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In response to the COVID-19 pandemic, we rapidly implemented a plasma coordination center, within two months, to support transfusion for two outpatient randomized controlled trials. The center design was based on an investigational drug services model and a Food and Drug Administration-compliant database to manage blood product inventory and trial safety.
Methods:
A core investigational team adapted a cloud-based platform to randomize patient assignments and track inventory distribution of control plasma and high-titer COVID-19 convalescent plasma of different blood groups from 29 donor collection centers directly to blood banks serving 26 transfusion sites.
Results:
We performed 1,351 transfusions in 16 months. The transparency of the digital inventory at each site was critical to facilitate qualification, randomization, and overnight shipments of blood group-compatible plasma for transfusions into trial participants. While inventory challenges were heightened with COVID-19 convalescent plasma, the cloud-based system, and the flexible approach of the plasma coordination center staff across the blood bank network enabled decentralized procurement and distribution of investigational products to maintain inventory thresholds and overcome local supply chain restraints at the sites.
Conclusion:
The rapid creation of a plasma coordination center for outpatient transfusions is infrequent in the academic setting. Distributing more than 3,100 plasma units to blood banks charged with managing investigational inventory across the U.S. in a decentralized manner posed operational and regulatory challenges while providing opportunities for the plasma coordination center to contribute to research of global importance. This program can serve as a template in subsequent public health emergencies.
The beach–foredune system at Bengello Beach has been monitored monthly to bimonthly at four profiles (P1–P4) since 1972 and documented the building of a foredune. This paper addresses the remarkable changes which occurred in 2022 as storm waves overtopped and trimmed this foredune at all profiles, then later removed this entire feature at two of the profiles (P3, P4) but not the others (P1, P2). Wave parameters for these storm events, measured by deepwater and nearshore wave buoys, enable a comparison of storm characteristics and resulting beach–foredune impact. During the storm event which destroyed the foredune, nearshore wave height exceeded deepwater wave height, in contrast with other storms that year. The beach–foredune lost 78 m3/m in 2022 and the notable 1974 storms that impacted this coastline resulted in 95 m3/m volume loss. During 2023, beach recovery has occurred, but not rebuilt the foredune. It had persisted for ~40 years enduring many other severe storm events, and the coastal protection afforded by the dune system has been compromised. This highlights the need to consider dune morphology in assessments of erosion hazard and inundation risk along similar coastlines.
We identify a set of essential recent advances in climate change research with high policy relevance, across natural and social sciences: (1) looming inevitability and implications of overshooting the 1.5°C warming limit, (2) urgent need for a rapid and managed fossil fuel phase-out, (3) challenges for scaling carbon dioxide removal, (4) uncertainties regarding the future contribution of natural carbon sinks, (5) intertwinedness of the crises of biodiversity loss and climate change, (6) compound events, (7) mountain glacier loss, (8) human immobility in the face of climate risks, (9) adaptation justice, and (10) just transitions in food systems.
Technical summary
The Intergovernmental Panel on Climate Change Assessment Reports provides the scientific foundation for international climate negotiations and constitutes an unmatched resource for researchers. However, the assessment cycles take multiple years. As a contribution to cross- and interdisciplinary understanding of climate change across diverse research communities, we have streamlined an annual process to identify and synthesize significant research advances. We collected input from experts on various fields using an online questionnaire and prioritized a set of 10 key research insights with high policy relevance. This year, we focus on: (1) the looming overshoot of the 1.5°C warming limit, (2) the urgency of fossil fuel phase-out, (3) challenges to scale-up carbon dioxide removal, (4) uncertainties regarding future natural carbon sinks, (5) the need for joint governance of biodiversity loss and climate change, (6) advances in understanding compound events, (7) accelerated mountain glacier loss, (8) human immobility amidst climate risks, (9) adaptation justice, and (10) just transitions in food systems. We present a succinct account of these insights, reflect on their policy implications, and offer an integrated set of policy-relevant messages. This science synthesis and science communication effort is also the basis for a policy report contributing to elevate climate science every year in time for the United Nations Climate Change Conference.
