The role of adiposity in cardiometabolic traits:a Mendelian randomization analysis

The association between adiposity and cardiometabolic traits is well known from epidemiological studies. Whilst the causal relationship is clear for some of these traits, for others it is not. We aimed to determine whether adiposity is causally related to various cardiometabolic traits using the Mendelian randomization approach.

An Event Driven Fusion Approach for Enjoyment Recognition in Real-time

Social signals and interpretation of carried information is of high importance in Human Computer Interaction. Often used for affect recognition, the cues within these signals are displayed in various modalities. Fusion of multi-modal signals is a natural and interesting way to improve automatic classification of emotions transported in social signals. Throughout most present studies, uni-modal affect recognition as well as multi-modal fusion, decisions are forced for fixed annotation segments across all modalities. In this paper, we investigate the less prevalent approach of event driven fusion, which indirectly accumulates asynchronous events in all modalities for final predictions. We present a fusion approach, handling short-timed events in a vector space, which is of special interest for real-time applications. We compare results of segmentation based uni-modal classification and fusion schemes to the event driven fusion approach. The evaluation is carried out via detection of enjoyment-episodes within the audiovisual Belfast Story-Telling Corpus.

An analysis of stage performance in automotive turbocharger centrifugal compressors

As the concept of engine downsizing becomes ever more integrated into automotive powertrain development strategies, so too does the pressure on turbocharger manufacturers to deliver improvements in map width and a reduction in the mass flow rate at which compressor surge occurs. A consequence of this development is the increasing importance of recirculating flows, both in the impeller inlet and outlet domains, on stage performance.
The current study seeks to evaluate the impact of the inclusion of impeller inlet recirculation on a meanline centrifugal compressor design tool. Using a combination of extensive test data, single passage CFD predictions, and 1-D analysis it is demonstrated how the addition of inlet recirculation modelling impacts upon stage performance close to the surge line. It is also demonstrated that, in its current configuration, the accuracy of the 1-D model prediction diminishes significantly with increasing blade tip speed.
Having ascertained that the existing model requires further work, an evaluation of the vaneless diffuser modelling method currently employed within the existing 1-D model is undertaken. The comparison of the predicted static pressure recovery coefficient with test data demonstrated the inherent inadequacies in the resulting prediction, in terms of both magnitude and variation with flow rate. A simplified alternative method based on an equivalent friction coefficient is also presented that, with further development, could provide a significantly improved stage performance prediction.

Dose-response relationship in phase 1 clinical trials: a European Drug Development Network (EDDN) Collaboration Study

Introduction: Because a dose–response relationship is characteristic of conventional chemotherapy, this concept is widely used for the development of novel cytotoxic (CTX) drugs. However, the need to reach the MTD to obtain optimal benefit with molecularly targeted agents (MTA) is controversial. In this study, we evaluated the relationship between dose and efficacy in a large cohort of phase I patients with solid tumors.

Experimental Design: We collected data on 1,182 consecutive patients treated in phase I trials in 14 European institutions in 2005–2007. Inclusion criteria were: (i) patients treated within completed single-agent studies in which a maximum-administered dose was defined and (ii) RECIST/survival data available.

Results: Seventy-two percent of patients were included in trials with MTA (N = 854) and 28% in trials with CTX (N = 328). The objective response (OR) rate was 3% and disease control at 6 months was 11%. OR for CTX was associated with higher doses (median 92% of MTD); this was not the case for MTA, where patients achieving OR received a median of 50% of MTD. For trials with MTA, patients treated at intermediate doses (40%–80%) had better survival compared with those receiving low or high doses (P = 0.038). On the contrary, there was a direct association between higher dose and better OS for CTX agents (P = 0.003).

Conclusion: Although these results support the development of novel CTX based on MTD, we found no direct relationship between higher doses and response with MTA in unselected patients. However, the longest OS was seen in patients treated with MTA at intermediate doses (40%–80% of MTD)

High variability in the dosing of commonly used antibiotics revealed by a Europe-wide point prevalence study: implications for research and dissemination

BACKGROUND: Antibiotic dosing in neonates varies between countries and centres, suggesting suboptimal exposures for some neonates. We aimed to describe variations and factors influencing the variability in the dosing of frequently used antibiotics in European NICUs to help define strategies for improvement.

