Lithium Prescribing during Pregnancy: A UK Primary Care Database Study

Women taking lithium must decide whether to continue the medication if they conceive or plan to conceive. Little is known about the extent of prescribing of lithium during pregnancy

New information on the Jurassic lepidosauromorph Marmoretta oxoniensis

The earliest known crown-group lepidosaurs are known from the Middle Triassic; however, their stem group is poorly sampled, with only a few representative fossils found. This is partly due to the small size and delicate bones of early stem-lepidosaurs (= non-lepidosaurian lepidosauromorphs), which make both preservation in the fossil record and subsequent discovery less likely. The Middle Jurassic lepidosauromorph Marmoretta oxoniensis is re-examined using high-resolution micro-computed tomography to reveal parts of the skull anatomy that were previously unknown. These include a squamosal, postorbital, more complete parietal, pterygoids, and an articulated posterior section of the mandible. Some differences between this and other Marmoretta specimens were identified as a result, such as the arrangement of palatal teeth and the shape of the parabasisphenoid. The status of Marmoretta as a stem-lepidosaur or stem-squamate has been debated. To evaluate this, we tested the phylogenetic position of Marmoretta by including our new data in an adapted phylogenetic character matrix. We recover Marmoretta as a stem-lepidosaur and sister to Fraxinisaura rozynekae. Our findings support the hypothesis that both taxa belonged to a clade of non-lepidosaurian lepidosauromorphs that co-existed with lepidosaurs into the Middle Jurassic

Gatekeeping and delayed diagnosis - Delayed diagnosis: longer and improved GP training and more GPs are the answer

This is the final version. Available from BMJ Publishing Group via the DOI in this record

A reassessment of the enigmatic diapsid Paliguana whitei and the early history of Lepidosauromorpha

Lepidosaurs include lizards, snakes, amphisbaenians and the tuatara, comprising a highly speciose evolutionary radiation with widely varying anatomical traits. Their stem-lineage originated by the late middle Permian 259 million years ago, but its early fossil record is poorly documented, obscuring the origins of key anatomical and functional traits of the group. Paliguana whitei, from the Early Triassic of South Africa, is an enigmatic fossil species with the potential to provide information on this. However, its anatomy and phylogenetic affinities remain highly uncertain, and have been debated since its discovery more than 100 years ago. We present microtomographic three-dimensional imaging of the cranial anatomy of P. whitei that clarifies these uncertainties, providing strong evidence for lepidosauromorph affinities based on the structure of the temporal region and the implantation of marginal dentition. Phylogenetic analysis including these new data recovers Paliguana as the earliest known stem-lepidosaur, within a long-lived group of early diverging lepidosauromorphs that persisted to at least the Middle Jurassic. Our results provide insights into cranial evolution on the lepidosaur stem-lineage, confirming that characteristics of pleurodont dental implantation evolved early on the lepidosaur stem-lineage. By contrast, key functional traits related to hearing (quadrate conch) and feeding (streptostyly) evolved later in the lepidosaur crown-group

Spatiotemporal summation of perimetric stimuli in healthy observers

Spatial summation of perimetric stimuli has been used to derive conclusions about the spatial extent of retinal-cortical convergence, mostly from the size of the critical area of summation (Ricco's area, RA) and critical number of retinal ganglion cells (RGCs). However, spatial summation is known to change dynamically with stimulus duration. Conversely, temporal summation and critical duration also vary with stimulus size. Such an important and often neglected spatiotemporal interaction has important implications for modeling perimetric sensitivity in healthy observers and for formulating hypotheses for changes measured in disease. In this work, we performed experiments on visually heathy observers confirming the interaction of stimulus size and duration in determining summation responses in photopic conditions. We then propose a simplified computational model that captures these aspects of perimetric sensitivity by modelling the total retinal input, the combined effect of stimulus size, duration, and retinal cones-to-RGC ratio. We additionally show that, in the macula, the enlargement of RA with eccentricity might not correspond to a constant critical number of RGCs, as often reported, but to a constant critical total retinal input. We finally compare our results with previous literature and show possible implications for modeling disease, especially glaucoma

Access to Principal Treatment Centres and survival rates for children and young people with cancer in Yorkshire, UK

Background: Principal Treatment Centres (PTC) were established to provide age-appropriate care as well as clinical expertise for children and young people with cancer. However, little is known about the effects of specialist treatment centres on survival outcomes especially for teenagers and young adults. This population-based study aimed to describe access to PTC and the associated trends in survival for 0–24 year olds accounting for stage of disease at presentation and treatment. Methods: Patients diagnosed from 1998–2009 aged 0–24 years were extracted from the Yorkshire Specialist Register of Cancer in Children and Young People, including information on all treating hospitals, followed-up until 31st December 2014. The six commonest cancer types were included: leukaemia (n = 684), lymphoma (n = 558), CNS tumours (n = 547), germ cell tumours (n = 364), soft tissue sarcomas (n = 171) and bone tumours (n = 163). Treatment was categorised into three groups: ‘all’, ‘some’ or ‘no’ treatment received at a PTC. Treatment at PTC was examined by diagnostic group and patient characteristics. Overall survival was modelled using Cox regression adjusting for case-mix including stage, treatment and other socio-demographic and clinical characteristics. Results: Overall 72% of patients received all their treatment at PTC whilst 13% had no treatment at PTC. This differed by diagnostic group and age at diagnosis. Leukaemia patients who received no treatment at PTC had an increased risk of death which was partially explained by differences in patient case-mix (adjusted Hazard Ratio (HR) = 1.73 (95%CI 0.98–3.04)). Soft tissue sarcoma patients who had some or no treatment at PTC had better survival outcomes, which remained after adjustment for patient case-mix (adjusted HR = 0.48 (95%CI 0.23–0.99)). There were no significant differences in outcomes for other diagnostic groups (lymphoma, CNS tumours, bone tumours and germ cell tumours). For leukaemia patients survival outcomes for low risk patients receiving no treatment at PTC were similar to high risk patients who received all treatment at PTC, implying a benefit for care at the PTC. Conclusion: This study demonstrates that for leukaemia patients receiving treatment at a PTC is associated with improved survival that may compensate for a poorer prognosis presentation. However, further information on risk factors is needed for all diagnostic groups in order to fully account for differences in patient case-mix

A dynamical trichotomy for structured populations experiencing positive density-dependence in stochastic environments

Positive density-dependence occurs when individuals experience increased survivorship, growth, or reproduction with increased population densities. Mechanisms leading to these positive relationships include mate limitation, saturating predation risk, and cooperative breeding and foraging. Individuals within these populations may differ in age, size, or geographic location and thereby structure these populations. Here, I study structured population models accounting for positive density-dependence and environmental stochasticity i.e. random fluctuations in the demographic rates of the population. Under an accessibility assumption (roughly, stochastic fluctuations can lead to populations getting small and large), these models are shown to exhibit a dynamical trichotomy: (i) for all initial conditions, the population goes asymptotically extinct with probability one, (ii) for all positive initial conditions, the population persists and asymptotically exhibits unbounded growth, and (iii) for all positive initial conditions, there is a positive probability of asymptotic extinction and a complementary positive probability of unbounded growth. The main results are illustrated with applications to spatially structured populations with an Allee effect and age-structured populations experiencing mate limitation

Comments on a class of orthogonality relations relevant to fluid-structure interaction

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