The precautions of clinical waste: disposable medical sharps in the United Kingdom

This article deals with recent changes in UK guidance on clinical waste, in particular a shift to disposable, single-use instruments and sharps. I use interviews conducted with nurses from a GP practice and two clinical waste managers at alternative treatment and incineration sites as a springboard for reflection on the relationship between the legislation on clinical waste management and its implementation. Scrutinizing the UK guidance, European legislation and World Health Organization principles, I draw out interviewees’ concerns that the changed practices lead to an expansion of the hazardous waste category, with an increased volume going to incineration. This raises questions regarding the regulations’ environmental and health effects, and regarding the precautionary approach embedded in the regulations. Tracing the diverse reverberations of the term ‘waste’ in different points along the journeys made by sharps in particular, and locating these questions in relation to existing literature on waste, I emphasize that public health rationales for the new practices are not made clear in the guidance. I suggest that this relative silence on the subject conceals both the uncertainties regarding the necessity for these means of managing the risks of infectious waste, and the tensions between policies of precautionary public health and environmental sustainability

Evolutionary conservation and selection of human disease gene orthologs in the rat and mouse genomes

BACKGROUND: Model organisms have contributed substantially to our understanding of the etiology of human disease as well as having assisted with the development of new treatment modalities. The availability of the human, mouse and, most recently, the rat genome sequences now permit the comprehensive investigation of the rodent orthologs of genes associated with human disease. Here, we investigate whether human disease genes differ significantly from their rodent orthologs with respect to their overall levels of conservation and their rates of evolutionary change. RESULTS: Human disease genes are unevenly distributed among human chromosomes and are highly represented (99.5%) among human-rodent ortholog sets. Differences are revealed in evolutionary conservation and selection between different categories of human disease genes. Although selection appears not to have greatly discriminated between disease and non-disease genes, synonymous substitution rates are significantly higher for disease genes. In neurological and malformation syndrome disease systems, associated genes have evolved slowly whereas genes of the immune, hematological and pulmonary disease systems have changed more rapidly. Amino-acid substitutions associated with human inherited disease occur at sites that are more highly conserved than the average; nevertheless, 15 substituting amino acids associated with human disease were identified as wild-type amino acids in the rat. Rodent orthologs of human trinucleotide repeat-expansion disease genes were found to contain substantially fewer of such repeats. Six human genes that share the same characteristics as triplet repeat-expansion disease-associated genes were identified; although four of these genes are expressed in the brain, none is currently known to be associated with disease. CONCLUSIONS: Most human disease genes have been retained in rodent genomes. Synonymous nucleotide substitutions occur at a higher rate in disease genes, a finding that may reflect increased mutation rates in the chromosomal regions in which disease genes are found. Rodent orthologs associated with neurological function exhibit the greatest evolutionary conservation; this suggests that rodent models of human neurological disease are likely to most faithfully represent human disease processes. However, with regard to neurological triplet repeat expansion-associated human disease genes, the contraction, relative to human, of rodent trinucleotide repeats suggests that rodent loci may not achieve a 'critical repeat threshold' necessary to undergo spontaneous pathological repeat expansions. The identification of six genes in this study that have multiple characteristics associated with repeat expansion-disease genes raises the possibility that not all human loci capable of facilitating neurological disease by repeat expansion have as yet been identified

The DEEP2 Galaxy Redshift Survey: Spectral classification of galaxies at z~1

We present a Principal Component Analysis (PCA)-based spectral classification, eta, for the first 5600 galaxies observed in the DEEP2 Redshift Survey. This parameter provides a very pronounced separation between absorption and emission dominated galaxy spectra - corresponding to passively evolving and actively star-forming galaxies in the survey respectively. In addition it is shown that despite the high resolution of the observed spectra, this parameter alone can be used to quite accurately reconstruct any given galaxy spectrum, suggesting there are not many `degrees of freedom' in the observed spectra of this galaxy population. It is argued that this form of classification, eta, will be particularly valuable in making future comparisons between high and low-redshift galaxy surveys for which very large spectroscopic samples are now readily available, particularly when used in conjunction with high-resolution spectral synthesis models which will be made public in the near future. We also discuss the relative advantages of this approach to distant galaxy classification compared to other methods such as colors and morphologies. Finally, we compare the classification derived here with that adopted for the 2dF Galaxy Redshift Survey and in so doing show that the two systems are very similar. This will be particularly useful in subsequent analyses when making comparisons between results from each of these surveys to study evolution in the galaxy populations and large-scale structure.Comment: 10 pages, 9 figures, Accepted for publication in Ap

