WHAT ARE THE RISKS ASSOCIATED WITH DIFFERENT SELECTIVE SEROTONIN RE-UPTAKE INHIBITORS (SSRIS) TO TREAT DEPRESSION AND ANXIETY IN PREGNANCY? AN EVALUATION OF CURRENT EVIDENCE

A literature review was conducted to elucidate the respective reproductive safety profiles of different SSRIs to inform the prescribing practices of doctors treating pregnant women with anxiety and depression. Background: Women are most likely to be diagnosed with depression or anxiety between the ages of 25 and 44 years, which are also the years of childbearing potential (Burke et al., 1991). Therefore a substantial number of women face a decision about whether or not to take an antidepressant or anxiolytic during pregnancy. There are no psychotropic medications that have UK marketing authorisation (NICE, 2014), no clear clinical consensus has been reached regarding the use of SSRIs in pregnancy, and clinicians lack a resource which discusses the reproductive safety profiles of different SSRIs rather than the class of drugs as a whole. Subjects and methods: We performed a search for the English language literature indexed on MEDLINE/PubMed for the period 2012 to 2017, using the following key terms: fluoxetine, prozac, paxil, oxactin, paroxetine, seroxat, sertraline, lustral, citalopram, cipramil, escitalopram, cipralex, fluvoxamine, faverin, with \u27pregnant woman\u27, \u27pregnant women\u27, pregnancy. We excluded general SSRI and pregnancy articles (although we did read these papers for valuable background information) because we are interested in elucidating the differences between the drugs in this class, rather than the general effects of the SRRI class as a whole. Results: The literature shows that paroxetine and fluoxetine have the strongest association with negative outcomes (significant malformations, PPHN and PNAS) whilst the associations between sertraline and citalopram with negative outcomes remains mixed and generally unsubstantiated when studies that show an association are controlled for the effects of maternal depression and associated factors. There are too few studies to draw definite conclusions regarding the safety of escitalopram and fluvoxamine. Conclusions: Sertraline and citalopram should be first-line drug treatments for anxiety and depression in pregnant women in the SSRI class. Sertraline can be continued in breast-feeding as the concentration found in breast milk is very low and has not been linked to infant complications. Furthermore, it would be useful to assess GPs current knowledge and confidence levels about prescribing, to see whether further education is needed in this area to encourage an open discussion of the risks and benefits of medication or no medication. It would also be useful to conduct further research on escitalopram which is likely to grow in popularity in the coming years as it came off patent in 2012. When these holes are filled, a clinical protocol for treating anxiety and depression in pregnant women should be created and implemented for the UK population

Variation in the access to deep soil water pools explains tree-to-tree differences in drought-triggered dieback of Mediterranean oaks

Individual differences in the access to deep soil water pools may explain the differential damage among coexisting, conspecific trees as a consequence of drought-induced dieback. We addressed this issue by comparing the responses to a severe drought of three Mediterranean oak species with different drought tolerance, Quercus pubescens L. and Quercus frainetto Ten., mainly thriving at xeric and mesic sites, respectively, and Quercus cerris L., which dominates at intermediate sites. For each species, we compared coexisting declining (D) and non-declining (ND) trees. The stable isotope composition (d2H, d18O) of xylem and soil water was used to infer a differential use of soil water sources. We also measured tree size and radial growth to quantify the long-term divergence of wood production between D and ND trees and non-structural carbohydrates (NSCs) in sapwood to evaluate if D trees presented lower NSC values. The ND trees had access to deeper soil water than D trees except in Q. frainetto, as indicated by significantly more depleted xylem water values. However, a strong d2H offset between soil and xylem water isotopes observed in peak summer could suggest that both tree types were not physiologically active under extreme drought conditions. Alternative processes causing deuterium fractionation, however, could not be ruled out. Tree height and recent (last 15-25 years) growth rates in all species studied were lower in D than in ND trees by 22 and 44%, respectively. Lastly, there was not a consistent pattern of NSC sapwood concentration; in Q. pubescens, it was higher in ND trees while in Q. frainetto, the D trees were the ones exhibiting the higher NSC concentration. We conclude that the vulnerability to drought among conspecific Mediterranean oaks depends on the differential access to deep soil water pools, which may be related to differences in rooting depth, tree size and growth rate

Variation in the access to deep soil water pools explains tree-to-tree differences in drought-triggered dieback of Mediterranean oaks

