Continuous Magnesium Sulfate Infusions for Status Asthmaticus in Children: A Systematic Review.

Objectives: Magnesium sulfate is a second-tier therapy for asthma exacerbations in children; guidelines recommend a single-dose to improve pulmonary function and decrease the odds of admission to the in-patient setting. However, many clinicians utilize prolonged magnesium sulfate infusions for children with refractory asthma. The purpose of this review is to describe the efficacy and safety of magnesium sulfate infusions administered over ≥ 1 h in children with status asthmaticus. Methods: Medline was searched using the keywords "magnesium sulfate" and "children." Articles evaluating the use of magnesium sulfate infusions for ≥1 h published between 1946 and August 2021 were included. Published abstracts were not included because of lack of essential details. All articles were screened by two reviewers. Results: Eight reports including 447 children were included. The magnesium regimens evaluated included magnesium delivered over 1 h (n = 148; 33.1%), over 4-5 h (n = 105; 23.5%), and over >24 h (n = 194; 43.4%). Majority of patients received a bolus dose of 25-75 mg/kg/dose prior to initiation of a prolonged infusion (n = 299; 66.9%). For the patients receiving magnesium infusions over 4-5 h, the dosing regimen varied between 40 and 50 mg/kg/h. For those receiving magnesium infusions >24 h, the dosing varied between 18.4 and 25 mg/kg/h for a duration between 53.4 and 177.5 h. Only three reports including 186 patients (41.6%) included an evaluation of clinical outcomes including evaluation of lung function parameters, reduction in PICU transfers, and/or decrease in emergency department length of stay. Five reports including 261 patients (58.4%) evaluated magnesium serum concentrations. In most reports, the goal concentrations were between 4 and 6 mg/dL. Only 3 (1.1%) out of the 261 patients had supratherapeutic magnesium concentrations. The only reports finding adverse events attributed to magnesium were noted in those receiving infusions for >24 h. Clinically significant adverse events included hypotension (n = 74; 16.6%), nausea/vomiting (n = 35; 7.8%), mild muscle weakness (n = 22; 4.9%), flushing (n = 10; 2.2%), and sedation (n = 2; 0.4%). Conclusion: Significant variability was noted in magnesium dosing regimens, with most children receiving magnesium infusions over >4 h. Most reports did not assess clinical outcomes. Until future research is conducted, the use of prolonged magnesium sulfate infusions should be reserved for refractory asthma therapy.

High-latitude biomes and rock weathering mediate climate-carbon cycle feedbacks on eccentricity timescales.

The International Ocean Discovery Programme (IODP) and its predecessors generated a treasure trove of Cenozoic climate and carbon cycle dynamics. Yet, it remains unclear how climate and carbon cycle interacted under changing geologic boundary conditions. Here, we present the carbon isotope (δ13C) megasplice, documenting deep-ocean δ13C evolution since 35 million years ago (Ma). We juxtapose the δ13C megasplice with its δ18O counterpart and determine their phase-difference on ~100-kyr eccentricity timescales. This analysis reveals that 2.4-Myr eccentricity cycles modulate the δ13C-δ18O phase relationship throughout the Oligo-Miocene (34-6 Ma), potentially through changes in continental weathering. At 6 Ma, a striking switch from in-phase to anti-phase behaviour occurs, signalling a reorganization of the climate-carbon cycle system. We hypothesize that this transition is consistent with Arctic cooling: Prior to 6 Ma, low-latitude continental carbon reservoirs expanded during astronomically-forced cool spells. After 6 Ma, however, continental carbon reservoirs contract rather than expand during cold periods due to competing effects between Arctic biomes (ice, tundra, taiga). We conclude that, on geologic timescales, System Earth experienced state-dependent modes of climate-carbon cycle interaction.

An astronomically dated record of Earth's climate and its predictability over the last 66 million years.

