An exploration of the parental experience of diagnosis of foetal abnormalities during routine antenatal ultrasound screening

Background: Prenatal ultrasound screening is a routine aspect of antenatal care for women in the UK, typically at 12 weeks of gestation to confirm pregnancy and at 20 weeks to screen for foetal abnormalities. The diagnosis of foetal abnormality is likely to be an emotional and stressful time for a woman and her family; however, the impact on maternal mental health in the short-term has not been systematically evaluated. This systematic review aimed to assess the mental health consequences of diagnosis of foetal abnormalities by routine ultrasound screening for women in the perinatal period. Methods: A systematic review of six electronic databases (Embase, Medline, PsycInfo, CINAHL, Scopus, and Web of Science) was conducted to identify relevant studies published before April 2023. A narrative synthesis of findings was produced. Included studies were those using standardised measures to assess maternal mental health following prenatal diagnosis of foetal abnormality. Results: A total of 3221 studies were screened and 13 met inclusion criteria (eight prospective observational and five cross-sectional studies). A narrative synthesis of findings was presented according to three main mental health outcome domains identified: anxiety, depression, and traumatic stress. Women with recent diagnoses of foetal abnormality on average had anxiety reaching clinical threshold for concern, significantly higher than normal controls. Depression symptoms were, on average, higher than those with normal ultrasound findings. Approximately one third of those surveyed demonstrated traumatic stress above threshold for clinical concern. Risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal Tool for Quasi-Experimental Studies. Conclusions: Prenatal diagnosis of foetal abnormality appears to be associated with poor mental health, and increased risk of anxiety, depression, and traumatic stress symptoms for women during pregnancy. Studies in this area are limited by the lack of assessment of mental health prior to diagnosis. It is recommended that clinicians providing ultrasound screening and prenatal diagnoses should consider the psychological needs of women during this process. Sources of support should be considered to minimise the potential impact of these risks on obstetric and child development outcomes. Background: Congenital pulmonary airway malformation (CPAM) is a term used to describe a range of foetal abnormalities of the lung typically identified during routine antenatal ultrasound screening at 20 weeks' gestation. Babies are typically born without symptoms and as such there is uncertainty about the best course of treatment: to operate, or to watch and wait. This uncertainty can have psychological consequences for the parents receiving such a diagnosis. This study aims to explore the experience of parents who have been involved in decision making about their infant’s care following diagnosis of CPAM in the context of uncertainty about treatment. Methods: This study used a qualitative approach in which four participants participated in a semi-structured interview about their experiences. Interviews were recorded and transcribed verbatim. Transcripts were then analysed using Interpretative Phenomenological Analysis (IPA) to generate group experiential themes. Results: Four group experiential themes were developed across the four interviews conducted: diagnosis changed the expected course of pregnancy; searching for information about the condition; making decisions about surgery; and life after decision making. Eleven subthemes were identified and are discussed. Conclusions: The findings of this study provide an insight into the experiences of parents who received a diagnosis of CPAM during routine antenatal screening. Participants highlighted the changes to the course of pregnancy, the importance of finding out more information about the condition, the process of making decisions about surgery, and the impact this continued to have on their lives in the present day. Recommendations are made for clinicians when providing similar diagnoses, particularly with regards to families’ informational needs. Possible future research directions are also discussed

Catalytic Gels for a Prebiotically Relevant Asymmetric Aldol Reaction in Water : From Organocatalyst Design to Hydrogel Discovery and Back Again

