1
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Lo Piano S, Lőrincz MJ, Puy A, Pye S, Saltelli A, Smith ST, van der Sluijs J. Unpacking the modeling process for energy policy making. Risk Anal 2023. [PMID: 37963564 DOI: 10.1111/risa.14248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 09/07/2023] [Accepted: 10/12/2023] [Indexed: 11/16/2023]
Abstract
This article explores how the modeling of energy systems may lead to an undue closure of alternatives by generating an excess of certainty around some of the possible policy options. We retrospectively exemplify the problem with the case of the International Institute for Applied Systems Analysis (IIASA) global modeling in the 1980s. We discuss different methodologies for quality assessment that may help mitigate this issue, which include Numeral Unit Spread Assessment Pedigree (NUSAP), diagnostic diagrams, and sensitivity auditing (SAUD). We illustrate the potential of these reflexive modeling practices in energy policy-making with three additional cases: (i) the case of the energy system modeling environment (ESME) for the creation of UK energy policy; (ii) the negative emission technologies (NETs) uptake in integrated assessment models (IAMs); and (iii) the ecological footprint indicator. We encourage modelers to adopt these approaches to achieve more robust, defensible, and inclusive modeling activities in the field of energy research.
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Affiliation(s)
- Samuele Lo Piano
- School of the Built Environment, University of Reading, Reading, Berkshire, UK
| | - Máté János Lőrincz
- School of the Built Environment, University of Reading, Reading, Berkshire, UK
| | - Arnald Puy
- School of Geography, Earth and Environmental Sciences, University of Birmingham, Birmingham, UK
| | - Steve Pye
- Bartlett School Env, Energy & Resources, University College London, London, UK
| | - Andrea Saltelli
- UPF-Barcelona School of Management, Barcelona, Catalonia, Spain
- Centre for the Study of the Sciences and the Humanities, University of Bergen, Bergen, Norway
| | - Stefán Thor Smith
- School of the Built Environment, University of Reading, Reading, Berkshire, UK
| | - Jeroen van der Sluijs
- Centre for the Study of the Sciences and the Humanities, University of Bergen, Bergen, Norway
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2
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Achakulwisut P, Erickson P, Guivarch C, Schaeffer R, Brutschin E, Pye S. Global fossil fuel reduction pathways under different climate mitigation strategies and ambitions. Nat Commun 2023; 14:5425. [PMID: 37704643 PMCID: PMC10499994 DOI: 10.1038/s41467-023-41105-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 08/21/2023] [Indexed: 09/15/2023] Open
Abstract
The mitigation scenarios database of the Intergovernmental Panel on Climate Change's Sixth Assessment Report is an important resource for informing policymaking on energy transitions. However, there is a large variety of models, scenario designs, and resulting outputs. Here we analyse the scenarios consistent with limiting warming to 2 °C or below regarding the speed, trajectory, and feasibility of different fossil fuel reduction pathways. In scenarios limiting warming to 1.5 °C with no or limited overshoot, global coal, oil, and natural gas supply (intended for all uses) decline on average by 95%, 62%, and 42%, respectively, from 2020 to 2050, but the long-term role of gas is highly variable. Higher-gas pathways are enabled by higher carbon capture and storage (CCS) and carbon dioxide removal (CDR), but are likely associated with inadequate model representation of regional CO2 storage capacity and technology adoption, diffusion, and path-dependencies. If CDR is constrained by limits derived from expert consensus, the respective modelled coal, oil, and gas reductions become 99%, 70%, and 84%. Our findings suggest the need to adopt unambiguous near- and long-term reduction benchmarks in coal, oil, and gas production and use alongside other climate mitigation targets.
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Affiliation(s)
- Ploy Achakulwisut
- Stockholm Environment Institute, Seattle, WA, USA.
- Stockholm Environment Institute, Bangkok, Thailand.
| | | | - Céline Guivarch
- International Research Center on Environment and Development (CIRED), École des Pont, Nogent-sur-Marne, France
| | - Roberto Schaeffer
- Centre for Energy and Environmental Economics (CENERGIA), COPPE, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Elina Brutschin
- International Institute for Applied Systems Analysis (IIASA), Laxenburg, Austria
| | - Steve Pye
- UCL Energy Institute, University College London, London, UK
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3
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Andreoni P, Reis LA, Drouet L, Dessens O, Fragkos P, Pietzcker R, Pye S, Rodrigues R, Tavoni M. Fossil extraction bans and carbon taxes: assessing their interplay through multiple models. iScience 2023; 26:106377. [PMID: 37035002 PMCID: PMC10074154 DOI: 10.1016/j.isci.2023.106377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 12/07/2022] [Accepted: 03/06/2023] [Indexed: 03/12/2023] Open
Abstract
Given concerns about the ambition and effectiveness of current climate policies, a case has been made for the combination of demand side policies such as carbon pricing with supply side bans on fossil fuel extraction. However, little is known about their interplay in the context of climate stabilization strategies. Here, we present a multi-model assessment quantifying the effectiveness of supply side policies and their interactions with demand-side ones. We explore a variety of fossil fuel bans with four integrated assessment models and find that international supply side policies reduce carbon emissions but not at sufficient levels to stabilize temperature increase to well below 2°C. When combined with demand side policies, supply side policies reduce the required carbon price, dampen reliance on CO2 removal technologies, and increase investment in renewable energy. The results indicate the opportunity to integrate fossil fuel bans alongside price-based policies when exploring pathways to reach ambitious mitigation targets.
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4
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Watts N, Amann M, Arnell N, Ayeb-Karlsson S, Belesova K, Boykoff M, Byass P, Cai W, Campbell-Lendrum D, Capstick S, Chambers J, Dalin C, Daly M, Dasandi N, Davies M, Drummond P, Dubrow R, Ebi KL, Eckelman M, Ekins P, Escobar LE, Fernandez Montoya L, Georgeson L, Graham H, Haggar P, Hamilton I, Hartinger S, Hess J, Kelman I, Kiesewetter G, Kjellstrom T, Kniveton D, Lemke B, Liu Y, Lott M, Lowe R, Sewe MO, Martinez-Urtaza J, Maslin M, McAllister L, McGushin A, Jankin Mikhaylov S, Milner J, Moradi-Lakeh M, Morrissey K, Murray K, Munzert S, Nilsson M, Neville T, Oreszczyn T, Owfi F, Pearman O, Pencheon D, Phung D, Pye S, Quinn R, Rabbaniha M, Robinson E, Rocklöv J, Semenza JC, Sherman J, Shumake-Guillemot J, Tabatabaei M, Taylor J, Trinanes J, Wilkinson P, Costello A, Gong P, Montgomery H. The 2019 report of The Lancet Countdown on health and climate change: ensuring that the health of a child born today is not defined by a changing climate. Lancet 2019; 394:1836-1878. [PMID: 31733928 DOI: 10.1016/s0140-6736(19)32596-6] [Citation(s) in RCA: 548] [Impact Index Per Article: 109.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 09/03/2019] [Accepted: 09/05/2019] [Indexed: 12/12/2022]
Affiliation(s)
- Nick Watts
- Institute for Global Health, University College London, London, UK.
| | - Markus Amann
- Air Quality and Greenhouse Gases Programme, International Institute for Applied Systems Analysis, Laxenburg, Austria
| | - Nigel Arnell
- Department of Meteorology, University of Reading, Reading, UK
| | | | - Kristine Belesova
- Centre on Climate Change and Planetary Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Maxwell Boykoff
- Cooperative Institute for Research in Environmental Sciences and Environmental Studies, University of Colorado Boulder, Boulder, CO, USA
| | - Peter Byass
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Wenjia Cai
- Department of Earth System Science, Tsinghua University, Beijing, China
| | | | | | - Jonathan Chambers
- Institute for Environmental Sciences, University of Geneva, Geneva, Switzerland
| | - Carole Dalin
- Institute for Sustainable Resources, University College London, London, UK
| | - Meaghan Daly
- Department of Environmental Studies, University of New England, Biddeford, ME, USA
| | - Niheer Dasandi
- School of Government, University of Birmingham, Birmingham, UK
| | - Michael Davies
- Institute for Environmental Design and Engineering, University College London, London, UK
| | - Paul Drummond
- Institute for Sustainable Resources, University College London, London, UK
| | - Robert Dubrow
- Yale Climate Change and Health Initiative, Yale University, New Haven, CT, USA
| | - Kristie L Ebi
- Department of Global Health, University of Washington, Washington, DC, USA
| | - Matthew Eckelman
- Department of Civil and Environmental Engineering, Northeastern University, Boston, MA, USA
| | - Paul Ekins
- Institute for Sustainable Resources, University College London, London, UK
| | - Luis E Escobar
- Department of Fish and Wildlife Conservation, Virginia Polytechnic Institute and State University, Blacksburg, VA, USA
| | | | | | - Hilary Graham
- Department of Health Sciences, University of York, York, UK
| | - Paul Haggar
- School of Psychology, Cardiff University, Cardiff, UK
| | - Ian Hamilton
- Energy Institute, University College London, London, UK
| | - Stella Hartinger
- The Integrated Development, Health and Environment Unit, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Jeremy Hess
- Centre for Health and the Global Environment, University of Washington, Washington, DC, USA
| | - Ilan Kelman
- Institute for Global Health, University College London, London, UK
| | - Gregor Kiesewetter
- Air Quality and Greenhouse Gases Programme, International Institute for Applied Systems Analysis, Laxenburg, Austria
| | - Tord Kjellstrom
- Health and Environment International Trust, Nelson, New Zealand
| | | | - Bruno Lemke
- Nelson Marlborough Institute of Technology, Nelson, New Zealand
| | - Yang Liu
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Melissa Lott
- Center on Global Energy Policy School of International and Public Affairs, Columbia University, New York City, NY, USA
| | - Rachel Lowe
- Centre on Climate Change and Planetary Health, London School of Hygiene & Tropical Medicine, London, UK
| | | | | | - Mark Maslin
- Department of Geography, University College London, London, UK
| | - Lucy McAllister
- History and Society Division, Babson College, Wellesley, MA, USA
| | - Alice McGushin
- Institute for Global Health, University College London, London, UK
| | | | - James Milner
- Department of Public Health, Environments, and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Maziar Moradi-Lakeh
- Preventive Medicine and Public Health Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Karyn Morrissey
- European Centre for Environment and Human Health, University of Exeter, Exeter, UK
| | - Kris Murray
- Faculty of Medicine, School of Public Health, Imperial College London, London, UK
| | | | - Maria Nilsson
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Tara Neville
- Department of Public Health and the Environment, WHO, Geneva, Switzerland
| | | | - Fereidoon Owfi
- Iranian Fisheries Science Research Institute, Agricultural Research, Education, and Extension Organisation, Tehran, Iran
| | - Olivia Pearman
- Center for Science and Technology Policy Research, University of Colorado Boulder, Boulder, CO, USA
| | | | - Dung Phung
- School of Medicine, Griffith University, Brisbane, QLD, Australia
| | - Steve Pye
- Energy Institute, University College London, London, UK
| | - Ruth Quinn
- School of Biological Sciences, University of Aberdeen, Aberdeen, UK
| | - Mahnaz Rabbaniha
- Iranian Fisheries Science Research Institute, Agricultural Research, Education, and Extension Organisation, Tehran, Iran
| | - Elizabeth Robinson
- School of Agriculture, Policy, and Development, University of Reading, Reading, UK
| | - Joacim Rocklöv
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Jan C Semenza
- Scientific Assessment Section, European Centre for Disease Prevention and Control, Solna, Sweden
| | - Jodi Sherman
- Department of Anesthesiology, Yale University, New Haven, CT, USA
| | | | - Meisam Tabatabaei
- Faculty of Plantation and Agrotechnology, Universiti Teknologi MARA, Shah Alam, Malaysia
| | - Jonathon Taylor
- Institute for Environmental Design and Engineering, University College London, London, UK
| | - Joaquin Trinanes
- Physical Oceanography Division, Atlantic Oceanographic and Meteorological Laboratory, National Oceanic and Atmospheric Administration, Miami, FL, USA
| | - Paul Wilkinson
- Department of Public Health, Environments, and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Anthony Costello
- Office of the Vice Provost for Research, University College London, London, UK
| | - Peng Gong
- Department of Earth System Science, Tsinghua University, Beijing, China
| | - Hugh Montgomery
- Institute for Human Health and Performance, University College London, London, UK
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5
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Watts N, Amann M, Arnell N, Ayeb-Karlsson S, Belesova K, Berry H, Bouley T, Boykoff M, Byass P, Cai W, Campbell-Lendrum D, Chambers J, Daly M, Dasandi N, Davies M, Depoux A, Dominguez-Salas P, Drummond P, Ebi KL, Ekins P, Montoya LF, Fischer H, Georgeson L, Grace D, Graham H, Hamilton I, Hartinger S, Hess J, Kelman I, Kiesewetter G, Kjellstrom T, Kniveton D, Lemke B, Liang L, Lott M, Lowe R, Sewe MO, Martinez-Urtaza J, Maslin M, McAllister L, Mikhaylov SJ, Milner J, Moradi-Lakeh M, Morrissey K, Murray K, Nilsson M, Neville T, Oreszczyn T, Owfi F, Pearman O, Pencheon D, Pye S, Rabbaniha M, Robinson E, Rocklöv J, Saxer O, Schütte S, Semenza JC, Shumake-Guillemot J, Steinbach R, Tabatabaei M, Tomei J, Trinanes J, Wheeler N, Wilkinson P, Gong P, Montgomery H, Costello A. The 2018 report of the Lancet Countdown on health and climate change: shaping the health of nations for centuries to come. Lancet 2018; 392:2479-2514. [PMID: 30503045 DOI: 10.1016/s0140-6736(18)32594-77] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 08/30/2018] [Accepted: 10/12/2018] [Indexed: 05/27/2023]
Affiliation(s)
- Nick Watts
- Institute for Global Health, University College London, London, UK.
