristics of plants-determine how plants respond to environmental factors, affect other trophic levels, and influence ecosystem properties and their benefits and detriments to people. Plant trait data thus represent the basis for a vast area of research spanning from evolutionary biology, community and functional ecology, to biodiversity conservation, ecosystem and landscape management, restoration, biogeography and earth system modelling. Since its foundation in 2007, the TRY database of plant traits has grown continuously. It now provides unprecedented data coverage under an open access data policy and is the main plant trait database used by the research community worldwide. Increasingly, the TRY database also supports new frontiers of trait-based plant research, including the identification of data gaps and the subsequent mobilization or measurement of new data. To support this development, in this article we evaluate the extent of the trait data compiled in TRY and analyse emerging patterns of data coverage and representativeness. Best species coverage is achieved for categorical traits-almost complete coverage for 'plant growth form'. However, most traits relevant for ecology and vegetation modelling are characterized by continuous intraspecific variation and trait-environmental relationships. These traits have to be measured on individual plants in their respective environment. Despite unprecedented data coverage, we observe a humbling lack of completeness and representativeness of these continuous traits in many aspects. We, therefore, conclude that reducing data gaps and biases in the TRY database remains a key challenge and requires a coordinated approach to data mobilization and trait measurements. This can only be achieved in collaboration with other initiatives.
882 citations
University of Birmingham1, The Royal Marsden NHS Foundation Trust2, HealthPartners3, St George’s University Hospitals NHS Foundation Trust4, University of Leeds5, Glasgow Royal Infirmary6, King's College London7, University of Oxford8, University College London9, University of Manchester10, Chelsea and Westminster Hospital NHS Foundation Trust11, Clatterbridge Cancer Centre NHS Foundation Trust12, St George's, University of London13, Edinburgh Cancer Research Centre14
TL;DR: The clinical and demographic characteristics and COVID-19 outcomes in patients with cancer appear to be principally driven by age, gender, and comorbidities.
846 citations
TL;DR: Most pregnant women admitted to hospital with SARS-CoV-2 infection were in the late second or third trimester, supporting guidance for continued social distancing measures in later pregnancy.
Abstract: Objectives To describe a national cohort of pregnant women admitted to hospital with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in the UK, identify factors associated with infection, and describe outcomes, including transmission of infection, for mothers and infants. Design Prospective national population based cohort study using the UK Obstetric Surveillance System (UKOSS). Setting All 194 obstetric units in the UK. Participants 427 pregnant women admitted to hospital with confirmed SARS-CoV-2 infection between 1 March 2020 and 14 April 2020. Main outcome measures Incidence of maternal hospital admission and infant infection. Rates of maternal death, level 3 critical care unit admission, fetal loss, caesarean birth, preterm birth, stillbirth, early neonatal death, and neonatal unit admission. Results The estimated incidence of admission to hospital with confirmed SARS-CoV-2 infection in pregnancy was 4.9 (95% confidence interval 4.5 to 5.4) per 1000 maternities. 233 (56%) pregnant women admitted to hospital with SARS-CoV-2 infection in pregnancy were from black or other ethnic minority groups, 281 (69%) were overweight or obese, 175 (41%) were aged 35 or over, and 145 (34%) had pre-existing comorbidities. 266 (62%) women gave birth or had a pregnancy loss; 196 (73%) gave birth at term. Forty one (10%) women admitted to hospital needed respiratory support, and five (1%) women died. Twelve (5%) of 265 infants tested positive for SARS-CoV-2 RNA, six of them within the first 12 hours after birth. Conclusions Most pregnant women admitted to hospital with SARS-CoV-2 infection were in the late second or third trimester, supporting guidance for continued social distancing measures in later pregnancy. Most had good outcomes, and transmission of SARS-CoV-2 to infants was uncommon. The high proportion of women from black or minority ethnic groups admitted with infection needs urgent investigation and explanation. Study registration ISRCTN 40092247.
775 citations
TL;DR: This review begins by reviewing protocols of quantum key distribution based on discrete variable systems, and considers aspects of device independence, satellite challenges, and high rate protocols based on continuous variable systems.
Abstract: Quantum cryptography is arguably the fastest growing area in quantum
information science. Novel theoretical protocols are designed on a regular
basis, security proofs are constantly improving, and experiments are
gradually moving from proof-of-principle lab demonstrations to in-field
implementations and technological prototypes. In this paper, we provide
both a general introduction and a state-of-the-art description of the
recent advances in the field, both theoretical and experimental. We start
by reviewing protocols of quantum key distribution based on discrete
variable systems. Next we consider aspects of device independence,
satellite challenges, and protocols based on continuous-variable systems.
We will then discuss the ultimate limits of point-to-point private
communications and how quantum repeaters and networks may overcome these
restrictions. Finally, we will discuss some aspects of quantum
cryptography beyond standard quantum key distribution, including quantum
random number generators and quantum digital signatures.
769 citations
TL;DR: In this article, the authors show that the global surface temperature response to CO2 doubling has increased substantially in the Coupled Model Intercomparison Project phase 6 (CMIP6), with values spanning 1.8-5.6k across 27 GCMs and exceeding 4.5K in 10 of them.
