Screening for Down's syndrome: effects, safety, and cost effectiveness of first and second trimester strategies commentary: rasults may not be widely applicable authors' response

Objective: To compare the effects, safety, and cost effectiveness of antenatal screening strategies for Down's syndrome. Design: Analysis of incremental cost effectiveness. Setting: United Kingdom. Main outcome measures: Number of liveborn babies with Down's syndrome, miscarriages due to chorionic villus sampling or amniocentesis, healthcare costs of screening programme, and additional costs and additional miscarriages per additional affected live birth prevented by adopting a more effective strategy. Results: Compared with no screening, the additional cost per additional liveborn baby with Down's syndrome prevented was £22 000 for measurement of nuchal translucency. The cost of the integrated test was £51 000 compared with measurement of nuchal translucency. All other strategies were more costly and less effective, or cost more per additional affected baby prevented. Depending on the cost of the screening test, the first trimester combined test and the quadruple test would also be cost effective options. Conclusions: The choice of screening strategy should be between the integrated test, first trimester combined test, quadruple test, or nuchal translucency measurement depending on how much service providers are willing to pay, the total budget available, and values on safety. Screening based on maternal age, the second trimester double test, and the first trimester serum test was less effective, less safe, and more costly than these four options

Combination therapy with tranilast and angiotensin-converting enzyme inhibition provides additional renoprotection in the remnant kidney model

Despite current therapy with agents that block the renin–angiotensin system, renal dysfunction continues to progress in a significant proportion of patients with kidney disease. Several pre-clinical studies have reported beneficial effects of tranilast, an inhibitor of transforming growth factor (TGF)-β's actions in a range of diseases that are characterized by fibrosis. However, whether such therapy provides additional benefits in renal disease, when added to angiotensin-converting enzyme (ACE) inhibition, has not been explored. We randomized subtotally (5/6) nephrectomized rats to receive vehicle, the ACE inhibitor, perindopril (6 mg/l), tranilast (400 mg/kg/day), or their combination for 12 weeks. When compared with sham-nephrectomized animals, subtotally nephrectomized animals had reduced creatinine clearance, proteinuria, glomerulosclerosis, interstitial fibrosis, tubular atrophy, and evidence of TGF-β activity, as indicated by the abundant nuclear staining of phosphorylated Smad2. These manifestations of injury and TGF-β activation were all attenuated by treatment with either tranilast or perindopril, with the latter also attenuating the animals’ hypertension. When compared with single-agent treatment, the combination of tranilast and perindopril provided additional, incremental improvements in creatinine clearance, proteinuria, and glomerulosclerosis, and a reduction in nuclear phsopho-Smad2 beyond single-agent treatment. These findings indicate that the combination of tranilast and perindopril was superior to single-agent treatment on kidney structure and function in the remnant kidney model, and suggests the potential for such dual therapy in kidney disease that continues to progress despite blockade of the renin–angiotensin system

Dynamics and distribution of natural and human-caused hypoxia

Water masses can become undersaturated with oxygen when natural processes alone or in combination with anthropogenic processes produce enough organic carbon that is aerobically decomposed faster than the rate of oxygen re-aeration. The dominant natural processes usually involved are photosynthetic carbon production and microbial respiration. The re-supply rate is indirectly related to its isolation from the surface layer. Hypoxic water masses (\u3c 2 mg L-1, or approximately 30% saturation) can form, therefore, under \u27natural\u27 conditions, and are more likely to occur in marine systems when the water residence time is extended, water exchange and ventilation are minimal, stratification occurs, and where carbon production and export to the bottom layer are relatively high. Hypoxia has occurred through geological time and naturally occurs in oxygen minimum zones, deep basins, eastern boundary upwelling systems, and fjords. Hypoxia development and continuation in many areas of the world\u27s coastal ocean is accelerated by human activities, especially where nutrient loading increased in the Anthropocene. This higher loading set in motion a cascading set of events related to eutrophication. The formation of hypoxic areas has been exacerbated by any combination of interactions that increase primary production and accumulation of organic carbon leading to increased respiratory demand for oxygen below a seasonal or permanent pycnocline. Nutrient loading is likely to increase further as population growth and resource intensification rises, especially with increased dependency on crops using fertilizers, burning of fossil fuels, urbanization, and waste water generation. It is likely that the occurrence and persistence of hypoxia will be even more widespread and have more impacts than presently observed. Global climate change will further complicate the causative factors in both natural and human-caused hypoxia. The likelihood of strengthened stratification alone, from increased surface water temperature as the global climate warms, is sufficient to worsen hypoxia where it currently exists and facilitate its formation in additional waters. Increased precipitation that increases freshwater discharge and flux of nutrients will result in increased primary production in the receiving waters up to a point. The interplay of increased nutrients and stratification where they occur will aggravate and accelerate hypoxia. Changes in wind fields may expand oxygen minimum zones onto more continental shelf areas. On the other hand, not all regions will experience increased precipitation, some oceanic water temperatures may decrease as currents shift, and frequency and severity of tropical storms may increase and temporarily disrupt hypoxia more often. The consequences of global warming and climate change are effectively uncontrollable at least in the near term. On the other hand, the consequences of eutrophication-induced hypoxia can be reversed if long-term, broad-scale, and persistent efforts to reduce substantial nutrient loads are developed and implemented. In the face of globally expanding hypoxia, there is a need for water and resource managers to act now to reduce nutrient loads to maintain, at least, the current status