Social media summary
We highlight recent and policy-relevant advances in climate change research – with input from more than 200 experts.
The UK Biobank contains data with varying degrees of reliability and completeness for assessing depression. A third of participants completed a Mental Health Questionnaire (MHQ) containing the gold-standard Composite International Diagnostic Interview (CIDI) criteria for assessing mental health disorders.
Aims
To investigate whether multiple observations of depression from sources other than the MHQ can enhance the validity of major depressive disorder (MDD).
Method
In participants who did not complete the MHQ, we calculated the number of other depression measures endorsed, for example from hospital episode statistics and interview data. We compared cases defined this way with CIDI-defined cases for several estimates: the variance explained by polygenic risk scores (PRS), area under the curve attributable to PRS, single nucleotide polymorphisms (SNPs)-based heritability and genetic correlations with summary statistics from the Psychiatric Genomics Consortium MDD genome-wide association study.
Results
The strength of the genetic contribution increased with the number of measures endorsed. For example, SNP-based heritability increased from 7% in participants who endorsed only one measure of depression, to 21% in those who endorsed four or five measures of depression. The strength of the genetic contribution to cases defined by at least two measures approximated that for CIDI-defined cases. Most genetic correlations between UK Biobank and the Psychiatric Genomics Consortium MDD study exceeded 0.7, but there was variability between pairwise comparisons.
Conclusions
Multiple measures of depression can serve as a reliable approximation for case status where the CIDI measure is not available, indicating sample size can be optimised using the entire suite of UK Biobank data.
Stress-induced stimulation of corticotropic function involves the activation of hypothalamic corticotropin-releasing hormone (CRH) and arginine vasopressin (AVP), which can be measured by improved methods of neuroendocrine investigation. The antiserotoninergic tricyclic antidepressant, tianeptine, reduces the corticotropic response to stress, as shown by a reduction in hypothalamo-hypophyseal portal CRH and AVP levels.
This paper describes a model of electron energization and cyclotron-maser emission applicable to astrophysical magnetized collisionless shocks. It is motivated by the work of Begelman, Ergun and Rees [Astrophys. J. 625, 51 (2005)] who argued that the cyclotron-maser instability occurs in localized magnetized collisionless shocks such as those expected in blazar jets. We report on recent research carried out to investigate electron acceleration at collisionless shocks and maser radiation associated with the accelerated electrons. We describe how electrons accelerated by lower-hybrid waves at collisionless shocks generate cyclotron-maser radiation when the accelerated electrons move into regions of stronger magnetic fields. The electrons are accelerated along the magnetic field and magnetically compressed leading to the formation of an electron velocity distribution having a horseshoe shape due to conservation of the electron magnetic moment. Under certain conditions the horseshoe electron velocity distribution function is unstable to the cyclotron-maser instability [Bingham and Cairns, Phys. Plasmas 7, 3089 (2000); Melrose, Rev. Mod. Plasma Phys. 1, 5 (2017)].
Malaria elimination is on global agendas following successful transmission reductions. Nevertheless moving from low to zero transmission is challenging. South Africa has an elimination target of 2018, which may or may not be realised in its hypoendemic areas.
Methods
The Agincourt Health and Demographic Surveillance System has monitored population health in north-eastern South Africa since 1992. Malaria deaths were analysed against individual factors, socioeconomic status, labour migration and weather over a 21-year period, eliciting trends over time and associations with covariates.
Results
Of 13 251 registered deaths over 1.58 million person-years, 1.2% were attributed to malaria. Malaria mortality rates increased from 1992 to 2013, while mean daily maximum temperature rose by 1.5 °C. Travel to endemic Mozambique became easier, and malaria mortality increased in higher socioeconomic groups. Overall, malaria mortality was significantly associated with age, socioeconomic status, labour migration and employment, yearly rainfall and higher rainfall/temperature shortly before death.
