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Liverpool, United Kingdom

Tacutu R.,University of Liverpool | Craig T.,University of Liverpool | Budovsky A.,Ben - Gurion University of the Negev | Budovsky A.,Regional Development Centre | And 6 more authors.
Nucleic Acids Research | Year: 2013

The Human Ageing Genomic Resources (HAGR, http://genomics.senescence.info) is a freely available online collection of research databases and tools for the biology and genetics of ageing. HAGR features now several databases with high-quality manually curated data: (i) GenAge, a database of genes associated with ageing in humans and model organisms; (ii) AnAge, an extensive collection of longevity records and complementary traits for >4000 vertebrate species; and (iii) GenDR, a newly incorporated database, containing both gene mutations that interfere with dietary restriction-mediated lifespan extension and consistent gene expression changes induced by dietary restriction. Since its creation about 10 years ago, major efforts have been undertaken to maintain the quality of data in HAGR, while further continuing to develop, improve and extend it. This article briefly describes the content of HAGR and details the major updates since its previous publications, in terms of both structure and content. The completely redesigned interface, more intuitive and more integrative of HAGR resources, is also presented. Altogether, we hope that through its improvements, the current version of HAGR will continue to provide users with the most comprehensive and accessible resources available today in the field of biogerontology. © The Author(s) 2012.

Morgan C.,Liverpool Womens Hospital
Early Human Development | Year: 2015

Preterm hyperglycaemia in the first 2. weeks of life is common under 29. weeks gestation and is associated with increased mortality and morbidity. While the definition of hyperglycaemia is reasonably consistent (>. 8. mmol/L) the treatment threshold varies widely in clinical practice. Insulin therapy is the most common approach despite international guidance urging caution because of hypoglycaemia. Significant hypoglycaemia is unusual outside studies targeting normoglycaemia. Insulin treatment also forms part of a nutritional strategy aiming to optimise early protein and energy intake so minimising the risk of preterm postnatal growth failure. Early parenteral amino acids also improve blood glucose control. There is some evidence of improved postnatal head growth with this approach but longer term neurodevelopmental studies are required. Glucose reduction is the alternative approach. This compromises early nutritional intake but avoids the potential for long-term cardiovascular and metabolic complications linked with high postnatal nutritional intakes and theoretically, insulin treatment. © 2015 Elsevier Ireland Ltd.

McNamara H.,Liverpool Womens Hospital | Barclay P.,Liverpool Womens Hospital | Sharma V.,University of Liverpool
British journal of anaesthesia | Year: 2014

Cardiac output (CO) monitoring is helpful in the assessment of critically ill pregnant women, but invasive monitors are often unsuitable for use. We aimed to measure agreement between the non-invasive ultrasound cardiac output monitor (USCOM) and three-dimensional transthoracic echocardiography (3D-TTE) in pregnant women. Healthy pregnant women from 25 weeks gestation onwards participated. In the left lateral position at rest, CO was measured with the USCOM and 3D-TTE. A single operator performed all USCOM measurements, with a different operator performing all echocardiography. Both were blinded to results from the other device. Each USCOM trace was analysed using two modes: flowtrace (FT) and touchpoint (TP). A second, blinded USCOM reading was taken to assess reproducibility. USCOM readings were obtained in 92, and 3D-TTE images in 85 participants. The mean CO was 5.7, 7.7, and 6.2 litre min(-1) measured by 3D-TTE, USCOM FT, and USCOM TP, respectively. USCOM bias was +2.0 litre min(-1) (FT) and +0.4 litre min(-1) (TP). Limits of agreement were -0.2 to +4.2 litre min(-1) (FT) and -1.4 to +2.3 litre min(-1) (TP). The mean percentage difference was 32.6% (FT) and 31.4% (TP) for CO and 27.0% (FT) and 27.5% (TP) for stroke volume. Intraclass correlation between repeated USCOM readings was 0.9 (FT) and 0.86 (TP). USCOM has acceptable agreement with 3D-TTE for the measurement of CO in pregnancy. The positive bias of the USCOM, particularly in the FT mode, may be due to the hyperdynamic cardiovascular state in pregnancy. We suggest using the TP mode in this patient population. © The Author 2014. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Sharp A.N.,Liverpool Womens Hospital | Alfirevic Z.,Liverpool Womens Hospital
BJOG: An International Journal of Obstetrics and Gynaecology | Year: 2014

Objective: To identify the current status of specialist preterm labour (PTL) clinic provision and management within the UK. Design: Postal survey of clinical practice. Setting: UK Population: All consultant-led obstetric units within the UK. Methods: A questionnaire was sent by post to all 210 NHS consultant-led obstetric units within the UK. Units that had a specialist PTL clinic were asked to complete a further 20 questions defining their protocol for risk stratification and management. Main outcome measures: Current practice in specialist preterm labour clinics. Results: We have identified 23 specialist clinics; the most common indications for attendance were previous PTL (100%), preterm prelabour rupture of membranes (95%), two large loop excisions of the transformation zone (95%) or cone biopsy (95%). There was significant heterogeneity in the indications for and method of primary treatment for short cervix, with cervical cerclage used in 45% of units, progesterone in 18% of units and Arabin cervical pessary in 5%. A further 23% used multiple treatment modalities in combination. Conclusions: A significant heterogeneity in all topics surveyed suggests an urgent need for networking, more evidence-based guidelines and prospective comparative audits to ascertain the real impact of specialist PTL clinics on the reduction in preterm birth and its sequelae. © 2013 Royal College of Obstetricians and Gynaecologists.

Singaravelu S.,Liverpool Womens Hospital | Barclay P.,Liverpool Womens Hospital
British Journal of Anaesthesia | Year: 2013

BackgroundAutomated control of end-tidal inhalation anaesthetic concentration is now possible. The EtControl™ module of an Aisys Carestation Anaesthetic machine digitally adjusts fresh gas flow and plenum vaporizer output to achieve a target end-tidal concentration.MethodsWe evaluated EtControl in clinical practice by measuring volatile agent consumption and the need for user input. We compared these values with contemporaneous controls using manual control of fresh gas flow rates.ResultsA total of 321 patients were anaesthetized with EtControl and 168 with manual control of fresh gas flow. The mean [95% confidence interval (CI)] sevoflurane usage for cases of 20-40 min duration was 14 (13-16) ml h-1 with EtControl and 30 (26-35) ml h-1 with manual control. For cases of the same duration, the mean (95% CI) desflurane consumption was 27 (21-33) ml h-1 with EtControl and 45 (29-62) ml h-1 with manual control. The average number of keypresses per case was 6.5 with EtControl and 13.6 during manual control of fresh gas flow.ConclusionsAutomatic implementation of low-flow anaesthesia using EtControl allows the user to set and maintain a desired end-tidal volatile concentration while using less volatile agent. © 2013 © The Author [2013]. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

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