This randomised controlled trial of 357 patients who had had an incomplete abortion compared suction curettage with conventional curettage for evacuation ofthe uterus. The 179 patients undergoing suction curettage had a significantly lower intra-operative blood loss (P < 0,0001) and a significantly higher mean ...
Zaidi, Shahida; Yasmin, Haleema; Hassan, Lubna; Khakwani, Mehnaz; Sami, Shehla; Abbas, Tazeen
Manual vacuum aspiration (MVA) and medical abortion were introduced to replace dilation and curettage/evacuation for incomplete abortions, and postabortion contraception was provided in 5 selected public hospitals in Pakistan. In the largest hospital, an Ipas MVA training center since 2007, MVA use reached 21% in 2008. After the International Federation of Gynecology and Obstetrics (FIGO) and UNFPA provided MVA kits, MVA use increased dramatically to 70%-90% in 2010-2013. In 2 of the remaining 4 hospitals in which the Society of Obstetricians and Gynecologists of Pakistan trained doctors in May 2012 and January 2013, the target of having 50% of women managed by MVA and medical abortion (MA) was met; however, in the third hospital only 43% were treated with MVA and MA. In the fourth hospital, where misoprostol and electric vacuum aspiration use was 64% and 9%, respectively, before training, an MVA workshop introduced the technique. Postabortion contraception was provided to 9%-29% of women, far below the target of 60%. Copyright © 2014 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.
Evacuation of the uterus for incomplete abortion is one of the most common operations performed world-wide. At Harare Central Hospital,. Zimbabwe, over 4 000 patients undergo evacuation for an incomplete abortion each year.' This accounts for. 50% of the emergency gynaecological workload. Most patients satisfy the ...
Khadijeh Rezaie Keikhaie and Zohreh Mahmoodi*
Diagnostic curettage, endometrial biopsy, and hysteroscopy are some diagnostic methods for patients who are hospitalized with abnormal uterine bleeding. In fact, curettage is implemented to diagnose uterine complications, treat forgotten abortions, and determine the cause of infertility. The main objective of the present study is investigating the prevalence of abnormal pathologies in evacuative curettage products in Amiralmomenin Hospital in Zabol from 2013 to 2016. The present descriptive s...
A technique of ambulatory abortion for first trimester pregnancies by vacuum suction curettage under local anesthesia with intracervical block is described. The apparatus and relevant problems are discussed. A shortened speculum devised by the author and considered an improvement for this procedure, and a simplified sterile field are described. The complication rate of 0.48% based on 5641 reported cases is very low: there were no deaths, two cases of uterine perforation, 14 of incomplete abortion, 20 of infection, 1 of depression, no cervical lacerations; 27 patients were hospitalized. The advantages of this method are safety, simplicity, minimal blood loss and immediate recovery. It is preferable to the usual dilatation and curettage, does not require general anesthesia and can be used in small clinics or in hospitals on an ambulatory basis. PMID:4758593
Iftikhar, G.; Tanveer, S.; Gilani, T.A.; Gilani, S.T.A.
To compare the safety and efficacy of manual vacuum aspiration and sharp curettage in the treatment of first trimester abortions. Study Design: Randomized controlled trial. Place and Duration of Study: Department of Gynecology, Social Security Hospital Shahdra Lahore in collaboration with Family Health Hospital Johar Town Lahore, from May 2007 to May 2012. Patients and Methods: Six hundred women admitted with the diagnosis of first trimester less than or equal to 12 weeks abortions were randomly assigned, 300 to manual vacuum aspiration (MVA) and 300 to traditional sharp curettage. Diagnosis of abortion was confirmed by last menstrual period, physical examination and ultrasonography. Results: In total of 600 patients, 300 randomly assigned to MVA and another 300 patients assigned to sharp curettage management were having mean age of 31.8 and 33 yrs respectively. Mean parity was in both groups, mean gestational age 8.9 and 8.2 weeks, mean duration of procedure was 6.4 and 5.8 minutes, duration of hospital stay was 4 and 40 hrs, missed abortion in 47% and 43% patients, incomplete abortion in 53% and 57% patients, cervical dilatation was needed in 1% against 53%, 10% against 8 % experienced mild pain in both groups, no patient of incomplete evacuation against 0.6%, uterine perforation in none against 0.3 %, excessive bleeding was experienced by 0.3% against 0.6% patients in both groups, and patient satisfaction rate was 99% against 99.4% in the two groups respectively. Conclusion: In the management of first trimester pregnancy loss, MVA offers a quick solution to the problem with reduced hospital stay and lower rate of complications. (author)
Full Text Available Spinal epidural abscess (SEA is a rare infection complicated in patients who have some risk factors such as injection-drug use, diabetes mellitus, and several illnesses. However, no case of SEA associated with abortion has been reported. Here we report a case of SEA in a 30-year-old woman after dilation and curettage for incomplete abortion. The diagnosis of SEA was done by MRI and pus was drained after the cervical discectomy. Bacteroides fragilis group was cultured from the aspirated pus sample. The patient responded to surgical drainage and antibiotics.
Mostafa Abdulla Elsayed
Background: The clinical management of miscarriage has changed little over the years and many women undergo surgical uterine evacuation. Surgical evacuation of the uterine contents in missed abortion is a challenge to the obstetrician as it is done blindly. The current study recommends the use of ultrasound guided surgical evacuation. It serves two important advantages; the first is to complete evacuation without the need of additional step. The second is to protect against uterine perforatio...
Azumaguchi, Atsushi; Henmi, Hirofumi; Ohnishi, Hirofumi; Endo, Toshiaki; Saito, Tsuyoshi
The aim of this study was to clarify the role of dilatation and curettage (D&C) performed for spontaneous or induced abortion in the etiology of endometrial thinning. This was a retrospective and cross-sectional study of 310 infertile patients from January 2013 through December 2015. Endometrial thickness observed 5-7 days after ovulation in a natural menstrual cycle was correlated with the number of D&C noted in each patient's history. Study 1 was an investigation of patients without D&C (group A: n = 232) and patients with D&C performed for spontaneous abortion (group B: n = 46). Study 2 was an investigation of patients in group A and patients with D&C performed for induced abortion (group C: n = 32). A significant negative correlation (P spontaneous or induced abortion may play a causal role in endometrial thinning. © 2017 Japan Society of Obstetrics and Gynecology.
Fertility and obstetric outcomes after curettage versus expectant management in randomised and non-randomised women with an incomplete evacuation of the uterus after misoprostol treatment for miscarriage.
Lemmers, M; Verschoor, M A C; Overwater, K; Bossuyt, P M; Hendriks, D; Hemelaar, M; Schutte, J M; Adriaanse, A H; Ankum, W M; Huirne, J A F; Mol, B W J
To assess fertility and obstetric outcomes in women treated with curettage or undergoing expectant management for an incomplete miscarriage after misoprostol treatment. Between June 2012 and July 2014, we conducted a multicentre randomised clinical trial (RCT) with a parallel cohort study for non-randomised women, treated according to their preference. In the RCT 30 women were allocated curettage and 29 expectant management. In the cohort 197 women participated; 65 underwent curettage and 132 women underwent expectant management. Primary outcome was curation, defined as either an empty uterus on sonography at six weeks or an uneventful clinical follow-up. We used questionnaires to assess fertility and obstetric outcome of the first new pregnancy subsequent to study enrolment. Curation was seen in 91/95 women treated with curettage (95.8%) versus 134/161 women managed expectantly (83.2%) (p=0.003). The response rate was 211/255 (82%). In 198 women pursuing a new pregnancy, conception rates were 92% (67/73) in the curettage group versus 96% (120/125) in the expectant management group (OR 0.96, 95% CI 0.89;1.03, p=0.34), with ongoing pregnancy rates of 87% (58/67) versus 78% (94/120), respectively (OR 1.12, 95% CI 0.99;1.28, p=0.226). Preterm birth rates were 1/46 in the curettage group versus 8/81 in the expectant management group (OR 0.22, 95% CI 0.03;1.71 P=0.15). Caesarean section rates were 23% and 24% for women in the curettage group and expectant management group respectively. In women with an incomplete evacuation of the uterus after misoprostol treatment, curettage and expectant management does not lead to different fertility and pregnancy outcomes, as compared to expectant management. Copyright © 2017 Elsevier B.V. All rights reserved.
Reeves, Matthew F; Monmaney, Jessica A; Creinin, Mitchell D
We sought to determine predictors of uterine evacuation for women undergoing medical abortion using mifepristone and vaginal misoprostol through 63 days' gestation. We pooled data from two prospective multicenter medical abortion trials. In one study, women received mifepristone 200 mg followed either 6-8 or 23-25 h later by misoprostol 800 mcg vaginally. In the second study, women received mifepristone 200 mg followed either misoprostol 800 mcg vaginally. We examined the absolute risk (AR) of uterine evacuation using Fisher's Exact Tests for categorical variables and Student t test and Wilcoxon rank-sum tests for continuous variables. We used logistic regression to calculate odds ratios (ORs) of uterine evacuation. Uterine evacuation was performed for 75 (3.5%) of 2160 women. In multivariable analysis, 5 or more prior deliveries (AR 11.9%, OR 4.6) and gestational age of 8 weeks or more (AR 4.1%, OR 2.1) were significantly associated with uterine evacuation, while age of 20 years or younger (AR 1.4%, OR 0.4) was significantly and inversely associated with uterine evacuation. Prior cesarean delivery, multiple gestations, smoking, weight, body surface area and body mass index were not predictive of uterine evacuation in univariate or multivariable analysis. Uterine evacuation is an uncommon outcome in medical abortion with mifepristone and vaginal misoprostol. Five or more deliveries are the only significant predictor that identifies a group with an AR of uterine evacuation of more than 6%. Uterine evacuation is uncommon in medical abortion with mifepristone and vaginal misoprostol. Parity of five or more is the only significant predictor of uterine evacuation exceeding 6%. Until additional research is completed, medical abortion should not be withheld from women with five or more deliveries. Copyright © 2016 Elsevier Inc. All rights reserved.
Objective. To compare evacuation under systemic analgesia (fentanyl and midazolam) in a treatment room (ward group) with evacuation under general anaesthesia in theatre. Design. A prospective randomised clinical trial. Setting. A tertiary medical centre serving a black urban population. Subjects. One hundred and ...
Suction curettage; Surgical abortion; Elective abortion - surgical; Therapeutic abortion - surgical ... Surgical abortion involves dilating the opening to the uterus (cervix) and placing a small suction tube into the uterus. ...
Fertility and obstetric outcomes after curettage versus expectant management in randomised and non-randomised women with an incomplete evacuation of the uterus after misoprostol treatment for miscarriage
Lemmers, M.; Verschoor, M. A. C.; Overwater, K.; Bossuyt, P. M.; Hendriks, D.; Hemelaar, M.; Schutte, J. M.; Adriaanse, A. H.; Ankum, W. M.; Huirne, J. A. F.; Mol, B. W. J.
To assess fertility and obstetric outcomes in women treated with curettage or undergoing expectant management for an incomplete miscarriage after misoprostol treatment. Between June 2012 and July 2014, we conducted a multicentre randomised clinical trial (RCT) with a parallel cohort study for
Lin, L M; Gaengler, P; Langeland, K
Periradicular curettage is a part of the treatment procedure of periradicular surgery. Its main purpose is to remove pathological periradicular tissues for visibility and accessibility to facilitate the treatment of the apical root canal system, or sometimes for the removal of harmful foreign materials present in the periradicular area. Inflammatory periradicular lesions (granuloma and cysts) are the responses of the periradicular tissues to irritants from the root canal and not from the periradicular area unless medicaments and/or filling materials have been forced through the apical foramina or perforations into the periodontium. Histologically, the inflammatory periradicular lesion is similar to healing granulation tissue, which is composed of cells which have natural and specific immunological defence capability and cooperate by means of cytokines to amplify the protective mechanisms of the host. Accordingly, it is not necessary to completely curette out all the inflamed periradicular tissues during surgery, since this granulation-like tissue will be incorporated into the new granulation tissue as part of the healing process. To control the source of irritants in the root canal is far more important than to remove all periradicular tissues affected by the irritants. The successful removal of all irritants from the root canal system results in resolution of pulpally induced periradicular lesions. In the case where the periradicular lesion is caused by endodontic instruments or cytotoxic filling materials placed in the periradicular tissues, removal of these foreign objects is required for resolution of the lesion.
Pedro Paulo Pereira
Full Text Available OBJETIVOS: Comparar aspiração manual intra-uterina (AMIU com curetagem uterina (D&C em abortamentos no primeiro trimestre no que se refere a eficiência para eliminar restos ovulares do método de aspiração manual intra-uterina com a dilatação e curetagem, ocorrência de complicações (perfuração uterina, laceração cervical, hemorragia pós-tratamento, tempo duração dos procedimentos e tempo de internação das pacientes. MÉTODOS: Cinqüenta pacientes no grupo AMIU e 50 pacientes no grupo D&C foram incluídas prospectivamente de maneira aleatória. Critérios de inclusão: abortamento espontâneo, idade gestacional de até 13 semanas, colo pérvio, espessura endometrial maior que 15 mm, estado afebril, hemoglobina superior a 10 g/dl. Amostras sangüíneas foram colhidas antes e após os procedimentos cirúrgicos para controle dos níveis de hemoglobina; anestesia foi realizada em todos os casos. O tempo para realização de cada procedimento cirúrgico foi cronometrado. RESULTADOS: Os grupos eram semelhantes quanto à idade gestacional (9,93±2,40; 9,73±2,58, p 0,71, espessura endometrial antes da cirurgia (22,14±4,80; 22,68±5,68, p 0,65. Não foram observadas complicações cirúrgicas ou anestésicas em nenhum grupo. Os tempos de realização do procedimento e internação foram significativamente menores nas pacientes do grupo AMIU (3,71; 10,18 min, p OBJECTIVES: To compare manual vacuum aspiration (MVA and uterine curettage (D&C for first trimester abortions, in terms of the efficiency of eliminating ovular remnants, frequency of complications, duration of the procedure, and duration of patients' hospitalization. METHODS: In a prospective study, 50 patients in the MVA group and 50 in the D&C group were randomly included. Inclusion criteria were: spontaneous abortion, gestational age less than 13 weeks, patent cervix, endometrial thickness >15 mm, afebrile state, and hemoglobin >10 g/dl. Blood samples were collected before
Full Text Available We present a case of intestinal infarctus through the vagina. This was a consequence of induced abortion done clandestinely. The main objective was to point out the surgical complications of uterine dilatation and curettage by means of this rare case.
Conclusion: Although vaginal surgical evacuation is more effective than misoprostol in solving the problem still medical treatment is effective and acceptable especially when surgical management is not available or risky or patients refuse to do surgical management.
Cates, W; Grimes, D A; Schulz, K F
In the late 1960s, states began to liberalize their abortion laws, and a new era in women's health began. Under the leadership of Jack Smith, the Centers for Disease Control and Prevention (CDC) established a voluntary abortion surveillance system that provided the first nationwide information on the numbers and characteristics of women having abortions. Studies of abortion morbidity done by the CDC revealed that suction curettage was safer than sharp curettage, local anesthesia was safer than general anesthesia, free-standing clinics were safer than hospitals, and dilation and evacuation (D&E) was safer than the alternative of labor induction for early second-trimester abortions. This evidence, which contradicted traditional medical tenets, rapidly changed the practice of abortion in the United States. CDC also established a surveillance system for abortion deaths. This demonstrated a rapid improvement in the safety of abortion in the early 1970s. Lessons learned from mortality investigations helped to change practice as well.Today, more is known about the epidemiology of abortion than any other operation in the history of medicine. In the midst of strident debate over the abortion issue, CDC abortion surveillance data have helped to guide judicial rulings, legislative actions, and Surgeon General's reports, which have supported safer choices for women of reproductive age. When medical historians of the future look back on this century, the increasing availability of safe, legal abortion will stand out as a public health triumph.
Full Text Available Post abortion complications are the third leading cause of maternal death after hemorrhage and hypertension in Botswana where abortion is not legalized. This study aimed at assessing the management of post abortion complications in Botswana.A retrospective study was conducted at four hospitals in Botswana in 2014. Socio-demographic, patient management and outcomes data were extracted from patients' medical records. Descriptive statistics and chi-square test were used to analyze and present the data.A total of 619 patients' medical records were reviewed. The duration of hospital stay prior to uterine evacuation ranged from less than an hour to 480 hours. All the patients received either prophylactic or therapeutic antibiotics. Use of parenteral antibiotics was significantly associated with severity of abortion, second trimester abortion, use of blood products and the interval between management's decision and uterine evacuation. Uterine evacuation for retained products of conception was achieved by metallic curettage among 516 (83.4% patients and by vacuum aspiration in 18 (2.9%. At all the study sites, Misoprostol or Oxytocin were used concurrently with surgical evacuation of the uterus. None use of analgesics or anesthetics in the four hospitals ranged between 12.4% to 28.8%.There is evidence of delayed patient care and prolonged hospital stay. Metallic curette was the primary method used for uterine evacuation across all the facilities. Pain management and antibiotics use was not standardized. A protocol has to be developed with the aim of standardizing post abortion care.
Apr 17, 1974 ... A trial of the Vabra aspirator, a sterile disposable suction curette, was carried out on 136 outpatients. The apparatus is designed to allow full curettage of the uterine cavity. Adequate specimens for diagnostic histology were ob- tained in' all but 10 cases. Of these, no specimen was obtained in 4 cases.
Mellerup, Natja; Sørensen, Bjarke L; Kuriigamba, Gideon K; Rudnicki, Martin
Complications of unsafe abortion are a major contributor to maternal deaths in developing countries. This study aimed to evaluate the clinical assessment for life-threatening complications and the following management in women admitted with complications from abortions at a rural hospital in Uganda. A partially completed criterion-based audit was conducted comparing actual to optimal care. The audit criteria cover initial clinical assessment of vital signs and management of common severe complications such as sepsis and haemorrhage. Sepsis shall be managed by immediate evacuation of the uterus and antibiotics in relation to and after surgical management. Shock by aggressive rehydration followed by evacuation. In total 238 women admitted between January 2007 and April 2012 were included. Complications were categorized as incomplete, threatened, inevitable, missed or septic abortion and by trimester. Actual management was compared to the audit criteria and presented by descriptive statistics. Fifty six per cent of the women were in second trimester. Abortion complications were distributed as follows: 53 % incomplete abortions, 28 % threatened abortions, 12 % inevitable abortions, 4 % missed abortions and 3 % septic abortions. Only one of 238 cases met all criteria of optimal clinical assessment and management. Thus, vital signs were measured in 3 %, antibiotic criteria was met in 59 % of the cases, intravenous fluid resuscitation was administered to 35 % of women with hypotension and pain was managed in 87 % of the cases. Sharp curettage was used in 69 % of those surgically evacuated and manual vacuum aspiration in 14 %. In total 3 % of the abortions were categorized as unsafe. Two of eight women with septic abortion had evacuation performed during admission-day, one woman died due to septic abortion and one from severe haemorrhage. Guidelines were not followed and suboptimal assessment or management was observed in all but one case. This was especially due to
An abortion is a procedure to end a pregnancy. It uses medicine or surgery to remove the embryo or ... personal. If you are thinking of having an abortion, most health care providers advise counseling.
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Background and Objectives
Epstein Barr Virus (EBV infection leading to Infectious Mononucleosis (IM is one of the etiologies of fever in women after curettage. EBV is a virus that can be transferred from carrier to the recipient through contact.
The focus of this article is to bring more awareness to EBV as a rare cause of infection and fever after curettage procedure.
Case ReportThis is a case of a woman who developed fever after curettage procedure. After a series of medical tests, the cause of her fever was found to be IM from an EBV infection. The emphasis of this report is to bring medical team’s attention to both common and uncommon etiologies of fever after an abortion procedure for better diagnosis and treatment of patients
Duprez, D; Fortuna, P
All physicians should be aware of the possible complications of induced abortions if only because the procedure is so commonplace. Some 250,000 induced abortions occur annually in France, amounting to 24.4 abortions per 100 live births. The rates of different complications of induced abortions before 12 weeks are .5-5/1000 for uterine perforation, .5-3.4% for hemorrhage with or without placental retention, 1% for endometritis, .3% for salpingitis .5% for continuing pregnancy, and .006 to .3/10,000 for death. A well done curettage is preferable to a poorly performed aspiration procedure. If an aspiration is done, the practitioner should bear in mind that retention of 50-200 cc of blood clots may occur if dilatation is insufficient. Symptoms appear 1-5 days after the abortion and end with expulsion of the clots or aspiration. Curettage is useless, as the clots do not represent a true retention. Uterine contractions during the aspiration can occasionally prompt a premature decision that evacuation is complete. Retention is difficult to diagnose immediately after aspiration but can be sonographically confirmed after the 8th day. Aspiration should be done after the 6th week and before the 12th week. Aspiration before the 6th week is often painful and is associated with higher rates of partial retention and of complete failure. Endouterine aspiration, regardless of technical proficiency, establishes a pathway between the vagina and the uterine cavity, which exposes the latter to the risk of trauma, endometrial lesions, and perforation. Induced abortion promotes infection by 2 mechanisms. Latent infections that were not detected in the medical history or physical examination can emerge and cause endometritis, which should be treated by ice, rest, and antibiotics. Or contamination of the passage by an infected cervical mucus can lead to salpingitis, abscess, and pelviperitonitis, or even general peritonitis. More often, these conditions develop from inadequately treated
This paper highlights the findings pertaining to profiles of abortion seekers, reasons for induced abortions and methods used, and treatment for post-abortion complications (PACs). This paper is a review of community studies on induced abortion in Pakistan between 1969 and 2010, including the Induced Abortion Survey (IAS) 2010, in which the author took part. Findings from the review show that the profile of abortion seekers has remained by and large that of uneducated women aged over 30 with at least three children. A predominant reason for seeking abortion was contraceptive failure. Providers fall into both trained and untrained categories, yet complication rates are high even when women believe that they are going to safe providers in clinics or hospital settings. Dilation and curettage (D&C) (or evacuation) predominates among methods used while the use of folk methods may be on the decline. The IAS shows that women seek assistance for complications sooner than earlier studies have found. The review shows that despite a perceived stigma around the subject, community-level research is possible and further studies need to be done in other parts of the country. The paper concludes with suggestions for more community studies to explore these findings further and capture the diversity of the Pakistani context. It also suggests that advocacy and further research into the role of "semi-safe" providers be explored.
Full Text Available Abstract The highly pathogenic avian influenza H5N1 virus is one of candidates for future pandemic. Since H5N1 viruses had previously been isolated only from avian species, the outbreak raised questions about the ability of these viruses to cause severe disease and death in humans. Pregnant women are at increased risk for influenza-associated illness and death. However, little is known about whether influenza viruses could transmit to the fetus through the placenta, and the effects of abortion and preterm delivery to maternal influenza infection are not well understood. We found that the H5N1 viruses could vertical transmit to the fetus through the placenta in the BALB/c mouse model, and the viruses could partly be evacuated by the pregnant mice during abortion or preterm delivery. This study may further our understanding about the transmission of this highly pathogenic avian influenza viruses, supply optimized clinical treatment method for pregnant women, and shed some light on better preventing and controlling for future potential outbreak of H5N1 influenza pandemic.
Nunes, J P
Abortion is the interruption of a dynamic process in a final and irreversible form. The legalization of abortion is applied to human ontogenesis, that is, the development of the human being. However, the embryo that is growing in the uterus is not a human being because a human being is a complex organism with differentiated systems, its own identity and intrinsic autonomy in its process of development. There are basically four levels of the analysis of the problem of abortion: 1) fundamental emotional arguments; 2) profound ignorance of technical and scientific facts; 3) rational positions obfuscated by the dramatic intensity of everyday situations; and 4) the conjunction of deliberated position where culpability is avoided with solidarity for all subjects of the process with a socially oriented view. The phenomenon of abortion from an epidemiological point of view summons the facts with which it is associated: poverty, illiteracy, shortage or lack of community health resources, absence of centers for adolescents, degradation of the environment, and precariousness of employment.
With the advent of legalized abortion in the US in 1973, the innovation, adoption and dissemination of new and improved medical procedures for the voluntary termination of pregnancy became an important objective. 3 principal techniques were introduced: suction curettage, instillation procedures using saline solution or prostaglandin, and dilatation and evacuation (D and E). Suction curettage in the 1st trimester was readily adopted because the procedure was less traumatic than the traditional dilatation and curettage. Instillation procedures for abortions in the 2nd trimester were also readily adopted. Physicians preferred them to surgical procedures, were familiar with the delivery simulation, and were comfortable with the hospital setting in which the procedure was performed. D and E, an extension of the suction procedure to abortions in the 2nd trimester has lower complication rates than instillation procedures and can be performed early in the midtrimester. A 1981 membership survey conducted by the National Abortion Federation found that about 1/3 of the members performed D and E midtrimester abortions, a wider acceptance than was expected. In 1978, of the 2nd trimester abortions, 85% of the early midtrimester and 25% of the 16 weeks gestation or later abortions were done by D and E. Acceptance in some other countries is also increasing. A study of the relationship of a history of 2nd trimester abortions and subsequent adverse pregnancy outcomes was unable to identify any statistically significant relationship with the possible exception of low birth weight infants. According to a 1976 survey of teaching hospitals, less than 1/4 require their residents to perform midtrimester abortions. Very few medical schools include D and E procedures in their residency training programs. Residents should use the D and E technique only under supervision and after becoming experienced in 1st trimester suction curettage. A survey reported that D and E techniques can be learned
Tobías González, Pablo; Mateos Guillem, Alejandra; Zapardiel, Ignacio; Diestro, María Dolores; De Santiago, Javier
To show the removal of an intramyometrial fetus after uterine curettage using laparoscopy as a safe surgical technique that offers excellent results and fewer complications than laparotomy. Presentation of the clinical case and step-by-step explanation of the technique. Uterine curettage is a frequently performed gynecologic abortion procedure. Dilatation and curettage is considered to be a safe surgical technique, with a low percentage of complications. The most common is uterine perforation, with higher risks in advanced gestational age, retroflexed uterus, or uterine leiomyomas. After institutional review board approval, we present the case of a 29-year-old women referred to our hospital from another clinic with a suspected uterine perforation after an elective curettage for a 14-week pregnancy. She presented with moderate abdominal pain. Vaginal ultrasound revealed intramyometrial fetal parts on isthmus and right parametrium and minimal free fluid in the pouch of Douglas. A laparoscopic approach was chosen. After a complete revision of the abdominal cavity, the right paravesical space was dissected, confirming no right uterine artery or ureter injury. One cavity was objectified in the posterior leaf of the broad ligament related to a uterine perforation and containing fetal bone parts, which were removed. The myometrial defect and the peritoneum were closed with intracorporeal sutures. The removal of fetal parts was done with a surgical glove thimble. After the procedure, the patient was treated with clindamycin and gentamycin, with a satisfactory recovery. The presence of an intramyometrial fetus is not a common complication of curettage. The use of laparoscopy is feasible and offers excellent results and advantages versus laparotomy regarding its treatment. Copyright © 2015 AAGL. Published by Elsevier Inc. All rights reserved.
Full Text Available Objectives: To study the hysteroscopic findings in cases of secondary infertility following abortion compared to cases with primary infertility. Methods: This was a case control study of 200 selected infertile women undergoing diagnostic hysteroscopy as a part of their infertility work-up. These 200 patient were classified into the following: A – 100 patients in whom abortion has occurred whether evacuation and curettage (E.&C. was done or not and B – 100 patients complaining of primary infertility. Results: Hysteroscopy was normal in about 44% of patients group and 45% in control group. Observed abnormalities were septate uterus in 17 cases, intrauterine synechiae in 30 cases, submucus myoma in 10 cases, deformed cavity in 5 cases and endometrial polyp in 35 cases. Endometrial abnormalities (fibrosis, inflammation or atrophy were observed in 7 patients. No significance was found regarding the total number of intrauterine pathologies when comparing the groups of primary versus secondary infertility. Patients group showed higher prevalence of Intra Uterine Septum and Intra Uterine Adhesions. Control group showed higher prevalence of endometrial polyp, submucous myoma and Endometritis. Other findings showed nearly equal prevalence in the two groups. Conclusion: There is a direct correlation between the number of abortions, number of evacuations (E.&C. and degree of intra-uterine adhesion, and an increase in the number of abortions is associated with an increase in the degree of intra-uterine adhesions. However, in this study, there was no significant difference between degree of intra-uterine adhesions in the two groups (patient group and control group. Our data are an additional argument to suggest hysteroscopy as part of investigation in infertile woman. Routine diagnostic hysteroscopy should be part of an infertility work-up in primary and secondary infertility.
Winer, Norbert; Resche-Rigon, Mathieu; Morin, Christine; Ville, Yves; Rozenberg, Patrick
To examine whether a first or second trimester induced abortion with misoprostol influences the risk of late abortion or preterm delivery in subsequent pregnancies. Case-control study in a teaching hospital from January 2005 to June 2006. The cases had singleton pregnancies delivered at 16-36 weeks of gestation after spontaneous late abortions, preterm labor or preterm premature rupture of membrane, or induction of labor for preterm premature rupture of membrane before 37 weeks. The control group was composed of the two consecutive spontaneous singleton deliveries at >or=37 weeks of gestation after each new case (ratio 2/1). The principal outcome measure was late abortion or preterm delivery. The association between late abortion or preterm delivery and a previous induced abortion with misoprostol was first assessed with the Cochran-Mantel-Haenszel chi-square test. Conditional logistic regression models adapted for clustered data were then further used to quantify the effect size, measured by estimated odds ratios (ORs) with their 95% confidence intervals (95% CI). The study included 245 cases and 490 controls. There was no significant difference in mean maternal age, number of pregnancies, parity, smoking, or history of first trimester miscarriage between cases and controls. However, a history of late abortion or previous preterm delivery was significantly more frequent among cases than controls. Forty (16.3%) cases and 56 (11.5%) controls had a history of cervical ripening with misoprostol before vacuum curettage or evacuation, or of medical abortion by misoprostol alone or with mifepristone (OR 1.51, 95% CI: 0.95-2.39; p=0.08). After adjustment for maternal age and number of pregnancies with a multivariable conditional regression model, the adjusted OR was estimated at 1.33 (95% CI: 0.81-2.17; p=0.25). Despite the need for prudence, these results provide some reassurance that induced abortion with misoprostol during the first or second trimester of pregnancy is
The "rightness" of a technology for completing a particular task is negotiated by medical professionals, patients, state institutions, manufacturing companies, and non-governmental organizations. This paper shows how certain technologies may challenge the meaning of the "job" they are designed to accomplish. Manual vacuum aspiration (MVA) is a syringe device for uterine evacuation that can be used to treat complications of incomplete abortion, known as post-abortion care (PAC), or to terminate pregnancy. I explore how negotiations over the rightness of MVA as well as PAC unfold at the intersection of national and global reproductive politics during the daily treatment of abortion complications at three hospitals in Senegal, where PAC is permitted but induced abortion is legally prohibited. Although state health authorities have championed MVA as the "preferred" PAC technology, the primary donor for PAC, the United States Agency for International Development, does not support the purchase of abortifacient technologies. I conducted an ethnography of Senegal's PAC program between 2010 and 2011. Data collection methods included interviews with 49 health professionals, observation of PAC treatment and review of abortion records at three hospitals, and a review of transnational literature on MVA and PAC. While MVA was the most frequently employed form of uterine evacuation in hospitals, concerns about off-label MVA practices contributed to the persistence of less effective methods such as dilation and curettage (D&C) and digital curettage. Anxieties about MVA's capacity to induce abortion have constrained its integration into routine obstetric care. This capacity also raises questions about what the "job," PAC, represents in Senegalese hospitals. The prioritization of MVA's security over women's access to the preferred technology reinforces gendered inequalities in health care. Copyright © 2015 Elsevier Ltd. All rights reserved.
Lemmers, M.; Verschoor, M. A. C.; Rengerink, K. Oude; Naaktgeboren, C.; Opmeer, B. C.; Bossuyt, P. M.; Huirne, J. A. F.; Janssen, C. A. H.; Radder, C.; Klinkert, E. R.; Langenveld, J.; Catshoek, R.; Van der Voet, L.; Siemens, F.; Geomini, P.; Van Hooff, M. H.; Van der Ploeg, J. M.; Coppus, S. F. P. J.; Ankum, W. M.; Mol, B. W. J.
Is curettage more effective than expectant management in case of an incomplete evacuation after misoprostol treatment for first trimester miscarriage? Curettage leads to a higher chance of complete evacuation but expectant management is successful in at least 76% of women with an incomplete
Lemmers, M; Verschoor, M A C; Oude Rengerink, K; Naaktgeboren, C; Opmeer, B C; Bossuyt, P M; Huirne, J A F; Janssen, C A H; Radder, C; Klinkert, E R; Langenveld, J; Catshoek, R; Van der Voet, L; Siemens, F; Geomini, P; Van Hooff, M H; Van der Ploeg, J M; Coppus, S F P J; Ankum, W M; Mol, B W J
STUDY QUESTION: Is curettage more effective than expectant management in case of an incomplete evacuation after misoprostol treatment for first trimester miscarriage? SUMMARY ANSWER: Curettage leads to a higher chance of complete evacuation but expectant management is successful in at least 76% of
with induced abortion did well after evacuation and antibiotics. Discussion. It has been estimated that up to 20% of reco~ nised pregnancies end in spontaneous abortion , and this usually occurs in the first trimester. The uterus is not efficient at emptying its contents in early pregnancy, so that abortion is often compli-.
