Medications and Breastfeeding

The aim of this chapter is to provide the reader with an understanding of the impact of the administration of medication to breast-feeding women and the key points related to this. The management and administration of medication is an essential skill for midwives. Equally, promoting breast feeding and supporting women’s infant feeding choices are essential skills for midwives. It is important that midwives and student midwives have knowledge around the use of medication during the lactating period in order to provide safe and effective care for breast-feeding women. This chapter will focus on the role of the midwife and student midwife in administration of medication to breast-feeding women and the key points related to this. As part of this process, it is necessary that midwives and student midwives understand the transfer of medication into breast milk and use the most up-to-date knowledge about medicines management and breast feeding. This is essential in order to provide accurate and evidence-based information to women, enabling them to make an informed choice (Nursing and Midwifery Council (NMC), 2018). This chapter will also explore some safe medication that can be used during the lactation period and common challenges arising while women breast feed and how these can be managed with and without the use of medicine

Metamorphic Conditions of an Archean Core Complex in the Northern Wind River Range, Wyoming

The Archean granulite-facies rocks of the northern Wind River Range consist of extensive granitic orthogneisses and migmatites hosting banded iron formations, amphibolites, metapelites, metabasites, ultramafites and quartzites. Quantitative pressure and temperature estimates from inclusions within garnet porphyroblasts are 815±5O%C and 8±1 kb using equilibria buffered by the assemblages spinel-quartz-garnet-sillimanite and garnet-rutile-ilmenite-sillimanite-quartz. Pressure-temperature estimates from the groundmass core assemblages of the banded iron formations and hornblende granulites are 750 ±50 %C and 5·5 ± 1 kb using garnet-clinopyroxene, garnet-orthopyroxene, and two-pyroxene thermometry, and geobarometers based on the assemblages garnet-quartz-plagioclase-orthopyroxene and orthopyroxene-olivine-quartz. Rim compositions of the matrix minerals indicate nearly isobaric cooling from the conditions of 750 %C and 5-5 kb to < 600%C at 5 kb. Taken together, the P-T estimates from both the garnet inclusions and matrix assemblages are consistent with a clockwise P-T-t path for this terrane. Temperature estimates based on oxygen isotope thermometry in the banded iron formations vary systematically with the degree of visible late-stage deformation. There is no correlation between the isotopic temperature estimates and those from cation-based thermometers. The highest pressures and temperatures for the Wind River terrane are preserved by the inclusions in garnet porphyroblasts. The ability of these inclusions to preserve chemistries corresponding to higher pressures and temperatures is attributed to the combined effects of inclusion isolation and fixed inclusion volume within the garnet porphyroblasts. Cation-based thermometers in the groundmass preserve lower temperatures as a result of diffusional partial resetting. Isotopic thermometry will yield the lowest temperatures if there is even minor retrograde deformation. Geothermobarometry for the northern Wind River Archean terrane is consistent with a tectonic regime of doubly thickened crust. Peak metamorphic conditions preserved in the cores of the garnets are compatible with deep burial during the early stages of tectonism. Rapid to intermediate uplift due to erosion of the upper plate could explain the nearly isothermal decompression from 8·0 to 5-5 kb. The later, nearly isobaric, cooling path indicated by the rim compositions of the matrix minerals is consistent with relaxation of the elevated geother

The Oxygen Isotopic Composition of MIL 090001: A CR2 Chondrite with Abundant Refractory Inclusions

MIL 090001 is a large (>6 kg) carbonaceous chondrite that was classified as a member of the CV reduced subgroup (CVred) that was recovered during the 2009-2010 ANSMET field season [1]. Based on the abundance of refractory inclusions and the extent of aqueous alteration, Keller [2] suggested a CV2 classification. Here we report additional mineralogical and petrographic data for MIL 090001, its whole-rock oxygen isotopic composition and ion microprobe analyses of individual phases. The whole rock oxygen isotopic analyses show that MIL 090001 should be classified as a CR chondrite

Cadherin-26 (CDH26) regulates airway epithelial cell cytoskeletal structure and polarity.

Polarization of the airway epithelial cells (AECs) in the airway lumen is critical to the proper function of the mucociliary escalator and maintenance of lung health, but the cellular requirements for polarization of AECs are poorly understood. Using human AECs and cell lines, we demonstrate that cadherin-26 (CDH26) is abundantly expressed in differentiated AECs, localizes to the cell apices near ciliary membranes, and has functional cadherin domains with homotypic binding. We find a unique and non-redundant role for CDH26, previously uncharacterized in AECs, in regulation of cell-cell contact and cell integrity through maintaining cytoskeletal structures. Overexpression of CDH26 in cells with a fibroblastoid phenotype increases contact inhibition and promotes monolayer formation and cortical actin structures. CDH26 expression is also important for localization of planar cell polarity proteins. Knockdown of CDH26 in AECs results in loss of cortical actin and disruption of CRB3 and other proteins associated with apical polarity. Together, our findings uncover previously unrecognized functions for CDH26 in the maintenance of actin cytoskeleton and apicobasal polarity of AECs

