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Showing papers by "University of Liverpool published in 2011"


Journal ArticleDOI
TL;DR: The energy that can be stored in Li-air and Li-S cells is compared with Li-ion; the operation of the cells is discussed, as are the significant hurdles that will have to be overcome if such batteries are to succeed.
Abstract: Li-ion batteries have transformed portable electronics and will play a key role in the electrification of transport. However, the highest energy storage possible for Li-ion batteries is insufficient for the long-term needs of society, for example, extended-range electric vehicles. To go beyond the horizon of Li-ion batteries is a formidable challenge; there are few options. Here we consider two: Li-air (O(2)) and Li-S. The energy that can be stored in Li-air (based on aqueous or non-aqueous electrolytes) and Li-S cells is compared with Li-ion; the operation of the cells is discussed, as are the significant hurdles that will have to be overcome if such batteries are to succeed. Fundamental scientific advances in understanding the reactions occurring in the cells as well as new materials are key to overcoming these obstacles. The potential benefits of Li-air and Li-S justify the continued research effort that will be needed.

7,895 citations


Journal ArticleDOI
TL;DR: The idea of operating an inverter to mimic a synchronous generator (SG) is motivated and developed, and the inverters that are operated in this way are called synchronverters.
Abstract: In this paper, the idea of operating an inverter to mimic a synchronous generator (SG) is motivated and developed. We call the inverters that are operated in this way synchronverters. Using synchronverters, the well-established theory/algorithms used to control SGs can still be used in power systems where a significant proportion of the generating capacity is inverter-based. We describe the dynamics, implementation, and operation of synchronverters. The real and reactive power delivered by synchronverters connected in parallel and operated as generators can be automatically shared using the well-known frequency- and voltage-drooping mechanisms. Synchronverters can be easily operated also in island mode, and hence, they provide an ideal solution for microgrids or smart grids. Both simulation and experimental results are given to verify the idea.

2,115 citations


Journal ArticleDOI
TL;DR: There is no current 'gold standard' amongst 15 measures of resilience, and a number of the scales are in the early stages of development, and all require further validation work.
Abstract: The evaluation of interventions and policies designed to promote resilience, and research to understand the determinants and associations, require reliable and valid measures to ensure data quality. This paper systematically reviews the psychometric rigour of resilience measurement scales developed for use in general and clinical populations. Eight electronic abstract databases and the internet were searched and reference lists of all identified papers were hand searched. The focus was to identify peer reviewed journal articles where resilience was a key focus and/or is assessed. Two authors independently extracted data and performed a quality assessment of the scale psychometric properties. Nineteen resilience measures were reviewed; four of these were refinements of the original measure. All the measures had some missing information regarding the psychometric properties. Overall, the Connor-Davidson Resilience Scale, the Resilience Scale for Adults and the Brief Resilience Scale received the best psychometric ratings. The conceptual and theoretical adequacy of a number of the scales was questionable. We found no current 'gold standard' amongst 15 measures of resilience. A number of the scales are in the early stages of development, and all require further validation work. Given increasing interest in resilience from major international funders, key policy makers and practice, researchers are urged to report relevant validation statistics when using the measures.

1,625 citations


Journal ArticleDOI
TL;DR: The evidence and the gaps in the published work in terms of prevalence, risk and protective factors, and interventions to prevent and treat childhood and adolescent mental health problems are reviewed.

1,477 citations


Journal ArticleDOI
K. Abe1, N. Abgrall2, Yasuo Ajima, Hiroaki Aihara1  +413 moreInstitutions (53)
TL;DR: The T2K experiment observes indications of ν (μ) → ν(e) appearance in data accumulated with 1.43×10(20) protons on target, and under this hypothesis, the probability to observe six or more candidate events is 7×10(-3), equivalent to 2.5σ significance.
Abstract: The T2K experiment observes indications of nu(mu) -> nu(mu) e appearance in data accumulated with 1.43 x 10(20) protons on target. Six events pass all selection criteria at the far detector. In a three-flavor neutrino oscillation scenario with |Delta m(23)(2)| = 2.4 x 10(-3) eV(2), sin(2)2 theta(23) = 1 and sin(2)2 theta(13) = 0, the expected number of such events is 1.5 +/- 0.3(syst). Under this hypothesis, the probability to observe six or more candidate events is 7 x 10(-3), equivalent to 2.5 sigma significance. At 90% C.L., the data are consistent with 0.03(0.04) < sin(2)2 theta(13) < 0.28(0.34) for delta(CP) = 0 and a normal (inverted) hierarchy.