| | - Markus Amann
- Air Quality and Greenhouse Gases Programme, International Institute for Applied Systems Analysis, Laxenburg, Austria
| | - Nigel Arnell
- Department of Meteorology, University of Reading, Reading, UK
| | | | - Kristine Belesova
- Department of Public Health, Environments, and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Helen Berry
- Sydney School of Public Health, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Timothy Bouley
- Health and Climate Change Unit, World Bank, Washington, DC, USA
| | - Maxwell Boykoff
- Cooperative Institute for Research in Environmental Sciences, University of Colorado Boulder, Boulder, CO, USA
| | - Peter Byass
- Epidemiology and Global Health Unit, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Wenjia Cai
- Department of Earth System Science, Tsinghua University, Beijing, China
| | | | | | - Meaghan Daly
- Department of Environmental Studies, University of New England, Biddeford, ME, USA
| | - Niheer Dasandi
- School of Government and Society, University of Birmingham, Birmingham, UK
| | - Michael Davies
- Institute for Environmental Design and Engineering, University College London, London, UK
| | - Anneliese Depoux
- Centre Virchow-Villermé for Public Health Paris-Berlin, Université Sorbonne Paris Cité and Université Paris Sorbonne, Paris, France
| | - Paula Dominguez-Salas
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Paul Drummond
- Institute for Sustainable Resources, University College London, London, UK
| | - Kristie L Ebi
- Department of Global Health, University of Washington, Washington, DC, USA
| | - Paul Ekins
- Institute for Sustainable Resources, University College London, London, UK
| | | | - Helen Fischer
- Department of Psychology, Heidelberg University, Heidelberg, Germany
| | | | - Delia Grace
- International Livestock Research Institute, Nairobi, Kenya
| | - Hilary Graham
- Department of Health Sciences, University of York, York, UK
| | - Ian Hamilton
- UCL Energy Institute, University College London, London, UK
| | | | - Jeremy Hess
- Centre for Health and the Global Environment, University of Washington, Washington, DC, USA
| | - Ilan Kelman
- Institute for Global Health, University College London, London, UK
| | - Gregor Kiesewetter
- Air Quality and Greenhouse Gases Programme, International Institute for Applied Systems Analysis, Laxenburg, Austria
| | - Tord Kjellstrom
- Health and Environment International Trust, Nelson, New Zealand
| | | | - Bruno Lemke
- Nelson Marlborough Institute of Technology, Nelson, New Zealand
| | - Lu Liang
- University of North Texas, Denton, TX, USA
| | - Melissa Lott
- Asia Pacific Energy Research Centre, Tokyo, Japan
| | - Rachel Lowe
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Maquins Odhiambo Sewe
- Epidemiology and Global Health Unit, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | | | - Mark Maslin
- Department of Geography, University College London, London, UK
| | - Lucy McAllister
- History and Society Division, University of Colorado Boulder, Boulder, CO, USA
| | | | - James Milner
- Department of Public Health, Environments, and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Maziar Moradi-Lakeh
- Preventive Medicine and Public Health Research Centre, Iran University of Medical Sciences, Tehran, Iran
| | - Karyn Morrissey
- European Centre for the Environment and Human Health, University of Exeter, Exeter, UK
| | - Kris Murray
- Faculty of Medicine, School of Public Health, Imperial college London, London, UK
| | - Maria Nilsson
- Epidemiology and Global Health Unit, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Tara Neville
- Department of Public Health and the Environment, WHO, Geneva, Switzerland
| | - Tadj Oreszczyn
- UCL Energy Institute, University College London, London, UK
| | - Fereidoon Owfi
- Iranian Fisheries Science Research Institute, Agricultural Research, Education, and Extension Organisation, Tehran, Iran
| | - Olivia Pearman
- Centre for Science and Technology Policy Research, University of Colorado Boulder, Boulder, CO, USA
| | | | - Steve Pye
- UCL Energy Institute, University College London, London, UK
| | - Mahnaz Rabbaniha
- Iranian Fisheries Science Research Institute, Agricultural Research, Education, and Extension Organisation, Tehran, Iran
| | - Elizabeth Robinson
- School of Agriculture, Policy, and Development, University of Reading, Reading, UK
| | - Joacim Rocklöv
- Epidemiology and Global Health Unit, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Olivia Saxer
- Centre Virchow-Villermé for Public Health Paris-Berlin, Université Sorbonne Paris Cité and Université Paris Sorbonne, Paris, France
| | - Stefanie Schütte
- Centre Virchow-Villermé for Public Health Paris-Berlin, Université Sorbonne Paris Cité and Université Paris Sorbonne, Paris, France
| | - Jan C Semenza
- European Centre for Disease Control and Prevention, Solna, Sweden
| | | | - Rebecca Steinbach
- Department of Public Health, Environments, and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Meisam Tabatabaei
- Agricultural Biotechnology Research Institute of Iran, Agricultural Research, Education, and Extension Organisation, Tehran, Iran
| | - Julia Tomei
- Institute for Sustainable Resources, University College London, London, UK
| | - Joaquin Trinanes
- Physical Oceanography Division, Atlantic Oceanographic and Meteorological Laboratory, National Oceanic and Atmospheric Administration, Miami, FL, USA
| | - Nicola Wheeler
- Institute for Global Health, University College London, London, UK
| | - Paul Wilkinson
- Department of Public Health, Environments, and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Peng Gong
- Department of Earth System Science, Tsinghua University, Beijing, China
| | - Hugh Montgomery
- Centre for Human Health and Performance, Department of Medicine, University College London, London, UK
| | - Anthony Costello
- Office of the Vice-Provost (Research), University College London, London, UK
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6
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Watts N, Amann M, Arnell N, Ayeb-Karlsson S, Belesova K, Berry H, Bouley T, Boykoff M, Byass P, Cai W, Campbell-Lendrum D, Chambers J, Daly M, Dasandi N, Davies M, Depoux A, Dominguez-Salas P, Drummond P, Ebi KL, Ekins P, Montoya LF, Fischer H, Georgeson L, Grace D, Graham H, Hamilton I, Hartinger S, Hess J, Kelman I, Kiesewetter G, Kjellstrom T, Kniveton D, Lemke B, Liang L, Lott M, Lowe R, Sewe MO, Martinez-Urtaza J, Maslin M, McAllister L, Mikhaylov SJ, Milner J, Moradi-Lakeh M, Morrissey K, Murray K, Nilsson M, Neville T, Oreszczyn T, Owfi F, Pearman O, Pencheon D, Pye S, Rabbaniha M, Robinson E, Rocklöv J, Saxer O, Schütte S, Semenza JC, Shumake-Guillemot J, Steinbach R, Tabatabaei M, Tomei J, Trinanes J, Wheeler N, Wilkinson P, Gong P, Montgomery H, Costello A. The 2018 report of the Lancet Countdown on health and climate change: shaping the health of nations for centuries to come. Lancet 2018; 392:2479-2514. [PMID: 30503045 DOI: 10.1016/s0140-6736(18)32594-7] [Citation(s) in RCA: 328] [Impact Index Per Article: 54.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 08/30/2018] [Accepted: 10/12/2018] [Indexed: 12/16/2022]
Affiliation(s)
- Nick Watts
- Institute for Global Health, University College London, London, UK.
