91 research outputs found
Association of labor induction with offspring risk of autism spectrum disorders
IMPORTANCE: Induction of labor is a frequently performed obstetrical
intervention. It would thus be of great concern if reported associations between
labor induction and offspring risk of autism spectrum disorders (ASD) reflected
causal influence. OBJECTIVE: To assess the associations of labor induction with
ASD, comparing differentially exposed relatives (siblings and cousins discordant
for induction). DESIGN, SETTING, AND PARTICIPANTS: Follow-up of all live births
in Sweden between 1992 and 2005, defined in the Medical Birth Register. The
register was linked to population registers of familial relations, inpatient and
outpatient visits, and education records. Diagnoses of ASD were from 2001 through
2013, and data were analyzed in the 2015-2016 year. EXPOSURES: Induction of
labor. MAIN OUTCOMES AND MEASURES: Autism spectrum disorders identified by
diagnoses from inpatient and outpatient records between 2001 and 2013. Hazard
ratios (HRs) quantified the association between labor induction and offspring
ASD. In addition to considering a wide range of measured confounders, comparison
of exposure-discordant births to the same woman allowed additional control for
all unmeasured factors shared by siblings. RESULTS: The full cohort included
1362950 births, of which 22077 offspring (1.6%) were diagnosed with ASD by ages 8
years through 21 years. In conventional models of the full cohort, associations
between labor induction and offspring ASD were attenuated but remained
statistically significant after adjustment for measured potential confounders
(HR, 1.19; 95% CI, 1.13-1.24). When comparison was made within siblings whose
births were discordant with respect to induction, thus accounting for all
environmental and genetic factors shared by siblings, labor induction was no
longer associated with offspring ASD (HR, 0.99; 95% CI, 0.88-1.10). CONCLUSIONS
AND RELEVANCE: In this nationwide sample of live births we observed no
association between induction of labor and offspring ASD within sibling
comparison. Our findings suggest that concern for ASD should not factor into the
clinical decision about whether to induce labor.NonePublishe
Antipsychotic drug use in pregnancy: A multinational study from ten countries
Aim: To compare the prevalence and trends of antipsychotic drug use during pregnancy between countries across
four continents.
Methods: Individually linked health data in Denmark (2000−2012), Finland (2005–2014), Iceland (2004–2017),
Norway (2005–2015), Sweden (2006–2015), Germany (2006–2015), Australia (New South Wales, 2004–2012),
Hong Kong (2001–2015), UK (2006–2016), and the US (Medicaid, 2000–2013, and IBM MarketScan, 2012–2015)
were used. Using a uniformed approach, we estimated the prevalence of antipsychotic use as the proportion of
pregnancies where a woman filled at least one antipsychotic prescription within three months before pregnancy
until birth. For the Nordic countries, data were meta-analyzed to investigate maternal characteristics associated
with the use of antipsychotics.
Results: We included 8,394,343 pregnancies. Typical antipsychotic use was highest in the UK (4.4%) whereas
atypical antipsychotic use was highest in the US Medicaid (1.5%). Atypical antipsychotic use increased over
time in most populations, reaching 2% in Australia (2012) and US Medicaid (2013). In most countries,
prochlorperazine was the most commonly used typical antipsychotic and quetiapine the most commonly used
atypical antipsychotic. Use of antipsychotics decreased across the trimesters of pregnancy in all populations except Finland. Antipsychotic use was elevated among smokers and those with parity ≥4 in the Nordic countries.
Conclusion: Antipsychotic use during pregnancy varied considerably between populations, partly explained by
varying use of the typical antipsychotic prochlorperazine, which is often used for nausea and vomiting in early
pregnancy. Increasing usage of atypical antipsychotics among pregnant women reflects the pattern that was previously reported for the general population
Newly uncovered physics of MHD instabilities using 2-D electron cyclotron emission imaging system in toroidal plasmas
Validation of physics models using the newly uncovered physics with a 2-D electron cyclotron emission imaging (ECEi) system for magnetic fusion plasmas has either enhanced the confidence or substantially improved the modeling capability. The discarded "full reconnection model" in sawtooth instability is vindicated and established that symmetry and magnetic shear of the 1/1 kink mode are critical parameters in sawtooth instability. For the 2/1 instability, it is demonstrated that the 2-D data can determine critical physics parameters with a high confidence and the measured anisotropic distribution of the turbulence and its flow in presence of the 2/1 island is validated by the modelled potential and gyro-kinetic calculation. The validation process of the measured reversed-shear Alfveneigenmode (RSAE) structures has improved deficiencies of prior models. The 2-D images of internal structure of the ELMs and turbulence induced by the resonant magnetic perturbation (RMP) have provided an opportunity to establish firm physics basis of the ELM instability and role of RMPs. The importance of symmetry in determining the reconnection time scale and role of magnetic shear of the 1/1 kink mode in sawtooth instability may be relevant to the underlying physics of the violent kink instability of the filament ropes in a solar flare
Antipsychotic drug use in pregnancy: A multinational study from ten countries
Aim: To compare the prevalence and trends of antipsychotic drug use during pregnancy between countries across four continents
STACKing the odds for adolescent survival: health service factors associated with full retention in care and adherence amongst adolescents living with HIV in South Africa
INTRODUCTION: There are two million HIV-positive adolescents in southern Africa, and this group has low retention in care and
high mortality. There is almost no evidence to identify which healthcare factors can improve adolescent self-reported retention.
