Suppressor analysis links trans-translation and ribosomal protein uS7 to RluD function in Escherichia coli

The pseudouridine (ψ) synthase, RluD is responsible for three ψ modifications in the helix 69 (H69) of bacterial 23S rRNA. While normally dispensable, rluD becomes critical for rapid cell growth in bacteria that are defective in translation-termination. In slow-growing rluD- bacteria, suppressors affecting termination factors RF2 and RF3 arise frequently and restore normal termination and rapid cell growth. Here we describe two weaker suppressors, affecting rpsG, encoding ribosomal protein uS7 and ssrA, encoding tmRNA. In K-12 strains of E. coli, rpsG terminates at a TGA codon. In the suppressor strain, alteration of an upstream CAG to a TAG stop codon results in a shortened uS7 and partial alleviation of slow growth, likely by replacing an inefficient TGA stop codon with the more efficient TAG. Inefficient termination events, such as occurs in some rluD- strains, are targeted by trans-translation. Inactivation of the ssrA gene in slow-growing, termination-defective mutants lacking RluD and RF3, also partially restores robust growth, most probably by preventing destruction of completed polypeptides on ribosomes at slow-terminating stop codons. Finally, an additional role for RluD has been proposed, independent of its pseudouridine synthase activity. This is based on the observation that plasmids expressing catalytically dead (D139N or D139T) RluD proteins could nonetheless restore robust growth to an E. coli K-12 rluD- mutant. However, newly constructed D139N and D139T rluD plasmids do not have any growth-restoring activity and the original observations were likely due to the appearance of suppressors.

Abortion care at 20 weeks and over in Victoria: a thematic analysis of healthcare providers' experiences

BACKGROUND

In many countries, abortions at 20 weeks and over for indications other than fetal or maternal medicine are difficult to access due to legal restrictions and limited availability of services. The Abortion and Contraception Service at the Royal Women's Hospital in Victoria, Australia is the only service in the state that provides this service. The views and experiences of these abortion providers can give insight into the experiences of staff and women and the abortion system accessibility. The aim of this study was to examine health providers' perceptions and experiences of providing abortion care at 20 weeks and over for indications other than fetal or maternal medicine, as well as enablers and barriers to this care and how quality of care could be improved in one hospital in Victoria, Australia.

METHODS

A qualitative study was conducted at the Abortion and Contraception Service at the Royal Women's Hospital. Participants were recruited by convenience and purposive sampling. Semi-structured interviews were conducted one-on-one with participants either online or in-person. A reflexive thematic analysis was performed.

RESULTS

In total, 17 healthcare providers from medicine, nursing, midwifery, social work and Aboriginal clinical health backgrounds participated in the study. Ultimately, three themes were identified: 'Being committed to quality care: taking a holistic approach', 'Surmounting challenges: being an abortion provider is difficult', and 'Meeting external roadblocks: deficiencies in the wider healthcare system'. Participants felt well-supported by their team to provide person-centred and holistic care, while facing the emotional and ethical challenges of their role. The limited abortion workforce capacity in the wider healthcare system was perceived to compromise equitable access to care.

CONCLUSIONS

Providers of abortion at 20 weeks and over for non-medicalised indications encounter systemic enablers and barriers to delivering care at personal, service delivery and healthcare levels. There is an urgent need for supportive policies and frameworks to strengthen and support the abortion provider workforce and expand provision of affordable, acceptable and accessible abortions at 20 weeks and over in Victoria and in Australia more broadly.

A new perspective on isotretinoin in pregnancy: Pregnancy outcomes, evaluation of complex phenotypes, and importance of teratological counselling

OBJECTIVES

Teratogens are responsible for 5% of all known causes of congenital anomalies. Isotretinoin, a retinoic acid-derived agent, leads to congenital anomalies in 21-52% of cases when exposure occurs during pregnancy according to studies conducted before 2006. However, rates of congenital anomalies were much lower in later studies. The purpose of this study was to investigate the rates of congenital anomalies in isotretinoin exposure during pregnancy, isotretinoin exposure before pregnancy, and a control group unexposed to any teratogenic agents.

STUDY DESIGN

In this cohort study, we divided pregnant women admitted to our center between 2009 and 2020 into two groups: isotretinoin exposure before and during the pregnancy (n = 77) and isotretinoin exposure before the pregnancy (n = 75). We selected the control group from among the non-teratogen exposed pregnant women with a simple random sampling method. Obstetricians calculated the ages of all pregnancies via ultrasound (USG) (crown-rump diameter for the first trimester; biparietal diameter and femur length for the second trimester). After birth, a pediatric genetics specialist examined all babies. Whole-exome sequencing (WES) was conducted on the babies who displayed complex phenotypes.

RESULTS

Among the isotretinoin exposure before and during the pregnancy, isotretinoin exposure before the pregnancy, and the control groups, there were statistically significant differences in live births (respectively, 64.3 %, 88 %, 93.3 %), congenital anomalies (respectively, 28.6 %, 6.1 %, 1.4 %), miscarriages (respectively, 13 %, 2.7 %, 4 %), terminations (respectively, 32.5 %, 9.3 %, 2.7 %), and premature births (11.9 %, 16.7 %, 2.9 %) (respectively, p < 0.001, p < 0.001, p = 0.014, p < 0.001). We detected novel phenotypical features in five patients.

CONCLUSIONS

Our study demonstrated that study design, long-term follow-up, teratological counseling, and implementation of advanced molecular analysis in complex phenotypes with novel phenotypical features are beneficial for understanding the association of congenital anomalies with isotretinoin exposure. While evaluating congenital anomalies, we detected statistically significant differences between isotretinoin exposure before and during the pregnancy vs control, but we did not detect any statistically significant differences between isotretinoin exposure before the pregnancy and controls. Another finding of the study is that WES might be an efficient way to evaluate complex phenotypes in isotretinoin-exposed babies; however, further research is required.

Extra-legal abortion and post-abortion care knowledge, attitudes, and practices among obstetrician-gynecologist clinicians and medical residents in San José, Costa Rica: a qualitative study

BACKGROUND

Induced abortion in Costa Rica is illegal in all cases except to save the life of the pregnant person. Despite severe restrictions to legal abortion, individuals in Costa Rica still induce abortions outside of the formal healthcare system. These individuals and those with spontaneous abortions, also known as miscarriages, occasionally need medical care for complications. In Costa Rica, an estimated 41% of unintended pregnancies end in abortion, yet there is very little published literature exploring the perspectives of healthcare providers on abortion in Costa Rica.

METHODS

We interviewed ten obstetrician-gynecologist clinicians and five obstetrician-gynecologist medical residents in San José, Costa Rica about their beliefs and practices related to extra-legal abortion and post-abortion care (PAC) using a Spanish language in-depth semi-structured interview guide. After transcription and translation into English, analysis team pairs used a combination of deductive and inductive coding to identify themes and sub-themes within the data.

RESULTS

Obstetrician-gynecologist clinicians and medical residents were aware of the presence of extra-legal abortion, and particularly, medication abortion, in their communities, but less familiar with dosing for induction. They expressed the desire to provide non-judgmental care and support their patients through extra-legal abortion and PAC journeys. Study participants were most familiar with providing care to individuals with spontaneous abortions. When discussing PAC, they often spoke about a policy of reporting individuals who seek PAC following an extra-legal abortion, without commenting on whether or not they followed the guidance.

CONCLUSIONS

This study contributes to a gap in research about the knowledge, attitudes, and practices of Costa Rican obstetrician-gynecologist clinicians and medical residents around extra-legal abortion and PAC. The results reveal an opportunity to train these healthcare providers as harm reduction experts, who are able to accurately counsel individuals who are seeking abortion services outside of the healthcare system, and to provide training to improve care for individuals needing PAC.