Abstract: 15 Equilibrium climate sensitivity, the global surface temperature response to CO2 16 doubling, has been persistently uncertain. Recent consensus places it likely within 1.517 4.5K. Global climate models (GCMs), which attempt to represent all relevant physical 18 processes, provide the most direct means of estimating climate sensitivity via CO2 qua19 drupling experiments. Here we show that the closely related effective climate sensitiv20 ity has increased substantially in Coupled Model Intercomparison Project phase 6 (CMIP6), 21 with values spanning 1.8-5.6K across 27 GCMs and exceeding 4.5K in 10 of them. This 22 (statistically insignificant) increase is primarily due to stronger positive cloud feedbacks 23 from decreasing extratropical low cloud coverage and albedo. Both of these are tied to 24 the physical representation of clouds which in CMIP6 models lead to weaker responses 25 of extratropical low cloud cover and water content to unforced variations in surface tem26 perature. Establishing the plausibility of these higher sensitivity models is imperative 27 given their implied societal ramifications. 28 Plain Language Summary 29 The severity of climate change is closely related to how much the Earth warms in 30 response to greenhouse gas increases. Here we find that the temperature response to an 31 abrupt quadrupling of atmospheric carbon dioxide has increased substantially in the lat32 est generation of global climate models. This is primarily because low cloud water con33 tent and coverage decrease more strongly with global warming, causing enhanced plan34 etary absorption of sunlight – an amplifying feedback that ultimately results in more warm35 ing. Differences in the physical representation of clouds in models drive this enhanced 36 sensitivity relative to the previous generation of models. It is crucial to establish whether 37 the latest models, which presumably represent the climate system better than their pre38 decessors, are also providing a more realistic picture of future climate warming. 39
719 citations
Auburn University1, Commonwealth Scientific and Industrial Research Organisation2, Norwegian Institute for Air Research3, International Institute for Applied Systems Analysis4, University of Zielona Góra5, University of East Anglia6, University of Maryland Center for Environmental Science7, Centre national de la recherche scientifique8, Stanford University9, Ghent University10, University of California, Irvine11, Université libre de Bruxelles12, Food and Agriculture Organization13, Max Planck Society14, Peking University15, Karlsruhe Institute of Technology16, University of Bern17, University of Toulouse18, École Normale Supérieure19, Ocean University of China20, Utrecht University21, Netherlands Environmental Assessment Agency22, Zhejiang University23, University of Leeds24, Woods Hole Research Center25, National Oceanic and Atmospheric Administration26, Southern Cross University27, Chinese Academy of Sciences28, Beijing Normal University29, National Institute for Environmental Studies30, Leibniz Institute of Marine Sciences31, Université Paris-Saclay32, Tsinghua University33, Oeschger Centre for Climate Change Research34, Yale University35, Scotland's Rural College36, University of Minnesota37, Lund University38, Chiba University39, Japan Agency for Marine-Earth Science and Technology40, Massachusetts Institute of Technology41, VU University Amsterdam42, University of California, San Diego43, Mississippi State University44
TL;DR: A global N2O inventory is presented that incorporates both natural and anthropogenic sources and accounts for the interaction between nitrogen additions and the biochemical processes that control N 2O emissions, using bottom-up, top-down and process-based model approaches.
Abstract: Nitrous oxide (N2O), like carbon dioxide, is a long-lived greenhouse gas that accumulates in the atmosphere. Over the past 150 years, increasing atmospheric N2O concentrations have contributed to stratospheric ozone depletion1 and climate change2, with the current rate of increase estimated at 2 per cent per decade. Existing national inventories do not provide a full picture of N2O emissions, owing to their omission of natural sources and limitations in methodology for attributing anthropogenic sources. Here we present a global N2O inventory that incorporates both natural and anthropogenic sources and accounts for the interaction between nitrogen additions and the biochemical processes that control N2O emissions. We use bottom-up (inventory, statistical extrapolation of flux measurements, process-based land and ocean modelling) and top-down (atmospheric inversion) approaches to provide a comprehensive quantification of global N2O sources and sinks resulting from 21 natural and human sectors between 1980 and 2016. Global N2O emissions were 17.0 (minimum-maximum estimates: 12.2-23.5) teragrams of nitrogen per year (bottom-up) and 16.9 (15.9-17.7) teragrams of nitrogen per year (top-down) between 2007 and 2016. Global human-induced emissions, which are dominated by nitrogen additions to croplands, increased by 30% over the past four decades to 7.3 (4.2-11.4) teragrams of nitrogen per year. This increase was mainly responsible for the growth in the atmospheric burden. Our findings point to growing N2O emissions in emerging economies-particularly Brazil, China and India. Analysis of process-based model estimates reveals an emerging N2O-climate feedback resulting from interactions between nitrogen additions and climate change. The recent growth in N2O emissions exceeds some of the highest projected emission scenarios3,4, underscoring the urgency to mitigate N2O emissions.
TL;DR: The future of public health is likely to become increasingly digital, and the need for the alignment of international strategies for the regulation, evaluation and use of digital technologies to strengthen pandemic management, and future preparedness for COVID-19 and other infectious diseases is reviewed.