This paper reports an investigation into organocatalytic hydrogels as prebiotically-relevant systems. Gels are interesting prebiotic reaction media, combining heterogeneous and homogeneous characteristics with a structurally-organised active ‘solid-like’ catalyst separated from the surrounding environment, yet in intimate contact with the solution phase and readily accessible via ‘liquid-like’ diffusion. A simple self-assembling glutamine amide derivative 1 was initially found to catalyse a model aldol reaction between cyclohexanone and 4-nitrobenzaldehyde, but did not maintain its gel structure during reaction. In this study, it was observed that compound 1 could react directly with the benzaldehyde to form a hydrogel in situ based on Schiff base 2 as a low-molecular-weight gelator (LMWG) This new dynamic gel is a rare example of a two-component self-assembled LMWG hydrogel and was fully characterised. It was demonstrated that glutamine amide 1 could select an optimal aldehyde component and preferentially assemble from mixtures. In the hunt for an organocatalyst, reductive conditions were applied to the Schiff base to yield secondary amine 3, which is also a highly effective hydrogelator at very low loadings with a high degree of nanoscale order. Most importantly, the hydrogel based on 3 catalysed the prebiotically-relevant aldol dimerisation of glycolaldehyde to give threose and erythrose. In buffered conditions, this reaction gave excellent conversions, good diastereoselectivity and some enantioselectivity. Catalysis using the hydrogel of 3 was much better than using non-assembled 3 – demonstrating a clear benefit of self-assembly. The results sug-gest hydrogels offer a potential strategy by which prebiotic reactions can be promoted using simple prebiotically-plausible LMWGs, that can selectively assemble from complex mixtures. Such processes may have been of prebiotic im-portance

Enhanced Delivery of Neuroactive Drugs via Nasal Delivery with a Self-Healing Supramolecular Gel

This paper reports the use of a self-assembling hydrogel as a delivery vehicle for the Parkinson’s disease drug L-DOPA. Based on a two-component combination of an L-glutamine amide derivative and benzaldehyde, this gel has very soft rheological properties and self-healing characteristics. It is demonstrated that the gel can be formulated to encapsulate L-DOPA. These drug-loaded gels are characterized, and rapid release of the drug is obtained from the gel network. This drug-loaded hydrogel has appropriate rheological characteristics to be amenable for injection. We therefore tested this system as a vehicle for nasal delivery of neurologically-active drugs – a drug delivery strategy that can potentially avoid first pass liver metabolism and bypass the blood-brain barrier, hence enhancing brain uptake. In vitro tests indicated that the gel has biocompatibility with respect to nasal epithelial cells. Furthermore, animal studies demonstrated that the nasal delivery of a gel loaded with 3H-labelled L-DOPA out-performed a simple intranasal L-DOPA solution. This was attributed to longer residence times of the gel in the nasal cavity resulting in increased blood and brain concentrations. It was demonstrated that the likely routes of brain penetration of intranasally-delivered L-DOPA gel involve the trigeminal and olfactory nerves connecting to other brain regions

Maternal and neonatal risk factors for childhood type 1 diabetes: a matched case-control study

Peer reviewedPublisher PD

Repositioning of a diaminothiazole series confirmed to target the cyclin-dependent kinase CRK12 for use in the treatment of African animal trypanosomiasis

African animal trypanosomiasis or nagana, caused principally by infection of the protozoan parasites Trypanosoma congolense and Trypanosoma vivax, is a major problem in cattle and other livestocks in sub-Saharan Africa. Current treatments are threatened by the emergence of drug resistance and there is an urgent need for new, effective drugs. Here, we report the repositioning of a compound series initially developed for the treatment of human African trypanosomiasis. A medicinal chemistry program, focused on deriving more soluble analogues, led to development of a lead compound capable of curing cattle infected with both T. congolense and T. vivax via intravenous dosing. Further optimization has the potential to yield a single-dose intramuscular treatment for this disease. Comprehensive mode of action studies revealed that the molecular target of this promising compound and related analogues is the cyclin-dependent kinase CRK12

