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Effect modification occurs when a covariate alters the relative effectiveness of treatment compared to control. It is widely understood that, when effect modification is present, treatment recommendations may vary by population and by subgroups within the population. Population-adjustment methods are increasingly used to adjust for differences in effect modifiers between study populations and to produce population-adjusted estimates in a relevant target population for decision-making. It is also widely understood that marginal and conditional estimands for non-collapsible effect measures, such as odds ratios or hazard ratios, do not in general coincide even without effect modification. However, the consequences of both non-collapsibility and effect modification together are little-discussed in the literature.
In this article, we set out the definitions of conditional and marginal estimands, illustrate their properties when effect modification is present, and discuss the implications for decision-making. In particular, we show that effect modification can result in conflicting treatment rankings between conditional and marginal estimates. This is because conditional and marginal estimands correspond to different decision questions that are no longer aligned when effect modification is present. For time-to-event outcomes, the presence of covariates implies that marginal hazard ratios are time-varying, and effect modification can cause marginal hazard curves to cross. We conclude with practical recommendations for decision-making in the presence of effect modification, based on pragmatic comparisons of both conditional and marginal estimates in the decision target population. Currently, multilevel network meta-regression is the only population-adjustment method capable of producing both conditional and marginal estimates, in any decision target population.
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.
To investigate the symptoms of SARS-CoV-2 infection, their dynamics and their discriminatory power for the disease using longitudinally, prospectively collected information reported at the time of their occurrence. We have analysed data from a large phase 3 clinical UK COVID-19 vaccine trial. The alpha variant was the predominant strain. Participants were assessed for SARS-CoV-2 infection via nasal/throat PCR at recruitment, vaccination appointments, and when symptomatic. Statistical techniques were implemented to infer estimates representative of the UK population, accounting for multiple symptomatic episodes associated with one individual. An optimal diagnostic model for SARS-CoV-2 infection was derived. The 4-month prevalence of SARS-CoV-2 was 2.1%; increasing to 19.4% (16.0%–22.7%) in participants reporting loss of appetite and 31.9% (27.1%–36.8%) in those with anosmia/ageusia. The model identified anosmia and/or ageusia, fever, congestion, and cough to be significantly associated with SARS-CoV-2 infection. Symptoms’ dynamics were vastly different in the two groups; after a slow start peaking later and lasting longer in PCR+ participants, whilst exhibiting a consistent decline in PCR- participants, with, on average, fewer than 3 days of symptoms reported. Anosmia/ageusia peaked late in confirmed SARS-CoV-2 infection (day 12), indicating a low discrimination power for early disease diagnosis.
In this paper, we investigate finite solvable tidy groups. We prove that a solvable group with order divisible by at least two primes is tidy if all of its Hall subgroups that are divisible by only two primes are tidy.
Let G be a p-group for some prime p. Recall that the Hughes subgroup of G is the subgroup generated by all of the elements of G with order not equal to p. In this paper, we prove that if the Hughes subgroup of G is cyclic, then G has exponent p or is cyclic or is dihedral. We also prove that if the Hughes subgroup of G is generalised quaternion, then G must be generalised quaternion. With these results in hand, we classify the tidy p-groups.
‘Digital’ is an omnipresent yet often vague, misunderstood or feared topic in health services. There are many current and potential gains for individual patients and local populations, clinicians and organisations through optimisation of digital technologies. We argue that understanding the various aspects of digital psychiatry is an essential contemporary need. This is the first of two articles on the subject, exploring the gains and challenges of virtual/online assessments, including ethical considerations and the use of virtual reality and electronic prescribing.
Morgan and Parker proved that if G is a group with ${\textbf{Z}(G)} = 1$, then the connected components of the commuting graph of G have diameter at most $10$. Parker proved that if, in addition, G is solvable, then the commuting graph of G is disconnected if and only if G is a Frobenius group or a $2$-Frobenius group, and if the commuting graph of G is connected, then its diameter is at most $8$. We prove that the hypothesis $Z (G) = 1$ in these results can be replaced with $G' \cap {\textbf{Z}(G)} = 1$. We also prove that if G is solvable and $G/{\textbf{Z}(G)}$ is either a Frobenius group or a $2$-Frobenius group, then the commuting graph of G is disconnected.
