| 1. |
- Beard, David J., et al.
(författare)
-
Considerations and methods for placebo controls in surgical trials (ASPIRE guidelines)
- 2020
-
Ingår i: The Lancet. - 0140-6736. ; 395:10226, s. 828-838
-
Forskningsöversikt (refereegranskat)abstract
- Placebo comparisons are increasingly being considered for randomised trials assessing the efficacy of surgical interventions. The aim of this Review is to provide a summary of knowledge on placebo controls in surgical trials. A placebo control is a complex type of comparison group in the surgical setting and, although powerful, presents many challenges. This Review outlines what a placebo control entails and present understanding of this tool in the context of surgery. We consider when placebo controls in surgery are acceptable (and when they are desirable) in terms of ethical arguments and regulatory requirements, how a placebo control should be designed, how to identify and mitigate risk for participants in these trials, and how such trials should be done and interpreted. Use of placebo controls is justified in randomised controlled trials of surgical interventions provided there is a strong scientific and ethical rationale. Surgical placebos might be most appropriate when there is poor evidence for the efficacy of the procedure and a justified concern that results of a trial would be associated with high risk of bias, particularly because of the placebo effect. Feasibility work is recommended to optimise the design and implementation of randomised controlled trials. This Review forms an outline for best practice and provides guidance, in the form of the Applying Surgical Placebo in Randomised Evaluations (known as ASPIRE) checklist, for those considering the use of a placebo control in a surgical randomised controlled trial.
|
|
| 2. |
- Beard, David J., et al.
(författare)
-
Placebo comparator group selection and use in surgical trials : The aspire project including expert workshop
- 2021
-
Ingår i: Health Technology Assessment. - 1366-5278. ; 25:53
-
Tidskriftsartikel (refereegranskat)abstract
- Background: The use of placebo comparisons for randomised trials assessing the efficacy of surgical interventions is increasingly being considered. However, a placebo control is a complex type of comparison group in the surgical setting and, although powerful, presents many challenges. Objectives: To provide a summary of knowledge on placebo controls in surgical trials and to summarise any recommendations for designers, evaluators and funders of placebo-controlled surgical trials. Design: To carry out a state-of-the-art workshop and produce a corresponding report involving key stakeholders throughout. Setting: A workshop to discuss and summarise the existing knowledge and to develop the new guidelines. Results: To assess what a placebo control entails and to assess the understanding of this tool in the context of surgery is considered, along with when placebo controls in surgery are acceptable (and when they are desirable). We have considered ethics arguments and regulatory requirements, how a placebo control should be designed, how to identify and mitigate risk for participants in these trials, and how such trials should be carried out and interpreted. The use of placebo controls is justified in randomised controlled trials of surgical interventions provided that there is a strong scientific and ethics rationale. Surgical placebos might be most appropriate when there is poor evidence for the efficacy of the procedure and a justified concern that results of a trial would be associated with a high risk of bias, particularly because of the placebo effect. Conclusions: The use of placebo controls is justified in randomised controlled trials of surgical interventions provided that there is a strong scientific and ethics rationale. Feasibility work is recommended to optimise the design and implementation of randomised controlled trials. An outline for best practice was produced in the form of the Applying Surgical Placebo in Randomised Evaluations (ASPIRE) guidelines for those considering the use of a placebo control in a surgical randomised controlled trial. Limitations: Although the workshop participants involved international members, the majority of participants were from the UK. Therefore, although every attempt was made to make the recommendations applicable to all health systems, the guidelines may, unconsciously, be particularly applicable to clinical practice in the UK NHS. Future work: Future work should evaluate the use of the ASPIRE guidelines in making decisions about the use of a placebo-controlled surgical trial. In addition, further work is required on the appropriate nomenclature to adopt in this space.
|
|
| 3. |
- Martins, Inês S., et al.
