Absence of 21st century warming on Antarctic Peninsula consistent with natural variability.

Since the 1950s, research stations on the Antarctic Peninsula have recorded some of the largest increases in near-surface air temperature in the Southern Hemisphere. This warming has contributed to the regional retreat of glaciers, disintegration of floating ice shelves and a 'greening' through the expansion in range of various flora. Several interlinked processes have been suggested as contributing to the warming, including stratospheric ozone depletion, local sea-ice loss, an increase in westerly winds, and changes in the strength and location of low-high-latitude atmospheric teleconnections. Here we use a stacked temperature record to show an absence of regional warming since the late 1990s. The annual mean temperature has decreased at a statistically significant rate, with the most rapid cooling during the Austral summer. Temperatures have decreased as a consequence of a greater frequency of cold, east-to-southeasterly winds, resulting from more cyclonic conditions in the northern Weddell Sea associated with a strengthening mid-latitude jet. These circulation changes have also increased the advection of sea ice towards the east coast of the peninsula, amplifying their effects. Our findings cover only 1% of the Antarctic continent and emphasize that decadal temperature changes in this region are not primarily associated with the drivers of global temperature change but, rather, reflect the extreme natural internal variability of the regional atmospheric circulation.

The Signature of Southern Hemisphere Atmospheric Circulation Patterns in Antarctic Precipitation.

We provide the first comprehensive analysis of the relationships between large-scale patterns of Southern Hemisphere climate variability and the detailed structure of Antarctic precipitation. We examine linkages between the high spatial resolution precipitation from a regional atmospheric model and four patterns of large-scale Southern Hemisphere climate variability: the southern baroclinic annular mode, the southern annular mode, and the two Pacific-South American teleconnection patterns. Variations in all four patterns influence the spatial configuration of precipitation over Antarctica, consistent with their signatures in high-latitude meridional moisture fluxes. They impact not only the mean but also the incidence of extreme precipitation events. Current coupled-climate models are able to reproduce all four patterns of atmospheric variability but struggle to correctly replicate their regional impacts on Antarctic climate. Thus, linking these patterns directly to Antarctic precipitation variability may allow a better estimate of future changes in precipitation than using model output alone.

Recent changes in Antarctic Sea Ice.

In contrast to the Arctic, total sea ice extent (SIE) across the Southern Ocean has increased since the late 1970s, with the annual mean increasing at a rate of 186×10(3) km(2) per decade (1.5% per decade; p<0.01) for 1979-2013. However, this overall increase masks larger regional variations, most notably an increase (decrease) over the Ross (Amundsen-Bellingshausen) Sea. Sea ice variability results from changes in atmospheric and oceanic conditions, although the former is thought to be more significant, since there is a high correlation between anomalies in the ice concentration and the near-surface wind field. The Southern Ocean SIE trend is dominated by the increase in the Ross Sea sector, where the SIE is significantly correlated with the depth of the Amundsen Sea Low (ASL), which has deepened since 1979. The depth of the ASL is influenced by a number of external factors, including tropical sea surface temperatures, but the low also has a large locally driven intrinsic variability, suggesting that SIE in these areas is especially variable. Many of the current generation of coupled climate models have difficulty in simulating sea ice. However, output from the better-performing IPCC CMIP5 models suggests that the recent increase in Antarctic SIE may be within the bounds of intrinsic/internal variability.

Improving dialogue among researchers, local and indigenous peoples and decision-makers to address issues of climate change in the North.

The Circumpolar North has been changing rapidly within the last decades, and the socioeconomic systems of the Eurasian Arctic and Siberia in particular have displayed the most dramatic changes. Here, anthropogenic drivers of environmental change such as migration and industrialization are added to climate-induced changes in the natural environment such as permafrost thawing and increased frequency of extreme events. Understanding and adapting to both types of changes are important to local and indigenous peoples in the Arctic and for the wider global community due to transboundary connectivity. As local and indigenous peoples, decision-makers and scientists perceive changes and impacts differently and often fail to communicate efficiently to respond to changes adequately, we convened a meeting of the three groups in Salekhard in 2017. The outcomes of the meeting include perceptions of how the three groups each perceive the main issues affecting health and well-being and recommendations for working together better.

Engaging children in the development of obesity interventions: Exploring outcomes that matter most among obesity positive outliers.

OBJECTIVE: To explore outcomes and measures of success that matter most to 'positive outlier' children who improved their body mass index (BMI) despite living in obesogenic neighborhoods. METHODS: We collected residential address and longitudinal height/weight data from electronic health records of 22,657 children ages 6-12 years in Massachusetts. We defined obesity "hotspots" as zip codes where >15% of children had a BMI ≥95th percentile. Using linear mixed effects models, we generated a BMI z-score slope for each child with a history of obesity. We recruited 10-12 year-olds with negative slopes living in hotspots for focus groups. We analyzed group transcripts and discussed emerging themes in iterative meetings using an immersion/crystallization approach. RESULTS: We reached thematic saturation after 4 focus groups with 21 children. Children identified bullying and negative peer comparisons related to physical appearance, clothing size, and athletic ability as motivating them to achieve a healthier weight, and they measured success as improvement in these domains. Positive relationships with friends and family facilitated both behavior change initiation and maintenance. CONCLUSIONS: The perspectives of positive outlier children can provide insight into children's motivations leading to successful obesity management. PRACTICE IMPLICATIONS: Child/family engagement should guide the development of patient-centered obesity interventions.

