Instability of misoprostol tablets stored outside the blister: a potential serious concern for clinical outcome in medical abortion

Misoprostol (Cytotec) is recognised to be effective for many gynaecological indications including termination of pregnancy, management of miscarriage and postpartum haemorrhage. Although not licensed for such indications, it has been used for these purposes by millions of women throughout the world. Misoprostol tablets are most often packaged as multiple tablets within an aluminium strip, each within an individual alveolus. When an alveolus is opened, tablets will be exposed to atmospheric conditions

North Korean Decisionmaking

Discerning the decisionmaking of Kim Jong-Un and the North Korean regime on issues of peaceful engagement and warlike actions endures as a mighty challenge for U.S. intelligence analysts and policymakers. In this report, we seek to inform analysis of Democratic People’s Republic of Korea (DPRK) leadership decisionmaking. To do so, we use three discussion papers that were written to facilitate discussion of an interagency working group. The three papers are assembled here in a single report. The first discussion paper describes decisionmaking among different authoritarian regimes, including North Korea, and the opening up of those economies to outside engagement. The second paper outlines two different scenarios that might occur when conventional deterrence on the Korean Peninsula breaks down and the resulting decisions that North Korea’s leadership could face. The third paper assesses DPRK decisionmaking about nuclear weapon use. The report concludes with some observations, drawn from the issues covered in these three discussion papers, about DPRK decisionmaking and stability on the Korean Peninsula

Management of pain associated with up-to-9-weeks medical termination of pregnancy (MToP) using mifepristone–misoprostol regimens: expert consensus based on a systematic literature review

Evidence-based guidelines on the management of pain associated with first-trimester medical abortion are lacking. Most published clinical trials have failed to report on this important aspect of the procedure. The aim of this comprehensive work was to provide clinical advice based on a comprehensive literature review, supplemented by the clinical experience of a group of European experts in case no evidence is available. Pain level ranged from 5 to 8 in 80% of studies where pain was measured on a 0–10 visual analogue scale; severe pain was reported by 20–80% of women. Pain assessment was rarely reported in studies. Pain treatment should be preventive and avoidance of unnecessary uterine contractions should be considered. Analgesic treatment should follow the WHO three-step ladder, starting with the use of NSAIDs and allowing for easily available back-up treatment with weak opioids

Developments of new proton conducting membranes based on different polybenzimidazole structures for fuel cells applications

The current goal on PEMFCs research points towards the optimization of devices working at temperatures above 100°C and at low humidity levels. Acid-doped polybenzimidazoles are particularly appealing because of high proton conductivity without humidification and promising fuel cells performances. In this paper we present the development of new proton conducting membranes based on different polybenzimidazole (PBI) structures. Phosphoric acid-doped membranes, synthesised from benzimidazole-based monomers with increased basicity and molecular weight, are presented and discussed. Test of methanol crossover and diffusion were performed in order to check the membrane suitability for DMFCs. Both the acid doping level and proton conductivity remarkably increase with the membrane molecular weight and basicity, which strictly depend on the amount of NH-groups as well as on their position in the polymer backbone. In particular, a conductivity value exceeding 0.1 S/cm at RH=40% and 80°C was reached in the case of the pyridine-based PBI

Agroecological practices supporting food production and reducing food insecurity in developing countries: A study on scientific literature in 17 countries

This report represents the initial effort to structure existing knowledge about agroecology as farming and food system in support of the EC Knowledge Centre on Food and Nutrition Security (https://ec.europa.eu/knowledge4policy/global-food-nutrition-security_en). Scientific literature has been screened on a selection of developing countries in which food and nutrition security and sustainable agriculture represent a focal sector for EU intervention (Benin, Burkina Faso, Cuba, Ethiopia, Ghana, Guatemala, Kenya, Lao PDR, Madagascar, Malawi, Mali, Nicaragua, Niger, Senegal, Tanzania, Togo, Zimbabwe). In total, 172 documents have been synthesised, a country brief has been prepared for each investigated country, and some general conclusions have been drawn. Overall, the majority of analysed publications focuses on small scale, extensive farming systems that produce food at subsistence levels and for sale on local markets. This includes smallholder farming producing staple crops (millet, sorghum, yam, etc.) or vegetable gardening for local markets. The agroecological practices that are mostly studied are: agroforestry, intercropping (or mixed cropping), introduction of legumes in rotations, soil and water conservation practices (mulching, return of crop residues, zaï holes etc.), use of animal manure, biocontrol methods to mitigate chemical pesticide use. At least 50% of the analysed papers report a positive contribution of agroecological practices to food security, mostly due to improved yields and/or a better economic situation of producers. The improvement of soil quality is key to improve yields and consequently income and food security; this can be achieved using various practices including the use of residue mulch from tree leaves in agroforestry, as well as crop mixtures or intercropping and longer more diversified crop rotations. Moreover, higher on-farm crop species diversity often results in more diversified diets. Diversified crop systems, including the introduction of agroforestry, improve household nutritional status and have positive links to better health conditions. On the other hand, the lack of access to inputs is an important limitation to the improvement of soil fertility (manure, mineral fertilizer, leaf litter, etc.), which remains a major hindrance for food security. The agroecological cultivation of cash crops, post-harvest practices and crop-livestock integration were overall lacking in the scientific analyses, as well as the assessments of fully agroecological systems compared to individual agroecological practices or groups of practices. The report identifies three factors required for the substantial development of agroecology at the farm level: more financial support from the government, greater scientific knowledge on novel agroecological practices, and a higher market value for agroecological products

Impact of diabetes mellitus on acute outcomes of percutaneous coronary intervention in chronic total occlusions: insights from a US multicentre registry

AimTo examine the impact of diabetes mellitus on procedural outcomes of patients who underwent percutaneous coronary intervention for chronic total occlusion.MethodsWe assessed the impact of diabetes mellitus on the outcomes of percutaneous coronary intervention for chronic total occlusion among 1308 people who underwent such procedures at 11 US centres between 2012 and 2015.ResultsThe participants' mean ± sd age was 66 ± 10 years, 84% of the participants were men and 44.6% had diabetes. As compared with participants without diabetes, participants with diabetes were more likely to have undergone coronary artery bypass graft surgery (38 vs 31%; P = 0.006), and to have had previous heart failure (35 vs 22%; P = 0.0001) and peripheral arterial disease (19 vs 13%; P = 0.002). They also had a higher BMI (31 ± 6 kg/m2 vs 29 ± 6 kg/m2 ; P = 0.001), similar Japanese chronic total occlusion scores (2.6 ± 1.2 vs 2.5 ± 1.2; P = 0.82) and similar final successful crossing technique: antegrade wire escalation (46 vs 47%; P = 0.66), retrograde (30 vs 28%; P = 0.66) and antegrade dissection re-entry (24 vs 25%; P = 0.66). Technical (91 vs 90%; P = 0.80) and procedural (89 vs 89%; P = 0.93) success was similar in the two groups, as was the incidence of major adverse cardiac events (2.2 vs 2.5%; P = 0.61).ConclusionsIn a contemporary cohort of people undergoing percutaneous coronary intervention for chronic total occlusion, nearly one in two (45%) had diabetes mellitus. Procedural success and complication rates were similar in people with and without diabetes