1,361 citations



Journal ArticleDOI
TL;DR: This review focuses on recent advances in JIA, especially developments in its classification, validation of appropriate measures of holistic outcome, and the specific contribution of established and newer pharmacologic agents available for treating children and young people.
Abstract: Significant advances have taken place in recent years in our understanding of the aetiopathogenesis, anagement, and clinical outcome of juvenile idiopathic arthritis (JIA). Fundamental to this advancement has been international collaborative efforts of the clinical scientific community and all those involved in the multidisciplinary care of children and young people with JIA.

1,110 citations


Journal ArticleDOI
Marcos Daniel Actis1, G. Agnetta2, Felix Aharonian3, A. G. Akhperjanian  +682 moreInstitutions (109)
TL;DR: The ground-based gamma-ray astronomy has had a major breakthrough with the impressive results obtained using systems of imaging atmospheric Cherenkov telescopes as mentioned in this paper, which is an international initiative to build the next generation instrument, with a factor of 5-10 improvement in sensitivity in the 100 GeV-10 TeV range and the extension to energies well below 100GeV and above 100 TeV.
Abstract: Ground-based gamma-ray astronomy has had a major breakthrough with the impressive results obtained using systems of imaging atmospheric Cherenkov telescopes. Ground-based gamma-ray astronomy has a huge potential in astrophysics, particle physics and cosmology. CTA is an international initiative to build the next generation instrument, with a factor of 5-10 improvement in sensitivity in the 100 GeV-10 TeV range and the extension to energies well below 100 GeV and above 100 TeV. CTA will consist of two arrays (one in the north, one in the south) for full sky coverage and will be operated as open observatory. The design of CTA is based on currently available technology. This document reports on the status and presents the major design concepts of CTA.

1,006 citations


Journal ArticleDOI
01 Jan 2011-Pain
TL;DR: Screening questionnaires are suitable for identifying potential patients with neuropathic pain, but further validation of them is needed for epidemiological purposes and quantitative sensory testing is recommended for selected cases in clinic, including the diagnosis of small fiber neuropathies and for research purposes.
Abstract: This is a revision of guidelines, originally published in 2004, for the assessment of patients with neuropathic pain. Neuropathic pain is defined as pain arising as a direct consequence of a lesion or disease affecting the somatosensory system either at peripheral or central level. Screening questionnaires are suitable for identifying potential patients with neuropathic pain, but further validation of them is needed for epidemiological purposes. Clinical examination, including accurate sensory examination, is the basis of neuropathic pain diagnosis. For more accurate sensory profiling, quantitative sensory testing is recommended for selected cases in clinic, including the diagnosis of small fiber neuropathies and for research purposes. Measurement of trigeminal reflexes mediated by A-beta fibers can be used to differentiate symptomatic trigeminal neuralgia from classical trigeminal neuralgia. Measurement of laser-evoked potentials is useful for assessing function of the A-delta fiber pathways in patients with neuropathic pain. Functional brain imaging is not currently useful for individual patients in clinical practice, but is an interesting research tool. Skin biopsy to measure the intraepidermal nerve fiber density should be performed in patients with clinical signs of small fiber dysfunction. The intensity of pain and treatment effect (both in clinic and trials) should be assessed with numerical rating scale or visual analog scale. For future neuropathic pain trials, pain relief scales, patient and clinician global impression of change, the proportion of responders (50% and 30% pain relief), validated neuropathic pain quality measures and assessment of sleep, mood, functional capacity and quality of life are recommended.

909 citations


Journal ArticleDOI
TL;DR: It is shown that at least 20% of CAFs originate from bone marrow (BM) and derive from mesenchymal stem cells (MSCs), and αSMA+ myofibroblasts (MFs) are niche cells normally present in BM and increase markedly during cancer progression.