Full Text Available Curettage is used in periodontics to scrap off the gingival wall of a periodontal pocket, and is needed to reduce loss of attachment (LOA by developing new connective tissue attachment in patients with periodontitis. The purpose of this study was to evaluate the success of curettage by the formation of tissue attachment. This clinical experiment was done by comparing LOA before curettage, 2 weeks and 3 weeks after curettage on 30 teeth with the indication of curettage. Study population were periodontitis patient who attending dental clinic at Hospital University Science Malaysia (HUSM with inclusion criteria good general health condition, 18 to 55 years old male or female and presented with pocket depth > 3mm. The teeth were thoroughly scaling before intervention and evaluated by measuring the periodontal attachment before curettage, two weeks and three weeks after curettage. Repeated measure ANOVA and Paired T Test were used to analyze the data. The result of the study showed that there was reduction in the periodontal attachment loss in periodontitis patient after curettage either in the anterior or posterior teeth which were supported by statistical analysis. This study concluded that curettage could make reattachment of the tissue
The “rightness” of a technology for completing a particular task is negotiated by medical professionals, patients, state institutions, manufacturing companies, and non-governmental organizations. This paper shows how certain technologies may challenge the meaning of the “job” they are designed to accomplish. Manual vacuum aspiration (MVA) is a syringe device for uterine evacuation that can be used to treat complications of incomplete abortion, known as post-abortion care (PAC), or to terminate pregnancy. I explore how negotiations over the rightness of MVA as well as PAC unfold at the intersection of national and global reproductive politics during the daily treatment of abortion complications at three hospitals in Senegal, where PAC is permitted but induced abortion is legally prohibited. Although state health authorities have championed MVA as the “preferred” PAC technology, the primary donor for PAC, the United States Agency for International Development, does not support the purchase of abortifacient technologies. I conducted an ethnography of Senegal's PAC program between 2010 and 2011. Data collection methods included interviews with 49 health professionals, observation of PAC treatment and review of abortion records at three hospitals, and a review of transnational literature on MVA and PAC. While MVA was the most frequently employed form of uterine evacuation in hospitals, concerns about off-label MVA practices contributed to the persistence of less effective methods such as dilation and curettage (D&C) and digital curettage. Anxieties about MVA's capacity to induce abortion have constrained its integration into routine obstetric care. This capacity also raises questions about what the “job,” PAC, represents in Senegalese hospitals. The prioritization of MVA's security over women's access to the preferred technology reinforces gendered inequalities in health care. PMID:25948127
Carine Luíze Panke
Full Text Available OBJECTIVE: To identify the incidence of pelvic infection after miscarriage undergoing uterine evacuation in a tertiary hospital in southern Brazil and to compare with the international literature.METHODS: we reviewed electronic medical records of the Hospital de Clinicas de Porto Alegre of all patients who underwent uterine evacuation for miscarriage between August 2008 and January 2012 were reviewed. We included all patients submitted to uterine curettage due to abortion and who had outpatient visits for review after the procedure. We calculated emographic and laboratory data of the study population, number needed for treatment (NNT and number needed to harm (NNH.RESULTS: of the 857 revised electronic medical records, 377 patients were subjected to uterine evacuation for miscarriage; 55 cases were lost to follow-up, leaving 322 cases that were classified as not infected abortion on admission. The majority of the population was white (79%; HIV prevalence and positive VDRL was 0.3% and 2%, respectively. By following these 322 cases for a minimum of seven days, it was found that the incidence of post-procedure infection was 1.8% (95% CI 0.8 to 4. The NNT and NNH calculated for 42 months were 63 and 39, respectively.CONCLUSION: The incidence of post-abortion infection between August 2008 to January 2012 was 1.8% (0.8 to 4.
In the event of an emergency, it is important that staff and visitors are evacuated safely and efficiently. Hence CERN organises regularly emergency response and evacuation exercise (also known as an ‘evacuation drill’) in different buildings across the sites.
Odland, Maria Lisa; Membe-Gadama, Gladys; Kafulafula, Ursula; Jacobsen, Geir W; Kumwenda, James; Darj, Elisabeth
Malawi has a high maternal mortality rate, of which unsafe abortion is a major cause. About 140,000 induced abortions are estimated every year, despite there being a restrictive abortion law in place. This leads to complications, such as incomplete abortions, which need to be treated to avoid further harm. Although manual vacuum aspiration (MVA) is a safe and cheap method of evacuating the uterus, the most commonly used method in Malawi is curettage. Medical treatment is used sparingly in the country, and the Ministry of Health has been trying to increase the use of MVA. The aim of this study was to investigate the treatment of incomplete abortions in three public hospitals in Southern Malawi during a three-year period. All medical files from the female/gynecological wards from 2013 to 2015 were reviewed. In total, information on obstetric history, demographics, and treatment were collected from 7270 women who had been treated for incomplete abortions. The overall use of MVA at the three hospitals during the study period was 11.4% (95% CI, 10.7-12.1). However, there was a major increase in MVA application at one District Hospital. Why there was only one successful hospital in this study is unclear, but may be due to more training and dedicated leadership at this particular hospital. Either way, the use of MVA in the treatment of incomplete abortions continues to be low in Malawi, despite recommendations from the World Health Organization (WHO) and the Malawi Ministry of Health.
Darney, Blair G; Simancas-Mendoza, Willis; Edelman, Alison B; Guerra-Palacio, Camilo; Tolosa, Jorge E; Rodriguez, Maria I
Until 2006, legal induced abortion was completely banned in Colombia. Few facilities are equipped or willing to offer abortion services; often adolescents experience even greater barriers of access in this context. We examined post abortion care (PAC) and legal induced abortion in two large public hospitals. We tested the association of hospital site, procedure type (manual vacuum aspiration vs. sharp curettage), and age (adolescents vs. women 20 years and over) with service type (PAC or legal induced abortion). Retrospective cohort study using 2010 billing data routinely collected for reimbursement (N=1353 procedures). We utilized descriptive statistics, multivariable logistic regression and predicted probabilities. Adolescents made up 22% of the overall sample (300/1353). Manual vacuum aspiration was used in one-third of cases (vs. sharp curettage). Adolescents had lower odds of documented PAC (vs. induced abortion) compared with women over age 20 (OR=0.42; 95% CI=0.21-0.86). The absolute difference of service type by age, however, is very small, controlling for hospital site and procedure type (.97 probability of PAC for adolescents compared with .99 for women 20 and over). Regardless of age, PAC via sharp curettage is the current standard in these two public hospitals. Both adolescents and women over 20 are in need of access to legal abortion services utilizing modern technologies in the public sector in Colombia. Documentation of abortion care is an essential first step to determining barriers to access and opportunities for quality improvement and better health outcomes for women. Following partial decriminalization of abortion in Colombia, in public hospitals nearly all abortion services are post-abortion care, not induced abortion. Sharp curettage is the dominant treatment for both adolescents and women over 20. Women seek care in the public sector for abortion, and must have access to safe, quality services. Copyright © 2014. Published by Elsevier Inc.
Aspiration Curettage and its Outpatient Usage. D. A. G. BARFORD, M, NOTELOVITZ. SUMMARY ... its use on a number of outpatients without anaesthesia is discussed. S. Afr. Med. l., 48, 22 (1974). In order to ... plastic aspiration chamber and suction is applied centrally at the base of the chamber, a cylindrical filter within the.
... Dilation and Curettage (D&C) Page Navigation ▼ ACOG Pregnancy Book Patient Education FAQs Patient Education Pamphlets - Spanish FAQ062, February 2016 ... written permission from the publisher. Related FAQs Early Pregnancy Loss (Miscarriage) (FAQ090) Abnormal Uterine Bleeding ... Committee Opinions Practice Bulletins Patient ...
CONCLUSION: Misoprostol reduces intrauterine adhesions after surgical termination of missed abortion, possibly by improving the convenience of curettage. Pretreatment with misoprostol can be justified for women who have history of infertility or recurrent pregnancy loss and who are to undergo curettage.
Full Text Available Background. The detection of a morbidly adherent placenta (MAP in the first trimester is rare. Risk factors such as multiparity, advanced maternal age, prior cesarean delivery, prior myomectomy, placenta previa, or previous uterine evacuation place patients at a higher risk for having abnormal placental implantation. If these patients have a first trimester missed abortion and fail medical management, it is important that providers have a heightened suspicion for a MAP. Case. A 24-year-old G4P3003 with 3 prior cesarean deliveries underwent multiple rounds of failed medical management for a missed abortion. She had a dilation and curettage that was complicated by a significant hemorrhage and ultimately required an urgent hysterectomy. Conclusion. When patients fail medical management for a missed abortion, providers need to assess the patient’s risk factors for a MAP. If risk factors are present, a series of specific evaluations should be triggered to rule out a MAP and help further guide management. Early diagnosis of a MAP allows providers to coordinate a multidisciplinary treatment approach and thoroughly counsel patients. Ensuring adequate resources and personnel at a tertiary hospital is essential to provide the highest quality of care and improve outcomes.
Farooq, F.; Javed, L.; Mumtaz, A.; Naveed, N.
Objectives: To compare the efficacy, safety and cost effectiveness of Manual Vacuum Aspiration (MVA) with dilatation and curettage (DNC) in the management of early pregnancy failure. Methods: One hundred patients of spontaneous abortion, incomplete or missed, with gestational age <12 weeks were included in the study. Using a Random Number Table, these patients were assigned to undergo either DNC or MVA. Results: The distribution of age, parity and gestational age was similar in both groups. The mean duration of procedure was significantly higher (p<0.0001) in DNC (8.98+-2.64 minutes) as compared to 5.88+-2.43 minutes in MVA. The duration of hospital stay was significantly lower (p<0.0001) in MVA group (3.48+-1.2 hours) as compared to 7.42+-1.93 minutes in DNC group. Similarly the cost of procedure was also significantly lower (p=0.0001) in MVA group (PKR 1410+-243.4) compared to PKR 3460+-908.24 in DNC group. Conclusion: MVA is as effective as conventional dilatation and curettage for treatment of early pregnancy failure while it causes less blood loss, is less time consuming, requires a shorter hospital stay and thus costs less. It does not require general anaesthesia and complication rate is less than dilatation and curettage. (author)
Farooq, Fariha; Javed, Lubna; Mumtaz, Ambreen; Naveed, Nosheen
To compare the efficacy, safety and cost effectiveness of Manual Vacuum Aspiration (MVA) with dilatation and curettage (DNC) in the management of early pregnancy failure. One hundred patients of spontaneous abortion, incomplete or missed, with gestational age DNC or MVA. The distribution of age, parity and gestational age was similar in both groups. The mean duration of procedure was significantly higher (pDNC (8.98 +/- 2.64 minutes) as compared to 5.88 +/- 2.43 minutes in MVA. The duration of hospital stay was significantly lower (pDNC group. Similarly the cost of procedure was also significantly lower (p=0.0001) in MVA group (PKR 1410 +/- 243.4) compared to PKR 3460 +/- 908.24 in DNC group. MVA is as effective as conventional dilatation and curettage for treatment of early pregnancy failure while it causes less blood loss, is less time consuming, requires a shorter hospital stay and thus costs less. It does not require general anaesthesia and complication rate is less than dilatation and curettage.
Liang, Hong; Gao, Er-sheng; Chen, Ai-min; Luo, Lin; Cheng, Yi-min; Yuan, Wei
The aim of this study is to explore the effect of first-trimester mifepristone-induced abortion on vaginal bleeding in subsequent pregnancy. This observational cohort study was conducted during 1998-2001 at antenatal clinics in Beijing, Chengdu, and Shanghai, China. The study enrolled 4,931 women with one previous mifepristone-induced abortion, 4,925 women with no history of induced abortion, and 4,800 women with one previous surgical abortion and followed them through pregnancy and childbirth. The rates of vaginal bleeding in pregnant women with a history of medical abortion, no abortion, and surgical abortion were 16.5%, 13.9%, and 17.3%, respectively. The women with medical abortion had a higher risk (adjusted relative risk (aRR)=1.17, 95% confidence interval (CI): 1.07, 1.29) of vaginal bleeding compared with those with no abortion but similar risk to prior surgical abortion. When the correlation between medical abortion and vaginal bleeding was examined by period, increased risk was observed only in the early period (abortion and no abortion showed that the observed risks increased particularly in those with abortion at gestational age ≤ 7 weeks (aRR=1.33, 95% CI: 1.18, 1.49), those followed by a postabortion curettage (aRR=1.58, 95% CI: 1.37, 1.84) or complications (aRR=1.99, 95% CI: 1.67, 2.37). There was no difference between women with medical abortion and women with surgical abortion in the occurrence of vaginal bleeding for either period. One previous mifepristone-induced abortion increased the risk of vaginal bleeding in early gestation period of subsequent pregnancy compared with no abortion, especially if abortion occurred before 7 weeks of gestation and was followed by a curettage or complications. Copyright © 2011 Elsevier Inc. All rights reserved.
Dayananda, Ila; Walker, Dilys; Atienzo, Erika E; Haider, Sadia
Little is known about abortion practice in Mexico postlegalization of abortion in Mexico City in 2007. In 2009, we anonymously surveyed 418 Mexican health care providers at the Colegio Mexicano de Especialistas en Ginecologia y Obstetricia meeting using audio computer-assisted self-interview technology. The majority of respondents were obstetrician gynecologists (376, 90%), Catholic (341, 82%), 35-60 years old (332, 79%) and male (222, 53%) and worked with trainees (307, 74%). Prior to 2007, 11% (46) and 17% (71) provided medical and surgical abortions; now, 15% (62) and 21% (86) provide these services, respectively. Practitioners from Mexico City were more likely to provide services than those from other areas. Most medical abortion providers (50, 81%) used ineffective protocols. Surgical abortion providers mainly used either manual vacuum aspiration (39, 45%) or sharp curettage (27, 32%). Most abortion providers were trained in residency and wanted more training in medical (54, 87%) and surgical (59, 69%) abortion. Among nonproviders, 49% (175) and 27% (89) expressed interest in learning to perform medical and surgical abortion, respectively. Given the interest in learning to provide safe abortion services and the prevalent use of ineffective medical abortion regimens and sharp curettage, abortion training in Mexico should be strengthened. Copyright © 2012 Elsevier Inc. All rights reserved.
Dönmez, Sevgül; Kısa, Sezer
This study examined the opinions of married couples concerning induced abortion in a sample of 674 married couples obtaining services at a large obstetrical/gynecological outpatient service. Although approximately half of the sample were not using birth control, a similar percentage felt that curettage (selective abortion) should never be performed. A larger percentage felt that selective abortion is a sin and should be banned. Sex differences in attitudes were minimal. Couples may benefit from a birth control education program in a hospital that is designed to cover abortion in order to provide accurate information in a more professional environment.
Vayssière, C; Gaudineau, A; Attali, L; Bettahar, K; Eyraud, S; Faucher, P; Fournet, P; Hassoun, D; Hatchuel, M; Jamin, C; Letombe, B; Linet, T; Msika Razon, M; Ohanessian, A; Segain, H; Vigoureux, S; Winer, N; Wylomanski, S; Agostini, A
Develop recommendations for the practice of induced abortion. The Pubmed database, the Cochrane Library and the recommendations from the French and foreign Gyn-Obs societies or colleges have been consulted. The number of induced abortions (IA) has been stable for several decades. There are a lot of factors explaining the choice of abortion when there is an unplanned pregnancy (UPP). Early initiation and choice of contraception in connection to the woman's life are associated with lower NSP. Reversible contraceptives of long duration of action should be positioned fist in line for the teenager because of its efficiency (grade C). Ultrasound before induced abortion must be encouraged but should not be obligatory before performing IA (Professional consensus). As soon as the sonographic apparition of the embryo, the estimated date of pregnancy is done by measuring the crown-rump length (CRL) or by measuring the biparietal diameter (BIP) from 11 weeks on (grade B). Reliability of these parameters being±5 days, IA could be done if measurements are respectively less than 90mm for CRL and less than 30mm for BIP (Professional consensus). A medical IA performed with a dose of 200mg mifepristone combined with misoprostol is effective at any gestational age (EL1). Before 7 weeks, mifepristone followed between 24 and 48hours by taking misoprostol orally, buccally sublingually or eventually vaginally at a dose of 400 ug possibly renewed after 3hours (EL1, grade A). Beyond 7 weeks, misoprostol given vaginally, sublingually or buccally are better tolerated with fewer side effects than oral route (EL1). It is recommended to always use a cervical preparation during an instrumental abortion (Professional consensus). Misoprostol is a first-line agent for cervical preparation at a dose of 400 mcg (grade A). Aspiration evacuation is preferable to curettage (grade B). A perforated uterus during an instrumental suction should not be considered as a scarred uterus (Professional
The rate of induced abortions (9/1000 women aged 15-49 y in 2011) is low in Finland. Ninety-two per cent of them are performed on grounds of social reasons. Use of medical abortion (combination of mifepristone and misoprostol) has increased to nearly 90 % of abortions, also in abortions of 9-12 weeks of pregnancy. Intrauterine contraception started at the time of abortion lowers the risk of future unplanned pregnancies. Prophylactic antibiotics are recommended in cases of surgical evacuation of the uterus. Written instructions for patients and professionals are introduced in the guideline.
Ju, W.; Kim, S.C. [Dept. of Obstetrics and Gynecology, and Medical Research Inst., School of Medicine, Ewha Womens Univ., Seoul (Korea)
Placenta increta during the first trimester of pregnancy is extremely rare. Only a few cases of placenta accreta during the latter half of pregnancy manifesting as a uterine mass have been published. This report describes a case of placenta increta that caused prolonged bleeding after a first-trimester abortion, and was identified by magnetic resonance imaging (MRI) as a heterogeneous mass in the myometrium. This is the first report of a placenta increta detected as a uterine mass after first-trimester dilatation and curettage, and its MRI findings.
Department of Homeland Security — Hurricane Evacuation Routes in the United States A hurricane evacuation route is a designated route used to direct traffic inland in case of a hurricane threat. This...
Schiavon, Raffaela; Collado, Maria Elena; Troncoso, Erika; Soto Sánchez, José Ezequiel; Zorrilla, Gabriela Otero; Palermo, Tia
In 2007, first trimester abortion was legalized in Mexico City, and the public sector rapidly expanded its abortion services. In 2008, to obtain information on the effect of the law on private sector abortion services, we interviewed 135 physicians working in private clinics, located through an exhaustive search. A large majority of the clinics offered a range of reproductive health services, including abortions. Over 70% still used dilatation and curettage (D&C); less than a third offered vacuum aspiration or medical abortion. The average number of abortions per facility was only three per month; few reported more than 10 abortions monthly. More than 90% said they had been offering abortion services for less than 20 months. Many women are still accessing abortion services privately, despite the availability of free or low-cost services at public facilities. However, the continuing use of D&C, high fees (mean of $157-505), poor pain management practices, unnecessary use of ultrasound, general anaesthesia and overnight stays, indicate that private sector abortion services are expensive and far from optimal. Now that abortions are legal, these results highlight the need for private abortion providers to be trained in recommended abortion methods and quality of private abortion care improved. Copyright © 2010 Reproductive Health Matters. Published by Elsevier Ltd. All rights reserved.
Francisco Carlos Nogueira Arcanjo
anteroposterior diameter of the endometrial cavity measured 8 weeks of gestational age were compared using the binomial test and Student's t test regarding outcome: frequency of complete abortion and the interval between administration of misoprostol and abortion (in minutes. The level of significance was 5%. RESULTS: The mean gestational age at diagnosis was 8.5 weeks (SD=1.5. The intervals between administration of misoprostol and uterine contractions and between the administration and abortion were 322.5±97.0 minutes and 772.5±201.0 minutes, respectively. There was complete abortion in 80.3%. The success rate was 96.2% for the first group and 53.3% for the second (p<0.01. We observed a statistically significant difference in time between administration and uterine evacuation (676.2±178.9 vs. 939.5±105.7 minutes, p<0.01. The side effects observed were hyperthermia (12.1%, nausea (7.3%, diarrhea or breast pain (2.4%. No case of genital infection was observed. CONCLUSIONS: The use of vaginal misoprostol is a safe and effective alternative to curettage for interrupted early pregnancies, being better in pregnancies up to the 8th week. The time interval until emptying was lower in pregnancies that were interrupted earlier.
... Search FAQs Induced Abortion Page Navigation ▼ ACOG Pregnancy Book Induced Abortion Patient Education FAQs Induced Abortion Patient ... given for the procedure? Before the procedure, local anesthesia is given to numb the cervix. Sedatives may ...
Full Text Available To document clinical outcomes and women's experiences following the introduction of mifepristone into South African public sector second-trimester medical abortion services, and compare with historic cohorts receiving misoprostol-only.Repeated cross-sectional observational studies documented service delivery and experiences of women undergoing second-trimester medical abortion in public sector hospitals in the Western Cape, South Africa. Women recruited to the study in 2008 (n = 84 and 2010 (n = 58 received misoprostol only. Those recruited in 2014 (n = 208 received mifepristone and misoprostol. Consenting women were interviewed during hospitalization by study fieldworkers with respect to socio-demographic information, reproductive history, and their experiences with the abortion. Clinical details were extracted from medical charts following discharge. Telephone follow-up interviews to record delayed complications were conducted 2-4 weeks after discharge for the 2014 cohort.The 2014 cohort received 200 mg mifepristone, which was self-administered 24-48 hours prior to admission. For all cohorts, following hospital admission, initial misoprostol doses were generally administered vaginally: 800 mcg in the 2014 cohort and 600 mcg in the earlier cohorts. Women received subsequent doses of misoprostol 400 mcg orally every 3-4 hours until fetal expulsion. Thereafter, uterine evacuation of placental tissue was performed as needed. With one exception, all women in all cohorts expelled the fetus. Median time-to-fetal expulsion was reduced to 8.0 hours from 14.5 hours (p<0.001 in the mifepristone compared to the 2010 misoprostol-only cohort (time of fetal expulsion was not recorded in 2008. Uterine evacuation of placental tissue using curettage or vacuum aspiration was more often performed (76% vs. 58%, p<0.001 for those receiving mifepristone; major complication rates were unchanged. Hospitalization duration and extreme pain levels were reduced (p<0
As a psychoanalyst the author takes exception to a paper by Menne and Moersch entitled: "Psychoanalytical Experiences from the Supervision of Pregnancy Counseling," concerning the counseling of abortion applicants under West German Law No. 218. He disagrees with much of the psychoanalytical interpretations of women's desire for children and desire for abortion. Where the authors reason too much from the psychoanalytical viewpoint in the counseling situation this author accuses them of overlooking sociocritical arguments which find more elbow-room in the Law allowing "internal conflict" and "social counseling" as reasons for abortion. He accuses them of adhering too much to the letter of the law and urges them to resolve their not-so-easy task by helping the applicant achieve her desire for abortion as skillfully and responsibly as possible within the letter of that law.
In the UK in 1988, 13.3% of abortions were performed at 13 weeks' gestation or later. Reasons for this delay, in addition to the diagnosis through amniocentesis of a fetal abnormality, include late recognition of pregnancy, a change of mind about completing the pregnancy, a failure of primary care physicians to entertain the diagnosis of pregnancy, travel or financial problems, and referral difficulties and scheduling delays. Women with little education and very young women are most likely to present for late abortions. From 13-16 weeks, dilatation and evacuation is the safest method of pregnancy termination. The procedure can be made easier through preparation of the cervix with a prostaglandin pessary or Foley catheter. After 16 weeks, an instillation method is recommended; prostaglandin administration can be intro- or extra-amniotic. Complication rates at 13-19 weeks are 14.5/1000 for vaginal methods of abortion and 7.2/1000 for prostaglandin methods. The risk of complications is 3 times higher for women who have 2nd-trimester abortions through the National Health Service. Although it is not realistic to expect that late abortions ever can be eliminated, improved sex education and contraceptive reliability as well as reforms in the National Health Service could reduce the number substantially. To reduce delay, it is suggested that the National Health Service set up satellite day care units and 1-2 central units in each region to deal quickly with midtrimester abortions. Delays would be further reduced by legislation to allow abortion on request in at least the 1st trimester of pregnancy.
Larusdottir, Aldis Run; Dederichs, Anne
The purpose of this study is to deliver new data and to bring attention to the subject of evacuation of children. Evacuation characteristics such as flow, densities and walking speeds are in focus. Currently literature on evacuation com-prehends mostly studies on adults. Ten Danish daycare centers...... participated in full scale evacuation experiments where the age groups 0-2 years and 3-6 years were analyzed separately. The work had the following overall finding. Flows through doors, walking speeds and densities are age-dependent and differ strongly from the data in existing literature. The results show...
Schultz, Jørgen Munthe; Jensen, Karsten Ingerslev
This paper describes the main characteristics of monolithic silica aerogel and its application in evacuated superinsulating aerogel glazing including the evacuation and assembling process. Furthermore, the energetic benefit of aerogel glazing is quantified. In evacuated aerogel glazing the space...... between the glass panes is filled with monolithic silica aerogel evacuated to a rough vacuum of approximately 1-10 hPa. The aerogel glazing does not depend on use of low emissive coatings that have the drawback of absorbing a relatively large part of the solar radiation that otherwise could reduce...
A trial of the Vabra aspirator, a sterile disposable suction curette, was carried out on 136 outpatients. The apparatus is designed to allow full curettage of the uterine cavity. Adequate specimens for diagnostic histology were obtained in' all but 10 cases. Of these, no specimen was obtained in 4 cases. The side-effects were ...
Ramos-Pascua, Luis R; Carro-Fernández, José A; Santos-Sánchez, José A; Casas Ramos, Paula; Díez-Romero, Luis J; Izquierdo-García, Francisco M
We presented three patients with trochanteric tuberculosis and described the clinical and imaging findings of the infection. Histology revealed a necrotizing granulomatous bursitis and microbiology confirmed tuberculosis. All cases were successfully treated with bursectomy and curettage of the trochanteric lesion and antituberculous chemotherapy including isoniazid, pyrazinamide, rifampicin, and ethambutol.
Full Text Available Twenty-eight-year-old female while undergoing a medical termination of pregnancy (MTP encounter complete urethral loss and massive bladder curettage. After resuscitation, she developed continuous urinary leakage followed by progressive decline in urine output. Case is highlighted here because of the massive vesico-urethral trauma because of MTP, leading to permanent urinary diversion.
Schreuder, HWB; Veth, RPH; Pruszczynski, M; Lemmens, JAM; Molenaar, WM; Schraffordt Koops, H.
We treated 26 patients with 27 aneurysmal bone cysts by curettage and cryotherapy and evaluated local tumour control. complications and functional outcome. The mean follow-up time was 37 months (19 to 154), There was local recurrence in one patient. Two patients developed deep wound infections and
Lemmers, Marilee; Verschoor, Marianne A. C.; Rengerink, Katrien Oude; Naaktgeboren, Christiana; Bossuyt, Patrick M.; Huirne, Judith A. F.; Janssen, Ineke A. H.; Radder, Celine; Klinkert, Ellen. R.; Langenveld, Josje; van der Voet, Lucet; Siemens, E. Frederike; Bongers, Marlies Y.; van Hooff, Marcel H.; van der Ploeg, Marinus; Sjors, F. P. J.; Coppus, S. F. P. J.; Ankum, W. M.; Mol, Ben Willem J.
Objective: To assess the effectiveness of curettage versus expectant management in women with an incomplete evacuation of the uterus after misoprostol treatment for first trimester miscarriage. Study design: We conducted a multicenter cohort study alongside a randomized clinical trial (RCT) between
Wijngaarden, S.J. van; Bronkhorst, A.W.; Boer, L.C.
Auditory evacuation beacons can be used to guide people to safe exits, even when vision is totally obscured by smoke. Conventional beacons make use of modulated noise signals. Controlled evacuation experiments show that such signals require explicit instructions and are often misunderstood. A new
Hoogendoorn, S.P.; Daamen, W.; Duives, D.C.; Van Wageningen-Kessels, F.L.M.
This paper deals with the optimal allocation of routes, destination, and departure times to members of a crowd, for instance in case of an evacuation or another hazardous situation in which the people need to leave the area as quickly as possible. The generic approach minimizes the evacuation times,
Larusdottir, Aldis Run
Saving human lives is the highest priority in case of fire, according to fire codes around the world. Codes state that everyone should be able to escape to safety in case of fire. In order to design buildings that enable this the available safe egress time (ASET) must be held up against...... is to provide new data and information on children’s evacuation, which is a step towards including children in evacuation models and calculations. Little is known about children’s evacuation characteristics in fire compared to other parts of the population. In recent years there has been more focus on children......, indicating that an alarm with audio signal is preferable to a light signal only or no alarm at all. Children’s evacuation cannot be described using adults’ evacuation models throughout. Young children are slower than adults and travel speed increases with age. At the age of 12 years children can be described...
Sato, Tomoko; Fujimori, Keiya; Sato, Akira; Ohto, Hitoshi
To investigate fetomaternal microchimerism in women with induced abortion or spontaneous pregnancy loss. Peripheral blood samples were obtained from 76 healthy women who underwent dilation and curettage in the first trimester but had never had an abortion or male delivery before. Samples were collected at three time points: just before, 7 days after, and 30 days after abortion. Y chromosome-specific, nested polymerase chain reaction targeting the sex-determining region of Y (SRY) was used to test DNA extracted from buffy coat cells. DNA was also extracted from the chorion to determine sex. The sensitivity of our assay allowed detection of approximately one male cell in 100,000 female cells. Thirty-six male and 40 female chorions were obtained. Male DNA was found in 52.8% of women who had a male chorion before abortion, decreasing to 5.6% at 7 days after abortion. At 30 days after abortion, no male DNA was detected. Male DNA was never detected at any point from women with a female chorion. Fetal cells in the maternal circulation are undetectable 30 days after induced abortion or spontaneous pregnancy loss. Fetal cells may be harbored in maternal organs.
Rehan, N; Inayatullah, A; Chaudhary, I
A study of the characteristics of Pakistani women seeking abortion and a profile of abortion clinics was conducted in 32 abortion clinics in three provincial capitals of the country. All 452 women who had their pregnancies terminated between October and December 1997 were interviewed. Except for 39 women (8.6%), all study subjects were married. A majority of the women (36.6%) were aged >35 years, 61.0% had given birth to > or =5 children, and 40.2% were illiterate. The predominant reasons for abortion were "too many children" (64.4%), contraceptive failure (20.3%), premarital affairs (8.6%), medical reasons (5.4%), and extramarital affairs (1.3%). Nearly two thirds of the abortions were induced by inadequately trained persons. Only 22% of the abortion clinics met the World Health Organization (WHO) standards required for safe termination of pregnancy. At all these clinics, the procedure used to terminate the pregnancy was dilatation and curettage (D&C). Only one clinic was using manual vacuum aspiration (MVA). Induced abortion seems to be fairly common among married women of high parity, advanced age, and low educational status. Keeping in view the large number of terminations, new medical and surgical techniques of pregnancy termination should be introduced to those already providing abortion services.
Lee, Eun Ju; Ryu, Hee Sug; Ji, Hoon; Suh, Jung Ho
Cervical abortion is a spontaneous abortion of an intrauterine pregnancy into the cervical canal where the abortus is retained by a closed external os, causing distension of the cervical canal. Cervical abortion should be distinguished from the cervical pregnancy. We present a case of cervical abortion diagnosed preoperatively by transvaginal sonography and color doppler imaging, and treated by dilatation and curettage. Charateristic transvaginal sonographic findings and identification of subtrophoblastic blood flow by color doppler imaging could allow differentiation of the cevical aborition from the cervical pregnancy
... its own before the 20th week of pregnancy. Surgical abortion uses surgery to end a pregnancy. ... happens, another dose of the medicine or a surgical abortion procedure may need to be done. Physical recovery ...
However, there is no previous study that has determined the prevalence and associ- ated risk factors of HM among patients with incomplete abortion evacuated at Bugando Medical Centre (BMC) and Sekou. Toure Regional Hospital (STRH). Methods: A total of 180 patients with incomplete abortion were enrolled between ...
Unsafe abortion remains a major reproductive health problem in Nigeria. These are 2 case reports of unsafe abortion, one performed by a patent medicine dealer where a false passage was created in the substance of the cervix to evacuate the uterus using a cannula. A piece of the cannula was left in situ for five years ...
Abortion is common. Data on abortion rates are inexact but can be used to explore trends. Globally, the estimated rate in the period 2010-2014 was 35 abortions per 1000 women (aged 15-44 years), five points less than the rate of 40 for the period 1990-1994. Abortion laws vary around the world but are generally more restrictive in developing countries. Restrictive laws do not necessarily deter women from seeking abortion but often lead to unsafe practice with significant mortality and morbidity. While a legal framework for abortion is a prerequisite for availability, many laws, which are not evidence based, restrict availability and delay access. Abortion should be available in the interests of public health and any legal framework should be as permissive as possible in order to promote access. In the absence of legal access, harm reduction strategies are needed to reduce abortion-related mortality and morbidity. Abortion can be performed surgically (in the first trimester, by manual or electric vacuum aspiration) or with medication: both are safe and effective. Cervical priming facilitates surgery and reduces the risk of incomplete abortion. Diagnosis of incomplete abortion should be made on clinical grounds, not by ultrasound. Septic abortion is a common cause of maternal death almost always following unsafe abortion and thus largely preventable. While routine follow-up after abortion is unnecessary, all women should be offered a contraceptive method immediately after the abortion. This, together with improved education and other interventions, may succeed in reducing unintended pregnancy. © The Author 2017. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please e-mail: email@example.com.
.... Actual emergency data to support ditching certification are not available; there have been questions as to whether evacuation flow rates onto land are appropriate for use in ditching-related flotation time computations...
Akaba, Godwin O; Adeka, Benard I; Ogolekwu, Pius I
Abortion in Nigeria is permitted only to save a woman's life. Most abortions in that country take place under unsafe conditions and constitute a major source of maternal morbidity and mortality. We present a case of multiple visceral injuries complicating an induced abortion. A 28-year-old multiparous woman at 12 weeks' gestation had an induced abortion by dilatation and curettage in a private clinic. The procedure was complicated by uterine perforation and bowel injury, with protrusion of gangrenous loops of bowel from the vagina. At laparotomy the uterus was repaired, and a bowel resection with re-anastomosis was performed. The patient's recovery was uneventful. Increasing the uptake of contraception, training healthcare providers in safe methods of induced abortion, and liberalising abortion laws can reduce abortion-related morbidity and mortality in Nigeria.
Ayman H. Shaamash
Full Text Available First trimester placenta accreta (PA is a rare event; there are few reported cases worldwide. Herein we report a case of abortion hysterectomy at 11 weeks’ gestation due to undiagnosed first trimester placenta accreta. Also, we reviewed medical literatures over the past 20 years for case reports of first trimester PA diagnosed after the occurrence of severe bleeding during abortive curettage or in the post abortive period.
Zhu, Qian-Xi; Gao, Er-Sheng; Chen, Ai-Min; Luo, Lin; Cheng, Yi-Min; Yuan, Wei
The aim of the study was to explore the effect of first-trimester mifepristone-induced abortion (MA) on placental complications in subsequent pregnancy. Two cohorts of nulliparous pregnant women were recruited in China during early pregnancy, one with a history of one MA and the other with no abortion (NA). Women were followed up until delivery. The incidence proportions of abruptio placenta, placenta previa, placenta accreta and retained placenta in the MA group (4673) and NA group (4690) were, respectively, 0.5 and 0.3, 0.8 and 0.9, 0.5 and 0.5, and 0.7 and 0.8% (all differences non-significant). After adjustment for center, age, education, occupation, residence, income, BMI and type of delivery, the incidence rates of placenta previa, accreta and retained placenta in the MA and NA groups showed no significant differences. The risk of abruptio placenta in women with a MA was nearly double that of women with no abortion, although this apparent increased risk was not statistically significant. Furthermore, this increased risk of abruptio placenta was found only in those with a gestational age >6 weeks at abortion (aOR: 2.46; 95% CI: 1.00-6.04), a curettage after abortion (aOR: 3.00; 95% CI: 1.25-7.20) or a longer inter-pregnancy interval (P-value for trend: 0.022). Mifepristone-induced abortion itself is not associated with placental complications in subsequent pregnancy, but other factors related to medical abortion-such as a gestational age >6 weeks at abortion, a curettage after abortion, and a longer interpregnancy interval-may increase the risk of abruptio placenta.
