Incidence of Severe Adverse Drug Reactions to Ultrasound Enhancement Agents in a Contemporary Echocardiography Practice.

OBJECTIVES: Prior data indicate a very rare risk of serious adverse drug reaction (ADR) to ultrasound enhancement agents (UEAs). We sought to evaluate the frequency of ADR to UEA administration in contemporary practice. METHODS: We retrospectively reviewed 4 US health systems to characterize the frequency and severity of ADR to UEA. Adverse drug reactions were considered severe when cardiopulmonary involvement was present and critical when there was loss of consciousness, loss of pulse, or ST-segment elevation. Rates of isolated back pain and headache were derived from the Mayo Clinic Rochester stress echocardiography database where systematic prospective reporting of ADR was performed. RESULTS: Among 26,539 Definity and 11,579 Lumason administrations in the Mayo Clinic Rochester stress echocardiography database, isolated back pain or headache was more frequent with Definity (0.49% vs 0.04%, P < .0001) but less common with Definity infusion versus bolus (0.08% vs 0.53%, P = .007). Among all sites there were 201,834 Definity and 84,943 Lumason administrations. Severe and critical ADR were more frequent with Lumason than with Definity (0.0848% vs 0.0114% and 0.0330% vs 0.0010%, respectively; P < .001 for each). Among the 3 health systems with >2,000 Lumason administrations, the frequency of severe ADR with Lumason ranged from 0.0755% to 0.1093% and the frequency of critical ADR ranged from 0.0293% to 0.0525%. Severe ADR rates with Definity were stable over time but increased in more recent years with Lumason (P = .02). Patients with an ADR to Lumason since the beginning of 2021 were more likely to have received a COVID-19 vaccination compared with matched controls (88% vs 75%; P = .05) and more likely to have received Moderna than Pfizer-Biotech (71% vs 26%, P < .001). CONCLUSION: Severe and critical ADR, while rare, were more frequent with Lumason, and the frequency has increased in more recent years. Additional work is needed to better understand factors, including associations with recently developed mRNA vaccines, which may be contributing to the increased rates of ADR to UEA since 2021.

Connectivity between countries established by landbirds and raptors migrating along the African-Eurasian flyway.

The conservation of long-distance migratory birds requires coordination between the multiple countries connected by the movements of these species. The recent expansion of tracking studies is shedding new light on these movements, but much of this information is fragmented and inaccessible to conservation practitioners and policy makers. We synthesized current knowledge on the connectivity established between countries by landbirds and raptors migrating along the African-Eurasian flyway. We reviewed tracking studies to compile migration records for 1229 individual birds, from which we derived 544 migratory links, each link corresponding to a species' connection between a breeding country in Europe and a nonbreeding country in sub-Saharan Africa. We used these migratory links to analyze trends in knowledge over time and spatial patterns of connectivity per country (across species), per species (across countries), and at the flyway scale (across all countries and all species). The number of tracking studies available increased steadily since 2010 (particularly for landbirds), but the coverage of existing tracking data was highly incomplete. An average of 7.5% of migratory landbird species and 14.6% of raptor species were tracked per country. More data existed from central and western European countries, and it was biased toward larger bodied species. We provide species- and country-level syntheses of the migratory links we identified from the reviewed studies, involving 123 populations of 43 species, migrating between 28 European and 43 African countries. Several countries (e.g., Spain, Poland, Ethiopia, Democratic Republic of Congo) are strategic priorities for future tracking studies to complement existing data, particularly on landbirds. Despite the limitations in existing tracking data, our data and results can inform discussions under 2 key policy instruments at the flyway scale: the African-Eurasian Migratory Landbirds Action Plan and the Memorandum of Understanding on the Conservation of Migratory Birds of Prey in Africa and Eurasia.