Abstract: Digital technologies are being harnessed to support the public-health response to COVID-19 worldwide, including population surveillance, case identification, contact tracing and evaluation of interventions on the basis of mobility data and communication with the public. These rapid responses leverage billions of mobile phones, large online datasets, connected devices, relatively low-cost computing resources and advances in machine learning and natural language processing. This Review aims to capture the breadth of digital innovations for the public-health response to COVID-19 worldwide and their limitations, and barriers to their implementation, including legal, ethical and privacy barriers, as well as organizational and workforce barriers. The future of public health is likely to become increasingly digital, and we review the need for the alignment of international strategies for the regulation, evaluation and use of digital technologies to strengthen pandemic management, and future preparedness for COVID-19 and other infectious diseases.
01 Jul 2020
TL;DR: The immune mechanism underlying diffuse alveolar and pulmonary interstitial inflammation in COVID-19 involves a MAS-like state that triggers extensive immunothrombosis, which might unmask subclinical cardiovascular disease and is distinct from the MAS and disseminated intravascular coagulation that is more familiar to rheumatologists.
Abstract: The lung pathology seen in patients with coronavirus disease 2019 (COVID-19) shows marked microvascular thrombosis and haemorrhage linked to extensive alveolar and interstitial inflammation that shares features with macrophage activation syndrome (MAS). We have termed the lung-restricted vascular immunopathology associated with COVID-19 as diffuse pulmonary intravascular coagulopathy, which in its early stages is distinct from disseminated intravascular coagulation. Increased circulating D-dimer concentrations (reflecting pulmonary vascular bed thrombosis with fibrinolysis) and elevated cardiac enzyme concentrations (reflecting emergent ventricular stress induced by pulmonary hypertension) in the face of normal fibrinogen and platelet levels are key early features of severe pulmonary intravascular coagulopathy related to COVID-19. Extensive immunothrombosis over a wide pulmonary vascular territory without confirmation of COVID-19 viraemia in early disease best explains the adverse impact of male sex, hypertension, obesity, and diabetes on the prognosis of patients with COVID-19. The immune mechanism underlying diffuse alveolar and pulmonary interstitial inflammation in COVID-19 involves a MAS-like state that triggers extensive immunothrombosis, which might unmask subclinical cardiovascular disease and is distinct from the MAS and disseminated intravascular coagulation that is more familiar to rheumatologists.
The Pew Charitable Trusts1, University of Oxford2, University of Leeds3, University of Innsbruck4, Council for Scientific and Industrial Research5, University of Applied Sciences Western Switzerland6, University of Plymouth7, Imperial College London8, University of Victoria9, University of British Columbia10
TL;DR: To avoid a massive build-up of plastic in the environment, coordinated global action is urgently needed to reduce plastic consumption; increase rates of reuse, waste collection, and recycling; expand safe disposal systems; and accelerate innovation in the plastic value chain.
Abstract: Plastic pollution is a pervasive and growing problem. To estimate the effectiveness of interventions to reduce plastic pollution, we modeled stocks and flows of municipal solid waste and four sources of microplastics through the global plastic system for five scenarios between 2016 and 2040. Implementing all feasible interventions reduced plastic pollution by 40% from 2016 rates and 78% relative to “business as usual” in 2040. Even with immediate and concerted action, 710 million metric tons of plastic waste cumulatively entered aquatic and terrestrial ecosystems. To avoid a massive build-up of plastic in the environment, coordinated global action is urgently needed to reduce plastic consumption; increase rates of reuse, waste collection, and recycling; expand safe disposal systems; and accelerate innovation in the plastic value chain.
TL;DR: The authors highlight the role of bottom-up movements to overcome structural economic growth imperatives spurring consumption by changing structures and culture towards safe and just systems.
Abstract: For over half a century, worldwide growth in affluence has continuously increased resource use and pollutant emissions far more rapidly than these have been reduced through better technology The affluent citizens of the world are responsible for most environmental impacts and are central to any future prospect of retreating to safer environmental conditions We summarise the evidence and present possible solution approaches Any transition towards sustainability can only be effective if far-reaching lifestyle changes complement technological advancements However, existing societies, economies and cultures incite consumption expansion and the structural imperative for growth in competitive market economies inhibits necessary societal change
Queen Mary University of London1, University of Bath2, University of Leeds3, Bocconi University4, London School of Economics and Political Science5, European Society of Cardiology6, Intermountain Medical Center7, Ghent University8, University of East Anglia9, University of Cape Town10, University of Adelaide11, Leipzig University12, Leiden University Medical Center13, John Radcliffe Hospital14, University of Erlangen-Nuremberg15, University of Oxford16
TL;DR: A seemingly inexorable rise in the prevalence of obesity and diabetes currently provides the greatest challenge to achieving further reductions in CVD burden across ESC member countries.
Abstract: Aims: The 2019 report from the European Society of Cardiology (ESC) Atlas provides a contemporary analysis of cardiovascular disease (CVD) statistics across 56 member countries, with particular emphasis on international inequalities in disease burden and healthcare delivery together with estimates of progress towards meeting 2025 World Health Organization (WHO) non-communicable disease targets.