METHODS: A sub-analysis of the European Study of Neonatal Exposure to Excipients point prevalence study was undertaken. Demographic data of neonates receiving any antibiotic on the study day within one of three two-week periods from January to June 2012, the dose, dosing interval and route of administration of each prescription were recorded. The British National Formulary for Children (BNFC) and Neofax were used as reference sources. Risk factors for deviations exceeding ±25% of the relevant BNFC dosage recommendation were identified by multivariate logistic regression analysis.

RESULTS: In 89 NICUs from 21 countries, 586 antibiotic prescriptions for 342 infants were reported. The twelve most frequently used antibiotics - gentamicin, penicillin G, ampicillin, vancomycin, amikacin, cefotaxime, ceftazidime, meropenem, amoxicillin, metronidazole, teicoplanin and flucloxacillin - covered 92% of systemic prescriptions. Glycopeptide class, GA <32 weeks, 5(th) minute Apgar score <5 and geographical region were associated with deviation from the BNFC dosage recommendation. While the doses of penicillins exceeded recommendations, antibiotics with safety concerns followed (gentamicin) or were dosed below (vancomycin) recommendations.

CONCLUSIONS: The current lack of compliance with existing dosing recommendations for neonates needs to be overcome through the conduct of well-designed clinical trials with a limited number of antibiotics to define pharmacokinetics/pharmacodynamics, efficacy and safety in this population and by efficient dissemination of the results.

Potentially harmful excipients in neonatal medicines: A pan-European observational study

Objectives We aimed to describe administration of eight potentially harmful excipients of interest (EOI)-parabens, polysorbate 80, propylene glycol, benzoates, saccharin sodium, sorbitol, ethanol and benzalkonium chloride-to hospitalised neonates in Europe and to identify risk factors for exposure. Methods All medicines administered to neonates during 1 day with individual prescription and demographic data were registered in a web-based point prevalence study. Excipients were identified from the Summaries of Product Characteristics. Determinants of EOI administration (geographical region, gestational age (GA), active pharmaceutical ingredient, unit level and hospital teaching status) were identified using multivariable logistical regression analysis. Results Overall 89 neonatal units from 21 countries participated. Altogether 2095 prescriptions for 530 products administered to 726 neonates were recorded. EOI were found in 638 (31%) prescriptions and were administered to 456 (63%) neonates through a relatively small number of products (n=142; 27%). Parabens, found in 71 (13%) products administered to 313 (43%) neonates, were used most frequently. EOI administration varied by geographical region, GA and route of administration. Geographical region remained a significant determinant of the use of parabens, polysorbate 80, propylene glycol and saccharin sodium after adjustment for the potential covariates including anatomical therapeutic chemical class of the active ingredient. Conclusions European neonates receive a number of potentially harmful pharmaceutical excipients. Regional differences in EOI administration suggest that EOI-free products are available and provide the potential for substitution to avoid side effects of some excipients.

A 1-D Vaneless Diffuser Model Accounting for the Effects of Spanwise Flow Stratification

The radial vaneless diffuser, though comparatively simple in terms of geometry, poses a significant challenge in obtaining an accurate 1-D based performance prediction due to the swirling, unsteady and distorted nature of the flow field. Turbocharger compressors specifically, with the ever increasing focus on achieving a wide operating range, have been recognised to operate with significant regions of spanwise separated flow, particularly at off design conditions.
Using a combination of single passage Computational Fluid Dynamics (CFD) simulations and extensive gas stand test data for three geometries, the current study aims to evaluate the onset and impact of spanwise flow stratification in radial vaneless diffusers, and how the extent of the aerodynamic blockage presented to the flow throughout the diffuser varies with both geometry and operating condition. Having analysed the governing performance parameters and flow phenomena, a novel 1-D modelling method is presented and compared to an existing baseline method as well as test data to quantify the improvement in prediction accuracy achieved.