Conclusions
Malaria persists as a small but important cause of death in this semi-rural South African population. Detailed longitudinal population data were crucial for these analyses. The findings highlight practical political, socioeconomic and environmental difficulties that may also be encountered elsewhere in moving from low-transmission scenarios to malaria elimination.
Africa is experiencing a rapid increase in adult obesity and associated cardiometabolic diseases (CMDs). The H3Africa AWI-Gen Collaborative Centre was established to examine genomic and environmental factors that influence body composition, body fat distribution and CMD risk, with the aim to provide insights towards effective treatment and intervention strategies. It provides a research platform of over 10 500 participants, 40–60 years old, from Burkina Faso, Ghana, Kenya and South Africa. Following a process that involved community engagement, training of project staff and participant informed consent, participants were administered detailed questionnaires, anthropometric measurements were taken and biospecimens collected. This generated a wealth of demographic, health history, environmental, behavioural and biomarker data. The H3Africa SNP array will be used for genome-wide association studies. AWI-Gen is building capacity to perform large epidemiological, genomic and epigenomic studies across several African counties and strives to become a valuable resource for research collaborations in Africa.
A retrospective cohort study was performed following several reported cases of gastrointestinal illness after a catered event. The attack rate was 45/77 (58·4%) by clinical case definition, with four individuals confirmed to have Campylobacter. There was near universal exposure to most foodstuffs served; consumption of duck liver pâté [relative risk (RR) 2·53, 95% confidence interval (CI) 1·05–6·10], mixed leaf salad (RR 2·91, 95% CI 1·22–6·92) and table water (RR undefined, P < 0·01) were associated with illness in univariate analysis, with only the latter associated in the final multivariable model (P < 0·001). Samples of cooked duck liver pâté subsequently prepared using identical methods at the venue were contaminated with Campylobacter jejuni and C. coli; water sampling was negative. Making inferences about causation in the presence of near universal exposures in this study required consideration of the limitations of statistical analysis, with the most compelling evidence of the causal role of inadequately prepared duck liver pâté provided by environmental investigation.
Poor maternal nutrition during pregnancy can result in increased disease risk in adult offspring. Many of these effects are proposed to be mediated via altered hypothalamo–pituitary–adrenal axis (HPAA) function, and are sex and age specific. Maternal undernutrition around the time of conception alters HPAA function in foetal and early postnatal life, but there are limited conflicting data about later effects. The aim of this study was to investigate the effect of moderate periconceptional undernutrition on HPAA function of offspring of both sexes longitudinally, from juvenile to adult life. Ewes were undernourished from 61 days before until 30 days after conception or fed ad libitum. HPAA function in offspring was assessed by arginine vasopressin plus corticotropin-releasing hormone challenge at 4, 10 and 18 months. Plasma cortisol response was lower in males than in females, and was not different between singles and twins. Periconceptional undernutrition suppressed offspring plasma cortisol but not adrenocorticotropic hormone responses. In males, this suppression was apparent by 4 months, and was more profound by 10 months, with no further change by 18 months. In females, suppression was first observed at 10 months and became more profound by 18 months. Maternal undernutrition limited to the periconceptional period has a prolonged, sex-dependent effect on adrenal function in the offspring.