Usability of EtCO2 values in the decision to terminate resuscitation by integrating them into the TOR rule (an extended TOR rule): A preliminary analysis

Objective

End tidal carbon dioxide (EtCO2) is measured to confirm the placement of an endotracheal tube and evaluate the efficacy of cardiopulmonary resuscitation (CPR), and as an assistive tool for terminating CPR. However, there are no highly accurate or definitive recommendations for its use when deciding on the termination of CPR. We aimed to merge EtCO2 values with existing termination of resuscitation (TOR) rules to obtain a more accurate combination for terminating resuscitation.

Methods

This observational, prospective study included non-traumatic adult patients who were admitted to a tertiary university hospital Emergency Medicine Department due to cardiac arrest. EtCO2 cutoff values (at 5, 10, and 20 min) were integrated into currently used TOR parameters (arrest was not witnessed, no bystander CPR was provided, no return of spontaneous circulation (ROSC) after full advanced life support care in the field, and no shock was delivered) and the extended TOR rule was created. These extended TOR rules were compared at three different times (5, 10, and 20 min) for specificity and positive predictive value for ROSC.

Results

We included a total of 86 cases. The cutoff value of EtCO2 from ROC analysis was 19.5, 23.5, and 20.5 mmHg at 5, 10, and 20 min, respectively. "The extended TOR rule created with the 20-min EtCO2 cutoff (20.5 mmHg) was the most accurate in detecting ROSC (-) patients. The specificity was 100% (95% CI 63.1-100.0) sensitivity was 20.0% (95% CI 9.1-35.7), positive predictive value was 100% and negative predictive value was 20.0% (95% CI 17.6-22.6) for ROSC (-) patients. The parameters of this rule were as follows: arrest was not witnessed, no bystander CPR was provided, no ROSC after full advanced life support care in the field, no shock was delivered, and EtCO2 value at 20 min of resuscitation <20.5 mmHg.

Conclusions

Integration of EtCO2 values into the classically used TOR criteria increases the specificity to 100% without a significant decrease in sensitivity. These results need to be validated in larger groups before this rule is used clinically. EtCO2 seems to be a beneficial tool in establishing new TOR rules.

"Out Like a Lion:" Terminating the COVID-19 National Public Health Emergency

From its inception, the COVID-19 pandemic has been a disruptive force on U.S. health care and public health systems. President Biden's announced termination of the national public health emergency on May 11, 2023 portends a return to normalcy and relief for Americans from the greatest infectious disease scourge the nation has ever faced. In reality, closing out this pandemic presents a tempest of legal and practical complications.

The missing voices in the conscientious objection debate: British service users' experiences of conscientious objection to abortion

BACKGROUND

The fourth section of the 1967 Abortion Act states that individuals (including health care practitioners) do not have to participate in an abortion if they have a conscientious objection. A conscientious objection is a refusal to participate in abortion on the grounds of conscience. This may be informed by religious, moral, philosophical, ethical, or personal beliefs. Currently, there is very little investigation into the impact of conscientious objection on service users in Britain. The perspectives of service users are imperative in understanding the real-world consequences and potential impact of conscientious objection and should be considered when creating and reviewing policies and guidelines. This research provided a platform for women and those who can become pregnant to share their experiences and opinions at a time when these voices are largely excluded in the great tradition of Western political philosophy and law-making processes.

METHOD

Five service users were interviewed using a narrative interview approach to uncover their abortion journeys and experiences of conscientious objection.

FINDINGS

The findings were presented as found poems and uncovered that doctors are not always: informing service users that they have a conscientious objection to abortion, giving service users enough information to access abortion (indirect referral), treating them non-judgmentally, and providing medically correct information. Service users did not experience burdens such as long waiting times and were still able to access legal abortion. However, service users did experience negative emotional effects, as they were often left feeling scared, angry, and hopeless when they were not referred and/or were mistreated.

CONCLUSIONS

Findings indicate that conscientious objection could work in practice. However, it is currently failing some individuals on an emotional level, as not all doctors are adhering to guidelines. Conscientious objection in Britain needs to be addressed, to ensure service users receive fair, impartial, non-judgmental care.

Evaluating How Physician Attitudes May Affect Practice in Fetal Cardiac Counseling

Advances in fetal cardiac imaging over the last few decades have allowed for increased prenatal detection and detailed counseling of congenital heart disease (CHD). When CHD is detected, fetal cardiologists are faced with the challenge of providing nuanced prenatal counseling. Studies in other specialties have shown that differences in physician attitudes exist around termination of pregnancy and correlate with variations in the counseling provided to parents. We conducted an anonymous cross-sectional survey of fetal cardiologists in New England (n = 36) regarding attitudes toward termination of pregnancy and the counseling provided to parents with a fetal diagnosis of hypoplastic left heart syndrome. Using a screening questionnaire, there was no significant difference in the counseling provided to parents regardless of the physician's personal or professional views on termination of pregnancy, age, gender, location, type of practice, or years of experience. There were, however, differences among physicians on reasons to consider termination and their perceived professional responsibility to the fetus or mother. Further investigation on a larger geographic scale may reveal additional insights on variations in physician beliefs and whether such beliefs affect variability in counseling practices.

Real-world utilization of the pill-in-the-pocket method for terminating episodes of atrial fibrillation: data from the multinational Antiarrhythmic Interventions for Managing Atrial Fibrillation (AIM-AF) survey

AIMS

Atrial fibrillation (AF) is the most common sustained arrhythmia encountered in clinical practice. Episodes may stop spontaneously (paroxysmal AF); may terminate only via intervention (persistent AF); or may persist indefinitely (permanent AF) (see European and American guidelines, referenced below, for more precise definitions). Recently, there has been renewed interest in an approach to terminate AF acutely referred to as 'pill-in-the-pocket' (PITP). The PITP is recognized in both the US and European guidelines as an effective option using an oral antiarrhythmic drug for acute conversion of acute/recent-onset AF. However, how PITP is currently used has not been systematically evaluated.

METHODS AND RESULTS

The recently published Antiarrhythmic Interventions for Managing Atrial Fibrillation (AIM-AF) survey included questions regarding current PITP usage, stratified by US vs. European countries surveyed, by representative countries within Europe, and by cardiologists vs. electrophysiologists. This manuscript presents the data from this planned sub-study. Our survey revealed that clinicians in both the USA and Europe consider PITP in about a quarter of their patients, mostly for recent-onset AF with minimal or no structural heart disease (guideline appropriate). However, significant deviations exist. See the Graphical abstract for a summary of the data.

CONCLUSION

Our findings highlight the frequent use of PITP and the need for further physician education about appropriate and optimal use of this strategy.

The Impact of New and Renewed Restrictive State Abortion Laws on Pregnancy-Capable People with Diabetes

PURPOSE OF REVIEW

When the Supreme Court handed down its decision in Dobbs v Jackson Women's Health Organization in June 2022, the constitutional right to abortion was no longer protected by Roe v Wade. Fifteen states now have total or near-total bans on abortion care or no clinics providing abortion services. We review how these restrictions affect the medical care of people with pregestational diabetes.

RECENT FINDINGS

Of the ten states with the highest percent of adult women living with diabetes, eight currently have complete or 6-week abortion bans. People with diabetes are at high risk of diabetes-related pregnancy complications and pregnancy-related diabetes complications and are disproportionately burdened by abortion bans. Abortion is an essential part of comprehensive, evidence-based diabetes care, yet no medical society has published guidelines on pregestational diabetes that explicitly discuss the importance and role of safe abortion care. Medical societies enacting standards for diabetes care and clinicians providing diabetes care must advocate for access to abortion to reduce pregnancy-related morbidity and mortality for pregnant people with diabetes.

Pregnancy Loss in Relation to the Risks of Female-Specific Cancers in a Population-Based Cohort and Mendelian Randomization Study - China, 2004-2017

What is already known about this topic?

