British mapping of Africa: publishing histories of imperial cartography, c. 1880 – c. 1915

This thesis investigates how the mapping of Africa by British institutions between c.1880 and c.1915 was more complex and variable than is traditionally recognised. The study takes three ‘cuts’ into this topic, presented as journal papers, which examine: the Bartholomew map-publishing firm, the cartographic coverage of the Second Boer War, and the maps associated with Sir Harry H. Johnston. Each case-study focuses on what was produced – both quantitative output and the content of representations – and why. Informed by theories from the history of cartography, book history and the history of science, particular attention is paid to the concerns and processes embodied in the maps and map-making that are irreducible to simply ‘imperial’ discourse; these variously include editorial processes and questions of authorship, concerns for credibility and intended audiences, and the circulation and ‘life-cycles’ of maps. These findings are also explored in relation to the institutional geography of cartography in Britain: the studies illustrate the institutional contingency of such factors and how this gave rise to highly variable representations of Africa. These three empirical papers represent the first sustained studies of each of the topics. By connecting their findings, the thesis also offers broader reconceptualisations of the British mapping of Africa between c.1880 and c.1915: with respect to cartographic representations, maps as objects, and the institutions producing them. Maps did not simply reflect ‘imperial’ discourse; they were highly variable manifestations of multifaceted and institutionally contingent factors and were mobile and mutable objects that were re-used and re-produced in different ways across different settings. Mapmaking institutions were discrete but interconnected sites that not only produced different representations, but played different roles in the mapping of Africa. By illuminating the institutional provenance, ‘life-cycles’ and content of the maps studied, this thesis extends current knowledge of British mapping of Africa during the late nineteenth and early twentieth centuries and raises questions for further research incorporating its lessons, sources and theories

New genetic loci link adipose and insulin biology to body fat distribution.

Body fat distribution is a heritable trait and a well-established predictor of adverse metabolic outcomes, independent of overall adiposity. To increase our understanding of the genetic basis of body fat distribution and its molecular links to cardiometabolic traits, here we conduct genome-wide association meta-analyses of traits related to waist and hip circumferences in up to 224,459 individuals. We identify 49 loci (33 new) associated with waist-to-hip ratio adjusted for body mass index (BMI), and an additional 19 loci newly associated with related waist and hip circumference measures (P < 5 × 10(-8)). In total, 20 of the 49 waist-to-hip ratio adjusted for BMI loci show significant sexual dimorphism, 19 of which display a stronger effect in women. The identified loci were enriched for genes expressed in adipose tissue and for putative regulatory elements in adipocytes. Pathway analyses implicated adipogenesis, angiogenesis, transcriptional regulation and insulin resistance as processes affecting fat distribution, providing insight into potential pathophysiological mechanisms

Postoperative continuous positive airway pressure to prevent pneumonia, re-intubation, and death after major abdominal surgery (PRISM): a multicentre, open-label, randomised, phase 3 trial

Background: Respiratory complications are an important cause of postoperative morbidity. We aimed to investigate whether continuous positive airway pressure (CPAP) administered immediately after major abdominal surgery could prevent postoperative morbidity. Methods: PRISM was an open-label, randomised, phase 3 trial done at 70 hospitals across six countries. Patients aged 50 years or older who were undergoing elective major open abdominal surgery were randomly assigned (1:1) to receive CPAP within 4 h of the end of surgery or usual postoperative care. Patients were randomly assigned using a computer-generated minimisation algorithm with inbuilt concealment. The primary outcome was a composite of pneumonia, endotracheal re-intubation, or death within 30 days after randomisation, assessed in the intention-to-treat population. Safety was assessed in all patients who received CPAP. The trial is registered with the ISRCTN registry, ISRCTN56012545. Findings: Between Feb 8, 2016, and Nov 11, 2019, 4806 patients were randomly assigned (2405 to the CPAP group and 2401 to the usual care group), of whom 4793 were included in the primary analysis (2396 in the CPAP group and 2397 in the usual care group). 195 (8\ub71%) of 2396 patients in the CPAP group and 197 (8\ub72%) of 2397 patients in the usual care group met the composite primary outcome (adjusted odds ratio 1\ub701 [95% CI 0\ub781-1\ub724]; p=0\ub795). 200 (8\ub79%) of 2241 patients in the CPAP group had adverse events. The most common adverse events were claustrophobia (78 [3\ub75%] of 2241 patients), oronasal dryness (43 [1\ub79%]), excessive air leak (36 [1\ub76%]), vomiting (26 [1\ub72%]), and pain (24 [1\ub71%]). There were two serious adverse events: one patient had significant hearing loss and one patient had obstruction of their venous catheter caused by a CPAP hood, which resulted in transient haemodynamic instability. Interpretation: In this large clinical effectiveness trial, CPAP did not reduce the incidence of pneumonia, endotracheal re-intubation, or death after major abdominal surgery. Although CPAP has an important role in the treatment of respiratory failure after surgery, routine use of prophylactic post-operative CPAP is not recommended

Genetic studies of body mass index yield new insights for obesity biology

Note: A full list of authors and affiliations appears at the end of the article. Obesity is heritable and predisposes to many diseases. To understand the genetic basis of obesity better, here we conduct a genome-wide association study and Metabochip meta-analysis of body mass index (BMI), a measure commonly used to define obesity and assess adiposity, in up to 339,224 individuals. This analysis identifies 97 BMI-associated loci (P 20% of BMI variation. Pathway analyses provide strong support for a role of the central nervous system in obesity susceptibility and implicate new genes and pathways, including those related to synaptic function, glutamate signalling, insulin secretion/action, energy metabolism, lipid biology and adipogenesis.</p