(författare)
-
Widespread shifts in body size within populations and assemblages
- 2023
-
Ingår i: Science. - 0036-8075 .- 1095-9203. ; 381:6662, s. 1067-1071
-
Tidskriftsartikel (refereegranskat)abstract
- Biotic responses to global change include directional shifts in organismal traits. Body size, an integrative trait that determines demographic rates and ecosystem functions, is thought to be shrinking in the Anthropocene. Here, we assessed the prevalence of body size change in six taxon groups across 5025 assemblage time series spanning 1960 to 2020. Using the Price equation to partition this change into within-species body size versus compositional changes, we detected prevailing decreases in body size through time driven primarily by fish, with more variable patterns in other taxa. We found that change in assemblage composition contributes more to body size changes than within-species trends, but both components show substantial variation in magnitude and direction. The biomass of assemblages remains quite stable as decreases in body size trade off with increases in abundance.
|
|
| 4. |
- Asuk, Sijeh A., et al.
(författare)
-
Impact of human foraging on tree diversity, composition, and abundance in a tropical rainforest
- 2023
-
Ingår i: Biotropica. - : Wiley. - 0006-3606 .- 1744-7429. ; 55:1, s. 232-245
-
Tidskriftsartikel (refereegranskat)abstract
- Tropical forest tree communities are structured by a range of large-scale drivers including elevation, certain high-impact anthropogenic activities (e.g., deforestation), and fires. However, low-impact human activities such as foraging may also be subtly but notably altering the composition of tropical forest tree communities. The study assessed the (i) differences in species diversity, patterns of relative abundance, and pairwise beta diversity between trees with edible and inedible fruits and seeds along an elevation gradient, and (ii) impact of human foraging on the forest tree communities in Oban Division of Cross River National Park, Nigeria. Fifteen permanent 40 by 40 m plots were established along an elevational gradient (120–460 m above mean sea level). All trees of 0.1 m diameter at breast height (dbh) and above were measured, identified, and, with the aid of structured questionnaires, classified into those with edible and inedible fruits/seeds. A total of 35 edible species with density of 128 stems/hectare and basal area of 11.99 m2/hectare, and 109 inedible species with density of 364 stems/hectare and basal area of 22.42 m2/hectare were sampled. However, the evenness of edible and inedible species was similar at pooled and plot levels. For inedible species, there was a positive relationship between pairwise beta diversity and elevation, and this was driven mainly by turnover. In contrast, edible species exhibited a non-significant trend between elevation and beta diversity. Thus, the study showed that human foraging of edible fruits may have subtly influenced patterns of species diversity and community structure in this tropical forest.
|
|
| 5. |
- Jung, Christian, et al.
(författare)
-
A comparison of very old patients admitted to intensive care unit after acute versus elective surgery or intervention
- 2019
-
Ingår i: Journal of critical care. - : W B SAUNDERS CO-ELSEVIER INC. - 0883-9441 .- 1557-8615. ; 52, s. 141-148
-
Tidskriftsartikel (refereegranskat)abstract
- Background: We aimed to evaluate differences in outcome between patients admitted to intensive care unit (ICU) after elective versus acute surgery in a multinational cohort of very old patients (80 years; VIP). Predictors of mortality, with special emphasis on frailty, were assessed.Methods: In total, 5063 VIPs were induded in this analysis, 922 were admitted after elective surgery or intervention, 4141 acutely, with 402 after acute surgery. Differences were calculated using Mann-Whitney-U test and Wilcoxon test. Univariate and multivariable logistic regression were used to assess associations with mortality.Results: Compared patients admitted after acute surgery, patients admitted after elective surgery suffered less often from frailty as defined as CFS (28% vs 46%; p < 0.001), evidenced lower SOFA scores (4 +/- 5 vs 7 +/- 7; p < 0.001). Presence of frailty (CFS >4) was associated with significantly increased mortality both in elective surgery patients (7% vs 12%; p = 0.01), in acute surgery (7% vs 12%; p = 0.02).Conclusions: VIPs admitted to ICU after elective surgery evidenced favorable outcome over patients after acute surgery even after correction for relevant confounders. Frailty might be used to guide clinicians in risk stratification in both patients admitted after elective and acute surgery.
|
|
| 6. |
- Krause, Andreas, et al.
