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Changes in climate are usually considered in terms of trends or differences over time. However, for many impacts requiring adaptation, it is the amplitude of the change relative to the local amplitude of climate variability which is more relevant. Here, we develop the concept of "signal‐to‐noise" in observations of local temperature, highlighting that many regions are already experiencing a climate which would be "unknown" by late 19th century standards. The emergence of observed temperature changes over both land and ocean is clearest in tropical regions, in contrast to the regions of largest change which are in the northern extratropics—broadly consistent with climate model simulations. Significant increases and decreases in rainfall have also already emerged in different regions with the United Kingdom experiencing a shift toward more extreme rainfall events, a signal which is emerging more clearly in some places than the changes in mean rainfall. Plain Language Summary: Changes in climate are translated into impacts on society not just though the amount of change, but how this change compares to the variations in climate that society is used to. Here we demonstrate that significant changes, when compared to the size of past variations, are present in both temperature and rainfall observations over many parts of the world. Key Points: The signal of changes in observed temperature and rainfall due to global warming has clearly emerged in many regions and at mesoscalesTropical regions have experienced the largest changes in temperature relative to the amplitude of internal variabilitySignals of increasing extreme rainfall are emerging more quickly than signals in mean rainfall over many parts of the United Kingdom [ABSTRACT FROM AUTHOR]

The article reports on a case study conducted to a 21-year-old shop assistant with severe psychotic illness to examine the effect of influenza infection in Great Britain. The patient, which was said to be in good health, and without a family history of affective illness, has developed influenza infection such as fever, headache, backache and abdominal pain. The patient was then accompanied by the passage of an intra-uterine device. Symptoms of an acute confusional state, which developed into a manic psychosis of prolonged duration has been found out. During such period of illness, unusual high levels of Influenza An antibody titer is said to have developed at an extreme range, which have remained high, compared to influenza patients tested at a general hospital.

Maintaining the ecosystem is one of the main concerns in this modern age. With the fear of ever-increasing global warming, the UK is one of the key players to participate actively in taking measures to slow down at least its phenomenal rate. As an ingredient to this process, the Springer vehicle has been designed and is being developed for environmental monitoring and pollutant tracking. This paper highlights the Springer hardware and software architecture including various navigational sensors, a speed controller, and an environmental monitoring unit. In addition, details regarding the modelling of the vessel are outlined which are based mainly on recent trials data. The formulation of a fault tolerant multi-sensor data fusion technique is also presented. Moreover, control strategy based on a linear quadratic Gaussian controller is developed and simulated on the Springer model. [ABSTRACT FROM AUTHOR]

There are hundreds of thousands of new bikes sold in the UK every year but until recently the number of people cycling has fallen every year for the last 20 years. This paper explores some of the reasons for this decline in use and reviews the role the National Cycle Network in trying to reverse the trend. The provision of funding and the maintenance requirements of cycle routes are also explored. [ABSTRACT FROM AUTHOR]

Summarizes results of a study comparing the epidemiological and clinical features of oesophageal and gastric carcinomas. Criteria of the International Classification of Diseases; Comparison of incidence of carcinomas between males and females based on the Merseyside and Cheshire Cancer Registry in Great Britain.

Genetic abnormalities provide vital diagnostic and prognostic information in pediatric acute lymphoblastic leukemia (ALL) and are increasingly used to assign patients to risk groups. We recently proposed a novel classifier based on the copy-number alteration (CNA) profile of the 8 most commonly deleted genes in B-cell precursor ALL. This classifier defined 3 CNA subgroups in consecutive UK trials and was able to discriminate patients with intermediate-risk cytogenetics. In this study, we sought to validate the United Kingdom ALL (UKALL)-CNA classifier and reevaluate the interaction with cytogenetic risk groups using individual patient data from 3239 cases collected from 12 groups within the International BFM Study Group. The classifier was validated and defined 3 risk groups with distinct event-free survival (EFS) rates: good (88%), intermediate (76%), and poor (68%) ( P < .001). There was no evidence of heterogeneity, even within trials that used minimal residual disease to guide therapy. By integrating CNA and cytogenetic data, we replicated our original key observation that patients with intermediate-risk cytogenetics can be stratified into 2 prognostic subgroups. Group A had an EFS rate of 86% (similar to patients with good-risk cytogenetics), while group B patients had a significantly inferior rate (73%, P < .001). Finally, we revised the overall genetic classification by defining 4 risk groups with distinct EFS rates: very good (91%), good (81%), intermediate (73%), and poor (54%), P < .001. In conclusion, the UKALL-CNA classifier is a robust prognostic tool that can be deployed in different trial settings and used to refine established cytogenetic risk groups., (© 2019 by The American Society of Hematology.)