Decadal changes in fire frequencies shift tree communities and functional traits

Global change has resulted in chronic shifts in fire regimes. Variability in the sensitivity of tree communities to multi-decadal changes in fire regimes is critical to anticipating shifts in ecosystem structure and function, yet remains poorly understood. Here, we address the overall effects of fire on tree communities and the factors controlling their sensitivity in 29 sites that experienced multi-decadal alterations in fire frequencies in savanna and forest ecosystems across tropical and temperate regions. Fire had a strong overall effect on tree communities, with an average fire frequency (one fire every three years) reducing stem density by 48% and basal area by 53% after 50 years, relative to unburned plots. The largest changes occurred in savanna ecosystems and in sites with strong wet seasons or strong dry seasons, pointing to fire characteristics and species composition as important. Analyses of functional traits highlighted the impact of fire-driven changes in soil nutrients because frequent burning favoured trees with low biomass nitrogen and phosphorus content, and with more efficient nitrogen acquisition through ectomycorrhizal symbioses. Taken together, the response of trees to altered fire frequencies depends both on climatic and vegetation determinants of fire behaviour and tree growth, and the coupling between fire-driven nutrient losses and plant traits

Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial

Background Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral microbleeds) are associated with greater risks of recurrent intracerebral haemorrhage. We did subgroup analyses of the RESTART trial to explore whether these brain imaging features modify the effects of antiplatelet therapy

Mechanisms of Risk and Resilience in Military Families: Theoretical and Empirical Basis of a Family-Focused Resilience Enhancement Program

Recent studies have confirmed that repeated wartime deployment of a parent exacts a toll on military children and families and that the quality and functionality of familial relations is linked to force preservation and readiness. As a result, family-centered care has increasingly become a priority across the military health system. FOCUS (Families OverComing Under Stress), a family-centered, resilience-enhancing program developed by a team at UCLA and Harvard Schools of Medicine, is a primary initiative in this movement. In a large-scale implementation project initiated by the Bureau of Navy Medicine, FOCUS has been delivered to thousands of Navy, Marine, Navy Special Warfare, Army, and Air Force families since 2008. This article describes the theoretical and empirical foundation and rationale for FOCUS, which is rooted in a broad conception of family resilience. We review the literature on family resilience, noting that an important next step in building a clinically useful theory of family resilience is to move beyond developing broad “shopping lists” of risk indicators by proposing specific mechanisms of risk and resilience. Based on the literature, we propose five primary risk mechanisms for military families and common negative “chain reaction” pathways through which they undermine the resilience of families contending with wartime deployments and parental injury. In addition, we propose specific mechanisms that mobilize and enhance resilience in military families and that comprise central features of the FOCUS Program. We describe these resilience-enhancing mechanisms in detail, followed by a discussion of the ways in which evaluation data from the program’s first 2 years of operation supports the proposed model and the specified mechanisms of action

AIDS-related mycoses: the way forward.

The contribution of fungal infections to the morbidity and mortality of HIV-infected individuals is largely unrecognized. A recent meeting highlighted several priorities that need to be urgently addressed, including improved epidemiological surveillance, increased availability of existing diagnostics and drugs, more training in the field of medical mycology, and better funding for research and provision of treatment, particularly in developing countries

The Beaker phenomenon and the genomic transformation of northwest Europe

From around 2750 to 2500 bc, Bell Beaker pottery became widespread across western and central Europe, before it disappeared between 2200 and 1800 bc. The forces that propelled its expansion are a matter of long-standing debate, and there is support for both cultural diffusion and migration having a role in this process. Here we present genome-wide data from 400 Neolithic, Copper Age and Bronze Age Europeans, including 226 individuals associated with Beaker-complex artefacts. We detected limited genetic affinity between Beaker-complex-associated individuals from Iberia and central Europe, and thus exclude migration as an important mechanism of spread between these two regions. However, migration had a key role in the further dissemination of the Beaker complex. We document this phenomenon most clearly in Britain, where the spread of the Beaker complex introduced high levels of steppe-related ancestry and was associated with the replacement of approximately 90% of Britain’s gene pool within a few hundred years, continuing the east-to-west expansion that had brought steppe-related ancestry into central and northern Europe over the previous centuries