(författare)
-
Large uncertainty in carbon uptake potential of land-based climate-change mitigation efforts
- 2018
-
Ingår i: Global Change Biology. - : Wiley. - 1354-1013. ; 24:7, s. 3025-3038
-
Tidskriftsartikel (refereegranskat)abstract
- Most climate mitigation scenarios involve negative emissions, especially those that aim to limit global temperature increase to 2°C or less. However, the carbon uptake potential in land-based climate change mitigation efforts is highly uncertain. Here, we address this uncertainty by using two land-based mitigation scenarios from two land-use models (IMAGE and MAgPIE) as input to four dynamic global vegetation models (DGVMs; LPJ-GUESS, ORCHIDEE, JULES, LPJmL). Each of the four combinations of land-use models and mitigation scenarios aimed for a cumulative carbon uptake of ~130 GtC by the end of the century, achieved either via the cultivation of bioenergy crops combined with carbon capture and storage (BECCS) or avoided deforestation and afforestation (ADAFF). Results suggest large uncertainty in simulated future land demand and carbon uptake rates, depending on the assumptions related to land use and land management in the models. Total cumulative carbon uptake in the DGVMs is highly variable across mitigation scenarios, ranging between 19 and 130 GtC by year 2099. Only one out of the 16 combinations of mitigation scenarios and DGVMs achieves an equivalent or higher carbon uptake than achieved in the land-use models. The large differences in carbon uptake between the DGVMs and their discrepancy against the carbon uptake in IMAGE and MAgPIE are mainly due to different model assumptions regarding bioenergy crop yields and due to the simulation of soil carbon response to land-use change. Differences between land-use models and DGVMs regarding forest biomass and the rate of forest regrowth also have an impact, albeit smaller, on the results. Given the low confidence in simulated carbon uptake for a given land-based mitigation scenario, and that negative emissions simulated by the DGVMs are typically lower than assumed in scenarios consistent with the 2°C target, relying on negative emissions to mitigate climate change is a highly uncertain strategy.
|
|
| 7. |
|
|
| 8. |
- Pugh, Thomas A.M., et al.
(författare)
-
Understanding the uncertainty in global forest carbon turnover
- 2020
-
Ingår i: Biogeosciences. - : Copernicus GmbH. - 1726-4170 .- 1726-4189. ; 17:15, s. 3961-3989
-
Tidskriftsartikel (refereegranskat)abstract
- The length of time that carbon remains in forest biomass is one of the largest uncertainties in the global carbon cycle, with both recent historical baselines and future responses to environmental change poorly constrained by available observations. In the absence of large-scale observations, models used for global assessments tend to fall back on simplified assumptions of the turnover rates of biomass and soil carbon pools. In this study, the biomass carbon turnover times calculated by an ensemble of contemporary terrestrial biosphere models (TBMs) are analysed to assess their current capability to accurately estimate biomass carbon turnover times in forests and how these times are anticipated to change in the future. Modelled baseline 1985-2014 global average forest biomass turnover times vary from 12.2 to 23.5 years between TBMs. TBM differences in phenological processes, which control allocation to, and turnover rate of, leaves and fine roots, are as important as tree mortality with regard to explaining the variation in total turnover among TBMs. The different governing mechanisms exhibited by each TBM result in a wide range of plausible turnover time projections for the end of the century. Based on these simulations, it is not possible to draw robust conclusions regarding likely future changes in turnover time, and thus biomass change, for different regions. Both spatial and temporal uncertainty in turnover time are strongly linked to model assumptions concerning plant functional type distributions and their controls. Thirteen model-based hypotheses of controls on turnover time are identified, along with recommendations for pragmatic steps to test them using existing and novel observations. Efforts to resolve uncertainty in turnover time, and thus its impacts on the future evolution of biomass carbon stocks across the world's forests, will need to address both mortality and establishment components of forest demography, as well as allocation of carbon to woody versus non-woody biomass growth.
|
|
| 9. |
- Wayman, Joseph P., et al.