880 citations


Journal ArticleDOI
TL;DR: The rate of change in FEV(1) among patients with COPD is highly variable, with increased rates of decline among current smokers, patients with bronchodilator reversibility, and patients with emphysema.
Abstract: A b s t r ac t We analyzed the changes in FEV1 after administration of a bronchodilator over a 3-year period in 2163 patients. A random-coefficient model was used to evaluate possible predictors of both FEV1 levels and their changes over time. Results The mean (±SE) rate of change in FEV 1 was a decline of 33±2 ml per year, with sig - nificant variation among the patients studied. The between-patient standard devia- tion for the rate of decline was 59 ml per year. Over the 3-year study period, 38% of patients had an estimated decline in FEV1 of more than 40 ml per year, 31% had a decline of 21 to 40 ml per year, 23% had a change in FEV1 that ranged from a de- crease of 20 ml per year to an increase of 20 ml per year, and 8% had an increase of more than 20 ml per year. The mean rate of decline in FEV1 was 21±4 ml per year greater in current smokers than in current nonsmokers, 13±4 ml per year greater in patients with emphysema than in those without emphysema, and 17±4 ml per year greater in patients with bronchodilator reversibility than in those without reversibility. Conclusions The rate of change in FEV1 among patients with COPD is highly variable, with increased rates of decline among current smokers, patients with bronchodilator reversibility, and patients with emphysema. (Funded by GlaxoSmithKline; ECLIPSE ClinicalTrials.gov number, NCT00292552.)

Journal ArticleDOI
TL;DR: The presence of the HLA-A*3101 allele was associated with carbamazepine-induced hypersensitivity reactions among subjects of Northern European ancestry.
Abstract: Background Carbamazepine causes various forms of hypersensitivity reactions, ranging from maculopapular exanthema to severe blistering reactions. The HLA-B*1502 allele has been shown to be strongly correlated with carbamazepine-induced Stevens–Johnson syndrome and toxic epidermal necrolysis (SJS–TEN) in the Han Chinese and other Asian populations but not in European populations. Methods We performed a genomewide association study of samples obtained from 22 subjects with carbamazepine-induced hypersensitivity syndrome, 43 subjects with carbamazepine-induced maculopapular exanthema, and 3987 control subjects, all of European descent. We tested for an association between disease and HLA alleles through proxy single-nucleotide polymorphisms and imputation, confirming associations by high-resolution sequence-based HLA typing. We replicated the associations in samples from 145 subjects with carbamazepine-induced hypersensitivity reactions. Results The HLA-A*3101 allele, which has a prevalence of 2 to 5% in Nor...

Journal ArticleDOI
TL;DR: The ISUOG Clinical Standards Committee (CSC) has a remit to develop Practice Guidelines and Consensus Statements as educational recommendations that provide healthcare practitioners with a consensus-based approach for diagnostic imaging.
Abstract: The International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) is a scientific organization that encourages sound clinical practice, teaching and research for diagnostic imaging in women’s healthcare. The ISUOG Clinical Standards Committee (CSC) has a remit to develop Practice Guidelines and Consensus Statements as educational recommendations that provide healthcare practitioners with a consensus-based approach for diagnostic imaging. They are intended to reflect what is considered by ISUOG to be the best practices at the time at which they were issued. Although ISUOG has made every effort to ensure that guidelines are accurate when issued, neither the Society nor any of its employees or members accepts any liability for the consequences of any inaccurate or misleading data, opinions or statements issued by the CSC. They are not intended to establish a legal standard of care because interpretation of the evidence that underpins the guidelines may be influenced by individual circumstances and available resources. Approved guidelines can be distributed freely with the permission of ISUOG (info@isuog.org).

Journal ArticleDOI
TL;DR: In this article, two MCP Realizer machines were used to process 6061 and AlSi12 alloys, one processing at 50 W and the other at 100 W laser power.

Journal ArticleDOI
TL;DR: Genome sequences of Pseudomonas spp.
Abstract: Members of the genus Pseudomonas inhabit a wide variety of environments, which is reflected in their versatile metabolic capacity and broad potential for adaptation to fluctuating environmental conditions. Here, we examine and compare the genomes of a range of Pseudomonas spp. encompassing plant, insect and human pathogens, and environmental saprophytes. In addition to a large number of allelic differences of common genes that confer regulatory and metabolic flexibility, genome analysis suggests that many other factors contribute to the diversity and adaptability of Pseudomonas spp. Horizontal gene transfer has impacted the capability of pathogenic Pseudomonas spp. in terms of disease severity (Pseudomonas aeruginosa) and specificity (Pseudomonas syringae). Genome rearrangements likely contribute to adaptation, and a considerable complement of unique genes undoubtedly contributes to strain- and species-specific activities by as yet unknown mechanisms. Because of the lack of conserved phenotypic differences, the classification of the genus has long been contentious. DNA hybridization and genome-based analyses show close relationships among members of P. aeruginosa, but that isolates within the Pseudomonas fluorescens and P. syringae species are less closely related and may constitute different species. Collectively, genome sequences of Pseudomonas spp. have provided insights into pathogenesis and the genetic basis for diversity and adaptation.