This study examines factors associated with retention amongst antiretroviral therapy (ART)-initiated adolescents in South
Africa.
METHODS: We collected clinical records and detailed standardized interviews (n = 1059) with all 10- to 19 year-olds ever initiated
on ART in all 53 government clinics of a health subdistrict, and community traced to include lost-to-follow-up (90.1% of
eligible adolescents interviewed). Associations between full self-reported retention in care (no past-year missed appointments
and 85% past-week adherence) and health service factors were tested simultaneously in sequential multivariate regression and
marginal effects modelling, controlling for covariates of age, gender, urban/rural location, formal/informal housing, maternal
and paternal orphanhood, vertical/horizontal HIV infection, overall health, length of time on ART and type of healthcare facility.
RESULTS: About 56% of adolescents had self-reported retention in care, validated against lower detectable viral load
(AOR: 0.63, CI: 0.45 to 0.87, p = 0.005). Independent of covariates, five factors (STACK) were associated with improved
retention: clinics Stocked with medication (OR: 3.0, CI: 1.6 to 5.5); staff with Time for adolescents (OR: 2.7, CI: 1.8 to 4.1);
adolescents Accompanied to the clinic (OR: 2.3, CI: 1.5 to 3.6); enough Cash to get to clinic safely (OR: 1.4, CI: 1.1 to 1.9);
and staff who are Kind (OR: 2.6, CI: 1.8 to 3.6). With none of these factors, 3.3% of adolescents reported retention. With all
five factors, 69.5% reported retention.
CONCLUSIONS: This study identifies key intervention points for adolescent retention in HIV care. A basic package of clinic and
community services has the potential to STACK the odds for health and survival for HIV-positive adolescents.IS
Velocity-space sensitivity of the time-of-flight neutron spectrometer at JET
The velocity-space sensitivities of fast-ion diagnostics are often described by so-called weight functions. Recently, we formulated weight functions showing the velocity-space sensitivity of the often dominant beam-target part of neutron energy spectra. These weight functions for neutron emission spectrometry (NES) are independent of the particular NES diagnostic. Here we apply these NES weight functions to the time-of-flight spectrometer TOFOR at JET. By taking the instrumental response function of TOFOR into account, we calculate time-of-flight NES weight functions that enable us to directly determine the velocity-space sensitivity of a given part of a measured time-of-flight spectrum from TOFOR
Relationship of edge localized mode burst times with divertor flux loop signal phase in JET
A phase relationship is identified between sequential edge localized modes (ELMs) occurrence times in a set of H-mode tokamak plasmas to the voltage measured in full flux azimuthal loops in the divertor region. We focus on plasmas in the Joint European Torus where a steady H-mode is sustained over several seconds, during which ELMs are observed in the Be II emission at the divertor. The ELMs analysed arise from intrinsic ELMing, in that there is no deliberate intent to control the ELMing process by external means. We use ELM timings derived from the Be II signal to perform direct time domain analysis of the full flux loop VLD2 and VLD3 signals, which provide a high cadence global measurement proportional to the voltage induced by changes in poloidal magnetic flux. Specifically, we examine how the time interval between pairs of successive ELMs is linked to the time-evolving phase of the full flux loop signals. Each ELM produces a clear early pulse in the full flux loop signals, whose peak time is used to condition our analysis. The arrival time of the following ELM, relative to this pulse, is found to fall into one of two categories: (i) prompt ELMs, which are directly paced by the initial response seen in the flux loop signals; and (ii) all other ELMs, which occur after the initial response of the full flux loop signals has decayed in amplitude. The times at which ELMs in category (ii) occur, relative to the first ELM of the pair, are clustered at times when the instantaneous phase of the full flux loop signal is close to its value at the time of the first ELM
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