Limited evidence exists regarding the relationship between pregnancy loss and female-specific cancers within the Chinese population from prospective cohort studies.

What is added by this report?

Terminations were associated with a 13% lower risk of endometrial cancer, whereas stillbirths were related to an 18% higher risk of cervical cancer. Rural residents with a history of pregnancy loss experienced a 19% and 38% increased risk of breast and cervical cancers, respectively, compared to their urban counterparts. Moreover, a positive graded relationship between live births and pregnancy loss on cervical cancer was observed.

What are the implications for public health practice?

This study has significant implications for identifying women at an increased risk for breast and genital cancers and contributes to the development of effective public health strategies for female cancer prevention. Future research on reproductive history, particularly in rural areas, should be given priority in efforts to improve female cancer screening and early detection.

Predictors of premature termination and completion of randomized controlled trials

Randomized clinical trials (RCTs) have a key role in progressing biomedical research and guiding clinical decision making, but premature termination remains high (up to 30%), raising concerns regarding funding expenditure and resource allocation. This brief report sought to identify variables associated with RCTs' premature termination and completion.

Early MRI termination with major impact on the radiological interpretation: The experience of a large university hospital

PURPOSE

To report the incidence of early magnetic resonance imaging (MRI) terminations and analyse their risk factors in a large university hospital.

METHOD

All consecutive patients aged > 16 years who underwent an MRI over a 14-month period were included. The following parameters were collected: demographics, in- or outpatient, history of claustrophobia, anatomical region investigated, and early MRI termination along with its cause. The potential link between these parameters and early MRI termination was statistically analysed.

RESULTS

Overall, 22,566MRIs were performed (10,792 [48%] men and 11,774[52%] women, mean age: 57 [range: 16-103] years). Early MRI termination was reported in 183 (0.8%) patients (99 men and 84 women, mean age: 63 years). Of these early terminations, 103 (56%) were due to claustrophobia and 80 (44%) to other causes. Early terminations were more common in inpatients than outpatients (1.2% vs. 0.6%, p < 0.001), for both claustrophobia- and non-claustrophobia-related reasons. A prior history of claustrophobia was strongly associated with claustrophobia-related early termination (6.6% vs. 0.2%, p = 0.0001). Non-claustrophobia-related early terminations were significantly more common (0.6% vs. 0.2%) in elderly patients (>65 years old) than in younger ones. No other parameter was significantly associated with early termination.

CONCLUSIONS

Early MRI termination is currently rare. The main risk factors for claustrophobia-related terminations comprised a prior history of claustrophobia, and examinations in inpatients. Non-claustrophobia-related early terminations were more common in both elderly patients and inpatients.

Translation in Mitochondrial Ribosomes

Mitochondrial protein synthesis is essential for the life of aerobic eukaryotes. Without it, oxidative phosphorylation cannot be coupled. Evolution has shaped a battery of factors and machinery that are key to production of just a handful of critical proteins. In this general concept chapter, we attempt to briefly summarize our current knowledge of the overall process in mitochondria from a variety of species, breaking this down to the four parts of translation: initiation, elongation, termination, and recycling. Where appropriate, we highlight differences between species and emphasize gaps in our understanding. Excitingly, with the current revolution in cryoelectron microscopy and mitochondrial genome editing, it is highly likely that many of these gaps will be resolved in the near future. However, the absence of a faithful in vitro reconstituted system to study mitochondrial translation is still problematic.

Does crossbreeding improve the performance and carcass traits of Berganês sheep?

This study aimed to evaluate the performance and carcass of lambs of different genotypes through univariate and multivariate analysis. Intact male lambs of the Berganês (BG), Berganês x Santa Inês (BSI), and Berganês x Dorper (BD) genotypes and the control group Dorper x Santa Inês (DSI) were used. Eight lambs of each genotype were used, aged between 4 and 5 months, with an average initial weight of 27.52 ± 3.79 kg, distributed in a completely randomized design. Data were tested by analyzing variance, followed by Tukey's test and principal component analysis (PCA) and discriminant analysis (DA). Slaughter body and average daily gain were higher for BD and BG than BSI (P < 0.05). On the other hand, BSI, BD, and DSI showed higher cold carcass yield than BG (P < 0.05). Lower cooling losses (CL) and more excellent conformation were observed in DSI (P < 0.05). BD showed a higher carcass compactness index (CCI), and DSI showed a higher leg compactness index (LCI) (P < 0.05). PCA produced seven components explaining 83.59% of total data variability. Based on the discriminant analysis, LCI, CL, CCI, and conformation showed greater power to distinguish the genotypes, with a high index of the lambs' classification to their respective genotypes. The crossbreeding improved carcass yield and reduced cooling weight loss. The Berganês ecotype and its crossbreeds have performance and carcass traits compatible with the DSI genotype. According to the DA, heterogeneity was found between the Berganês ecotype and its crossbreeds, with CL, LCI CCI, and conformation showing greater discrimination power.

Termination of Pregnancy for Ultrasound diagnosed Major Fetal Anomalies at a Nigerian Tertiary Hospital: An Initial Experience

BACKGOUND

Major Congenital anomalies are conditions that are severe enough to reduce life expectancy or compromise normal function. The introduction of prenatal screening for fetal anomalies to mid-trimester ultrasonography allows for early detection of many anomalies including the major ones. Once the diagnosis is made, the parents have the options of either terminating or continuing with the pregnancy after proper counselling. The purpose of this study is to determine the pattern of pregnancy termination for major congenital anomalies in our hospital after seven years of commencement of the screening programme.

METHODS

This was a retrospective study in which all women who presented for prenatal ultrasound screening for fetal anomalies at the University College Hospital, Ibadan, Nigeria between August 2012 and July 2019 were scanned. Those with ultrasound diagnosed major fetal anomalies were counselled on the severity of the anomalies and were given the options of either continuing with the pregnancy or terminating it. All the data were recorded in a spreadsheet while Statistical analysis was performed using the IBM-SPSS version 20 spreadsheet.

RESULTS

During the seven-year period, three thousand, one hundred and twenty (3,120) fetuses were screened for fetal anomalies, out of which sixty-one (1.95%) had major anomalies. Twenty (32.8%) of the major anomalies were terminated at various stages of pregnancy. Anomalies of the central nervous system and the musculoskeletal system were the most frequently terminated anomalies, each having 8 fetuses. This was followed by anomalies involving more than one system which were diagnosed in 3 of the fetuses. All the mothers were counselled before the termination of the pregnancies. Nineteen (95%) of the anomalies were confirmed after termination.

CONCLUSION

The availability of prenatal ultrasound screening permits precise diagnosis of a range of fetal abnormalities, including those incompatible with life. Therefore, termination of pregnancies with major anomalies significantly contributes to the global decrease in perinatal morbidity and mortality associated with birth defects.

Real world data on adjuvant treatment of older HER2-positive breast cancer patients - A single institution experience through 8 years

BACKGROUND

The large randomized trials on trastuzumab for primary breast cancer (BC) included few old patients. With exception of endocrine treatment, trials on adjuvant therapy for the old group specifically are scarce.

AIMS

To compare adjuvant treatment, recurrences and survival in old and older-old patients with primary HER2 positive BC.

MATERIAL AND METHODS

Patients ≥ 70 years with diagnose of primary HER2 positive BC from 2008 through 2015 were included in this retrospective non-randomized investigation. Standard clinical and biological data (age, surgery, tumor size, nodal status, histopathological grade, vascular invasion, expression of hormone receptors, recurrences and death) were extracted from patient's charts. Comparisons were performed according to age (old; 70-74 years vs older old; ≥ 75 years) and treatment with trastuzumab or not. Patients that initiated adjuvant trastuzumab but did not complete one year (n = 8) were included in the trastuzumab group in survival analyzes. Recurrence-free survival (RFS) and overall survival (OS) were calculated in uni- and multivariate analyses.