Journal ArticleDOI
K. Abe1, N. Abgrall2, Hiroaki Aihara1, Yasuo Ajima  +533 moreInstitutions (53)
TL;DR: The T2K experiment as discussed by the authors is a long-baseline neutrino oscillation experiment whose main goal is to measure the last unknown lepton sector mixing angle by observing its appearance in a particle beam generated by the J-PARC accelerator.
Abstract: The T2K experiment is a long-baseline neutrino oscillation experiment Its main goal is to measure the last unknown lepton sector mixing angle {\theta}_{13} by observing { u}_e appearance in a { u}_{\mu} beam It also aims to make a precision measurement of the known oscillation parameters, {\Delta}m^{2}_{23} and sin^{2} 2{\theta}_{23}, via { u}_{\mu} disappearance studies Other goals of the experiment include various neutrino cross section measurements and sterile neutrino searches The experiment uses an intense proton beam generated by the J-PARC accelerator in Tokai, Japan, and is composed of a neutrino beamline, a near detector complex (ND280), and a far detector (Super-Kamiokande) located 295 km away from J-PARC This paper provides a comprehensive review of the instrumentation aspect of the T2K experiment and a summary of the vital information for each subsystem

Journal ArticleDOI
TL;DR: The estimate of the global incidence of JE remains substantial despite improvements in vaccination coverage, and more and better incidence studies in selected countries, particularly China and India, are needed to further refine these estimates.
Abstract: OBJECTIVE: To update the estimated global incidence of Japanese encephalitis (JE) using recent data for the purpose of guiding prevention and control efforts. METHODS: Thirty-two areas endemic for JE in 24 Asian and Western Pacific countries were sorted into 10 incidence groups on the basis of published data and expert opinion. Population-based surveillance studies using laboratory-confirmed cases were sought for each incidence group by a computerized search of the scientific literature. When no eligible studies existed for a particular incidence group, incidence data were extrapolated from related groups. FINDINGS: A total of 12 eligible studies representing 7 of 10 incidence groups in 24 JE-endemic countries were identified.Approximately 67 900 JE cases typically occur annually (overall incidence: 1.8 per 100 000), of which only about 10% are reported to the World Health Organization. Approximately 33 900 (50%) of these cases occur in China (excluding Taiwan) and approximately 51 000 (75%) occur in children aged 0-14 years (incidence: 5.4 per 100 000). Approximately 55 000 (81%) cases occur in areas with well established or developing JE vaccination programmes, while approximately 12 900 (19%) occur in areas with minimal or no JE vaccination programmes. CONCLUSION: Recent data allowed us to refine the estimate of the global incidence of JE, which remains substantial despite improvements in vaccination coverage. More and better incidence studies in selected countries, particularly China and India, are needed to further refine these estimates.

Journal ArticleDOI
TL;DR: The allele frequency net database is an online repository that contains information on the frequencies of immune genes and their corresponding alleles in different populations that has been used in a wide variety of contexts, including clinical applications, epidemiology and population genetics.
Abstract: The allele frequency net database (http://www.allelefrequencies.net) is an online repository that contains information on the frequencies of immune genes and their corresponding alleles in different populations. The extensive variability observed in genes and alleles related to the immune system response and its significance in transplantation, disease association studies and diversity in populations led to the development of this electronic resource. At present, the system contains data from 1133 populations in 608 813 individuals on the frequency of genes from different polymorphic regions such as human leukocyte antigens, killer-cell immunoglobulin-like receptors, major histocompatibility complex Class I chain-related genes and a number of cytokine gene polymorphisms. The project was designed to create a central source for the storage of frequency data and provide individuals with a set of bioinformatics tools to analyze the occurrence of these variants in worldwide populations. The resource has been used in a wide variety of contexts, including clinical applications (histocompatibility, immunology, epidemiology and pharmacogenetics) and population genetics. Demographic information, frequency data and searching tools can be freely accessed through the website.