Costescu, Dustin; Guilbert, Edith; Bernardin, Jeanne; Black, Amanda; Dunn, Sheila; Fitzsimmons, Brian; Norman, Wendy V; Pymar, Helen; Soon, Judith; Trouton, Konia; Wagner, Marie-Soleil; Wiebe, Ellen; Gold, Karen; Murray, Marie-Ève; Winikoff, Beverly; Reeves, Matthew
This guideline reviews the evidence relating to the provision of first-trimester medical induced abortion, including patient eligibility, counselling, and consent; evidence-based regimens; and special considerations for clinicians providing medical abortion care. Gynaecologists, family physicians, registered nurses, midwives, residents, and other healthcare providers who currently or intend to provide pregnancy options counselling, medical abortion care, or family planning services. Women with an unintended first trimester pregnancy. Published literature was retrieved through searches of PubMed, MEDLINE, and Cochrane Library between July 2015 and November 2015 using appropriately controlled vocabulary (MeSH search terms: Induced Abortion, Medical Abortion, Mifepristone, Misoprostol, Methotrexate). Results were restricted to systematic reviews, randomized controlled trials, clinical trials, and observational studies published from June 1986 to November 2015 in English. Additionally, existing guidelines from other countries were consulted for review. A grey literature search was not required. The quality of evidence in this document was rated using the criteria described in the Report of the Canadian Task Force for Preventive Medicine rating scale (Table 1). Medical abortion is safe and effective. Complications from medical abortion are rare. Access and costs will be dependent on provincial and territorial funding for combination mifepristone/misoprostol and provider availability. Introduction Pre-procedure care Medical abortion regimens Providing medical abortion Post-abortion care Introduction Pre-procedure care Medical abortion regimens Providing medical abortion Post-abortion care. Copyright © 2016 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada. Published by Elsevier Inc. All rights reserved.
Full Text Available OBJETIVO: Determinar a frequência de mola hidatiforme em tecidos obtidos por curetagem uterina. MÉTODOS: Estudo transversal, prospectivo e descritivo que incluiu pacientes submetidas à curetagem uterina por diagnóstico de aborto ou mola hidatiforme cujo material obtido foi encaminhado para exame anatomopatológico. Foram excluídas aquelas que não aceitaram participar da pesquisa, recusando-se a assinar o Termo de Consentimento Informado Livre e Esclarecido. Foram analisadas as seguintes variáveis: achados anatomopatológicos, idade, raça/cor, número de gestações e abortos prévios, idade gestacional no momento do diagnóstico, níveis séricos quantitativos da fração beta da gonadotrofina coriônica humana e achados ultrassonográficos. As variáveis foram empregadas para a verificação com o diagnóstico histológico, considerado o padrão-ouro. Os dados foram armazenados e analisados no software Microsoft Excel® e no programa Epi-Info, versão 6.0 (STATCALC e os resultados apresentados como frequência (porcentagem ou média±desvio padrão. Para a associação entre variáveis qualitativas foi usado o teste do χ², e admitiu-se significância estatística quando pPURPOSE: To determine the frequency of hydatiform mole in tissues obtained by curettage. METHODS: A cross-sectional, prospective and descriptive conducted on patients who underwent curretage due to a diagnosis of abortion or hydatiform mole whose material was sent for pathological examination. We excluded women who did not accept to participate and refused to sign the free informed consent form. We studied the following variables: pathological findings, age, race, number of pregnancies and previous abortions, gestational age at diagnosis, quantitative serum beta fraction of human chorionic gonadotropin and ultrasound findings. The data were compared to the to histological diagnosis, considered to be the gold standard. Data were stored and analyzed in Microsoft Excel
Full Text Available Abstract Introduction Mycoplasma hominis is mostly known for causing urogenital infections. However, it has rarely been described as an agent of brain abscess. Case presentation We describe a case of M. hominis brain abscess in a 41-year-old Caucasian woman following uterus curettage. The diagnosis was obtained by 16S rDNA amplification, cloning and sequencing from the abscess pus, and confirmed by a specifically designed real-time polymerase chain reaction assay. Conclusions Findings from our patient's case suggest that M. hominis should be considered as a potential agent of brain abscess, especially following uterine manipulation.
Dalton, Vanessa K; Harris, Lisa H; Bell, Jason D; Schulkin, Jay; Steinauer, Jodi; Zochowski, Melissa; Fendrick, A Mark
The objective of the study was to examine the relationship between induced abortion training and views toward, and use of, office uterine evacuation and misoprostol in early pregnancy failure (EPF) care. We surveyed 308 obstetrician-gynecologists on their knowledge and attitudes toward treatment options for EPF and previous training in office-based uterine evacuation. Sixty-seven percent of respondents reported training in office uterine evacuation, and 20.3% reported induced abortion training. Induced abortion training was associated with strongly positive views toward both office-based uterine evacuation and misoprostol as treatment for EPF compared with those with office uterine evacuation training in other settings (odds ratio [OR], 2.64; P abortion training was associated with the use of office uterine evacuation for EPF treatment compared with those with office evacuation training in other settings (OR, 2.90; P = .004). Training experiences, especially induced abortion training, are associated with the use of office uterine evacuation for EPF. Copyright © 2011 Mosby, Inc. All rights reserved.
A historical review of the legislation of abortion in America leads to the paramount 1973 amendment by the Supreme Court to legalize abortion. The 16 year old decision is currently up for reconsideration. As compared to the consensus of other countries who have similar policies, in the United States, the issue of abortion is still highly controversial. The Reagan era reflected an attitude of "anti-choice" that was further propagated by Reagan appointees. However, only 1 in 10 Americans believes abortion is murder as many are pro-choice. It is also observed that women who work outside the home are more likely to favor the right to choose an abortion than women who stay home. Compared to England and Wales, contraceptive measures are more limited and expensive in the U.S., and consequently, the overall ratio of abortions to live births is higher in the United States. As well, contraception remains elusive to the American teenager, and as a result, 80% of the 1.1 million teenage pregnancies are unwanted and 450,000 terminate their pregnancies. The final Supreme Court decision is expected at the end of June, and few expect a reversal of the 1973 decision. A possible decision may turn the authority to dictate the legal status of abortions back to the state. If this would happen, as with the situation of contraception, teenagers would be the hardest hit group and might be forced to seek illegal abortions or cross state lines.
Christiansen, Connie; Schmidt, Garbi; Christoffersen, Mogens
Gennem en række interview om kvinders oplevelse og erfaringer med provokert abort, samt ved at bruge data fra en stor forløbsundersøgelse af kvinder født i 1966, giver forfatterne bag denne rapport et præcist signalement af de kvinder, der vælger at få foretaget en provokeret abort og de eventuelle...... for sundhedspersonale og andre socialarbejdere. Den statistiske undersøgelse viser, at hver fjerde danske kvinde vil komme i den situation at skulle have en abort. Især kvinder med vanskelige opvækstvilkår er i risikogruppen. Tilgengæld er der næsten ingen langvarige fysiske og psykiske virkninger abort af abort, med...
Evacuation operations are conducted under the authority of, and based on decisions by, local and state authorities. The purpose of this primer, Evacuating Populations with Special Needs, is to provide local and state emergency managers, government of...
20 High-Vacuum Oral Evacuation System (HIVAC) for Oral Surgery, Periodontics, and Endodontics Treatment Rooms..................... 20...box-section steel rails. Rubber isolator pads between this frame and the structure floor absorb vibration and prevent its magnification . The inlet...System (HIVAC) for Oral Surgery, Periodontics, and Endodontics Treatment Rooms The HIVAC system is designed to build and sustain high vacuum pressures
... solution − Emergency preparedness kit − Clothing and bedding − Car keys If local officials haven’t advised an immediate evacuation, take these steps to protect your home before you leave: − Turn off electricity at the main fuse or breaker and turn ...
Niels Dupont-Sagorin and Christoph Schaefer
Training personnel, including evacuation guides and shifters, checking procedures, improving collaboration with the CERN Fire Brigade: the first real-life evacuation drill at CMS took place on Friday 3 February from 12p.m. to 3p.m. in the two caverns located at Point 5 of the LHC. CERN personnel during the evacuation drill at CMS. Evacuation drills are required by law and have to be organized periodically in all areas of CERN, both above and below ground. The last drill at CMS, which took place in June 2007, revealed some desiderata, most notably the need for a public address system. With this equipment in place, it is now possible to broadcast audio messages from the CMS control room to the underground areas. The CMS Technical Coordination Team and the GLIMOS have focused particularly on preparing collaborators for emergency situations by providing training and organizing regular safety drills with the HSE Unit and the CERN Fire Brigade. This Friday, the practical traini...
Farra, Sharon; Miller, Elaine T; Gneuhs, Matthew; Timm, Nathan; Li, Gengxin; Simon, Ashley; Brady, Whittney
Hospitals conduct evacuation exercises to improve performance during emergency events. An essential aspect in this process is the creation of reliable and valid evaluation tools. The objective of this article is to describe the development and implications of a disaster evacuation performance tool that measures one portion of the very complex process of evacuation. Through the application of the Delphi technique and DeVellis's framework, disaster and neonatal experts provided input in developing this performance evaluation tool. Following development, content validity and reliability of this tool were assessed. Large pediatric hospital and medical center in the Midwest. The tool was pilot tested with an administrative, medical, and nursing leadership group and then implemented with a group of 68 healthcare workers during a disaster exercise of a neonatal intensive care unit (NICU). The tool has demonstrated high content validity with a scale validity index of 0.979 and inter-rater reliability G coefficient (0.984, 95% CI: 0.948-0.9952). The Delphi process based on the conceptual framework of DeVellis yielded a psychometrically sound evacuation performance evaluation tool for a NICU.
Li Suping; Wu Xiaohua; Li Hui
Objective: To investigate the changes of serum and chorion-villi contents of EGF in pregnant women undergone artificial abortion with drug (mifepristone) or surgery (curettage). Methods: Serum epidermal growth factor (EGF), E 2 , progesterone levels changes as well as chorion-villi EGF contents were measured with RIA in 36 pregnant women with drug abortion (before and after mifepristone 25mg bid x 3 days), 30 pregnant women undergone curettage (determined twice, 3 days apart) and 32 controls (serum only). Results: Serum EGF, E 2 , and progesterone contents in all pregnant women were significantly higher than those in controls (P<0.01). The chorion-villi contents of EGF in patients undergone drug abortion were significantly lower than those in patients undergone curettage (P<0.05). Both serum EGF and progesterone contents dropped after 3 days treatment with mifepristone (vs those in curettage group, P<0.05). Conclusion: Mifepristone might exert the effect of abortion through decrease of EGF levels, which was detrimental to fetus growth. (authors)
Prada, Elena; Maddow-Zimet, Isaac; Juarez, Fatima
Although Colombia partially liberalized its abortion law in 2006, many abortions continue to occur outside the law and result in complications. Assessing the costs to the health care system of safe, legal abortions and of treating complications of unsafe, illegal abortions has important policy implications. The Post-Abortion Care Costing Methodology was used to produce estimates of direct and indirect costs of postabortion care and direct costs of legal abortions in Colombia. Data on estimated costs were obtained through structured interviews with key informants at a randomly selected sample of facilities that provide abortion-related care, including 25 public and private secondary and tertiary facilities and five primary-level private facilities that provide specialized reproductive health services. The median direct cost of treating a woman with abortion complications ranged from $44 to $141 (in U.S. dollars), representing an annual direct cost to the health system of about $14 million per year. A legal abortion at a secondary or tertiary facility was costly (medians, $213 and $189, respectively), in part because of the use of dilation and curettage, as well as because of administrative barriers. At specialized facilities, where manual vacuum aspiration and medication abortion are used, the median cost of provision was much lower ($45). Provision of postabortion care and legal abortion services at higher-level facilities results in unnecessarily high health care costs. These costs can be reduced significantly by providing services in a timely fashion at primary-level facilities and by using safe, noninvasive and less costly abortion methods.
In this work, we present a formulation of an evacuation planning problem that is inspired by motion planning and describe an integrated behavioral agent-based and roadmap-based motion planning approach to solve it. Our formulation allows users to test the effect on evacuation of a number of different environmental factors. One of our main focuses is to provide a mechanism to investigate how the interaction between agents influences the resulting evacuation plans. Specifically, we explore how various types of control provided by a set of directing agents effects the overall evacuation planning strategies of the evacuating agents. ©2010 IEEE.
Khanna, G.; Sundaram, M.; El-Khoury, G.Y.; Merkel, K.
We describe two cases of focal fibrocartilaginous dysplasia, one treated conservatively while the other underwent curettage of the lesion. Resolution of tibia vara and healing of the focal fibrocartilaginous dysplasia was noted at 6 months in the patient who underwent curettage while the conservatively managed patient required 8 years of follow-up. Of the 17 cases of conservatively followed tibial focal fibrocartilaginous dysplasia described in the literature, 11 showed complete recovery after a median interval of 57 months. We believe that curettage may result in rapid healing by removing the persistent mesenchymal anlage which can interfere with the normal growth of the tibia. (orig.)
Full Text Available Maternal mortality due to abortion complications stands among the three leading causes of maternal death in Botswana where there is a restrictive abortion law. This study aimed at assessing the patterns and determinants of post-abortion complications.A retrospective institution based cross-sectional study was conducted at four hospitals from January to August 2014. Data were extracted from patients' records with regards to their socio-demographic variables, abortion complications and length of hospital stay. Descriptive statistics and bivariate analysis were employed.A total of 619 patients' records were reviewed with a mean (SD age of 27.12 (5.97 years. The majority of abortions (95.5% were reported to be spontaneous and 3.9% of the abortions were induced by the patient. Two thirds of the patients were admitted as their first visit to the hospitals and one third were referrals from other health facilities. Two thirds of the patients were admitted as a result of incomplete abortion followed by inevitable abortion (16.8%. Offensive vaginal discharge (17.9%, tender uterus (11.3%, septic shock (3.9% and pelvic peritonitis (2.4% were among the physical findings recorded on admission. Clinically detectable anaemia evidenced by pallor was found to be the leading major complication in 193 (31.2% of the cases followed by hypovolemic and septic shock 65 (10.5%. There were a total of 9 abortion related deaths with a case fatality rate of 1.5%. Self-induced abortion and delayed uterine evacuation of more than six hours were found to have significant association with post-abortion complications (p-values of 0.018 and 0.035 respectively.Abortion related complications and deaths are high in our setting where abortion is illegal. Mechanisms need to be devised in the health facilities to evacuate the uterus in good time whenever it is indicated and to be equipped to handle the fatal complications. There is an indication for clinical audit on post-abortion care
Mogensen, S T; Bak, Martin; Dueholm, M
The validity of cytobrush and endocervical curettage combined with colposcopically directed biopsies in the diagnosis of cervical dysplasia and malignancy has not been evaluated in randomized trials. We aimed to elucidate the diagnostic validity of the two methods....
Ai Zhigang; Gao Shufeng; Zhang Xuehui
Objective: To evaluate uterine arterial chemoembolization combined with curettage in treating cesarean scar pregnancy. Methods: Super-selective bilateral uterine arterial catheterization and angiography was performed in 64 patients with cesarean scar pregnancy (duration of amenorrhea 43-84 days), which was followed by arterial infusion of MTX and embolization with Gelfoam particles. Then curettage was carried out. The technical success rate and the therapeutic results were observed and analyzed. Results: Technical success in catheterization and in performing chemoembolization was achieved in all 64 patients. The pregnant tissues were successfully cleared away in 62 patients. The average blood loss during curettage procedure was 21.4 ml. For the remaining two patients lesion resection together with repair of lower segment was employed. No severe complications occurred after the treatment. Conclusion: Uterine arterial chemoembolization combined with curettage is a safe,minimally-invasive and effective treatment for cesarean scar pregnancy. It is worth popularizing this technique in clinical practice. (authors)
Moradan, Sanam; Ghorbani, Raheb; Lotfi, Azita
To examined the diagnostic value of dilatation and curettage (D and C) in patients with abnormal uterine bleeding (AUB) by conducting a histopathological examination of endometrial tissues by D and C and hysterectomy. Methods: In this retrospective study, the medical records of 163 women who had been hospitalized in the Obstetrics and Gynecology Ward, Amir-al-Momenin Hospital, Semnan, Iran between 2010 and 2015 for diagnostic curettage due to AUB and who had undergone hysterectomy were investigated. The patients' characteristics and histopathologic results of curettage and hysterectomy were extracted, and sensitivity and specificity and positive and negative predictive values of curettage were calculated. Results: The mean ± standard deviation age of the patients was 49.8±7.8 years. The sensitivity values of D and C in the diagnosis of endometrial pathologies was 49.1%, specificity 84.5%, positive 60.5%, and negative predictive 77.5%. The sensitivities of D and C in the diagnosis of various endometrial hyperplasia was 62.5%, disordered proliferative endometrium 36.8%, and endometrial cancer 83.3%. Of 6 patients with endometrial polyps on performing hysterectomy, no patient was diagnosed by curettage. Conclusions: Dilatation and curettage has acceptable sensitivity in the diagnosis of endometrial cancer, low sensitivity in the diagnosis of endometrial hyperplasia, and very low sensitivity in the diagnosis of disordered proliferative endometrium and endometrial polyps.
Sørensen, Janne Gress; Dederichs, Anne
How is the total evacuation time of a mixed population and its subgroups predicted by the evacuation tool STEPS? Simulation using STEPS is compared with experimental data and evaluated based on individual total egress times. It was found that the total egress times were similar for the simulation...... and experiment, but the human behavior occurring in the experiment was not reproduced in the simulations....
McCaughey, Jamie W.; Mundzir, Ibnu; Patt, Anthony; Rosemary, Rizanna; Safrina, Lely; Mahdi, Saiful; Daly, Patrick
Uncertainties in forecasting extreme events force an unavoidable tradeoff between false alarms and misses. The appropriate balance depends on the level of societal acceptance of unnecessary evacuations, but there has been little empirical research on this. Intuitively it may seem that an unnecessary evacuation would make people less likely to evacuate again in the future, but our study finds no support for this intuition. Using new quantitative (n=800) and qualitative evidence, we examine individual- and household-level evacuation decisions in response to the strong 11-Apr-2012 earthquake in Aceh, Indonesia. This earthquake did not produce a tsunami, but the population had previously experienced the devastating 2004 tsunami. In our sample, the vast majority of people (86%) evacuated in the 2012 earthquake, and nearly all (94%) say they would evacuate again if a similar earthquake happened in the future. Self-reported level of fear at the moment of the 2012 earthquake explains more of the variance in evacuation decisions and intentions than does a combination of perceived tsunami risk and perceived efficacy of evacuation modeled on protection motivation theory. These findings suggest that the appropriate balance between false alarms and misses may be highly context-specific. Investigating this in each context would make an important contribution to the effectiveness of early-warning systems.
performed to clarify which are the best antibiotic regimens for secondary prophylaxis of rheumatic fever. The findings of this study suggest that benzathine penicillin 1,8 MU. 4-weekly may protect against recurrences even though patients may not have therapeutic serum penicillin concentrations. Such studies should include ...
Abreu, Orlando; Alvear, Daniel
This book presents an overview of modeling definitions and concepts, theory on human behavior and human performance data, available tools and simulation approaches, model development, and application and validation methods. It considers the data and research efforts needed to develop and incorporate functions for the different parameters into comprehensive escape and evacuation simulations, with a number of examples illustrating different aspects and approaches. After an overview of basic modeling approaches, the book discusses benefits and challenges of current techniques. The representation of evacuees is a central issue, including human behavior and the proper implementation of representational tools. Key topics include the nature and importance of the different parameters involved in ASET and RSET and the interactions between them. A review of the current literature on verification and validation methods is provided, with a set of recommended verification tests and examples of validation tests. The book c...
The mean time between expulsion of fetus and uterine evacuation was 4.31 hours. Complications noted included uterine perforation, hemorrhage, cervical or vaginal lacerations, shock and even death. Conclusion: The determinants of the second trimester abortion cases at the University Teaching Hospital are social, ...
Remnant products of conception in the uterine cavity following a miscarriage or induced abortion presents a serious threat to a woman because it increases the risk of infection or continued bleeding and therefore uterine evacuation in such cases is imperative. Surgical and medical methods using drugs like misoprostol may ...
Background: Prevalence of hydatidiform mole is not clearly defined, partly because most studies have reported different prevalence rates from different regions. However, there is no previous study that has determined the prevalence and associated risk factors of HM among patients with incomplete abortion evacuated at ...
Behroozi-Lak, T; Derakhshan-Aydenloo, S; Broomand, F
Abortion, spontaneous or induced, is a common complication of pregnancy and exploration of available and safe regimens for medical abortion in developing countries seems crucial. The present study was aimed to assess the effect of letrozole in combination with misoprostol in women eligible for legal therapeutic abortion with gestational age ≤14weeks. This clinical randomized trial was conducted on 78 women who were candidate of medical abortion and eligible for legal abortion with gestational age ≤14 weeks that were randomly divided into two groups of case and controls. Case group received daily oral dose of 10mg letrozole for three days followed by vaginal misoprostol. In control group the patients received only vaginal misoprostol. The rate of complete abortion, induction-of-abortion time, and side-effects were assessed. Complete abortion was observed in 30 patients (76.9%) in case group and 9 (23.1%) cases were failed. In control group there was 16 (41.03%) complete abortions and 23 (58.97%) cases were failed to abort. Patients with gestational age of between 6 and 10 weeks did not show significant difference in both groups (P=0.134). Regarding pregnancy remnants there were significant differences between two groups (P=0.034). The time form admission to discharge in case groups were significantly shorter than those in control group (P=0.001). The indication for curettage in case group was significantly less than control group (P=0.001). A 3-day course of letrozole (10mg/daily) followed by misoprostol was associated with a higher complete abortion and lower curettage rates and reduction in time from admission to discharge in women with gestational age ≤14 weeks compared to misoprostol alone. Copyright © 2017 Elsevier Masson SAS. All rights reserved.
In evacuation models of buildings, neighborhoods, areas, cities and countries important psychological parameters are not frequently used. In this paper the relevance of some important variables from disaster psychology will be discussed. Modeling psychological variables will enhance prediction of
... What CDC is Doing Blog: Public Health Matters Chemical Agents: Facts About Evacuation Format: Select one PDF [ ... on Facebook Tweet Share Compartir Some kinds of chemical accidents or attacks, such as a train derailment ...
Mankowski, Jennifer L; Kingston, Jessica; Moran, Thomas; Nager, Charles W; Lukacz, Emily S
To estimate the efficacy of paracervical compared with intracervical administration of local anesthesia during first-trimester suction curettage. A double-blind, randomized controlled trial comparing paracervical with intracervical lidocaine was performed in women undergoing elective first-trimester suction curettage with conscious sedation. Pain was assessed at baseline, with dilation, and with curettage using a 10-cm visual analog scale (VAS). Assuming a minimal clinically important difference in pain score of 1.6 cm and a mean pain score (+/-standard deviation [SD]) of 4.7 (+/-2.9) cm for paracervical block, 120 patients would provide 80% power with an alpha of .05. For the 132 women randomly assigned, no significant differences in VAS scores (mean+/-SD) were observed between paracervical and intracervical blocks during dilation (2.6+/-2.3 compared with 2.8+/-2.2, P=.72) or curettage (3.9+/-2.9 compared with 3.3+/-2.5, P=.16). For women undergoing first-trimester suction curettage with conscious sedation, there was no clinically meaningful difference in pain relief between paracervical and intracervical lidocaine. Providers should feel confident that both techniques provide equally effective and acceptable analgesia.
Shemer, A; Trau, H; Davidovici, B; Grunwald, M H; Amichai, B
Onychomycosis is a common problem. Obtaining a positive laboratory test before treatment is important in clinical practice because the treatment of onychomycosis requires expensive oral antifungal therapy with potentially serious side-effects. The purpose of this study was to compare curettage and subungual drilling techniques of nail sampling in the diagnosis of onychomycosis. We evaluated 194 patients suffering from distal and lateral subungual onychomycosis and lateral subungual onychomycosis using curettage and subungual drilling sampling techniques. Nail samples were obtained in each case from proximal, medial and distal parts of the nail. KOH examination and fungal culture were used for detection and identification of fungal infection. With each technique, the culture sensitivity improved as the location of the sample was more proximal (drilling proximal vs. distal, chi(2) = 5.15, P = 0.023; curettage proximal vs. distal, chi(2) = 4.2, P = 0.041). In each sample location, the drilling technique has a better culture sensitivity (drilling vs. curettage proximal, chi(2) = 11.9, P = 0.001; drill vs. curettage distal, chi(2) = 13.7, P nails.
The rapidly growing world population and increasingly dense settlements demand ever-larger and more complex buildings from today's engineers. In comparison to this technological progress, a building's equipment for emergency evacuation has been hardly developed further. This work presents a concept for a building evacuation system based on mobile devices. Furthermore, various algorithms for route planning with mobile devices and for indoor localization of mobile devices are addressed.
Full Text Available Background. This contribution describes the history of the abortion pill, its introduction in the world and in our country. On the basis of the findings of the studies, carried out since the early ’80s, the authors provide the indications and contraindications for the application of the method.Conclusions. The most efficient method for termination of an early pregnancy with least adverse side effects is the combination of drugs, viz. 1 tablet of mifepristone (200 mg administered orally and 4 tablets (4 × 200 mcg of misoprostol applied vaginally.
Correia, Divanise Suruagy; Monteiro, Vera Grácia Neumann; Cavalcante, Jairo Calado; Maia, Eulália Maria Chaves
This study aimed to identify the knowledge about induced abortion complications and its relation to age. This is a cross-sectional study performed in schools of Maceió, state of Alagoas, Brazil, with students 12 to 19 years old. The sample was calculated considering post-abortion curettage data. The Epi Info computer program was used for data analysis. From 2,592 female adolescents studied 65.64% didn't know about any complications of induced abortion. The most mentioned complications were death and sterility. Clinical manifestations of abortion were wrongly mentioned by them as complications. Signification was found between the knowledge of the complications sterility, hemorrhage, and age. Death was significant fo rgirls under 15 and sterility for the older ones. The conclusion is that female adolescents don't have a correct knowledge of induced abortion complications, which shows the risk suffered by the ones that induce it. Thus, there is a need to further clarify the issue and for sexual education.
Nissen, Christoffer V; Wiegell, Stine Regin; Philipsen, Peter Alshede
pretreatment with curettage and two combination ointments containing calcipotriol/betamethasone and salicylic acid/betamethasone affect PpIX fluorescence after the application of methyl aminolevulinate MAL and 5-aminolevulinic acid (BF-200 ALA). METHODS: Four fields on the forearms of 30 healthy volunteers...... were pretreated with curettage or short-term application of calcipotriol/betamethasone or salicylic acid/betamethasone for 20 min. Two fields were not pretreated, thus serving as reference. After pretreatment, MAL or BF-200 ALA was applied for 24 h, and PpIX fluorescence was measured hourly from 1 to 5...... h and after 18, 21 and 24 h. RESULTS: Curettage significantly enhanced PpIX fluorescence for MAL from 1 to 21 h (P salicylic acid...
López Ortiz, E; Sandoval Sevilla, S; Arteaga, V M; Rosas Arceo, J; Ortíz Arroyo, R
268 cases of septic abortion which occurred between 1964-72 in a large metropolitan hospital in Mexico were analyzed retrospecively. There cases represented 0.88% of all cases of abortion during the same time. Most patients were between 21-30, and 48% with parity 2-5; 63% were at their first abortion; only 16 patients declared to have attempted abortion, and most cases were first trimester abortion. Pre- and postoperative procedures and vital signs were carefully taken, and time elapsed from medical treatment to surgery was 4-12 hours. There were 237 curettages, and 28 hysterectomies. Complication from surgery were 4.1%; there were 19 deaths, i.e. 7.5% of patients, of which 10 only 24 hours after hospitalization. Protocol of treatment of septic abortion is discussed, and surgical treatment highly recommended.
de Rezende, Rebeca Maffra; Luz, Flávio Barbosa
Suction curettage is a dermatologic surgery technique for the treatment of axillary hyperhidrosis, which is becoming more popular. Objective: The purpose of this study is to describe the current technique of removal of axillary sweat glands, and evaluate its efficacy and safety. Conclusion: Suction-curettage of sweat glands is a minimally invasive surgical technique that is easy to perform, safe, has high rates of success and relatively few side-effects. It is generally well tolerated by patients and requires shorter time away from daily activities, when compared with other surgical modalities. PMID:25387499
Berdzuli, Nino; Pestvenidze, Ekaterine; Lomia, Nino; Stray-Pedersen, Babill
In Georgia, which has a longstanding, liberalised abortion law, the abortion procedure is generally safe if it is performed in a medical facility. However, when socioeconomic barriers prevent women from seeking safe abortion services, some risk their life by self-terminating an unintended pregnancy. We present a case of maternal mortality after a self-induced medical abortion, with the aim to investigate the underlying non-clinical causes of maternal death and the relevant policy implications. A 34-year-old socially vulnerable woman self-administered 10 tablets of oral misoprostol to terminate an 18-week pregnancy. She expelled the fetus the following day. A week later, she developed excessive vaginal bleeding, difficulty in breathing and tachycardia. She was hospitalised and diagnosed with sepsis due to a retained placenta. Uterine curettage and aggressive conservative management, followed by total abdominal hysterectomy, failed to stop the fulminant septic process. The patient's condition deteriorated rapidly and she died 15 h after admission to hospital. Socially disadvantaged women in Georgia have limited access to safe abortion services, and some are impelled to self-induce abortion in order to terminate an unintended pregnancy. Inclusion of family planning and abortion services in the Universal Health Care benefits package for socially vulnerable families may reduce the morbidity and mortality associated with unsafe abortion practices.
Kumar, Anuradha; Hessini, Leila; Mitchell, Ellen M. H.
Abortion stigma is widely acknowledged in many countries, but poorly theorised. Although media accounts often evoke abortion stigma as a universal social fact, we suggest that the social production of abortion stigma is profoundly local. Abortion stigma is neither natural nor 'essential' and relies
Diedrich, Justin; Drey, Eleanor
For decades, the induction of fetal demise has been used before both surgical and medical second-trimester abortion. Intracardiac potassium chloride and intrafetal or intra-amniotic digoxin injections are the pharmacologic agents used most often to induce fetal demise. In the last several years, induction of fetal demise has become more common before second-trimester abortion. The only randomized, placebo-controlled trial of induced fetal demise before surgical abortion used a 1 mg injection of intra-amniotic digoxin before surgical abortion at 20-23 weeks' gestation and found no difference in procedure duration, difficulty, estimated blood loss, pain scores or complications between groups. Inducing demise before induction terminations at near viable gestational ages to avoid signs of life at delivery is practiced widely. The role of inducing demise before dilation and evacuation (D&E) remains unclear, except for legal considerations in the United States when an intact delivery is intended. There is a discrepancy between the one published randomized trial that used 1 mg intra-amniotic digoxin that showed no improvement in D&E outcomes and observational studies using different routes, doses and pre-abortion intervals that have made claims for its use. Additional randomized trials might provide clearer evidence upon which to make further recommendations about any role of inducing demise before surgical abortion. At the current time, the Society of Family Planning recommends that pharmacokinetic studies followed by randomized controlled trials be conducted to assess the safety and efficacy of feticidal agents to improve abortion safety.
Hare, C.; Halligan, S.; Bartram, C.I.; Gupta, R.; Walker, A.E.; Renfrew, I.
The goal of this study was to reduce the patient radiation dose from evacuation proctography. Ninety-eight consecutive adult patients referred for proctography to investigate difficult rectal evacuation were studied using a digital imaging system with either a standard digital program for barium examinations, a reduced dose digital program (both with and without additional copper filtration), or Video fluoroscopy. Dose-area products were recorded for each examination and the groups were compared. All four protocols produced technically acceptable examinations. The low-dose program with copper filtration (median dose 382 cGy cm 2 ) and Video fluoroscopy (median dose 705 cGy cm 2 ) were associated with significantly less dose than other groups (p < 0.0001). Patient dose during evacuation proctography can be reduced significantly without compromising the diagnostic quality of the examination. A digital program with added copper filtration conveyed the lowest dose. (orig.)
Binner, Jane; Branicki, Layla; Galla, Tobias; Jones, Nick; King, James; Kolokitha, Magdalini; Smyrnakis, Michalis
Evacuating a city is a complex problem that involves issues of governance, preparedness education, warning, information sharing, population dynamics, resilience and recovery. As natural and anthropogenic threats to cities grow, it is an increasingly pressing problem for policy makers and practitioners. The book is the result of a unique interdisciplinary collaboration between researchers in the physical and social sciences to consider how an interdisciplinary approach can help plan for large scale evacuations. It draws on perspectives from physics, mathematics, organisation theory, economics, sociology and education. Importantly it goes beyond disciplinary boundaries and considers how interdisciplinary methods are necessary to approach a complex problem involving human actors and increasingly complex communications and transportation infrastructures. Using real world case studies and modelling the book considers new approaches to evacuation dynamics. It addresses questions of complexity, not only ...
Wullen, B; Mühlhöfer, A; Luz, H; Zoller, W G
A 30-year-old woman was referred to our clinic because she had developed recurrent spontaneous hematomas of both calves within the last 2 months. 6 months earlier the patient had developed an ovarian hyperstimulation syndrome after ovarian stimulation treatment and intrauterine insemination. Shortly afterwards a missed abortion (8 (th) week) had been diagnosed. A curettage was carried out. Routine coagulation tests confirmed a prolongation of aPTT to 90 s and a lupus anticoagulant. A high-titre factor VIII inhibitor (56 Bethesda units) was identified. Given these facts an acquired post-partum hemophilia was diagnosed. The patient was treated with prednisolone and immunoglobulins. The aPTT shortened to normal values. The factor VIII inhibitor and lupus anticoagulant disappeared. There were no further hematomas. The simultaneous occurrence of antibodies in an altered immune state such as pregnancy is well known. In our case, acquired factor VIII inhibitor was found after an early abortion. Treatment with steroids and immunoglobulines led to the disappearance of factor VIII inhibitor and lupus anticoagulant.
Turnbull, Robert J.; Foster, Christopher A.; Hendricks, Charles D.
A method is provided for producing solid, evacuated microspheres comprised of hydrogen. The spheres are produced by forming a jet of liquid hydrogen and exciting mechanical waves on the jet of appropriate frequency so that the jet breaks up into drops with a bubble formed in each drop by cavitation. The drops are exposed to a pressure less than the vapor pressure of the liquid hydrogen so that the bubble which is formed within each drop expands. The drops which contain bubbles are exposed to an environment having a pressure just below the triple point of liquid hydrogen and they thereby freeze giving solid, evacuated spheres of hydrogen.
Transient bacteremia is induced by adenoidectomy when the integrity of the nasopharyngeal membrane is broken. The aim of this study was to determine the incidence of bacteremia in patients undergoing adenoidectomy, to identify the causative organisms, and to compare the incidences of bacteremia between the two techniques suction diathermy and curettage.
