ObjectivesTo describe the epidemiology of diagnosed hypermobility spectrum disorder (HSD) and Ehlers-Danlos syndromes (EDS) using linked electronic medical records. To examine whether these conditions remain rare and primarily affect the musculoskeletal system.DesignNationwide linked electronic cohort and nested case–control study.SettingRoutinely collected data from primary care and hospital admissions in Wales, UK.ParticipantsPeople within the primary care or hospital data systems with a coded diagnosis of EDS or joint hypermobility syndrome (JHS) between 1 July 1990 and 30 June 2017.Main outcome measuresCombined prevalence of JHS and EDS in Wales. Additional diagnosis and prescription data in those diagnosed with EDS or JHS compared with matched controls.ResultsWe found 6021 individuals (men: 30%, women: 70%) with a diagnostic code of either EDS or JHS. This gives a diagnosed point prevalence of 194.2 per 100 000 in 2016/2017 or roughly 10 cases in a practice of 5000 patients. There was a pronounced gender difference of 8.5 years (95% CI: 7.70 to 9.22) in the mean age at diagnosis. EDS or JHS was not only associated with high odds for other musculoskeletal diagnoses and drug prescriptions but also with significantly higher odds of a diagnosis in other disease categories (eg, mental health, nervous and digestive systems) and higher odds of a prescription in most disease categories (eg, gastrointestinal and cardiovascular drugs) within the 12 months before and after the first recorded diagnosis.ConclusionsEDS and JHS (since March 2017 classified as EDS or HSD) have historically been considered rare diseases only affecting the musculoskeletal system and soft tissues. These data demonstrate that both these assertions should be reconsidered.

Measurements of tree ring width and relative density have contributed significantly to many of the large‐scale reconstructions of past climatic change, but to extract the climate signal it is first necessary to remove any nonclimatic age‐related trends. This detrending can limit the lower‐frequency climate information that may be extracted from the archive (the “segment length curse”). This paper uses a data set of ring widths, maximum latewood density and stable carbon and oxygen isotopes from 28 annually resolved series of known‐age Pinus sylvestris L. trees in northwestern Norway to test whether stable isotopes in tree rings require an equivalent statistical detrending. Results indicate that stable oxygen and carbon isotope ratios from tree rings whose cambial age exceeds c.50 years exhibit no significant age trends and thus may be used to reconstruct environmental variability and physiological processes at this site without the potential loss of low‐frequency information associated with detrending.

OBJECTIVE: To investigate the risk of emergency respiratory hospital admission during childhood associated with gestational age at birth and growth restriction in utero. METHODS: The study included a total population electronic birth cohort with anonymized record-linkage of multiple health and administrative data sets. Participants were 318 613 children born in Wales, United Kingdom, between May 1, 1998, and December 31, 2008. The main outcome measure was emergency respiratory hospital admissions. RESULTS: The rate of admission in the first year of life ranged from 41.5 per 100 child-years for infants born before 33 weeks’ gestation to 9.8 per 100 child-years for infants born at 40 to 42 weeks’ gestation. The risk of any emergency respiratory admission up to age 5 years increased as gestational age decreased to <40 weeks. Even at 39 weeks’ gestation, there was an increased risk of emergency hospital admissions for respiratory conditions compared with infants born at 40 to 42 weeks (adjusted hazard ratio 1.10; 95% confidence interval 1.08–1.13). Small for gestational age (<10th centile for gestation and gender-specific birth weight) was independently associated with an increased risk of any emergency respiratory admission to hospital (adjusted hazard ratio 1.07; 95% confidence interval 1.04–1.10). CONCLUSIONS: The risk of emergency respiratory admission up to age 5 years decreased with each successive week in gestation up to 40 to 42 weeks. Although the magnitude of increased risk associated with moderate and late preterm births is small, the number of infants affected is large and therefore presents a significant impact on health care services.

Cloud cover currently represents the single greatest source of uncertainty in General Circulation Models. Stable carbon isotope ratios (d 13 C) from treerings, in areas of low moisture stress, are likely to be primarily controlled by photosynthetically active radiation (PAR), and therefore should provide a proxy record for cloud cover or sunshine; indeed this association has previously been demonstrated experimentally for Scots pine in Fennoscandia, with sunlight explaining ca 90% of the variance in photosynthesis and temperature only ca 4%. We present a statistically verifiable 1011-year reconstruction of cloud cover from a well replicated, annuallyresolved d 13 C record from Forfjord in coastal northwestern Norway. This reconstruction exhibits considerable variability in cloud cover over the past millennium, including extended sunny periods during the cool seventeenth and eighteenth centuries and warm cloudy periods during the eleventh, early fifteenth and twentieth centuries. We find that while a generally positive relationship persists between sunshine and temperature at high-frequency, at lower (multi-decadal) frequencies the relationship is more often a negative one, with cool periods being sunny (most notably the Little Ice Age period from 1600 to 1750 CE) and warm periods more cloudy (e.g. the mediaeval and the twentieth century). We conclude that these long-term changes may be caused by changes in the dominant circulation mode, likely to be associated with the Arctic Oscillation. There is also strong circumstantial evidence that prolonged periods of high summer cloud cover, with low PAR and probably high precipitation, may be in part responsible for major European famines caused by crop failures.

United Kingdom (UK) summers dominated by anti-cyclonic circulation patterns are characterised by clear skies, warm temperatures, low precipitation totals, low air humidity and more enriched oxygen isotope ratios ( 18 O) in precipitation. Such conditions usually result in relatively more positive (enriched) oxygen isotope ratios in tree leaf sugars and ultimately in the tree-ring cellulose formed in that year, the converse being true in cooler, wet summers dominated by westerly air flow and cyclonic conditions. There should therefore be a strong link between tree-ring  18 O and the amount of summer precipitation. Stable oxygen isotope ratios from the latewood cellulose of 40 oak trees sampled at eight locations across Great Britain produce a mean  18 O chronology that correlates strongly and significantly with summer indices of total shear vorticity, surface air pressure, and the amount of summer precipitation across the England and Wales region of the United Kingdom. The isotope-based rainfall signal is stronger and much more stable over time than reconstructions based upon oak ring widths. Using recently developed methods that are precise, efficient and highly costeffective it is possible to measure both carbon ( 13 C) and oxygen ( 18 O) isotope ratios simultaneously from the same tree-ring cellulose. In our study region, these two measurements from multiple trees can be used to reconstruct summer temperature ( 13 C) and summer precipitation ( 18 O) with sufficient independence to allow the evolution of these climate parameters to be reconstructed with high levels of confidence. The existence of long, well-replicated oak tree-ring chronologies across the British Isles mean that it should now be possible to reconstruct both summer temperature and precipitation over many centuries and potentially millennia.