Gabapentin for pain management after osmotic dilator insertion and prior to dilation and evacuation: A randomized controlled trial.

ObjectiveTo evaluate if gabapentin 600 mg reduces pain after osmotic dilator placement the day before a dilation and evacuation (D&E) procedure.Study designWe conducted a double-blind, placebo-controlled, randomized (stratified by vaginal parity) trial among women undergoing osmotic dilator placement before D&E at 15-23 5/7 weeks gestation. Subjects received gabapentin 600 mg or placebo 30 min before dilator placement, with re-dosing 8 h later. We assessed pain after dilator placement using a numeric rating scale (NRS; scale 0-10) at 5 min, 2, 4, and 8 h, and at presentation for D&E. The primary outcome was median NRS pain score change from baseline to 8 h after dilator placement. Secondary outcomes included gabapentin-related side effects and analgesic use.ResultsOf 121 randomized women, we excluded three subjects (allergic reaction [placebo], randomization error, no NRS data), leaving 60 gabapentin and 58 placebo subjects. Of 110 (93%) women who provided 8-hour data, median pain score changes from baseline did not differ between gabapentin and placebo groups overall (2 vs. 2.5, p = 0.52), in vaginally nulliparous women (2 vs. 4, p = 0.10) or in parous women (2 vs. 1.5, p = 0.37). We found no statistically significant differences in median pain score change from baseline to any timepoint overall or when stratified by parity. Beginning at 2 h after dilator placement, more gabapentin than placebo users experienced dizziness (29/53[55%] vs. 11/53[21%], p = 0.001) and tiredness (34/54[63%] vs. 17/54[31%], p = 0.002). The proportion of women using narcotics did not differ between gabapentin (35/60[58%]) or placebo (40/58[69%]) users (p = 0.26).ConclusionsGabapentin does not reduce pain with overnight osmotic dilator placement prior to D&E and causes drug-related side effects.Implications statementWomen experience pain, mostly mild to moderate, with overnight cervical dilator placement at 15-23 5/7 weeks gestation. About 2/3 of women will use a limited quantity of narcotics if provided. Gabapentin does not decrease the pain with or following dilator placement and does not decrease narcotic use

Mifepristone Antagonization With Progesterone to Prevent Medical Abortion: A Randomized Controlled Trial.

ObjectiveTo estimate the efficacy and safety of mifepristone antagonization with high-dose oral progesterone.MethodsWe planned to enroll 40 patients in a double-blind, placebo-controlled, randomized trial. We enrolled patients at 44-63 days of gestation with ultrasound-confirmed gestational cardiac activity who were planning surgical abortion. Participants ingested mifepristone 200 mg and initiated oral progesterone 400 mg or placebo 24 hours later twice daily for 3 days, then once daily until their planned surgical abortion 14-16 days after enrollment. Follow-up visits were scheduled 3±1, 7±1, and 15±1 days after mifepristone intake with ultrasonography and blood testing for human chorionic gonadotropin and progesterone. Participants exited from the study when they had their surgical abortion or earlier for gestational cardiac activity absence, gestational sac expulsion, or medically indicated suction aspiration. We assessed the primary outcome of continued gestational cardiac activity at approximately 2 weeks (15±1 day), side effects after drug ingestion, and safety outcomes including hemorrhage and emergent treatment.ResultsWe enrolled participants from February to July 2019 and stopped enrollment after 12 patients for safety concerns. Mean gestational age was 52.5 days. Two (one per group) voluntarily discontinued 3 days after mifepristone ingestion for subjective symptoms (nausea and vomiting, bleeding). Among the remaining 10 patients (five per group), gestational cardiac activity continued for 2 weeks in four in the progesterone group and two in the placebo group. One patient in the placebo group had no gestational cardiac activity 3 days after mifepristone use. Severe hemorrhage requiring ambulance transport to hospital occurred in three patients; one received progesterone (complete expulsion, no aspiration) and two received placebo (aspiration for both, one required transfusion). We halted enrollment after the third hemorrhage. No other significant side effects were reported.ConclusionWe could not estimate the efficacy of progesterone for mifepristone antagonization due to safety concerns when mifepristone is administered without subsequent prostaglandin analogue treatment. Patients in early pregnancy who use only mifepristone may be at high risk of significant hemorrhage.Clinical trial registrationClinicalTrials.gov, NCT03774745

From Building Vocabulary to Talking about Family Traditions Together: Discussions on the Facebook Group “Hoisan Phrases 學講台山話”

This poster focuses on online discourses of an online Facebook group - “Hoisan Phrases.” “Hoisan Phrases” is used to construct positive ideologies about Hoisan-wa. Using multicompetence and symbolic competence frameworks, these online interactions are sites where Hoisan-wa speakers engage in the ability “to perform and construct various historicities in dialogue with others” (Kramsch & Whiteside). Humor serves as a way of moving beyond negative ideologies of Hoisan-wa. Data comes from a corpus of three years’ worth of posts. The data demonstrates a re-envisioning of the way we view Hoisan-wa vis-à-vis online communication, and expands the domains of language use

School Counseling Supervision in Challenging Times: The CAFE Supervisor Model

Given the increased need for school counselors to proactively address the pervasive achievement, opportunity, and attainment gaps, school counselor preparation should move from traditional supervision models to one with an equitable K-12 student outcomes focus. The Change Agent for Equity (CAFE) model presented can help school counselors-in-training foster a change agent identity, aimed at helping all K-12 students succeed and reach their postsecondary dreams. The CAFE model and the supervisor’s identity and supervision practices within the model are described. Additionally, internship assignments and rubrics are outlined and supervisory recommendations and implications are discussed

Constrained Emergence of Universals and Variation in Syllable Systems

A computational model of emergent syllable systems is developed based on a set of functional constraints on syllable systems and the assumption that language structure emerges through cumulative change over time. The constraints were derived from general communicative factors as well as from the phonetic principles of perceptual distinctiveness and articulatory ease. Through evolutionary optimization, the model generated mock vocabularies optimized for the given constraints. Several simulations were run to understand how these constraints might define the emergence of universals and variation in complex sound systems. The predictions were that (1) CV syllables would be highly frequent in all vocabularies evolved under the constraints; (2) syllables with consonant clusters, consonant codas and vowel onsets would occur much less frequently; (3) a relationship would exist between the number of syllable types in a vocabulary and the average word length in the vocabulary; (4) different syllable types would emerge according to, what we termed, an <EM iterative principle of syllable structure> and their frequency would be directly related to their complexity; and (5) categorical differences would emerge between vocabularies evolved under the same constraints. Simulation results confirmed these predictions and provided novel insights into why regularities and differences may occur across languages. Specifically, the model suggested that both language universals and variation are consistent with a set of functional constraints that are fixed relative to one another. Language universals reflect underlying constraints on the system and language variation represents the many different and equally-good solutions to the unique problem defined by these constraints

Reducing depressive symptoms and increasing positive feelings with expressive writing

This experimental study examined the effect of expressive writing on depressive symptoms. 86 undergraduate students were recruited from a private university to perform online positive experience writing (PEW) (n=31), negative experience (NEW) (n=32) and control topic (CW) (n=23) for three sessions in three consecutive weeks. The depressive symptoms of participants were measured at pre-treatment and post-treatment. It was hypothesized that PEW has significant greater reduction in depressive symptoms compared to NEW and CW based on broaden and build model. Nevertheless, results showed that PEW had significantly greater symptoms reduction than CW, yet there was no significant difference between PEW and NEW. The findings suggested that PEW might be potentially useful in reducing depressive symptoms among undergraduates