The DEEP2 Galaxy Redshift Survey: Design, Observations, Data Reduction, and Redshifts

We describe the design and data sample from the DEEP2 Galaxy Redshift Survey, the densest and largest precision-redshift survey of galaxies at z ~ 1 completed to date. The survey has conducted a comprehensive census of massive galaxies, their properties, environments, and large-scale structure down to absolute magnitude M_B = -20 at z ~ 1 via ~90 nights of observation on the DEIMOS spectrograph at Keck Observatory. DEEP2 covers an area of 2.8 deg^2 divided into four separate fields, observed to a limiting apparent magnitude of R_AB=24.1. Objects with z < 0.7 are rejected based on BRI photometry in three of the four DEEP2 fields, allowing galaxies with z > 0.7 to be targeted ~2.5 times more efficiently than in a purely magnitude-limited sample. Approximately sixty percent of eligible targets are chosen for spectroscopy, yielding nearly 53,000 spectra and more than 38,000 reliable redshift measurements. Most of the targets which fail to yield secure redshifts are blue objects that lie beyond z ~ 1.45. The DEIMOS 1200-line/mm grating used for the survey delivers high spectral resolution (R~6000), accurate and secure redshifts, and unique internal kinematic information. Extensive ancillary data are available in the DEEP2 fields, particularly in the Extended Groth Strip, which has evolved into one of the richest multiwavelength regions on the sky. DEEP2 surpasses other deep precision-redshift surveys at z ~ 1 in terms of galaxy numbers, redshift accuracy, sample number density, and amount of spectral information. We also provide an overview of the scientific highlights of the DEEP2 survey thus far. This paper is intended as a handbook for users of the DEEP2 Data Release 4, which includes all DEEP2 spectra and redshifts, as well as for the publicly-available DEEP2 DEIMOS data reduction pipelines. [Abridged]Comment: submitted to ApJS; data products available for download at http://deep.berkeley.edu/DR4

Tocilizumab in Hospitalized Patients with Severe Covid-19 Pneumonia

BACKGROUND Coronavirus disease 2019 (Covid-19) is associated with immune dysregulation and hyperinflammation, including elevated interleukin-6 levels. The use of tocilizu- mab, a monoclonal antibody against the interleukin-6 receptor, has resulted in better outcomes in patients with severe Covid-19 pneumonia in case reports and retrospective observational cohort studies. Data are needed from randomized, placebo-controlled trials. METHODS In this phase 3 trial, we randomly assigned patients who were hospitalized with severe Covid-19 pneumonia in a 2:1 ratio receive a single intravenous infusion of tocilizumab (at a dose of 8 mg per kilogram of body weight) or placebo. Approxi- mately one quarter of the participants received a second dose of tocilizumab or placebo 8 to 24 hours after the first dose. The primary outcome was clinical status at day 28 on an ordinal scale ranging from 1 (discharged or ready for discharge) to 7 (death) in the modified intention-to-treat population, which included all the patients who had received at least one dose of tocilizumab or placebo. RESULTS Of the 452 patients who underwent randomization, 438 (294 in the tocilizumab group and 144 in the placebo group) were included in the primary and secondary analyses. The median value for clinical status on the ordinal scale at day 28 was 1.0 (95% confidence interval [CI], 1.0 to 1.0) in the tocilizumab group and 2.0 (non-ICU hospitalization without supplemental oxygen) (95% CI, 1.0 to 4.0) in the placebo group (between-group difference, −1.0; 95% CI, −2.5 to 0; P=0.31 by the van Elteren test). In the safety population, serious adverse events occurred in 103 of 295 patients (34.9%) in the tocilizumab group and in 55 of 143 patients (38.5%) in the placebo group. Mortality at day 28 was 19.7% in the tocilizumab group and 19.4% in the placebo group (weighted difference, 0.3 percentage points (95% CI, –7.6 to 8.2; nominal P=0.94). CONCLUSIONS In this randomized trial involving hospitalized patients with severe Covid-19 pneu- monia, the use of tocilizumab did not result in significantly better clinical status or lower mortality than placebo at 28 days. (Funded by F. Hoffmann–La Roche and the Department of Health and Human Services; COVACTA ClinicalTrials.gov num- ber, NCT04320615.