Full Text Available Patella is a relative uncommon site for chondroblastoma. Most of cases of chondroblastoma in patella reported in literature are treated with patellectomy. We treated a large chondroblastic lesion in patella of an 18- year-old male with curettage, burring & bone graft and the result was satisfactory after 3 years post operation.
Trommel, N.E. van; Massuger, L.F.A.G.; Verheijen, R.; Sweep, C.G.J.; Thomas, C.M.G.
OBJECTIVE: To assess the curative effect of a second curettage in patients with low-risk Persistent Trophoblastic Disease (PTD) after molar pregnancy. METHODS: A retrospective cohort survey was performed on 2122 patients registered with the Dutch Central Registry for Hydatidiform Moles between 1987
Axillary hyperhidrosis is a common and most distressing problem, which can be addressed by a variety of treatment modalities. To assess the value of tumescent suction curettage in the treatment of axillary hyperhidrosis. 63 patients (39 female, 25 male; mean age 30.3 +/- 7.6 years) with axillary hyperhidrosis were enrolled in the study. All patients were treated in an outpatient setting with tumescent suction curettage of the axillary cavity, using two entry sites. The results were evaluated with the iodine-starch test after 4 weeks and after 6 months. Two years after the procedure, patient satisfaction was evaluated as 'satisfied', 'partially satisfied' or 'dissatisfied'. None of the patients had early postoperative complications of infection or seroma. All patients had a marked reduction of hyperhidrosis after 4 weeks, confirmed by the iodine-starch test. After 6 months, 15 patients had high sweat rates and asked for repeat surgery. Two years after the procedure, 49 patients were satisfied, 11 patients were partially satisfied and 3 patients were dissatisfied. Tumescent suction curettage is a safe and effective treatment of axillary hyperhidrosis resulting in a high level of patient satisfaction. Some patients will need repeat surgery. Suction curettage, however, should not be used as the first line of treatment in axillary hyperhidrosis.
van der Marel, Jacolien; Rodriguez, Agata; del Pino, Marta; van Baars, Romy; Jenkins, David; van de Sandt, Miekel M.; Torne, Aureli; Ordi, Jaume; ter Harmsel, Bram; Verheijen, Rene H. M.; Schiffman, Mark; Gage, Julia C.; Quint, Wim G. V.; Wentzensen, Nicolas
Objective Performing endocervical curettage (ECC) at colposcopy may increase the yield of cervical intraepithelial neoplasia grade 2 (CIN2) or worse (CIN2+) compared to biopsies alone. The additional benefit of ECC in detecting CIN2+ was studied in women with lesion-targeted biopsies (low-grade or
Full Text Available A case of cervical ectopic pregnancy in a 37 years old woman with history of two previous cesarean sections and one dilatation/curettage. The case was the advanced cervical pregnancy reported in Iran, which diagnosed in 12 week of gestation by MRI and finally treated by hysterectomy.
Full Text Available Background and Aims: In spite abortion has been legalized in India over three decades, unsafe abortion continues to be a significant contributor of maternal mortality and morbidity. The aim of the present study is to assess the magnitude of septic abortion in a tertiary care hospital over a period of three years with a special emphasis on maternal mortality and morbidity and various surgical complications. Settings and Design: Retrospective study of patients who were admitted with unsafe abortions over a three year period from 2005 to 2008 in a tertiary teaching Hospital of Rural India. Materials and Methods: Hospital records of the patients who were admitted with unsafe abortion in three years (2005-2008 were reviewed to evaluate the demographic and clinical profile in relation to age, parity, marital status, indication of abortion , the methods of abortion ,qualification of abortion provider complications and maternal mortality. Results: Unsafe abortion constitutes 11.6% ( n=132 of total abortion cases admitted over 3 years. Majority of women (70.45% were in their thirties, married (89%.Sixty percent wanted abortion for birth spacing. Abortion methods included various primitive methods (30% but majority by dilatation and evacuation. About 60% of abortionists were unqualified. Majority of women admitted with serious complications like peritonitis (70%, visceral injuries (60%, hemorrhagic and septic shock, renal failure (17.4%, and life threatening conditions like DIC, hepatic failure and encephalopathy. A total of 231 women died of unsafe abortion making it 12.55% of total maternal mortality in our institution. Out of 73 women requiring laparotomy, 22% were done within 24 hours of admission and majority (49% were performed beyond 24-48 hours. Interestingly no women died when early aggressive surgery was done. Conclusion: The present study confirms that unsafe abortion is a great neglected health care problem leading to a considerable loss of
Perez Duarte, A E
Analysis of abortion in Mexico from a juridical perspective requires recognition that Mexico as a national community participates in a double system of values. Politically it is defined as a liberal, democratic, and secular state, but culturally the Judeo-Christian ideology is dominant in all social strata. This duality complicates all juridical-penal decisions regarding abortion. Public opinion on abortion is influenced on the 1 hand by extremely conservative groups who condemn abortion as homicide, and on the other hand by groups who demand legislative reform in congruence with characteristics that define the state: an attitude of tolerance toward the different ideological-moral positions that coexist in the country. The discussion concerns the rights of women to voluntary maternity, protection of health, and to making their own decisions regarding their bodies vs. the rights of the fetus to life. The type of analysis is not objective, and conclusions depend on the ideology of the analyst. Other elements must be examined for an objective consideration of the social problem of abortion. For example, aspects related to maternal morbidity and mortality and the demographic, economic, and physical and mental health of the population would all seem to support the democratic juridical doctrine that sees the clandestine nature of abortion as the principal problem. It is also observed that the illegality of abortion does not guarantee its elimination. Desperate women will seek abortion under any circumstances. The illegality of abortion also impedes health and educational policies that would lower abortion mortality. There are various problems from a strictly juridical perspective. A correct definition of the term abortion is needed that would coincide with the medical definition. The discussion must be clearly centered on the protected juridical right and the definition of reproductive and health rights and rights to their own bodies of women. The experiences of other
NSGIC Local Govt | GIS Inventory — A label feature class of Miami-Dade County Hurricane Evacuation Shelters (HEC) including Special Need Evacuation Centers (SNEC) and Medical Management Facilities...
A spate of recent hurricanes and other natural disasters have drawn a lot of attention to the evacuation decision of individuals. Here we focus on evacuation models that incorporate two economic phenomena that seem to be increasingly important in exp...
rescheduling of aeromedical evacuation. Artificial Intelligence Magazine 20, no. 1: 43-53. Leineweber, Albert J., Fort Campbell Range Operations... cardiovascular , respiratory, and central nervous system functions. Lower scores indicated increased rates for mortality. ISS calculated the three...clinics or ambulatory care centers Role 1 Medical Care. Provides immediate lifesaving measures, disease and non-battle injury prevention and care
Nero C Wabo; P Örtenwall; A Khorram-Manesh
Objective: Malfunction in hospitals' complex internal systems, or extern threats, may result in a hospital evacuation. Factors contributing to such evacuation must be identified, analyzed and action plans should be prepared. Our aims in this study were 1) to evaluate the use of risk and vulnerability analysis as a basis for hospital evacuation plan, 2) to identify risks/hazards triggering an evacuation and evaluate the respond needed and 3) to propose a template with main key points for plann...
Chen, Melissa J; York, Sloane; Hammond, Cassing; Gawron, Lori
Uterine perforation is an infrequent but serious complication of dilation and evacuation (O&E). The purpose of this case report is to describe management strategies once a uterine perforation is identified. A 15-year-old female at 15 weeks' gestation presented to a freestanding clinic for elective abortion. After serial cervical dilation, omentum was seen in the suction curette. The patient was transferred to a nearby hospital, she underwent an exploratory laparotomy. A 1.5-cm anterior uterine perforation was found. The uterus was evacuated under direct visualization prior to repair of the defect. Uterine perforation during D&E often requires laparotomy to repair the defect and to evaluate for injury to adjacent organs. Evacuation can be completed transcervically under direct visualization or through the perforation site.
Divanise S. Correia
Full Text Available The purpose of this study was to analyze risk factors for abortion among female teenagers from 12 to 19 years of age in the city of Maceió, Brazil. This is a cross-sectional study, conducted in ten schools. The sample was calculated by considering the number of admissions for postabortion curettage, obtained from the Information System of Hospitalization. Data were obtained through a semi-structured questionnaire divided into three basic blocks of data: sociodemographic, sexual life, and pregnancy/abortion. To analyze the data, the logistic regression model was used. The Forward Method was chosen to set the final model that minimizes the number of variables and maximizes the accuracy of the model. The significant analysis between the dichotomous variables provided eight significant variables. Two of them are protective for abortion: the ages 12-14 years and talking with parents about sex. After the logistic regression, the receipt of support for abortion was the most significant variable of all. The adolescent with an active sexual life, a previous pregnancy, who is married, and has received support for an abortion has a 99.74% probability for an abortion. The results of this study, demonstrating the importance of the group in adolescence, and the statistical significance of having a partner to support and approve the pregnancy appears as a preventive factor for abortion. It shows the importance of support and companionship for adolescent women.
Okonofua, Friday E; Hammed, Afolabi; Abass, Tajudeen; Mairiga, Abdulkarim Garba; Mohammed, Abubakar Bako; Adewale, Adeniyi; Garba, Danjuma
To investigate the knowledge and practices regarding medical abortion and postabortion care in northern Nigeria among private physicians--the principal providers of such services in the area--122 doctors operating separate clinics in five states--Bauchi, Borno, Kaduna, Niger, and Taraba--were interviewed by means of a structured questionnaire. The results showed that 22 percent of the doctors reported that they terminate unwanted pregnancies, whereas nearly all reported that they manage complications of unsafe abortion. Manual vacuum aspiration and dilatation and curettage performed singly or in combination were the most common methods of abortion and postabortion care reported by the doctors. Only one doctor reported exclusive use of medical abortion in the first trimester, and three reported its exclusive use in the second trimester. Only 35 percent of the doctors listed misoprostol as a drug that they knew could be used for abortion and postabortion care, and only 12 percent listed mifepristone. By contrast, 49 percent listed inappropriate or dangerous drugs for use in abortion provision in the first and second trimesters of pregnancy. We conclude that private practitioners in northern Nigeria have limited knowledge of medical abortion and postabortion care, and that a capacity-building program on the subject should be instituted for them.
Uso da aspiração manual a vácuo na redução do custo e duração de internamentos por aborto incompleto em Fortaleza, CE, Brasil Adoption of manual vacuum aspiration for treatment of incomplete abortion reduces costs and duration of patient's hospital stay in an urban area of Northeastern Brazil
Full Text Available INTRODUÇÃO: O uso de aspiração a vácuo (AV no tratamento do aborto incompleto é prática bastante difundida em países desenvolvidos. Vários estudos nesses países indicam que o uso da técnica de aspiração manual a vácuo (AMV pode conservar recursos do sistema de saúde e melhorar a qualidade do tratamento do aborto. No Brasil, o uso da AMV é procedimento de rotina nos hospitais e clínicas privados. Entretanto, na maioria dos hospitais da rede pública é utilizada somente a técnica de dilatação e curetagem (D&C. METODOLOGIA: Foram utilizados métodos de avaliação rápida para estimar a variação do custo médio do tratamento e duração da estadia hospitalar, em um grupo de 30 pacientes admitidas com aborto incompleto em hospital público de Fortaleza, CE (Brasil. Participantes foram alocadas, randomicamente, em um dos dois grupos de tratamento investigados (AMV ou D&C. RESULTADOS E CONCLUSÕES: Os resultados sugerem que o uso da AMV, em substituição a D&C, no tratamento do aborto incompleto, pode reduzir em até 41% o custo médio do tratamento e em 77% o tempo médio de hospitalização. Recomenda-se a realização de estudos confirmatórios, como também que se aprofunde os conhecimentos sobre a percepção do aborto e seu tratamento por parte do pessoal de saúde e da população feminina.INTRODUCTION: In most developed countries vacuum aspiration has been shown to be safer and less costly than sharp curettage (SC for uterine evacuation. In many of the developing countries, including Brazil, sharp curettage (SC is the most commonly used technique for treating cases of incomplete abortion admitted to hospital. The procedure often involves light to heavy sedation for pain control and an overnight hospital stay for patient recuperation and monitoring. Two hypotheses are examined: the first, that the use of manual vacuum aspiration (MVA - a variation of the vacuum aspiration, would be less costly than SC for the treatment
Ziraba, Abdhalah Kasiira; Izugbara, Chimaraoke; Levandowski, Brooke A; Gebreselassie, Hailemichael; Mutua, Michael; Mohamed, Shukri F; Egesa, Caroline; Kimani-Murage, Elizabeth W
Complications due to unsafe abortion cause high maternal morbidity and mortality, especially in developing countries. This study describes post-abortion complication severity and associated factors in Kenya. A nationally representative sample of 326 health facilities was included in the survey. All regional and national referral hospitals and a random sample of lower level facilities were selected. Data were collected from 2,625 women presenting with abortion complications. A complication severity indicator was developed as the main outcome variable for this paper and described by women's socio-demographic characteristics and other variables. Ordered logistic regression models were used for multivariable analyses. Over three quarters of abortions clients presented with moderate or severe complications. About 65% of abortion complications were managed by manual or electronic vacuum aspiration, 8% by dilation and curettage, 8% misoprostol and 19% by forceps and fingers. The odds of having moderate or severe complications for mistimed pregnancies were 43% higher than for wanted pregnancies (OR, 1.43; CI 1.01-2.03). For those who never wanted any more children the odds for having a severe complication was 2 times (CI 1.36-3.01) higher compared to those who wanted the pregnancy then. Women who reported inducing the abortion had 2.4 times higher odds of having a severe complication compared to those who reported that it was spontaneous (OR, 2.39; CI 1.72-3.34). Women who had a delay of more than 6 hours to get to a health facility had at least 2 times higher odds of having a moderate/severe complication compared to those who sought care within 6 hours from onset of complications. A delay of 7-48 hours was associated with OR, 2.12 (CI 1.42-3.17); a delay of 3-7 days OR, 2.01 (CI 1.34-2.99) and a delay of more than 7 days, OR 2.35 (CI 1.45-3.79). Moderate and severe post-abortion complications are common in Kenya and a sizeable proportion of these are not properly managed
Mellerup, Natja; Sørensen, Bjarke Lund; Kuriigamba, Gideon K.
hospital in Uganda. METHODS: A partially completed criterion-based audit was conducted comparing actual to optimal care. The audit criteria cover initial clinical assessment of vital signs and management of common severe complications such as sepsis and haemorrhage. Sepsis shall be managed by immediate......BACKGROUND: Complications of unsafe abortion are a major contributor to maternal deaths in developing countries. This study aimed to evaluate the clinical assessment for life-threatening complications and the following management in women admitted with complications from abortions at a rural...... evacuation of the uterus and antibiotics in relation to and after surgical management. Shock by aggressive rehydration followed by evacuation. In total 238 women admitted between January 2007 and April 2012 were included. Complications were categorized as incomplete, threatened, inevitable, missed or septic...
... Simplified (Mandarin dialect)) PDF Reproductive Health Access Project Emergency Contraceptive Pill and the Abortion Pill: What's the Difference? - English PDF Emergency Contraceptive Pill and the Abortion Pill: What's the Difference? - ...
Kumar, Anuradha; Hessini, Leila; Mitchell, Ellen M H
Abortion stigma is widely acknowledged in many countries, but poorly theorised. Although media accounts often evoke abortion stigma as a universal social fact, we suggest that the social production of abortion stigma is profoundly local. Abortion stigma is neither natural nor 'essential' and relies upon power disparities and inequalities for its formation. In this paper, we identify social and political processes that favour the emergence, perpetuation and normalisation of abortion stigma. We hypothesise that abortion transgresses three cherished 'feminine' ideals: perpetual fecundity; the inevitability of motherhood; and instinctive nurturing. We offer examples of how abortion stigma is generated through popular and medical discourses, government and political structures, institutions, communities and via personal interactions. Finally, we propose a research agenda to reveal, measure and map the diverse manifestations of abortion stigma and its impact on women's health.
Yuzal, Hendri; Kim, Karl; Pant, Pradip; Yamashita, Eric
Indonesia, a country of more than 17,000 islands, is exposed to many hazards. A magnitude 9.1 earthquake struck off the coast of Sumatra, Indonesia, on December 26, 2004. It triggered a series of tsunami waves that spread across the Indian Ocean causing damage in 11 countries. Banda Aceh, the capital city of Aceh Province, was among the most damaged. More than 31,000 people were killed. At the time, there were no early warning systems nor evacuation buildings that could provide safe refuge for residents. Since then, four tsunami evacuation buildings (TEBs) have been constructed in the Meuraxa subdistrict of Banda Aceh. Based on analysis of evacuation routes and travel times, the capacity of existing TEBs is examined. Existing TEBs would not be able to shelter all of the at-risk population. In this study, additional buildings and locations for TEBs are proposed and residents are assigned to the closest TEBs. While TEBs may be part of a larger system of tsunami mitigation efforts, other strategies and approaches need to be considered. In addition to TEBs, robust detection, warning and alert systems, land use planning, training, exercises, and other preparedness strategies are essential to tsunami risk reduction.
Mentula, M; Männistö, J; Gissler, M; Heikinheimo, O; Niinimäki, M
Intrauterine adhesions (IUA) are a problematic complication after abortion, but their incidence is unknown. Our objective was to assess the incidence of IUA following induced abortion and the risk factors for IUA. Retrospective cohort study. A nationwide registry study. All women undergoing induced abortion (n = 80 015) in Finland between 2000 and 2008. The data were retrieved from the Finnish Abortion Registry and the Hospital Discharge Registry. The diagnosis of IUA or complications was based on the diagnostic codes (ICD-10) and operative codes according to the NOMESCO Classification of Surgical Procedures (NCSP). IUA were defined as ICD-10 code N85.6 or operative code LCG02. A sub-analysis of IUA cases and five matched controls was performed. The incidence of and risk factors for IUA. A total of 12 (1.5 per 10 000) IUA diagnoses were identified from 79 960 eligible induced abortions. The rate of IUA was 1.5 and 2.0 cases per 10 000 abortions following medically and surgically induced abortion, respectively (P = 0.19). In a subgroup analysis of IUA cases and five matched controls, surgical treatment of the remaining products of conception following abortion significantly increased the risk of IUA [odds ratio 5.50 (95% CI 1.46-20.79; P = 0.012)]. IUA that require further treatment are rare after induced abortion. Surgical evacuation following medical or surgical abortion was a risk factor for diagnosis of IUA. These results suggest that trauma to a recently pregnant uterus is an important risk factor for IUA. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
Cheng, Yuan; Zheng, Xiaoping
This study aims to get insight into the question whether cooperative behaviors can promote the evacuation efficiency during an evacuation process. In this work, cooperative behaviors and evacuation efficiency have been examined in detail by using a cellular automata model with behavioral extension. The simulation results show that moderate cooperative behaviors can result in the highest evacuation efficiency. It is found that in a mixture of cooperative and competitive individuals, more cooperative people will lead to relatively high evacuation efficiency, and the larger subgroup will play a leading role. This work can also provide some new insights for the study of cooperative behaviors and evacuation efficiency which can be a scientific decision-making basis for emergency response involving large-scale crowd evacuation in emergencies.
Adler, Nancy E.; Ozer, Emily J.; Tschann, Jeanne
Reviews the current status of abortion laws pertaining to adolescents worldwide, examining questions raised by parental consent laws in the United States and by the relevant psychological research (risk of harm from abortion, informed consent, consequences of parental involvement in the abortion decision, and current debate). Discusses issues…
Gattermann, Peter; Knoflacher, Hermann; Schreckenberg, Michael
Due to an increasing number of reported catastrophes all over the world, the safety especially of pedestrians today, is a dramatically growing field of interest, both for practitioners as well as scientists from various disciplines. The questions arising mainly address the dynamics of evacuating people and possible optimisations of the process by changing the architecture and /or the procedure. This concerns not only the case of ships, stadiums or buildings, all with restricted geometries, but also the evacuation of complete geographical regions due to natural disasters. Furthermore, also ‘simple’ crowd motion in ‘relaxed’ situations poses new questions with respect to higher comfort and efficiency since the number of involved persons at large events is as high as never before. In addition, as a new research topic in this field, collective animal behaviour is attracting increasing attention. All this was in the scope of the conference held in Vienna, September 28–30, 2005, the third one in a series ...
Mo, Xiaoliang; Qin, Guirong; Zhou, Zhoulin; Jiang, Xiaoli
To explore the risk factors for intrauterine adhesions in patients with artificial abortion and clinical efficacy of hysteroscopic dissection. 1500 patients undergoing artificial abortion between January 2014 and June 2015 were enrolled into this study. The patients were divided into two groups with or without intrauterine adhesions. Univariate and Multiple logistic regression were conducted to assess the effects of multiple factors on the development of intrauterine adhesions following induced abortion. The incidence rate for intrauterine adhesions following induced abortion is 17.0%. Univariate showed that preoperative inflammation, multiple pregnancies and suction evacuation time are the influence risk factors of intrauterine adhesions. Multiple logistic regression demonstrates that multiple pregnancies, high intrauterine negative pressure, and long suction evacuation time are independent risk factors for the development of intrauterine adhesions following induced abortion. Additionally, intrauterine adhesions were observed in 105 mild, 80 moderate, and 70 severe cases. The cure rates for these three categories of intrauterine adhesions by hysteroscopic surgery were 100.0%, 93.8%, and 85.7%, respectively. Multiple pregnancies, high negative pressure suction evacuation and long suction evacuation time are independent risk factors for the development of intrauterine adhesions following induced abortions. Hysteroscopic surgery substantially improves the clinical outcomes of intrauterine adhesions.
Seyit Ali Gumustas
Conclusion: This is the first report of osteoblastoma on the distal phalanx. The possibility of osteoblastoma should be considered in cases of pain and swelling of phalanx, and if diagnosed, curettage and polymethylmethacrylate filling may be the treatment of choice.
Every year fire evacuation exercises are organized through out CERN and our facility's Kindergarten is no exception. Just a few weeks ago, a fire simulation was carried out in the Kindergarten kitchen facility using synthetic smoke. The purpose of the exercise was to teach staff to react in a disciplined and professional manner when in the presence of danger. The simulation is always carried out at a random time so as to ensure that people in the area under the test are not aware of the exercise. For the Kindergarten the exercise was held early in the school year so as to train those who are new to the establishment. The evacuation was a complete success and all went as it was supposed to. When the children and teachers smelt smoke they followed the prescribed evacuation routes and left the building immediately. Once outside the situation was revealed as an exercise and everyone went back to business as usual, everyone that is, except the fire brigade and fire inspector. The fire brigade checked t...
Full Text Available Shan-rong Shu, Xin Luo, Zhi-xin Wang, Yu-hong Yao Department of Obstetrics and Gynecology, The First Affiliated Hospital of JiNan University, HuangPu Road West, Guangzhou, People’s Republic of China Abstract: Pregnancy in a cesarean scar is the rarest form of an ectopic pregnancy. The treatment for cesarean scar pregnancy mainly includes systemic methotrexate and uterine artery embolization. Here, we reported a case of cesarean scar pregnancy treated by curettage and aspiration guided by laparoscopy. The treatment plan included two phases. Three days after a combination of methotrexate and mifepristone was administered, the gestational sac was removed under laparoscopy, which enabled a successful treatment for the unruptured ectopic pregnancy in a previous cesarean scar and made it possible to preserve the reproductive capability of the patient. Keywords: cesarean scar pregnancy, laparoscopy, curettage and aspiration
Ishikawa, Hiroshi; Unno, Youichi; Omoto, Akiko; Shozu, Makio
To report the results of local injection of diluted vasopressin followed by suction curettage as a conservative treatment for women with cervical ectopic pregnancy, who wish to preserve their future fertility. This was a retrospective chart review in a university hospital and a municipal hospital. We injected diluted vasopressin (Pitressin R, total amount of 4-10 units) transvaginally into the cervix surrounding the gestational sac, but not directly into the gestational sac, and/or the lower segment of the uterine body under transvaginal ultrasonographic guidance. After cessation of fetal heartbeats, we aspirated the conceptus by performing suction curettage. We injected additional vasopressin into the gestational sac in cases with a viable fetus after the initial injection. Forced contraction of the cervical smooth muscle facilitated removal of the conceptus with minimal blood loss during curettage. We measured operative time, total blood loss, complications, and the need for additional treatment. We included 11 women. Mean patient age, gestational age, and serum human chorionic gonadotrophin (hCG) at the intervention were 31.2±6.4years, 6.0±0.6 weeks, and 18,370±21,570 IU/L, respectively. Mean size of the gestational sac was 19.6±9.5mm. The uterus was successfully preserved without any complications in all patients. All procedures were completed within 15min except for the first case (range: 5-33min). In 4 cases, the conceptus containing a gestational sac was spontaneously extruded en bloc from the external os after the injection. Additional systematic methotrexate administration was required in one case because of remaining villi at the implantation site with persistence of serum hCG levels after the procedure. Local injection of diluted vasopressin and subsequent suction curettage is a feasible conservative treatment for cervical ectopic pregnancy. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.
Kaimbo W A Kaimbo, D; Nkidiaka, M C
To evaluate the efficacy of incision and curettage in the treatment of chalazion in black African patients. In a prospective study performed between February 1999 and February 2000, 25 black African patients with chalazion (27 eyes, 30 chalazions), ranging in age from 15 to 51 years (mean age +/-SD, 25.2 years +/-7), were treated with incision and curettage. Measurements of eyebrow height, pretarsal skin height, crease height, inferior eyelid height and the palpebral fissure height were performed before and after treatment. Success was defined as a total disappearance or a decrease in size (less than one millimeter). Success was achieved in all of 25 patients. Recurrence occurred in 3.0% after 5 to 6 weeks. During a mean +/-SD of 4.7 months +/-2.9 of follow-up, fistula (3.0%) was noted as postincision ocular complication. After treatment, a significant decrease of pretarsal skin (P = 0.018) and inferior eyelid height (P=0.004) measurements and an increase in palpebral fissure height measurement (P = 0.025) were noted. Incision and curettage in chalazion treatment appears to be effective in managing chalazion in black African patients as reported in previous studies in Caucasian patients.
Full Text Available Cerebral venous sinus thrombosis (CVST is a relatively rare cerebrovascular disease, of which the risk has been documented in patients with numerous conditions. However, CVST has never been previously described in association with the use of a diagnostic curettage in patient with uterine fibroid. Herein, we described a 43-year-old woman who presented with recurrent convulsive seizures and severe and progressive headache 1 day after a diagnostic curettage of the uterus, which was confirmed to be uterine fibroid pathologically later, and her condition subsequently progressed to confusion. Brain magnetic resonance imaging (MRI revealed an acute extensive thrombosis of the left transverse and sigmoid sinus and the ipsilateral cerebellum infarction. Evaluation for primary thrombophilia revealed that an iron deficiency anemia (IDA due to the fibroid bleeding induced menorrhagia together with a diagnostic curettage might be the sole hypercoagulable risk factor identified. Treatment with anticoagulation led to full recovery of her symptoms and recanalization of the thrombosis was proven on magnetic resonance venography (MRV 2 months later. We suggest that CVST should be recognized as a potential complication related to this diagnostic technique, especially in patient with IDA. The early diagnosis and timely treatment would be of significance in improving the prognosis of this potentially lethal condition.
Bromham, D R; Oloto, E J
It is known that, since antiquity, women confronted with an unwanted pregnancy have used abortion as a means of resolving their dilemma. Although undoubtedly widely used in all historical ages, abortion has come to be regarded as an event preferably avoided because of the impact on the women concerned as well as considerations for fetal life. Policies to reduce numbers and rates of abortion must acknowledge certain observations. Criminalization does not prevent abortion but increases maternal risks. A society's 'openness' in discussing sexual matters inversely correlates with abortion rates. Correlation between contraceptive use and abortion is also inverse but relates most closely to the efficacy of contraceptive methods used. 'Revolution' in the range of contraceptive methods used will have an equivalent impact on abortion rates. Secondary or emergency contraceptive methods have a considerable role to play in the reduction of abortion numbers. Good sex (and 'relationships') education programs may delay sexual debut, increase contraceptive usage and be associated with reduced abortion. Finally, interaction between socioeconomic factors and the choice between abortion and ongoing pregnancy are complex. Abortion is not necessarily chosen by those least able to support a child financially.
Abortion has become something to hide, something you can't tell other people, something you have to expiate forever. Besides, abortion is more and more difficult to achieve because of the raising average of consciencious objection (from 70 to 90% of health care providers are conscientious objectors, 2014 data, Ministero della Salute) and illegal abortion is "coming back"from the 70s, when abortion was a crime (Italian law n. 194/1978). Abortion is often blamed as a murder, an unforgivenable sin, even as genocide. Silence against shouting "killers!" to women who are going to have an abortion: this is a common actual scenario. Why is it so difficult to discuss and even to mention abortion?
Hogue, C J; Cates, W; Tietze, C
-fold rise in relative risk; 3) midtrimester spontaneous abortion is not more frequent for women who have experienced 1 previous abortion than for women who are in their 1st pregnancy; 4) shortened gestation in pregnancies after 1 induced abortion has an incidence similar to that in 1st pregnancies; 5) low birth weight is more frequent in 1st births after abortion performed by dilatation and curettage under general anesthesia, but it is not more frequent in 1st births after abortions performed by other methods, when compared with 1st pregnancy births; 6) 1 induced abortion does not protect a woman from the higher risks of low birth weight and pregnancy complications associated with a 1st birth; 7) repeat induced abortion has not been studied sufficiently to clarify whether the increased risks associated with it in some studies are caused by confounding factors or the procedures performed; and 8) 1st born infants whose mothers had 1 induced abortion are at similar risk of morbidity and infant mortality as other 1st born children.
Hisel, L M
This review traces the discussion of abortion in the US through 10 of the best books published on the subject in the past 25 years. The first book considered is Daniel Callahan's "Abortion: Law, Choice and Morality," which was published in 1970. Next is book of essays also published in 1970: "The Morality of Abortion: Legal and Historical Perspectives," which was edited by John T. Noonan, Jr., who became a prominent opponent to the Roe decision. It is noted that Roman Catholics would find the essay by Bernard Haring especially interesting since Haring supported the Church's position on abortion but called for acceptance of contraception. Third on the list is historian James C. Mohr's review of "Abortion in America: The Origins and Evolution of National Policy," which was printed five years after the Roe decision. Selection four is "Enemies of Choice: The Right-to-Life Movement and Its Threat to Abortion" by Andrew Merton. This 1981 publication singled out a concern about sexuality as the overriding motivator for anti-abortion groups. Two years later, Beverly Wildung Harrison published a ground-breaking, feminist, moral analysis of abortion entitled "Our Right to Choose: Toward a New Ethic of Abortion. This was followed by a more empirical and sociopolitical feminist analysis in Kristin Luker's 1984 "Abortion and the Politics of Motherhood." The seventh book is by another feminist, Rosalind Pollack Petchesky, whose work "Abortion and Women's Choice: The State, Sexuality, and Reproductive Freedom" was first published in 1984 and reprinted in 1990. The eighth important book was "Abortion and Catholicism: The American Debate," edited by Thomas A. Shannon and Patricia Beattie Jung. Rounding out the list are the 1992 work "Life Itself: Abortion in the American Mind" by Roger Rosenblatt and Ronald Dworkin's 1993 "Life's Dominion: An Argument About Abortion, Euthanasia, and Individual Freedom."
Zile Singh Kundu
Full Text Available Background: Curettage is one of the most common treatment options for benign lytic bone tumors and tumor like lesions. The resultant defect is usually filled. We report our outcome curettage of benign bone tumors and tumor like lesions without filling the cavity. Materials and Methods: We retrospectively studied 42 patients (28 males and 14 females with benign bone tumors who had undergone curettage without grafting or filling of the defect by any other bone graft substitute. The age of the patients ranged from 14 to 66 years. The most common histological diagnosis was that of giant cell tumor followed by simple bone cyst, aneurysamal bone cyst, enchondroma, fibrous dysplasia, chondromyxoid fibroma, and chondroblastoma and giant cell reparative granuloma. Of the 15 giant cell tumors, 4 were radiographic grade 1 lesions, 8 were grade 2 and 3 grade 3. The mean maximum diameter of the cysts was 5.1 (range 1.1-9 cm cm and the mean volume of the lesions was 34.89 cm 3 (range 0.94-194.52 cm 3 . The plain radiographs of the part before and after curettage were reviewed to establish the size of the initial defect and the rate of reconstitution, filling and remodeling of the bone defect. Patients were reviewed every 3 monthly for a minimum period of 2 years. Results: Most of the bone defects completely reconstituted to a normal appearance while the rest filled partially. Two patients had preoperative and three had postoperative fractures. All the fractures healed uneventfully. Local recurrence occurred in three patients with giant cell tumor who were then reoperated. All other patients had unrestricted activities of daily living after surgery. The rate of bone reconstitution, risk of subsequent fracture or the incidence of complications was related to the size of the cyst/tumor at diagnosis. The benign cystic bone lesions with volume greater than approximately 70 cm 3 were found to have higher incidence of complications. Conclusion: This study
Definitive management was by conservative measures in 79.4 % with antibiotics and evacuation. The mean interval between abortion and presentation at OOUTH was 9.9days. There was only one case of mortality in the series giving a case fatality rate as 2.94%. Conclusion There is a need for training and retraining of ...
Mileti, D.; Sorensen, J.; Bogard, W.
The purpose was to describe the processes of evacuation decision-making, identify and document uncertainties in that process and discuss implications for federal assumption of liability for precautionary evacuations at nuclear facilities under the Price-Anderson Act. Four major categories of uncertainty are identified concerning the interpretation of hazard, communication problems, perceived impacts of evacuation decisions and exogenous influences. Over 40 historical accounts are reviewed and cases of these uncertainties are documented. The major findings are that all levels of government, including federal agencies experience uncertainties in some evacuation situations. Second, private sector organizations are subject to uncertainties at a variety of decision points. Third, uncertainties documented in the historical record have provided the grounds for liability although few legal actions have ensued. Finally it is concluded that if liability for evacuations is assumed by the federal government, the concept of a ''precautionary'' evacuation is not useful in establishing criteria for that assumption. 55 refs., 1 fig., 4 tabs
Wellisch, Lawren; Chor, Julie
Abortion is an extremely common procedure in the United States, with approximately 2% of women having an abortion before age 19 years. Although most pediatricians do not provide abortions, many will care for a young woman who is either considering an abortion or has already had one; therefore, the pediatrician should be able to provide accurate and appropriate counseling about this option. To provide the best care for adolescent patients considering abortion, pediatricians must be knowledgeable of aspects of abortion that are universal to all women and have an understanding of considerations specific to the adolescent patient. The purpose of this article is to (1) review recent statistics about teenagers and abortion, (2) explain the different types of abortion available to teenagers who desire to terminate an unwanted pregnancy, (3) discuss aspects of abortion unique to the adolescent population, such as insurance coverage and parental involvement laws, and (4) address common misconceptions about abortion. [Pediatr Ann. 2015;44(9):384-385,388,390,392.]. Copyright 2015, SLACK Incorporated.