Exploring innovative approaches and patient-centered outcomes from positive outliers in childhood obesity.

OBJECTIVE: New approaches for obesity prevention and management can be gleaned from positive outliers-that is, individuals who have succeeded in changing health behaviors and reducing their body mass index (BMI) in the context of adverse built and social environments. We explored perspectives and strategies of parents of positive outlier children living in high-risk neighborhoods. METHODS: We collected up to 5 years of height/weight data from the electronic health records of 22,443 Massachusetts children, ages 6 to 12 years, seen for well-child care. We identified children with any history of BMI in the 95th percentile or higher (n = 4007) and generated a BMI z-score slope for each child using a linear mixed effects model. We recruited parents for focus groups from the subsample of children with negative slopes who also lived in zip codes where >15% of children were obese. We analyzed focus group transcripts using an immersion/crystallization approach. RESULTS: We reached thematic saturation after 5 focus groups with 41 parents. Commonly cited outcomes that mattered most to parents and motivated change were child inactivity, above-average clothing sizes, exercise intolerance, and negative peer interactions; few reported BMI as a motivator. Convergent strategies among positive outlier families were family-level changes, parent modeling, consistency, household rules/limits, and creativity in overcoming resistance. Parents voiced preferences for obesity interventions that include tailored education and support that extend outside clinical settings and are delivered by both health care professionals and successful peers. CONCLUSIONS: Successful strategies learned from positive outlier families can be generalized and tested to accelerate progress in reducing childhood obesity.

Accelerating progress in reducing childhood obesity disparities: exploring best practices of positive outliers.

Childhood obesity rates may have plateaued in some U.S. population subgroups, yet overall rates remain high and racial/ethnic and socioeconomic disparities appear to be widening. Successful strategies and best practices to inform obesity interventions and accelerate progress in reducing disparities in childhood obesity can be found among people who can be categorized as positive outliers, i.e., individuals who have succeeded, where many others have not, in changing their health behaviors, reducing their body mass index, and developing resilience in the context of adverse built and social environments. In this commentary, we discuss the central premise of a positive outlier approach and how successful strategies learned from positive outliers can be generalized and promoted to accelerate progress in childhood obesity.

Adverse drug reactions and adverse events of 33 varieties of traditional Chinese medicine injections on National Essential medicines List (2004 edition) of China: an overview on published literatures.

OBJECTIVES: We conducted a literature review on adverse drug reactions (ADRs) related to 33 kinds of traditional Chinese medicine injections (CMIs) on China's National Essential medicines List (2004 edition). We aimed to retrieve basic ADR information, identify trends related to CMIs, and provide evidence for the research, development, and application of CMIs. METHODS: We electronically searched the Chinese Biomedical Literature Database (CBM, January 1978-April 2009), the China National Knowledge Infrastructure Database (CNKI, January 1979-April 2009), the Chinese Science and Technology Periodical Database (January 1989-April 2009) and the Traditional Chinese Medicine Database (January 1984-April 2009). We used the terms of 'adverse drug reaction', 'adverse event', 'side effects', 'side reaction', 'toxicity', and 'Chinese medicine injections', as well as the names of the 33 CMIs to search. We also collected CMI-related ADR reports and regulations from the Chinese Food and Drug Administration's 'Newsletter of Adverse Drug Reactions' (Issue 1 to 22). Then we descriptively analyzed all the articles by year published, periodical, and study design. We also analyzed regulations relevants to ADRs. RESULTS: (1) We found 5405 relevant citations, of which 1010 studies met the eligibility criteria. (2) The rate of publishing of research articles on CMI-linked ADRs has risen over time. (3) The included 1010 articles were scattered among 297 periodicals. Of these, 55 journals on pharmaceutical medicine accounted for 39.5% of the total (399/1010); the 64 journals on traditional Chinese medicine, accounted for only 19.5% (197/1010). Only 22 periodicals with relevant articles were included on the core journals of the Beijing University List (2008 edition); these published 129 articles (12.8% of the included articles). (4) The relevant articles consisted of 348 case reports (34.5%), 254 case series (25.2%), 119 reviews (11.8%), 116 randomized controlled trials (11.5%), 78 cross-sectional studies (7.7%), 61 literature analyses of ADR (6.0%), and 28 non-randomized controlled clinical studies (2.8%). (5) Three journals, Adverse Drug Reactions Journal, China Medical Herald, and Chinese Pharmaceuticals, together published 12.3% of the included literature. (6) The most commonly-reported CMI-related ADRs were to Shuanghuanglian, Qingkailing, and Yuxingcao injections, each of which had ADRs mentioned in more than 200 articles. Four of the five CMIs with the most ADR reports (Shuanghuanglian, Ciwujia, Yuxingcao, and Yinzhihuang injections) had been suspended use or sale in the market. CONCLUSIONS: (1) Articles published on CMI-related ADRs increased over time, but overall the research is of low quality and is scattered through a large number of sources. (2) Four CMIs (Shuanghuanglian, Ciwujia, Yuxingcao, and Yinzhihuang injections) had been suspended for clinical use or sale. (3) There is an urgent need for a clear standard to grade ADRs of CMIs in order to better risk manage. (4) It is necessary to continually re-evaluate the safety of CMIs and to promote rational use of CMIs.