| | - Markus Amann
- Air Quality and Greenhouse Gases Programme, International Institute for Applied Systems Analysis, Laxenburg, Austria
| | - Nigel Arnell
- Department of Meteorology, University of Reading, Reading, UK
| | | | - Kristine Belesova
- Department of Public Health, Environments, and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Helen Berry
- Sydney School of Public Health, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Timothy Bouley
- Health and Climate Change Unit, World Bank, Washington, DC, USA
| | - Maxwell Boykoff
- Cooperative Institute for Research in Environmental Sciences, University of Colorado Boulder, Boulder, CO, USA
| | - Peter Byass
- Epidemiology and Global Health Unit, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Wenjia Cai
- Department of Earth System Science, Tsinghua University, Beijing, China
| | | | | | - Meaghan Daly
- Department of Environmental Studies, University of New England, Biddeford, ME, USA
| | - Niheer Dasandi
- School of Government and Society, University of Birmingham, Birmingham, UK
| | - Michael Davies
- Institute for Environmental Design and Engineering, University College London, London, UK
| | - Anneliese Depoux
- Centre Virchow-Villermé for Public Health Paris-Berlin, Université Sorbonne Paris Cité and Université Paris Sorbonne, Paris, France
| | - Paula Dominguez-Salas
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Paul Drummond
- Institute for Sustainable Resources, University College London, London, UK
| | - Kristie L Ebi
- Department of Global Health, University of Washington, Washington, DC, USA
| | - Paul Ekins
- Institute for Sustainable Resources, University College London, London, UK
| | | | - Helen Fischer
- Department of Psychology, Heidelberg University, Heidelberg, Germany
| | | | - Delia Grace
- International Livestock Research Institute, Nairobi, Kenya
| | - Hilary Graham
- Department of Health Sciences, University of York, York, UK
| | - Ian Hamilton
- UCL Energy Institute, University College London, London, UK
| | | | - Jeremy Hess
- Centre for Health and the Global Environment, University of Washington, Washington, DC, USA
| | - Ilan Kelman
- Institute for Global Health, University College London, London, UK
| | - Gregor Kiesewetter
- Air Quality and Greenhouse Gases Programme, International Institute for Applied Systems Analysis, Laxenburg, Austria
| | - Tord Kjellstrom
- Health and Environment International Trust, Nelson, New Zealand
| | | | - Bruno Lemke
- Nelson Marlborough Institute of Technology, Nelson, New Zealand
| | - Lu Liang
- University of North Texas, Denton, TX, USA
| | - Melissa Lott
- Asia Pacific Energy Research Centre, Tokyo, Japan
| | - Rachel Lowe
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Maquins Odhiambo Sewe
- Epidemiology and Global Health Unit, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | | | - Mark Maslin
- Department of Geography, University College London, London, UK
| | - Lucy McAllister
- History and Society Division, University of Colorado Boulder, Boulder, CO, USA
| | | | - James Milner
- Department of Public Health, Environments, and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Maziar Moradi-Lakeh
- Preventive Medicine and Public Health Research Centre, Iran University of Medical Sciences, Tehran, Iran
| | - Karyn Morrissey
- European Centre for the Environment and Human Health, University of Exeter, Exeter, UK
| | - Kris Murray
- Faculty of Medicine, School of Public Health, Imperial college London, London, UK
| | - Maria Nilsson
- Epidemiology and Global Health Unit, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Tara Neville
- Department of Public Health and the Environment, WHO, Geneva, Switzerland
| | - Tadj Oreszczyn
- UCL Energy Institute, University College London, London, UK
| | - Fereidoon Owfi
- Iranian Fisheries Science Research Institute, Agricultural Research, Education, and Extension Organisation, Tehran, Iran
| | - Olivia Pearman
- Centre for Science and Technology Policy Research, University of Colorado Boulder, Boulder, CO, USA
| | | | - Steve Pye
- UCL Energy Institute, University College London, London, UK
| | - Mahnaz Rabbaniha
- Iranian Fisheries Science Research Institute, Agricultural Research, Education, and Extension Organisation, Tehran, Iran
| | - Elizabeth Robinson
- School of Agriculture, Policy, and Development, University of Reading, Reading, UK
| | - Joacim Rocklöv
- Epidemiology and Global Health Unit, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Olivia Saxer
- Centre Virchow-Villermé for Public Health Paris-Berlin, Université Sorbonne Paris Cité and Université Paris Sorbonne, Paris, France
| | - Stefanie Schütte
- Centre Virchow-Villermé for Public Health Paris-Berlin, Université Sorbonne Paris Cité and Université Paris Sorbonne, Paris, France
| | - Jan C Semenza
- European Centre for Disease Control and Prevention, Solna, Sweden
| | | | - Rebecca Steinbach
- Department of Public Health, Environments, and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Meisam Tabatabaei
- Agricultural Biotechnology Research Institute of Iran, Agricultural Research, Education, and Extension Organisation, Tehran, Iran
| | - Julia Tomei
- Institute for Sustainable Resources, University College London, London, UK
| | - Joaquin Trinanes
- Physical Oceanography Division, Atlantic Oceanographic and Meteorological Laboratory, National Oceanic and Atmospheric Administration, Miami, FL, USA
| | - Nicola Wheeler
- Institute for Global Health, University College London, London, UK
| | - Paul Wilkinson
- Department of Public Health, Environments, and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Peng Gong
- Department of Earth System Science, Tsinghua University, Beijing, China
| | - Hugh Montgomery
- Centre for Human Health and Performance, Department of Medicine, University College London, London, UK
| | - Anthony Costello
- Office of the Vice-Provost (Research), University College London, London, UK
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Williams ML, Beevers S, Kitwiroon N, Dajnak D, Walton H, Lott MC, Pye S, Fecht D, Toledano MB, Holland M. Public health air pollution impacts of pathway options to meet the 2050 UK Climate Change Act target: a modelling study. Public Health Res 2018. [DOI: 10.3310/phr06070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundThe UK’sClimate Change Act 2008(CCA; Great Britain.Climate Change Act 2008. Chapter 27. London: The Stationery Office; 2008) requires a reduction of 80% in carbon dioxide-equivalent emissions by 2050 on a 1990 base. This project quantified the impact of air pollution on health from four scenarios involving particulate matter of ≤ 2.5 µm (PM2.5), nitrogen dioxide (NO2) and ozone (O3). Two scenarios met the CCA target: one with limited nuclear power build (nuclear replacement option; NRPO) and one with no policy constraint on nuclear (low greenhouse gas). Another scenario envisaged no further climate actions beyond those already agreed (‘baseline’) and the fourth kept 2011 concentrations constant to 2050 (‘2011’).MethodsThe UK Integrated MARKAL–EFOM System (UKTM) energy system model was used to develop the scenarios and produce projections of fuel use; these were used to produce air pollutant emission inventories for Great Britain (GB) for each scenario. The inventories were then used to run the Community Multiscale Air Quality model ‘air pollution model’ to generate air pollutant concentration maps across GB, which then, combined with relationships between concentrations and health outcomes, were used to calculate the impact on health from the air pollution emitted in each scenario. This is a significant improvement on previous health impact studies of climate policies, which have relied on emissions changes. Inequalities in exposure in different socioeconomic groups were also calculated, as was the economic impact of the pollution emissions.ResultsConcentrations of NO2declined significantly because of a high degree of electrification of the GB road transport fleet, although the NRPO scenario shows large increases in oxides of nitrogen emissions from combined heat and power (CHP) sources. Concentrations of PM2.5show a modest decrease by 2050, which would have been larger if it had not been for a significant increase in biomass (wood burning) use in the two CCA scenarios peaking in 2035. The metric quantifying long-term exposure to O3is projected to decrease, while the important short-term O3exposure metric increases. Large projected increases in future GB vehicle kilometres lead to increased non-exhaust PM2.5and particulate matter of ≤ 10 µm emissions. The two scenarios which achieve the CCA target resulted in more life-years lost from long-term exposures to PM2.5than in the baseline scenario. This is an opportunity lost and arises largely from the increase in biomass use, which is projected to peak in 2035. Reduced long-term exposures to NO2lead to many more life-years saved in the ‘CCA-compliant’ scenarios, but the association used may overestimate the effects of NO2itself. The more deprived populations are estimated currently to be exposed to higher concentrations than those less deprived, the contrast being largest for NO2. Despite reductions in concentrations in 2050, the most socioeconomically deprived are still exposed to higher concentrations than the less deprived.LimitationsModelling of the atmosphere is always uncertain; we have shown the model to be acceptable through comparison with observations. The necessary complexity of the modelling system has meant that only a small number of scenarios were run.ConclusionsWe have established a system which can be used to explore a wider range of climate policy scenarios, including more European and global scenarios as well as local measures. Future work could explore wood burning in more detail, in terms of the sectors in which it might be burned and the spatial distribution of this across the UK. Further analyses of options for CHP could also be explored. Non-exhaust emissions from road transport are an important source of particles and emission factors are uncertain. Further research on this area coupled with our modelling would be a valuable area of research.FundingThe National Institute for Health Research Public Health Research programme.
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Affiliation(s)
| | - Sean Beevers
- Environmental Research Group, King’s College London, London, UK
| | | | - David Dajnak
- Environmental Research Group, King’s College London, London, UK
| | - Heather Walton
- Environmental Research Group, King’s College London, London, UK
- National Institute for Health Research (NIHR) Biomedical Research Centre at Guy’s and St Thomas’ NHS Foundation Trust and King’s College London, NIHR Health Protection Research Unit on Health Effects of Environmental Hazards, London, UK
| | - Melissa C Lott
- Institute for Sustainable Resources, University College London, London, UK
| | - Steve Pye
- Energy Institute, University College London, London, UK
| | - Daniela Fecht
- UK Small Area Health Statistics Unit, Medical Research Council–Public Health England Centre for Environment and Health, School for Public Health, Imperial College London, London, UK
| | - Mireille B Toledano
- UK Small Area Health Statistics Unit, Medical Research Council–Public Health England Centre for Environment and Health, School for Public Health, Imperial College London, London, UK
| | - Mike Holland
- Ecometrics, Research and Consulting, Reading, UK
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8
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Williams ML, Lott MC, Kitwiroon N, Dajnak D, Walton H, Holland M, Pye S, Fecht D, Toledano MB, Beevers SD. The Lancet Countdown on health benefits from the UK Climate Change Act: a modelling study for Great Britain. Lancet Planet Health 2018; 2:e202-e213. [PMID: 29709284 DOI: 10.1016/s2542-5196(18)30067-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 03/19/2018] [Accepted: 04/16/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Climate change poses a dangerous and immediate threat to the health of populations in the UK and worldwide. We aimed to model different scenarios to assess the health co-benefits that result from mitigation actions. METHODS In this modelling study, we combined a detailed techno-economic energy systems model (UK TIMES), air pollutant emission inventories, a sophisticated air pollution model (Community Multi-scale Air Quality), and previously published associations between concentrations and health outcomes. We used four scenarios and focused on the air pollution implications from fine particulate matter (PM2·5), nitrogen dioxide (NO2) and ozone. The four scenarios were baseline, which assumed no further climate actions beyond those already achieved and did not meet the UK's Climate Change Act (at least an 80% reduction in carbon dioxide equivalent emissions by 2050 compared with 1990) target; nuclear power, which met the Climate Change Act target with a limited increase in nuclear power; low-greenhouse gas, which met the Climate Change Act target without any policy constraint on nuclear build; and a constant scenario that held 2011 air pollutant concentrations constant until 2050. We predicted the health and economic impacts from air pollution for the scenarios until 2050, and the inequalities in exposure across different socioeconomic groups. FINDINGS NO2 concentrations declined leading to 4 892 000 life-years saved for the nuclear power scenario and 7 178 000 life-years saved for the low-greenhouse gas scenario from 2011 to 2154. However, the associations that we used might overestimate the effects of NO2 itself. PM2·5 concentrations in Great Britain are predicted to decrease between 42% and 44% by 2050 compared with 2011 in the scenarios that met the Climate Change Act targets, especially those from road traffic and off-road machinery. These reductions in PM2·5 are tempered by a 2035 peak (and subsequent decline) in biomass (wood burning), and by a large, projected increase in future demand for transport leading to potential increases in non-exhaust particulate matter emissions. The potential use of biomass in poorly controlled technologies to meet the Climate Change Act commitments would represent an important missed opportunity (resulting in 472 000 more life-years lost from PM2·5 in the low-greenhouse gas scenario and 1 122 000 more life-years lost in the nuclear power scenario from PM2·5 than the baseline scenario). Although substantial overall improvements in absolute amounts of exposure are seen compared with 2011, these outcomes mask the fact that health inequalities seen (in which socioeconomically disadvantaged populations are among the most exposed) are projected to be maintained up to 2050. INTERPRETATION The modelling infrastructure created will help future researchers explore a wider range of climate policy scenarios, including local, European, and global scenarios. The need to strengthen the links between climate change policy objectives and public health imperatives, and the benefits to societal wellbeing that might result is urgent. FUNDING National Institute for Health Research.