Methods and results: In this report, contemporary CVD statistics are presented for member countries of the ESC. The statistics are drawn from the ESC Atlas which is a repository of CVD data from a variety of sources including the WHO, the Institute for Health Metrics and Evaluation, and the World Bank. The Atlas also includes novel ESC sponsored data on human and capital infrastructure and cardiovascular healthcare delivery obtained by annual survey of the national societies of ESC member countries. Across ESC member countries, the prevalence of obesity (body mass index >= 30 kg/m(2)) and diabetes has increased two- to three-fold during the last 30years making the WHO 2025 target to halt rises in these risk factors unlikely to be achieved. More encouraging have been variable declines in hypertension, smoking, and alcohol consumption but on current trends only the reduction in smoking from 28% to 21% during the last 20years appears sufficient for the WHO target to be achieved. The median age-standardized prevalence of major risk factors was higher in middle-income compared with high-income ESC member countries for hypertension {23.8% [interquartile range (IQR) 22.5-23.1%] vs. 15.7% (IQR 14.5-21.1%)}, diabetes [7.7% (IQR 7.1-10.1%) vs. 5.6% (IQR 4.8-7.0%)], and among males smoking [43.8% (IQR 37.4-48.0%) vs. 26.0% (IQR 20.9-31.7%)] although among females smoking was less common in middle-income countries [8.7% (IQR 3.0-10.8) vs. 16.7% (IQR 13.9-19.7%)]. There were associated inequalities in disease burden with disability-adjusted life years per 100 000 people due to CVD over three times as high in middle-income [7160 (IQR 5655-8115)] compared with high-income [2235 (IQR 1896-3602)] countries. Cardiovascular disease mortality was also higher in middle-income countries where it accounted for a greater proportion of potential years of life lost compared with high-income countries in both females (43% vs. 28%) and males (39% vs. 28%). Despite the inequalities in disease burden across ESC member countries, survey data from the National Cardiac Societies of the ESC showed that middle-income member countries remain severely under-resourced compared with high-income countries in terms of cardiological person-power and technological infrastructure. Under-resourcing in middle-income countries is associated with a severe procedural deficit compared with high-income countries in terms of coronary intervention, device implantation and cardiac surgical procedures.
Conclusion: A seemingly inexorable rise in the prevalence of obesity and diabetes currently provides the greatest challenge to achieving further reductions in CVD burden across ESC member countries. Additional challenges are provided by inequalities in disease burden that now require intensification of policy initiatives in order to reduce population risk and prioritize cardiovascular healthcare delivery, particularly in the middle-income countries of the ESC where need is greatest.
TL;DR: A distinct mutational signature in colorectal cancer is described and it is implied that the underlying mutational process results directly from past exposure to bacteria carrying the colibactin-producing pks pathogenicity island.
Abstract: Various species of the intestinal microbiota have been associated with the development of colorectal cancer1,2, but it has not been demonstrated that bacteria have a direct role in the occurrence of oncogenic mutations. Escherichia coli can carry the pathogenicity island pks, which encodes a set of enzymes that synthesize colibactin3. This compound is believed to alkylate DNA on adenine residues4,5 and induces double-strand breaks in cultured cells3. Here we expose human intestinal organoids to genotoxic pks+ E. coli by repeated luminal injection over five months. Whole-genome sequencing of clonal organoids before and after this exposure revealed a distinct mutational signature that was absent from organoids injected with isogenic pks-mutant bacteria. The same mutational signature was detected in a subset of 5,876 human cancer genomes from two independent cohorts, predominantly in colorectal cancer. Our study describes a distinct mutational signature in colorectal cancer and implies that the underlying mutational process results directly from past exposure to bacteria carrying the colibactin-producing pks pathogenicity island.
University of New South Wales1, Met Office2, University of Washington3, University of Leeds4, University of Edinburgh5, University of California, Berkeley6, Goddard Institute for Space Studies7, Columbia University8, Australian National University9, National Oceanography Centre10, University of Tokyo11, Université Paris-Saclay12, Breakthrough Institute13, Utrecht University14, Stockholm University15, Scripps Institution of Oceanography16, University of Illinois at Urbana–Champaign17, Max Planck Society18
TL;DR: Evidence relevant to Earth's equilibrium climate sensitivity per doubling of atmospheric CO2, characterized by an effective sensitivity S, is assessed, using a Bayesian approach to produce a probability density function for S given all the evidence, and promising avenues for further narrowing the range are identified.
Abstract: We assess evidence relevant to Earth's equilibrium climate sensitivity per doubling of atmospheric CO2, characterized by an effective sensitivity S. This evidence includes feedback process understanding, the historical climate record, and the paleoclimate record. An S value lower than 2 K is difficult to reconcile with any of the three lines of evidence. The amount of cooling during the Last Glacial Maximum provides strong evidence against values of S greater than 4.5 K. Other lines of evidence in combination also show that this is relatively unlikely. We use a Bayesian approach to produce a probability density function (PDF) for S given all the evidence, including tests of robustness to difficult-to-quantify uncertainties and different priors. The 66% range is 2.6-3.9 K for our Baseline calculation and remains within 2.3-4.5 K under the robustness tests; corresponding 5-95% ranges are 2.3-4.7 K, bounded by 2.0-5.7 K (although such high-confidence ranges should be regarded more cautiously). This indicates a stronger constraint on S than reported in past assessments, by lifting the low end of the range. This narrowing occurs because the three lines of evidence agree and are judged to be largely independent and because of greater confidence in understanding feedback processes and in combining evidence. We identify promising avenues for further narrowing the range in S, in particular using comprehensive models and process understanding to address limitations in the traditional forcing-feedback paradigm for interpreting past changes.
