Antiemetic use among pregnant women in the United States: the escalating use of ondansetron

PURPOSE: To examine ondansetron use in pregnancy in the context of other antiemetic use among a large insured United States population of women delivering live births. METHODS: We assessed ondansetron and other antiemetic use among pregnant women delivering live births between 2001 and 2015 in 15 data partners contributing data to the Mini-Sentinel Distributed Database. We identified live birth pregnancies using a validated algorithm, and all forms of ondansetron and other available antiemetics were identified using National Drug Codes or procedure codes. We assessed the prevalence of antiemetic use by trimester, calendar year, and formulation. RESULTS: In over 2.3 million pregnancies, the prevalence of ondansetron, promethazine, metoclopramide, or doxylamine/pyridoxine use anytime in pregnancy was 15.2, 10.3, 4.0, and 0.4%, respectively. Ondansetron use increased from \u3c1% of pregnancies in 2001 to 22.2% in 2014, with much of the increase attributable to oral ondansetron beginning in 2006. Promethazine and metoclopramide use increased modestly between 2001 (13.8%, 3.2%) and 2006 (16.0%, 6.0%) but decreased annually through 2014 (8.0%, 3.2%). Doxylamine/pyridoxine, approved for management of nausea and vomiting in pregnancy in 2013, was used in 1.8% of pregnancies in 2014. For all antiemetics, use was highest in the first trimester. CONCLUSIONS: We observed a marked increase in ondansetron use by study year, prescribed to nearly one-quarter of insured pregnant women in 2014, occurring in conjunction with decreased use of promethazine and metoclopramide. Given the widespread use of ondansetron in pregnancy, data establishing product efficacy and methodologically rigorous evaluation of post-marketing safety are needed

Extended magnetic reconnection across the dayside magnetopause

The extent of where magnetic reconnection (MR), the dominant process responsible for energy and plasma transport into the magnetosphere, operates across Earth’s dayside magnetopause has previously been only indirectly shown by observations. We report the first direct evidence of X-line structure resulting from the operation of MR at each of two widely separated locations along the tilted, subsolar line of maximum current on Earth’s magnetopause, confirming the operation of MR at two or more sites across the extended region where MR is expected to occur. The evidence results from in-situ observations of the associated ion and electron plasma distributions, present within each magnetic X-line structure, taken by two spacecraft passing through the active MR regions simultaneously

COMPTEL observations of cosmic gamma‐ray bursts

The imaging γ‐ray telescope COMPTEL on board NASA’s Compton Gamma‐Ray Observatory (GRO) has observed many cosmic gamma‐ray bursts during the early mission phase of GRO. COMPTEL records time‐resolved burst spectra over 0.1 MeV to 10 MeV energies, and, for the first time, produces direct single‐telescope gamma‐ray images (0.8–30 MeV) of cosmic gamma‐ray bursts occurring in its 1 sr field of field

Green Plants in the Red: A Baseline Global Assessment for the IUCN Sampled Red List Index for Plants

Plants provide fundamental support systems for life on Earth and are the basis for all terrestrial ecosystems; a decline in plant diversity will be detrimental to all other groups of organisms including humans. Decline in plant diversity has been hard to quantify, due to the huge numbers of known and yet to be discovered species and the lack of an adequate baseline assessment of extinction risk against which to track changes. The biodiversity of many remote parts of the world remains poorly known, and the rate of new assessments of extinction risk for individual plant species approximates the rate at which new plant species are described. Thus the question ‘How threatened are plants?’ is still very difficult to answer accurately. While completing assessments for each species of plant remains a distant prospect, by assessing a randomly selected sample of species the Sampled Red List Index for Plants gives, for the first time, an accurate view of how threatened plants are across the world. It represents the first key phase of ongoing efforts to monitor the status of the world’s plants. More than 20% of plant species assessed are threatened with extinction, and the habitat with the most threatened species is overwhelmingly tropical rain forest, where the greatest threat to plants is anthropogenic habitat conversion, for arable and livestock agriculture, and harvesting of natural resources. Gymnosperms (e.g. conifers and cycads) are the most threatened group, while a third of plant species included in this study have yet to receive an assessment or are so poorly known that we cannot yet ascertain whether they are threatened or not. This study provides a baseline assessment from which trends in the status of plant biodiversity can be measured and periodically reassessed