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Affiliation(s)
- Martin L Williams
- Environmental Research Group and Medical Research Council-Public Health England (MRC-PHE), King's College London, London, UK.
| | - Melissa C Lott
- Institute for Sustainable Resources, University College London, London, UK
| | - Nutthida Kitwiroon
- Environmental Research Group and Medical Research Council-Public Health England (MRC-PHE), King's College London, London, UK
| | - David Dajnak
- Environmental Research Group and Medical Research Council-Public Health England (MRC-PHE), King's College London, London, UK
| | - Heather Walton
- National Institute for Health Research Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK
| | | | - Steve Pye
- Energy Institute, University College London, London, UK
| | - Daniela Fecht
- MRC-PHE, Centre for Environment and Health, Imperial College London, London, UK
| | - Mireille B Toledano
- MRC-PHE, Centre for Environment and Health, Imperial College London, London, UK
| | - Sean D Beevers
- Environmental Research Group and Medical Research Council-Public Health England (MRC-PHE), King's College London, London, UK
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Watts N, Amann M, Ayeb-Karlsson S, Belesova K, Bouley T, Boykoff M, Byass P, Cai W, Campbell-Lendrum D, Chambers J, Cox PM, Daly M, Dasandi N, Davies M, Depledge M, Depoux A, Dominguez-Salas P, Drummond P, Ekins P, Flahault A, Frumkin H, Georgeson L, Ghanei M, Grace D, Graham H, Grojsman R, Haines A, Hamilton I, Hartinger S, Johnson A, Kelman I, Kiesewetter G, Kniveton D, Liang L, Lott M, Lowe R, Mace G, Odhiambo Sewe M, Maslin M, Mikhaylov S, Milner J, Latifi AM, Moradi-Lakeh M, Morrissey K, Murray K, Neville T, Nilsson M, Oreszczyn T, Owfi F, Pencheon D, Pye S, Rabbaniha M, Robinson E, Rocklöv J, Schütte S, Shumake-Guillemot J, Steinbach R, Tabatabaei M, Wheeler N, Wilkinson P, Gong P, Montgomery H, Costello A. The Lancet Countdown on health and climate change: from 25 years of inaction to a global transformation for public health. Lancet 2018; 391:581-630. [PMID: 29096948 DOI: 10.1016/s0140-6736(17)32464-9] [Citation(s) in RCA: 418] [Impact Index Per Article: 69.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 08/31/2017] [Accepted: 09/08/2017] [Indexed: 12/13/2022]
Affiliation(s)
- Nick Watts
- Institute of Global Health, University College London, London, UK.
| | - Markus Amann
- Air Quality and Greenhouse Gases Program and Greenhouse Gas Initiative, International Institute for Applied Systems Analysis, Vienna, Austria
| | - Sonja Ayeb-Karlsson
- Environmental Migration, Social Vulnerability and daptation section (EMSVA), Institute for Environment and Security, United Nations University, Bonn, Germany
| | - Kristine Belesova
- Department of Social and Environmental Health Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Timothy Bouley
- Climate Change Department, World Bank, Washington, DC, USA
| | - Maxwell Boykoff
- Center for Science and Technology Policy, University of Colorado-Boulder, Boulder, CO, USA
| | - Peter Byass
- Epidemiology & Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Wenjia Cai
- School of Environment, Tsinghua University, Beijing, China
| | - Diarmid Campbell-Lendrum
- Department of Public Health, Environmental and Social Determinants of Health, World Health Organization, Geneva, Switzerland
| | | | - Peter M Cox
- College of Engineering, Mathematics, and Physical Sciences, University of Exeter, Exeter, UK
| | - Meaghan Daly
- Center for Science and Technology Policy, University of Colorado-Boulder, Boulder, CO, USA
| | - Niheer Dasandi
- International Development Department, University of Birmingham, Birmingham, UK
| | - Michael Davies
- UCL Institute for Environmental Design and Engineering, University College London, London, UK
| | | | - Anneliese Depoux
- Centre Virchow-Villermé for Public Health Paris-Berlin, Paris, France
| | - Paula Dominguez-Salas
- Department of Production and Population Health, Royal Veterinary College, London, UK
| | - Paul Drummond
- UCL Institute of Sustainable Resources, University College London, London, UK
| | - Paul Ekins
- UCL Institute of Sustainable Resources, University College London, London, UK
| | - Antoine Flahault
- Centre Virchow-Villermé for Public Health Paris-Berlin, Paris, France
| | - Howard Frumkin
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, USA
| | | | - Mostafa Ghanei
- Chemical Injuries Research Center, University of Medical Sciences, Tehran, Iran
| | - Delia Grace
- Food Safety and Zoonoses Program, International Livestock Research Institute, Nairobi, Kenya
| | - Hilary Graham
- Department of Health Sciences, University of York, York, UK
| | - Rébecca Grojsman
- Centre Virchow-Villermé for Public Health Paris-Berlin, Paris, France
| | - Andy Haines
- Department of Social and Environmental Health Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Ian Hamilton
- UCL Energy Institute, University College London, London, UK
| | - Stella Hartinger
- Unidad de Desarrollo Integral, Ambiente y Salud, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Anne Johnson
- UCL Institute of Epidemiology and Health Care, University College London, London, UK
| | - Ilan Kelman
- UCL Institute for Risk and Disaster Reduction, University College London, London, UK
| | - Gregor Kiesewetter
- Air Quality and Greenhouse Gases Program and Greenhouse Gas Initiative, International Institute for Applied Systems Analysis, Vienna, Austria
| | | | - Lu Liang
- School of Forestry and Natural Resources, University of Arkansas at Monticello, Monticello, AR, USA
| | - Melissa Lott
- UCL Institute of Sustainable Resources, University College London, London, UK
| | - Robert Lowe
- UCL Energy Institute, University College London, London, UK
| | - Georgina Mace
- Department of Genetics, Evolution and Environment, University College London, London, UK
| | - Maquins Odhiambo Sewe
- Epidemiology & Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Mark Maslin
- Department of Geography, University College London, London, UK
| | - Slava Mikhaylov
- Institute for Analytics and Data Science, University of Essex, Colchester, UK
| | - James Milner
- Department of Social and Environmental Health Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Ali Mohammad Latifi
- Applied Biotechnology Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | | | - Karyn Morrissey
- European Centre for Environment & Human Health, University of Exeter, Exeter, UK
| | - Kris Murray
- Grantham Institute-Climate Change and the Environment, Imperial College London, London, UK
| | - Tara Neville
- Department of Public Health, Environmental and Social Determinants of Health, World Health Organization, Geneva, Switzerland
| | - Maria Nilsson
- Epidemiology & Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Tadj Oreszczyn
- Bartlett School of Environment, Energy and Resources, Bartlett Faculty of the Built Environment, University College London, London, UK
| | - Fereidoon Owfi
- Iranian Fisheries Science Research Institute, AREEO, Tehran, Iran
| | | | - Steve Pye
- UCL Energy Institute, University College London, London, UK
| | - Mahnaz Rabbaniha
- Iranian Fisheries Science Research Institute, AREEO, Tehran, Iran
| | - Elizabeth Robinson
- School of Agriculture, Policy and Development, University of Reading, Reading, UK
| | - Joacim Rocklöv
- Epidemiology & Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Stefanie Schütte
- Centre Virchow-Villermé for Public Health Paris-Berlin, Paris, France
| | - Joy Shumake-Guillemot
- WHO/WMO Joint Climate and Health Office, World Meteorological Organization, Geneva, Switzerland
| | - Rebecca Steinbach
- Department of Social and Environmental Health Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Meisam Tabatabaei
- Biofuel Research Team, Agricultural Biotechnology Research Institute of Iran, AREEO, Karaj, Iran
| | - Nicola Wheeler
- Institute of Global Health, University College London, London, UK
| | - Paul Wilkinson
- Department of Social and Environmental Health Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Peng Gong
- Centre for Earth System Science, Tsinghua University, Beijing, China
| | - Hugh Montgomery
- Centre for Human Health and Performance, Division of Medicine, University College London, London, UK
| | - Anthony Costello
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland
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Watts N, Adger WN, Agnolucci P, Blackstock J, Byass P, Cai W, Chaytor S, Colbourn T, Collins M, Cooper A, Cox PM, Depledge J, Drummond P, Ekins P, Galaz V, Grace D, Graham H, Grubb M, Haines A, Hamilton I, Hunter A, Jiang X, Li M, Kelman I, Liang L, Lott M, Lowe R, Luo Y, Mace G, Maslin M, Nilsson M, Oreszczyn T, Pye S, Quinn T, Svensdotter M, Venevsky S, Warner K, Xu B, Yang J, Yin Y, Yu C, Zhang Q, Gong P, Montgomery H, Costello A. Health and climate change: policy responses to protect public health. Lancet 2015; 386:1861-914. [PMID: 26111439 DOI: 10.1016/s0140-6736(15)60854-6] [Citation(s) in RCA: 728] [Impact Index Per Article: 80.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- Nick Watts
- Institute for Global Health, University College London, London, UK.