Journal ArticleDOI
TL;DR: There is strong evidence that the CCP score is a robust prognostic marker, which, after additional validation, could have an essential role in determining the appropriate treatment for patients with prostate cancer.
Abstract: Summary Background Optimum management of clinically localised prostate cancer presents unique challenges because of the highly variable and often indolent natural history of the disease. To predict disease aggressiveness, clinicians combine clinical variables to create prognostic models, but the models have limited accuracy. We assessed the prognostic value of a predefined cell cycle progression (CCP) score in two cohorts of patients with prostate cancer. Methods We measured the expression of 31 genes involved in CCP with quantitative RT-PCR on RNA extracted from formalin-fixed paraffin-embedded tumour samples, and created a predefined score and assessed its usefulness in the prediction of disease outcome. The signature was assessed retrospectively in a cohort of patients from the USA who had undergone radical prostatectomy, and in a cohort of randomly selected men with clinically localised prostate cancer diagnosed by use of a transurethral resection of the prostate (TURP) in the UK who were managed conservatively. The primary endpoint was time to biochemical recurrence for the cohort of patients who had radical prostatectomy, and time to death from prostate cancer for the TURP cohort. Findings After prostatectomy, the CCP score was useful for predicting biochemical recurrence in the univariate analysis (hazard ratio for a 1-unit change [doubling] in CCP 1·89; 95% CI 1·54–2·31; p=5·6×10 −9 ) and the best multivariate analysis (1·77, 1·40–2·22; p=4·3×10 −6 ). In the best predictive model (final multivariate analysis), the CCP score and prostate-specific antigen (PSA) concentration were the most important variables and were more significant than any other clinical variable. In the TURP cohort, the CCP score was the most important variable for prediction of time to death from prostate cancer in both univariate analysis (2·92, 2·38–3·57, p=6·1×10 −22 ) and the final multivariate analysis (2·57, 1·93–3·43; p=8·2×10 −11 ), and was stronger than all other prognostic factors, although PSA concentration also added useful information. Heterogeneity in the hazard ratio for the CCP score was not noted in any case for any clinical variables. Interpretation The results of this study provide strong evidence that the CCP score is a robust prognostic marker, which, after additional validation, could have an essential role in determining the appropriate treatment for patients with prostate cancer. Funding Cancer Research UK, Queen Mary University of London, Orchid Appeal, US National Institutes of Health, and Koch Foundation.

Journal ArticleDOI
TL;DR: Ian Sinha and colleagues advise that when using the Delphi process to develop core outcome sets for clinical trials, patients and clinicians be involved, researchers and facilitators avoid imposing their views on participants, and attrition of participants be minimized.
Abstract: Summary Points N Studies that use the Delphi process for gainingconsensus around a core outcome set for clinical trialsshould be of sufficiently high quality in order for theirrecommendations to be considered valid. N We report a systematic review of 15 studies that usedthe Delphi technique for this purpose, in which weidentified variability in methodology and reporting. N To improve the quality of studies that use the Delphiprocess for developing core outcome sets, we recom-mend that patients and clinicians be involved, research-ers and facilitators avoid imposing their views onparticipants, and attrition of participants be minimised. N Methodological decisions should be clearly described inthe main publication in order to enable appraisal of thestudy.Table 1. Reporting quality of the 15 included studies. Broad Aspect of ReportingSpecific Items for Which the ReportingQuality Was AssessedStudies in WhichClearly ReportedStudies in Which NotClearly Reported N/ASize and composition of the panel Number of participants 15 0 0Types of participants (e.g., clinicians, patients) 15 0 0Proportion of each type of participant 15 0 0How participants were identified/sampled 14 1 0Methodology of the Delphi process Administration of questionnaires (e.g., postal) 15 0 0How items were generated for first questionnaire 14 1 0What was asked in each round 15 0 0Information provided to participants beforethe first round69 0How the overall group response was fedback to participants87 0Level of anonymity (total or quasi-anonymity) 4 11 0A priori definition of ‘‘consensus’’ aboutwhether an outcome should be measured)71 7