Edited by
Alex S. Evers, Washington University School of Medicine, St Louis,Mervyn Maze, University of California, San Francisco,Evan D. Kharasch, Washington University School of Medicine, St Louis
An adaptive numerical method is employed to simulate shear instabilities in open-ocean internal solitary-like gravity waves. The method is second-order accurate, employs block-structured adaptive mesh refinement, solves the incompressible Navier–Stokes equations and allows for the simulation of all of the length scales of interest by dynamically tracking important regions with recursively-nested finer grids. Two-dimensional simulations are performed over a range of parameters, which allows us to assess the conditions under which the shear instabilities in the waves occur, including a method to evaluate the critical Richardson number for instability based on the bulk wave parameters. The results show that although the minimum Richardson number is well below the canonical value of 1/4 in all simulations, this value is not a sufficient condition for instability, but instead a much lower Richardson number of 0.1 is required. When the Richardson number falls below 0.1, shear instabilities develop and grow into two-dimensional billows of the Kelvin–Helmholtz type. A linear stability analysis with the Taylor–Goldstein equation indicates that an alternate criterion for instability is given by σiTw > 5, where σi is the growth rate of the instability averaged over Tw, the period in which parcels of fluid are subjected to a Richardson number of less than 1/4. A third criterion for instability requires that Lw/L > 0.86, where Lw is half the length of the region in which the Richardson number falls below 1/4 and L is the solitary wave half-width. An eigendecomposition of the rate-of-strain tensor is performed to show that the pycnocline thickness increases within the wave because of pycnocline-normal strain and not because of diffusion, which has important ramifications for stability. A three-dimensional simulation indicates that the primary instability is two-dimensional and that secondary, three-dimensional instabilities occur thereafter and lead to strong dissipation and mixing.
The efficacy and acceptability of yeast-derived recombinant hepatitis B vaccine given by the intradermal route was investigated in 221 health care volunteers. Two hundred and sixteen received a full course of three doses of vaccine. Only one subject was withdrawn because of a significant adverse reaction (psoriasis). The vaccine stimulated an antibody response in 81%. The response to the vaccine was better in women than in men (87% compared with 71%, p = 0·007) and in women below the age of 40 years compared with older women (94% compared with 76%, p = 0·01). For men the response showed a sequential decline with age for each decade (90% responders from age 29 or less, 72% aged 30—39 and 65% aged 40 or more, p = 0·04). Retrospective enquiry showed that over 90% had found the intradermal route acceptable and 59% would prefer vaccine by the intradermal route in preference to intramuscular notwithstanding local reactions. Although the seroconversion rate was of a high order in younger women the antibody titres were not high with only 9 of 215 recipients developing titres >1000 mIU/ml, a level which could be expected to ensure prolonged immunity. A fourth intradermal dose of vaccine given to 60 volunteers who had shown a low response (<38 mIU/ml) or no serological response to a three-dose course stimulated a good booster effect (to 150—600 mIU/ml) in only 5 (8%).
We have begun to explore the use of continuous stiffness techniques for studying the mechanical properties of coated systems using nanoindentation and thus to critically assess the differing types of sample information available from simple load-displacement (P-δ) curves, P-δ2 analyses and P-S2 (i.e. load-vs-(contact stiffness)2) data. We have also examined whether the small superposed AC signal used to continuously measure contact stiffness has had any marked effect on the sample load-displacement response. A range of fully calibrated Nano Indenter II and Nano Indenter XP instruments have been used for data acquisition, while transmission electron microscopy (TEM) and high resolution scanning electron microscopy (HRSEM) have both been employed to characterise the resultant indentation appearances and deformation structures. Samples have spanned a number of monolithic and coated materials systems including fused silica, 6H-SiC, 3C-SiC on Si and TiN on both M2 and 304 steels. Plots of P-δ and P-δ2recorded with and without the additional AC signal were found to be indistinguishable. Further, apart from some small statistical variation in the loads at which crack initiation was observed in a SiC-on-Si coated system, TEM and HRSEM studies showed no detectable differences in deformation substructures between nominally identical indentations made with and without the AC signal.
While the parameter P/S2 is independent of detailed tip shape and is a constant with displacement for monolithic systems, it was found to display unexpected variations with displacement for the coated systems. In order to explore the origins of these variations, we have examined plots of system elastic modulus (Es) and system hardness (Hs) as a function of indenter displacement which have shown that the effective contact elastic modulus decreases more rapidly with increasing contact scale than does the effective system hardness P/S2 can also be related to the plasticity index (ψ) widely used to describe the balance between the elastic and plastic responses of materials subjected to contact damage. Thus, the observations of maxima in plots of P/S2 with displacement, for at least some coated systems, suggests that there may be an optimum contact scale for maximising the elastic contribution to the contact response of such systems