(författare)
-
Assessing taxonomic and functional change in British breeding bird assemblages over time
- 2022
-
Ingår i: Global Ecology and Biogeography. - : Wiley. - 1466-822X .- 1466-8238. ; 31:5, s. 925-939
-
Tidskriftsartikel (refereegranskat)abstract
- Aim: The aim was to identify the primary drivers of compositional change in breeding bird assemblages over a 40-year period. Location: Britain. Time period: From 1970 to 2010. Major taxa studied: Birds. Methods: Using morphological trait measurements and a dataset of presence–absence data for British breeding birds surveyed in 10 km × 10 km hectads during two time periods, we calculated temporal taxonomic and functional beta diversity for each hectad alongside the change in species richness, mean nearest taxon distance (MNTD) and mean pairwise distance (MPD). We also estimated potential drivers of beta diversity, including climatic and land-use and land-cover (LULC) change variables, elevation and assemblage species richness in 1970 (1970rich). We used random forest regressions to test which variables best explained compositional change in the assemblages. We also assessed spatial taxonomic and functional change by analysing multiple-site beta diversity and pairwise dissimilarities between time periods. Results: Initial (1970) species richness was the most important predictor (highest importance score) across all models, with areas characterized by higher initial richness experiencing less assemblage change overall. The coordinates included to capture spatial autocorrelation in the data were also important predictors of change. Most climate and LULC variables had relatively low explanatory power; elevation and average temperature were the most influential. All metrics increased slightly with increasing elevation, except for species richness change and MPD, which decreased. Main conclusions: The composition of British breeding bird assemblages changed substantially between 1970 and 2010. Spatial heterogeneity increased, both taxonomically and functionally. We show evidence that hectads with larger assemblages have been buffered from temporal diversity change and that those at higher elevations changed more in composition than those at lower elevations. Overall, coarse-resolution climate and LULC explained only small to moderate amounts of variation, suggesting that stochastic assembly change or finer-scale drivers might be drivers of temporal changes in assemblage composition.
|
|
| 10. |
- Wayman, Joseph P., et al.
(författare)
-
Identifying the Drivers of Spatial Taxonomic and Functional Beta-Diversity of British Breeding Birds
- 2021
-
Ingår i: Frontiers in Ecology and Evolution. - : Frontiers Media SA. - 2296-701X. ; 9
-
Tidskriftsartikel (refereegranskat)abstract
- Spatial variation in community composition may be driven by a variety of processes, including environmental filtering and dispersal limitation. While work has been conducted on the relative importance of these processes on various taxa and at varying resolutions, tests using high-resolution empirical data across large spatial extents are sparse. Here, we use a dataset on the presence/absence of breeding bird species collected at the 10 km × 10 km scale across the whole of Britain. Pairwise spatial taxonomic and functional beta diversity, and the constituent components of each (turnover and nestedness/richness loss or gain), were calculated alongside two other measures of functional change (mean nearest taxon distance and mean pairwise distance). Predictor variables included climate and land use measures, as well as a measure of elevation, human influence, and habitat diversity. Generalized dissimilarity modeling was used to analyze the contribution of each predictor variable to variation in the different beta diversity metrics. Overall, we found that there was a moderate and unique proportion of the variance explained by geographical distance per se, which could highlight the role of dispersal limitation in community dissimilarity. Climate, land use, and human influence all also contributed to the observed patterns, but a large proportion of the explained variance in beta diversity was shared between these variables and geographical distance. However, both taxonomic nestedness and functional nestedness were uniquely predicted by a combination of land use, human influence, elevation, and climate variables, indicating a key role for environmental filtering. These findings may have important conservation implications in the face of a warming climate and future land use change.
|
|