Aims: Diagnostic ambulatory electrocardiogram (AECG) monitoring is widely used for evaluating syncope/collapse. In Europe, two sets of practice guidelines [National Institute for Health and Clinical Excellence (NICE) and European Society of Cardiology (ESC)] provide recommendations concerning optimal selection of AECG devices. However, whether practising physicians' select AECGs based on published guidelines is unclear. This study examined AECG use by Emergency Department (EDs) physicians and cardiologists in two European countries: Germany (D) and United Kingdom (UK)., Methods and Results: A quantitative survey was undertaken in which 177 respondents participated (ED: UK 33, Germany 40; Cardiology: UK 54, Germany 50). The choice of AECG technology varied by specialty. Thus, among EDs, despite patients having daily symptoms, 20% (UK), 31% (D) of respondents chose an AECG other than Holter monitor. Conversely, when monitoring for infrequent events (

Background: Pancreatic cancer diagnosis and staging can be difficult in 10-20% of patients. Positron emission tomography (PET)/computed tomography (CT) adds precise anatomical localisation to functional data. The use of PET/CT may add further value to the diagnosis and staging of pancreatic cancer., Objective: To determine the incremental diagnostic accuracy and impact of PET/CT in addition to standard diagnostic work-up in patients with suspected pancreatic cancer., Design: A multicentre prospective diagnostic accuracy and clinical value study of PET/CT in suspected pancreatic malignancy., Participants: Patients with suspected pancreatic malignancy., Interventions: All patients to undergo PET/CT following standard diagnostic work-up., Main Outcome Measures: The primary outcome was the incremental diagnostic value of PET/CT in addition to standard diagnostic work-up with multidetector computed tomography (MDCT). Secondary outcomes were (1) changes in patients' diagnosis, staging and management as a result of PET/CT; (2) changes in the costs and effectiveness of patient management as a result of PET/CT; (3) the incremental diagnostic value of PET/CT in chronic pancreatitis; (4) the identification of groups of patients who would benefit most from PET/CT; and (5) the incremental diagnostic value of PET/CT in other pancreatic tumours., Results: Between 2011 and 2013, 589 patients with suspected pancreatic cancer underwent MDCT and PET/CT, with 550 patients having complete data and in-range PET/CT. Sensitivity and specificity for the diagnosis of pancreatic cancer were 88.5% and 70.6%, respectively, for MDCT and 92.7% and 75.8%, respectively, for PET/CT. The maximum standardised uptake value (SUV max. ) for a pancreatic cancer diagnosis was 7.5. PET/CT demonstrated a significant improvement in relative sensitivity ( p  = 0.01) and specificity ( p  = 0.023) compared with MDCT. Incremental likelihood ratios demonstrated that PET/CT significantly improved diagnostic accuracy in all scenarios ( p  < 0.0002). PET/CT correctly changed the staging of pancreatic cancer in 56 patients ( p  = 0.001). PET/CT influenced management in 250 (45%) patients. PET/CT stopped resection in 58 (20%) patients who were due to have surgery. The benefit of PET/CT was limited in patients with chronic pancreatitis or other pancreatic tumours. PET/CT was associated with a gain in quality-adjusted life-years of 0.0157 (95% confidence interval -0.0101 to 0.0430). In the base-case model PET/CT was seen to dominate MDCT alone and is thus highly likely to be cost-effective for the UK NHS. PET/CT was seen to be most cost-effective for the subgroup of patients with suspected pancreatic cancer who were thought to be resectable., Conclusion: PET/CT provided a significant incremental diagnostic benefit in the diagnosis of pancreatic cancer and significantly influenced the staging and management of patients. PET/CT had limited utility in chronic pancreatitis and other pancreatic tumours. PET/CT is likely to be cost-effective at current reimbursement rates for PET/CT to the UK NHS. This was not a randomised controlled trial and therefore we do not have any information from patients who would have undergone MDCT only for comparison. In addition, there were issues in estimating costs for PET/CT. Future work should evaluate the role of PET/CT in intraductal papillary mucinous neoplasm and prognosis and response to therapy in patients with pancreatic cancer., Study Registration: Current Controlled Trials ISRCTN73852054 and UKCRN 8166., Funding: The National Institute for Health Research Health Technology Assessment programme.