Understanding Behavioral Health and Treatment Engagement with Former Users of Prenatal Substances: A Strengths-Focused Mixed Methods Inquiry

Accessible services for users of prenatal substances are lacking, and treatment engagement is poor with services that are available. Furthermore, legal consequences are often punitive, which ultimately damages the well-being of mother and child. Milagro and FOCUS are two New Mexico programs that provide comprehensive, coordinated care, including medication-assisted treatment, to former users of prenatal substances during pregnancy (in the Milagro Program) and for three years post-birth (in the FOCUS Program). This mixed methods study explored the lived experiences of women from this complex, high-risk population, using a high-engagement sample of women who utilized services at both Milagro and FOCUS. Twenty-four former opioid users ages 25 to 42, with children ages 3 months to 35 months, were interviewed about their experiences of substance use, treatment services, and motherhood. To further characterize this sample, the study measured adverse childhood experiences, socioeconomic status, social support, and participants’ therapeutic alliances with their early intervention specialists in the FOCUS program. Significant themes emerged from both qualitative and quantitative data highlighting considerable hardships but also the substantial resiliency of these women, especially as it related to their commitments to their children. Most had been surprised by their pregnancy, and half had tried and failed to obtain substance use treatment due to lack of services or accessibility, even before engaging with the Milagro program. All participants expressed desire to maintain sobriety for the sake of their children. Most reported at least one childhood trauma as well as current psychosocial stressors, and yet all women also reported some kind of positive growth or resiliency factor(s). All participants reported having positive interpersonal support from the Milagro and FOCUS programs. Such findings advance an alternative narrative to understanding this population than those motivating the punitive legal measures mandated in 24 states. This study suggests that comprehensive, coordinated care from pregnancy through toddlerhood that fosters strong therapeutic alliances between providers and patients, can effectively engage women in this population and help sustain both sobriety and well-being. Suggestions for future research, such as exploring the potentially critical role of therapeutic relationships in the engagement process for this substance-using population, are offered

Linear tracks and restricted temperature ranges characterise penguin foraging pathways

Marine predators are thought to follow sophisticated scale-dependent search strategies when seeking patchy and unpredictable prey. However, fine-scale information about these strategies has hitherto been difficult to obtain for diving predators that often remain at the sea surface for only limited periods of time. Using ARGOS telemetry and novel, low-powered, archival GPS, we followed the fine-scale at-sea behaviour of king penguins breeding on South Georgia. Results revealed that foraging pathways were generally linear, except at the finest scale, where movements probably reflected either fine-scale searching behaviour, or fine-scale random movements associated with having found prey. King penguins focused 45% of their foraging effort in waters with a specific surface temperature (5.0 to 5.5 degrees C) - an environmental cue potentially important in helping them locate prey, thereby reducing their need to expend energy in area-restricted search patterns. Within these waters, penguins slowed down and increased their dive effort and degree of meandering. First Passage Time analysis revealed that penguins focused much of their effort at local scales, generally in areas with a radius of 2 km. In these areas, penguins dived marginally deeper and targeted waters that, were significantly warmer at the bottom of their dives. Such information about fine-scale foraging behaviour will help increase our understanding of the environmental correlates that characterise areas where marine predators exploit their prey. The scale of these behavioural processes is better resolved using the fine-scale temporal and spatial resolution of GPS tracking data

MicroRNA-143 activation regulates smooth muscle and endothelial cell crosstalk in pulmonary arterial hypertension