Several dietary factors have been extensively investigated for associations with risk of breast cancer, but to date unequivocal evidence only exists for alcohol consumption. We sought to systematically evaluate the association between 92 dietary factors and breast cancer risk using a nutrient-wide association study approach. Using data from 272,098 women participating in the European Prospective Investigation into Cancer and Nutrition (EPIC) study, we assessed dietary intake of 92 foods and nutrients estimated by dietary questionnaires. Cox regression with age as the time scale and adjustment for potential confounders, was used to quantify the association between each food or nutrient and risk of breast cancer. A false discovery rate (FDR) of 0.05 was used to select the set of foods and nutrients to evaluate in the independent replication cohort, the Netherlands Cohort Study (NLCS). During a median follow-up time of 15 years, 10,979 incident invasive breast cancers were identified in the women from the EPIC study. Six foods and nutrients were associated with risk of breast cancer when controlling the FDR at 0.05. Higher intake of alcohol overall was associated with a higher risk of breast cancer (hazard ratio (HR) for a 1 SD increment in intake = 1.05, 95% confidence interval (CI) 1.03–1.07), as was beer/cider intake and wine intake (HRs per 1 SD increment = 1.05, 95% CI 1.03–1.06 and 1.04, 95% CI 1.02–1.06, respectively), whereas higher intakes of fibre, apple/pear, and carbohydrates were associated with a lower risk of breast cancer (HRs per 1 SD increment = 0.96, 95% CI 0.94–0.98; 0.96, 95% CI 0.94–0.99; and 0.96, 95% CI 0.95–0.98, respectively). When evaluated in the NLCS (2368 invasive breast cancer cases), estimates for each of these foods and nutrients were similar in magnitude and direction, with the exception of beer/cider intake, which was not associated with risk of breast cancer in the NLCS. Our findings confirm the well-established increased risk of breast cancer associated with alcohol consumption, and suggest that higher intake of dietary fibre, and possibly fruit and carbohydrates, might be associated with reduced breast cancer risk.
Important Bird and Biodiversity Areas (IBAs) are sites identified as being globally important for the conservation of bird populations on the basis of an internationally agreed set of criteria. We present the first review of the development and spread of the IBA concept since it was launched by BirdLife International (then ICBP) in 1979 and examine some of the characteristics of the resulting inventory. Over 13,000 global and regional IBAs have so far been identified and documented in terrestrial, freshwater and marine ecosystems in almost all of the world’s countries and territories, making this the largest global network of sites of significance for biodiversity. IBAs have been identified using standardised, data-driven criteria that have been developed and applied at global and regional levels. These criteria capture multiple dimensions of a site’s significance for avian biodiversity and relate to populations of globally threatened species (68.6% of the 10,746 IBAs that meet global criteria), restricted-range species (25.4%), biome-restricted species (27.5%) and congregatory species (50.3%); many global IBAs (52.7%) trigger two or more of these criteria. IBAs range in size from < 1 km2 to over 300,000 km2 and have an approximately log-normal size distribution (median = 125.0 km2, mean = 1,202.6 km2). They cover approximately 6.7% of the terrestrial, 1.6% of the marine and 3.1% of the total surface area of the Earth. The launch in 2016 of the KBA Global Standard, which aims to identify, document and conserve sites that contribute to the global persistence of wider biodiversity, and whose criteria for site identification build on those developed for IBAs, is a logical evolution of the IBA concept. The role of IBAs in conservation planning, policy and practice is reviewed elsewhere. Future technical priorities for the IBA initiative include completion of the global inventory, particularly in the marine environment, keeping the dataset up to date, and improving the systematic monitoring of these sites.