| | - W Neil Adger
- Geography, College of Life and Environmental Sciences, University of Exeter, Exeter, UK
| | - Paolo Agnolucci
- Institute for Sustainable Resources, University College London, London, UK
| | - Jason Blackstock
- Department of Science, Technology, Engineering and Public Policy, University College London, London, UK
| | - Peter Byass
- Centre for Global Health Research, Umea University, Umea, Sweden
| | - Wenjia Cai
- Centre for Earth System Science, Tsinghua University, Haidian, Beijing, China
| | - Sarah Chaytor
- Public Policy, University College London, London, UK
| | - Tim Colbourn
- Institute for Global Health, University College London, London, UK
| | - Mat Collins
- College of Engineering, Mathematics and Physical Sciences, University of Exeter, Exeter, UK
| | - Adam Cooper
- Department of Science, Technology, Engineering and Public Policy, University College London, London, UK
| | - Peter M Cox
- College of Engineering, Mathematics and Physical Sciences, University of Exeter, Exeter, UK
| | - Joanna Depledge
- Department of Politics and International Studies, University of Cambridge, Cambridge, UK
| | - Paul Drummond
- Institute for Sustainable Resources, University College London, London, UK
| | - Paul Ekins
- Institute for Sustainable Resources, University College London, London, UK
| | - Victor Galaz
- Stockholm Resilience Centre, Stockholm University, Stockholm, Sweden
| | - Delia Grace
- International Livestock Research Institute, Nairobi, Kenya
| | - Hilary Graham
- Department of Health Sciences, University of York, York, UK
| | - Michael Grubb
- Institute for Sustainable Resources, University College London, London, UK
| | - Andy Haines
- London School of Hygiene and Tropical Medicine, London, UK
| | - Ian Hamilton
- Energy Institute, University College London, London, UK
| | - Alasdair Hunter
- College of Engineering, Mathematics and Physical Sciences, University of Exeter, Exeter, UK
| | - Xujia Jiang
- Centre for Earth System Science, Tsinghua University, Haidian, Beijing, China
| | - Moxuan Li
- Centre for Earth System Science, Tsinghua University, Haidian, Beijing, China
| | - Ilan Kelman
- Institute for Global Health, University College London, London, UK
| | - Lu Liang
- Centre for Earth System Science, Tsinghua University, Haidian, Beijing, China
| | - Melissa Lott
- Institute for Sustainable Resources, University College London, London, UK
| | - Robert Lowe
- Energy Institute, University College London, London, UK
| | - Yong Luo
- Centre for Earth System Science, Tsinghua University, Haidian, Beijing, China
| | - Georgina Mace
- Centre for Biodiversity and Environment Research, University College London, London, UK
| | - Mark Maslin
- Department of Geography, University College London, London, UK
| | - Maria Nilsson
- Centre for Global Health Research, Umea University, Umea, Sweden
| | | | - Steve Pye
- Energy Institute, University College London, London, UK
| | - Tara Quinn
- Environment and Sustainability Institute, University of Exeter, Exeter, UK
| | - My Svensdotter
- Stockholm Resilience Centre, Stockholm University, Stockholm, Sweden
| | - Sergey Venevsky
- Centre for Earth System Science, Tsinghua University, Haidian, Beijing, China
| | - Koko Warner
- UN University Institute for Environment and Human Security, Bonn, Germany
| | - Bing Xu
- Centre for Earth System Science, Tsinghua University, Haidian, Beijing, China
| | - Jun Yang
- Centre for Earth System Science, Tsinghua University, Haidian, Beijing, China
| | - Yongyuan Yin
- Centre for Earth System Science, Tsinghua University, Haidian, Beijing, China
| | - Chaoqing Yu
- Centre for Earth System Science, Tsinghua University, Haidian, Beijing, China
| | - Qiang Zhang
- Centre for Earth System Science, Tsinghua University, Haidian, Beijing, China
| | - Peng Gong
- Centre for Earth System Science, Tsinghua University, Haidian, Beijing, China
| | - Hugh Montgomery
- Institute for Human Health and Performance, University College London, London, UK
| | - Anthony Costello
- Institute for Global Health, University College London, London, UK
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Perchard R, MacDonald D, Say J, Pitts J, Pye S, Allgrove J, Banerjee K, Amin R. Islet autoantibody status in a multi-ethnic UK clinic cohort of children presenting with diabetes. Arch Dis Child 2015; 100:348-52. [PMID: 25409982 DOI: 10.1136/archdischild-2014-306542] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE We prospectively determined islet autoantibody status in children presenting with diabetes to a single UK region in relation to ethnicity. DESIGN 316 (68.0% non-white) children presenting with diabetes between 2006 and 2013 were tested centrally for islet cell autoantibodies (ICA) and glutamic acid decarboxylase autoantibodies (GAD-65) at diagnosis, and if negative for both, tested for insulin autoantibodies (IAA). The assay used to measure GAD-65 autoantibodies changed from an in-house to a standardised ELISA method during the study. RESULTS Even with use of the standardised ELISA method, 25.8% of children assigned a diagnosis of type 1 diabetes still tested negative for all three autoantibodies. 30% of children assigned a diagnosis of type 2 diabetes were autoantibody positive, and these had the highest glycated haemoglobin (HbA1c) levels at 12 months follow-up compared with other groups (p value for analysis of variance <0.001), although the sample size was small. Autoantibody positivity was similar between non-white and white children regardless of assay used (60.0% (n=129) vs 56.4% (n=57), χ(2)=0.9, p=0.35), as was mean GAD-65 autoantibody levels, but fewer non-white children had two or more autoantibodies detectable (13% (n=28) vs 27.7% (n=28), χ(2)=12.1, p=0.001). CONCLUSIONS Islet autoantibody positivity was associated with a more severe phenotype, as demonstrated by poorer glycaemic control, regardless of assigned diabetes subtype. Positivity did not differ by ethnic group.
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Affiliation(s)
- R Perchard
- Department of Paediatrics, Royal London Hospital, London, UK Department of Paediatrics, Queens Hospital, Romford, UK
| | - D MacDonald
- Department of Immunology, Royal London Hospital, London, UK
| | - J Say
- Department of Paediatrics, Royal London Hospital, London, UK
| | - J Pitts
- Department of Paediatrics, Queens Hospital, Romford, UK
| | - S Pye
- Department of Immunology, Royal London Hospital, London, UK
| | - J Allgrove
- Department of Paediatrics, Royal London Hospital, London, UK
| | - K Banerjee
- Department of Paediatrics, Queens Hospital, Romford, UK
| | - R Amin
- Clinical & Molecular Genetics Unit, UCL Institute of Child Health, London, UK
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Gielen E, O'Neill T, Pye S, Adams J, Ward K, Wu F, Laurent M, Claessens F, Boonen S, Vanderschueren D, Verschueren S. Bone turnover markers predict hip bone loss in elderly European men: results of the European Male Ageing Study (EMAS). Osteoporos Int 2015; 26:617-27. [PMID: 25224294 DOI: 10.1007/s00198-014-2884-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2014] [Accepted: 09/03/2014] [Indexed: 12/19/2022]
Abstract
SUMMARY The aim of this study was to determine whether bone turnover markers (BTMs) predict changes in areal bone mineral density (aBMD) in middle-aged and elderly European men. Older men with high bone turnover are at a higher risk of accelerated hip bone loss, but the clinical utility of BTMs in individuals is limited. INTRODUCTION Prospective studies on the value of BTMs to predict changes in aBMD in men are few and conflicting. The aim of this study was to determine whether BTMs predict changes in aBMD in middle-aged and elderly European men. METHODS In 487 men aged 40-79 years from the European Male Ageing Study (EMAS), BTMs were assessed at baseline and dual-energy X-ray absorptiometry (DXA) at the lumbar spine (LS), femoral neck (FN) and total hip (TH) was performed at baseline and after a mean follow-up of 4.3 years. RESULTS The mean aBMD decreased by 0.32%/year at FN and 0.22%/year at TH and increased by 0.32%/year at LS. Higher baseline levels of β C-terminal cross-linked telopeptide (β-CTX) and N-terminal propeptide of type I procollagen (PINP) were significantly associated with higher loss of hip aBMD in the whole cohort and men aged 60-79 years. These associations remained significant after adjustment for age, centre and body mass index (BMI). Men aged 60-79 years with β-CTX in the upper quintile were more likely of being in the upper quintile of annual percentage (%) aBMD loss at FN (OR=4.27; 95% CI=2.09-8.73) and TH (OR=3.73; 95% CI=1.84-7.57). The positive predictive value (PPV) was 46% at both hip sites. CONCLUSION Older men with high bone turnover have a higher risk of accelerated hip bone loss, but the PPV is low. BTMs are therefore unlikely to be of clinical utility in predicting accelerated hip bone loss in individual subjects.
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Affiliation(s)
- E Gielen
- Gerontology and Geriatrics, Department of Clinical and Experimental Medicine, KU Leuven, Leuven, Belgium,
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Pye S, Dobbins A, Baffert C, Brajković J, Deane P, De Miglio R. Addressing Energy Poverty and Vulnerable Consumers in the Energy Sector Across the EU. ACTA ACUST UNITED AC 2015. [DOI: 10.3917/eufor.378.0064] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Callaghan M, Pye S. BET 1. THE EFFECTS OF GLUCOSAMINE ON OSTEOARTHRITIS OF THE KNEE JOINT. Arch Emerg Med 2008; 25:285-7. [DOI: 10.1136/emj.2008.059386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Radziuk J, Pye S. Diurnal rhythm in endogenous glucose production is a major contributor to fasting hyperglycaemia in type 2 diabetes. Suprachiasmatic deficit or limit cycle behaviour? Diabetologia 2006; 49:1619-28. [PMID: 16752180 DOI: 10.1007/s00125-006-0273-9] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2005] [Accepted: 02/18/2006] [Indexed: 10/24/2022]
Abstract
AIMS/HYPOTHESIS An increase in endogenous glucose production (EGP) is a major contributor to fasting morning hyperglycaemia in type 2 diabetes. This increase is dissipated with fasting, later in the day. To understand its origin, EGP, gluconeogenesis and hormones that regulate metabolism were measured over 24 h. We hypothesised that EGP, and therefore glycaemia, would demonstrate a centrally mediated circadian rhythm in type 2 diabetes. SUBJECTS AND METHODS Seven subjects with type 2 diabetes and six age- and BMI-matched control subjects, fasting after breakfast (08.00 h), underwent a further 24-h fast, with the infusion of [U-(13)C]glucose and [3-(14)C]lactate, starting at 14.00 h. The MCR and production of total and gluconeogenic glucose were determined from the tracer concentrations using compartmental analysis. RESULTS MCR was near constant: 1.73+/-0.10 in control and 1.40+/-0.14 ml kg(-1) min(-1) in diabetic subjects (p=0.04). EGP in diabetes rose gradually overnight from 8.2+/-0.7 to 11.3+/-0.5 micromol kg(-1) min(-1) at 06.00 h (p<0.05). Glucose utilisation lagged EGP, rising from 8.5+/-0.6 to 10.5+/-0.4 micromol kg(-1) min(-1) (p<0.05), inducing a fall in glycaemia from a peak of 8.0+/-0.5 mmol/l to 6.3+/-0.4 mmol/l (p<0.05). Cortisol and melatonin showed diurnal variations, whereas insulin, glucagon and leptin did not. Melatonin was most closely related to EGP, but its secretion was attenuated in diabetes (p<0.05). CONCLUSIONS/INTERPRETATION In type 2 diabetes, EGP and gluconeogenesis display diurnal rhythms that drive the fasting hyperglycaemia and are absent in healthy control subjects. The rise in EGP may be related to a deficit in suprachiasmatic nucleus activity in diabetes, or result from non-linear behaviour plus a transition from a normal steady state to a limit cycle pattern in diabetes, or both.