RESULTS

A total of 115 patients were registered, eleven patients had distant metastasis and seven were omitted from all treatment including primary surgery due to serious concomitant illness and a poor general condition leaving 97 patients for analysis. There were no differences between the groups (70-74; n = 40), (≥75; n = 57) in tumor size (p = 0.86), nodal status (p = 0.10), ER (p = 0.25), PgR (p = 1.0) or vascular invasion (p = 1.0). A lower proportion of patients ≥ 75 years received adjuvant trastuzumab (21% versus 70%, p < 0.001). Adjuvant trastuzumab improved RFS (p = 0.027) and OS (p = 0.002) in univariate analyses. The corresponding figures in multivariate analysis adjusted for tumor size, nodal status and grade were RFS (p = 0.0052) and OS (p = 0.0003) respectively. Brain was the most common site of distant metastasis (15% of patients at first recurrence).

CONCLUSIONS

We show a large difference in delivered adjuvant treatment between old and older old patients with a small proportion of patients aged 75 years or more receiving HER2 directed therapy that resulted in a worse survival. The vast majority can complete the planned treatment. Our results indicate that brain metastases is common also among older patients.

The "dragons of primeval days": Termination and the persistence of the infantile

The persistence of the infantile is nowhere more apparent than in the termination process. This dread of termination may interfere with both the patient's capacity to terminate and the analyst's capacity to let patients go. Certain patients have an intense wish to maintain a permanent connection with the analyst. Analysing that wish does not necessarily change the patient's conviction that they are not ready to fully terminate. The love experienced in the transference may be the best love relationship that the patient has ever had. The intensity and pervasiveness of the infantile in our work may best be glimpsed by studying the defences against the infantile. Ultimately, we must respect the patient's limits in some cases, rather than pick them apart and cajole the patient into another view that we prefer. Freud was perhaps uncharacteristically candid in saying that he questioned whether a true transformation was achieved at the time of termination.

Post-termination self-analysis and the relinquishment of the psychoanalytic frame: thoughts on a fragment of self-analytic work following a traumatic termination

Months following the traumatic termination of my analysis I engaged in self-analytic work in which I was able to rework the events of the termination and their significance in terms of my history. Fundamental differences between my self-analytic process and that of my formal analysis led me to consider how termination may affect the ensuing self-analytic process. In this paper, I look at aspects of termination that have to do with the dissolution of symbiotic ties with the analyst; I will try to show that relinquishment of the frame provides an impetus both for consolidation and reworking of an identification with the analyst, which may enable the analysand to develop a personal way of thinking about the unconscious that differs from that of the analyst. I further suggest that there are inevitable limitations to the analytic process which manifest in the development of irreducible bastions, and that the dissolution of the frame at termination provides an opportunity for self-analytic resolution of those bastions which may allow self-understanding beyond what could have been attained within the formal analytic setting. Finally, I offer some speculations on how these processes may have played out between Freud and Fliess in Freud's self-analysis.

Multifaceted control of mRNA translation machinery in cancer

The mRNA translation machinery is tightly regulated through several, at times overlapping, mechanisms that modulate its efficiency and accuracy. Due to their fast rate of growth and metabolism, cancer cells require an excessive amount of mRNA translation and protein synthesis. However, unfavorable conditions, such as hypoxia, amino acid starvation, and oxidative stress, which are abundant in cancer, as well as many anti-cancer treatments inhibit mRNA translation. Cancer cells adapt to the various internal and environmental stresses by employing specialised transcript-specific translation to survive and gain a proliferative advantage. We will highlight the major signaling pathways and mechanisms of translation that regulate the global or mRNA-specific translation in response to the intra- or extra-cellular signals and stresses that are key components in the process of tumourigenesis.

Towards efficient verification of population protocols

Population protocols are a well established model of computation by anonymous, identical finite-state agents. A protocol is well-specified if from every initial configuration, all fair executions of the protocol reach a common consensus. The central verification question for population protocols is the well-specification problem: deciding if a given protocol is well-specified. Esparza et al. have recently shown that this problem is decidable, but with very high complexity: it is at least as hard as the Petri net reachability problem, which is TOWER-hard, and for which only algorithms of non-primitive recursive complexity are currently known. In this paper we introduce the class WS 3 of well-specified strongly-silent protocols and we prove that it is suitable for automatic verification. More precisely, we show that WS 3 has the same computational power as general well-specified protocols, and captures standard protocols from the literature. Moreover, we show that the membership and correctness problems for WS 3 reduce to solving boolean combinations of linear constraints over N . This allowed us to develop the first software able to automatically prove correctness for all of the infinitely many possible inputs.

Prognostic factors of time to first abortion after sexual debut among fragile state Congolese women: a survival analysis

BACKGROUND

Despite the common restrictive abortion laws, abortion remains widespread in sub-Saharan Africa (SSA) countries. Women still utilize abortion services and put their lives and health at risk because abortion can only be procured illegally in private facilities such as mid-level or small patent medicine store that may be manned by unskilled providers or through a non-medicated approach. The objective of this study was to investigate the prevalence of abortion, the reasons women had abortions, median years to first abortion after sexual debut and examine the factors of time to first abortion among women of reproductive age in the Republic of Congo.

METHODS

We used data from the most recent Republic of Congo Demographic and Health Survey (DHS). A total sample of 3622 women aged 15-49 years was analyzed. We estimated the overall prevalence of abortion and median years to first abortion. Furthermore, we examined the factors of time to first abortion after sexual debut using multivariable Cox regression and reported the estimates using adjusted Hazard Ratio (aHR) and 95% confidence intervals (CI). Statistical significance was determined at p < 0.05.

RESULTS

The prevalence of abortion was 60.0% and median years of time to first abortion after sexual debut was 9.0. The prominent reasons for abortion were due to too short birth interval (23.8%), lack of money (21.0%) and that husband/partner did not need a child at that time (14.0%). Women's age and region were notable factors in timing to first abortion. Furthermore, women from poorer, middle, richer and richest households had 34, 67, 86 and 94% higher risk of abortion respectively, when compared with women from poorest households (all p < 0.05). Women currently in union/living with a man and formerly in union had 41 and 29% reduction in the risk of abortion respectively, when compared with those never in union (all p < 0.05). In addition, women with primary and secondary+ education had 42 and 76% higher risk of abortion respectively, when compared with women with no formal education (all p < 0.05).

CONCLUSION

There was high prevalence of abortion with short years at first abortion. Abortion was associated with women's characteristics. There is need for unwanted pregnancy prevention intervention and the improvement in pregnancy care to reduce adverse pregnancy outcomes among women.

"I had to think: This is not a child." A qualitative exploration of how women/couples articulate their relation to the fetus/child following termination of a wanted pregnancy due to Down syndrome

OBJECTIVE

Termination of a wanted pregnancy due to fetal anomaly may generate complex feelings of grief and loss. The aim of this study was to explore the different ways that women/couples articulated their relation to the fetus/child following a termination of pregnancy due to a prenatal diagnosis of Down syndrome.

METHOD

Qualitative interview study with 21 women/couples who had recently terminated a wanted pregnancy. Data were analyzed using thematic analysis.

RESULTS

The analysis identified how some women detached themselves from the fetus/child following the diagnosis by mentally separating from the fetus/child, by acting as if they were not pregnant (e.g., by drinking wine), or by deliberately using the term 'fetus' to designate the fetus/child as a biological entity. The analysis also identified accounts of attachment such as singing a lullaby to the fetus/child or using the term 'our child' or 'my baby'. However, accounts of detachment and attachment often intermingled and changed over time. Following the termination, many women/couples felt ambiguous about the sonogram as a symbol of the potential child. Overall, the analysis showed that the relation to and the meaning of the fetus/child was ambiguous and open to reinterpretation.