BirdLife International´s Important Bird and Biodiversity Areas (IBA) Programme has identified, documented and mapped over 13,000 sites of international importance for birds. IBAs have been influential with governments, multilateral agreements, businesses and others in: (1) informing governments’ efforts to expand protected area networks (in particular to meet their commitments through the Convention on Biological Diversity); (2) supporting the identification of Ecologically or Biologically Significant Areas (EBSAs) in the marine realm, (3) identifying Wetlands of International Importance under the Ramsar Convention; (4) identifying sites of importance for species under the Convention on Migratory Species and its sister agreements; (5) identifying Special Protected Areas under the EU Birds Directive; (6) applying the environmental safeguards of international finance institutions such as the International Finance Corporation; (7) supporting the private sector to manage environmental risk in its operations; and (8) helping donor organisations like the Critical Ecosystems Partnership Fund (CEPF) to prioritise investment in site-based conservation. The identification of IBAs (and IBAs in Danger: the most threatened of these) has also triggered conservation and management actions at site level, most notably by civil society organisations and local conservation groups. IBA data have therefore been widely used by stakeholders at different levels to help conserve a network of sites essential to maintaining the populations and habitats of birds as well as other biodiversity. The experience of IBA identification and conservation is shaping the design and implementation of the recently launched Key Biodiversity Areas (KBA) Partnership and programme, as IBAs form a core part of the KBA network.
Approximately half of the variation in wellbeing measures overlaps with variation in personality traits. Studies of non-human primate pedigrees and human twins suggest that this is due to common genetic influences. We tested whether personality polygenic scores for the NEO Five-Factor Inventory (NEO-FFI) domains and for item response theory (IRT) derived extraversion and neuroticism scores predict variance in wellbeing measures. Polygenic scores were based on published genome-wide association (GWA) results in over 17,000 individuals for the NEO-FFI and in over 63,000 for the IRT extraversion and neuroticism traits. The NEO-FFI polygenic scores were used to predict life satisfaction in 7 cohorts, positive affect in 12 cohorts, and general wellbeing in 1 cohort (maximal N = 46,508). Meta-analysis of these results showed no significant association between NEO-FFI personality polygenic scores and the wellbeing measures. IRT extraversion and neuroticism polygenic scores were used to predict life satisfaction and positive affect in almost 37,000 individuals from UK Biobank. Significant positive associations (effect sizes <0.05%) were observed between the extraversion polygenic score and wellbeing measures, and a negative association was observed between the polygenic neuroticism score and life satisfaction. Furthermore, using GWA data, genetic correlations of -0.49 and -0.55 were estimated between neuroticism with life satisfaction and positive affect, respectively. The moderate genetic correlation between neuroticism and wellbeing is in line with twin research showing that genetic influences on wellbeing are also shared with other independent personality domains.
To investigate relationships between mortality and circulating 25-hydroxyvitamin D (25(OH)D), 25-hydroxycholecalciferol (25(OH)D3) and 25-hydroxyergocalciferol (25(OH)D2).
Design
Case–cohort study within the Melbourne Collaborative Cohort Study (MCCS). We measured 25(OH)D2 and 25(OH)D3 in archived dried blood spots by LC–MS/MS. Cox regression was used to estimate mortality hazard ratios (HR), with adjustment for confounders.
Setting
General community.
Subjects
The MCCS included 29 206 participants, who at recruitment in 1990–1994 were aged 40–69 years, had dried blood spots collected and no history of cancer. For the present study we selected participants who died by 31 December 2007 (n 2410) and a random sample (sub-cohort, n 2996).
Results
The HR per 25 nmol/l increment in concentration of 25(OH)D and 25(OH)D3 were 0·86 (95 % CI 0·78, 0·96; P=0·007) and 0·85 (95 % CI 0·77, 0·95; P=0·003), respectively. Of 5108 participants, sixty-three (1·2 %) had detectable 25(OH)D2; their mean 25(OH)D concentration was 11·9 (95 % CI 7·3, 16·6) nmol/l higher (P<0·001). The HR for detectable 25(OH)D2 was 1·80 (95 % CI 1·09, 2·97; P=0·023); for those with detectable 25(OH)D2, the HR per 25 nmol/l increment in 25(OH)D was 1·06 (95 % CI 0·87, 1·29; P interaction=0·02). HR were similar for participants who reported being in good, very good or excellent health four years after recruitment.