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Affiliation(s)
- J Radziuk
- Diabetes and Metabolism Research Unit, Ottawa Hospital (Civic Campus), 1053 Carling Avenue, Ottawa, ON, K1Y 4E9, Canada.
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Radziuk J, Pye S. Quantitation of basal endogenous glucose production in Type II diabetes: importance of the volume of distribution. Diabetologia 2002; 45:1053-84. [PMID: 12189437 DOI: 10.1007/s00125-002-0841-6] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2001] [Revised: 02/27/2002] [Indexed: 10/27/2022]
Abstract
The rate of endogenous glucose production (EGP) is important in understanding the pathophysiology of Type II (non-insulin-dependent) diabetes mellitus, the aetiology of its complications, and the identification of potential therapeutic targets. A great deal of effort has therefore been expended in its evaluation. Most measurements in humans have been made using tracers, or labelled analogues of glucose. Experimental strategies have included the injection and the infusion of such tracers which were often primed to achieve constant concentrations of the label more quickly. Primers have either been fixed or adjusted to the ambient glycaemia in each diabetic subject. Analyses were carried out using steady-state or non-steady-state calculations, the latter based on a one-compartment model or higher order systems. The principal finding of this review is that all approaches yield the same EGP when an appropriate model of the system is used. Under basal conditions, a single compartment model is sufficient to evaluate EGP, but the estimation of the volume of distribution, V, from individual data is critical in obtaining consistent results. Other sources of variation arose from the length of the fasting period and the patient population being studied. Overall, in Type II diabetes, EGP is frequently high in the morning and decreases gradually to rates comparable to healthy control subjects. This can be a very delayed response to a preceding meal, but more likely corresponds to an accentuated circadian rhythm in glucose production. Metabolic clearance of glucose, on the other hand, is decreased in diabetes, and remains so during the course of the day.
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Affiliation(s)
- J Radziuk
- Diabetes and Metabolism Research Unit, Ottawa Hospital, Ottawa Health Research Institute and University of Ottawa, Canada.
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17
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Lawler P, White B, Pye S, Hermans C, Riddell A, Costello C, Brown S, Lee CA. Successful use of recombinant factor VIIa in a patient with inhibitor secondary to severe factor XI deficiency. Haemophilia 2002; 8:145-8. [PMID: 11952851 DOI: 10.1046/j.1365-2516.2002.00590.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Factor XI (FXI) inhibitors are a rare complication of inherited FXI deficiency. We report the successful use of recombinant factor VIIa (FVIIa) in a patient with a high-responding inhibitor undergoing cataract extraction. At the time of surgery there were limited available data on the optimal management of patients with FXI deficiency. A 62-year-old Ashkenazi Jewish woman had a lifelong history of excessive bleeding secondary to severe FXI deficiency (2 U dL-1), and received FXI concentrate (FXI:C) when she underwent a colposuspension procedure. She was subsequently diagnosed with a FXI inhibitor of 16 Bethesda units (BU) when she developed a poor response to FXI:C at the time of total hip replacement. Two months later she was admitted for cataract extraction. The FXI level was < 1 U dL-1 with an inhibitor titre of 48 BU. She received 90 microg kg-1 of FVIIa immediately preoperatively followed by continuous infusion at a rate of 20 microg kg-1 h-1 for 24 h. The cataract extraction was successful and there was no excess bleeding during surgery or in the postoperative period. Mutation analysis of the FXI gene showed that the patient was homozygous for the type II genotype [exon 5, Glu117-->Ter]. The reason for the low prevalence of inhibitor formation in patients with FXI deficiency is unclear but may reflect a number of factors including reporting bias, the rarity of absent circulating FXI:C activity, and the infrequent use of FXI replacement therapy.
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Affiliation(s)
- P Lawler
- Haemophilia Centre and Haemostasis Unit and Department of Haematology, Royal Free University College London Medical School, UK
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18
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Abstract
AIMS/HYPOTHESIS The pathogenesis of fasting hyperglycaemia in Type II (non-insulin-dependent) diabetes mellitus has yet to be clarified. Rates of glucose production (Ra), utilization and metabolic clearance rate were therefore measured during an extended fast, in control subjects and in Type II diabetic patients. METHODS Nine subjects with newly-diagnosed or diet-treated diabetes and seven control subjects matched for age and weight (BMI 36.0 +/- 2.4 and 35.3 +/- 3.1 kg/m2 respectively) underwent an overnight fast followed by a 10-h unprimed infusion of [6-3H]glucose. Plasma tracer concentrations were fitted by a single-compartment model. RESULTS The metabolic clearance rate was near-constant [61.7 + 2.4 ml/(min-m2)] in diabetic patients and [75.5 +/- 3.3 ml/(min-m2)] in control subjects (p < 0.05). It was correlated to the glucose concentrations both at t = 0 (r = -0.752, p = 0.0008) and t = 10 h (r = -0.675, p = 0.004). The calculated volume of distribution was 17.3 +/- 1.4 l (18.2 % weight, diabetes), 19.6 +/- 2.4 l (18.4 % weight, control). Glycaemia fell from 10.7 +/- 0.8 mmol/l to 6.5 +/- 0.3 mmol/l by 10 h (p < 0.05) in diabetes and from 5.6 +/- 0.6 to 4.8 +/- 0.1 mmol/l in control subjects (p < 0.05). The rate of glucose production decreased in parallel, from 563 +/- 33 to 363 +/- 23 micromol/(min-m2) (p < 0.05) in diabetes from 419 +/- 20 to 347 +/- 32 micromol/(min-m2) in control subjects. Initial Ra was higher in diabetic patients than in control subjects (p < 0.05) and was highly correlated to glycaemia (r = 0.836, p = 0.0001). By 10 h, Ra had converged in diabetic patients and control subjects and all correlation with glycaemia was lost (r = 0.0017, p = 0.95). CONCLUSIONS/INTERPRETATION In relatively early diabetes, the more "labile" portion of fasting hyperglycaemia, which subsequently decreased, was closely related to the simultaneously decreasing Ra. The 25 % increase in glucose concentrations which persisted as stabilized Ra, resulted from about a 20 % lower metabolic clearance rate.
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Affiliation(s)
- J Radziuk
- Diabetes and Metabolism Research Unit, Ottawa Hospital and The University of Ottawa, Ottawa, ON, Canada
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19
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Abstract
Hepatic glycogen is replenished during the absorptive period postprandially. This repletion is prompted partly by an increased hepatic uptake of glucose by the liver, partly by metabolite and hormonal signals in the portal vein, and partly by an increased gluconeogenic flux to glycogen (glyconeogenesis). There is some evidence that the direct formation of glycogen from glucose and that formed by gluconeogenic pathways is linked. This includes: (i) the inhibition of all glycogen synthesis, in vivo, when gluconeogenic flux is blocked by inhibitors; (ii) a dual relationship between glucose concentrations, lactate uptake by the liver and glycogen synthesis (by both pathways) which indicates that glucose sets the maximal rates of glycogen synthesis while lactate uptake determines the actual flux rate to glycogen; (iii) the decrease of both gluconeogenesis and glycogen synthesis by the biguanide, metformin; and (iv) correlations between increased gluconeogenesis and liver glycogen in obese patients and animal models. The degree to which the liver extracts portal glucose is not entirely agreed upon although a preponderance of evidence points to about a 5% extraction rate, following meals, which is dependent on a stimulation of glucokinase. This enzyme may be linked to the expression of other enzymes in the gluconeogenic pathway. Perivenous cells in the liver may induce additional gluconeogenesis in the periportal cells by increasing glycolytically produced lactate. A number of potential mechanisms therefore exist which could link glycogen synthesis from glucose and gluconeogenic substrate.
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Affiliation(s)
- J Radziuk
- Diabetes and Metabolism Research Unit, Ottawa Hospital, 1053 Carling Avenue, Ottawa, Ontario, Canada K1Y 4E9.
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Richards JP, Stickelmeyer MP, Frank BH, Pye S, Barbeau M, Radziuk J, Smith GD, DeFelippis MR. Preparation of a microcrystalline suspension formulation of Lys(B28)Pro(B29)-human insulin with ultralente properties. J Pharm Sci 1999; 88:861-7. [PMID: 10479347 DOI: 10.1021/js990107o] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The monomeric analogue, Lys(B28)Pro(B29)-human insulin (LysPro), has been crystallized using similar conditions employed to prepare extended-acting insulin ultralente formulations. In the presence of zinc ions, sodium acetate and sodium chloride, but without phenolic preservative, LysPro surprisingly forms small rhombohedral crystals with similar morphology to human insulin ultralente crystals with a mean particle size of 20 +/- 1 microm. X-ray powder diffraction studies on the LysPro crystals prior to dilution in ultralente vehicle ([NaCl] = 1.2 M) revealed the presence of T(3)R(3)(f) hexamers. Consistent with human insulin ultralente preparations, LysPro crystals formulated as an ultralente suspension ([NaCl] = 0. 12 M) contain T(6) hexamers indicating that a conformational change occurs in the hexamer units of the crystals upon dilution of the salt concentration. The pharmacological properties of subcutaneously administered ultralente LysPro (ULP) were compared to ultralente human insulin (UHI) using a conscious dog model (n = 5) with glucose levels clamped at basal. There were no statistically significant differences between the kinetic and dynamic responses of ULP compared to UHI [C(max) (ng/mL): 3.58 +/- 0.76, ULP and 3.61 +/- 0. 66, UHI; T(max) (min): 226 +/- 30, ULP and 185 +/- 42, UHI; R(max) (mg/kg min): 11.2 +/- 1.9, ULP and 13.3 +/- 2.0, UHI; and T(Rmax) (min): 336 +/- 11, ULP and 285 +/- 57, UHI]. Although the Pro to Lys sequence inversion destabilizes insulin self-assembly and greatly alters the time action of soluble LysPro preparations, this modification has now been found neither to prevent the formation of ultralente crystals in the absence of phenolics nor to compromise the protracted activity of the insulin analogue suspension.
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Affiliation(s)
- J P Richards
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, Indiana 46285, USA
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21
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Pye S. Diagnosis and referral of Wilms' tumor. Nurse Pract 1999; 24:121-2, 127. [PMID: 10349674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
Wilms' Tumor, also know as nephroblastoma, is a childhood renal tumor. The assessment and diagnosis of a Wilms' tumor is one of the many challenges faced in the primary care setting. This article presents a brief review of Wilms' tumor in the pediatric population and its occurrence in a case presentation.