Rationale: The pathogenesis of PAH remains unclear. The four microRNAs representing the miR-143 and miR-145 stem loops are genomically clustered. Objective: To elucidate the transcriptional regulation of the miR-143/145 cluster, and the role of miR-143 in PAH. Methods and Results: We identified the promoter region that regulates miR-143/145 miRNA expression in pulmonary artery smooth muscle cells (PASMCs). We mapped PAH-related signalling pathways, including estrogens receptor (ER), liver X factor/retinoic X receptor (LXR/RXR), TGF-β (Smads), and hypoxia (HRE) that regulated levels of all pri-miR stem loop transcription and resulting miRNA expression. We observed that miR-143-3p is selectively upregulated compared to miR-143-5p during PASMC migration. Modulation of miR-143 in PASMCs significantly altered cell migration and apoptosis. In addition, we found high abundance of miR-143-3p in PASMCs-derived exosomes. Using assays with pulmonary arterial endothelial cells (PAECs) we demonstrated a paracrine pro-migratory and pro-angiogenic effect of miR-143-3p enriched exosomes from PASMC. Quantitative PCR and in situ hybridisation showed elevated expression of miR-143 in calf models of PAH as well as in samples from PAH patients. Moreover, in contrast to our previous findings that had not supported a therapeutic role in vivo, we now demonstrate a protective role for miR-143 in experimental PH in vivo in miR-143-/- and antimiR143-3p-treated mice exposed to chronic hypoxia in both preventative and reversal settings. Conclusions: MiR-143-3p modulated both cellular and exosome-mediated responses in pulmonary vascular cells, while inhibition of miR-143-3p blocked experimental PH. Taken together these findings confirm an important role for the miR-143/145 cluster in PAH pathobiology

The mystery of massive mitochondrial complexes: the apicomplexan respiratory chain

The mitochondrial respiratory chain is an essential pathway in most studied eukaryotes due to its roles in respiration and other pathways that depend on mitochondrial membrane potential. Apicomplexans are unicellular eukaryotes whose members have an impact on global health. The respiratory chain is a drug target for some members of this group, notably the malaria-causing Plasmodium spp. This has motivated studies of the respiratory chain in apicomplexan parasites, primarily Toxoplasma gondii and Plasmodium spp. for which experimental tools are most advanced. Studies of the respiratory complexes in these organisms revealed numerous novel features, including expansion of complex size. The divergence of apicomplexan mitochondria from commonly studied models highlights the diversity of mitochondrial form and function across eukaryotic life

Hypogammaglobulinemia with Facial Edema

Knight and colleagues discuss the diagnosis and management of a 35-year-old man with a past history of recurrent cellulitis and otitis media and a two-year history of facial swelling

One-year outcomes in a multicentre cohort study of incident rare diffuse parenchymal lung disease in children (ChILD)

We performed a prospective, observational, cohort study of children newly diagnosed with children's interstitial lung disease (ChILD), with structured follow-up at 4, 8, 12 weeks and 6 and 12 months. 127 children, median age 0.9 (IQR 0.3-7.9) years had dyspnoea (68%, 69/102), tachypnoea (75%, 77/103) and low oxygen saturation (SpO(2)) median 92% (IQR 88-96). Death (n=20, 16%) was the most common in those <6 months of age with SpO(2)<94% and developmental/surfactant disorders. We report for the first time that ChILD survivors improved multiple clinical parameters within 8-12 weeks of diagnosis. These data can inform family discussions and support clinical trial measurements

Res Medica, Spring 1958, Volume 1, Number 2

TABLE OF CONTENTSTHE ROYAL MEDICAL SOCIETY TO-DAYTHE CONCEPTUAL BASIS OF MODERN SURGERY: Professor John Bruce, C.B.E., T.D., P. R.C.S.E., F.A.C.S. (HONS.)SOME PATHOLOGICAL ASPECTS OF DISSECTING ANEURYSM: M. J.MacLeanCHANGING FASHIONS IN DIABETES: Professor D. M. Dunlop, B.A., M.D., F. R.C. P. F. , F.R.C.P.OPERA OCCULTA: C. Vaughan RuckleySOME ASPECTS OF NUTRITIONAL AND TOXIC LIVER INJURY: A. W. DellipianiSIR JAMES YOUNG SIMPSON: William L.FordTHE AETIOLOGY OF DISSEMINATED SCLEROSIS: J. G. TurnbullHAZARDS OF RADIATION: Andrew Gun