Postpartum hemorrhage (PPH) is a major cause of maternal mortality and morbidity worldwide. Several recent publications have noted an increasing trend in incidence over time. The international PPH ...collaboration was convened to explore the observed trends and to set out actions to address the factors identified.
We reviewed available data sources on the incidence of PPH over time in Australia, Belgium, Canada, France, the United Kingdom and the USA. Where information was available, the incidence of PPH was stratified by cause.
We observed an increasing trend in PPH, using heterogeneous definitions, in Australia, Canada, the UK and the USA. The observed increase in PPH in Australia, Canada and the USA was limited solely to immediate/atonic PPH. We noted increasing rates of severe adverse outcomes due to hemorrhage in Australia, Canada, the UK and the USA.
Key Recommendations 1. Future revisions of the International Classification of Diseases should include separate codes for atonic PPH and PPH immediately following childbirth that is due to other causes. Also, additional codes are required for placenta accreta/percreta/increta. 2. Definitions of PPH should be unified; further research is required to investigate how definitions are applied in practice to the coding of data. 3. Additional improvement in the collection of data concerning PPH is required, specifically including a measure of severity. 4. Further research is required to determine whether an increased rate of reported PPH is also observed in other countries, and to further investigate potential risk factors including increased duration of labor, obesity and changes in second and third stage management practice. 5. Training should be provided to all staff involved in maternity care concerning assessment of blood loss and the monitoring of women after childbirth. This is key to reducing the severity of PPH and preventing any adverse outcomes. 6. Clinicians should be more vigilant given the possibility that the frequency and severity of PPH has in fact increased. This applies particularly to small hospitals with relatively few deliveries where management protocols may not be defined adequately and drugs or equipment may not be on hand to deal with unexpected severe PPH.
The capacity for using external cues to guide behavior ("cue detection") constitutes an essential aspect of attention and goal-directed behavior. The cortical cholinergic input system, via phasic ...increases in prefrontal acetylcholine release, plays an essential role in attention by mediating such cue detection. However, the relationship between cholinergic signaling during cue detection and neural activity dynamics in prefrontal networks remains unclear. Here we combined subsecond measures of cholinergic signaling, neurophysiological recordings, and cholinergic receptor blockade to delineate the cholinergic contributions to prefrontal oscillations during cue detection in rats. We first confirmed that detected cues evoke phasic acetylcholine release. These cholinergic signals were coincident with increased neuronal synchrony across several frequency bands and the emergence of theta-gamma coupling. Muscarinic and nicotinic cholinergic receptors both contributed specifically to gamma synchrony evoked by detected cues, but the effects of blocking the two receptor subtypes were dissociable. Blocking nicotinic receptors primarily attenuated high-gamma oscillations occurring during the earliest phases of the cue detection process, while muscarinic (M1) receptor activity was preferentially involved in the transition from high to low gamma power that followed and corresponded to the mobilization of networks involved in cue-guided decision making. Detected cues also promoted coupling between gamma and theta oscillations, and both nicotinic and muscarinic receptor activity contributed to this process. These results indicate that acetylcholine release coordinates neural oscillations during the process of cue detection.
The capacity of learned cues to direct attention and guide responding ("cue detection") is a key component of goal-directed behavior. Rhythmic neural activity and increases in acetylcholine release in the prefrontal cortex contribute to this process; however, the relationship between these neuronal mechanisms is not well understood. Using a combination of
neurochemistry, neurophysiology, and pharmacological methods, we demonstrate that cue-evoked acetylcholine release, through distinct actions at both nicotinic and muscarinic receptors, triggers a procession of neural oscillations that map onto the multiple stages of cue detection. Our data offer new insights into cholinergic function by revealing the temporally orchestrated changes in prefrontal network synchrony modulated by acetylcholine release during cue detection.
Abstract Proton pump inhibitors (PPIs) are among the most widely prescribed medications worldwide. Their use has resulted in dramatic improvements in treatment of peptic ulcer disease and ...gastroesophageal reflux disease. Despite an acceptable safety profile, mounting data demonstrate concerns about the long-term use of PPIs. To provide a comprehensive review regarding the concerns of long-term PPI use, a literature search was performed to identify pertinent original and review articles. Despite study shortcomings, the collective body of information overwhelmingly suggests an increased risk of infectious complications and nutritional deficiencies. Data regarding any increased risk in gastric or colon malignancy are less convincing. PPIs have revolutionized the management and complications of acid-related disorders with a high margin of safety; however, with the data available, efforts to reduce the dosing of or discontinue the use of PPIs must be reassessed frequently.