TL;DR: In this article, the authors investigated the effect of the COVID-19 pandemic on admissions of patients with acute coronary syndromes in England and evaluated whether in-hospital management of patients has been affected.
University of Birmingham1, University of Oxford2, HealthPartners3, University of Leeds4, The Royal Marsden NHS Foundation Trust5, King's College London6, University College London7, University of Manchester8, University of Southampton9, St George’s University Hospitals NHS Foundation Trust10, Chelsea and Westminster Hospital NHS Foundation Trust11, Clatterbridge Cancer Centre NHS Foundation Trust12, Edinburgh Cancer Research Centre13, University of Warwick14
TL;DR: This study compared adult patients with cancer enrolled in the UK Coronavirus Cancer Monitoring Project between March 18 and May 8, 2020 with a parallel non-COVID-19 UK cancer control population, and analyzed the effect of primary tumour subtype, age, and sex and on severe acute respiratory syndrome coronavirus 2 prevalence and the case–fatality rate during hospital admission.
Abstract: BACKGROUND: Patients with cancer are purported to have poor COVID-19 outcomes. However, cancer is a heterogeneous group of diseases, encompassing a spectrum of tumour subtypes. The aim of this study was to investigate COVID-19 risk according to tumour subtype and patient demographics in patients with cancer in the UK. METHODS: We compared adult patients with cancer enrolled in the UK Coronavirus Cancer Monitoring Project (UKCCMP) cohort between March 18 and May 8, 2020, with a parallel non-COVID-19 UK cancer control population from the UK Office for National Statistics (2017 data). The primary outcome of the study was the effect of primary tumour subtype, age, and sex and on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) prevalence and the case-fatality rate during hospital admission. We analysed the effect of tumour subtype and patient demographics (age and sex) on prevalence and mortality from COVID-19 using univariable and multivariable models. FINDINGS: 319 (30·6%) of 1044 patients in the UKCCMP cohort died, 295 (92·5%) of whom had a cause of death recorded as due to COVID-19. The all-cause case-fatality rate in patients with cancer after SARS-CoV-2 infection was significantly associated with increasing age, rising from 0·10 in patients aged 40-49 years to 0·48 in those aged 80 years and older. Patients with haematological malignancies (leukaemia, lymphoma, and myeloma) had a more severe COVID-19 trajectory compared with patients with solid organ tumours (odds ratio [OR] 1·57, 95% CI 1·15-2·15; p<0·0043). Compared with the rest of the UKCCMP cohort, patients with leukaemia showed a significantly increased case-fatality rate (2·25, 1·13-4·57; p=0·023). After correction for age and sex, patients with haematological malignancies who had recent chemotherapy had an increased risk of death during COVID-19-associated hospital admission (OR 2·09, 95% CI 1·09-4·08; p=0·028). INTERPRETATION: Patients with cancer with different tumour types have differing susceptibility to SARS-CoV-2 infection and COVID-19 phenotypes. We generated individualised risk tables for patients with cancer, considering age, sex, and tumour subtype. Our results could be useful to assist physicians in informed risk-benefit discussions to explain COVID-19 risk and enable an evidenced-based approach to national social isolation policies. FUNDING: University of Birmingham and University of Oxford.
TL;DR: It is confirmed that fever and cough are the most prevalent symptoms of adults infected by SARS-CoV-2, however, there is a large proportion of infected adults which symptoms-alone do not identify.
Abstract: Background To limit the spread of SARS-CoV-2, an evidence-based understanding of the symptoms is critical to inform guidelines for quarantining and testing. The most common features are purported to be fever and a new persistent cough, although the global prevalence of these symptoms remains unclear. The aim of this systematic review is to determine the prevalence of symptoms associated with COVID-19 worldwide. Methods We searched PubMed, Embase, CINAHL, AMED, medRxiv and bioRxiv on 5th April 2020 for studies of adults (>16 years) with laboratory test confirmed COVID-19. No language or publication status restrictions were applied. Data were independently extracted by two review authors into standardised forms. All datapoints were independently checked by three other review authors. A random-effects model for pooling of binomial data was applied to estimate the prevalence of symptoms, subgrouping estimates by country. I2 was used to assess inter-study heterogeneity. Results Of 851 unique citations, 148 articles were included which comprised 24,410 adults with confirmed COVID-19 from 9 countries. The most prevalent symptoms were fever (78% [95% CI 75%-81%]; 138 studies, 21,701 patients; I2 94%), a cough (57% [95% CI 54%-60%]; 138 studies, 21,682 patients; I2 94%) and fatigue (31% [95% CI 27%-35%]; 78 studies, 13,385 patients; I2 95%). Overall, 19% of hospitalised patients required non-invasive ventilation (44 studies, 6,513 patients), 17% required intensive care (33 studies, 7504 patients), 9% required invasive ventilation (45 studies, 6933 patients) and 2% required extra-corporeal membrane oxygenation (12 studies, 1,486 patients). The mortality rate was 7% (73 studies, 10,402 patients). Conclusions We confirm that fever and cough are the most prevalent symptoms of adults infected by SARS-CoV-2. However, there is a large proportion of infected adults which symptoms-alone do not identify.