A 1-D radial vaneless diffuser model accounting for the effects of aerodynamic blockage

The radial vaneless diffuser, though comparatively simple in terms of geometry, poses a significant challenge in obtaining an accurate 1-D based performance prediction due to the swirling, unsteady and distorted nature of the flow field. Turbocharger compressors specifically, with the ever increasing focus on achieving a wide operating range, have been recognised to operate with significant regions of spanwise separated flow, particularly at off-design conditions.

Using a combination of single passage Computational Fluid Dynamics (CFD) simulations and extensive gas stand test data for three geometries, the current study aims to evaluate the onset and impact of spanwise aerodynamic blockage in radial vaneless diffusers, and how the extent of the blocked region throughout the diffuser varies with both geometry and operating condition. Having analysed the governing performance parameters and flow phenomena, a novel 1-D modelling method is presented and compared to an existing baseline method as well as test data to quantify the improvement in prediction accuracy achieved.

An Evaluation of Vaneless Diffuser Modelling Methods as a Means of Improving the Off-Design Performance Prediction of Centrifugal Compressors

An evaluation of existing 1-D vaneless diffuser design tools in the context of improving the off-design performance prediction of automotive turbocharger centrifugal compressors is described. A combination of extensive gas stand test data and single passage CFD simulations have been employed in order to permit evaluation of the different methods, allowing conclusions about the relative benefits and deficiencies of each of the different approaches to be determined. The vaneless diffuser itself has been isolated from the incumbent limitations in the accuracy of 1-D impeller modelling tools through development of a method to fully specify impeller exit conditions (in terms of mean quantities) using only standard test stand data with additional interstage static pressure measurements at the entrance to the diffuser. This method allowed a direct comparison between the test data and 1-D methods through sharing common inputs, thus achieving the aim of diffuser isolation.

Crucial to the accuracy of determining the performance of each of the vaneless diffuser configurations was the ability to quantify the presence and extent of the spanwise aerodynamic blockage present at the diffuser inlet section. A method to evaluate this critical parameter using CFD data is described herein, along with a correlation for blockage related to a new diffuser inlet flow parameter ⚡, equal to the quotient of the local flow coefficient and impeller tip speed Mach number. The resulting correlation permitted the variation of blockage with operating condition to be captured.

Abundant genetic overlap between blood lipids and immune-mediated diseases indicates shared molecular genetic mechanisms

Epidemiological studies suggest a relationship between blood lipids and immune-mediated diseases, but the nature of these associations is not well understood. We used genome-wide association studies (GWAS) to investigate shared single nucleotide polymorphisms (SNPs) between blood lipids and immune-mediated diseases. We analyzed data from GWAS (n~200,000 individuals), applying new False Discovery Rate (FDR) methods, to investigate genetic overlap between blood lipid levels [triglycerides (TG), low density lipoproteins (LDL), high density lipoproteins (HDL)] and a selection of archetypal immune-mediated diseases (Crohn's disease, ulcerative colitis, rheumatoid arthritis, type 1 diabetes, celiac disease, psoriasis and sarcoidosis). We found significant polygenic pleiotropy between the blood lipids and all the investigated immune-mediated diseases. We discovered several shared risk loci between the immune-mediated diseases and TG (n = 88), LDL (n = 87) and HDL (n = 52). Three-way analyses differentiated the pattern of pleiotropy among the immune-mediated diseases. The new pleiotropic loci increased the number of functional gene network nodes representing blood lipid loci by 40%. Pathway analyses implicated several novel shared mechanisms for immune pathogenesis and lipid biology, including glycosphingolipid synthesis (e.g. FUT2) and intestinal host-microbe interactions (e.g. ATG16L1). We demonstrate a shared genetic basis for blood lipids and immune-mediated diseases independent of environmental factors. Our findings provide novel mechanistic insights into dyslipidemia and immune-mediated diseases and may have implications for therapeutic trials involving lipid-lowering and anti-inflammatory agents.

Adiposity as a cause of cardiovascular disease: a Mendelian randomization study

Background: Adiposity, as indicated by body mass index (BMI), has been associated with risk of cardiovascular diseases in epidemiological studies. We aimed to investigate if these associations are causal, using Mendelian randomization (MR) methods.