A pilot randomized controlled clinical trial of second uterine curettage versus usual care to determine the effect of re-curettage on patients’ need for chemotherapy among women with low risk, nonmetastatic gestational trophoblastic neoplasm in Urmia, Iran
Full Text Available Haleh Ayatollahi,1 Zahra Yekta,2 Elnaz Afsari1 1Department of Gynecology and Obstetrics, Reproductive Health Research Center, 2Department of Community and Preventive Medicine, Urmia University of Medical Sciences, Urmia, Iran Objective: The objective of this study was to determine if second curettage was associated with a decreased need for the number of chemotherapy treatments compared to usual care. Methods: A pilot randomized controlled clinical trial was designed at Motahhari Referral Hospital in 2014. Fifty-two patients with low risk, nonmetastatic gestational trophoblastic neoplasm were assigned randomly to two arms. The interventional arm included a repeat uterine curettage, and the control group received standard care (chemotherapy. All participants were followed periodically over 6 months. Primary outcome was defined as the number of chemotherapy courses in each arm. Student’s t-test and receiver operator characteristics (ROC curve were applied for statistical analysis as appropriate.Results: Fifty percent of participants who underwent re-curettage did respond to intervention with no further chemotherapy after 6 months of follow-up. The intervention arm had higher number of remissions without chemotherapy compared to those who received usual care. In the subgroup analysis, the ROC curve could predict the re-curettage treatment response by beta human chorionic gonadotropin (BhCG level significantly. No complications were reported in the intervention arm. Conclusion: Second curettage is an alternative effective procedure to decrease the need for chemotherapy among patients with low risk, nonmetastatic gestational trophoblastic neoplasm. Further clinical trials with larger sample size may be needed to determine the effective role of second curettage among patients. Keywords: gestational trophoblastic neoplasm, uterine curettage, chemotherapy
Full Text Available Background/Aim. Medicamentous abortion was first introduced in Serbia and Montenegro in September 2001. The aim of this study was to assess the efficiency, side effects, and acceptability of medicamentous abortion using mifeprostone orally (600 mg, and 48 hours later, misoprostol both orally and vaginally in different regiments in our population (400 mcg, 600 mcg, 800 mcg. Methods. A total of 235 consecutive women with pregnancies up to 49 days of gestational age were assigned to 4 groups according to the different misoprostol regiment (group I 400 mcg, group II 600 mcg, group III 800 mcg orally, and group IV 800 mcg both orally and vaginally. The principal outcome measure was a successful abortion defined as a complete expulsion of intrauterine contents without a need for surgical intervention 14 days after the procedure. Other outcome measures were the following: drug related effects, and adverse effects related to the abortion process. Results. In general, the success rate was 50%, 89.48%, 75% and 92.11% in the groups I, II, III, and IV, respectively, as judged by the complete expulsion of the intrauterine contents without surgical intervention (t1:4 = 7.005; t2:4 = 0.3872, t3:4 = 2.9784, p < 0.01. The incidence of adverse effects (vomiting, abdominal pain, bleeding, and fever was low in general, but among our groups it occurred mostly with the higher doses of orally applied misoprostol (800 and 600 mcg. Only one case required urgent curettage for heavy vaginal bleeding, and two blood transfusions, as well. No cases of intact pregnancies were recorded in the study. Conclusion. Our study showed that a mifepristone dose of 600 mg orally, and misoprostol 400 mcg orally and 400 mcg vaginally were most effective. Thus, a combination of mifepristone and misoprostol for medicamentous abortion should take a higher proportion in the termination of early pregnancy in our population.
Manolea, Maria Magdalena; Dijmărescu, Anda Lorena; Popescu, Florina Carmen; Novac, Marius Bogdan; DiŢescu, Damian
The aim of this study was the characterization of the implantation site through histological and immunohistochemical exams and the evaluation of the changes that appear in the pregnancies ended by spontaneous abortion compared to normal pregnancies ended by requested abortion. One hundred eight patients were divided in two groups: the study group that included 58 patients with spontaneous abortion and the control group that included 50 patients with requested abortion. There has been made uterine curettage in all the cases after a complete preoperative evaluation and the obtained product was sent for histopathological evaluation and immunohistochemical study using a VEGF antibody. Studying the histological sections, we noticed the vasculogenesis stages chronology and then according to the histological aspects of normal pregnancy we noticed the histological changes that occurred at the site of implantation in the cases with pathological pregnancies ended by miscarriage. Our results from this study seem to indicate a correlation between decidual vascular changes and the appearance of miscarriage. In pregnancies ended by miscarriage, we found delays in the trophoblast development according to the gestational age at which the event abortifacient happened. The study emphases the temporal differentiation of utero-placental angiogenesis comparing to villous vasculogenesis and angiogenesis in the first trimester miscarriage and normal pregnancy. At the control group, VEGF expression was positive in 88% of cases, while in the study group, pregnancies ended by spontaneous abortion, positive expression of VEGF was present in only 31% of cases. Our data suggest vascular disorders and are in concordance with other histological and ultrasound studies postulating the idea of a link between miscarriage and placental vascular bed pattern changes.
Borsari, Cristina Mendes Gigliotti; Nomura, Roseli Mieko Yamamoto; Benute, Gláucia Rosana Guerra; Lucia, Mara Cristina Souza de; Francisco, Rossana Pulcineli Vieira; Zugaib, Marcelo
To compare and analyze socioeconomic aspects and the emotional experience of women with spontaneous or induced abortion and in women living in the outskirts of São Paulo. A prospective case-control study carried out from July 2008 to March 2010, involving semi-structured interviews with women who presented a previous diagnosis of abortion and who had been admitted to two public hospitals in the outskirts of São Paulo. The study included 100 women with diagnosis of abortion and were hospitalized for curettage. Eleven women who reported induced abortion (11%) represented the case group. The control group (n=22) was selected at a 2:1 ratio according to the following procedure: for every case of induced abortion, the next two cases of spontaneous abortion at the same hospital. A semistructured interview was conducted with questions regarding emotional aspects and family, social and economic context. The women with induced abortion compared to the group with spontaneous abortion had lower educational level, with more frequent elementary level (82 versus 36%, p=0.04), lower income (median, R$ 1,000.00 versus R$ 1,400.00, p=0.04), lower personal income (median, R$ 200.00 versus R$ 333.00, p=0.04), higher frequency of negative feelings upon suspicion (82 versus 22%, p=0.004) and confirmation (72 versus 22%, p=0.03) of pregnancy. Among women looking for health care in hospitals in the outskirts of São Paulo, induced abortion is related to unfavorable socioeconomic conditions, which affects the emotional experiences of suspicion and confirmation of pregnancy.
Evacuation operations are conducted under the authority of, and based on decisions by, local and state authorities. The purpose of this primer, Evacuating Populations with Special Needs, is to provide local and state emergency managers, government of...
Hammond, Gregory D.; Bier, Vicki M.
In the U.S., current protective-action strategies to safeguard the public following a nuclear power accident have remained largely unchanged since their implementation in the early 1980s. In the past thirty years, new technologies have been introduced, allowing faster computations, better modeling of predicted radiological consequences, and improved accident mapping using geographic information systems (GIS). Utilizing these new technologies, we evaluate the efficacy of alternative strategies, called adaptive protective action zones (APAZs), that use site-specific and event-specific data to dynamically determine evacuation boundaries with simple heuristics in order to better inform protective action decisions (rather than relying on pre-event regulatory bright lines). Several candidate APAZs were developed and then compared to the Nuclear Regulatory Commission’s keyhole evacuation strategy (and full evacuation of the emergency planning zone). Two of the APAZs were better on average than existing NRC strategies at reducing either the radiological exposure, the population evacuated, or both. These APAZs are especially effective for larger radioactive plumes and at high population sites; one of them is better at reducing radiation exposure, while the other is better at reducing the size of the population evacuated. - Highlights: • Developed framework to compare nuclear power accident evacuation strategies. • Evacuation strategies were compared on basis of radiological and evacuation risk. • Current strategies are adequate for smaller scale nuclear power accidents. • New strategies reduced radiation exposure and evacuation size for larger accidents
Budamakuntla, Leelavathy; Loganathan, Eswari; George, Anju; Revanth, BN; Sankeerth, V; Sarvjnamurthy, Sacchidananda Aradhya
Background: Primary focal axillary hyperhidrosis is a chronic distressing disorder affecting both the sexes. When the condition is refractory to conservative management, we should go for more promising therapies like intradermal botulinum toxin A (BtxA) injections in the axilla, and surgical therapies like subcutaneous curettage of sweat glands. Aims and Objectives: The aim of this study is to compare the efficacy, safety and duration of action of intradermal BtxA injections in one axilla and subcutaneous curettage of sweat glands in the other axilla of the same patient with axillary hyperhidrosis. Materials and Methods: Twenty patients (40 axillae) received intradermal BtxA injections on the right side (20 axillae) and underwent tumescent subcutaneous curettage of sweat glands on the left side (20 axillae). Sweat production rate was measured using gravimetry analyses at baseline and at 3 months after the procedure. Subjective analyses were done using hyperhidrosis disease severity scale (HDSS) score at baseline, at 3rd and 6th month after the procedure. Results: At 3 months post-treatment, the resting sweat rate in the toxin group improved by 80.32% versus 79.79% in the subcutaneous curettage method (P = 0.21). Exercise-induced sweat rate in the toxin group improved by 88.76% versus 88.8% in the subcutaneous curettage group (P = 0.9). There was a significant difference in the HDSS score after treatment with both the modalities. There were no adverse events with BtxA treatment compared to very minor adverse events with the surgical method. Conclusion: Both intradermal BtxA injections and tumescent subcutaneous curettage of sweat glands had a significant decrease in the sweat rates with no significant difference between the two modalities. Hence, in resource poor settings where affordability of BtxA injection is a constraint, subcutaneous curettage of sweat glands can be preferred which has been found equally effective with no or minimal adverse events. PMID
Polaino Lorente, Aquilino
The author explores the possible relationship between psychopathology and abortion. The paper starts with the updating of epidemiological data regarding the incidence of abortion, especially in the current Spanish society. In this partnership there are three sections in the study of these possible relations between the abortion and the psychopathology: (a) in the new emerging sexual behaviour, especially among young people, and psychopathological factors possibly determining their sexual behaviour; (b) in the psychological and psychopathological context that makes the decision to abort, in regard to the factors of the couple and their families of origin and social context, and (c) in the frequent psychopathological disorders that seem to arise from the abortion, according to recent data reported by many researchers in the international scientific community. The study of the so-called Post-Abortion Syndrome (PAS) puts an end to this cooperation, distinguishing psychopathological profile characteristic that distinguishes the various stages of this syndrome.
Che, Yan; Liu, Xiaoting; Zhang, Bin; Cheng, Linan
Abstract Oral contraceptives (OCs) following induced abortion offer a reliable method to avoid repeated abortion. However, limited data exist supporting the effective use of OCs postabortion. We conducted this systematic review and meta-analysis in the present study reported immediate administration of OCs or combined OCs postabortion may reduce vaginal bleeding time and amount, shorten the menstruation recovery period, increase endometrial thickness 2 to 3 weeks after abortion, and reduce the risk of complications and unintended pregnancies. A total of 8 major authorized Chinese and English databases were screened from January 1960 to November 2014. Randomized controlled trials in which patients had undergone medical or surgical abortions were included. Chinese studies that met the inclusion criteria were divided into 3 groups: administration of OC postmedical abortion (group I; n = 1712), administration of OC postsurgical abortion (group II; n = 8788), and administration of OC in combination with traditional Chinese medicine postsurgical abortion (group III; n = 19,707). In total, 119 of 6160 publications were included in this analysis. Significant difference was observed in group I for vaginal bleeding time (P = 0.0001), the amount of vaginal bleeding (P = 0.03), and menstruation recovery period (P abortion (P abortion, and reduce the risk of complications and unintended pregnancies. PMID:27399060
To find the latest and most accurate information on aspects of induced abortion. A literature survey was carried out in which five aspects of abortion were scrutinised: risk to life, risk of breast cancer, risk to mental health, risk to future fertility, and fetal pain. Abortion is clearly safer than childbirth. There is no evidence of an association between abortion and breast cancer. Women who have abortions are not at increased risk of mental health problems over and above women who deliver an unwanted pregnancy. There is no negative effect of abortion on a woman's subsequent fertility. It is not possible for a fetus to perceive pain before 24 weeks' gestation. Misinformation on abortion is widespread. Literature and websites are cited to demonstrate how data have been manipulated and misquoted or just ignored. Citation of non-peer reviewed articles is also common. Mandates insisting on provision of inaccurate information in some US State laws are presented. Attention is drawn to how women can be misled by Crisis Pregnancy Centres. There is extensive promulgation of misinformation on abortion by those who oppose abortion. Much of this misinformation is based on distorted interpretation of the scientific literature.
Madeiro, Alberto Pereira; Rufino, Andréa Cronemberger
Treatment of complications resulting from induced abortion may be hampered by discriminatory attitudes manifested by healthcare professionals in hospitals and abortion services. This article retrieved stories of institutional abuse directed at women who had an induced abortion in illegal and unsafe conditions. Seventy-eight women admitted to a public hospital in Teresina for complications after an induced abortion were interviewed. A semi-structured script was used with questions about practices and itineraries of abortion and institutional violence during hospitalization. Discriminatory practices and maltreatment during care were reported by 26 women, especially among those who confessed to induction of the abortion. Moral judgement, threat of filing a complaint to the police, negligence in the control of pain, long wait for uterine curettage, and hospitalization with mothers who have recently given birth were the main types of institutional violence reported by women. Cases of institutional violence in the care of induced abortion violates the duty of the healthcare service and prevents women from receiving the necessary health care.
Sahin Hodoglugil, Nuriye Nalan; Ngabo, Fidele; Ortega, Joanna; Nyirazinyoye, Laetitia; Ngoga, Eugene; Dushimeyezu, Evangeline; Kanyamanza, Eugene; Prata, Ndola
Penal code was revised in Rwanda in 2012 allowing legal termination of pregnancy resulting from rape, incest, forced marriage, or on medical grounds. An evaluation was conducted to assess women's access to abortion services as part of an ongoing program to operationalize the new exemptions for legal abortion. Data was collected from eight district hospitals; seven gender-based violence (GBV) centers and six intermediate courts. Three focus group discussions and 22 in-depth interviews were conducted with key informants. At hospitals, of the 2,644 uterine evacuation records (July 2012-June 2014), and 312 monitoring cases (August-December 2014), majority of all uterine evacuations (97% and 85% respectively, for the two periods) were for obstetric conditions, and induced abortion on medical grounds accounted for 2% vs. 15% respectively. Medical abortion was the prominent method of uterine evacuation. At the GBV centers, 3,763 records were identified retrospectively; 273 women were pregnant. Since the legal reform there was only one abortion for a pregnancy resulting from rape. Abortion stigma and court order requirement are major barriers to access services. The operationalization program has made significant contributions to make abortion safer in Rwanda but this evaluation demonstrates that further work is required to reach the goal of providing safe abortion services to all eligible women. Addressing abortion stigma at the community, organizational and structural levels; further strengthening of service provision; and streamlining legal requirements to protect particularly young women from sexual violence and making abortion a realistic option for GBV victims are some of the important next steps.
Cho, Hwan Seong; Park, Yeong Kyoon; Oh, Joo Han; Lee, Jung Hyun; Han, Ilkyu; Kim, Han-Soo
Chondroblastoma has a predilection for the epiphyses or apophyses of long tubular bones. Management of lesions in the proximal tibia is challenging because it is difficult to gain access to intraepiphyseal lesions for completion of curettage. From October 2007 to December 2011, 9 patients with de novo chondroblastoma of the proximal tibia underwent surgery at the authors' institution. All patients initially presented with pain, and 5 patients had limitation of range of motion of the ipsilateral knee. Four lesions abutted the tibial attachment sites of the cruciate ligaments. Surgical procedures included intralesional tumor curettage, additional burring, and packing of the defect with bone graft and/or bone cement. The extra-articular approach was used according to tumor location. The medial or lateral parapatellar approach was used when the tumor was located in the anterior two-thirds of the horizontal plane. When a lesion was located in the posterior third, the posteromedial or posterolateral approach was used as the lesion was cornered. Mean duration of follow-up was 47.2 months (range, 27-80 months). No local recurrence or pulmonary metastasis was noted at latest follow-up. Mean functional score was 29.3 points (range, 28-30 points). All patients fully recovered range of motion in the affected knee. No avulsion fracture or anteroposterior instability of the knee joint was detected. Results of the current study suggest that intralesion curettage followed by additional burring with an extra-articular approach is a successful treatment option for chondroblastoma of the proximal tibia. Copyright 2016, SLACK Incorporated.
Jagannath Mala Sherigar
Full Text Available Uterine perforation is the well known complication of induced abortion. We report a rare case of uterine perforation with subtotal prolapse of small bowel following first trimester abortion by an unqualified physician. Early surgical exploration with resection and anastomosis of bowel performed. Patient discharged uneventfully after postoperative recovery.
Belevitin, A B; Shelepov, A M; Bochenkov, A A; Iamenskov, V V; Grebeniuk, S A; Peshkov, V V
There was effectuated an analyze of using of aircrafts for medical air evacuation of ill and wounded persons, was shown it's place in system of treatment-evacuation measures during the war and peaceful time in course of liquidation of consequences of natural disasters. The article presents main clinical-physiological aspects of medical air evacuation, peculiarities of organization of delivery of health care aboard aircraft, state of medical air evacuation for now-days. The article presents characteristics of purposes and supply of created sanitary planes and helicopters: Mi-8MB "Bisectrix", An-26M "Saver", Il-76MD "Bistoury". There elaborated recommendations upon organization of medical air evacuation during war and peaceful time.
Nick Rohrbaugh; Kelsey Bogue; Melissa G. Hunt
Simple Summary Ninety pet owners and 27 non-pet owners who lived in mandatory evacuation zones during the 2011 Hurricane Irene were surveyed about whether or not they evacuated and about their experiences during the hurricane. Although pet-ownership was not statistically associated with evacuation failure, many pet owners who chose not to evacuate still claimed that they did not evacuate because of difficulties with evacuating their pet. These findings suggest that more work needs to be done ...
Full Text Available Abstract Background In low-resource settings, where abortion is highly restricted and self-induced abortions are common, access to post-abortion care (PAC services, especially treatment of incomplete terminations, is a priority. Standard post-abortion care has involved surgical intervention but can be hard to access in these areas. Misoprostol provides an alternative to surgical intervention that could increase access to abortion care. We sought to gather additional evidence regarding the efficacy of 400 mcg of sublingual misoprostol vs. standard surgical care for treatment of incomplete abortion in the environments where need for economical non-surgical treatments may be most useful. Methods A total of 860 women received either sublingual misoprostol or standard surgical care for treatment of incomplete abortion in a multi-site randomized trial. Women with confirmed incomplete abortion, defined as past or present history of vaginal bleeding during pregnancy and an open cervical os, were eligible to participate. Participants returned for follow-up one week later to confirm clinical status. If abortion was incomplete at that time, women were offered an additional follow-up visit or immediate surgical evacuation. Results Both misoprostol and surgical evacuation are highly effective treatments for incomplete abortion (misoprostol: 94.4%, surgical: 100.0%. Misoprostol treatment resulted in a somewhat lower chance of success than standard surgical practice (RR = 0.90; 95% CI: 0.89-0.92. Both tolerability of side effects and women’s satisfaction were similar in the two study arms. Conclusion Misoprostol, much easier to provide than surgery in low-resource environments, can be used safely, successfully, and satisfactorily for treatment of incomplete abortion. Focus should shift to program implementation, including task-shifting the provision of post-abortion care to mid- and low- level providers, training and assurance of drug availability. Trial
Background In low-resource settings, where abortion is highly restricted and self-induced abortions are common, access to post-abortion care (PAC) services, especially treatment of incomplete terminations, is a priority. Standard post-abortion care has involved surgical intervention but can be hard to access in these areas. Misoprostol provides an alternative to surgical intervention that could increase access to abortion care. We sought to gather additional evidence regarding the efficacy of 400 mcg of sublingual misoprostol vs. standard surgical care for treatment of incomplete abortion in the environments where need for economical non-surgical treatments may be most useful. Methods A total of 860 women received either sublingual misoprostol or standard surgical care for treatment of incomplete abortion in a multi-site randomized trial. Women with confirmed incomplete abortion, defined as past or present history of vaginal bleeding during pregnancy and an open cervical os, were eligible to participate. Participants returned for follow-up one week later to confirm clinical status. If abortion was incomplete at that time, women were offered an additional follow-up visit or immediate surgical evacuation. Results Both misoprostol and surgical evacuation are highly effective treatments for incomplete abortion (misoprostol: 94.4%, surgical: 100.0%). Misoprostol treatment resulted in a somewhat lower chance of success than standard surgical practice (RR = 0.90; 95% CI: 0.89-0.92). Both tolerability of side effects and women’s satisfaction were similar in the two study arms. Conclusion Misoprostol, much easier to provide than surgery in low-resource environments, can be used safely, successfully, and satisfactorily for treatment of incomplete abortion. Focus should shift to program implementation, including task-shifting the provision of post-abortion care to mid- and low- level providers, training and assurance of drug availability. Trial registration This study has
Kirsch, Uwe; Schreckenberg, Michael
The 6th International Conference on Pedestrian and Evacuation Dynamics conference (PED2012) showcased research on human locomotion. This book presents the proceedings of PED2012. Humans have walked for eons; our drive to settle the globe began with a walk out of Africa. However, much remains to discover. As the world moves toward sustainability while racing to assess and accommodate climate change, research must provide insight on the physical requirements of walking, the dynamics of pedestrians on the move and more. We must understand, predict and simulate pedestrian behaviour, to avoid dangerous situations, to plan for emergencies, and not least, to make walking more attractive and enjoyable. PED2012 offered 70 presentations and keynotes and 70 poster presentations covering new and improved mathematical models, describing new insights on pedestrian behaviour in normal and emergency cases and presenting research based on sensors and advanced observation methods. These papers offer a starting point for innova...
Full Text Available Study Objective: To investigate the use of operative hysteroscopy instead of traditional curettage in women with retained products of conception (RPOC following first trimester medical abortion, with the aim of reducing post-operative intrauterine adhesions. Design: Retrospective study. Setting: Gynecology department in a University affiliated hospital. Patients: All women treated by hysteroscopy for RPOC following first trimester medical abortion using the mifepristone-misoprostol protocol for pregnancy termination or the misoprostol protocol for early missed abortion from January 2013 to August 2016. Intervention: Operative hysteroscopy for removal of RPOC. Post-operative intrauterine adhesions were assessed by diagnostic office hysteroscopy after 6â8 weeks. Measurements and Main Results: 50 cases were identified. The mean time from medication administration to the operative hysteroscopy was 1.7Â Â±Â 0.7 months. Operative hysteroscopy with blunt use of the resectoscopic loop was used to remove all specimens, and all procedures were completed without intra-operative complications. Two patients (4.0% were readmitted for fever. Pathology confirmed the presence of RPOC in 45 (90.0% cases. On follow-up office hysteroscopy, a normal uterine cavity without evidence of intrauterine adhesions was seen in 29/29 (100% women. Conclusion: Hysteroscopy for removal of RPOC following medical abortion is associated with low rates of complications and post-operative intrauterine adhesions. Keywords: abortion, hysteroscopy, intrauterine adhesions, retained products of conception
Lawson, H W; Atrash, H K; Franks, A L
To determine the risk factors for abortion-related deaths caused by pulmonary embolism, we investigated all deaths from legal abortions in the United States from 1972 through 1985. Of 213 deaths, 45 (21%) were due to air, blood clot, or amniotic fluid embolism. The risk of embolism death was higher among minority women and older women (34 to 44 years). Our analysis revealed that curettage at less than or equal to 21 weeks and abortions at less than or equal to 12 weeks, regardless of method, were both associated with the least risk of embolism death. In comparing 1972 to 1978 and 1979 to 1985, we found that the embolism mortality rate decreased 79%. During 1979 to 1985, the number of abortions performed by noncurettage methods decreased 58%, possibly as a result of earlier abortion morbidity studies, which showed that these methods carried a greater risk of complications. Although a decrease in mortality rates may be partially attributable to the declining use of these methods, our analysis suggests that changes in methods over time have not been universally applied to all racial groups.
As of July 1991 abortion is still legal in Poland. Currently the Polish Parliament has taken a break from the debate because the issue is so important that any decision must not be made in past. There is strong pressure from the Catholic Church to eliminate access to abortion. In the fall the Polish people will vote for and elect their first truly democratic Parliament. Abortion does not seem to be playing as important a role as other political issues. In 1956 a law was passed that allowed a woman to have an abortion for medical or social reasons. This law resulted in allowing women in Poland to use abortion as their primary form of contraception. The vast majority of the abortions were performed under the social justification. Then, when democracy same to Poland with the help of the Catholic Church, an unprecedented debate in the mass media, churches, and educational institutions was stirred up. The government attempted to stay out of the debate at first. But as people from different side of the debate saw that they had an opportunity to influence things in their favor, they began to politicize the issue. Currently there are 4 different drafts of the new Polish abortion law. 3 of them radically condemn abortion while the 4th condemns it as a method of family planning, but allows to terminate pregnancies in order to save the life of the mother.
PREVIOUS SECOND TRIMESTER ABORTION: A risk factor for third trimester uterine rupture in three ... for accurate diagnosis of uterine rupture. KEY WORDS: Induced second trimester abortion - Previous uterine surgery - Uterine rupture. ..... scarred uterus during second trimester misoprostol- induced labour for a missed ...
Bjerregaard, P; Kristensen, L M; Kiil-Nielsen, J; Egelund, B; Kollemorten, I K
The purpose of the study was to seek knowledge about the reasons for the very high rate of legal abortions in Greenland. In four municipalities in the Disko Bay region of West Greenland all pregnant women were asked to fill in a questionnaire. Due to organisational problems only 39% of the women were asked to participate and a total of 82 women seeking abortion and 175 women who wished to continue the pregnancy were enrolled in the study. A few Danish women (22) were subsequently removed from the study base. The women who wanted an abortion were more often than the other women single, their knowledge of Danish as a second language was poorer, and they less often had a job. Although the age distributions of the two groups were similar the women who wanted an abortion had more often been pregnant before (more births and more abortions). The women who wanted an abortion more often than the other women reported having been drunk, having had a pelvic inflammation or VD, and having been admitted to hospital. Half of the women who wanted an abortion reported that they had forgotten to use their contraception and one fourth were opposed to the use of contraception. There seems not to be a well defined high risk group for legal abortion but a general need for a more realistic view on contraception.
Breitbart, V; Rogers, M K; Vanderhei, D
Medical abortion with mifepristone and methotrexate regimens may be offered in a variety of American medical practice settings. In this article the new provider will find information on all aspects of the patient care delivery system for medical abortion, including physical space requirements, staffing and training, patient flow, cost, security, marketing, and quality assurance. Because of the limited published data available regarding logistic issues surrounding abortion care, the information in this article derives largely from the experiences of providers who have established medical abortion practices in their offices or clinics. Its goals are to help make the initial start-up phase briefer and more rewarding for new providers, to offer helpful guidelines for incorporation of medical abortion into practice, and to encourage more practitioners to see the benefits of adding this option to their practices.
Counseling and education are correlated with women's satisfaction with all abortion care. They often assume a larger role in medical abortion because the patient is a more active participant in the abortion process. This article aims to enhance the practitioner's expertise in providing the information and care necessary for women considering early abortion with medical regimens. It offers general counseling guidelines and several likely clinical scenarios regarding the decision-making process, the screening of patients, and the initial and follow-up visits. Through effective communication, practitioners can provide the information and support that patients need to complete the abortion process safely and can help to strengthen women's confidence in managing their reproductive health experiences.
This review of abortion history considers sacred and secular practice and traces abortion in the US, the legacy of the 19th century, and the change that occurred in the 20th century. Abortion has been practiced since ancient times, but its legality and availability have been threatened continuously by forces that would denigrate women's fundamental rights. Currently, while efforts to decrease the need for abortion through contraception and education continue, access to abortion remains crucial for the well-being of millions of women. That access will never be secure until profound changes occur in the whole society. Laws that prohibit absolutely the practice of abortion are a relatively recent development. In the early Roman Catholic church, abortion was permitted for male fetuses in the first 40 days of pregnancy and for female fetuses in the first 80-90 days. Not until 1588 did Pope Sixtus V declare all abortion murder, with excommunication as the punishment. Only 3 years later a new pope found the absolute sanction unworkable and again allowed early abortions. 300 years would pass before the Catholic church under Pius IX again declared all abortion murder. This standard, declared in 1869, remains the official position of the church, reaffirmed by the current pope. In 1920 the Soviet Union became the 1st modern state formally to legalize abortion. In the early period after the 1917 revolution, abortion was readily available in state operated facilities. These facilities were closed and abortion made illegal when it became clear that the Soviet Union would have to defend itself against Nazi Germany. After World War II women were encouraged to enter the labor force, and abortion once again became legal. The cases of the Catholic church and the Soviet Union illustrate the same point. Abortion legislation has never been in the hands of women. In the 20th century, state policy has been determined by the rhythms of economic and military expansion, the desire for cheap
Full Text Available Background: In developing countries it is important to the exploration of available and safe regimens for medical abortion. The present study was designed to assess the effect of letrozole compared to placebo pretreatment followed by sublingual misoprostol for therapeutic abortion in eligible women with gestational age less than 17 weeks. Materials and Methods: In this randomized control trail, 130 women eligible for legal abortions were randomly divided into two groups of case and controls. Cases received daily oral dose of 10 mg letrozole 10 mg letrozole for three days followed by sublingual misoprostol. Controls received daily oral dose of placebo followed by sublingual misoprostol. The dose of misoprostol was administrated according to ACOG guidelines based on patients′ gestational age. The rate of complete abortion, induction-of-abortion time, and side-effects were assessed as main outcomes. Results: Complete abortion was observed in 46 (76.7% letrozole group and 26 (42.6% controls (P < 0.0001. Also, in 14 subjects of letrozole group and 35 subjects in placebo group, the placenta was not delivered during follow-up and curettage was performed. The mean interval induction-to-abortion was 5.1 h in letrozole group and 8.9 h in control (P < 0.0001. The cumulative rates of the induction-of-abortion time were a significant difference between the two groups (P < 0.0001. The incidence and severity of side-effects was comparable for the two groups (P = 0.9. Conclusion: Letrozole could be a quite beneficial adjuvant to misoprostol for induction of complete abortion in those who are candidates for legal medical abortion.
Full Text Available Introduction: The importance of high-grade cervical intraepithelial neoplasia (CIN as a precursor to invasive cervical cancer suggests a considerable need for accurate screening of the patients for the risk of these lesions. This systematic review aimed to study the diagnostic significance of endocervical curettage (ECC at the time of colposcopy in the detection of CIN 2, 3, and preinvasive lesions.Methods: PubMed was searched to obtain the relevant articles based on the following search term: (endocervical curettage OR ECC AND colposcopy. The most relevant articles were included after studying the title, abstract, and full text of the obtained articles at initial search. Only English language articles published after 1992 with at least 500 patients were included in this study.Result: Among 300 articles identified by the first search, only seven articles were in line with the purpose of this systematic review. Majority of the included studies were retrospective observational studies.Conclusion: Performing ECC has higher sensitivity in women older than 40 years and those with unsatisfactory colposcopy results. However exact diagnostic usefulness of ECC at the time of colposcopy needs to be investigated in further studies.
Abdelazim, Ibrahim A; Abdelrazak, Khaled M; Elbiaa, Assem A M; Al-Kadi, Mohamed; Yehia, Amr H
To compare the diagnostic accuracy of brush endometrial sampling with conventional dilatation and curettage in women with abnormal uterine bleeding. Two hundred and twenty (220) women with abnormal uterine bleeding were included in this comparative study; endometrial sampling was done before cervical dilatation using Tao Bruch followed by conventional dilatation and curettage (D&C). The histopathology report of the Tao Bruch samples was compared with that of the D&C samples and the D&C results were considered as the gold standard. 100% of samples obtained by conventional D&C, while 98.2% of the samples obtained by Tao Brush were adequate for histopathology examination. In this study; Tao Brush had 100% sensitivity, 100% specificity, 100% predictive values and accuracy for diagnosing endometrial hyperplasia, endometrial carcinoma, proliferative and secretory endometrium, also, it had 86.7% sensitivity, 100% specificity, 100% positive predictive value (PPV) and 99% negative predictive value (NPV) and accuracy for diagnosing endometritis (no significant difference compared to conventional D&C), while, it had 77.8% sensitivity, 100% specificity, 100% PPV and 99% NPV and accuracy for diagnosing endometrial polyps (no significant difference compared to conventional D&C) CONCLUSION: Endometrial sampling using endometrial brush cytology (EBC) is safe, accurate, cost-effective outpatient procedure, avoids general anesthesia with high sensitivity and specificity for detection of endometrial hyperplasia and endometrial carcinoma. EBC could be used as complementary diagnostic tool when hysteroscopic biopsies or other blinded procedures for endometrial sampling are unwanted or not available.
Full Text Available Background: In this study we evaluated the treatment of giant cell tumor (GCT of long bones using cryosurgery combined with curettage and polymethylmetacrylate (PMMA cementing. Material and methods: From January 1999 to December 2004, twenty patients (mean age at the time of surgery 29.2 years; 13 females and 7 males; were included in the study. Cortical disruption were presented in 7 patients; 4 with soft tissue extension, but none of them had intra-articular extension of tumor, 3 patients presented with pathologic fracture of distal femoral lesions. These tumors were located in distal femur in 6 patients, proximal tibia in 7, distal radius in 3, proximal femur in 2, and each of proximal humerus and distal ulna in one patient. In each case diagnostic biopsy was done and surgical procedure performed including curettage, power burr of the wall, cryosurgery with liquid nitrogen and finally filling the space with PMMA cementing. The mean follow-up was 34 months (7 to 61 . Results: During follow-up, we observed one recurrence of GCT of proximal tibia. Secondary Aneurysmal bone cyst was reported at the site of one primary distal femoral lesion, without any finding in favor of a recurrence. Neurapraxia of the proneal nerve was occurred in one patient with proximal tibia tumor improved after 8 months. Conclusion: Cryosurgery combined with power burr and PMMA cementing in the treatment of GCT could be an effective approach in tumor eradication. This method obviates the need for extensive resections and reconstructive procedure.
Medoff, Marshall H.
This study examines the effect restrictive state abortion laws have on the pregnancy resolution decisions of women with unintended pregnancies. The empirical results find that the abortion ratio and the abortion rate of unintended pregnancies are more sensitive to increases in the abortion price than previous estimates that analyzed total pregnancies (unintended and intended). A Medicaid funding restriction has very little effect on a state's abortion rate of unintended pregnancies, but cause...
AJRH Managing Editor
In Ghana, despite the availability of safe, legally permissible abortion services, high rates of morbidity and mortality from unsafe abortion persist. Through interviews with Ghanaian physicians on the front lines of abortion provision, we begin to describe major barriers to widespread safe abortion. Their stories illustrate the ...