Trophic Dynamics of the Boreal Forests of the Kluane Region

The trophic dynamics of the Yukon boreal forest have been under investigation at the Kluane Lake Research Station since 1973. We monitored and conducted experiments on the major species in this ecosystem, except the large mammals (for logistic reasons). The central problem has been to determine the causes of the 9 – 10 year cycle of snowshoe hares, and to achieve this we carried out several large-scale experiments manipulating food supplies, predator pressure, and soil nutrient availability to test hypotheses that food, predation, or habitat quality regulate populations. The hare cycle is driven top-down by predators, and most hares die because they are killed by predators. Predators also cause stress in female hares, and the stress response seems to be responsible for the loss of reproductive potential in the decline and low phases of the hare cycle. Many of the specialist predators and some herbivores in this ecosystem fluctuate with the hare cycle. Arctic ground squirrels do, but red squirrels do not, being linked closely to white spruce seed masting years. Small rodents fluctuate in numbers in two patterns. Red-backed voles and four species of Microtus voles have a 3 – 4 year cycle that seems to be driven by food supplies and social behaviour. Deer mice, in contrast, have fluctuated dramatically in the 38 years we have monitored them, but not cyclically. White spruce seed production varies with temperature and rainfall, but was not affected by adding nutrients in fertilizer. Global warming and reduced hare browsing in the last 20 years have helped to increase the abundance of shrubs in these forests. It will be challenging to predict how this system will change as climatic warming proceeds, because even closely related species in the same trophic level respond differently to perturbations. We recommend continued monitoring of the major species in these boreal forests.La dynamique trophique de la forêt boréale du Yukon fait l’objet d’une étude à la station de recherche du lac Kluane depuis 1973. Nous avons fait des expériences et surveillé les espèces importantes de cet écosystème, sauf en ce qui a trait aux principaux mammifères (pour des raisons de logistique). Le problème central a consisté à déterminer les causes du cycle de 9 à 10 ans du lièvre d’Amérique. Pour ce faire, nous avons effectué plusieurs expériences à grande échelle dans le cadre desquelles nous avons manipulé les disponibilités alimentaires, la pression exercée par les prédateurs et la disponibilité en nutriments dans le sol afin de mettre à l’épreuve les hypothèses selon lesquelles la nourriture, la prédation ou la qualité de l’habitat régularisent les populations. Le cycle du lièvre est dicté par les prédateurs de haut en bas, et la plupart des lièvres meurent parce qu’ils sont tués par les prédateurs. Par ailleurs, les prédateurs sont une source de stress chez les lièvres femelles, et la réaction au stress semble responsable de la perte de capacité de reproduction dans la phase du déclin et la phase basse du cycle du lièvre. Grand nombre des prédateurs spécialistes et certains herbivores de cet écosystème fluctuent en fonction du cycle du lièvre. C’est le cas du spermophile arctique, mais ce n’est pas le cas de l’écureuil roux, car il est étroitement lié aux années de paisson de graines d’épinette blanche. Le nombre de petits rongeurs fluctue en fonction de deux modèles. Le campagnol à dos roux et quatre espèces de campagnols Microtus ont un cycle de trois à quatre ans qui semble dicté par les disponibilités alimentaires et le comportement social, tandis que la souris sylvestre a connu d’énormes fluctuations pendant les 38 années qui ont fait l’objet d’une surveillance, sans toutefois afficher de cycles. La production de graines d’épinette blanche varie en fonction des températures et des chutes de pluie, mais n’a pas été influencée par l’ajout de nutriments au fertilisant. Le réchauffement planétaire et le broutage réduit des lièvres ces 20 dernières années ont aidé à accroître l’abondance d’arbustes dans ces forêts. Il sera difficile de prévoir comment ce système changera au fur et à mesure du réchauffement climatique, car même les espèces étroitement liées du même niveau trophique réagissent aux perturbations de manière différente. Nous recommandons la surveillance continue des principales espèces de ces forêts boréales

The Self Model and the Conception of Biological Identity in Immunology

The self/non-self model, first proposed by F.M. Burnet, has dominated immunology for sixty years now. According to this model, any foreign element will trigger an immune reaction in an organism, whereas endogenous elements will not, in normal circumstances, induce an immune reaction. In this paper we show that the self/non-self model is no longer an appropriate explanation of experimental data in immunology, and that this inadequacy may be rooted in an excessively strong metaphysical conception of biological identity. We suggest that another hypothesis, one based on the notion of continuity, gives a better account of immune phenomena. Finally, we underscore the mapping between this metaphysical deflation from self to continuity in immunology and the philosophical debate between substantialism and empiricism about identity

Gender Differences in Publication Output: Towards an Unbiased Metric of Research Performance