CONCLUSION

The main contribution of this study is the identification of how articulations of attachment and detachment are not mutually exclusive but coexist and may change over time. Furthermore, we argue that detachment does not equal indifference. Thus, healthcare professionals must support the couple in finding a terminology and a narrative that are meaningful for them.

A Simple Fluorescence Microplate Assay to Monitor RNA-DNA Hybrid Unwinding by the Bacterial Transcription Termination Factor Rho

Transcription termination factor Rho contributes to shape the transcriptomes of many bacteria and is essential in a large subset of them. Although the transcription termination function of Rho is not always easy to reconstitute and to study in vitro, assays based on the ATP-dependent RNA-DNA hybrid unwinding activity of the factor can prove useful to dissect Rho mechanisms or to seek new antibiotics targeting Rho. However, current in vitro assays of Rho helicase activity are time-consuming, as they usually require radiolabeling of the hybrid substrates and analysis of reaction products by gel electrophoresis. Here, we describe a fluorescence-based microplate assay that informs on Rho helicase activity in a matter of minutes and allows the multiplexed analysis of conditions required for primary biochemical characterization or for drug screening.

Outpatient abortion in a patient with a previously undiagnosed transverse vaginal septum: A case report

A multigravida presented for a 13-week abortion. The surgeon noted a transverse vaginal septum with small central perforation at the time of bimanual exam. The surgeon performed dilation and suction curettage through the septum without resection in the outpatient setting.

Enforcement of legal remedies against construction projects time overrun in Ethiopia: A critical appraisal

Construction time overrun is one of the common inefficiencies of public construction projects in Ethiopia. Laws and standard construction contracts stipulate different legal remedies against project time overrun. This paper is meant to unravel these legal remedies and their application to construction project time overrun in public construction projects in Ethiopia. To this end, the magnitude of time overrun, its common causes, and the practical implementation of legal remedies against it is exposed through literature review, primary data obtained from 18 roads and 10 public building projects, and interviews of 10 key informants. The result showed, although time is not the essence of construction contract in international standard conditions of contracts, it is a fundamental obligation the breach of which would give rise to termination of the contract under the laws and standard conditions of contracts applicable to public works in Ethiopia. However, the paper established that the practical implantation of these legal remedies against time overrun in public construction projects is very erratic although time overrun is a rampant challenge of the construction industry of the country in general and public construction projects in particular.

Complications associated with second trimester inductions of labor requiring greater than five doses of misoprostol

OBJECTIVE

To evaluate outcomes associated with induction at 14 weeks 0 days-23 weeks 6 days gestation that require five or less vs. six or more misoprostol doses.

STUDY DESIGN

We performed a retrospective study of vaginal misoprostol inductions from January 2003 to February 2016 to assess complications based on number of misoprostol doses.

RESULTS

Among 390 women receiving five or fewer doses and 78 women receiving six or more doses, we found similar rates of chorioamnionitis, postpartum hemorrhage, transfusion and retained placenta.

CONCLUSION

Complication rates were comparable in women receiving more than five versus less than five misoprostol doses for labor induction in the second trimester.

IMPLICATIONS

Women undergoing second trimester induction undelivered after five doses of misoprostol can receive additional doses without any concern for increased complications.

Contributions of the basal ganglia to action sequence learning and performance

Animals engage in intricately woven and choreographed action sequences that are constructed from trial-and-error learning. The mechanisms by which the brain links together individual actions which are later recalled as fluid chains of behavior are not fully understood, but there is broad consensus that the basal ganglia play a crucial role in this process. This paper presents a comprehensive review of the role of the basal ganglia in action sequencing, with a focus on whether the computational framework of reinforcement learning can capture key behavioral features of sequencing and the neural mechanisms that underlie them. While a simple neurocomputational model of reinforcement learning can capture key features of action sequence learning, this model is not sufficient to capture goal-directed control of sequences or their hierarchical representation. The hierarchical structure of action sequences, in particular, poses a challenge for building better models of action sequencing, and it is in this regard that further investigations into basal ganglia information processing may be informative.

Parental decision-making following a prenatal diagnosis that is lethal, life-limiting, or has long term implications for the future child and family: a meta-synthesis of qualitative literature

BACKGROUND

Information on the factors influencing parents' decision-making process following a lethal, life-limiting or severely debilitating prenatal diagnosis remains deficient. A comprehensive systematic review and meta-synthesis was conducted to explore the influencing factors for parents considering termination or continuation of pregnancy following identification of lethal, life-limiting or severely debilitating fetal abnormalities.

METHODS

Electronic searches of 13 databases were conducted. These searches were supplemented by hand-searching Google Scholar and bibliographies and citation tracing. Thomas and Harden's (2008) thematic synthesis method was used to synthesise data from identified studies.

RESULTS

Twenty-four papers were identified and reviewed, but two papers were removed following quality assessment. Three main themes were identified through systematic synthesis. Theme 1, entitled 'all life is precious', described parents' perception of the importance of the fetus' life, a fatalistic view of their situation alongside moral implications as well as the implications decisions would have on their own life, in consideration of previous life experiences. Theme 2 ('hope for a positive outcome') contained two sub-themes which considered the parent's own imagined future and the influence of other people's experiences. Finally, Theme 3 ('a life worth living') presented three sub-themes which may influence their parental decision-making: These described parental consideration of the quality of life for their unborn child, the possibility of waiting to try for another pregnancy, and their own responsibilities and commitments.

CONCLUSION

The first review to fully explore parental decision-making process following lethal, life-limiting, or severely debilitating prenatal diagnosis provided novel findings and insight into which factors influenced parents' decision-making process. This comprehensive and systematic review provides greater understanding of the factors influential on decision-making, such as hope, morality and potential implications on their own and other's quality of life, will enable professionals to facilitate supported decision-making, including greater knowledge of the variables likely to influence parental choices.

Pregnancy outcomes after removal of osmotic dilators in patients who presented for second-trimester abortion

OBJECTIVE

The objective was to report pregnancy outcomes and potentially related complications among 13 patients who had osmotic dilators placed for second-trimester dilation and evacuation (D&E) followed by subsequent removal with the intention to continue their pregnancies.

STUDY DESIGN

We reviewed billing and scheduling data between 2005 and 2017 to identify the total number of women seen for D&E and to identify the individuals who had dilators placed without a subsequent scheduled dilation and evacuation. We then performed chart reviews to determine pregnancy outcomes.

RESULTS

Between 2005 and 2017, we treated 2532 patients who presented for second-trimester abortions by D&E and received osmotic dilators for cervical preparation. Twenty (0.8%) of these women had cervical dilators removed with the intention of continuing their pregnancies. We could obtain outcome data for 13 of these pregnancies; one of these women ultimately elected to have an abortion. Eight of the remaining 12 women (66%) experienced complications which included premature preterm rupture of membranes, preterm delivery, maternal infection and hemorrhage. Six (50%) pregnancies ended in spontaneous abortion or fetal or neonatal death.

CONCLUSION

Continuation of pregnancy after placement and removal of osmotic dilators may increase the risk of adverse pregnancy outcomes.

IMPLICATIONS

Of the women who had outcome data available, 50% who had cervical dilators removed experienced spontaneous abortion or fetal or neonatal death. Conservatively assuming that all women lost to follow-up had healthy pregnancies, 30% of women experienced fetal or neonatal death and 40% had an adverse pregnancy outcome.

Regulatory Tools for Controlling Gene Expression in Cyanobacteria

Cyanobacteria are attractive hosts for converting carbon dioxide and sunlight into desirable chemical products. To engineer these organisms and manipulate their metabolic pathways, the biotechnology community has developed genetic tools to control gene expression. Many native cyanobacterial promoters and related sequence elements have been used to regulate genes of interest, and heterologous tools that use non-native small molecules to induce gene expression have been demonstrated. Overall, IPTG-based induction systems seem to be leaky and initially demonstrate small dynamic ranges in cyanobacteria. Consequently, a variety of other induction systems have been optimized to enable tighter control of gene expression. Tools require significant optimization because they function quite differently in cyanobacteria when compared to analogous use in model heterotrophs. We hypothesize that these differences are due to fundamental differences in physiology between organisms. This review is not intended to summarize all known products made in cyanobacteria nor the performance (titer, rate, yield) of individual strains, but instead will focus on the genetic tools and the inherent aspects of cellular physiology that influence gene expression in cyanobacteria.