Effect of thermal decarbonation on the stable isotope composition of carbonates

The unusual texture and stable isotope variability of carbonates in AH84001 have been used as evidence for early life on Mars (Romanek et al., 1994; McKay et al., 1996). Oxygen and carbon isotope variability is most commonly attributed to low-temperature processes, including Rayleigh-like fractionation associated with biological activity. Another possible explanation for the isotopic variability in meteoritic samples is thermal decarbonation. In this report, different carbonates were heated in a He-stream until decomposition temperatures were reached. The oxygen and carbon isotope ratios ({delta}{sup 18}O and {delta}{sup 13}C values) of the resulting gas were measured on a continuous flow isotope ratio mass spectrometer. The aim of this work is to evaluate the possibility that large isotopic variations can be generated on a small scale abiogenically, by the process of thermal decarbonation. Oxygen isotope fractionations of &gt;4{per_thousand} have been measured during decarbonation of calcite at high temperatures (McCrea, 1950), and in excess of 6{per_thousand} for dolomite decarbonated between 500 and 600 C (Sharma and Clayton, 1965). Isotopic fractionations of this magnitude, coupled with Rayleigh-like distillation behavior could result in very large isotopic variations on a small scale. To test the idea, calcite, dolomite and siderite were heated in a quartz tube in a He-stream in excess of 1 atmosphere. Simultaneous determinations of {delta}{sup 13}C and {Delta}{sup 18}O values were obtained on 250 {micro}l aliquots of the CO{sub 2}-bearing He gas using an automated 6-way switching valve system (Finnigan MAT GasBench II) and a Finnigan MAT Delta Plus mass spectrometer. It was found that decarbonation of calcite in a He atmosphere begins at 720 C, but the rate significantly increases at temperatures of 820 C. After an initial light {delta}{sup 18}O value of -14.1{per_thousand} at 720 C associated with very early decarbonation, {delta}{sup 18}0 values increase to a constant -11.8{per_thousand}, close to the accepted value of -12.09{per_thousand} (PDB). After 10 minutes at 820 C, the {delta}{sup 18}O values and signal strength both begin to decrease linearly to a {delta}{sup 18}O value of -14.75 and very low amounts of CO{sub 2} (Fig. 1). In contrast, the {delta}{sup 13}C values are extremely constant (0.12 {+-} 0.25{per_thousand}) for all measurements, in very good agreement with accepted values of 0.33{per_thousand} (PDB). There is much less isotopic variability during dolomite decarbonation. CO{sub 2} is first detected at 600 C. The signal strength increases by an order of magnitude between 670 and 700 C and again at 760 C. Both {delta}{sup 13}C and {delta}{sup 18}O values are nearly constant over the entire temperature range and sample size. For oxygen, the measured {delta}{sup 18}O values averaged -20.9 {+-} 0.7{per_thousand} (n = 30). Including only samples over 700 C, the average is -21.2 {+-} 0.2{per_thousand} compared to the accepted value of -21{per_thousand}. Carbon is similarly constant. The average {delta}{sup 13}C value is -2.50{per_thousand} compared to the accepted value of -2.62{per_thousand}. Far more variability is seen during the decomposition of siderite. Two samples were analyzed. In both samples, the initial {delta}{sup 18}O values were far lower than expected

Low carbon electricity systems for Great Britain in 2050: An energy-land-water perspective

The decarbonisation of the power sector is key to achieving the Paris Agreement goal of limiting global mean surface temperature rise to well below 2 °C. This will require rapid, national level transitions to low carbon electricity generation, such as variable renewables (VRE), nuclear and fossil fuels with carbon capture and storage, across the world. At the same time it is essential that future power systems are sustainable in the wider sense and thus respect social, environmental and technical limitations. Here we develop an energy-land-water nexus modelling framework and use it to perform a scenario analysis with the aim of understanding the planning and operational implications of these constraints on Great Britain's (GB) power system in 2050. We consider plausible scenarios for limits on installed nuclear capacity, siting restrictions that shape VRE deployment and water use for thermal power station cooling. We find that these factors combined can lead to up to a 25% increase in the system's levelised cost of electricity (LCOE). VRE siting restrictions can result in an up to 13% increase in system LCOE as the deployment of onshore wind is limited while nuclear capacity restrictions can drive an up to 17% greater LCOE. We also show that such real-world limitations can cause substantial changes in system design both in terms of the spatial pattern of where generators are located and the capacity mix of the system. Thus we demonstrate the large impact simultaneously considering a set of nexus factors can have on future GB power systems. Finally, given our plausible assumptions about key energy-land-water restrictions and emission limits effecting the GB power system in 2050, the cost optimal penetration of VREs is found to be at least 50%

Structural Controls on Crustal Fluid Circulation and Hot Spring Geochemistry Above a Flat‐Slab Subduction Zone, Peru