Individual differences in the access to deep soil water pools may explain the differential damage among coexisting, conspecific trees as a consequence of drought-induced dieback. We addressed this issue by comparing the responses to a severe drought of three Mediterranean oak species with different drought tolerance, Quercus pubescens L. and Quercus frainetto Ten., mainly thriving at xeric and mesic sites, respectively, and Quercus cerris L., which dominates at intermediate sites. For each species, we compared coexisting declining (D) and non-declining (ND) trees. The stable isotope composition (δ2H, δ18O) of xylem and soil water was used to infer a differential use of soil water sources. We also measured tree size and radial growth to quantify the long-term divergence of wood production between D and ND trees and non-structural carbohydrates (NSCs) in sapwood to evaluate if D trees presented lower NSC values. The ND trees had access to deeper soil water than D trees except in Q. frainetto, as indicated by significantly more depleted xylem water values. However, a strong δ2H offset between soil and xylem water isotopes observed in peak summer could suggest that both tree types were not physiologically active under extreme drought conditions. Alternative processes causing deuterium fractionation, however, could not be ruled out. Tree height and recent (last 15-25 years) growth rates in all species studied were lower in D than in ND trees by 22 and 44%, respectively. Lastly, there was not a consistent pattern of NSC sapwood concentration; in Q. pubescens, it was higher in ND trees while in Q. frainetto, the D trees were the ones exhibiting the higher NSC concentration. We conclude that the vulnerability to drought among conspecific Mediterranean oaks depends on the differential access to deep soil water pools, which may be related to differences in rooting depth, tree size and growth rate.This research was financially supported by the project OT4CLIMA (Italian Ministry of Education, University and Research (MIUR), Project N. ARS01_00405) ‘Advanced EO Technologies for studying climate change impacts on the environment’ and by the project ‘Alarm of forest mortality in Southern Italy’ (Gorgoglione Administration, Basilicata Region, Italy). M.C. was supported by the PhD program from the University of Basilicata (Italy). J.J.C. acknowledges funding by the project CGL2015-69186-C2-1-R project (Spanish Ministry of Economy). We acknowledge the E-OBS dataset from the EU-FP6 project UERRA (http://www.uerra.eu) and the data providers in the ECA&D project (https://www.ecad.eu)

Shifts in Growth Responses to Climate and Exceeded Drought-Vulnerability Thresholds Characterize Dieback in Two Mediterranean Deciduous Oaks

Drought stress has induced dieback episodes affecting many forest types and tree species worldwide. However, there is scarce information regarding drought-triggered growth decline and canopy dieback in Mediterranean deciduous oaks. These species face summer drought but have to form new foliage every spring which can make them vulnerable to hotter and drier conditions during that season. Here, we investigated two stands dominated byQuercus frainettoTen. andQuercus canariensisWilld. and situated in southern Italy and Spain, respectively, showing drought-induced dieback since the 2000s. We analyzed how radial growth and its responses to climate differed between non-declining (ND) and declining (D) trees, showing different crown defoliation and coexisting in each stand by: (i) characterizing growth variability and its responsiveness to climate and drought through time, and (ii) simulating growth responses to soil moisture and temperature thresholds using the Vaganov-Shashkin VS-lite model. Our results show how growth responsiveness to climate and drought was higher in D trees for both oak species. Growth has become increasingly limited by warmer-drier climate and decreasing soil moisture availability since the 1990s. These conditions preceded growth drops in D trees indicating they were more vulnerable to warming and aridification trends. Extremely warm and dry conditions during the early growing season trigger dieback. Changes in the seasonal timing of water limitations caused contrasting effects on long-term growth trends of D trees after the 1980s inQ. frainettoand during the 1990s inQ. canariensis. Using growth models allows identifying early-warning signals of vulnerability, which can be compared with shifts in the growth responses to warmer and drier conditions. Our approach facilitates establishing drought-vulnerability thresholds by combining growth models with field records of dieback

Stomatal conductance and leaf water potential responses to hydraulic conductance variation in Pinus pinaster seedlings

In this study, tree hydraulic conductance (K tree) was experimentally manipulated to study effects on short-term regulation of stomatal conductance (g s), net photosynthesis (A) and bulk leaf water potential (Ψleaf) in well watered 5–6 years old and 1.2 m tall maritime pine seedlings (Pinus pinaster Ait.). K tree was decreased by notching the stem and increased by progressively excising the root system and stem. Gas exchange was measured in a chamber at constant irradiance, vapour pressure deficit, leaf temperature and ambient CO2 concentration. As expected, we found a strong and positive relationship between g s and K tree (r = 0.92, P = 0.0001) and between A and K tree (r = 0.9, P = 0.0001). In contrast, however, we found that the response of Ψleaf to K tree depended on the direction of change in K tree: increases in K tree caused Ψleaf to decrease from around −1.0 to −0.6 MPa, but reductions in K tree were accompanied by homeostasis in Ψleaf (at −1 MPa). Both of these observations could be explained by an adaptative feedback loop between g s and Ψleaf, with Ψleaf prevented from declining below the cavitation threshold by stomatal closure. Our results are consistent with the hypothesis that the observed stomatal responses were mediated by leaf water status, but they also suggest that the stomatal sensitivity to water status increased dramatically as Ψleaf approached −1 MPa