Princess Margaret Cancer Centre1, University of Toronto2, University College Hospital3, University of Oxford4, University of Leeds5, University of Milan6, Queen Mary University of London7, Beth Israel Deaconess Medical Center8, Cliniques Universitaires Saint-Luc9, Vita-Salute San Raffaele University10, Montefiore Medical Center11, University of North Carolina at Chapel Hill12, St. Michael's Hospital13
TL;DR: Adult patients with hematologic malignancy and COVID-19, especially hospitalized patients, have a high risk of dying and adults aged ≥60 years have significantly higher mortality; pediatric patients appear to be relatively spared.
Brigham and Women's Hospital1, University of Zurich2, Case Western Reserve University3, Yale University4, University of California, San Francisco5, University of California, Los Angeles6, University of Texas MD Anderson Cancer Center7, Mayo Clinic8, National Institutes of Health9, University of Lausanne10, Northwestern University11, NewYork–Presbyterian Hospital12, Johns Hopkins University School of Medicine13, Memorial Sloan Kettering Cancer Center14, University of Siena15, Heidelberg University16, Medical University of Vienna17, University of Paris18, University of Virginia19, University of Leeds20, Leiden University Medical Center21, Ludwig Maximilian University of Munich22, University Hospital Heidelberg23, Princess Margaret Cancer Centre24, Erasmus University Rotterdam25
TL;DR: Novel therapies such as targeted molecular therapies, agents targeting DNA damage response and metabolism, immunotherapies and viral therapies will be reviewed, as well as the current challenges and future directions for research.
Abstract: Glioblastomas are the most common form of malignant primary brain tumor and an important cause of morbidity and mortality. In recent years there have been important advances in understanding the molecular pathogenesis and biology of these tumors, but this has not translated into significantly improved outcomes for patients. In this consensus review from the Society for Neuro-Oncology (SNO) and the European Association of Neuro-Oncology (EANO), the current management of isocitrate dehydrogenase wildtype (IDHwt) glioblastomas will be discussed. In addition, novel therapies such as targeted molecular therapies, agents targeting DNA damage response and metabolism, immunotherapies, and viral therapies will be reviewed, as well as the current challenges and future directions for research.
TL;DR: Using a genotype-driven approach, this disorder is identified that connects seemingly unrelated adult-onset inflammatory syndromes and is named the VEXAS (vacuoles, E1 enzyme, X-linked, autoinflammatory, somatic) syndrome.
Abstract: Background Adult-onset inflammatory syndromes often manifest with overlapping clinical features. Variants in ubiquitin-related genes, previously implicated in autoinflammatory disease, may...
TL;DR: In this paper, the authors estimate that the direct effect of the pandemic-driven response will be negligible, with a cooling of around 0.01 ± 0.005°C by 2030 compared to a baseline scenario that follows current national policies.
Abstract: The global response to the COVID-19 pandemic has led to a sudden reduction of both GHG emissions and air pollutants. Here, using national mobility data, we estimate global emission reductions for ten species during the period February to June 2020. We estimate that global NOx emissions declined by as much as 30% in April, contributing a short-term cooling since the start of the year. This cooling trend is offset by ~20% reduction in global SO2 emissions that weakens the aerosol cooling effect, causing short-term warming. As a result, we estimate that the direct effect of the pandemic-driven response will be negligible, with a cooling of around 0.01 ± 0.005 °C by 2030 compared to a baseline scenario that follows current national policies. In contrast, with an economic recovery tilted towards green stimulus and reductions in fossil fuel investments, it is possible to avoid future warming of 0.3 °C by 2050.
University of Cambridge1, King's College London2, University of Connecticut3, University of Washington4, Anschutz Medical Campus5, Louisiana State University6, Icahn School of Medicine at Mount Sinai7, Mount Sinai Hospital8, Diabetes UK9, Boston Medical Center10, Boston University11, Cornell University12, University College Hospital13, University College London14, Louisiana State University System15, Adolfo Ibáñez University16, University of Padua17, Rabin Medical Center18, Indiana University19, Stanford University20, University of Leeds21, City University of New York22, Harvard University23, Pennington Biomedical Research Center24, Columbia University25, University College Dublin26, American Diabetes Association27, The Catholic University of America28, Penn State Milton S. Hershey Medical Center29, University of Michigan30, Complutense University of Madrid31, Baker IDI Heart and Diabetes Institute32
TL;DR: In this paper, a multidisciplinary group of international experts, including representatives of scientific organizations, reviewed available evidence on the causes and harms of weight stigma and, using a modified Delphi process, developed a joint consensus statement with recommendations to eliminate weight bias.
Abstract: People with obesity commonly face a pervasive, resilient form of social stigma. They are often subject to discrimination in the workplace as well as in educational and healthcare settings. Research indicates that weight stigma can cause physical and psychological harm, and that affected individuals are less likely to receive adequate care. For these reasons, weight stigma damages health, undermines human and social rights, and is unacceptable in modern societies. To inform healthcare professionals, policymakers, and the public about this issue, a multidisciplinary group of international experts, including representatives of scientific organizations, reviewed available evidence on the causes and harms of weight stigma and, using a modified Delphi process, developed a joint consensus statement with recommendations to eliminate weight bias. Academic institutions, professional organizations, media, public-health authorities, and governments should encourage education about weight stigma to facilitate a new public narrative about obesity, coherent with modern scientific knowledge.
