Objective
Conflicting data have led to controversy regarding antidepressant use during pregnancy. The objectives of this study are to i) review the risks of untreated depression and anxiety, ii) ...review the literature on risks of exposure to antidepressants during pregnancy, iii) discuss the strengths and weaknesses of the different study designs used to evaluate those risks, and iv) provide clinical recommendations.
Method
MEDLINE/PubMed was searched for reports and studies on the risk of first‐trimester teratogenicity, postnatal adaptation syndrome (PNAS), and persistent pulmonary hypertension (PPHN) with in utero antidepressant exposure.
Results
While some individual studies suggest associations between some specific major malformations, the findings are inconsistent. Therefore, the absolute risks appear small. PNAS occurs in up to 30% of neonates exposed to antidepressants. In some studies, PPHN has been weakly associated with in utero antidepressant exposure, while in other studies, there has been no association.
Conclusion
Exposures of concern include that of untreated maternal illness as well as medication exposure. It is vital to have a careful discussion, tailored to each patient, which incorporates the evidence to date and considers methodological and statistical limitations. Past medication trials, previous success with symptom remission, and women's preference should guide treatment decisions.
Global aviation operations contribute to anthropogenic climate change via a complex set of processes that lead to a net surface warming. Of importance are aviation emissions of carbon dioxide (CO2), ...nitrogen oxides (NOx), water vapor, soot and sulfate aerosols, and increased cloudiness due to contrail formation. Aviation grew strongly over the past decades (1960–2018) in terms of activity, with revenue passenger kilometers increasing from 109 to 8269 billion km yr−1, and in terms of climate change impacts, with CO2 emissions increasing by a factor of 6.8 to 1034 Tg CO2 yr−1. Over the period 2013–2018, the growth rates in both terms show a marked increase. Here, we present a new comprehensive and quantitative approach for evaluating aviation climate forcing terms. Both radiative forcing (RF) and effective radiative forcing (ERF) terms and their sums are calculated for the years 2000–2018. Contrail cirrus, consisting of linear contrails and the cirrus cloudiness arising from them, yields the largest positive net (warming) ERF term followed by CO2 and NOx emissions. The formation and emission of sulfate aerosol yields a negative (cooling) term. The mean contrail cirrus ERF/RF ratio of 0.42 indicates that contrail cirrus is less effective in surface warming than other terms. For 2018 the net aviation ERF is +100.9 milliwatts (mW) m−2 (5–95% likelihood range of (55, 145)) with major contributions from contrail cirrus (57.4 mW m−2), CO2 (34.3 mW m−2), and NOx (17.5 mW m−2). Non-CO2 terms sum to yield a net positive (warming) ERF that accounts for more than half (66%) of the aviation net ERF in 2018. Using normalization to aviation fuel use, the contribution of global aviation in 2011 was calculated to be 3.5 (4.0, 3.4) % of the net anthropogenic ERF of 2290 (1130, 3330) mW m−2. Uncertainty distributions (5%, 95%) show that non-CO2 forcing terms contribute about 8 times more than CO2 to the uncertainty in the aviation net ERF in 2018. The best estimates of the ERFs from aviation aerosol-cloud interactions for soot and sulfate remain undetermined. CO2-warming-equivalent emissions based on global warming potentials (GWP* method) indicate that aviation emissions are currently warming the climate at approximately three times the rate of that associated with aviation CO2 emissions alone. CO2 and NOx aviation emissions and cloud effects remain a continued focus of anthropogenic climate change research and policy discussions.
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•Global aviation warms Earth's surface through both CO2 and net non-CO2 contributions.•Global aviation contributes a few percent to anthropogenic radiative forcing.•Non-CO2 impacts comprise about 2/3 of the net radiative forcing.•Comprehensive and quantitative calculations of aviation effects are presented.•Data are made available to analyze past, present and future aviation climate forcing.
New technologies have vastly increased the available data on animal movement and behaviour. Consequently, new methods deciphering the spatial and temporal interactions between individuals and their ...environments are vital. Network analyses offer a powerful suite of tools to disentangle the complexity within these dynamic systems, and we review these tools, their application, and how they have generated new ecological and behavioural insights. We suggest that network theory can be used to model and predict the influence of ecological and environmental parameters on animal movement, focusing on spatial and social connectivity, with fundamental implications for conservation. Refining how we construct and randomise spatial networks at different temporal scales will help to establish network theory as a prominent, hypothesis-generating tool in movement ecology.
Network theory is developing in its application across multiple disciplines.
Animal movement networks can reveal important insight about ecological connectivity.
Further development is necessary to fully encapsulate temporal dynamics.
We discuss using network metrics to understand spatial and social ecology.
There is a need to increase access to surgical treatments in African countries, but perioperative complications represent a major global health-care burden. There are few studies describing surgical ...outcomes in Africa.