Methods: The associations of BMI with cardiovascular outcomes [coronary heart disease (CHD), heart failure and ischaemic stroke], and associations of a genetic score (32 BMI single nucleotide polymorphisms) with BMI and cardiovascular outcomes were examined in up to 22 193 individuals with 3062 incident cardiovascular events from nine prospective follow-up studies within the ENGAGE consortium. We used random-effects meta-analysis in an MR framework to provide causal estimates of the effect of adiposity on cardiovascular outcomes.

Results: There was a strong association between BMI and incident CHD (HR = 1.20 per SD-increase of BMI, 95% CI, 1.12–1.28, P = 1.9·10−7), heart failure (HR = 1.47, 95% CI, 1.35–1.60, P = 9·10−19) and ischaemic stroke (HR = 1.15, 95% CI, 1.06–1.24, P = 0.0008) in observational analyses. The genetic score was robustly associated with BMI (β = 0.030 SD-increase of BMI per additional allele, 95% CI, 0.028–0.033, P = 3·10−107). Analyses indicated a causal effect of adiposity on development of heart failure (HR = 1.93 per SD-increase of BMI, 95% CI, 1.12–3.30, P = 0.017) and ischaemic stroke (HR = 1.83, 95% CI, 1.05–3.20, P = 0.034). Additional cross-sectional analyses using both ENGAGE and CARDIoGRAMplusC4D data showed a causal effect of adiposity on CHD.

Conclusions: Using MR methods, we provide support for the hypothesis that adiposity causes CHD, heart failure and, previously not demonstrated, ischaemic stroke.

Effectiveness of a biomarker-based exclusion of ventilator-acquired pneumonia to reduce antibiotic use: protocol for a randomised controlled trial (VAPrapid-2):Study protocol for a randomised controlled trial

Background Ventilator-acquired pneumonia (VAP) is a common reason for antimicrobial therapy in the intensive care unit (ICU). Biomarker-based diagnostics could improve antimicrobial stewardship through rapid exclusion of VAP. Bronchoalveloar lavage (BAL) fluid biomarkers have previously been shown to allow the exclusion of VAP with high confidence. Methods/Design This is a prospective, multi-centre, randomised, controlled trial to determine whether a rapid biomarker-based exclusion of VAP results in fewer antibiotics and improved antimicrobial management. Patients with clinically suspected VAP undergo BAL, and VAP is confirmed by growth of a potential pathogen at > 104 colony-forming units per millilitre (CFU/ml). Patients are randomised 1:1, to either a ‘biomarker-guided recommendation on antibiotics’ in which BAL fluid is tested for IL-1β and IL-8 in addition to routine microbiology testing, or to ‘routine use of antibiotics’ in which BAL undergoes routine microbiology testing only. Clinical teams are blinded to intervention until 6 hours after randomisation, when biomarker results are reported to the clinician. The primary outcome is a change in the frequency distribution of antibiotic-free days (AFD) in the 7 days following BAL. Secondary outcome measures include antibiotic use at 14 and 28 days; ventilator-free days; 28-day mortality and ICU mortality; sequential organ failure assessment (SOFA) at days 3, 7 and 14; duration of stay in critical care and the hospital; antibiotic-associated infections; and antibiotic-resistant pathogen cultures up to hospital discharge, death or 56 days. A healthcare-resource-utilisation analysis will be calculated from the duration of critical care and hospital stay. In addition, safety data will be collected with respect to performing BAL. A sample size of 210 will be required to detect a clinically significant shift in the distribution of AFD towards more patients having fewer antibiotics and therefore more AFD. Discussion This trial will test whether a rapid biomarker-based exclusion of VAP results in rapid discontinuation of antibiotics and therefore improves antibiotic management in patients with suspected VAP.

Thermodynamics of trajectories and local fluctuation theorems for harmonic quantum networks

We present a general method to undertake a thorough analysis of the thermodynamics of the quantum jump trajectories followed by an arbitrary quantum harmonic network undergoing linear and bilinear dynamics. The approach is based on the phase-space representation of the state of a harmonic network. The large deviation function associated with this system encodes the full counting statistics of exchange and also allows one to deduce for fluctuation theorems obeyed by the dynamics. We illustrate the method showing the validity of a local fluctuation theorem about the exchange of excitations between a restricted part of the environment (i.e., a local bath) and a harmonic network coupled with different schemes.