Journal ArticleDOI
TL;DR: In this article, the authors make a detailed study of the effect of replacing the measurements of the inclusive cross section, σ(e+e− → hadrons), by the sum of the exclusive channels in the energy interval GeV, which includes a QCD sum-rule analysis of this region.
Abstract: We update our standard model predictions for g − 2 of the muon and for the hadronic contributions to the running of the QED coupling, Δα(5)had(M2Z). Particular emphasis is put on recent changes in the hadronic contributions from new data in the 2π channel and from the energy region just below 2 GeV. In particular, for the e+e− → π+π− contribution we include the recent 'radiative return' data from KLOE and BaBar. We also include the recent BaBar data on other exclusive channels. We make a detailed study of the effect of replacing the measurements of the inclusive cross section, σ(e+e− → hadrons), by the sum of the exclusive channels in the energy interval GeV, which includes a QCD sum-rule analysis of this energy region. Our favoured prediction for the muon anomalous magnetic moment is (g − 2)/2 = (11 659 182.8 ± 4.9) × 10−10 which is 3.3 σ below the present world-average measurement. We compare our g − 2 value with other recent calculations. Our prediction for the QED coupling, obtained via Δα(5)had(MZ2) = (276.26 ± 1.38) × 10−4 , is α(M2Z)−1 = 128.944 ± 0.019.

Journal ArticleDOI
TL;DR: A basic introduction to the most important procedures of computational model updating is provided, including tutorial examples to reinforce the reader’s understanding and a large scale model updating example of a helicopter airframe.

Journal ArticleDOI
TL;DR: Epidural analgesia was found to offer better pain relief and the need for additional means of pain relief; maternal satisfaction; and the length of second stage of labour; and oxytocin augmentation.
Abstract: Background Epidural analgesia is a central nerve block technique achieved by injection of a local anaesthetic close to the nerves that transmit pain and is widely used as a form of pain relief in labour. However, there are concerns regarding unintended adverse effects on the mother and infant. Objectives To assess the effects of all modalities of epidural analgesia (including combined-spinal-epidural) on the mother and the baby, when compared with non-epidural or no pain relief during labour. Search methods We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 March 2011). Selection criteria Randomised controlled trials comparing all modalities of epidural with any form of pain relief not involving regional blockade, or no pain relief in labour. Data collection and analysis Two of the review authors independently assessed trials for eligibility, methodological quality and extracted all data. We entered data into RevMan and double checked it for accuracy. Primary analysis was by intention to treat; we conducted subgroup and sensitivity analyses where substantial heterogeneity was evident. Main results We included 38 studies involving 9658 women; all but five studies compared epidural analgesia with opiates. Epidural analgesia was found to offer better pain relief (mean difference (MD) -3.36, 95% confidence interval (CI) -5.41 to -1.31, three trials, 1166 women); a reduction in the need for additional pain relief (risk ratio (RR) 0.05, 95% CI 0.02 to 0.17, 15 trials, 6019 women); a reduced risk of acidosis (RR 0.80, 95% CI 0.68 to 0.94, seven trials, 3643 women); and a reduced risk of naloxone administration (RR 0.15, 95% CI 0.10 to 0.23, 10 trials, 2645 women). However, epidural analgesia was associated with an increased risk of assisted vaginal birth (RR 1.42, 95% CI 1.28 to 1.57, 23 trials, 7935 women), maternal hypotension (RR 18.23, 95% CI 5.09 to 65.35, eight trials, 2789 women), motor-blockade (RR 31.67, 95% CI 4.33 to 231.51, three trials, 322 women), maternal fever (RR 3.34, 95% CI 2.63 to 4.23, six trials, 2741 women), urinary retention (RR 17.05, 95% CI 4.82 to 60.39, three trials, 283 women), longer second stage of labour (MD 13.66 minutes, 95% CI 6.67 to 20.66, 13 trials, 4233 women), oxytocin administration (RR 1.19, 95% CI 1.03 to 1.39, 13 trials, 5815 women) and an increased risk of caesarean section for fetal distress (RR 1.43, 95% CI 1.03 to 1.97, 11 trials, 4816 women). There was no evidence of a significant difference in the risk of caesarean section overall (RR 1.10, 95% CI 0.97 to 1.25, 27 trials, 8417 women), long-term backache (RR 0.96, 95% CI 0.86 to 1.07, three trials, 1806 women), Apgar score less than seven at five minutes (RR 0.80, 95% CI 0.54 to 1.20, 18 trials, 6898 women), and maternal satisfaction with pain relief (RR 1.31, 95% CI 0.84 to 2.05, seven trials, 2929 women). We found substantial heterogeneity for the following outcomes: pain relief; maternal satisfaction; need for additional means of pain relief; length of second stage of labour; and oxytocin augmentation. This could not be explained by subgroup or sensitivity analyses, where data allowed analysis. No studies reported on rare but potentially serious adverse effects of epidural analgesia. Authors' conclusions Epidural analgesia appears to be effective in reducing pain during labour. However, women who use this form of pain relief are at increased risk of having an instrumental delivery. Epidural analgesia had no statistically significant impact on the risk of caesarean section, maternal satisfaction with pain relief and long-term backache and did not appear to have an immediate effect on neonatal status as determined by Apgar scores. Further research may be helpful to evaluate rare but potentially severe adverse effects of epidural analgesia on women in labour and long-term neonatal outcomes.