Standardized Measures of Coastal Wetland Condition: Implementation at a Laurentian Great Lakes Basin-Wide Scale

Since European settlement, over 50 % of coastal wetlands have been lost in the Laurentian Great Lakes basin, causing growing concern and increased monitoring by government agencies. For over a decade, monitoring efforts have focused on the development of regional and organism-specific measures. To facilitate collaboration and information sharing between public, private, and government agencies throughout the Great Lakes basin, we developed standardized methods and indicators used for assessing wetland condition. Using an ecosystem approach and a stratified random site selection process, birds, anurans, fish, macroinvertebrates, vegetation, and physico-chemical conditions were sampled in coastal wetlands of all five Great Lakes including sites from the United States and Canada. Our primary objective was to implement a standardized basin-wide coastal wetland monitoring program that would be a powerful tool to inform decision-makers on coastal wetland conservation and restoration priorities throughout the Great Lakes basin

Standardized Measures of Coastal Wetland Condition: Implementation at a Laurentian Great Lakes Basin-Wide Scale

Since European settlement, over 50 % of coastal wetlands have been lost in the Laurentian Great Lakes basin, causing growing concern and increased monitoring by government agencies. For over a decade, monitoring efforts have focused on the development of regional and organism-specific measures. To facilitate collaboration and information sharing between public, private, and government agencies throughout the Great Lakes basin, we developed standardized methods and indicators used for assessing wetland condition. Using an ecosystem approach and a stratified random site selection process, birds, anurans, fish, macroinvertebrates, vegetation, and physico-chemical conditions were sampled in coastal wetlands of all five Great Lakes including sites from the United States and Canada. Our primary objective was to implement a standardized basin-wide coastal wetland monitoring program that would be a powerful tool to inform decision-makers on coastal wetland conservation and restoration priorities throughout the Great Lakes basin

The DEEP2 Galaxy Redshift Survey: Clustering of Galaxies in Early Data

We measure the two-point correlation function xi(r) using a sample of 2219 galaxies in an area of 0.32 degrees^2 at z=0.7-1.35 from the first season of the DEEP2 Galaxy Redshift Survey. We find that xi(r) can be approximated by a power-law, xi(r)=(r/r_0)^-gamma, on scales 0.1-20 Mpc/h. In a sample with an effective redshift of z_eff=0.82, for a Lcdm cosmology we find r_0=3.53 +/-0.81 Mpc/h (comoving) and gamma=1.66 +/-0.12, while in a higher-redshift sample with z_eff=1.14 we find r_0=3.14 +/-0.72 Mpc/h and gamma=1.61 +/-0.11. We find that red, absorption-dominated, passively-evolving galaxies have a larger clustering scale length, r_0, and more prominent ``fingers of God'' than blue, emission-line, actively star-forming galaxies. Intrinsically brighter galaxies also cluster more strongly than fainter galaxies at z~1, with a significant luminosity-bias seen for galaxies fainter than M*. Our results are suggestive of evolution in the galaxy clustering within our survey volume and imply that the DEEP2 galaxies, with a median brightness one magnitude fainter than M* have an effective bias b=0.97 +/-0.13 if sigma_{8 DM}=1 today or b=1.20 +/-0.16 if sigma_{8 DM}=0.8 today. Given the strong luminosity-dependence in the bias that we measure at z~1, the galaxy bias at M* may be significantly greater. We note that our star-forming sample at z~1 has very similar selection criteria as the Lyman-break galaxies at z~3 and that our red, absorption-line sample displays a clustering strength comparable to the expected clustering of the Lyman-break galaxy descendants at z~1. Our results demonstrate that the clustering properties in the galaxy distribution seen in the local Universe were largely in place by z~1.Comment: 17 pages, 8 figures, Revised version accepted by ApJ, minor changes to text and figure