We did a 7-day, international, prospective, observational cohort study of patients aged 18 years and older undergoing any inpatient surgery in 25 countries in Africa (the African Surgical Outcomes Study). We aimed to recruit as many hospitals as possible using a convenience sampling survey, and required data from at least ten hospitals per country (or half the surgical centres if there were fewer than ten hospitals) and data for at least 90% of eligible patients from each site. Each country selected one recruitment week between February and May, 2016. The primary outcome was in-hospital postoperative complications, assessed according to predefined criteria and graded as mild, moderate, or severe. Data were presented as median (IQR), mean (SD), or n (%), and compared using t tests. This study is registered on the South African National Health Research Database (KZ_2015RP7_22) and ClinicalTrials.gov (NCT03044899).
We recruited 11 422 patients (median 29 IQR 10–70) from 247 hospitals during the national cohort weeks. Hospitals served a median population of 810 000 people (IQR 200 000–2 000 000), with a combined number of specialist surgeons, obstetricians, and anaesthetists totalling 0·7 (0·2–1·9) per 100 000 population. Hospitals did a median of 212 (IQR 65–578) surgical procedures per 100 000 population each year. Patients were younger (mean age 38·5 years SD 16·1), with a lower risk profile (American Society of Anesthesiologists median score 1 IQR 1–2) than reported in high-income countries. 1253 (11%) patients were infected with HIV, 6504 procedures (57%) were urgent or emergent, and the most common procedure was caesarean delivery (3792 patients, 33%). Postoperative complications occurred in 1977 (18·2%, 95% CI 17·4–18·9) of 10 885 patients. 239 (2·1%) of 11 193 patients died, 225 (94·1%) after the day of surgery. Infection was the most common complication (1156 10·2% of 10 970 patients), of whom 112 (9·7%) died.
Despite a low-risk profile and few postoperative complications, patients in Africa were twice as likely to die after surgery when compared with the global average for postoperative deaths. Initiatives to increase access to surgical treatments in Africa therefore should be coupled with improved surveillance for deteriorating physiology in patients who develop postoperative complications, and the resources necessary to achieve this objective.
Medical Research Council of South Africa.
Measurements of ionospheric flow vorticity can be used for studying ionospheric plasma transport processes, such as convection and turbulence, over a wide range of spatial scales. Here, we analyze ...probability density functions (PDFs) of ionospheric vorticity for selected regions of the northern hemisphere high‐latitude ionosphere as measured by the Super Dual Auroral Radar Network over a 6‐year interval (2000–2005 inclusive). Subdividing these PDFs for opposite polarities of the By component of the prevailing interplanetary magnetic field allows the separation into two distinct components: (a) A single‐sided Weibull distribution which relates to the large‐scale convection driven by magnetic reconnection; (b) A double‐sided and symmetric q‐exponential distribution which arises from meso‐scale plasma flow related to processes such as turbulence.
Plain Language Summary
This study investigates the processes that contribute to the vorticity of the flow of ionized gases (plasma) in the Earth's ionosphere (at an altitude of ∼250–400 km). Vorticity is a measure of how straight or curved this flow of plasma is at a particular location. We show that the measured probability distributions of ionospheric vorticity at high‐latitude locations can be explained as a combination of vorticity inherent in the large‐scale ionospheric plasma flow pattern driven by variations in the solar wind (plasma and magnetic field ejected by the Sun), and vorticity resulting from meso‐scale fluid processes such as turbulence. Being able to model ionospheric vorticity in this way helps to improve models of the ionospheric flow process, which are often key components of larger operational space weather models.
Key Points
Subdividing ionospheric vorticity probability density functions by the interplanetary magnetic field By direction allows their separation into large‐scale and meso‐scale components
The large‐scale vorticity relates predominantly to convection and the meso‐scale vorticity to processes such as turbulence
Models of ionospheric plasma flow need to incorporate the effects of meso‐scale processes such as turbulence
Measurements of vorticity in the Earth's ionosphere enable the characterization of turbulent structure in the ionospheric plasma flow and how it varies spatially in relation to large‐scale magnetic ...field‐aligned current (FAC) systems. We have determined the spatial variation of the probability density function (PDF) of ionospheric vorticity measurements made by the Super Dual Auroral Radar Network (SuperDARN) across the northern polar ionosphere for the 6‐year interval 2000–2005 inclusive. These PDFs are highly leptokurtic, with heavy tails, and are well‐modeled by Tsallis q‐exponential probability distributions. The parameters of the model q‐exponential distributions have been determined using maximum likelihood estimation, resulting in a statistical model of ionospheric vorticity that covers the polar ionosphere. The spatial variation of the model parameters is highly variable, with the shape and scale of the model distributions varying systematically in relation to the well‐known FAC regions, showing that FACs have a major influence on the character of ionospheric plasma vorticity. From the model distributions, we estimate the probability of observing extreme vorticity values with the SuperDARN radars (beyond thresholds of 5, 10, 20, and 40 mHz) across the northern polar ionosphere.