Background While induced abortion is considered to be illegal and socially unacceptable in Nigeria, it is still practiced by many women in the country. Poor family planning and unsafe abortion practices have daunting effects on maternal health. For instance, Nigeria is on the verge of not meeting the Millennium development goals on maternal health due to high maternal mortality ratio, estimated to be about 630 maternal deaths per 100,000 live births. Recent evidences have shown that a major factor in this trend is the high incidence of abortion in the country. The objective of this paper is, therefore, to investigate the factors determining the demand for abortion and post-abortion care in Ibadan city of Nigeria. Methods The study employed data from a hospital-based/exploratory survey carried out between March to September 2010. Closed ended questionnaires were administered to a sample of 384 women of reproductive age from three hospitals within the Ibadan metropolis in South West Nigeria. However, only 308 valid responses were received and analysed. A probit model was fitted to determine the socioeconomic factors that influence demand for abortion and post-abortion care. Results The results showed that 62% of respondents demanded for abortion while 52.3% of those that demanded for abortion received post-abortion care. The findings again showed that income was a significant determinant of abortion and post-abortion care demand. Women with higher income were more likely to demand abortion and post-abortion care. Married women were found to be less likely to demand for abortion and post-abortion care. Older women were significantly less likely to demand for abortion and post-abortion care. Mothers’ education was only statistically significant in determining abortion demand but not post-abortion care demand. Conclusion The findings suggest that while abortion is illegal in Nigeria, some women in the Ibadan city do abort unwanted pregnancies. The consequence of this
Awoyemi, Bosede O; Novignon, Jacob
While induced abortion is considered to be illegal and socially unacceptable in Nigeria, it is still practiced by many women in the country. Poor family planning and unsafe abortion practices have daunting effects on maternal health. For instance, Nigeria is on the verge of not meeting the Millennium development goals on maternal health due to high maternal mortality ratio, estimated to be about 630 maternal deaths per 100,000 live births. Recent evidences have shown that a major factor in this trend is the high incidence of abortion in the country. The objective of this paper is, therefore, to investigate the factors determining the demand for abortion and post-abortion care in Ibadan city of Nigeria. The study employed data from a hospital-based/exploratory survey carried out between March to September 2010. Closed ended questionnaires were administered to a sample of 384 women of reproductive age from three hospitals within the Ibadan metropolis in South West Nigeria. However, only 308 valid responses were received and analysed. A probit model was fitted to determine the socioeconomic factors that influence demand for abortion and post-abortion care. The results showed that 62% of respondents demanded for abortion while 52.3% of those that demanded for abortion received post-abortion care. The findings again showed that income was a significant determinant of abortion and post-abortion care demand. Women with higher income were more likely to demand abortion and post-abortion care. Married women were found to be less likely to demand for abortion and post-abortion care. Older women were significantly less likely to demand for abortion and post-abortion care. Mothers' education was only statistically significant in determining abortion demand but not post-abortion care demand. The findings suggest that while abortion is illegal in Nigeria, some women in the Ibadan city do abort unwanted pregnancies. The consequence of this in the absence of proper post-abortion
Ohannessian, A; Jamin, C
To establish guidelines of the French National College of Gynecologists and Obstetricians about post-abortion contraception. A systematic review of the literature about post-abortion contraception was performed on Medline and Cochrane Database between 1978 and March 2016. The guidelines of the French and foreign scientific societies were also consulted. After an abortion, if the woman wishes to use a contraception, it should be started as soon as possible because of the very early ovulation resumption. The contraception choice must be done in accordance with the woman's expectations and lifestyle. The contraindications of each contraception must be respected. The long-acting reversible contraception, intra-uterine device (IUD) and implant, could be preferred (grade C) as the efficacy is not dependent on compliance. Thus, they could better prevent repeat abortion (LE3). In case of surgical abortion, IUD should be proposed and inserted immediately after the procedure (grade A), as well as the implant (grade B). In case of medical abortion, the implant can be inserted from the day of mifépristone, the IUD after an ultrasound examination confirming the success of the abortion (no continuing pregnancy or retained sac) (grade C). Copyright © 2016 Elsevier Masson SAS. All rights reserved.
The author conducted a survey of one hundred women in Zadar seeking an abortion during the first trimester ofpregnancy. His purpose was to determine the women's motives for seeking abortions and evaluate their knowledge on abortion and the fetus. He found that the majority lacked a clear understanding of abortion techniques as well as fetal development. After an informative conversation, twelve of the women decided against having abortions. The author concluded that great ignorance, inhumane ...
Sugiki, Nao; Hirata, Yoshiki; Matsuo, Kojiro
Large scale earthquakes occur frequently in Japan in recent years. In the Great East Japan Earthquake that occurred in 2011 and caused major damage, more than 90% of the dead were due to the tsunami. The speed of evacuation is important in considering evacuation at the time of the attack of the tsunami, especially the elderly evacuation speed is assumed to be slower than non-elderly people. Elderly people may have different means of evacuation and speed depending on the composition of the households to which they belong because of the different possibilities of riding in families' driven cars. However, a simulation taking such a difference of evacuation into consideration has not been conducted. The purpose of this study is to conduct a tsunami evacuation simulation in consideration of evacuation measures and speed depending on the type of households belonging to in the tsunami inundation area of Toyohashi city, Japan. In order to conduct the tsunami evacuation simulation considering the household type, detailed data on individual households is necessary. However, it is difficult to obtain from aggregated data such as National Census. Therefore, detailed data on individual households is created by using the household micro data estimation system developed by Sugiki et al. . Evacuation simulation is performed by shortest path search using Esri's ArcGIS Network Analyst's OD cost matrix analysis. The elderly people who cannot complete evacuation by the time of the arrival of the tsunami were found from evacuation simulation results assuming evacuation measures available for each household attribute to which the evacuees belong.
Gershon, Robyn R M; Qureshi, Kristine A; Rubin, Marcie S; Raveis, Victoria H
Due to the fact that most high-rise structures (i.e., >75 feet high, or eight to ten stories) are constructed with extensive and redundant fire safety features, current fire safety procedures typically only involve limited evacuation during minor to moderate fire emergencies. Therefore, full-scale evacuation of high-rise buildings is highly unusual and consequently, little is known about how readily and rapidly high-rise structures can be evacuated fully. Factors that either facilitate or inhibit the evacuation process remain under-studied. This paper presents results from the qualitative phase of the World Trade Center Evacuation Study, a three-year, five-phase study designed to improve our understanding of the individual, organizational, and environmental factors that helped or hindered evacuation from the World Trade Center (WTC) Towers 1 and 2, on 11 September 2001. Qualitative data from semi-structured, in-depth interviews and focus groups involving WTC evacuees were collected and analyzed. On the individual level, factors that affected evacuation included perception of risk (formed largely by sensory cues), preparedness training, degree of familiarity with the building, physical condition, health status, and footwear. Individual behavior also was affected by group behavior and leadership. At the organizational level, evacuation was affected by worksite preparedness planning, including the training and education of building occupants, and risk communication. The environmental conditions affecting evacuation included smoke, flames, debris, general condition and degree of crowdedness on staircases, and communication infrastructure systems (e.g., public address, landline, cellular and fire warden's telephones). Various factors at the individual, organizational, and environmental levels were identified that affected evacuation. Interventions that address the barriers to evacuation may improve the full-scale evacuation of other high-rise buildings under extreme
Jatlaoui, Tara C; Shah, Jill; Mandel, Michele G; Krashin, Jamie W; Suchdev, Danielle B; Jamieson, Denise J; Pazol, Karen
Since 1969, CDC has conducted abortion surveillance to document the number and characteristics of women obtaining legal induced abortions in the United States. 2014. Each year, CDC requests abortion data from the central health agencies of 52 reporting areas (the 50 states, the District of Columbia, and New York City). The reporting areas provide this information voluntarily. For 2014, data were received from 49 reporting areas. For trend analysis, abortion data were evaluated from 48 areas that reported data every year during 2005-2014. Census and natality data, respectively, were used to calculate abortion rates (number of abortions per 1,000 women aged 15-44 years) and ratios (number of abortions per 1,000 live births). A total of 652,639 abortions were reported to CDC for 2014. Of these abortions, 98.4% were from the 48 reporting areas that provided data every year during 2005-2014. Among these 48 reporting areas, the abortion rate for 2014 was 12.1 abortions per 1,000 women aged 15-44 years, and the abortion ratio was 186 abortions per 1,000 live births. From 2013 to 2014, the total number and rate of reported abortions decreased 2%, and the ratio decreased 7%. From 2005 to 2014, the total number, rate, and ratio of reported abortions decreased 21%, 22%, and 21%, respectively. In 2014, all three measures reached their lowest level for the entire period of analysis (2005-2014). In 2014 and throughout the period of analysis, women in their 20s accounted for the majority of abortions and had the highest abortion rates; women in their 30s and older accounted for a much smaller percentage of abortions and had lower abortion rates. In 2014, women aged 20-24 and 25-29 years accounted for 32.2% and 26.7% of all reported abortions, respectively, and had abortion rates of 21.3 and 18.4 abortions per 1,000 women aged 20-24 and 25-29 years, respectively. In contrast, women aged 30-34, 35-39, and ≥40 years accounted for 17.1%, 9.7%, and 3.6% of all reported abortions
Tran, Minh D; Garner, Alan A; Morrison, Ion; Sharley, Peter H; Griggs, William M; Xavier, Colin
After the Bali bombing on 12 October 2002, many injured Australians required evacuation to Darwin, and then to burns units around Australia. Many patients were evacuated from Denpasar by Qantas, with assistance from staff of civilian medical retrieval services. The transport of patients from Darwin to specialist burns units involved a coordinated response of civilian and military services. Some issues in responding to such disasters were identified, and a national coordinating network could improve future responses.
Steele, S J
This discusses activities current in England under the abortion law of April 1968. In England and Wales in 1969 there were 54,013 recorded abortions and 15 related deaths. Since then both the number of deaths and the number of abortions have been increasing. This abortion increase is partly attributed to the adverse publicity regarding the pill which has caused many women to give up oral contraceptives. Complications have included incomplete removal of the products of conception, sepsis, hemorrhage, and perforation of the uterus. There have been wide variation in interpretations of the law by different hospitals and staffs. Sterilization operations are being done in increasing number for both men and women. Carefully worded consent forms are now in use to insure patient understanding and consent. Psychological changes may follow sterilization, but are relatively uncommon. Physicians should do all possible to help women avoid unwanted pregnancies and thereby reduce the demand for termination.
Because abortion is illegal in Senegal, it is not easy to determine its frequency. Women suffering complications of illegal abortions are often unwilling to aid in their own treatment by divulging the means used to induce the abortion. Clandestine abortions are associated with poor hygienic conditions exposing the woman to risk of infection. Abortion operators are often ignorant of elementary notions of genital anatomy and unskilled in gynecological surgery. Death may result in a few minutes from shock or embolism. The operator is unable to take any action because of the illegal status of the abortion. Secondary complications may appear because of local trauma, infection, or from caustic or toxic agents. Hemorrhage may be external and abundant, originating in the cervix, vagina, or uterine cavity. It may occur within the abdominal cavity if an organ is perforated. In both cases surgical treatment may be required to save the woman's life. An infection or a state of toxicity may result from the abortion, or both may occur simultaneously. Infections of varying degrees of seriousness may be localized in the genital organs (pelviperitonitis), spread throughout the abdomen (general peritonitis), or spread throughout the organism. Pelviperitonitis results from performing abortions under septic conditions and from uterine retention of part of the embryo. Symptoms include abdominal pain, fever, vomiting, and arrest of intestinal transit. Symptoms are often masked by uninformed use of antibiotics, which allows the infection to spread to the other abdominal organs. Generalized peritonitis results from grave lesions of the genital or intestinal tracts produced by traumatizing instruments. In the absence of medical and surgical treatment, the patient's condition rapidly deteriorates and death ensues. Generalized infection may be due to septicemia, tetanus, or hepatonephritis. Hospitalization in a specialized service is required. Thromboembolic complications may also follow
Conclusions: Parameters including patients' age, gender, tumor location, and radiological classification did not affect surgeons' treatments in cavity filling after GCT curettage. Cementation should be recommended because of easy usage, the similar postoperative knee function with bone grafting, and the better local tumor control than bone grafting.
Graziosi, GCM; van der Steeg, JW; Reuwer, PHW; Drogtrop, AP; Bruinse, HW; Mol, BWJ
BACKGROUND: The increased pressure on health care expenses implies that physicians should consider economic aspects as part of the clinical decision-making process. Direct and indirect costs of a strategy starting with misoprostol in treatment of early pregnancy failure as compared to curettage is
Graziosi, G. C. M.; van der Steeg, J. W.; Reuwer, P. H. W.; Drogtrop, A. P.; Bruinse, H. W.; Mol, B. W. J.
BACKGROUND: The increased pressure on health care expenses implies that physicians should consider economic aspects as part of the clinical decision-making process. Direct and indirect costs of a strategy starting with misoprostol in treatment of early pregnancy failure as compared to curettage is
Full Text Available Background: While determining the cause of abnormal uterine bleeding, sampling from the endometrium is necessary. Considering that pipelle suction curettage can be performed on an out patient basis and does not require hospitalization, using anesthesia and cervical dilatation, we performed this study. The aim of this study was to compare the diagnostic value of dilatation and curettage (D&C with pipelle suction curettage. Methods: This study was quasiexperimental on 200 pre and postmenopausal patients with abnormal uterine bleeding who refered to Shabihkhani hospital in Kashan, Iran. Endometrial sampling was performed in all patients with two methods namely pipelle and D&C. A pathologist examined the samples each having a predetermined code. Results: The mean age of subjects was 46.2 ±6.2 years, minimum age was 35 years and the maximum was 70 years. The various pathological lab findings were proliferative endometrium, secretory endometrium, athrophic, decidua, cystic and adenomatous hyperplasia. The reports were the same in two methods except for 2 cases where they were different: secretory endometrium with D&C but cystic hyperplasia in pipelle method. Conclusions: The result of our study shows the comparability of obtaining endometrial sample by pipelle with D&C. Due to comfort and convenience of patients in pipelle methode especially in the office setting which does not need anesthesia, pipelle method can easily be employed instead of D&C. Keywords: Pipelle Suction Curette, Dilatation and Curettage, Premenopause, Postmenopause.
Emanuel, M. H.; Wamsteker, K.; Lammes, F. B.
To determine the predictive value of dilatation and curettage (D&C) for diagnosing intrauterine disorders in patients with persistent abnormal uterine bleeding. An observational descriptive study was performed in a large university-affiliated teaching hospital. The suspicion of intrauterine
Álvarez-Jiménez, Jesús; Córdoba-Fernández, Antonio; Munuera, Pedro V
Segmental phenolization for the treatment of onychocryptosis has a number of disadvantages, resulting from the cauterization of the tissue, including delayed healing and prolonged drainage. Although one may expect excision or curettage of the cauterized tissue after phenolization to benefit the healing process, these simple procedures have not been suitably studied. To examine the effect of curettage primarily on cicatrization or healing time and secondarily on postoperative bleeding. Fifty-one patients (80 feet) with stage I or IIa onychocryptosis according to the classification of Mozena were enrolled in this randomized, double-blind, parallel-group, controlled clinical trial. A total of 137 phenolizations were performed on affected folds of ingrowing hallux nails. Each hallux was randomly assigned to one of two groups (experimental [phenolization with curettage]; control [phenolization alone]). Curettage reduced healing time (7.49 ± 1.76 days vs 12.38 ± 3.01 days; p = .001), increased postoperative bleeding (p Surgery, Inc. Published by Wiley Periodicals, Inc.
A large number of induced abortions exist in central Serbia, in spite of the fact that modern science made new methods and devices for the birth control available, which are more acceptable both from the medical and personal point of view. This fact shows contradictory situation and opens several questions. The crucial being: why do wome rely on abortion and do not use modern contraception? In research done in 1991--it refers to Belgrade and it includes four hundred women--confirmed was the accepted hypothesis that the extension of induced abortion developed from the discordance between comprehension of the need of birth control and the way it should be accomplished. The main causes of the discordance are insufficient knowledge about modern contraception, phychological barriers, insufficient cultural level (general, health, sex) of the population and lack of institutionalized contemporary concept fof family planning. Duration of prevalence of induced abortions indicates that underlying causes of frequency are numerous and stable over time. Considering this, and the slowness of any spontaneous change, it may be expected that the problem of abortions will be present in the years to come. However, duration of abortion prevalence will depend, to a large extent, on the ability and willingness of the State to cope with this issue.
The article considers three theses about postabortion regret which seek to illustrate its pertinence to reasoning about abortion, and which are often deployed, either explicitly or implicitly, to dissuade women out of that reproductive choice. The first is that postabortion regret renders an abortion morally unjustified. The second is that that a relatively high incidence of postabortion regret-compared with a lower incidence of postnatal regret in the relevant comparator field-is good evidence for the moral impermissibility of abortion choice. The third is that high rates of postabortion regret suggest that abortion is not the most prudent or welfare-maximising choice for the woman concerned. All three theses argue for the compellingness of knowledge about postabortion regret in moral and practical reasoning about abortion, especially from the pregnant woman's point of view. This article argues that all three theses are flawed. In particular, it seeks to remind readers that feelings of regret directed at past decisions are often decoupled from the fact of the matter about their moral or rational justification. Moreover, certain features of reproductive decisions in particular make regret an especially unsuitable yardstick for actual justification in this context, and even less epistemically reliable as evidence for a lack of justification than it may be in other fields of decision-making. The implication is that rates of postabortion regret, even if they can be presumed to be higher than rates of postnatal regret, are not as pertinent to moral and practical reasoning about abortion as is sometimes suggested.
Smith, T W
In the US attitudes toward abortion in the 1980s seem to have reached a more liberal plateau, much more favored than in the 1960s or earlier, but not longer moving in a liberal direction. Catholic attitudes basically have followed the same trend. Traditionally Catholic support has been slightly lower than Protestant, and both are less inclined to support abortion than Jews or the nonreligious. During the 1970s support among non-black Catholics averaged about 10 percentage points below non-black Protestants. Blacks tend to be anti-abortion and thereby lower support among Protestants as a whole. A comparison of Protestants and Catholics of both races shows fewer religious differences -- about 7 percentage points. There are some indications that this gap may be closing. In 1982, for the 1st time, support for abortions for social reasons, such as poverty, not wanting to marry, or not wanting more children, was as high among Catholics as among Protestants. 1 of the factors contributing to this narrowing gap has been the higher level of support for abortion among younger Catholics. Protestants show little variation on abortion attitudes, with those over age 65 being slightly less supportive. Among Catholics, support drops rapidly with age. This moderate and possibly vanishing difference between Catholics and Protestants contrasts sharply with the official positions of their respective churches. The Catholic Church takes an absolute moral position against abortion, while most Protestant churches take no doctrinaire position on abortion. Several, such as the Unitarians and Episcopalians, lean toward a pro-choice position as a matter of social policy, though fundamentalist sects take strong anti-abortion stances. Few Catholics agree with their church's absolutist anti-abortion position. The big split on abortion comes between what are sometimes termed the "hard" abortion reasons -- mother's health endangered, serious defect in fetus, rape, or incest. Support among Catholics
Lee, Byung Ho; Lee, Hwan-Mo; Kim, Tae-Hwan; Kim, Hak-Sun; Moon, Eun-Soo; Park, Jin-Oh; Chong, Hyun-Soo; Moon, Seong-Hwan
Infective spondylodiscitis usually occurs in patients of older age, immunocompromisation, co-morbidity, and individuals suffering from an overall poor general condition unable to undergo reconstructive anterior and posterior surgeries. Therefore, an alternative, less aggressive surgical method is needed for these select cases of infective spondylodiscitis. This retrospective clinical case series reports our novel surgical technique for the treatment of infective spondylodiscitis. Between January 2005 and July 2011, among 48 patients who were diagnosed with pyogenic lumbar spondylodiscitis or tuberculosis lumbar spondylodiscitis, 10 patients (7 males and 3 females; 68 years and 48 to 78 years, respectively) underwent transpedicular curettage and drainage. The mean postoperative follow-up period was 29 months (range, 7 to 61 months). The pedicle screws were inserted to the adjacent healthy vertebrae in the usual manner. After insertion of pedicle screws, the drainage pedicle holes were made through pedicles of infected vertebra(e) in order to prevent possible seeding of infective emboli to the healthy vertebra, as the same instruments and utensils are used for both pedicle screws and the drainage holes. A minimum of 15,000 mL of sterilized normal saline was used for continuous irrigation through the pedicular pathways until the drained fluid looked clear. All patients' symptoms and inflammatory markers significantly improved clinically between postoperative 2 weeks and postoperative 3 months, and they were satisfied with their clinical results. Radiologically, all patients reached the spontaneous fusion between infected vertebrae and 3 patients had the screw pulled-out but they were clinically tolerable. We suggest that our method of transpedicular curettage and drainage is a useful technique in regards to the treatment of infectious spondylodiscitic patients, who could not tolerate conventional combined anterior and posterior surgery due to multiple co
Kimport, Katrina; Weitz, Tracy A; Freedman, Lori
Roe v. Wade was heralded as an end to unequal access to abortion care in the United States. However, today, despite being common and safe, abortion is performed only selectively in hospitals and private practices. Drawing on 61 interviews with obstetrician-gynecologists in these settings, we examine how they determine which abortions to perform. We find that they distinguish between more and less legitimate abortions, producing a narrative of stratified legitimacy that privileges abortions for intended pregnancies, when the fetus is unhealthy, and when women perform normative gendered sexuality, including distress about the abortion, guilt about failure to contracept, and desire for motherhood. This stratified legitimacy can perpetuate socially-inflected inequality of access and normative gendered sexuality. Additionally, we argue that the practice by physicians of distinguishing among abortions can legitimate legislative practices that regulate and restrict some kinds of abortion, further constraining abortion access. © American Sociological Association 2016.
Full Text Available Abortion is seen as an immoral and unjust act by many. Nonetheless these views are under pressure to conform to the learned opinion on abortion. A variety of prestigious in the field of applied ethics support abortion in one way or another. And it is a dogma of modern liberalism that even if one is personally opposed to abortion, one must accept the neutral solution of its public permissibility. The present article defends the thesis that abortion is immoral and unjust against these contentions. With regards to the moral status of abortion, it argues that the prohibition of abortion is off a piece with the prohibition of killing generally, which is characterized by protecting all human beings equally. With regards to the compatibility of abortion permissibility with liberalism, the article argues that such a compromise is not neutral, but heavily rigged in favor of the interests and world-views of abortion proponents.
Parmar, Divya; Leone, Tiziana; Coast, Ernestina; Murray, Susan Fairley; Hukin, Eleanor; Vwalika, Bellington
Unsafe abortion is a significant but preventable cause of maternal mortality. Although induced abortion has been legal in Zambia since 1972, many women still face logistical, financial, social, and legal obstacles to access safe abortion services, and undergo unsafe abortion instead. This study provides the first estimates of costs of post abortion care (PAC) after an unsafe abortion and the cost of safe abortion in Zambia. In the absence of routinely collected data on abortions, we used multiple data sources: key informant interviews, medical records and hospital logbooks. We estimated the costs of providing safe abortion and PAC services at the University Teaching Hospital, Lusaka and then projected these costs to generate indicative cost estimates for Zambia. Due to unavailability of data on the actual number of safe abortions and PAC cases in Zambia, we used estimates from previous studies and from other similar countries, and checked the robustness of our estimates with sensitivity analyses. We found that PAC following an unsafe abortion can cost 2.5 times more than safe abortion care. The Zambian health system could save as much as US$0.4 million annually if those women currently treated for an unsafe abortion instead had a safe abortion.
Wood, Nathan J.; Jones, Jamie; Peters, Jeff; Richards, Kevin
Tsunami waves that arrive hours after generation elsewhere pose logistical challenges to emergency managers due to the perceived abundance of time and inclination of evacuees to use vehicles. We use coastal communities on the island of Oʻahu (Hawaiʻi, USA) to demonstrate regional evacuation modeling that can identify where successful pedestrian-based evacuations are plausible and where vehicle use could be discouraged. The island of Oʻahu has two tsunami-evacuation zones (standard and extreme), which provides the opportunity to examine if recommended travel modes vary based on zone. Geospatial path distance models are applied to estimate population exposure as a function of pedestrian travel time and speed out of evacuation zones. The use of the extreme zone triples the number of residents, employees, and facilities serving at-risk populations that would be encouraged to evacuate and slightly reduces the percentage of residents (98–76%) that could evacuate in less than 15 min at a plausible speed (with similar percentages for employees). Areas with lengthy evacuations are concentrated in the North Shore region for the standard zone but found all around the Oʻahu coastline for the extreme zone. The use of the extreme zone results in a 26% increase in the number of hotel visitors that would be encouraged to evacuate, and a 76% increase in the number of them that may require more than 15 min. Modeling can identify where pedestrian evacuations are plausible; however, there are logistical and behavioral issues that warrant attention before localized evacuation procedures may be realistic.
Cao, Mengxiao; Zhang, Guijuan; Wang, Mengsi; Lu, Dianjie; Liu, Hong
The current evacuation model does not consider the impact of emotion and personality on crowd evacuation. Thus, there is large difference between evacuation results and the real-life behavior of the crowd. In order to generate more realistic crowd evacuation results, we present a method of emotion contagion for crowd evacuation. First, we combine OCEAN (Openness, Extroversion, Agreeableness, Neuroticism, Conscientiousness) model and SIS (Susceptible Infected Susceptible) model to construct the P-SIS (Personalized SIS) emotional contagion model. The P-SIS model shows the diversity of individuals in crowd effectively. Second, we couple the P-SIS model with the social force model to simulate emotional contagion on crowd evacuation. Finally, the photo-realistic rendering method is employed to obtain the animation of crowd evacuation. Experimental results show that our method can simulate crowd evacuation realistically and has guiding significance for crowd evacuation in the emergency circumstances.
In the long-term prospective controlled study reported here, 1509 general practitioners and 795 gynaecologists in England, Scotland and Wales are cooperating in providing information on the sequelae of abortion, especially on the problems of later pregnancies, subfertility and all reported morbidity, in particular psychiatric illness. Morbidity within 21 days after induced abortion, and considered to be related to induced abortion, was found in 10% of 6105 women who had an induced abortion in their index pregnancy, and there were major complications in 2.1%. The main factors affecting morbidity were the place of operation, gestation at termination, the method of termination, sterilization at the time of operation, and smoking habits. Several differences between National Health Service and private sector operations were found which could affect the morbidity rates. Possible means of reducing early morbidity are discussed. The outcome of the first post-index pregnancy in 745 women whose index pregnancy had ended in induced abortion and in 1339 controls was also compared. There was no statistically significant difference between cases and controls. Further analysis of a large number of pregnancies is required to permit confident interpretation of these observations.
Campbell, N B; Franco, K; Jurs, S
Sexual attitudes and behavior of adolescent females have been the topic of much interest over the past decade. Feelings about contraception, conception, and abortion have been described in relation to the adolescents' beliefs about the possibility of becoming pregnant, who will or will not "protect" them, and the influence of significant others on their decision making. This study explores differences in 35 women who had abortions during their teenage years with 36 women whose abortions occurred after the age of twenty. A demographic questionnaire, the Millon Clinical Multiaxial Inventory, and the Beck Depression Inventory were completed by women who were members of a patient-led support group. Premorbid psychiatric histories, the decision-making process itself, and distressing symptoms postabortion are reported. Specific differences in perceptions of coercion, preabortion suicidal ideation, and nightmares post-abortion were found in the adolescent group. Antisocial and paranoid personality disorders as well as drug abuse and psychotic delusions were found to be significantly higher in the group who aborted as teenagers. Hypotheses regarding the influences of adolescent development on mother/child relationships, power struggles, and the use of fantasy as a coping device are explored.
Bish, Douglas R; Tarhini, Hussein; Amara, Roel; Zoraster, Richard; Bosson, Nichole; Gausche-Hill, Marianne
To develop optimal hospital evacuation plans within a large urban EMS system using a novel evacuation planning model and a realistic hospital evacuation scenario, and to illustrate the ways in which a decision support model may be useful in evacuation planning. An optimization model was used to produce detailed evacuation plans given the number and type of patients in the evacuating hospital, resource levels (teams to move patients, vehicles, and beds at other hospitals), and evacuation rules. Optimal evacuation plans under various resource levels and rules were developed and high-level metrics were calculated, including evacuation duration and the utilization of resources. Using this model we were able to determine the limiting resources and demonstrate how strategically augmenting the resource levels can improve the performance of the evacuation plan. The model allowed the planner to test various evacuation conditions and resource levels to demonstrate the effect on performance of the evacuation plan. We present a hospital evacuation planning analysis for a hospital in a large urban EMS system using an optimization model. This model can be used by EMS administrators and medical directors to guide planning decisions and provide a better understanding of various resource allocation decisions and rules that govern a hospital evacuation.
Nadarajah, Ravichandran; Quek, Yek Song; Kuppannan, Kaliammah; Woon, Shu Yuan; Jeganathan, Ravichandran
To show whether a clinically significant difference in success rates exists between expectant and surgical management of early pregnancy loss. Randomised controlled trial comparing expectant versus surgical management of early pregnancy loss over a 1-year period from 1st January to 31st December 2009 at Sultanah Aminah Hospital, Johor Bahru. Pregnant women with missed or incomplete miscarriages at gestations up to 14 weeks were recruited in this study. The success rate in the surgical group was measured as curettage performed without any complications during or after the procedure, while the success rate in the expectant group was defined as complete spontaneous expulsion of products of conception within 6 weeks without any complication. A total of 360 women were recruited and randomised to expectant or surgical management, with 180 women in each group. There was no statistically significant difference in the success rate between the groups and between the different types of miscarriage. With expectant management, 131 (74%) patients had a complete spontaneous expulsion of products of conception, of whom 106 (83%) women miscarried within 7 days. However, the rates of unplanned admissions (18.1%) and unplanned surgical evacuations (17.5%) in the expectant group were significantly higher than the rates (7.4% and 8% respectively) in the surgical group. The complications in both groups were similar. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.
In Ghana, abortion mortality constitutes 11% of maternal mortality. Empirical studies on possible disparities in abortion experience and access to safe abortion services are however lacking. Based on a retrospective survey of 1,370 women aged 15-49 years in two districts in Ghana, this paper examines disparities in ...
Setting: Selected public and private health facilities offering post abortion care services in Machakos and Trans Nzoia Counties. Subjects: ... abortion care. Therefore, understanding abortion-related stigma is a critical step to designing measures to address barriers to women accessing safe reproductive health services.
Fort, A L
In the past few years a greater openness to examination of the characteristics and consequences of abortion as a public health issue and as a social phenomenon has been evident in Peru. To study the attitudes and experiences regarding abortion of low income women living in squatter settlements, focus groups were organized in the Andean city of Cuzco and the Amazon city of Iquitos. The participating women were aged 15 to 49, married or in union, and had at least three living children. The women in each city were divided into three groups of modern contraceptive users, traditional contraceptive users, and nonusers of contraception. They were further divided into two age groups over and under 30 years old. Two focus groups were held for each age and contraception group in each city for a total of twelve sessions in each. A total of 173 women participated. The focus groups met in Iquitos in December 1986 and in Cuzco in March 1987. Younger users of modern contraception did not express approval of abortion but rather stressed its health risks and especially the belief that repeat abortions would lead to cancer. Contraceptive users over 30 and women in the other two groups cited health risks and moral condemnation, speaking in terms of crime, sin, and punishment. Some saw a distinction nevertheless between very early abortion and later abortions, which were disapproved. Some women expressed resentment at wealthier women who were suspected of using abortion to limit their family size. Women in both cities identified abortion seekers as predominantly young, unmarried, older, or multiparous. Private physicians and nurses were said to be the most frequent practitioners, although health workers of all kinds were mentioned. A wide variety of herbal preparations and abortifacients were mentioned, but doubt was expressed as to efficacy in some cases. Curettage was said to be performed by physicians but no details were given. Opinion was divided concerning the desirability of
Arifa Akter Jahan
Full Text Available Background: Abortion is an important social and public health issue. In Bangladesh complication from unsafe abortion is one of the leading causes of maternal mortality. It is a serious health problem. World Health Organisation estimates that 14% of maternal deaths which occur every year in the countries of South Asia including Bangladesh are due to abortion. Study shows manual vacuum aspiration procedure is safe and effective in incomplete abortion. Very few clinical trials were carried out in Bangladesh to assess the safety and effectivity of manual vacuum aspiration in managing incomplete abortion. Objective: To find out the outcome of manual vacuum aspiration in the management of patients of incomplete abortion. Materials and Methods: This observational descriptive study was conducted in the department of Obstetrics & Gynaecology, Dhaka Medical College & Hospital from June to December, 2004. One hundred cases of diagnosed incomplete abortion up to 12 weeks of gestation were managed by manual vacuum aspiration during this period. A data recording sheet was designed for this purpose. Haemodynamically stable patients with no history of induced abortion and fever were enrolled. Results: Procedure time of manual vacuum aspiration was short, average duration was 7 minutes. Bleeding was minimum (20-30 mL in 67% cases and weighted mean was 29.80 mL. Eighty three percent patients were stable during the procedure and only 3% needed blood transfusion. Nonnarcotic analgesics were used in 59% cases and 33% needed only proper counselling. Average duration of hospital stay was 2 hours. Effectiveness of the procedure was about 98% with very low post procedure complication rate (2%. Conclusion: MVA procedure is a safe and effective technique of uterine evacuation in incomplete abortion. It is quick, less expensive, effective and less painful. Hospital stay and chance of perforation of uterus is less. So this procedure should be considered by health care
Frank, G. A.; Dorso, C. O.
Understanding the timing requirements for evacuation of people has focused primarily on independent pedestrians rather than pedestrians emotionally connected. However, the main statistical effects observed in crowds, the so-called “faster is slower”, “clever is not always better” and the “low visibility enhancement”, cannot explain the overall behavior of a crowd during an evacuation process when correlated pedestrians due to, for example feelings, are present. Our research addresses this issue and examines the statistical behavior of a mixture of individuals and couples during a (panic) escaping process. We found that the attractive feeling among couples plays an important role in the time delays during the evacuation of a single exit room.
Dossetti, V.; Bouzat, S.; Kuperman, M. N.
In this work we study a model for the evacuation of pedestrians from an enclosure considering a continuous space substrate and discrete time. We analyze the influence of behavioral features that affect the use of the empty space, that can be linked to the attitudes or characters of the pedestrians. We study how the interaction of different behavioral profiles affects the needed time to evacuate completely a room and the occurrence of clogging. We find that neither fully egotistic nor fully cooperative attitudes are optimal from the point of view of the crowd. In contrast, intermediate behaviors provide lower evacuation times. This leads us to identify some phenomena closely analogous to the faster-is-slower effect. The proposed model allows for distinguishing between the role of the attitudes in the search for empty space and the attitudes in the conflicts.