Much of our understanding of Earth's past climate comes from the measurement of oxygen and carbon isotope variations in deep-sea benthic foraminifera. Yet, long intervals in existing records lack the temporal resolution and age control needed to thoroughly categorize climate states of the Cenozoic era and to study their dynamics. Here, we present a new, highly resolved, astronomically dated, continuous composite of benthic foraminifer isotope records developed in our laboratories. Four climate states-Hothouse, Warmhouse, Coolhouse, Icehouse-are identified on the basis of their distinctive response to astronomical forcing depending on greenhouse gas concentrations and polar ice sheet volume. Statistical analysis of the nonlinear behavior encoded in our record reveals the key role that polar ice volume plays in the predictability of Cenozoic climate dynamics.

'The Plastic Nile': First Evidence of Microplastic Contamination in Fish from the Nile River (Cairo, Egypt).

The presence of microplastics (MPs) in the world's longest river, the Nile River, has yet to be reported. This small-scale study aimed to provide the first information about MPs in the Nile River by sampling the digestive tracts of two fish species, the Nile tilapia (Oreochromis niloticus, n = 29) and catfish (Bagrus bayad, n = 14). Fish were purchased from local sellers in Cairo, and then their gastrointestinal tracts were dissected and examined for MPs. Over 75% of the fish sampled contained MPs in their digestive tract (MP prevalence of 75.9% and 78.6% for Nile tilapia and catfish, respectively). The most abundant MP type was fibers (65%), the next most abundant type was films (26.5%), and the remaining MPs were fragments. Polyethylene (PE), polyethylene terephthalate (PET) and polypropylene (PP) were all non-destructively identified by attenuated total reflectance Fourier transform infrared spectroscopy. A comparison with similar studies from marine and freshwater environments shows that this high level of MP ingestion is rarely found and that fish sampled from the Nile River in Cairo are potentially among the most in danger of consuming MPs worldwide. Further research needs to be conducted, but, in order to mitigate microplastic pollution in the Nile River, we must act now.

Adults' attitudes toward children with cancer.

More children with cancer are receiving effective treatment, which allows for increased participation in everyday settings. Yet, little information is available about people's acceptance of children with cancer. This study examined young adults' acceptance ratings for a child receiving chemotherapy for cancer, a child with cancer in remission, and a physically healthy child. Findings did not provide support for a cancer stereotype and call into question whether results of studies using total or global scores from attitude scales should be taken at face value. Adults' responses suggested that they perceived children with cancer as experiencing primarily physical limitations (e.g., less strength and agility). Exposure to information about cancer was related to higher acceptance ratings for children described as having cancer, providing support for the importance of continued efforts to improve knowledge about the effects of this disease.

Reading about over-the-counter medications.

Many adolescents and young adults purchase and use over-the-counter (OTC) medications, and some may take these medications without reading about how to use them. Most do read package inserts and labels to learn about the medication, but studies examining what influences label reading for youth are needed. This study assessed factors related to label reading for young people, including demographic variables (gender, health status) and the types of information they were seeking about the medication. Eight hundred and seventy-six high school and college students participated, and most reported reading labels or package inserts to learn about medications. Participants experiencing pain were more likely to read labels, except for those experiencing headaches who reported being less likely to read labels. When reading labels, participants were interested in information about side effects, ingredients, dosage instructions, and symptoms treated by the medication. Future research should examine whether youth take medications as directed and what factors make labels and inserts easier to read and understand.

Nonlinear photoluminescence from van Hove singularities in multiwalled carbon nanotubes.

Van Hove singularities (VHS) in the density of states of multiwalled carbon nanotubes (MWNTs) have been observed by optical spectroscopy for the first time to the authors' knowledge. Additionally, unexpected visible luminescence has been observed on photoexcitation at 1064 nm. This luminescence is believed to arise from radiative transitions between energy states in the VHS. A mechanism describing the underlying processes, which involve multiphoton absorption followed by upconverted luminescence from VHS energy states, is presented. Our results show that the presence of VHS readily facilitates efficient optical transitions in