The gamma-ray burst of 3 May 1991 observed by COMPTEL on board GRO

The Compton Gamma-Ray Observatory was launched on April 5, 1991, carrying the imaging Compton telescope COMPTEL. Since its activation on April 25, 1991, COMPTEL has observed several gamma-ray bursts in its 1-sr field of view. The strongest of these bursts was observed on May 3, 1991. Event data over 0.8 MeV to 30 MeV as well as time resolved spectra over 0.1 MeV to 10 MeV have been recorded. For the first time, a direct single-telescope MeV image of a cosmic gamma-ray burst has been produced. The burst is located at (l,b) = (171.8 deg, 6.4 deg) with a statistical uncertainty (99 percent level) of about 2 deg. The systematic error is about 1 deg, due to the location of the burst near the edge of the COMPTEL field-of-view. Spectral analysis indicates that GRB 910503 is a \u27classical\u27 hard burst, with power-law emission up to several MeV, showing \u27hard-to-soft\u27 spectral evolution in its light curve

Coordinated Cluster/Double Star observations of dayside reconnection signatures

The recent launch of the equatorial spacecraft of the Double Star mission, TC-1, has provided an unprecedented opportunity to monitor the southern hemisphere dayside magnetopause boundary layer in conjunction with northern hemisphere observations by the quartet of Cluster spacecraft. We present first results of one such situation where, on 6 April 2004, both Cluster and the Double Star TC-1 spacecraft were on outbound transits through the dawnside magnetosphere. The observations are consistent with ongoing reconnection on the dayside magnetopause, resulting in a series of flux transfer events (FTEs) seen both at Cluster and TC-1, which appear to lie north and south of the reconnection line, respectively. In fact, the observed polarity and motion of each FTE signature advocates the existence of an active reconnection region consistently located between the positions of Cluster and TC-1, with Cluster observing northward moving FTEs with +/− polarity, whereas TC-1 sees −/+ polarity FTEs. This assertion is further supported by the application of a model designed to track flux tube motion for the prevailing interplanetary conditions. The results from this model show, in addition, that the low-latitude FTE dynamics are sensitive to changes in convected upstream conditions. In particular, changing the interplanetary magnetic field (IMF) clock angle in the model suggests that TC-1 should miss the resulting FTEs more often than Cluster and this is borne out by the observations

Nation States, Cities, and People: Alternative Ways to Measure Globalization

In the last decade, attempts to measure globalization have multiplied, and they have led to the devising of diverse globalisation indexes. Besides other important similarities, the main feature shared by the most notable of these indexes is the fact that they use the same unit of analysis: the nation-state. This is a paradoxical situation, if one considers that one of the most distinctive characteristics of globalization is that its dynamics extend beyond the state. Gives this premise, the aim of the article is, on the one hand, to justify in any case the use of instruments that seek to measure globalization on the basis of states, and, on the other, to propose alternative approaches to such measurement. The paper\u2019s underlying assumption is that different approaches to the measurement of globalization are not mutually exclusive. Rather, such a plurality of perspectives is opportune given the complexity and multidimensionality of the concept of globalization

Instrument description and performance of the Imaging Gamma-Ray Telescope COMPTEL aboard the Compton Gamma-Ray Observatory

The COMPTEL instrument aboard the COMPTEL Gamma-Ray Observatory and its performance capabilities are described. Calibration data are used to determine the angular and energy response, and the effective detection area. The imaging properties of COMPTEL are demonstrated, and the sensitivity of Comptel to celestial gamma-ray sources are estimated from flight data

An overview of first results from COMPTEL

COMPTEL is the first imaging telescope to explore the MeV gamma-ray range (0.7 to 30 MeV). At present, it is performing a complete sky survey. Targets of special interest in the COMPTEL energy range are radio pulsars, X-ray binaries, novae, supernovae, supernova remnants, mulecular clouds, the interstellar medium within the Milky Way, active galactic nuclei, and the diffuse cosmic background radiation. The data from the first half year of the mission have demonstrated that COMPTEL performs as expected. The Crab is clearly seen at its proper position in the first images of the anticenter region of the galaxy. The Crab and Vela pulsar lightcurves have been measured with unprecedented accuracy. The quasars 3C273 and 3C279 have been seen for the first time at MeV energies. Both quasars show a break in their energy spectra in the COMPTEL energy range

COMPTEL observations of the Crab and VELA pulsars

The COMPTEL gamma-ray telescope, sensitive in the range 0.7-30 MeV, has viewed the Crab and Vela Pulsars. The light curves observed from both objects have been derived in several energy bands. Features of these light curves and some spectral details are discussed