Abortion has been a reality in women's lives since the beginning of recorded history, typically with a high risk of fatal consequences, until the last century when evolutions in the field of medicine, including techniques of safe abortion and effective methods of family planning, could have ended the need to seek unsafe abortion. The context of women's lives globally is an important but often ignored variable, increasingly recognised in evolving human rights especially related to gender and reproduction. International and regional human rights instruments are being invoked where national laws result in violations of human rights such as health and life. The individual right to conscientious objection must be respected and better understood, and is not absolute. Health professional organisations have a role to play in clarifying responsibilities consistent with national laws and respecting reproductive rights. Seeking common ground using evidence rather than polarised opinion can assist the future focus. Copyright 2010 Elsevier Ltd. All rights reserved.
Szénay, Martin; Lopušniak, Martin
Each building must meet requirements for safe evacuation in order to prevent casualties. Therefore methods for evaluation of evacuation are used when designing buildings. In the paper, calculation methods were tested on three real buildings. The testing used methods of evacuation time calculation pursuant to Slovak standards and evacuation time calculation using the buildingExodus simulation software. If calculation methods have been suitably selected taking into account the nature of evacuation and at the same time if correct values of parameters were entered, we will be able to obtain almost identical times of evacuation in comparison with real results obtained from simulation. The difference can range from 1% to 27%.
Criminal Aspects of Artificial Abortion This diploma thesis deals with the issue of artificial abortion, especially its criminal aspects. Legal aspects are not the most important aspects of artificial abortion. Social, ethical or ideological aspects are of the same importance but this diploma thesis cannot analyse all of them. The main issue with artificial abortion is whether it is possible to force a pregnant woman to carry a child and give birth to a child when she cannot or does not want ...
The author sets forth some of the most recent demographic data, important directions of legal documents as regards abortion, tackling medical and ethical problems of abortion. Some essentials particulars are also given as to the embryonic and foetal development. The whole paper concerns the problems of legal abortion during the first three months of pregnancy. The second part of the paper relates to the consequences of abortion affecting the physical and mental health of a woman as show...
Maxwell, Joseph W.
Attitudes toward the desirability of abortion were significaantly related to sex, college, classification, level of church activity, residence background, family size, exposure to abortion, and attitude toward premarital sex. The data suggest an increasing acceptance of abortion in the future. (Author)
Changes in homicide and arrest rates were compared among cohorts born before and after legalization of abortion and those who were unexposed to legalized abortion. It was found that legalized abortion improved the lives of many women as they could avoid unwanted births.
Font-Ribera, Laia; Pérez, Glòria; Espelt, Albert; Salvador, Joaquin; Borrell, Carme
In induced abortion, the method, the risk of complications and the economic cost of the abortion are determined by gestational age. The aim of this study was to describe the determinants of induced abortion delay until the second trimester of pregnancy in Barcelona. We performed a cross-sectional study of induced abortions due to the physical or mental health of the woman (Barcelona, 2004-2005; N=9,175). The city's induced abortion register provided data on gestational age at abortion (dependent variable), educational level, age, cohabitation with the partner, number of children previous abortions, and type of center. Adjusted prevalence ratios (aPR) were calculated with log-binomial regression models. A total of 7.7% of induced abortions were second-trimester abortions and 99.3% were performed in private centers. Compared with women with a university education, those with primary education or less had an aPR of 1.8 (95% confidence interval [95%CI]: 1.4-2.2) of delaying the abortion until the second trimester. A higher proportion of second-trimester abortions were also recorded in women aged less than 18 years old (aPR=2.6; 95%CI: 2.0-3.4), women not cohabiting with their partners (aRP=1.4; 95% CI: 1.2-1.6) and in public centers (aPR=2.8; 95% CI: 2.2-3.7). No differences were found in induced abortion delay among women with previous abortions and those without. Induced abortion delay until the second trimester of pregnancy was associated with low educational level, young ages, not cohabiting with a partner, and public centers. This study demonstrates the existence of socioeconomic inequalities in access conditions to abortion services.
Farfalli, Germán L; Albergo, Jose I; Piuzzi, Nicolas S; Ayerza, Miguel A; Muscolo, D Luis; Ritacco, Lucas E; Aponte-Tinao, Luis A
The treatment of locally aggressive bone tumors is a balance between achieving local tumor control and surgical morbidity. Wide resection decreases the likelihood of local recurrence, although wide resection may result in more complications than would happen after curettage. Navigation-assisted surgery may allow more precise resection, perhaps making it possible to expand the procedure's indications and decrease the likelihood of recurrence; however, to our knowledge, comparative studies have not been performed. The purpose of this study was to compare curettage plus phenol as a local adjuvant with navigation-guided en bloc resection in terms of (1) local recurrence; (2) nononcologic complications; and (3) function as measured by revised Musculoskeletal Tumor Society (MSTS) scores. Patients with a metaphyseal and/or epiphyseal locally aggressive primary bone tumor treated by curettage and adjuvant therapy or en bloc resection assisted by navigation between 2010 and 2014 were considered for this retrospective study. Patients with a histologic diagnosis of a primary aggressive benign bone tumor or low-grade chondrosarcoma were included. During this time period, we treated 45 patients with curettage of whom 43 (95%) were available for followup at a minimum of 24 months (mean, 37 months; range, 24-61 months), and we treated 26 patients with navigation-guided en bloc resection, of whom all (100%) were available for study. During this period, we generally performed curettage with phenol when the lesion was in contact with subchondral bone. We treated tumors that were at least 5 mm from the subchondral bone, such that en bloc resection was considered possible with computer-assisted block resection. There were no differences in terms of age, gender, tumor type, or tumor location between the groups. Outcomes, including allograft healing, nonunion, tumor recurrence, fracture, hardware failure, infection, and revised MSTS score, were recorded. Bone consolidation was defined
Camus, E; Nisand, I
In France, induced abortion was legalized under certain conditions since the January 1975 and December 1979 laws suspended the effects of Article 317 of the French Penal Code that forbade induced abortion. For more than 15 years, induced abortion has been part of current gynecological practice. Adverse effects of abortions have been reduced. In the upcoming years, the interest in drug-induced abortion and abortion under local anesthesia will increase due to a concern for reducing risks that deteriorate physical integrity and women's gynecological/obstetrical future. Induced abortion still remains a very important act, if not serious, in a woman's life. Prevention of induced abortion remains the absolute medical objective and is necessary for information campaigns on contraceptives, especially among youth. If accessible and equal access to induced abortion is becoming a reality in France, abortion will always remain a failure and proof for women that they have recourse to abortion. Induced abortions have remained relatively stable in France (170,000 in 1980; 181,154 in 1991). The abortion rate ranges from 20 to 25 per 100 live births. 50% of women of reproductive age will have an induced abortion in their life. The fertility rate in France has been 1.8 since 1976. First trimester abortion-related mortality is less than 1/100,000. Abortion-related mortality increases with gestational age (0.5/100,000 at 8 weeks vs. 1.1/100,000 at 12 weeks). It is also associated with the anesthesia used (0.15 for local anesthesia vs. 0.58 for general anesthesia). The leading causes of abortion-related mortality are infection, pulmonary embolism, and anesthetic accidents. Immediate complications of induced abortion are anesthetic accidents, hemorrhage, uterine perforations, accumulation of blood in the uterus, cervical tears, and vagal discomfort. In France, the induced abortion related-perforation rate is between 0.2% and 1.2%. Perforation is more likely after 10 weeks and under
Nguyen Thanh Binh
In recent years, the abortion rate in Vietnam has been likely rising. In rural area, this rate is a bit higher than in urban one. Young age groups’ abortion rate is relatively high and ofter higher than older age groups. The main reason is due to their limited awareness of contraceptive methods. Low education level also affects the abortion. The abortion of people at low education level is relatively high, but people with elementary school graduation has the lowest rate of abortion. The North...
Osayande, O O; Mahmoud, A O; Bolaji, B O
To compare the efficacy and side effects profile of topical 2% lidocaine gel with injectable 2% lidocaine solution as local anaesthetics for incision and curettage of chalazion. Overa 12 month period, 61 patients with unilateral chalazia who were scheduled for incision and curettage surgery under local anaesthesia were randomized into 2 groups: A & B. Group A received 1.5 ml of injectable lidocaine as local anaesthetic while Group B received 1.5 ml of lidocaine 2% gel topically. The major outcome of interest was pain experienced during anaesthetic administration and surgery. Mean pain score from anaesthesia administration was significantly higher in the injection group (A = 4.46 vs. B = 0.57), (p = 0.000005). There was a statistically significant difference in mean pain score during incision and curettage with more pain in the gel group (A = 2.84 vs. B = 4.83), (p = 0.0012). However, the mean total pain score (surgery plus anaesthesia) was more in the injection than the gel group (A = 7.3 vs. B = 5.4) (p = 0.0094). The proportions that had no fear for injection were 54.8% in A and 56.7 % in B. Group A had significantly more ptosis than Group B (2.2 vs. 1.4, p = 0.00003,). Bleeding occured in 93.5% in group A while none occurred in Group B (p = 0.000). Lidocaine 2% gel is an effective, safe and convenient alternative to injectable lidocaine 2% as local anaesthetic agent in incision and curettage for Chalazion in this study.
Günel, Uğur; Dağlar, Bülent; Günel, Nazan
This article reports a case of intraarticularly expanding benign osteoblastoma of the acetabulum caused femoral head destruction by impingement in a 17-year-old male that was diagnosed for two years from the onset of symptoms. As a treatment, by surgical dislocation of the hip joint, polymethyl-methacrylate was packed inside the gap of the acetabular site after intralesional wide curettage. Femoral head remodeling was observed without recurrence after ten years follow-up.
Kuriakku Puthur Dominic
Conclusion: Treatment of GCT of lateral femoral condyle by extended curettage and reconstruction with proximal fibula seems to be a viable option with a good functional outcome, even in cases with pathological fractures. The biological form of reconstruction has the long term advantage of remodeling and can incorporate with the reconstruction as permanent [Arch Clin Exp Surg 2017; 6(4.000: 189-194
14 Aug 1971 ... The literature on the pros and cons of therapeutic abortion must by now virtually fill an average- sized library. Every expert in every field has had his say, sometimes by invitation and sometimes unasked, yet we seem to be no nearer the answer than when we started. The legal boffins have put their case, the ...
Jun 1, 2014 ... unwanted pregnancy, abortion and adoption of children, and the laws relating to them.. Results: Participants felt that ... education of the young girl would be disrupted, if paternity of pregnancy is in dispute, or if it would save the ... Married young women, 15-24 years, rural/urban. 3. Married women, 25-49 ...
presentation, she noticed coital bleeding; it was mildI self with no associated dizziness or dyspareunis. She had been treated with drugs on many occasions at hospitals as well as over the counter medicaiions with no improvement. Eight years prior to presentation, she had an induced abortion at about 14 weeks of gestaiion ...
Claudia Escobar García
This work explains that the discourses opposing the criminalization ofabortion and that reject the constitutional rules that protect human life,are an artificially constructed ideology made only to justify abortion,and hide the asymmetrical relations of power between women and theunborn. In order for this purpose, these arguments are identified andsubjected to critical analysis, demonstrating that it is purely emotionaland lacking fundaments.
Guttmacher, Alan F.; And Others
A roundtable discussion on legal abortion includes Dr. Alan F. Guttmacher, President of The Planned Parenthood Federation of America, Robert Hall, Associate Professor of Obstetrics and Gynecology at Columbia University College of Physicians and Surgeons, Christopher Tietze, a diretor of The Population Council, and Harriet Pilpel, a lawyer.…
Jun 1, 2014 ... unwanted pregnancy, abortion and adoption of children, and the laws relating to them.. Results: Participants felt that there was high .... of cultural differences, formative research was first conducted and a set of ..... paternity, there is a problem of the stigma of bearing a child who would be regarded as a ...
Mermerkaya, Musa Ugur; Bekmez, Senol; Karaaslan, Fatih; Danisman, Murat; Kosemehmetoglu, Kemal; Gedikoglu, Gokhan; Ayvaz, Mehmet; Tokgozoglu, Ahmet Mazhar
Various treatment strategies for low-grade chondrosarcomas with variable outcomes have been reported in the literature. The aim of this study was to assess the oncological and functional outcomes associated with intralesional curettage followed by adjuvant therapy comprising high-speed burring, thermal cauterization, and bone cementation with polymethylmethacrylate. We performed a retrospective review of 21 consecutive patients with intramedullary low-grade chondrosarcoma of long bones treated by intralesional curettage and adjuvant therapy comprising high-speed burring, thermal cauterization, and cementation at our institution from 2007 to 2012. The average age of the patients was 48.7 (range, 18-71) years. There were 7 male and 14 female patients. The mean follow-up period was 58.4 (range, 26-85) months after surgery. The treated lesions were located in the proximal humerus (n=10), proximal tibia (n=6), and distal femur (n=5). At the average follow-up time point of 58.4 (range, 26-85) months, no patient had developed local recurrence and no distant metastases were observed. The average Musculoskeletal Tumor Society score among all 21 patients was 95% (84-100). The combination of intralesional curettage, application of high-speed burring, thermal cauterization, and cementation is an effective treatment strategy for low-grade intramedullary chondrosarcoma of long bones. Excellent oncological and functional results can be obtained.
Sørensen, Janne Gress; Dederichs, Anne
Evacuation characteristics for blind and visually impaired people are presented in the current study. The study was carried out in 2011 and engaged 40 participants in the age from 10 to 69 years. The participants had impairments for all of the four Danish categories for visual impairments (A...
If a hurricane warning is issued for your area, or authorities tell you to evacuate, take only essential items. If you have time, turn off gas, electricity, and water and disconnect appliances. Created: 8/10/2006 by Emergency Communications System. Date Released: 10/10/2007.
Mohd Ibrahim, Azhar; Venkat, Ibrahim; Wilde, Philippe De
Pedestrian movements in crowd motion can be perceived in terms of agents who basically exhibit patient or impatient behavior. We model crowd motion subject to exit congestion under uncertainty conditions in a continuous space and compare the proposed model via simulations with the classical social force model. During a typical emergency evacuation scenario, agents might not be able to perceive with certainty the strategies of opponents (other agents) owing to the dynamic changes entailed by the neighborhood of opponents. In such uncertain scenarios, agents will try to update their strategy based on their own rules or their intrinsic behavior. We study risk seeking, risk averse and risk neutral behaviors of such agents via certain game theory notions. We found that risk averse agents tend to achieve faster evacuation time whenever the time delay in conflicts appears to be longer. The results of our simulations also comply with previous work and conform to the fact that evacuation time of agents becomes shorter once mutual cooperation among agents is achieved. Although the impatient strategy appears to be the rational strategy that might lead to faster evacuation times, our study scientifically shows that the more the agents are impatient, the slower is the egress time.
Formolo, Daniel; van der Wal, C. Natalie
Building useful and efficient models and tools for a varied audience, such as evacuation simulators for scientists, engineers and crisis managers, can be tricky. Even good models can fail in providing information when the user’s tools for the model are scarce of resources. The aim of this work is to
Jensen, Karsten Ingerslev
The application of monolithic silica aerogel as transparent insulation material for windows has been investigated for some years. It has been realised that a major problem of an industrial production of aerogel glazings will be the time for evacuation of the aerogel material. However, in a previous...
Lecointre, L; Akladios, C-Y; Averous, G; Lefebvre, F; Baulon, E; Thoma, V; Fender, M; Baldauf, J-J
To evaluate the reliability of endocervical curettage (ECC) in patients previously treated for CIN. Retrospective analysis of data from 85 patients between January 1985 and December 2011 who received an ECC during monitoring after treatment of CIN. The reliability of the ECC was evaluated by comparison with the final histological analysis of the surgical specimen or the data for subsequent cyto-colpo-histological follow-up. Patients were referred to colposcopy either within the immediate post-treatment monitoring (n=42), meanly 9.7±5.3 months after treatment, or if cytological abnormalities were detected during long-term monitoring, meanly 78.6±52.4 months after treatment. Colposcopy was unsatisfactory in 75.3% of patients and normal colposcopic findings were found in 80% of patients. A perfect agreement between the ECC and the endocervical final diagnosis was noted in 68 patients (80%). For the diagnosis of severe cervical lesions (CIN 2+) ECC had a sensitivity of 86.2% (68.3-96.1), a specificity of 94.6% (85.1-98.9) and positive and negative predictive values of 61.4% (47.6-74.0) and 93% (83.0-98.1), respectively. The high sensitivity and negative predictive value of ECC for the diagnosis of severe post-therapeutic endocervical lesions avoid iterative treatment without increasing the risk of progression of a lesion to cancer. Copyright © 2014 Elsevier Masson SAS. All rights reserved.
Korol'chenko Aleksandr Yakovlevich
Full Text Available The authors argue that no collapse of structures is likely in the event of a fire emergency in multistoried buildings, rather, other fire-related factors may endanger the lives of people inside high-rise buildings exposed to the fire emergency, including open fire, sparks, high ambient temperature, smoke and toxic combustion products, reduced concentration of oxygen, and combined influence of various factors. In case of fire, the temperature inside buildings reaches 1100 °С. It exceeds the temperature of the ambient air acceptable for humans by far (70 °С. The experiments demonstrate that combustion products contain hundreds of toxic chemical compounds. The most hazardous of them include carbon oxide, carbon dioxide, chloride and cyanic hydrogen, aldehydes and acrolein. The author provides the pattern of their influence on the human body. The smoke consists of unburned particles of carbon and aerosols. The size of particles fluctuates within 0.05-50 MMK. Smoke produces a physiological and psychological impact on human beings. It has been proven that dangerous fire factors emerge within the first five to ten minutes of the emergency situation. Evacuation is the principal method of safety assurance. However, the velocity of propagation of smoke and heat is so high that even if the fire prevention system is in operation, people may be blocked both on the floors that are exposed to the fire and those that escape its propagation. New evacuation and rescue methods are recommended by the author. Various ways and methods of use of life-saving facilities are also provided. Safe evacuation is feasible from buildings where the number of stories does not exceed 10- 12. During evacuation, high density human streams are formed inside buildings, therefore, the period of stay in a burning building is increased. The calculations have proven that a two-minute delay of evacuation converts into a safe evacuation of only 13-15% of people. Low reliability of
Jones, Jeanne M.; Ng, Peter; Wood, Nathan J.
Recent disasters such as the 2011 Tohoku, Japan, earthquake and tsunami; the 2013 Colorado floods; and the 2014 Oso, Washington, mudslide have raised awareness of catastrophic, sudden-onset hazards that arrive within minutes of the events that trigger them, such as local earthquakes or landslides. Due to the limited amount of time between generation and arrival of sudden-onset hazards, evacuations are typically self-initiated, on foot, and across the landscape (Wood and Schmidtlein, 2012). Although evacuation to naturally occurring high ground may be feasible in some vulnerable communities, evacuation modeling has demonstrated that other communities may require vertical-evacuation structures within a hazard zone, such as berms or buildings, if at-risk individuals are to survive some types of sudden-onset hazards (Wood and Schmidtlein, 2013). Researchers use both static least-cost-distance (LCD) and dynamic agent-based models to assess the pedestrian evacuation potential of vulnerable communities. Although both types of models help to understand the evacuation landscape, LCD models provide a more general overview that is independent of population distributions, which may be difficult to quantify given the dynamic spatial and temporal nature of populations (Wood and Schmidtlein, 2012). Recent LCD efforts related to local tsunami threats have focused on an anisotropic (directionally dependent) path distance modeling approach that incorporates travel directionality, multiple travel speed assumptions, and cost surfaces that reflect variations in slope and land cover (Wood and Schmidtlein, 2012, 2013). The Pedestrian Evacuation Analyst software implements this anisotropic path-distance approach for pedestrian evacuation from sudden-onset hazards, with a particular focus at this time on local tsunami threats. The model estimates evacuation potential based on elevation, direction of movement, land cover, and travel speed and creates a map showing travel times to safety (a
, DIC, prolonged PT or PTT. Conclusion: This study confirmed that medical evacuation of missed abortion with vaginal misoprostol is an effective, safe and cost efficient method without any serious complications and can be a suitable alternative to surgery.
Михаил Юрьевич Мухин
Full Text Available The article is devoted to the work of the factories in 1941-1945 in the evacuation. The author analyzes the living conditions of workers in evacuated aviation plants, their daily life, maintenance, etc. The author concludes that in the early years of the War the conditions of life of the aviation industry's workers were very difficult, and the welfare and financial situation improved in 1944, the sure sign of fracture in the Second world war.
... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Cement monomer vapor evacuator. 888.4220 Section... (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Surgical Devices § 888.4220 Cement monomer vapor evacuator. (a) Identification. A cement monomer vapor evacuator is a device intended for use during surgery to contain or remove...
Lim, Limin; Wong, Hungchew; Yong, Euleong; Singh, Kuldip
Teenage abortions predispose women to adverse pregnancy outcomes in subsequent pregnancies such as anemia, stillbirths, preterm deliveries and low birth weight babies. We aim to profile the women presenting for abortions in our institution and determine risk factors for late presentation for abortions. In this retrospective cohort study, all women who underwent an abortion at the National University Hospital, Singapore, from 2005 to 2009 were recruited. Data was obtained from a prepared questionnaire during the mandatory pre-abortion counseling sessions. Profiles of women aged singlehood, nulliparity and lack of prior usage of contraception. Teenagers are more likely to have no prior contraceptive usage and to present late for abortions. Lack of proper sexual education and awareness of contraceptive measures may have a major contributory factor to such a trend in teenage abortions. Recommendations have been made in order to curb this societal problem. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.
Zhou Kang; Li Xiaoguang; Jin Zhengyu; Zhang Xiaobo; Shi Haifeng; Sun Hao; Wang Zhiwei
Objective: To evaluate the clinical outcomes of bilateral uterine artery chemoembolization (UACE) followed by uterine dilation and curettage in treating cesarean scar pregnancy. Methods: A total of 104 patients with cesarean scar pregnancy, admitted to hospital during the period from Jan. 2005 to Jan. 2009, were enrolled in the study. The patients were divided into group A (control group, n=49) and group B (study group, n=55). Patients in group A received uterine dilation and curettage only, and patients in group B received additional UACE, which was performed 24-72 hours before uterine dilation and curettage was carried out. The blood loss during the operation, the time for β-human chorionic gonadotrophin (β-hCG) level going down to normal, the success rate of operation, the hospitalization days, the occurrence of complications and the menstrual situation after operation were documented. The results were analyzed and compared between the two groups. Results: In group A, 4 patients had to receive hysterectomy due to massive hemorrhage or inadequate curettage. None of the patients in group B needed to have a hysterectomy. the technical success rates of curettage for group A and group B were 91.84% and 100%, respectively. The mean blood loss in group B was (54.36±38.09) ml, which was significantly lower than that of (54.36±38.09) ml in group A (P 0.05], while between those patients who had pregnancy time > 10 weeks, the blood loss in group B was much less than that of group A [(101.33±39.43) ml vs. (457.14±97.59) ml, P 0.05]. The difference in hospitalization days between the patients with pregnancy time ≤ 10 weeks in two groups [(11.21±3.24) days vs. (12.68±34.56) days] was not significant (P>0.05). But for patients with pregnancy time > 10 weeks, the hospitalization days of group B was significantly shorter than that of group A (13.46±4.87 days vs. 19.34±5.72 days, P<0.01), Except for 4 patients who had received hysterectomy, all patients regained
Kottow Lang, Miguel Hugo
Voluntarily induced abortion has been under permanent dispute and legal regulations, because societies invariably condemn extramarital pregnancies. In recent decades, a measure of societal tolerance has led to decriminalize and legalize abortion in accordance with one of two models: a more restricted and conservative model known as therapeutic abortion, and the model that accepts voluntary abortion within the first trimester of pregnancy. Liberalization of abortion aims at ending clandestine abortions and decriminalizes the practice in order to increase reproductive education and accessibility of contraceptive methods, dissuade women from interrupting their pregnancy and, ultimately, make abortion a medically safe procedure within the boundaries of the law, inspired by efforts to reduce the incidence of this practice. The current legal initiative to decriminalize abortion in Chile proposes a notably rigid set of indications which would not resolve the three main objectives that need to be considered: 1) Establish the legal framework of abortion; 2) Contribute to reduce social unrest; 3) Solve the public health issue of clandestine, illegal abortions. Debate must urgently be opened to include alternatives in line with the general tendency to respect women's decision within the first trimester of pregnancy.
Ogland, Curtis P; Verona, Ana Paula
This study examines the association between religion and attitudes toward the practice of abortion and abortion policy in Brazil. Drawing upon data from the 2002 Brazilian Social Research Survey (BSRS), we test a number of hypotheses with regard to the role of religion on opposition to the practice of abortion and its legalization. Findings indicate that frequently attending Pentecostals demonstrate the strongest opposition to the practice of abortion and both frequently attending Pentecostals and Catholics demonstrate the strongest opposition to its legalization. Additional religious factors, such as a commitment to biblical literalism, were also found to be significantly associated with opposition to both abortion issues. Ultimately, the findings have implications for the future of public policy on abortion and other contentious social issues in Brazil.
On January 27 and 28, 1989 a workshop and a meeting were organized in Paris by Mouvement Francais pour le Planning Familial (MFPF/France) and the IPPF Europe Region. The workshop was held on the first day. 24 staff and volunteers from Planned Parenthood Associations of 15 countries attended, reviewing abortion laws, the definition of therapeutic abortion, and the incidence and problems of second trimester abortion. Second trimester abortion is available in only a few European countries. Second trimester abortions are rare in France (about 2000 per annum), and in 1986 1717 French women travelled to England in order to seek an abortion. All late abortions are performed for serious reasons. Older women may mistake signs of pregnancy for the onset of the menopause; and women fearful of social or familial punishment, especially teenagers, may be reluctant to consult a doctor. The experiences of Denmark and Sweden, where the problem is partially solved, suggest some strategies: optimize accessibility of contraceptive services, particularly for women at higher risk of late abortion; diminish the taboo surrounding abortion, so that women are less frightened to seek help at an early stage of pregnancy; make abortion services available in all regions of the country; avert time-consuming enforced waiting periods or consent for minors; and stimulate public information campaigns on the importance of seeking help early. On January 28 a meeting involving about 200 participants took place at the Universite Paris Dauphine, Salle Raymond Aron. Speakers at the meeting discussed the issue of late abortion in Europe, the difficulties of obtaining late abortions, counseling, medical problems, the woman's point of view, and possible solutions. At the close of the meeting, the MFPF called on the French government to modify some of the articles in the Penal Code that restrict women's access to safe and legal abortion.
Rahman, Mizanur; DaVanzo, Julie; Razzaque, Abdur
In Bangladesh, both menstrual regulation (MR), which is thought to be a relatively safe method, and abortion, which in this setting is often performed using unsafe methods, are used to terminate pregnancies (known or suspected). However, little is known about changes over time in the use of these methods or their relative mortality risks. Data from the Demographic Surveillance System in Matlab, Bangladesh, on 110,152 pregnancy outcomes between 1989 and 2008 were used to assess changes in mortality risks associated with MR (and a small number of dilation and curettage procedures), abortion and live birth. Tabulation and logistic regression analyses were used to compare outcomes in two areas of Matlab--the comparison area, which receives standard government health and family planning services, and the Maternal and Child Health-Family Planning (MCH-FP) area, which receives enhanced health and family planning services. In Matlab as a whole, the proportion of pregnancies ending in MR increased from 1.9% in 1989-1999 to 4.2% in 2000-2008, while the proportion ending in abortion decreased from 1.6% to 1.1%. The odds of mortality from MR were 4.1 times those from live birth in 1989-1999, but were no longer elevated in 2000-2008. The odds of mortality from abortion were 12.0 and 4.9 times those of live birth in 1989-1999 and 2000-2008, respectively. Reduction in mortality risk was greater in the MCH-FP area than the comparison area (90% vs. 75%). MR is no longer associated with higher mortality risk than live birth in Bangladesh, but abortion is.
Full Text Available Objective. We sought to determine the prevalence of and factors associated with hydatidiform molar gestations amongst patients undergoing uterine evacuation at Mbarara Regional Referral Hospital (MRRH, Mbarara, Uganda. Methods. This was a cross-sectional study carried out from November 2016 to February 2017. All patients admitted for uterine evacuation for nonviable pregnancy were included. The study registered 181 patients. Data were collected on sociodemographics, medical conditions, obstetrics, and gynecological factors. The evacuated tissue received a full gross and histopathologic examination. Cases of pathologically suspected complete hydatidiform mole were confirmed by p57 immunohistochemistry. Data were analyzed using STATA 13. Results. The prevalence of hydatidiform mole was 6.1% (11/181. All detected moles were complete hydatidiform moles, and there were no diagnosed partial hydatidiform moles. Clinical diagnosis of molar pregnancy was suspected in 13 patients, but only 69.2% (9/13 were confirmed as molar pregnancies histologically. Two cases were clinically unsuspected. Factors that had a significant relationship with complete hydatidiform mole included maternal age of 35 years and above (aOR 13.5; CI: 1.46–125.31; p=0.00, gestational age beyond the first trimester at the time of uterine evacuation (aOR 6.2; CI: 1.07–36.14; p=0.04, and history of previous abortion (aOR 4.3; CI: 1.00–18.57; p=0.05. Conclusion. The prevalence of complete hydatidiform mole was high at 6.1%. Associated risk factors included advanced maternal age (35 years and above, history of previous abortions, and gestational age beyond the first trimester at the time of evacuations. Recommendations. We recommend putting in place capacity to do routine histopathological examination of all products of conception especially those at high risk for a molar gestation either by clinical suspicion or by risk factors including advanced maternal age, advanced gestational
Larrea, Sara; Palència, Laia; Perez, Glòria
To analyze reported complications and their treatment after a medical abortion with mifepristone and misoprostol provided by a telemedicine service to women living in Latin America. Observational study based on the registry of consultations in a telemedicine service. A total of 872 women who used the service in 2010 and 2011 participated in the study. The dependent variables were overall complications, hemorrhage, incomplete abortion, overall treatments, surgical evacuation, and antibiotics. Independent variables were age, area of residence, socioeconomic deprivation, previous children, pregnancies and abortions, and week of pregnancy. We fitted Poisson regression models with robust variance to estimate incidence ratios and 95% confidence intervals (95%CI). Complications were reported by 14.6% of the participants: 6.2% reported hemorrhage and 6.8% incomplete abortion. Nearly one-fifth (19.0%) received postabortion treatment: 10.9% had a surgical evacuation and 9.3% took antibiotics. Socioeconomic deprivation increased the risk of complications by 64% (95%CI: 15%-132%), and, among these, the risk of incomplete abortion by 82% (95%CI: 8%-206%) and the risk of surgical intervention by 62% (95%CI: 7%-144%). Previous pregnancies increased the risk of complications and, specifically, the risk of hemorrhage by 2.29 times (95%CI: 1.33-3.95%). Women with a pregnancy of 12 or more weeks had a 2.45 times higher risk of receiving medical treatment and a 2.94 times higher risk of taking antibiotics compared with women with pregnancies of 7 or less weeks. Medical abortion provided by telemedicine seems to be a safe and effective alternative in contexts where it is legally restricted. Copyright © 2014 SESPAS. Published by Elsevier Espana. All rights reserved.
Edwards, R B
This essay seeks to reveal the weakness in arguments against public funding of abortions and abortion counseling in the US based on economic, ethico-religious, anti-racist, and logical-consistency objections and to show that public funding of abortion is strongly supported by appeals to basic human rights, to freedom of speech, to informed consent, to protection from great harm, to justice, and to equal protection under the law. The first part of the article presents the case against public funding with detailed considerations of the economic argument, the ethico/religious argument, the argument that such funding supports racist genocide or eugenic quality control, and arguments that a logical inconsistency exists between the principles used to justify the legalization of abortions and arguments for public funding. The second part of the article presents the case for public funding by discussing the spending of public funds on morally offensive programs, arguments for public funding of abortion counseling for the poor, and arguments for public funding of abortions for the poor. It is concluded that it is morally unacceptable and rationally unjustifiable to refuse to expend public funds for abortions for low income women, because after all most money for legal abortions for the poor comes from welfare payments made to women. If conservative forces want to insure that no public funds pay for abortions, they must stop all welfare payments to pregnant women.
The author reports on current German court rulings on whether non-medically indicated abortions (although not prohibited by law and therefore not actionable) should be financed via the compulsory health insurance scheme or by the Federal Government. 1. The social welfare court at Dortmund ruled that current legislation governing the financing of welfare expenditure violates the Federal German constitution, and has, therefore, referred this matter to the Federal Constitutional Court. However, the Federal Constitutional Court turned down the referral and dismissed the case, since an application for declaring a Federal law null and void can be filed by the Federal Government or by a Federal Land Government or by at least one-third of the total number of members of the Federal German Parliament (Bundestag) only. This means that the current proceedings at the Dortmund social welfare court must continue. The plaintiff pleads to prohibit the compulsory health insurance scheme authorities from defraying the expenses for performing foeticide via legally permitted abortion without medical indication. 2. The Federal Land Government of Baden-Württemberg is the only Land Government of the Federal Republic of Germany that does not grant any financial aid towards performing non-medically indicated (albeit not legally actionable) abortions. Hence, the Baden-Württemberg Administrative Courts turned down the plea filed by a woman government servant towards paying such aid. The court decision was based on the judge's opinion that even the principle of equality before the law guaranteed by the Constitution would not compel the Land Government to emulate the example of the other Land Governments who are agreeable to bearing abortion costs.
Claudia Escobar García
Full Text Available This work explains that the discourses opposing the criminalization ofabortion and that reject the constitutional rules that protect human life,are an artificially constructed ideology made only to justify abortion,and hide the asymmetrical relations of power between women and theunborn. In order for this purpose, these arguments are identified andsubjected to critical analysis, demonstrating that it is purely emotionaland lacking fundaments.
With the improvement of China's urbanization, to ensure people survive the earthquake needs scientific routine emergency evacuation drills. Drawing on cellular automaton, shortest path algorithm and collision avoidance, we designed a model of earthquake emergency evacuation drill for school scenes. Based on this model, we made simulation software for earthquake emergency evacuation drill. The software is able to perform the simulation of earthquake emergency evacuation drill by building spatial structural model and selecting the information of people's location grounds on actual conditions of constructions. Based on the data of simulation, we can operate drilling in the same building. RFID technology could be used here for drill data collection which read personal information and send it to the evacuation simulation software via WIFI. Then the simulation software would contrast simulative data with the information of actual evacuation process, such as evacuation time, evacuation path, congestion nodes and so on. In the end, it would provide a contrastive analysis report to report assessment result and optimum proposal. We hope the earthquake emergency evacuation drill software and trainer can provide overall process disposal concept for earthquake emergency evacuation drill in assembly occupancies. The trainer can make the earthquake emergency evacuation more orderly, efficient, reasonable and scientific to fulfill the increase in coping capacity of urban hazard.