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Affiliation(s)
- S Pye
- Arkansas Children's Hospital's Cardiovascular Intensive Care Unit, Little Rock, USA
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22
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Elliott SL, Pye S, Le T, Mateo L, Cox J, Macdonald L, Scalzo AA, Forbes CA, Suhrbier A. Peptide based cytotoxic T-cell vaccines; delivery of multiple epitopes, help, memory and problems. Vaccine 1999; 17:2009-19. [PMID: 10217601 DOI: 10.1016/s0264-410x(98)00468-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Synthetic CD8+ cytotoxic T-lymphocyte (CTL) peptide epitope based vaccines are being developed against a number of human diseases. Here we describe extensive preclinical testing of peptide epitope vaccines formulated with a protein as a source of CD4 help and Montanide ISA 720, an adjuvant currently in human clinical trials. Such water-in-oil formulations could effectively co-deliver several peptide epitopes and simultaneously induce multiple independent CTL responses. The efficiency of CTL induction by some peptides was, however, dependent on the aqueous buffer conditions, with poor performance correlating with non-covalent peptide oligomerisation. Any of a number of proteins currently used in human vaccines could supply CD4 help and no difference in CTL induction was obtained if the CD4 response was amnestic or a primary. Peptide immunisation was found to induce long term CTL memory and the recall of protective responses did not depend on an amnestic CD4 response. Slow pyroglutamic acid formation and rapid oxidation of methionine residues was observed in water-in-oil formulations, however, the latter had no effect on CTL induction. These data highlight the need to monitor for potential deleterious chemical events and interpeptide interactions, but illustrate that peptide based vaccination can effectively deliver multiple epitopes, in conjunction with any protein, and induce protective memory.
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Affiliation(s)
- S L Elliott
- Co-operative Research Centre for Vaccine Technology, Queensland Institute of Medical Research, PO Royal Brisbane Hospital, Australia
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23
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Barron P, Davies J, Pye S, Radziuk J. Hemipancreatectomy and systemic diversion of pancreatic venous drainage lead to independent alterations in the determinants of glucose tolerance in dogs. Transplant Proc 1998; 30:618-20. [PMID: 9532201 DOI: 10.1016/s0041-1345(97)01429-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- P Barron
- Department of Surgery and Medicine, Ottawa Civic Hospital, Ontario, Canada
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24
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DeFelippis MR, Bakaysa DL, Bell MA, Heady MA, Li S, Pye S, Youngman KM, Radziuk J, Frank BH. Preparation and characterization of a cocrystalline suspension of [LysB28,ProB29]-human insulin analogue. J Pharm Sci 1998; 87:170-6. [PMID: 9519149 DOI: 10.1021/js970285m] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Soluble preparations of [LysB28,ProB29]-human insulin analogue (LysPro) exhibit more rapid absorption than human insulin upon subcutaneous injection. Biphasic mixtures of LysPro and intermediate-acting insulin suspensions could provide advantages over current preparations for the treatment of diabetes. To prepare biphasic mixtures of LysPro, a suspension formulation of the analogue is required. We have devised a method for crystallizing LysPro with the basic peptide protamine yielding neutral protamine LysPro (NPL) suspension. The crystallization conditions are strongly dependent on the precipitation procedure and temperature. Using various techniques, the crystalline and suspension characteristics of NPL are found to be similar to human insulin (neutral protamine Hagedorn, NPH) (8:1 molar ratio insulin:protamine, rod-shaped crystals, particle size of 4.0-6.0 microns, and Point of Zero Charge at 6.0-7.0). Using a dog model with NPL or NPH injected subcutaneously and glucose levels clamped at basal, NPL was found to have kinetic and dynamic responses analogous to human insulin NPH [Cmax (maximal insulin or LysPro concentration, ng/mL) of 2.61 +/- 0.22, NPL; 2.58 +/- 0.36, NPH, attained at Tmax (min) of 93 +/- 22, NPL; 145 +/- 33 NPH, and Rmax (maximal rate of glucose infusion, mg/kg min) of 10.8 +/- 1.2, NPL; 13.2 +/- 1.9, NPH, attained at TRmax (min) of 277 +/- 58, NPL; 265 +/- 38, NPH]. There are no statistically significant differences between the insulin curves or the glucose responses. These results provide insight into the mechanism of action of NPH suspensions and the relationship to duration of action. Furthermore, the formulation of a suspension of LysPro having an intermediate time-action makes possible the preparation of stable biphasic mixtures containing LysPro and NPL.
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Affiliation(s)
- M R DeFelippis
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, Indiana 46285, USA.
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25
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Radziuk J, Pye S, Bradley B, Braaten J, Vignati L, Roach P, Bowsher R, DiMarchi R, Chance R. Basal activity profiles of NPH and [Nepsilon-palmitoyl Lys (B29)] human insulins in subjects with IDDM. Diabetologia 1998; 41:116-20. [PMID: 9498640 DOI: 10.1007/s001250050876] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
[Nepsilon-palmitoyl Lys (B29)] human insulin is a fatty acid-acylated derivative of insulin with extended action compared to unmodified insulin when infused intravenously (i.v.) secondary to its binding to circulating albumin. The duration and activity profile of the acylated (A) and NPH (B) insulins were assessed following subcutaneous (s.c.) doses of (A) 6 nmol/kg and (B) 1.2 nmol/kg (equivalent to 0.2 U/kg) in 9 subjects with IDDM. After overnight i.v. infusion of regular human insulin, morning glucose was (A) 6.9 +/- 0.1 and (B) 6.8 +/- 0.1 mmol/l. After the s.c. injection, i.v. human insulin or glucose was infused to maintain near-basal glycaemia and tracer glucose to assess hepatic glucose production (HGP). An activity profile was deduced for each study by expressing the glucose infusion rate at each time point, as a fraction (%) of the basal (measured) HGP, and the i.v. insulin infusion rate as a fraction (%) of the basal requirement. The two fractions are combined by adding the fractional glucose infusion rate and subtracting the fractional insulin infusion rate. Infusion rates of i.v. insulin in the morning were (A) 0.96 +/- 0.096 and (B) 1.22 +/- 0.09 pmol x kg(-1) x min(-1). After insulin injection, i.v. insulin requirements decreased and were below 10% of basal between 100 and 150 min. A constant activity profile of 0% represents a perfect substitution of the basal i.v. insulin infusion by the s.c. dose. The actual profile is defined by deviations from this (above) and was -17 +/- 11, 7 +/- 10, -9 +/- 6 and -18 +/- 18% for [Nepsilon-palmitoyl Lys (B29)] human insulin and 17 +/- 12, 5 +/- 6, -9 +/- 15, 22 +/- 18% for NPH insulin at 3, 6, 9 and 12 h after s.c. injection. HGP was similar for the two insulins, demonstrating similar metabolic actions and profiles both peripherally and at the liver.
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Affiliation(s)
- J Radziuk
- Diabetes and Metabolism Research Unit, Ottawa Civic Hospital, ON, Canada
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Abstract
To directly assess the effects of the biguanide, metformin, on hepatic gluconeogenesis, it was added at high therapeutic levels (90 microg/ml) to the medium perfusing an isolated rat liver. Lactate (1 mg/min) was infused simultaneously along with [14C]lactate with or without [3H]lactate. [6-(3)H]glucose was added at the beginning of the perfusion in studies where [3H]lactate was not infused. Glucose levels decreased relative to control studies (metformin dose = 0) and lactate concentrations increased in this closed system. Quantitative analysis of the relationship between labeled glucose and lactate indicated that the flux of carbon from lactate to glucose and CO2 was halved, whereas reflux from glucose to lactate increased by approximately 80%. This was corroborated by measurement of labeled lactate extraction as well as glucose, CO2, and lactate production across the liver. Glycogen content of the liver fell by 60% relative to control and was greater for the gluconeogenic pathway. These data are consistent with an inhibitory action of metformin on gluconeogenesis, which is due to a primary inhibition of hepatic lactate uptake.
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Affiliation(s)
- J Radziuk
- Ottawa Civic Hospital and the University of Ottawa, Ontario, Canada
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Barron P, Goobi P, Davies J, Pye S, Radziuk J. Hemipancreatectomy, peripheral diversion of pancreatic venous drainage, and insulin sensitivity. Transplant Proc 1995; 27:3040-1. [PMID: 8539833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
It has been previously noted that a mild insulin deficiency could increase insulin sensitivity in rats. The data shown here are consistent with such an observation in that the insulin resistance, which was induced by diversion of pancreatic venous drainage to the peripheral circulation, was corrected by the insulin deficiency which was secondary to the hemipancreatectomy performed. These results also help to explain some of the apparent inconsistencies that appear to be present in the comparison often made of insulin sensitivity following various transplantation procedures. Both the site of pancreatic venous drainage and any decrease in beta-cell mass which may accompany pancreas or islet transplantation appear to have independent and opposite effects on insulin sensitivity.
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Affiliation(s)
- P Barron
- Ottawa Civic Hospital, Ontario, Canada
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29
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Pye S, Pavord I, Wilding P, Bennett J, Knox A, Tattersfield A. A comparison of the effects of inhaled furosemide and ethacrynic acid on sodium-metabisulfite-induced bronchoconstriction in subjects with asthma. Am J Respir Crit Care Med 1995; 151:337-9. [PMID: 7842188 DOI: 10.1164/ajrccm.151.2.7842188] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Inhaled furosemide prevents bronchoconstriction induced by a number of challenges in asthma. One approach to determine the mechanism underlying this protection has been to examine the effects of diuretics with different or overlapping pharmacologic effects. We have compared the effects of furosemide on sodium metabisulfite-induced bronchoconstriction with those of equivalent diuretic doses of ethacrynic acid, a loop diuretic that, unlike furosemide, does not interact directly with the membrane Na/K/Cl cotransporter protein or inhibit carbonic anhydrase. Eight subjects with mild asthma were studied on five occasions, receiving nebulized furosemide (20 and 40 mg), ethacrynic acid (25 and 50 mg), or placebo (normal saline) in random order and double-blind 10 min before a cumulative dose challenge with inhaled sodium metabisulfite. After placebo the geometric mean sodium metabisulfite PD20 was 7.9 mumol. Furosemide 20 mg and 40 mg increased the PD20 by a mean 1.1 (95% confidence interval, -0.2-2.4; p > 0.05) and 1.6 (0.4-2.9; p < 0.02) doubling doses to 17.1 and 24.7 mumol, respectively. After inhaled ethacrynic acid 25 mg and 50 mg, the geometric mean PD20 was increased by 0.9 (-0.4-2.2; p > 0.05) and 1.5 (0.2-2.8; p < 0.05) doubling doses to 14.5 and 22.4 mumol, respectively. Thus, equivalent diuretic doses of furosemide and ethacrynic acid have a similar inhibitory effect on sodium metabisulfite-induced bronchoconstriction in asthma. This suggests that interaction with the Na/K/Cl cotransporter protein, or carbonic anhydrase inhibition, is not relevant to the effects of furosemide in asthma.