Plain Language Summary
The term space weather defines the day‐to‐day variability of physical processes at the edges of the Earth's atmosphere and in the space environment. As with extreme meteorological weather in the lower atmosphere, it is important to understand the probability of occurrence of instances of extreme space weather. One way that this can be achieved is by using space weather observations to develop models of the probability of occurrence of space weather events of different intensity. Here, we specifically study the vorticity of the flow of ionized gases (plasma) in the Earth's ionosphere (located at an altitude of 250–400 km). Vorticity is a measure of how straight or curved this flow of plasma is at a given location, and its intensity is closely related to turbulence within the ionospheric environment. By making multiple measurements of vorticity across different locations in the high‐latitude ionosphere, we can model the probability distributions of vorticity at a range of locations. The probability of observing extreme values of vorticity can then be estimated from these model distributions, allowing us to quantify the likelihood of extreme space weather.
Key Points
Measurements of ionospheric vorticity enable the study of ionospheric turbulence
Probability density functions (PDFs) of ionospheric vorticity are highly leptokurtic
Modeling the PDFs of vorticity allows the estimation of the probability of extreme vorticity
Purpose
The average adult stands approximately 50–60 times per day. Cardiovascular responses evoked during the first 3 min of active standing provide a simple means to clinically assess short-term ...neural and cardiovascular function across the lifespan. Clinically, this response is used to identify the haemodynamic correlates of patient symptoms and attributable causes of (pre-)syncope, and to detect autonomic dysfunction, variants of orthostatic hypotension, postural orthostatic tachycardia syndrome and orthostatic hypertension.
Methods
This paper provides a set of experience/expertise-based recommendations detailing current state-of-the-art measurement and analysis approaches for the active stand test, focusing on beat-to-beat BP technologies. This information is targeted at those interested in performing and interpreting the active stand test to current international standards.
Results
This paper presents a practical step-by-step guide on (1) how to perform active stand measurements using beat-to-beat continuous blood pressure measurement technologies, (2) how to conduct an analysis of the active stand response and (3) how to identify the spectrum of abnormal blood pressure and heart rate responses which are of clinical interest.
Conclusion
Impairments in neurocardiovascular control are an attributable cause of falls and syncope across the lifespan. The simple active stand test provides the clinician with a powerful tool for assessing individuals at risk of such common disorders. However, its simplicity belies the complexity of its interpretation. Care must therefore be taken in administering and interpreting the test in order to maximise its clinical benefit and minimise its misinterpretation.
Nonimmunological connective tissue phenotypes in humans are common among some congenital and acquired allergic diseases. Several of these congenital disorders have been associated with either ...increased TGF-β activity or impaired STAT3 activation, suggesting that these pathways might intersect and that their disruption may contribute to atopy. In this study, we show that STAT3 negatively regulates TGF-β signaling via ERBB2-interacting protein (ERBIN), a SMAD anchor for receptor activation and SMAD2/3 binding protein. Individuals with dominant-negative
mutations (
) or a loss-of-function mutation in
(
) have evidence of deregulated TGF-β signaling with increased regulatory T cells and total FOXP3 expression. These naturally occurring mutations, recapitulated in vitro, impair STAT3-ERBIN-SMAD2/3 complex formation and fail to constrain nuclear pSMAD2/3 in response to TGF-β. In turn, cell-intrinsic deregulation of TGF-β signaling is associated with increased functional IL-4Rα expression on naive lymphocytes and can induce expression and activation of the IL-4/IL-4Rα/GATA3 axis in vitro. These findings link increased TGF-β pathway activation in
and
patient lymphocytes with increased T helper type 2 cytokine expression and elevated IgE.
We present a new quantitative technique that determines the times and durations of substorm expansion and recovery phases and possible growth phases based on percentiles of the rate of change of ...auroral electrojet indices. By being able to prescribe different percentile values, we can determine the onset and duration of substorm phases for smaller or larger variations of the auroral index or indeed any auroral zone ground‐based magnetometer data. We apply this technique to the SuperMAG AL (SML) index and compare our expansion phase onset times with previous lists of substorm onsets. We find that more than 50% of events in previous lists occur within 20 min of our identified onsets. We also present a comparison of superposed epoch analyses of SML based on our onsets identified by our technique and existing onset lists and find that the general characteristics of the substorm bay are comparable. By prescribing user‐defined thresholds, this automated, quantitative technique represents an improvement over any visual identification of substorm onsets or indeed any fixed threshold method.
Key Points
Identifies substorm expansion, recovery, and possible growth phases from magnetic indices
Phases identified from percentiles of the index rate change not fixed values
Technique provides greater information about substorms than existing lists
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