Journal ArticleDOI
TL;DR: The purpose of this article is to assist in the interpretation and use of CYP2C9 and VKORC1 genotype data for estimating therapeutic warfarin dose to achieve an INR of 2–3, should genotype results be available to the clinician.
Abstract: Warfarin is a widely used anticoagulant with a narrow therapeutic index and large interpatient variability in the dose required to achieve target anticoagulation. Common genetic variants in the cytochrome P450-2C9 (CYP2C9) and vitamin K–epoxide reductase complex (VKORC1) enzymes, in addition to known nongenetic factors, account for ~50% of warfarin dose variability. The purpose of this article is to assist in the interpretation and use of CYP2C9 and VKORC1 genotype data for estimating therapeutic warfarin dose to achieve an INR of 2–3, should genotype results be available to the clinician. The Clinical Pharmacogenetics Implementation Consortium (CPIC) of the National Institutes of Health Pharmacogenomics Research Network develops peer-reviewed gene–drug guidelines that are published and updated periodically on http://www.pharmgkb.org based on new developments in the field. 1 Focused Literature review The Supplementary Notes online include a systematic literature review of CYP2C9 and VKORC1 genotype and warfarin dosing, which forms the basis for this guideline. drug: w arF arin Warfarin (Coumadin and others) is the most commonly used oral anticoagulant worldwide, with annual prescriptions typically equaling 0.5–1.5% of the population. It is prescribed for treatment and prevention of thrombotic disorders. 2 Although highly efficacious, warfarin’s narrow therapeutic index and wide interindividual variability make its dosing notoriously challenging. 3–5 Complications from inappropriate warfarin dosing are among the adverse events most frequently reported to the US Food and Drug Administration (FDA) and one of the most common reasons for emergency room visits. 6 Warfarin is often dosed empirically: an initial dose is prescribed, typically followed by at least weekly measurement of the INR and subsequent dose adjustment. The initial dose is often based on population averages (e.g., 3–5 mg/day), but stable doses to achieve an INR of 2–3 can range from 1–20 mg/ day. The iterative process to define the appropriate dose can take weeks to months, and during this period patients are at increased risk of over- or under-anticoagulation and thus at risk of thromboembolism or bleeding.

Journal ArticleDOI
TL;DR: In this paper, global warming and eutrophication in fresh and coastal waters may mutually reinforce the symptoms they express and thus the problems they cause, which may cause more problems.
Abstract: Global warming and eutrophication in fresh and coastal waters may mutually reinforce the symptoms they express and thus the problems they cause.

Journal ArticleDOI
TL;DR: In this article, the adsorption of CO2 in a range of microporous organic polymers was tested, and the relationship between CO2 uptake and apparent surface area and pore size was described.
Abstract: Anthropogenic carbon dioxide emissions are thought to be one cause of global warming. Current methods for CO2 capture result in large energy penalties. Solid adsorbents are a potential method to capture CO2, but the sorbent-sorbate affinity is critical in determining the energetic viability of such processes. In this study, the adsorption of CO2 in a range of microporous organic polymers was tested. These materials adsorb up to 2.20 mmol/g CO2 at 298 K and 1 bar, and thus performance is compared with related porous solids in the literature. The relationship between CO2 uptake and apparent surface area and pore size is described, and this showed that heats of adsorption were important in the low pressure regime. The chemical tuning of gas-sorbent affinity provides a blueprint for the development of improved materials in this area.