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Affiliation(s)
- S Pye
- Respiratory Medicine Unit, City Hospital, Nottingham, United Kingdom
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John TG, Banting SW, Pye S, Paterson-Brown S, Garden OJ. Preliminary experience with intracorporeal laparoscopic ultrasonography using a sector scanning probe. A prospective comparison with intraoperative cholangiography in the detection of choledocholithiasis. Surg Endosc 1994; 8:1176-80; discussion 1180-1. [PMID: 7809800 DOI: 10.1007/bf00591045] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Laparoscopic ultrasonography is a novel technique which may be useful in screening for choledocholithiasis during laparoscopic cholecystectomy. Following concerns regarding the "learning curve" and accuracy associated with the adoption of this user-dependent technology, we have prospectively evaluated a commercially available 90 degrees sector scanning laparoscopic ultrasound probe during elective laparoscopic cholecystectomy. Laparoscopic ultrasonography was performed in 60 patients and identified common duct stones in nine patients (one "false positive" and "one false negative"), and previously unsuspected duct stones were defined in three out of four patients. The gallbladder and portal vein were constantly defined anatomical landmarks throughout the study, whereas the suprapancreatic bile duct, intrapancreatic bile duct, and pancreatic duct were identified in 100%, 80%, and 85% of patients in the third consecutive group of 20 patients examined. Laparoscopic ultrasonography has the potential to accurately identify common duct stones during laparoscopic cholecystectomy and thereby implement a policy of "superselective" operative cholangiography. However, adequate training for surgeons unfamiliar with this technology is recommended.
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Affiliation(s)
- T G John
- Department of Surgery, Royal Infirmary, Edinburgh, Scotland, UK
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Abstract
The metabolic response to graded decreases in insulin concentration was evaluated by measuring the concentration, production, and metabolic clearance rate of glucose in response to the infusion of different galanin doses (1-12 micrograms/kg/h) in 18-h fasted dogs. Peripheral and portal concentrations of insulin and glucagon were measured simultaneously before, during, and after galanin infusions. No increases in portal or peripheral glucagon levels were seen at any dose of galanin infused but, in contrast, dose-dependent decreases of insulin levels occurred in both circulations. The metabolic clearance rate of glucose fell by approximately 25-30% at each dose of galanin infused; suggesting that the maximum effect was reached at the lowest dose. The rate of glucose production increased in a dose-dependent manner with integrated responses of 210 +/- 170, 620 +/- 80, 1,330 +/- 440, 1,920 +/- 310, 1,940 +/- 170, and 1,970 +/- 600 mg/kg at galanin doses of 1, 2, 4, 7, 10, and 12 micrograms/kg/h respectively; saturation of this response occurs at the 7 micrograms/kg/h dose of galanin. The changes in glucose production reflect most closely changes in the fractional decrease in insulin levels both in the portal and peripheral circulations. These changes appear to be mediated by insulin acting directly on the liver, because no alterations in the concentrations of the glucogenic substrates, lactate and glycerol, were seen.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- J Radziuk
- Department of Medicine, Ottawa Civic Hospital, Ontario, Canada
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Radziuk J, Pye S, Seigler DE, Skyler JS, Offord R, Davies G. Splanchnic and systemic absorption of intraperitoneal insulin using a new double-tracer method. Am J Physiol 1994; 266:E750-9. [PMID: 7911276 DOI: 10.1152/ajpendo.1994.266.5.e750] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The absorption of a bolus of intraperitoneal insulin into the splanchnic and peripheral circulations was separately assessed in dogs using an infusion of two insulin tracers (A1-[3H]insulin and B1-[3H]insulin). One tracer was infused into the superior mesenteric artery and the second into the jugular vein. Serial samples were taken before and after an injection of insulin (1 U/kg ip). Sampling was from the portal vein and the inferior vena cava. By using the principle of equivalent entry of tracer and unlabeled material, we developed two simultaneous equations for the rate of splanchnic and peripheral insulin absorption at each time point. These were solved to yield the two rates. Mean concentrations in the portal vein were approximately 25% higher than in the inferior vena cava, reflecting the splanchnic absorption. This rate accounted for almost half (51 +/- 9%) of the insulin absorbed. The remainder of the absorption was peripheral. The total recovery of intraperitoneal insulin, absorbed by either route, was 88 +/- 11%. Portal absorption peaked earlier than peripheral. Absorption by both routes was 90% complete within approximately 2 h (131 +/- 16 min). In summary, therefore, intraperitoneal insulin is rapidly and almost completely absorbed, with absorption split between the splanchnic and peripheral routes of entry.
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Affiliation(s)
- J Radziuk
- Department of Medicine, McGill University, Montreal, Quebec, Canada
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Gutierrez P, Pye S, Bancroft J. What does duplex ultrasound add to sexual history, nocturnal penile tumescence and intracavernosal injection of smooth muscle relaxant, in the diagnosis of erectile dysfunction? Int J Impot Res 1993; 5:123-31; discussion 132. [PMID: 8124430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
A consecutive series of 52 men presenting with erectile dysfunction were assessed with (i) standardized sexual history, (ii) nocturnal penile tumescence and rigidity monitoring (NPTR), (iii) Rigiscan assessment of response to intracavernosal papaverine or prostaglandin injection (ICI), and (iv) duplex ultrasonography. Subjects were categorized into 'organic', 'psychogenic' or 'uncertain' on the basis of the first three assessments, and duplex variables compared across the diagnostic groups. Maximum increase in arterial diameter and maximum systolic flow following ICI did not discriminate between groups. End diastolic flow and resistance index at 15 min following ICI was significantly higher in the organic than the psychogenic groups. None of the duplex variables helped to diagnose further those in the 'uncertain' categories. The diagnostic value of the duplex is probably substantially reduced by psychological inhibition of the response to ICI. Duplex ultrasound scanning does not appear to be a helpful initial diagnostic method for erectile dysfunction, but may have value in further identifying the aetiology in 'organic' cases, especially venous leakage. NPTR appears to be the best single diagnostic procedure. Methods of identifying the occurrence of psychological inhibition and 'false negative' results with ICI will enhance the diagnostic value of duplex ultrasonography.
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Affiliation(s)
- P Gutierrez
- Dept. of Surgery, University of La Laguna, Tenerife, Spain
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Pye S, Watarai T, Davies G, Radziuk J. Comparison of the continuously calculated fractional splanchnic extraction of insulin with its fractional disappearance using a new double-tracer technique. Metabolism 1993; 42:145-53. [PMID: 8474310 DOI: 10.1016/0026-0495(93)90028-m] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
These studies were designed to calculate the fractional disappearance rate (FDR) and splanchnic extraction of insulin in response to an exogenous (intraperitoneal) input of insulin. A double-tracer technique using insulin tritiated on both the A1 and B1 positions was introduced for the measurement of hepatic extraction. The A1 tracer, not previously characterized in vivo, was compared in terms of its kinetics with H3-B1-insulin and unlabeled insulin. The metabolic clearance rates (MCR) of the three insulins were identical, as were the decay curves of the two tracers. To measure splanchnic insulin extraction, one tracer was infused systemically to evaluate the FDR of insulin, and the second was infused into the splanchnic circulation (superior mesenteric artery) and its peripheral appearance was calculated. Splanchnic extraction was determined from the difference between this rate of appearance and the rate of infusion of the mesenteric tracer. After intraperitoneal insulin injection, insulin levels increased to peaks of 549 +/- 93 microU/mL (portal vein) and 473 +/- 99 microU/mL (inferior vena cava) and decreased to basal levels over 3 hours. The FDR decreased from 0.295 +/- 0.051 min-1 to 0.125 +/- 0.026 min-1, and splanchnic extraction decreased from 0.534 +/- 0.06 to 0.232 +/- 0.088. The latter returned to near-basal values more rapidly than did the FDR. In conclusion, the kinetics of insulin both in and out of the steady state have been shown to be nonlinear through physiological insulin concentrations.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- S Pye
- Department of Medicine, McGill University, Montreal, Quebec, Ontario, Canada
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Abstract
Glycogen metabolism is a complex process which depends on the metabolic circumstances and the hormonal milieu. In this overview an intriguing new possibility has been emphasized--the possible central role of lactate in coordinating, with glucose, the net synthesis of glycogen. Since lactate changes acutely under many physiological circumstances, it would be a logical candidate for a signal which communicates to the liver the metabolic states of the periphery. It would then acutely determine the synthetic rate of glycogen synthesis within the range determined by the glucose concentrations which in turn could be said to reflect the nutritional state of the system. Interestingly, after oral glucose loading, portal glucose levels would be about 25% higher (Radziuk et al., 1978) relative to arterial. As seen from Figs 8 and 9 however the glycogen synthetic rate appears very sensitive to glucose (at a given lactate uptake). Everything else being assumed equal therefore, more glycogen would be synthesized than during intravenous loading with an equivalent peripheral concentration. This is indeed the case (Shulman and Rossetti, 1989). On the other hand, during equivalent loads, peripheral glucose levels are higher and the same quantity of glycogen is synthesized (Radziuk, 1989a, 1989b). If lactate is typical of other glucogenic substrates, then it is also logical that mixed meals with higher levels of portal substrate would maximize glycogen synthetic rates. Similarly, in diabetes where hyperglycemia and hyperlactatemia prevail, gluconeogenesis plays a predominant role in glycogen synthesis (Giaccari and Rossetti, 1992).(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- J Radziuk
- Diabetes and Metabolism Research Unit, Ottawa Civic Hospital, Canada
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Morishima T, Pye S, Bradshaw C, Radziuk J. Posthepatic rate of appearance of insulin: measurement and validation in the nonsteady state. Am J Physiol 1992; 263:E772-9. [PMID: 1415699 DOI: 10.1152/ajpendo.1992.263.4.e772] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
To assess the accuracy with which insulin appearance rates in the peripheral circulation can be measured out of steady state, seven conscious dogs were simultaneously infused with somatostatin and insulin at known variable rates. Tritiated insulin was infused concurrently at a constant rate. Insulin rates of appearance were estimated continuously on the basis of a two-compartment model for systemic insulin kinetics. The calculations were performed assuming that insulin kinetics were linear (tracer data not used) and nonlinear or time varying (tracer data used to assess the variation). The average error in areas under the curve was -3.5 +/- 2.5 and 27.0 +/- 14.2% when nonlinear or linear kinetics were assumed. The maximal errors when linearity was assumed was 39.9 +/- 11.3% and decreased to 16.3 +/- 2.6% when the tracer data was used to account for changes in the fractional removal rate of insulin. The accuracy of the linear estimates improved as the fractional removal rate remained closer to constant. These data suggest that a priori assumptions should not be made on the linearity of the insulin system in a given experimental situation.
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Affiliation(s)
- T Morishima
- Department of Medicine, Royal Victoria Hospital, Montreal, Quebec, Canada
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Abstract
In order to verify the calculation of nonsteady rates of secretion of C-peptide, dog C-peptide was infused into 5 normal conscious dogs at varying rates. Using the decay curve obtained following a preliminary injection of C-peptide in each animal, concentrations during the infusion, and mathematical deconvolution, the rate of appearance of the C-peptide was calculated. This rate was within 12% of the infusion rates, with 94% of the C-peptide infused recovered in the calculation. The metabolic clearance of C-peptide was calculated to be 10.1 +/- 1.0 ml/min following both its injection and constant infusion. In conclusion, within the limits of the errors determined, C-peptide and therefore insulin secretion can be calculated on a continuous basis under nonsteady-state conditions.
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