We examined the publication records of a cohort of 168 life scientists in the field of ecology and evolutionary biology to assess gender differences in research performance. Clear discrepancies in publication rate between men and women appear very early in their careers and this has consequences for the subsequent citation of their work. We show that a recently proposed index designed to rank scientists fairly is in fact strongly biased against female researchers, and advocate a modified index to assess men and women on a more equitable basis

Spallation reactions. A successful interplay between modeling and applications

The spallation reactions are a type of nuclear reaction which occur in space by interaction of the cosmic rays with interstellar bodies. The first spallation reactions induced with an accelerator took place in 1947 at the Berkeley cyclotron (University of California) with 200 MeV deuterons and 400 MeV alpha beams. They highlighted the multiple emission of neutrons and charged particles and the production of a large number of residual nuclei far different from the target nuclei. The same year R. Serber describes the reaction in two steps: a first and fast one with high-energy particle emission leading to an excited remnant nucleus, and a second one, much slower, the de-excitation of the remnant. In 2010 IAEA organized a worskhop to present the results of the most widely used spallation codes within a benchmark of spallation models. If one of the goals was to understand the deficiencies, if any, in each code, one remarkable outcome points out the overall high-quality level of some models and so the great improvements achieved since Serber. Particle transport codes can then rely on such spallation models to treat the reactions between a light particle and an atomic nucleus with energies spanning from few tens of MeV up to some GeV. An overview of the spallation reactions modeling is presented in order to point out the incomparable contribution of models based on basic physics to numerous applications where such reactions occur. Validations or benchmarks, which are necessary steps in the improvement process, are also addressed, as well as the potential future domains of development. Spallation reactions modeling is a representative case of continuous studies aiming at understanding a reaction mechanism and which end up in a powerful tool.Comment: 59 pages, 54 figures, Revie

Cardiovascular safety and lower severe hypoglycaemia of insulin degludec versus insulin glargine U100 in patients with type 2 diabetes aged 65 years or older: Results from DEVOTE (DEVOTE 7)

Aims: The aim of this study was to describe the risks of cardiovascular (CV) events and severe hypoglycaemia with insulin degludec (degludec) vs insulin glargine 100 units/mL (glargine U100) in patients with type 2 diabetes (T2D) aged 65 years or older. Materials and methods: A total of 7637 patients in the DEVOTE trial, a treat-to-target, randomized, double-blind trial evaluating the CV safety of degludec vs glargine U100, were divided into three age groups (50-64 years, n = 3682; 65-74 years, n = 3136; ≥75 years, n = 819). Outcomes by overall age group and randomized treatment differences were analysed for major adverse cardiovascular events (MACE), all-cause mortality, severe hypoglycaemia and serious adverse events (SAEs). Results: Patients with increasing age had higher risks of CV death, all-cause mortality and SAEs, and there were non-significant trends towards higher risks of MACE and severe hypoglycaemia. Treatment effects on the risk of MACE, all-cause mortality, severe hypoglycaemia and SAEs were consistent across age groups, based on the non-significant interactions between treatment and age with regard to these outcomes. Conclusions: There were higher risks of CV death, all-cause mortality and SAEs, and trends towards higher risks of MACE and severe hypoglycaemia with increasing age after adjusting for baseline differences. The effects across age groups of degludec vs glargine U100 on MACE, all-cause mortality and severe hypoglycaemia were comparable, suggesting that the risk of MACE, as well as all-cause mortality, is similar and the risk of severe hypoglycaemia is lower with degludec regardless of age. Evidence is conclusive only until 74 years of age

Hen Harrier Circus cyaneus nest sites on the Isle of Mull are associated with habitat mosaics and constrained by topography

This is an Accepted Manuscript of an article published by Taylor & Francis in Bird Study on 07/02/2018, available online: http://www.tandfonline.com/doi/full/10.1080/00063657.2017.1421611Capsule: Hen Harrier on the Isle of Mull, UK, are associated with habitat mosaics consisting of moorland, scrub and forestry but avoid grazed land, suggesting that forested habitats could be managed sympathetically for Hen Harrier in the future should the current UK population increase. Aims: To use distribution modelling to investigate nesting habitat associations using a long term dataset for Hen Harrier on Mull. Methods: We develop area-interaction models using a LASSO penalty to explore the distribution of 102 Hen Harrier nest sites in relation to habitat and topography. Our model is then successfully validated in tests using data for 70 nest sites from subsequent years. Results: Our model is effective in predicting suitable areas for Hen Harrier nest sites and indicates that Hen Harriers on Mull are found in habitat mosaics below 200 m asl. Hen Harrier nest intensity is positively associated with increasing proportions of moorland and scrub, open canopy forestry and closed canopy forestry. Nest intensity is negatively associated with increasing proportions of grazed land. Conclusion: Hen Harrier avoid grazed areas but are relatively tolerant of other habitat combinations. These findings are supported by previous observations of Hen Harrier habitat use and have implications for the recovery of some Hen Harrier SPA populations and future forest management. Open canopy forest and forest mosaics could potentially be incorporated into landscape-scale conservation plans for Hen Harriers using the population in Mull as an example