Journal ArticleDOI
TL;DR: It is demonstrated that increasing the Pd concentration to 8% leads to an increase of the electrocatalytic H( 2)O(2) production selectivity up to nearly 95%, when the nanoparticles are placed in an environment compatible with that of a proton exchange membrane.
Abstract: A novel strategy to direct the oxygen reduction reaction to preferentially produce H2O2 is formulated and evaluated The approach combines the inertness of Au nano-particles towards oxidation, with the improved O2 sticking probability of isolated transition metal “guest” atoms embedded in the Au “host” DFT modeling was employed to screen for the best alloy candidates Modeling indicates that isolated alloying atoms of Pd, Pt or Rh placed within the Au surface should enhance the H2O2 production relative to pure Au Consequently, Au1-xPdx nanoalloys with variable Pd content supported on Vulcan XC-72 were prepared to investigate the predicted selectivity towards H2O2 production for Au alloyed with Pd It is demonstrated that increasing of Pd concentration to 8% leads to an increase of the electrocatalytic H2O2 production selectivity up to nearly 95%, when the nanoparticles are placed in an environment compatible with that of a proton exchange membrane Further increase of Pd content leads to a drop of H2O2 selectivity, below 10% for x = 05 It is proposed that the enhancement in H2O2 selectivity is caused by the presence of individual surface Pd atoms surrounded by gold whereas surface ensembles of contiguous Pd atoms support H2O formation The results are discussed in the context of exergonic electrocatalytic H2O2 synthesis in Polymer Electrolyte Fuel Cells for the simultaneous cogeneration of chemicals and electricity, the latter a credit to production costs

Journal ArticleDOI
TL;DR: In a population heavily exposed to wood smoke from cooking, a reduction in exposure achieved with chimney stoves did not significantly reduce physician-diagnosed pneumonia for children younger than 18 months; the significant reduction of a third in severe pneumonia, however, if confirmed, could have important implications for reduction of child mortality.

Journal ArticleDOI
TL;DR: In this paper, the carbon dioxide sorption properties for a series of conjugated microporous polymer (CMP) networks were investigated and the carboxylic acid functionalised network, rather than its amine analogue, showed the highest isosteric heat of sorption for CO2.
Abstract: We report here the carbon dioxide sorption properties for a series of conjugated microporous polymer (CMP) networks. These CMP materials incorporate a range of chemical functionalities including carboxylic acids, amines, hydroxyl groups, and methyl groups. The carboxylic acid functionalised network, rather than its amine analogue, shows the highest isosteric heat of sorption for CO2. This supports recent computational predictions for metal–organic frameworks and suggests that acid-functionalised frameworks could outperform more widely studied amine sorbents in CO2 capture and separation application.

Journal ArticleDOI
24 May 2011-PLOS ONE
TL;DR: It is suggested that CRC-associated physiological and metabolic changes recruit tumor-foraging commensal-like bacteria that have an apparent competitive advantage in the tumor microenvironment and thereby seem to replace pathogenic bacteria that may be implicated in CRC etiology.
Abstract: Multiple factors drive the progression from healthy mucosa towards sporadic colorectal carcinomas and accumulating evidence associates intestinal bacteria with disease initiation and progression. Therefore, the aim of this study was to provide a first high-resolution map of colonic dysbiosis that is associated with human colorectal cancer (CRC). To this purpose, the microbiomes colonizing colon tumor tissue and adjacent non-malignant mucosa were compared by deep rRNA sequencing. The results revealed striking differences in microbial colonization patterns between these two sites. Although inter-individual colonization in CRC patients was variable, tumors consistently formed a niche for Coriobacteria and other proposed probiotic bacterial species, while potentially pathogenic Enterobacteria were underrepresented in tumor tissue. As the intestinal microbiota is generally stable during adult life, these findings suggest that CRC-associated physiological and metabolic changes recruit tumor-foraging commensal-like bacteria. These microbes thus have an apparent competitive advantage in the tumor microenvironment and thereby seem to replace pathogenic bacteria that may be implicated in CRC etiology. This first glimpse of the CRC microbiome provides an important step towards full understanding of the dynamic interplay between intestinal microbial ecology and sporadic CRC, which may provide important leads towards novel microbiome-related diagnostic tools and therapeutic interventions.