Ghent University1, University of Leeds2, Royal Museum for Central Africa3, University College London4, Forestry Commission5, University of York6, Wildlife Conservation Society7, University of Kisangani8, University of Plymouth9, World Wide Fund for Nature10, Norwegian University of Life Sciences11, University of Yaoundé I12, Manchester Metropolitan University13, University of British Columbia14, Center for International Forestry Research15, Bioversity International16, University of Toronto17, University of Stirling18, Forestry Research Institute of Ghana19, Centre de coopération internationale en recherche agronomique pour le développement20, University of Montpellier21, Mbarara University of Science and Technology22, Marien Ngouabi University23, University of Buea24, Duke University25, University of Edinburgh26, National Park Service27, Smithsonian Institution28, University of Cambridge29, Gembloux Agro-Bio Tech30, University of Birmingham31, University of Exeter32, Smithsonian Tropical Research Institute33, Chinese Academy of Sciences34, Royal Botanic Garden Edinburgh35, American Museum of Natural History36, African Wildlife Foundation37, University of Bristol38, University of Hong Kong39, Royal Society for the Protection of Birds40, Royal Botanic Gardens41, Environmental Change Institute42, University of the Sunshine Coast43, Fleming College44, Sokoine University of Agriculture45, University of Southampton46, University of Lincoln47, University of Florence48, University of Aberdeen49, Innovate UK50, National University of Singapore51, Washington State University Vancouver52, Yale University53, University of Nottingham54, Université libre de Bruxelles55, Florida International University56, Bangor University57, University of Liberia58
TL;DR: Overall, the uptake of carbon into Earth’s intact tropical forests peaked in the 1990s and independent observations indicating greater recent carbon uptake into the Northern Hemisphere landmass reinforce the conclusion that the intact tropical forest carbon sink has already peaked.
Abstract: Structurally intact tropical forests sequestered about half of the global terrestrial carbon uptake over the 1990s and early 2000s, removing about 15 per cent of anthropogenic carbon dioxide emissions. Climate-driven vegetation models typically predict that this tropical forest ‘carbon sink’ will continue for decades. Here we assess trends in the carbon sink using 244 structurally intact African tropical forests spanning 11 countries, compare them with 321 published plots from Amazonia and investigate the underlying drivers of the trends. The carbon sink in live aboveground biomass in intact African tropical forests has been stable for the three decades to 2015, at 0.66 tonnes of carbon per hectare per year (95 per cent confidence interval 0.53–0.79), in contrast to the long-term decline in Amazonian forests. Therefore the carbon sink responses of Earth’s two largest expanses of tropical forest have diverged. The difference is largely driven by carbon losses from tree mortality, with no detectable multi-decadal trend in Africa and a long-term increase in Amazonia. Both continents show increasing tree growth, consistent with the expected net effect of rising atmospheric carbon dioxide and air temperature. Despite the past stability of the African carbon sink, our most intensively monitored plots suggest a post-2010 increase in carbon losses, delayed compared to Amazonia, indicating asynchronous carbon sink saturation on the two continents. A statistical model including carbon dioxide, temperature, drought and forest dynamics accounts for the observed trends and indicates a long-term future decline in the African sink, whereas the Amazonian sink continues to weaken rapidly. Overall, the uptake of carbon into Earth’s intact tropical forests peaked in the 1990s. Given that the global terrestrial carbon sink is increasing in size, independent observations indicating greater recent carbon uptake into the Northern Hemisphere landmass reinforce our conclusion that the intact tropical forest carbon sink has already peaked. This saturation and ongoing decline of the tropical forest carbon sink has consequences for policies intended to stabilize Earth’s climate.
The Royal Marsden NHS Foundation Trust1, Institute of Cancer Research2, University College London Hospitals NHS Foundation Trust3, Beatson West of Scotland Cancer Centre4, Clatterbridge Cancer Centre NHS Foundation Trust5, University of Leeds6, Queen's University Belfast7, Musgrove Park Hospital8, Blackburn College9, University of Southampton10, Royal Sussex County Hospital11, Western General Hospital12, Royal Lancaster Infirmary13, Cardiff University14
TL;DR: The TOPARP-B trial aims to prospectively validate the association between DDR gene aberrations and response to olaparib in metastatic castration-resistant prostate cancer by recruiting participants from 17 UK hospitals and following follow-up for a period of 24·8 months.