Non-invasive recording in untethered animals is arguably the ultimate step in the analysis of neuronal function, but such recordings remain elusive. To address this problem, we devised a system that ...tracks neuron-sized fluorescent targets in real time. The system can be used to create virtual environments by optogenetic activation of sensory neurons, or to image activity in identified neurons at high magnification. By recording activity in neurons of freely moving C. elegans, we tested the long-standing hypothesis that forward and reverse locomotion are generated by distinct neuronal circuits. Surprisingly, we found motor neurons that are active during both types of locomotion, suggesting a new model of locomotion control in C. elegans. These results emphasize the importance of recording neuronal activity in freely moving animals and significantly expand the potential of imaging techniques by providing a mean to stabilize fluorescent targets.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
We investigate the response of surface temperature persistence, quantified using a lagged autocorrelation, to imposed Arctic sea‐ice loss in coupled model experiments. Sea‐ice loss causes increases ...in persistence over ocean in midlatitudes and the low‐Arctic, which are of a similar magnitude to the total response to climate change in these regions. Using an idealized model, we show that sea‐ice loss induces a slowing of meridional wind anomalies, which can drive the midlatitude persistence increase obtained in coupled models. Sea‐ice loss should induce persistence increases in the Arctic, through its effect on the surface heat capacity. However, in coupled models with imposed sea‐ice loss, persistence increase in the Arctic is essentially absent. We suggest that methods used to constrain sea‐ice in coupled models may spuriously reduce the effects of sea‐ice loss on persistence.
Plain Language Summary
It has been suggested that Arctic sea‐ice loss is driving an increase in extreme weather events in Northern Hemisphere midlatitudes. We discuss two routes through which Arctic sea‐ice loss can increase the persistence of weather in the Arctic and midlatitudes. First, sea‐ice loss increases the thermal inertia of the surface by exposing open ocean, which has a higher heat capacity, potentially leading to persistence increases in the Arctic. Second, sea‐ice loss drives changes in atmospheric circulation, which may affect surface temperature variability. We analyze climate model experiments where sea‐ice loss is artificially induced, in the absence of other climate forcings, to investigate whether either of these routes leads to an appreciable change in the persistence of surface weather. We find sea‐ice loss causes modest increases in persistence in midlatitudes, with the most significant changes occurring over ocean regions. Unexpectedly, we do not identify an increase in Arctic persistence in these experiments, even though this response is easily identifiable in experiments driven by greenhouse gas emissions. Using a simplified climate model, we show that underestimating the persistence response may be an unintended side‐effect of the methods used to isolate the effect of sea‐ice loss in climate models.
Key Points
Arctic sea‐ice loss drives local increases in persistence by reducing the effective heat capacity of the surface
Persistence in midlatitudes increases due to changes in the forcing of surface temperature variability by atmospheric circulation
The effect of sea‐ice loss on persistence may be underestimated in comprehensive models with constrained sea‐ice
Alemtuzumab is a humanized monoclonal antibody against CD52, an antigen found on the surface of normal and malignant lymphocytes. It is approved for the treatment of B-cell chronic lymphocytic ...leukaemia and is undergoing Phase III clinical trials for the treatment of multiple sclerosis. The exact mechanism by which alemtuzumab mediates its biological effects in vivo is not clearly defined and mechanism of action studies have been hampered by the lack of cross-reactivity between human and mouse CD52. To address this issue, a transgenic mouse expressing human CD52 (hCD52) was created. Transgenic mice did not display any phenotypic abnormalities and were able to mount normal immune responses. The tissue distribution of hCD52 and the level of expression by various immune cell populations were comparable to those seen in humans. Treatment with alemtuzumab replicated the transient increase in serum cytokines and depletion of peripheral blood lymphocytes observed in humans. Lymphocyte depletion was not as profound in lymphoid organs, providing a possible explanation for the relatively low incidence of infection in alemtuzumab-treated patients. Interestingly, both lymphocyte depletion and cytokine induction by alemtuzumab were largely independent of complement and appeared to be mediated by neutrophils and natural killer cells because removal of these populations with antibodies to Gr-1 or asialo-GM-1, respectively, strongly inhibited the activity of alemtuzumab whereas removal of complement by treatment with cobra venom factor had no impact. The hCD52 transgenic mouse appears to be a useful model and has provided evidence for the previously uncharacterized involvement of neutrophils in the activity of alemtuzumab.