Xylem Functional Traits as Indicators of Health in Mediterranean Forests

Purpose of Review: We conducted a literature survey and meta-analysis to assess, in Mediterranean forests impacted by drought, the role of xylem functional traits as indicators of tree health, and their potential to adjust over a range of climatic conditions to support tree performance and survival. We aimed also to depict the geographic variability of xylem functional traits among Mediterranean forest trees as a tool for regional scale-oriented vulnerability assessment. Recent Findings: Associations were investigated among xylem functional traits, hydraulic safety, and whole plant drought resistance for tree species in Mediterranean-type climates. Variable data were available from a number of study cases of Mediterranean forest communities impacted by intense drought, wherein tree growth and xylem functional traits were investigated along with tree decline and dieback episodes. Variable data were available from a number of studies that analyzed xylem trait adjustments to climatic conditions at different temporal scales. Summary: We observed differing growth patterns and xylem conduit area responses in healthy and unhealthy trees and we sketched hydraulic strategies that may fit observed patterns. Overall, a clear role of xylem conduit size as stand-alone tree health indicator did not emerge. We showed that xylem traits may adjust along different temporal scales and may support the performance and health of Mediterranean tree species over a range of climatic conditions. We outlined substantial geographic variability in xylem traits across the Mediterranean region, suggesting patchy responses to increasing drought. Knowledge gaps and needed lines of research are highlighted

Drought-induced oak decline in the western mediterranean region: An overview on current evidences, mechanisms and management options to improve forest resilience

Increased forest vulnerability is being reflected as more widespread and severe drought-induced decline episodes. In particular, the Mediterranean area is revealing a high susceptibility to phenomena of loss in tree vitality across species. Within tree species, oaks (Quercus spp.) are experiencing extensive decline in many countries. However, in the wake of the so-called âoak decline phenomenonâ, the attention on these species has generally been limited. In this paper, we review the current available literature on oakdecline cases reported within the Mediterranean Basin, with particular remark for those occurred in Italy and Spain. More specifically our main aims were to: (i) provide an update on the patterns and mechanisms of decline by focusing on tree-ring and wood-anatomical variables; (ii) provide some hints for improving the resistance and resilience of oak stands experiencing decline. Our review reveals that drought is reported as the main driver triggering oak decline within the Mediterranean Basin, although other causes (i.e., increasing temperature, pathogens attack or excessive stand density) could exacerbate decline. In most reported cases, drought induced a substantial reduction of growth and changes in some wood anatomical properties. Indeed, growth decline prior death is also indicated as an early-warning signal of impending death. In ring-porous oak species, declining trees were often characterized by a very low production of latewood and a decrease in lumen area of the widest earlywood vessels, suggesting a potential reduction of hydraulic conductivity. Moreover, hydraulic dysfunction is reported as the main cause of decline. Finally, regarding management actions that should be considered for improving the resilience of declining stands and preserve the species-specific stand composition, it could be useful to shorten the rotation period of coppice stands or promoting their gradual conversion towards high forests, and favoring more drought-resistant species should also be considered. In addition, regeneration prior to regeneration cuts should be improved by anticipating seed dispersal or by planting oak seedlings obtained from local germoplasm

Foreste e uso dell'acqua: fattori di controllo e possibilit\ue0 di gestione

Le foreste coprono oltre un terzo della superficie nazionale italiana e l\u2019evapo-traspirazione forestale ha quindi un effetto di primo piano sul ciclo dell\u2019acqua e sulla disponibilit\ue0 di risorse idriche per usi alternativi. La possibilit\ue0 di regolare attentamente il bilancio idrologico delle foreste aprirebbe importanti prospettive per la gestione delle risorse idriche a scala locale e territoriale. Il presente lavoro prende in esame l\u2019evidenza scientifica disponibile sugli effetti sul ciclo dell\u2019acqua di interventi di afforestazione e del trattamento selvicolturale delle foreste esistenti. La trasformazione di uso del suolo a foresta ha un impatto talvolta drammatico su evapo-traspirazione e deflussi, anche se l\u2019effetto dipende in larga misura dalle condizioni ambientali considerate. La gestione forestale ha effetti pi\uf9 limitati, ma di grande rilevanza a causa dell\u2019estensione delle foreste esistenti. In particolare, gli interventi di diradamento determinano solitamente un aumento dei deflussi, che risulta per\uf2 di breve durata. L\u2019evapo-traspirazione dell\u2019ecosistema viene ridotta in misura maggiore dai tagli di maturit\ue0, con un effetto variabile a seconda del trattamento applicato. L\u2019allungamento dei turni forestali potrebbe costituire lo strumento pi\uf9 importante, sostenibile e duraturo per incrementare la disponibilit\ue0 idrica per usi alternativi, ma evidenze sperimentali contrastanti sono presentate in letteratura. Nuovi studi sono indispensabili per quantificare gli effetti dell\u2019et\ue0 sull\u2019uso dell\u2019acqua dell\u2019ecosistema in ambienti rappresentativi del territorio nazionale