Magnetic Resonance Imaging Observations of the Conus Medullaris in a Korean Population

STUDY DESIGN

Retrospective study (level of evidence: level 3).

PURPOSE

To study the anatomy of the conus medullaris in Koreans.

OVERVIEW OF LITERATURE

The anatomical position of the conus medullaris is well-documented in anatomy textbooks; however, the shape of the conus in the canal rarely described. Furthermore, to our knowledge, no study in Korea has not yet assessed the shape of the conus as well as its position in the canal via cadavaric dissection and/or magnetic resonance imaging (MRI).

METHODS

MRI findings of 189 Korean patients aged 2-94 years (93 men and 94 women) were assessed. No subjects from other ethnicities were included. The method proposed by Arai and colleagues was used to assess the termination point and shape of the conus in the canal. The position of the intervertebral disc trisection of the vertebral body closest to the tip of the conus was recorded at the canal level.

RESULTS

The tip of the conus medullaris was positioned from the upper T12 body to the L2-L3 disc, mostly in L1 bodies (52.4%), followed by the L2 bodies (22.5%), the L1-L2 disc, and the L2-L3 disc (1.1%). The shape of the conus was classified as type A in 74 (39.6%), type B in 58 (31%), and type C in 55 patients (29.4%). The conus did not terminate at the L3 body in any patient. In the first decade ones (five children) conus positioned rather lowly from L1 bodies to L2-L3 disc, and no type A conus shape, and mostly type B (80%).

CONCLUSIONS

The conus medullaris was positioned mostly in the lower one-third of L1 and it in the first decades terminated lowly. No type A in the first decade one, and type B was mostly frequently formed which was followed by type C.

Antiepileptic drug exposure in pregnancy and pregnancy outcome from national drug usage data

Background

Antiepileptic drugs (AEDs) are used by pregnant women to manage conditions such as epilepsy and bipolar disorder even though they pose a risk to the developing foetus. This study aimed to determine the overall use of AEDs by women during their childbearing years and women who are pregnant and the association between AED use and rates of pregnancy termination and spontaneous abortion.

Methods

Retrospective population based cohort study using administrative databases in New Zealand between 2008 and 2014. Women who had been pregnant were identified by the National Minimum Dataset and were linked to the Pharmaceutical Collection to obtain information on use of AEDs. Women aged between 15 and 45 years dispensed AEDs were identified in the Pharmaceutical Collection.

Results

There was an increase in the number of women of child-bearing potential prescribed AEDs, from 9 women per 1000 women in 2008 to 11.4 women per 1000 women in 2014. Women who had been dispensed an AED had an increased rate of spontaneous abortion 8.97 spontaneous abortions per 100 pregnancies, compared with, 6.31 per 100 pregnancies (risk ratio 1.42, 95% CI 1.40 to 1.44), and a decreased rate of pregnancy termination, 18.51 terminations per 100 pregnancies compared with 19.58 per 100 pregnancies (risk ratio 1.95, 95% CI 0.94–0.96).

Conclusion

Use of newer AEDs is increasing in women of child-bearing potential in New Zealand leading to an overall increase in AED use in this group despite a fall in the use of older AEDs. AED use is this study was associated with an increased risk of spontaneous abortion and decreased rate of pregnancy termination, however confounding by indication could not be excluded.

Evaluating the Effect of Small RNAs and Associated Chaperones on Rho-Dependent Termination of Transcription In Vitro

Besides their well-known posttranscriptional effects on mRNA translation and decay, sRNAs and associated RNA chaperones (e.g., Hfq, CsrA) sometimes regulate gene expression at the transcriptional level. In this case, the sRNA-dependent machinery modulates the activity of the transcription termination factor Rho, a ring-shaped RNA translocase/helicase that dissociates transcription elongation complexes at specific loci of the bacterial genome. Here, we describe biochemical assays to detect Rho-dependent termination signals in genomic regions of interest and to assess the effects of sRNAs and/or associated RNA chaperones on such signals.

The Experience of Genetic Counselors Working with Patients Facing the Decision of Pregnancy Termination after 24 Weeks Gestation

Prenatal genetic counselors are health care professionals who counsel women making reproductive decisions which include decisions such as terminating pregnancies due to fetal anomalies. Little is known about the experiences and practices of prenatal genetic counselors working with women who have the option of termination after 24 weeks gestation. In this national survey of 168 genetic counselors who have practiced prenatal genetic counseling, we asked about their general practice patterns, including indications for which termination is offered and types of abortion care services that are coordinated by genetic counselors. We report respondents' self-assessments of level of understanding of federal abortion law and abortion procedures. Seventy-six percent of respondents have offered and counseled on termination after 24 weeks and 93% of respondents believe it is the responsibility of the counselor to discuss this option with patients. However, one-third report that they have some or no understanding of the procedures and three-quarters report that they have some or no understanding of federal abortion law. The results of this study provide insight into knowledge and experiences of genetic counselors working with these patients, allowing for improved genetic counselor training and continuing education to provide better guidance and develop more effective means of assisting patients.

Transcription control engineering and applications in synthetic biology

In synthetic biology, researchers assemble biological components in new ways to produce systems with practical applications. One of these practical applications is control of the flow of genetic information (from nucleic acid to protein), a.k.a. gene regulation. Regulation is critical for optimizing protein (and therefore activity) levels and the subsequent levels of metabolites and other cellular properties. The central dogma of molecular biology posits that information flow commences with transcription, and accordingly, regulatory tools targeting transcription have received the most attention in synthetic biology. In this mini-review, we highlight many past successes and summarize the lessons learned in developing tools for controlling transcription. In particular, we focus on engineering studies where promoters and transcription terminators (cis-factors) were directly engineered and/or isolated from DNA libraries. We also review several well-characterized transcription regulators (trans-factors), giving examples of how cis- and trans-acting factors have been combined to create digital and analogue switches for regulating transcription in response to various signals. Last, we provide examples of how engineered transcription control systems have been used in metabolic engineering and more complicated genetic circuits. While most of our mini-review focuses on the well-characterized bacterium Escherichia coli, we also provide several examples of the use of transcription control engineering in non-model organisms. Similar approaches have been applied outside the bacterial kingdom indicating that the lessons learned from bacterial studies may be generalized for other organisms.

Is diapause an ancient adaptation in Drosophila?

D. melanogaster enters a state of reproductive arrest when exposed to low temperatures (12°C) and shorter photoperiods. A number of studies have suggested that diapause has recently evolved in European D. melanogaster populations, that it is not present in the sibling species D. simulans, that it is non-photoperiodic in American D. melanogaster populations, and that it spontaneously terminates after 6-8weeks. We have studied the overwintering phenotype under different conditions and observe that American, European and, surprisingly, African D. melanogaster populations can show photoperiodic diapause, as can European, but not African D. simulans. Surprisingly other Drosophila species from pan-tropical regions can also show significant levels of photoperiodic diapause. We observe that spontaneous termination of diapause after a few weeks can be largely avoided with a more realistic winter simulation for D. melanogaster, but not D. simulans. Examining metabolite accumulation during diapause reveals that the shallow diapause of D. melanogaster has similar features to that of other more robustly-diapausing species. Our results suggest that diapause may be an ancient character that emerged in the tropics to resist unfavourable seasonal conditions and which has been enhanced during D. melanogaster's colonisation of temperate regions. Our results also highlight how different methodologies to quantify diapause can lead to apparently conflicting results that we believe can now largely be resolved.