Hot spring geochemistry from the Cordillera Blanca and Cordillera Huayhuash, Peru, reveal the influence of crustal‐scale structures on geothermal fluid circulation in an amagmatic region located above a flat‐slab subduction zone. To test the influence of contrasting modes of faulting in these regions, springs were targeted along the Cordillera Blanca detachment fault, within its hanging wall, in the footwall of the detachment, and in the Cordillera Huayhuash. Hot springs along the Cordillera Blanca detachment fault zone are associated with recent extension and normal faulting, and those in its footwall and the Cordillera Huayhuash are located in the Marañon fold and thrust belt where compressional structures dominate. Springs along and in the hanging wall of the Cordillera Blanca detachment fault yield brackish‐saline, alkaline‐chloride waters, with oxygen, hydrogen, carbon, and chlorine stable isotope values that suggest mixing between meteoric groundwater and saline brine affected by high water‐rock interaction. Geothermometry reservoir temperature estimates (RTEs) of 91–226°C indicate maximum flow path depths of 8.7 or 11 km, depending on geothermal gradient, associated with the Cordillera Blanca detachment fault. In contrast, springs in the footwall and in the Cordillera Huayhuash exhibit a wide range of water types with an isotopic affinity to meteoric water, suggesting a greater influence from shallow groundwater and less water‐rock interaction. For these springs, RTEs of 40–98°C correspond to much shallower circulation (1.6–4 km). Results indicate that the Cordillera Blanca detachment system accommodates significantly deeper circulation of crustal fluids compared to other regional compressional structures

Sulfur degassing at Erta Ale (Ethiopia) and Masaya (Nicaragua) volcanoes: Implications for degassing processes and oxygen fugacities of basaltic systems

We investigate the relationship between sulfur and oxygen fugacity at Erta Ale and Masaya volcanoes. Oxygen fugacity was assessed utilizing Fe 3+/ΣFe and major element compositions measured in olivine-hosted melt inclusions and matrix glasses. Erta Ale

Impact of treatment on damage and hospitalization in elderly patients with microscopic polyangiitis and granulomatosis with polyangiitis

OBJECTIVE: Age is a risk factor for organ damage, adverse events, and mortality in microscopic polyangiitis (MPA) and granulomatosis with polyangiitis (GPA). However, the relationship between treatment and damage, hospitalizations, and causes of death in elderly patients is largely unknown. METHODS: Consecutive patients from Sweden, England, and the Czech Republic diagnosed between 1997 and 2013 were included. Inclusion criteria were a diagnosis of MPA or GPA and age 75 years or more at diagnosis. Treatment with cyclophosphamide, rituximab, and corticosteroids the first three months was registered. Outcomes up to two years from diagnosis included vasculitis damage index (VDI), hospitalization, and cause of death. RESULTS: Treatment data was available for 167 of 202 patients. At two years, 4% had no items of damage. There was a positive association between VDI score at two years and Birmingham Vasculitis Activity Score at onset, and a negative association with treatment using cyclophosphamide or rituximab. Intravenous methylprednisolone dose was associated with treatment-related damage. During the first year, 69% of patients were readmitted to hospital. MPO-ANCA positivity and lower creatinine levels decreased the odds for readmission. The most common cause of death was infection, and this was associated with cumulative oral prednisolone dose. CONCLUSION: Immunosuppressive treatment with cyclophosphamide or rituximab in elderly patients with MPA and GPA was associated with development of less permanent organ damage and was not associated with hospitalization. However, higher doses of corticosteroids during the first three months was associated with treatment-related damage and fatal infections

Sulfur degassing at Erta Ale (Ethiopia) and Masaya (Nicaragua) volcanoes: Implications for degassing processes and oxygen fugacities of basaltic systems

We investigate the relationship between sulfur and oxygen fugacity at Erta Ale and Masaya volcanoes. Oxygen fugacity was assessed utilizing Fe3+/∑Fe and major element compositions measured in olivine‐hosted melt inclusions and matrix glasses. Erta Ale melts have Fe3+/∑Fe of 0.15–0.16, reflecting fO2 of ΔQFM 0.0 ± 0.3, which is indistinguishable from fO2 calculated from CO2/CO ratios in high‐temperature gases. Masaya is more oxidized at ΔQFM +1.7 ± 0.4, typical of arc settings. Sulfur isotope compositions of gases and scoria at Erta Ale (δ34Sgas − 0.5‰; δ34Sscoria + 0.9‰) and Masaya (δ34Sgas + 4.8‰; δ34Sscoria + 7.4‰) reflect distinct sulfur sources, as well as isotopic fractionation during degassing (equilibrium and kinetic fractionation effects). Sulfur speciation in melts plays an important role in isotope fractionation during degassing and S6+/∑S is 0.67 in Masaya melt inclusions. No change is observed in Fe3+/∑Fe or S6+/∑S with extent of S degassing at Erta Ale, indicating negligible effect on fO2, and further suggesting that H2S is the dominant gas species exsolved from the S2−‐rich melt (i.e., no redistribution of electrons). High SO2/H2S observed in Erta Ale gas emissions is due to gas re‐equilibration at low pressure and fixed fO2. Sulfur budget considerations indicate that the majority of S injected into the systems is emitted as gas, which is therefore representative of the magmatic S isotope composition. The composition of the Masaya gas plume (+4.8‰) cannot be explained by fractionation effects but rather reflects recycling of high δ34S oxidized sulfur through the subduction zone