Conclusions
Total 25(OH)D and 25(OH)D3 concentrations were inversely associated with mortality. The finding that the inverse association for 25(OH)D was restricted to those with no detectable 25(OH)D2 requires confirmation in populations with higher exposure to ergocalciferol.
This article develops and tests a set of theoretical mechanisms by which candidate ethnicity may have affected the party vote choice of both white British and ethnic minority voters in the 2010 British general election. Ethnic minority candidates suffered an average electoral penalty of about 4 per cent of the three-party vote from whites, mostly because those with anti-immigrant feelings were less willing to vote for Muslims. Ethnic minority voter responses to candidate ethnicity differed by ethnic group. There were no significant effects for non-Muslim Indian and black voters, while Pakistani candidates benefited from an 8-point average electoral bonus from Pakistani voters.
Imidazoles present a tunable, versatile and economical platform for the development of novel liquid solvents and polymer membranes for CO2 capture. An overview of our studies in this area is presented, with emphasis on characterization of structure-property relationships in imidazole-based materials through both experimental and computational studies. To this end, a growing library of systematically varied imidazole compounds has been synthesized using only commercial available starting materials and straightforward reactions. Using this library of compounds, we have sought to understand and develop predictive models for thermophysical properties relating to process design, including: density, viscosity, vapor pressure, pKa and CO2 absorption capacity. Furthermore, we have discovered that imidazoles are stable in the presence of SO2 and can form reversible 1:1 adducts, which can be beneficial as SO2 is typically present at ppm levels alongside CO2 in flue gas from coal-fired power plants.
To examine the use of vitamin D supplements during infancy among the participants in an international infant feeding trial.
Design
Longitudinal study.
Setting
Information about vitamin D supplementation was collected through a validated FFQ at the age of 2 weeks and monthly between the ages of 1 month and 6 months.
Subjects
Infants (n 2159) with a biological family member affected by type 1 diabetes and with increased human leucocyte antigen-conferred susceptibility to type 1 diabetes from twelve European countries, the USA, Canada and Australia.
Results
Daily use of vitamin D supplements was common during the first 6 months of life in Northern and Central Europe (>80 % of the infants), with somewhat lower rates observed in Southern Europe (>60 %). In Canada, vitamin D supplementation was more common among exclusively breast-fed than other infants (e.g. 71 % v. 44 % at 6 months of age). Less than 2 % of infants in the USA and Australia received any vitamin D supplementation. Higher gestational age, older maternal age and longer maternal education were study-wide associated with greater use of vitamin D supplements.
Conclusions
Most of the infants received vitamin D supplements during the first 6 months of life in the European countries, whereas in Canada only half and in the USA and Australia very few were given supplementation.
Because the determinants of anxiety and depression in late adolescence and early adulthood may differ from those in later life, we investigated the temporal stability and magnitude of genetic and environmental correlates of symptoms of anxiety and depression across the life span. Data were collected from a population-based Australian sample of 4364 complete twin pairs and 777 singletons aged 20 to 96 years who were followed-up over three studies between 1980 and 1996. Each study contained the 14-item self-report DSSI/sAD scale which was used to measure recently experienced symptoms of anxiety and depression. Symptom scores were then divided and assigned to age intervals according to each subject's age at time of participation. We fitted genetic simplex models to take into account the longitudinal nature of the data. For male anxiety and depression, the best fitting simplex models comprised a single genetic innovation at age 20 which was transmitted, and explained genetic variation in anxiety and depression at ages 30, 40, 50 and 60. Most of the lifetime genetic variation in female anxiety and depression could also be explained by innovations at age 20 which were transmitted to all other ages; however, there were also smaller age-dependent genetic innovations at 30 for anxiety and at 40 and 70 for depression. Although the genetic determinants of anxiety and depression appear relatively stable across the lifespan for males and females, there is some evidence to support additional mid-life and late age gene action in females for depression. The fact that mid-life onset for anxiety occurs one decade before depression is also consistent with a causal relationship (anxiety leading to depression) between these conditions. These findings have significance for large scale depression prevention projects.