Predictors of Premature Match Closure in Youth Mentoring Relationships

Although mentoring is a popular and effective means of intervention with youth, the positive effects of mentoring can be diminished by premature match closure of relationships. Program, mentor, and mentee characteristics were examined as predictors of premature match closure. Secondary data analyses were conducted on a large national database of mentoring programs consisting of match and youth risk information from 170 mentoring programs and 6468 matches from across the U.S. Premature closure was associated with mentee age at match inception and 19 individual mentee characteristics. The set of mentee characteristics were examined as part of a cumulative risk index encompassing seven conceptually combined categories including family background characteristics, school functioning problems, engagement in risky health behaviors, self-regulation difficulties, engagement in illegal or criminal activities, and internalizing and externalizing behavior problems. Both the age of mentees when matched and the cumulative risk index score significantly predicted premature closure. Results are discussed in terms of directions for future research and suggestions for enhancing mentoring program practices.

Chronic metformin treatment facilitates seizure termination

The AMP-activated protein kinase (AMPK) is a key energy sensor. Its activator metformin could suppress epileptogenesis in the pentylenetetrazol (PTZ) kindling model. However, the effect of metformin on the acute and chronic seizures has not been studied. We first detected the expression of AMPK in the brain tissue of human and mice with chronic seizures, as well as in mice with acute seizures. Second, using behavioral assay and local filed potentials (LFPs) recording, we investigated the effect of chronic metformin treatment on seizures in a acute seizure model and a chronic seizure model. Our results showed that AMPK was expressed in neurons in the epileptic brain. The expression level was decreased in the brain tissue that experienced chronic and acute seizures. In PTZ-induced acute seizures model, behavioral assay showed that chronic metformin treatment decreased the mortality, and LFPs recording showed that chronic metformin treatment shortened the duration of generalized tonic-clonic seizures and prolonged the duration of postictal depression. Moreover, in kainic acid-induced chronic seizures model, LFPs recording showed that chronic metformin treatment shortened the duration of epileptic activity. Our study suggests that chronic metformin treatment could facilitate seizure termination.

Relative Termination via Dependency Pairs

A term rewrite system is terminating when no infinite reduction sequences are possible. Relative termination generalizes termination by permitting infinite reductions as long as some distinguished rules are not applied infinitely many times. Relative termination is thus a fundamental notion that has been used in a number of different contexts, like analyzing the confluence of rewrite systems or the termination of narrowing. In this work, we introduce a novel technique to prove relative termination by reducing it to dependency pair problems. To the best of our knowledge, this is the first significant contribution to Problem #106 of the RTA List of Open Problems. We first present a general approach that is then instantiated to provide a concrete technique for proving relative termination. The practical significance of our method is illustrated by means of an experimental evaluation.

A Qualitative Study of Factors Influencing Decision-Making after Prenatal Diagnosis of down Syndrome

Previous research has identified twenty-six factors that may affect pregnancy management decisions following prenatal diagnosis of DS; however, there is no consensus about the relative importance or effects of these factors. In order to better understand patient decision-making, we conducted expansive cognitive interviews with nine former patients who received a prenatal diagnosis of DS. Our results suggest that patients attached unique meanings to factors influencing decision-making regardless of the pregnancy outcome. Nineteen of the twenty-six factors previously studied and four novel factors (rationale for testing, information quality, pregnancy experience, and perception of parenting abilities and goals) were found to be important to decision-making. We argue that qualitative studies can help characterize the complexity of decision-making following prenatal diagnosis of DS.

A Comparative Study of Misoprostol Only and Mifepristone Plus Misoprostol in Second Trimester Termination of Pregnancy

OBJECTIVE

To compare the effectiveness, success rate and induction to abortion interval between administration of misoprostol only and mifepristone with misoprostol in second trimester abortions (14-20 weeks) .

MATERIALS AND METHODS

The study was conducted by dividing women approaching for second trimester termination, into two groups each consisting of 100 women. Group-I received only misoprostol; 600 mcg initial vaginal insertion followed by 400 mcg sublingually every 3 h until termination. Women in Group-II received mifepristone 200 mg and after 24 h started with 600 mcg misoprostol, per vaginal followed by 400 mcg sublingually till abortion was completed, up to a maximum of five doses in both groups.

RESULTS

The success rate in Group-I was 89 %, whereas in Group-II it was 96 %. The mean induction abortion interval in Group-I was 10.67 ± 3.96 h compared to Group-II which was significantly less 6.19 ± 2.70 h (p value < 0.01). The mean dose of misoprostol in Group-I was 1610 ± 511.18 mcg and in Group-II, it was lesser 1046 ± 392.71 mcg (p value < 0.01). There was significant difference in the mean blood loss also, 97.20 ± 36.35 ml in Group-I and 52.55 ± 27.96 ml in Group-II. Also among the individual groups multigravidae and lower gestational age (<17 weeks), women had lesser IAI as well as lesser misoprostol dose was required.

CONCLUSION

Pretreatment with mifepristone significantly reduces the induction abortion interval and the misoprostol dose along with minimal blood loss.

A quantitative assessment of termination of sexual violence-related pregnancies in eastern Democratic Republic of Congo

BACKGROUND

Sexual violence is prevalent in eastern Democratic Republic of Congo (DRC), and has resulted in sexual violence-related pregnancies (SVRPs). Despite restrictive laws, women may seek to terminate SVRPs; however, there are limited data on termination of SVRPs.

METHODS

A mixed methods study was conducted in 2012 in Bukavu, DRC. Adult women who self-reported an SVRP and termination of that SVRP were recruited using respondent-driven sampling (RDS). Trained female interviewers verbally administered a quantitative survey to all participants and a semi-structured qualitative survey to a subset. Quantitative data on characteristics and complications of pregnancy termination, including mental health outcomes, were analyzed using SAS.

RESULTS

In total, 86 women completed quantitative surveys. Most SVRPs (93 %) involved two or more assailants; 73 % occurred while in captivity. Most women (82 %) terminated the SVRPs at 3 months gestation or earlier; 79 % reported one attempt at pregnancy termination and 21 % more than one attempt. The most common methods of termination were an oral medicine (55 %) or herb (35 %); cimpokolo (31 %) and quinine (18 %) were most frequently reported. These methods were accessed through friends (37 %), healthcare providers (18 %), family (16 %), or self-obtained (12 %). Following the termination, 79 % of women reported subsequent physical symptoms, including abdominal pain (74 %), bleeding (47 %), vaginal discharge (35 %) and fever (18 %); 44 % sought medical care for their symptoms. Varied emotional responses to the termination were reported and included relief (34 %), anxiety (21 %), anger (19 %), guilt (19 %), and regret (10 %). At the time of the study, many women met symptom criteria for post-traumatic stress disorder (57 %), depression (50 %), and generalized anxiety disorder (33 %).

CONCLUSION

Most women terminated SVRPs using medications or herbs not recognized as evidence-based methods of pregnancy termination and sought these methods outside of the formal healthcare sector. These data suggest that access to safe abortion methods is needed for women with SVRPs in DRC. Physical symptoms and emotional reactions related to the termination varied. While it is not possible to differentiate the impacts of sexual violence, SVRP, and pregnancy termination on mental health outcomes, the findings highlight the complex needs of women with SVRPs and opportunities for integrative health services.