The recent upsurge in "brain training and perceptual-cognitive training," proposing to improve isolated processes, such as brain function, visual perception, and decision-making, has created ...significant interest in elite sports practitioners, seeking to create an "edge" for athletes. The claims of these related "performance-enhancing industries" can be considered together as part of a
proposing enhanced cognitive and perceptual skills and brain capacity to support performance in everyday life activities, including sport. For example, the "process training industry" promotes the idea that playing games not only makes you a better player but also makes you smarter, more alert, and a faster learner. In this position paper, we critically evaluate the effectiveness of both types of process training programmes in generalizing transfer to sport performance. These issues are addressed in three stages. First, we evaluate empirical evidence in support of perceptual-cognitive process training and its application to enhancing sport performance. Second, we critically review putative modularized mechanisms underpinning this kind of training, addressing limitations and subsequent problems. Specifically, we consider merits of this highly specific form of training, which focuses on training of isolated processes such as cognitive processes (attention, memory, thinking) and visual perception processes, separately from performance behaviors and actions. We conclude that these approaches may, at best, provide some "general transfer" of underlying processes to specific sport environments, but lack "specificity of transfer" to contextualize actual performance behaviors. A major weakness of process training methods is their focus on enhancing the performance in body "modules" (e.g., eye, brain, memory, anticipatory sub-systems). What is lacking is evidence on
these isolated components are modified and subsequently interact with other process "modules," which are considered to underlie sport performance. Finally, we propose how an ecological dynamics approach, aligned with an embodied framework of cognition undermines the rationale that modularized processes can enhance performance in competitive sport. An ecological dynamics perspective proposes that the body is a complex adaptive system, interacting with performance environments in a functionally integrated manner, emphasizing that the inter-relation between motor processes, cognitive and perceptual functions, and the constraints of a sport task is best understood at the performer-environment scale of analysis.
Diffuse pollution remains a major threat to surface waters due to eutrophication caused by phosphorus (P) transfer from agricultural land. Vegetated buffer strips (VBSs) are increasingly used to ...mitigate diffuse P losses from agricultural land, having been shown to reduce particulate P transfer. However, retention of dissolved P (DP) has been lower, and in some cases VBSs have increased delivery to surface waters. The aims of this review were (i) to develop a conceptual model to enhance the understanding of VBS functioning in terms of DP, (ii) to identify key processes within the model that affect DP retention and delivery, and (iii) to explore evidence for the controls on these processes. A greater understanding in these areas will allow the development of management strategies that enhance DP retention. We found evidence of a surface layer in buffer strip soils that is enriched in soluble P compared with adjacent agricultural land and may be responsible for the reported increased DP delivery. Through increased biological activity in VBSs, plants and microorganisms may assimilate P from particulates retained in the VBSs or native soil P and remobilize this P in a more soluble form. These conclusions are based on a limited amount of research, and a better understanding of biogeochemical cycling of P in buffer strip soils is required.
●The potential of PES schemes to improve water quality varies spatially.●This study presents a flexible approach to mapping this variation at national scale.●The approach uses multi-criteria ...analysis, with supply and demand as key criteria.●When applied to England, it was used to identify areas of high potential for PES.●This should motivate further research into PES at the individual catchment level.
Payments for Ecosystem Services (PES) schemes are an increasingly popular form of catchment management for improving surface water and groundwater quality. In these schemes, downstream water users who are impacted by agricultural diffuse pollution incentivise upstream farmers to adopt better practices. However, this type of scheme will not be successful in all situations, in part, due to a lack of potential for agriculture to improve the suuply of good water quality and/or a lack in demand from downstream users for good water quality. As such, this study aims to present a flexible approach to mapping the potential for PES schemes to improve water quality in agricultural catchments. The approach is based on multi-criteria analysis, with supply and demand as key criteria. It uses expert judgement or current guidance on PES to select supply and demand sub-criteria, expert judgement to weight all criteria through pairwise comparisons and readily available, national datasets to indicate criteria. Once indicator data are normalized, it combines them in a weighted sums analysis and presents results spatially at the national scale, all within a geographical information system. The approach can easily be applied to the country or region of interest by using locally relevant criteria, expert judgement and data. For example, when applied to the situation for river waterbodies in England, supply sub-criteria were the contribution of agriculture to loads of the major pollutants (nitrogen, phosphorus and sediments) and demand sub-criteria were the different downstream water users present (water companies and, tourist and local recreational users). Experts assigned equal weight to supply and demand criteria and the highest weights to sediments and water companies for sub-criteria, respectively. When national scale datasets to indicate these criteria were combined in a weighted sums analysis, it was possible to identify areas of high potential for PES. This would hopefully motivate more detailed research at the individual catchment level into the constraints in linking supply and demand. Three case-study schemes were also examined to show how some of these constraints are being identified and overcome. As such, the approach forms the first tier in a two-tier framework for establishing PES schemes to improve water quality in agricultural catchments.
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Physical literacy is creating significant interest worldwide due to its holistic nature and the potential it has to impact on people's lives. It is underpinning many physical education programs, ...coaching strategies, health initiatives, and policymakers' decisions. However, the complex philosophical and holistic nature of the concept has meant that methods used to chart/assess/measure progress have been very much dependent on the pedagogues interpretation of the concept. This paper will provide a review of current practices and issues related to charting/assessing/measuring progress of an individual's journey. It will go on to highlight considerations that, we suggest, should be made by any organization developing methods to chart/assess/measure progress.
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