Previous genetic analyses of psychosis proneness have been limited by their small sample size. For the purposes of large-scale screening, a 12-item questionnaire was developed through a two-stage process of reduction from the full Chapman and Chapman scales. 3685 individuals (including 1438 complete twin pairs) aged 18–25 years and enrolled in the volunteer Australian Twin Registry returned a mail questionnaire which included this psychosis proneness scale and the Eysenck Personality Questionnaire. Despite the brevity of the questionnaire, item and factor analysis identified four unambiguous and essentially uncorrelated scales. There were (1) Perceptual Aberration – Magical Ideation; (2) Hypomania – Impulsivity/Nonconformity; (3) Social Anhedonia and (4) Physical Anhedonia. Model-fitting analyses showed additive genetic and specific environmental factors were sufficient for three of the four scales, with the Social Anhedonia scale requiring also a parameter for genetic dominance. There was no evidence for the previously hypothesised sex differences in the genetic determination of psychosis-proneness. The potential value of multivariate genetic analysis to examine the relationship between these four scales and dimensions of personality is discussed. The growing body of longitudinal evidence on psychosis-proneness suggests the value of incorporating this brief measure into developmental twin studies.
Wind energy offers significant potential for near-term (2020) and long-term (2050) greenhouse gas (GHG) emissions reductions. A number of different wind energy technologies are available across a range of applications, but the primary use of wind energy of relevance to climate change mitigation is to generate electricity from larger, grid-connected wind turbines, deployed either on- or offshore. Focusing on these technologies, the wind power capacity installed by the end of 2009 was capable of meeting roughly 1.8% of worldwide electricity demand, and that contribution could grow to in excess of 20% by 2050 if ambitious efforts are made to reduce GHG emissions and to address the other impediments to increased wind energy deployment. Onshore wind energy is already being deployed at a rapid pace in many countries, and no insurmountable technical barriers exist that preclude increased levels of wind energy penetration into electricity supply systems. Moreover, though average wind speeds vary considerably by location, ample technical potential exists in most regions of the world to enable significant wind energy deployment. In some areas with good wind resources, the cost of wind energy is already competitive with current energy market prices, even without considering relative environmental impacts. Nonetheless, in most regions of the world, policy measures are still required to ensure rapid deployment. Continued advances in on- and offshore wind energy technology are expected, however, further reducing the cost of wind energy and improving wind energy's GHG emissions reduction potential.
Bioenergy has a significant greenhouse gas (GHG) mitigation potential, provided that the resources are developed sustainably and that efficient bioenergy systems are used. Certain current systems and key future options including perennial cropping systems, use of biomass residues and wastes and advanced conversion systems are able to deliver 80 to 90% emission reductions compared to the fossil energy baseline. However, land use conversion and forest management that lead to a loss of carbon stocks (direct) in addition to indirect land use change (d+iLUC) effects can lessen, and in some cases more than neutralize, the net positive GHG mitigation impacts. Impacts of climate change through temperature increases, rainfall pattern changes and increased frequency of extreme events will influence and interact with biomass resource potential. This interaction is still poorly understood, but it is likely to exhibit strong regional differences. Climate change impacts on biomass feedstock production exist but if global temperature rise is limited to less than 2°C compared with the pre-industrial record, it may pose few constraints. Combining adaptation measures with biomass resource production can offer more sustainable opportunities for bioenergy and perennial cropping systems.
Biomass is a primary source of food, fodder and fibre and as a renewable energy (RE) source provided about 10.2% (50.3 EJ) of global total primary energy supply (TPES) in 2008. Traditional use of wood, straws, charcoal, dung and other manures for cooking, space heating and lighting by generally poorer populations in developing countries accounts for about 30.7 EJ, and another 20 to 40% occurs in unaccounted informal sectors including charcoal production and distribution.