Conectividad entre países establecida por aves terrestres y rapaces que migran a través del corredor aéreo africano-euroasiático Resumen La conservación de las aves que migran grandes distancias requiere de una coordinación entre los varios países conectados por los movimientos de estas especies. La expansión reciente de los estudios de rastreo está descubriendo novedades en estos movimientos, aunque gran parte de esta información está fragmentada y es inaccesible para quienes practican y elaboran las políticas de conservación. Sintetizamos el conocimiento actual sobre la conectividad establecida entre países por las aves terrestres y rapaces que migran a través del corredor aéreo africano-euroasiático. Revisamos los estudios de rastreo para compilar los registros migratorios de 1229 aves, de los cuales derivamos 544 conexiones migratorias, con cada conexión correspondiendo a la conexión que tiene una especie entre un país europeo en donde se reproduce con un país de la África subsahariana en donde no se reproduce. Usamos estas conexiones migratorias para analizar las tendencias informativas en patrones espaciales y temporales de conectividad por país (en todas las especies), por especie (en todos los países) y a escala del corredor aéreo (en todas las especies y en todos los países). El número de estudios de rastreo disponibles incrementó gradualmente a partir de 2010 (particularmente para las aves terrestres), pero la cobertura de los datos de rastreo existentes estaba incompleta. Se rastreó en promedio 7.5% de especies de aves terrestres migratorias y 14.6% de aves rapaces por país. Existían más datos de los países del centro y oeste de Europa, los cuales estaban sesgados hacia las especies de mayor tamaño. Proporcionamos varias síntesis a nivel de especie y país de las conexiones migratorias que identificamos a partir de la revisión de estudios, las cuales involucran a 123 poblaciones de 43 especies que migran entre 28 países europeos y 43 países africanos. Varios países, como España, Polonia, Etiopía y la República Democrática del Congo son prioridades estratégicas para complementar los datos existentes en los siguientes estudios de rastreo, en especial para las aves terrestres. A pesar de las limitaciones que tienen los datos de rastreo existentes, nuestros datos y resultados pueden orientar las discusiones con dos instrumentos claves para las políticas: el Plan de Acción de las Aves Terrestres Migratorias Africanas-Euroasiáticas y el Memorando de Entendimiento sobre la Conservación de las Aves Rapaces Migratorias de África y Eurasia.

Setting priorities for climate change adaptation of Critical Sites in the Africa-Eurasian waterbird flyways.

Despite their importance for biodiversity and ecosystem services, wetlands are among the most threatened ecosystems globally. The conservation of many migratory waterbirds depends on the conservation of a network of key sites along their flyways. However, the suitability of these sites is changing under climate change, and it is important that management of individual sites in the network adapts to these changes. Using bioclimatic models that also account for changes in inundation, we found that projected climate change will reduce habitat suitability for waterbirds at 57.5% of existing Critical Sites within Africa-Eurasia, varying from 20.1% in Eastern Europe to 87.0% in Africa. African and Middle East sites are particularly threatened, comprising 71 of the 100 most vulnerable sites. By highlighting priority sites for conservation and classifying Critical Sites into Climate Change Adaptation Strategy (CCAS) classes, our results can be used to support the climate change adaptation of both individual sites and the entire site network.

Global inequities and political borders challenge nature conservation under climate change.

Underlying sociopolitical factors have emerged as important determinants of wildlife population trends and the effectiveness of conservation action. Despite mounting research into the impacts of climate change on nature, there has been little consideration of the human context in which these impacts occur, particularly at the global scale. We investigate this in two ways. First, by modeling the climatic niches of terrestrial mammals and birds globally, we show that projected species loss under climate change is greatest in countries with weaker governance and lower Gross Domestic Product, with loss of mammal species projected to be greater in countries with lower CO2 emissions. Therefore, climate change impacts on species may be disproportionately significant in countries with lower capacity for effective conservation and lower greenhouse gas emissions, raising important questions of international justice. Second, we consider the redistribution of species in the context of political boundaries since the global importance of transboundary conservation under climate change is poorly understood. Under a high-emissions scenario, we find that 35% of mammals and 29% of birds are projected to have over half of their 2070 climatic niche in countries in which they are not currently found. We map these transboundary range shifts globally, identifying borders across which international coordination might most benefit conservation and where physical border barriers, such as walls and fences, may be an overlooked obstacle to climate adaptation. Our work highlights the importance of sociopolitical context and the utility of a supranational perspective for 21st century nature conservation.

Migratory diversity predicts population declines in birds.

Declines in migratory species are a pressing concern worldwide, but the mechanisms underpinning these declines are not fully understood. We hypothesised that species with greater within-population variability in migratory movements and destinations, here termed 'migratory diversity', might be more resilient to environmental change. To test this, we related map-based metrics of migratory diversity to recent population trends for 340 European breeding birds. Species that occupy larger non-breeding ranges relative to breeding, a characteristic we term 'migratory dispersion', were less likely to be declining than those with more restricted non-breeding ranges. Species with partial migration strategies (i.e. overlapping breeding and non-breeding ranges) were also less likely to be declining than full migrants or full residents, an effect that was independent of migration distance. Recent rates of advancement in Europe-wide spring arrival date were greater for partial migrants than full migrants, suggesting that migratory diversity may also help facilitate species responses to climate change.