"These things are dangerous": Understanding induced abortion trajectories in urban Zambia

Unsafe abortion is a significant but preventable cause of global maternal mortality and morbidity. Zambia has among the most liberal abortion laws in sub-Saharan Africa, however this alone does not guarantee access to safe abortion, and 30% of maternal mortality is attributable to unsafe procedures. Too little is known about the pathways women take to reach abortion services in such resource-poor settings, or what informs care-seeking behaviours, barriers and delays. In-depth qualitative interviews were conducted in 2013 with 112 women who accessed abortion-related care in a Lusaka tertiary government hospital at some point in their pathway. The sample included women seeking safe abortion and also those receiving hospital care following unsafe abortion. We identified a typology of three care-seeking trajectories that ended in the use of hospital services: clinical abortion induced in hospital; clinical abortion initiated elsewhere, with post-abortion care in hospital; and non-clinical abortion initiated elsewhere, with post-abortion care in hospital. Framework analyses of 70 transcripts showed that trajectories to a termination of an unwanted pregnancy can be complex and iterative. Individuals may navigate private and public formal healthcare systems and consult unqualified providers, often trying multiple strategies. We found four major influences on which trajectory a woman followed, as well as the complexity and timing of her trajectory: i) the advice of trusted others ii) perceptions of risk iii) delays in care-seeking and receipt of services and iv) economic cost. Even though abortion is legal in Zambia, girls and women still take significant risks to terminate unwanted pregnancies. Levels of awareness about the legality of abortion and its provision remain low even in urban Zambia, especially among adolescents. Unofficial payments required by some providers can be a major barrier to safe care. Timely access to safe abortion services depends on chance rather than informed exercise of entitlement.

Role of Meticulous Observation: Successful Pregnancy in a 30-Year-Old Woman with Severe Pulmonary Hypertension

Pregnancy is strongly discouraged in patients with pulmonary arterial hypertension (PAH). Herein, we report a successful delivery in a woman with PAH using a multidisciplinary approach. A 30-year-old pregnant woman with PAH was referred to us with a chief complaint of dyspnea. She was advised to terminate her pregnancy but she refused to do so despite several recommendations by healthcare professionals. She was scheduled for treatment with iloprost (brand name: Ilomedin) and heparin infusions for 3-4 days at 20-day intervals. She spent her last month of pregnancy in a hospital under close observation and received iloprost infusion. She underwent a successful cesarean section under general anesthesia at week 36 of gestation. Iloprost administration was continued for one week after delivery and was changed to bosentan after that. Meanwhile, heparin infusion was substituted by warfarin. However, treatment with bosentan led to a temporary interruption in breastfeeding. A few days later, she presented with severe dyspnea and pulmonary artery pressure of 110 mmHg. Treatment was restarted with iloprost, followed by stabilization with bosentan. A successful delivery was achieved in this situation by meticulous observation and aggressive treatment targeting PAH, along with long-term hospital stay and multidisciplinary management. Severe PAH is regarded as a contraindication to pregnancy. While physicians strongly recommend termination of pregnancy in such patients, some of them might refuse and insist on delivery of the baby. Similar pregnant cases with potential delivery are recommended to be evaluated for effective management of this condition.

Previous Pregnancies Among Young Women Having an Abortion in England and Wales

PURPOSE

The purpose of this study was to use national statistics on abortions carried out in England and Wales to more precisely estimate the proportion of young women aged <20 years obtaining an abortion who have had one or more previous pregnancies.

METHODS

Secondary analysis of abortion data from the Office of National Statistic and the Department of Health by parity for women aged <20 years, ordinarily residing in England and Wales, from 1992 to 2013.

RESULTS

Over the past 20 years, the proportion of teenagers in England and Wales having an abortion as a result of a subsequent pregnancy increased by 33% (from .172 in 1992 to .229 in 2013). Most of this increase occurred before 2004, and the proportion now appears to have stabilized. In 2013, 22.9% of the young women aged <20 years who underwent an abortion had had at least one previous pregnancy (either a birth or an abortion). Only a minority (<5% of young women who obtained an abortion) had had more than one previous pregnancy.

CONCLUSIONS

The findings show that nearly one in four teenagers presenting for an abortion have already been in contact with health services for a previous birth or abortion. Greater policy emphasis must be placed on the accurate identification of the proportion of teenage pregnancies that occur as a result of a subsequent pregnancy and developing more effective "secondary prevention" interventions to help the first-time pregnant and parenting teenagers manage their future reproductive lives and prevent further unplanned pregnancies.

Prevalence of rape-related pregnancy as an indication for abortion at two urban family planning clinics

OBJECTIVE

We sought to estimate the prevalence of rape-related pregnancy as an indication for abortion at two public Chicago facilities and to describe demographic and clinical correlates of women who terminated rape-related pregnancies.

METHODS

We performed a cross-sectional study of women obtaining abortion at the Center for Reproductive Health (CRH) at University of Illinois Health Sciences Center and Reproductive Health Services (RHS) at John H. Stroger, Jr. Hospital between August 2009 and August 2013. Gestational age limits at CRH and RHS were 23+6 and 13+6weeks, respectively. We estimated the prevalence of rape-related pregnancy based on billing code (CRH) or data from an administrative database (RHS), and examined relationships between rape-related pregnancy and demographic and clinical variables.

RESULTS

Included were 19,465 visits for abortion. The majority of patients were Black (85.6%). Prevalence of abortion for rape-related pregnancy was 1.9%, and was higher at CRH (6.9%) than RHS (1.5%). Later gestational age was associated with abortion for rape-related pregnancy (median 12days, p<.001). Younger age and Black race were associated with abortion for rape-related pregnancy at CRH only (p<.001 for both). Chlamydia and gonorrhea infection were no more prevalent among women terminating rape-related pregnancy than among those terminating for other indications.

CONCLUSION

Rape-related pregnancy as an indication for abortion had a low, but clinically significant prevalence at two urban Chicago family planning centers. Later gestational age was associated with abortion for rape-related pregnancy.

IMPLICATIONS

Rape-related pregnancy may occur with higher prevalence among some subgroups of women seeking abortion than others. Efforts to address rape-related pregnancy in the abortion care setting are needed.

Social and emotional adjustment following early pregnancy in young Australian women: a comparison of those who terminate, miscarry, or complete pregnancy

PURPOSE

To compare social and emotional adjustment including educational attainment and substance use in women who had a child, pregnancy termination, or miscarriage by young adulthood.

METHODS

Data were from a population-based longitudinal study of the health and well-being of 1,943 young Australians (Victorian Adolescent Health Cohort Study) followed from 15 to 24 years of age. The sample was restricted to female participants and based on pregnancies reported by age 24 years. Analyses were adjusted for early teenage depressive symptoms, cigarette smoking, alcohol use, cannabis use, and parent socioeconomic context.

RESULTS

A total of 208 pregnancies (in 170 women) were reported from a sample of 824 young women by 24 years of age. Compared with those who had never been pregnant, those who had a child had lower tertiary education completion and a higher risk of nicotine dependence; those who terminated a pregnancy were more commonly single and had a higher risk of smoking and alcohol use as well as nicotine and alcohol dependence; and those who had a miscarriage had a higher risk of depressive symptomatology and binge drinking as well as nicotine and cannabis dependence.

CONCLUSIONS

Young women who have been pregnant by their mid-twenties report a range of difficulties in social and emotional adjustment that vary across the different pregnancy outcomes. Broad-based psychosocial health care is essential not only for young women whose pregnancies proceed to live birth, but also for those whose pregnancies end with miscarriage or induced abortion.

Tuning NF-κB activity: a touch of COMMD proteins

NF-κB is an important regulator of immunity and inflammation, and its activation pathway has been studied extensively. The mechanisms that downregulate the activity of NF-κB have also received a lot of attention, particularly since its activity needs to be terminated to prevent chronic inflammation and subsequent tissue damage. The COMMD family has been identified as a new group of proteins involved in NF-κB termination. All ten COMMD members share the structurally conserved carboxy-terminal motif, the COMM domain, and are ubiquitously expressed. They seem to play distinct and non-redundant roles in various physiological processes, including NF-κB signaling. In this review, we describe the mechanisms and proteins involved in the termination of canonical NF-κB signaling, with a specific focus on the role of the COMMD family in the down-modulation of NF-κB.