Abstract: Summary Background Metastatic castration-resistant prostate cancer is enriched in DNA damage response (DDR) gene aberrations. The TOPARP-B trial aims to prospectively validate the association between DDR gene aberrations and response to olaparib in metastatic castration-resistant prostate cancer. Methods In this open-label, investigator-initiated, randomised phase 2 trial following a selection (or pick-the-winner) design, we recruited participants from 17 UK hospitals. Men aged 18 years or older with progressing metastatic castration-resistant prostate cancer previously treated with one or two taxane chemotherapy regimens and with an Eastern Cooperative Oncology Group performance status of 2 or less had tumour biopsies tested with targeted sequencing. Patients with DDR gene aberrations were randomly assigned (1:1) by a computer-generated minimisation method, with balancing for circulating tumour cell count at screening, to receive 400 mg or 300 mg olaparib twice daily, given continuously in 4-week cycles until disease progression or unacceptable toxicity. Neither participants nor investigators were masked to dose allocation. The primary endpoint of confirmed response was defined as a composite of all patients presenting with any of the following outcomes: radiological objective response (as assessed by Response Evaluation Criteria in Solid Tumors 1.1), a decrease in prostate-specific antigen (PSA) of 50% or more (PSA50) from baseline, or conversion of circulating tumour cell count (from ≥5 cells per 7·5 mL blood at baseline to ClinicalTrials.gov , NCT01682772 . Recruitment for the trial has completed and follow-up is ongoing. Findings 711 patients consented for targeted screening between April 1, 2015, and Aug 30, 2018. 161 patients had DDR gene aberrations, 98 of whom were randomly assigned and treated (49 patients for each olaparib dose), with 92 evaluable for the primary endpoint (46 patients for each olaparib dose). Median follow-up was 24·8 months (IQR 16·7–35·9). Confirmed composite response was achieved in 25 (54·3%; 95% CI 39·0–69·1) of 46 evaluable patients in the 400 mg cohort, and 18 (39·1%; 25·1–54·6) of 46 evaluable patients in the 300 mg cohort. Radiological response was achieved in eight (24·2%; 11·1–42·3) of 33 evaluable patients in the 400 mg cohort and six (16·2%; 6·2–32·0) of 37 in the 300 mg cohort; PSA50 response was achieved in 17 (37·0%; 23·2–52·5) of 46 and 13 (30·2%; 17·2–46·1) of 43; and circulating tumour cell count conversion was achieved in 15 (53·6%; 33·9–72·5) of 28 and 13 (48·1%; 28·7–68·1) of 27. The most common grade 3–4 adverse event in both cohorts was anaemia (15 [31%] of 49 patients in the 300 mg cohort and 18 [37%] of 49 in the 400 mg cohort). 19 serious adverse reactions were reported in 13 patients. One death possibly related to treatment (myocardial infarction) occurred after 11 days of treatment in the 300 mg cohort. Interpretation Olaparib has antitumour activity against metastatic castration-resistant prostate cancer with DDR gene aberrations, supporting the implementation of genomic stratification of metastatic castration-resistant prostate cancer in clinical practice. Funding Cancer Research UK, AstraZeneca, Prostate Cancer UK, the Prostate Cancer Foundation, the Experimental Cancer Medicine Centres Network, and the National Institute for Health Research Biomedical Research Centres.
TL;DR: Lung function abnormalities, psychological impairment and reduced exercise capacity were common in SARS and MERS survivors, and Clinicians should anticipate and investigate similar long-term outcomes in COVID-19 survivors.
Abstract: Objective: To determine long-term clinical outcomes in survivors of severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) coronavirus infections after hospitalization or intensive care unit admission.
Data sources: Ovid MEDLINE, EMBASE, CINAHL Plus, and PsycINFO were searched.
Study selection: Original studies reporting clinical outcomes of adult SARS and MERS survivors 3 months after admission or 2 months after discharge were included.
Data extraction: Studies were graded using the Oxford Centre for Evidence-Based Medicine 2009 Level of Evidence Tool. Meta-analysis was used to derive pooled estimates for prevalence/severity of outcomes up to 6 months after hospital discharge, and beyond 6 months after discharge.
Data synthesis: Of 1,169 identified studies, 28 were included in the analysis. Pooled analysis revealed that common complications up to 6 months after discharge were: impaired diffusing capacity for carbon monoxide (prevalence 27%, 95% confidence interval (CI) 15–45%); and reduced exercise capacity (mean 6-min walking distance 461 m, CI 450–473 m). The prevalences of post-traumatic stress disorder (39%, 95% CI 31–47%), depression (33%, 95% CI 20–50%) and anxiety (30%, 95% CI 10–61) beyond 6 months after discharge were considerable. Low scores on Short-Form 36 were identified beyond 6 months after discharge.
Conclusion: Lung function abnormalities, psychological impairment and reduced exercise capacity were common in SARS and MERS survivors. Clinicians should anticipate and investigate similar long-term outcomes in COVID-19 survivors.
TL;DR: This document addresses the need for agreement on specific standards for the interpretation and post-processing of CMR studies by providing consensus recommendations developed by the Task Force for Post-Processing of the Society for Cardiovascular Magnetic Resonance.
Abstract: With mounting data on its accuracy and prognostic value, cardiovascular magnetic resonance (CMR) is becoming an increasingly important diagnostic tool with growing utility in clinical routine. Given its versatility and wide range of quantitative parameters, however, agreement on specific standards for the interpretation and post-processing of CMR studies is required to ensure consistent quality and reproducibility of CMR reports. This document addresses this need by providing consensus recommendations developed by the Task Force for Post-Processing of the Society for Cardiovascular Magnetic Resonance (SCMR). The aim of the Task Force is to recommend requirements and standards for image interpretation and post-processing enabling qualitative and quantitative evaluation of CMR images. Furthermore, pitfalls of CMR image analysis are discussed where appropriate. It is an update of the original recommendations published 2013.