Ma, Yi; Lee, Eric Wai Ming; Shi, Meng
This study investigates the effects of guide-based guidance on the pedestrian evacuation under limited visibility via the simulations based on an extended social force model. The results show that the effects of guides on the pedestrian evacuation under limited visibility are dual, and related to the neighbor density within the visual field. On the one hand, in many cases, the effects of guides are positive, particularly when the neighbor density within the visual field is moderate; in this case, a few guides can already assist the evacuation effectively and efficiently. However, when the neighbor density within the visual field is particularly small or large, the effects of guides may be adverse and make the evacuation time longer. Our results not only provide a new insight into the effects of guides on the pedestrian evacuation under limited visibility, but also give some practical suggestions as to how to assign guides to assist the evacuation under different evacuation conditions.
Intelligent Transportation and Evacuation Planning: A Modeling-Based Approach provides a new paradigm for evacuation planning strategies and techniques. Recently, evacuation planning and modeling have increasingly attracted interest among researchers as well as government officials. This interest stems from the recent catastrophic hurricanes and weather-related events that occurred in the southeastern United States (Hurricane Katrina and Rita). The evacuation methods that were in place before and during the hurricanes did not work well and resulted in thousands of deaths. This book offers insights into the methods and techniques that allow for implementing mathematical-based, simulation-based, and integrated optimization and simulation-based engineering approaches for evacuation planning. This book also: Comprehensively discusses the application of mathematical models for evacuation and intelligent transportation modeling Covers advanced methodologies in evacuation modeling and planning Discusses principles a...
Madsen, Anne; Dederichs, Anne Simone
Fires in hospitals occur, and evacuation of bed-bound patients might be necessary in case of emergency. The current study concerns the evacuation of bed-bound patients from a fire section in a hospital using hospital porters. The simulations are performed using the STEPS program. The aim...... of the study is to investigate the evacuation time of bed-bound hospital patients using different walking speeds from the literature, and the influence of the number of hospital porters on the total evacuation times of bed-bound patients. Different scenarios were carried out with varying staff......-to-patient ratios that simulate the horizontal evacuation of 40 bed-bound patients into a different fire section. It was found that the staff-to-patient-ratio affects the total evacuation times. However, the total evacuation times do not decrease linearly and a saturation effect is seen at a staff-to-patient ratio...
Full Text Available Pet ownership has historically been one of the biggest risk factors for evacuation failure prior to natural disasters. The forced abandonment of pets during Hurricane Katrina in 2005 made national headlines and led to the passage of the Pet Evacuation and Transportation Standards Act (PETS, 2006 which mandated local authorities to plan for companion animal evacuation. Hurricane Irene hit the East Coast of the United States in 2011, providing an excellent opportunity to examine the impact of the PETS legislation on frequency and ease of evacuation among pet owners and non-pet owners. Ninety pet owners and 27 non-pet owners who lived in mandatory evacuation zones completed questionnaires assessing their experiences during the hurricane and symptoms of depression, PTSD, dissociative experiences, and acute stress. Pet ownership was not found to be a statistical risk factor for evacuation failure. However, many pet owners who failed to evacuate continue to cite pet related reasons.
Hunt, Melissa G; Bogue, Kelsey; Rohrbaugh, Nick
Pet ownership has historically been one of the biggest risk factors for evacuation failure prior to natural disasters. The forced abandonment of pets during Hurricane Katrina in 2005 made national headlines and led to the passage of the Pet Evacuation and Transportation Standards Act (PETS, 2006) which mandated local authorities to plan for companion animal evacuation. Hurricane Irene hit the East Coast of the United States in 2011, providing an excellent opportunity to examine the impact of the PETS legislation on frequency and ease of evacuation among pet owners and non-pet owners. Ninety pet owners and 27 non-pet owners who lived in mandatory evacuation zones completed questionnaires assessing their experiences during the hurricane and symptoms of depression, PTSD, dissociative experiences, and acute stress. Pet ownership was not found to be a statistical risk factor for evacuation failure. However, many pet owners who failed to evacuate continue to cite pet related reasons.
Picci, Piero; Sieberova, Gabriela; Alberghini, Marco; Balladelli, Alba; Vanel, Daniel; Hogendoorn, Pancras C.W.; Mercuri, Mario
Background and aim: Rarely sarcomas develop in previous benign lesions, after a long term disease free interval. We report the experience on these rare cases observed at a single Institution. Patients and methods: 12 cases curetted and grafted, without radiotherapy developed sarcomas, between 1970 and 2005, 6.5-28 years from curettage (median 18, average 19). Age ranged from 13 to 55 years (median 30, average 32) at first diagnosis; tumors were located in the extremities (9 GCT, benign fibrous histiocytoma, ABC, and solitary bone cyst). Radiographic and clinic documentation, for the benign and malignant lesions, were available. Histology was available for 7 benign and all malignant lesions. Results: To fill cavities, autogenous bone was used in 4 cases, allograft in 2, allograft and tricalcium-phosphate/hydroxyapatite in 1, autogenous/allograft in 1, heterogenous in 1. For 3 cases the origin was not reported. Secondary sarcomas, all high grade, were 8 osteosarcoma, 3 malignant fibrous histiocytoma, and 1 fibrosarcoma. Conclusions: Recurrences with progression from benign tumors are possible, but the very long intervals here reported suggest a different cancerogenesis for these sarcomas. This condition is extremely rare accounting for only 0.26% of all malignant bone sarcomas treated in the years 1970-2005 and represents only 8.76% of all secondary bone sarcomas treated in the same years. This incidence is the same as that of sarcomas arising on fibrous dysplasia, and is lower than those arising on bone infarcts or on Paget's disease. This possible event must be considered during follow-up of benign lesions.
Soulat, C; Gelly, M
While medical abortion is now available in non hospital facilities, abortions by vacuum aspiration remain illegal in non hospital settings. It is therefore important to assess through the literature the real risks associated with this method. All the most recent and large-scale studies showed that legal abortion by vacuum aspiration is an extremely safe procedure. It is less risky than other medical or surgical procedures performed outside the hospital. According to the studies, the death rate varies from 0 to 0.7 per 100,000 abortions, and is smaller when the procedure is done under local anesthesia than general anesthesia. The overall early complication rate (hemorrhage, uterine perforation, cervical injury) is between 0.01 and 1.16%. Complications are not more frequent than with medical abortions. In view of these low complication rates, surgical abortion by vacuum aspiration could be performed outside the hospital setting in France, as it is the case in many other countries.
Shoesmith, Gary L.
This article disaggregates Donohue and Levitt’s (DL’s) national panel-data models to the state level and shows that high concentrations of teenage abortions in a handful of states drive all of DL’s results in their 2001, 2004, and 2008 articles on crime and abortion. These findings agree with previous research showing teenage motherhood is a major maternal crime factor, whereas unwanted pregnancy is an insignificant factor. Teenage abortions accounted for more than 30% of U.S. abortions in the 1970s, but only 16% to 18% since 2001, which suggests DL’s panel-data models of crime/arrests and abortion were outdated when published. The results point to a broad range of future research involving teenage behavior. A specific means is proposed to reconcile DL with previous articles finding no relationship between crime and abortion. PMID:28943645
Cutter, S; Barnes, K
The responses of the residents to the nuclear power plant arcident at Three Mile Island, Pennsylvania illustrate the factors influencing pre-impact coping responses of populations exposed to technological hazards. Confusion itnd ambiguous information influenced both the decision to evaluate and to remain in place. Proximity to the facility, stage in life cycle and the actions of friends and neighbors influenced the decision to evacuate.
Informed consent mandates for abortion providers may infringe the First Amendment's freedom of speech. On the other hand, they may reinforce the physician's duty to obtain informed consent. Courts can promote both doctrines by ensuring that compelled physician speech pertains to medical facts about abortion rather than abortion ideology and that compelled speech is truthful and not misleading. © 2015 American Society of Law, Medicine & Ethics, Inc.
This thesis deals with ethical aspects of abortion. In the theoretical part, I focus first on the definition of the term abortion and its legal history. I also follow the use and development of contraception and review certain legal and medical conditions necessary for performing the procedure. I try to define ethics, discuss moral judgment and some ethical concepts. I list some of the groups fighting for the annulment of law that legalizes abortion in the Czech Republic. Further, I turn my a...
Miscarriage is an important cause of morbidity and mortality especially in developing countries. Traditionally, miscarriage is treated by surgical curettage. Misoprostol has been introduced in recent years for treatment of miscarriage. In this review, we systematically searched for and combined the evidence from randomized ...
Full Text Available Cyber-Physical-Human Systems (CPHS combine sensing, communication and control to obtain desirable outcomes in physical environments for human beings, such as buildings or vehicles. A particularly important application area is emergency management. While recent work on the design and optimisation of emergency management schemes has relied essentially on discrete event simulation, which is challenged by the substantial amount of programming or reprogramming of the simulation tools and by the scalability and the computing time needed to obtain useful performance estimates, this paper proposes an approach that offers fast estimates based on graph models and probability models. We show that graph models can offer insight into the critical areas in an emergency evacuation and that they can suggest locations where sensor systems are particularly important and may require hardening. On the other hand, we also show that analytical models based on queueing theory can provide useful estimates of evacuation times and for routing optimisation. The results are illustrated with regard to the evacuation of a real-life building.
Fergus, R.W.; Moe, H.J. Sr.
At Argonne National Laboratory, criticality alarms are required at widely separated locations to evacuate personnel in case of accident while emergency teams or maintenance personnel respond from a central location. The system functions have been divided in a similar manner. The alarm site hardware can independently detect a criticality and sound the evacuation signal while general monitoring and routine tests are handled by a communication link to a central monitoring station. The radiation detectors and evacuation sounders at each site are interconnected by a common two conductor cable in a unique telemonitoring format. This format allows both control and data information to be received or transmitted at any point on the cable which can be up to 3000 meters total length. The site microprocessor maintains a current data table, detects several faults, drives a printer, and communicates with the central telemonitoring station. The radiation detectors are made with plastic scintillators and photomultiplier tubes operated in a constant current mode with a 4 decade measurement range. The detectors also respond within microseconds to the criticality radiation burst. These characteristics can be tested with an internal light emitting diode either completely with a manual procedure or routinely with a system test initiated by the central monitoring station. Although the system was developed for a criticality alarm which requires reliable and redundant features, the basic techniques are useable for other monitoring and instrumentation applications
Every year fire evacuation exercises are organized through out CERN and our facility's Kindergarten is no exception. Just a few weeks ago, a fire simulation was carried out in the Kindergarten kitchen facility using synthetic smoke. The purpose of the exercise was to teach staff to react in a disciplined and professional manner when in the presence of danger. The simulation is always carried out at a random time so as to ensure that people in the area under the test are not aware of the exercise. For the Kindergarten the exercise was held early in the school year so as to train those who are new to the establishment. The evacuation was a complete success and all went as it was supposed to. When the children and teachers smelt smoke they followed the prescribed evacuation routes and left the building immediately. Once outside the situation was revealed as an exercise and everyone went back to business as usual, everyone that is, except the fire brigade and fire inspector. The fire brigade checked that the buil...
Feng Chenxia; Zhou Weimin; Leng Yongbin
Beam abort signal is a timing signal of the SSRF (Shanghai Synchrotron Radiation Facility) storage ring. It is used to synchronize BPM processor Libera logging beam position data to identify beam abort source and improve the stability of accelerator. The concept design and engineering design of beam abort trigger module are introduced in this paper, and lab test results of this module using RF signal source also presented. Online beam test results show that this module has achieved design goal, could be used to log beam position data before beam abort. (authors)
Dalvie, Suchitra S
This article gives an overview of what is known about second trimester abortions in India, including the reasons why women seek abortions in the second trimester, the influence of abortion law and policy, surgical and medical methods used, both safe and unsafe, availability of services, requirements for second trimester service delivery, and barriers women experience in accessing second trimester services. Based on personal experiences and personal communications from other doctors since 1993, when I began working as an abortion provider, the practical realities of second trimester abortion and case histories of women seeking second trimester abortion are also described. Recommendations include expanding the cadre of service providers to non-allopathic clinicians and trained nurses, introducing second trimester medical abortion into the public health system, replacing ethacridine lactate with mifepristone-misoprostol, values clarification among providers to challenge stigma and poor treatment of women seeking second trimester abortion, and raising awareness that abortion is legal in the second trimester and is mostly not requested for reasons of sex selection.
Gipson, Jessica D.; Becker, Davida; Mishtal, Joanna Z.; Norris, Alison H.
Nearly 20% of the 208 million pregnancies that occur annually are aborted. More than half of these (21.6 million) are unsafe, resulting in 47,000 abortion-related deaths each year. Accurate reports on the prevalence of abortion, the conditions under which it occurs, and the experiences women have in obtaining abortions are essential to addressing unsafe abortion globally. It is difficult, however, to obtain accurate and reliable reports of attitudes and practices given that abortion is often ...
AJRH Managing Editor
Department of Population, Family and Reproductive Health, School of Public health, University of Ghana, Legon, Accra,. Ghana1 ... years in two districts in Ghana, this paper examines disparities in women's experiences of abortion and access to safe abortion care. ..... cultural and religious attitudes towards induced.
Bettahar, K; Pinton, A; Boisramé, T; Cavillon, V; Wylomanski, S; Nisand, I; Hassoun, D
Updated clinical recommendations for medical induced abortion procedure. A systematic review of French and English literature, reviewing the evidence relating to the provision of medical induced abortion was carried out on PubMed, Cochrane Library and international scientific societies recommendations. The effectiveness of medical abortion is higher than 95% when the protocols are adjusted to gestational age (EL1). Misoprostol alone is less effective than a combination of mifepristone and misoprostol (EL1). Gemeprost is less effective than misoprostol (EL2). The dose of 200mg of mifepristone should be preferred to 600mg (NP1, Rank A). Mifepristone can be taken at home (professional agreement). The optimum interval between mifepristone and misoprostol intake should be 24 to 48 hours (EL1, grade A). Before 7 weeks LMP, the dose of 400μg misoprostol should be given orally (EL1, grade A) eventually repeated after 3hours if no bleeding occurs. For optimal effectiveness between 7 and 14 LMP, the interval between mifepristone and misoprostol should not be shortened to less than 8hours (grade 1). An interval of 24 to 48hours will not affect the effectiveness of the method provided misoprostol dosage is 800μg (EL1). Vaginal, sublingual or buccal routes of administration are more effective and better tolerated than the oral route, which should be abandoned (EL1). An amount of 800μg sublingual or buccal misoprostol route has the same effectiveness than the vaginal route but more gastrointestinal side effects (EL1, grade A). Between 7 and 9 LMP, it does not seem necessary to repeat misoprostol dose whereas it should be repeated beyond 9 SA (grade B). Between 9 and 14 LMP, the dose of 400μg misoprostol given either vaginally, buccally or sublingually should be repeated every 3hours if needed (with a maximum of 5 doses) (EL2, grade B). There is no strong evidence supporting routine antibiotic prophylaxis for medical abortion (professional agreement). Rare contraindications
Full Text Available Objective: Total intravenous anesthesia for uterine curettage with propofol is common in practice. Narcotics are used to decrease movement due to pain during the procedure. But narcotics may cause hypotension, hypoven- tilation, bradycardia, desaturation and apnea. We hypothesized that the use of ketamine instead of fentanyl can reduce the incidence of patients’ movement and other complications mentioned above. Methods: Eighty-four patients were enrolled into the study. The patients were randomized in to 2 groups: Fentanyl group (Propofol+Fentanyl and Ketamine group (Propofol+Ketamine. Low dose of ketamine (0.3 mg/kg or fentanyl (1 mcg/kg was injected, followed by propofol 1.5 mg/kg, then uterine curettage was started along with propofol infusion of 5 mg/kg/hr. Patients’ movement, respiratory rate, blood pressure, and O2 saturation were recorded every minute. After the procedure, the emergence duration and surgeon’s satisfaction were recorded. The incidence of nausea/vomiting, dizziness and any other complaints were recorded for 24 hours postoperatively. Results: There was no significant difference in patient’s movement, surgeon’s satisfaction and emergence dura- tion between the two groups. Patients in ketamine group significantly showed lower incidences of respiratory depression as shown by less requirement of airway manipulation with assisted ventilation, and lower incidences of hypotension than patients in the fentanyl group (2.4% vs. 19%, p=0.029 and 7.2% vs. 52.4%, p<0.01, respectively. Conclusion: The use of low dose ketamine with propofol in patients having uterine curettage can cause less hy- potension and less respiratory depression than using fentanyl with propofol, without any difference in patients’ movements and emergence from anesthesia.
Ma, Yi; Lee, Eric Wai Ming; Shi, Meng
This study investigates the effects of guide-based guidance on the pedestrian evacuation under limited visibility via the simulations based on an extended social force model. The results show that the effects of guides on the pedestrian evacuation under limited visibility are dual, and related to the neighbor density within the visual field. On the one hand, in many cases, the effects of guides are positive, particularly when the neighbor density within the visual field is moderate; in this case, a few guides can already assist the evacuation effectively and efficiently. However, when the neighbor density within the visual field is particularly small or large, the effects of guides may be adverse and make the evacuation time longer. Our results not only provide a new insight into the effects of guides on the pedestrian evacuation under limited visibility, but also give some practical suggestions as to how to assign guides to assist the evacuation under different evacuation conditions. - Highlights: • Extended social force model is used to simulate guided pedestrian evacuation. • Effects of guides on pedestrian evacuation under limited visibility are dual. • Effects of guides on pedestrian evacuation under limited visibility are related to neighbor density within visual field.
Full Text Available The key purpose of this paper is to demonstrate that optimization of evacuation warnings by time period and impacted zone is crucial for efficient evacuation of an area impacted by a hurricane. We assume that people behave in a manner consistent with the warnings they receive. By optimizing the issuance of hurricane evacuation warnings, one can control the number of evacuees at different time intervals to avoid congestion in the process of evacuation. The warning optimization model is applied to a case study of Hurricane Sandy using the study region of Brooklyn. We first develop a model for shelter assignment and then use this outcome to model hurricane evacuation warning optimization, which prescribes an evacuation plan that maximizes the number of evacuees. A significant technical contribution is the development of an iterative greedy heuristic procedure for the nonlinear formulation, which is shown to be optimal for the case of a single evacuation zone with a single evacuee type case, while it does not guarantee optimality for multiple zones under unusual circumstances. A significant applied contribution is the demonstration of an interface of the evacuation warning method with a public transportation scheme to facilitate evacuation of a car-less population. This heuristic we employ can be readily adapted to the case where response rate is a function of evacuation number in prior periods and other variable factors. This element is also explored in the context of our experiment.
Bastit i Costa, M A
Abortion is the termination of pregnancy prior to the 180th day, during which time the fetus is not yet viable outside the womb. Spontaneous abortion is the body's expulsion of a fetus during the 1st months of pregnancy. It is usually not very painful, does not involve much bleeding, and is rarely complicated by infection. Spontaneous abortion is much more frequent at the outset of pregnancy and may occur unnoticed. Its causes are unknown in over half of cases. The most important causes are developmental problems in the products of conception. Causes of spontaneous abortions of maternal etiology are most frequently uterine malposition or malformation. Serious illness in the mother is a less common cause of spontaneous abortion than once believed. Induced abortion is caused by the destruction of a normally implanted and healthy embryo. Its complications are related to the amount of bleeding or the introduction of germs from outside which can spread rapidly. Placental retention is a danger of all induced abortions. Induced abortion is common and in some countries it even creates demographic problems. Abortion is legal in many countries as an expression of the right to choose, but in others it is only legal on therapeutic grounds. Defenders and detractors of abortion have written extensively about it, with some works being sincere and some only tactical. The great majority of moralists are opposed to abortion, while biologists and scientists are divided on the question. The Spanish penal code punishes all persons who cause the death of a fetus or impede the process of gestation. The Catholic Church has considered abortion a homicide and against divine and natural laws. Legal or illegal, it is certain that the number of abortions increases each day. In the face of this reality, the need is for measures to avoid abortion whenever possible. Sex education in schools, full information on contraceptive methods and creation of family planning centers are some means of
Di Nucci, Ezio
This paper shows that the counterexamples proposed by Strong in 2008 in the Journal of Medical Ethics to Marquis's argument against abortion fail. Strong's basic idea is that there are cases--for example, terminally ill patients--where killing an adult human being is prima facie seriously morally......'s scenarios have some valuable future or admitted that killing them is not seriously morally wrong. Finally, if "valuable future" is interpreted as referring to objective standards, one ends up with implausible and unpalatable moral claims....
A state of the art of surgical method of abortion focusing on safety and practical aspects. A systematic review of French-speaking or English-speaking evidence-based literature about surgical methods of abortion was performed using Pubmed, Cochrane and international recommendations. Surgical abortion is efficient and safe regardless of gestational age, even before 7 weeks gestation (EL2). A systematic prophylactic antibiotics should be preferred to a targeted antibiotic prophylaxis (grade A). In women under 25 years, doxycycline is preferred (grade C) due to the high prevalence of Chlamydia trachomatis. Systematic cervical preparation is recommended for reducing the incidence of complications from vacuum aspiration (grade A). Misoprostol is a first-line agent (grade A). When misoprostol is used before a vacuum aspiration, a dose of 400 mcg is recommended. The choice of vaginal route or sublingual administration should be left to the woman: (i) the vaginal route 3 hours before the procedure has a good efficiency/safety ratio (grade A); (ii) the sublingual administration 1 to 3 hours before the procedure has a higher efficiency (EL1). The patient should be warned of more common gastrointestinal side effects. The addition of mifepristone 200mg 24 to 48hours before the procedure is interesting for pregnancies between 12 and 14 weeks gestations (EL2). The systematic use of nonsteroidal anti-inflammatory drugs is recommended for limiting the operative and postoperative pain (grade B). Routine vaginal application of an antiseptic prior to the procedure cannot be recommended (grade B). The type of anesthesia (general or local) should be left up to the woman after explanation of the benefit-risk ratio (grade B). Paracervical local anesthesia (PLA) is recommended before performing a vacuum aspiration under local anesthesia (grade A). The electric or manual vacuum methods are very effective, safe and acceptable to women (grade A). Before 9 weeks gestation
Full Text Available BACKGROUND Abnormal uterine bleeding is defined as any bleeding not conforming to the normal cyclical pattern as well as to the normal amount and frequency of menstrual cycle. Abnormal uterine bleeding can occur due to gynaecological as well as medical causes. Gynaecological causes include organic and nonorganic factors. It has various clinical presentations such as menorrhagia, polymenorrhagia, metrorrhagia and intermenstrual bleeding. Dilatation and Curettage (D and C is a safe and effective outpatient procedure performed in patients with AUB. It provides endometrial tissue for examination of histological variations of endometrium thus guiding in further management. MATERIALS AND METHODS This is a retrospective study of patients presenting with AUB over a period of one year (2015-2016 done in the Department of Obstetrics and Gynaecology at a tertiary care hospital. 89 patients with complaints of AUB attributable to isolated endometrial cause were included in the study. Patients with AUB due to vaginal, cervical causes, leiomyomas, adnexal pathology, medical causes and complications of pregnancy were excluded from the study. A structured proforma regarding the patient’s complaints, pattern of bleeding, medical, surgical history and a general systemic and pelvic examination was used to evaluate all patients. RESULTS Among all the patients who presented with AUB during the study period, 89 patients were identified to have isolated endometrial pathology as a cause of abnormal uterine bleeding. In our study, age of patients presenting with AUB ranged from 24 years to 70 years. AUB was most commonly seen in the age group of 41-50 years (42.6%. Menorrhagia in 32.5% was the most common presentation of AUB. The commonest histopathological finding was proliferative phase endometrium (25.84% followed by secretory phase endometrium (19.1%. Hyperplasia was observed in 19.1%, which included simple hyperplasia (6.74%, complex hyperplasia without atypia in
Fatima, Nishat; Ahmed, S H; Salhan, Sudha; Rehman, S M F; Kaur, Jatinder; Owais, M; Chauhan, Shyam S
We investigated the expression of methyl transferase G9a and methylated histone H3-K9 in fresh human decidual/endometrial tissue of 12 normal early pregnancies and 15 unexplained recurrent spontaneous abortions (URSA). The samples were obtained through dilatation and curettage and collected as per strict inclusion-exclusion criteria. The tissue was subjected to immunohistochemical analysis (IHC), western blotting (WB) and RT-PCR analysis. The results demonstrated methyl transferase G9a to have a lower expression in abortions when compared with that in normal pregnancy (P K9 was significantly lower (P < 0.0001) in URSA tissues than in controls. This study suggests that methylation may cause URSA and indicates the need for further work to explore the role of methylation in URSA and its possible prevention through locally acting methylating/demethylating agents.
Aug 14, 1971 ... elhlcal, legal, religious, social, demographic and humanitarian, ... REASONS FOR CHANGING THE LAW. Criminal Abortion. One of the main arguments in favour of legalizing abortion and of extending ·its indications is that the present .... asking a new attitude of us: that we honestly face and assume.
Fadale, Vincent E.; And Others
This transcript is the result of panel presentation given on the implications of liberalized abortion laws for counselors. A new law which went into effect in July, 1970, in New York State presented women with the option of obtaining a legal abortion up to the 24th week of pregnancy. Counselors in New York State were, therefore, presented with new…
Culwell, Kelly R; Hurwitz, Manuelle
The latest World Health Organization data estimate that the total number of unsafe abortions globally has increased to 21.6 million in 2008. There is increasing recognition by the international community of the importance of the contribution of unsafe abortion to maternal mortality. However, the barriers to delivery of safe abortion services are many. In 68 countries, home to 26% of the world's population, abortion is prohibited altogether or only permitted to save a woman's life. Even in countries with more liberal abortion legal frameworks, additional social, economic, and health systems barriers and the stigma surrounding abortion prevent adequate access to safe abortion services and postabortion care. While much has been achieved to reduce the barriers to comprehensive abortion care, much remains to be done. Only through the concerted action of public, private, and civil society partners can we ensure that women have access to services that are safe, affordable, confidential, and stigma free. Copyright © 2013 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.
Korejo, R.; Noorani, K.J.; Bhutta, S.
Objective: To determine the frequency of induced abortion and identity the role of sociocultural factors contributing to termination of pregnancy and associated morbidity and mortality in hospital setting. Subjects and Methods: The patients who were admitted for induced abortion were interviewed in privacy. On condition of anonymity they were asked about the age, parity, family setup and relationships, with particular emphasis on sociocultural reasons and factors contributing to induction of abortion. Details of status of abortionist and methods used for termination of pregnancy, the resulting complications and their severity were recorded. Results: Out of total admissions, 57(2.35%) gave history of induced abortion. All women belonged to low socioeconomic class and 59.6% of them were illiterate. Forty-three (75.5%) of these women had never practiced concentration. Twenty-four (42%) were grandmultiparae and did not want more children. In 29 women (50.9%) the decision for abortion had been supported by the husband. In 25 (43.8%) abortion was carried out by Daiyan (traditional midwives). Serious complications like uterine perforation with or without bowel injury were encouraged in 25 (43.8%) of these women. During the study period illegally induced abortion accounted for 6 (10.5%) maternal deaths. Conclusion: Prevalence of poverty, illiteracy, grand multiparity and non-practice of contraception are strong determinants of induced abortion. (author)
Newton, Danielle; Bayly, Chris; McNamee, Kathleen; Hardiman, Annarella; Bismark, Marie; Webster, Amy; Keogh, Louise
Depending on availability, many Australian women seeking an abortion will be faced with the choice between surgical or medical abortion. Little is known about the factors that influence Australian women's choice of method. Through the perspectives of abortion service providers, this study aimed to explore the factors that contribute to Australian women's decision to have a surgical or medical abortion. In 2015, in-depth interviews were conducted with fifteen Victorian-based key informants (KIs) directly providing or working within a service offering medical abortion. Ten KIs were working at a service that also provided surgical abortion. Interviews were semi-structured, conducted face-to-face or over the telephone, transcribed verbatim and analysed thematically. KIs described varying levels of awareness of medical abortion, with poorer awareness in regional areas. When it comes to accessing information, women were informed by: their own research (often online); their own experiences and the experiences of others; and advice from health professionals. Women's reasons for choosing surgical or medical abortion range from the pragmatic (timing and location of the method, support at home) to the subjective (perceived risk, emotional impact, privacy, control, and physical ability). Women benefit from an alternative to surgical abortion and are well-placed to choose between the two methods, however, challenges remain to ensure that all women are enabled to make an informed choice. KIs identify the need to: promote the availability of medical abortion; address misconceptions about this method; and increase general practitioner involvement in the provision of medical abortion. © 2016 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.
This SpringerBrief focuses on the use of egress models to assess the optimal strategy for total evacuation in high-rise buildings. It investigates occupant relocation and evacuation strategies involving the exit stairs, elevators, sky bridges and combinations thereof. Chapters review existing information on this topic and describe case study simulations of a multi-component exit strategy. This review provides the architectural design, regulatory and research communities with a thorough understanding of the current and emerging evacuation procedures and possible future options. A model case study simulates seven possible strategies for the total evacuation of two identical twin towers linked with two sky-bridges at different heights. The authors present the layout of the building and the available egress components including both vertical and horizontal egress components, namely stairs, occupant evacuation elevators (OEEs), service elevators, transfer floors and sky-bridges. The evacuation strategies employ a ...
Lipper, Irene; Cvejic, Helen; Benjamin, Peter; Kinch, Robert A.
A study was carried out at the Adolescent Unit of The Montreal Children's Hospital from September 1970 to December 1972, the focus of which evolved from the pregnant teenager in general to the short- and long-term effects of her abortion. Answers to a questionnaire administered to 65 pregnant girls to determine the psychosocial characteristics of the pregnant teenager indicated that these girls are not socially or emotionally abnormal. A follow-up study of 50 girls who had an abortion determined that the girls do not change their life styles or become emotionally unstable up to one year post-abortion, although most have a mild, normal reaction to the crisis. During the study period the clinic services evolved from mainly prenatal care to mainly abortion counselling, and then to providing the abortion with less counselling, placing emphasis on those cases which require other than medical services. PMID:4750298
Henshaw, S K
This article presents current estimates of the number, rate, and proportion of abortions for all countries which make such data available. 76% of the world's population lives in countries where induced abortion is legal at least for health reasons. Abortion is legal in almost all developed countries. Most developing countries have some laws against abortion, but it is permitted at least for health reasons in the countries of 67% of the developing world's population. The other 33%--over 1 billion persons--reside mainly in subSaharan Africa, Latin America, and the most orthodox Muslim countries. By the beginning of the 20th century, abortion had been made illegal in most of the world, with rules in Africa, Asia, and Latin America similar to those in Europe and North America. Abortion legislation began to change first in a few industrialized countries prior to World War II and in Japan in 1948. Socialist European countries made abortion legal in the first trimester in the 1950s, and most of the industrialized world followed suit in the 1960s and 1970s. The worldwide trend toward relaxed abortion restrictions continues today, with governments giving varying reasons for the changes. Nearly 33 million legal abortions are estimated to be performed annually in the world, with 14 million of them in China and 11 million in the USSR. The estimated total rises to 40-60 million when illegal abortions added. On a worldwide basis some 37-55 abortions are estimated to occur for each 1000 women aged 15-44 years. There are probably 24-32 abortions per 100 pregnancies. The USSR has the highest abortion rate among developed countries, 181/1000 women aged 15-44, followed by Rumania with 91/1000, many of them illegal. The large number of abortions in some countries is due to scarcity of modern contraception. Among developing countries, China apparently has the highest rate, 62/1000 women aged 15-44. Cuba's rate is 59/1000. It is very difficult to calculate abortion rates in countries
Wiebe, E R; Trouton, K J; Fielding, S L; Grant, H; Henderson, A
To examine the differences in anxiety levels and attitudes towards abortion between women having an early medical abortion and women having a surgical (manual vacuum aspiration) abortion. Women who presented for an early medical abortion or a surgical abortion at an urban, free-standing abortion clinic were invited to participate in this study. Fifty-nine women having a medical abortion and 43 women having a surgical abortion answered questionnaires before their scheduled abortion, and again 2 to 4 weeks after the abortion. Thirty women were interviewed about their answers. Anxiety levels were similar in both groups before the abortion procedure. Anti-choice views about abortion were seen in 60.5% of women having a medical abortion and in 37.3% of women having a surgical abortion (P = .027). Women who were pro-choice had a mean anxiety score of 5.0 (range, 0-10) before and 2.7 after the abortion, whereas women who were anti-choice had a mean anxiety score of 5.2 before and 4.4 after the abortion (P = .005). It is important for providers of abortion care to understand that women undergoing a medical abortion may be more ambivalent about abortion than women undergoing a surgical abortion, and women who are anti-choice but having an abortion may have unresolved anxiety after the procedure.
Hanschmidt, Franz; Linde, Katja; Hilbert, Anja; Riedel-Heller, Steffi G; Kersting, Anette
Although stigma has been identified as a potential risk factor for the well-being of women who have had abortions, little attention has been paid to the study of abortion-related stigma. A systematic search of the databases Medline, PsycArticles, PsycInfo, PubMed and Web of Science was conducted; the search terms were "(abortion OR pregnancy termination) AND stigma * ." Articles were eligible for inclusion if the main research question addressed experiences of individuals subjected to abortion stigma, public attitudes that stigmatize women who have had abortions or interventions aimed at managing abortion stigma. To provide a comprehensive overview of this issue, any study published by February 2015 was considered. The search was restricted to English- and German-language studies. Seven quantitative and seven qualitative studies were eligible for inclusion. All but two dated from 2009 or later; the earliest was from 1984. Studies were based mainly on U.S. samples; some included participants from Ghana, Great Britain, Mexico, Nigeria, Pakistan, Peru and Zambia. The majority of studies showed that women who have had abortions experience fear of social judgment, self-judgment and a need for secrecy. Secrecy was associated with increased psychological distress and social isolation. Some studies found stigmatizing attitudes in the public. Stigma appeared to be salient in abortion providers' lives. Evidence of interventions to reduce abortion stigma was scarce. Most studies had limitations regarding generalizability and validity. More research, using validated measures, is needed to enhance understanding of abortion stigma and thereby reduce its impact on affected individuals. Copyright © 2016 by the Guttmacher Institute.
The application of a simple evacuation model to the prediction of expected population exposures following acute releases of activity to the atmosphere is described. The evacuation model of Houston is coupled with a normalized Gaussian dispersion calculation to estimate the time integral of population exposure. The methodology described can be applied to specific sites to determine the expected reduction of population exposures due to evacuation
He Xiaomei; Wang Yuping; Wang Lisha; Yang Jingxiu; Gao Xueyan
Objective: To investigate the value of detection of HPL-expressing intermediate trophoblasts in endometrial specimens for diagnosis of intrauterine and ectopic pregnancies. Methods: The examined specimens included: (1) Group I, 35 specimens with suspected intermediate trophoblast in decidua (2) Group II, 30 specimens with decidua-like plump endometrial stroma cells and/ or A-S phenomena in glandular epithelium (3) 30 specimens from proven intrauterine pregnancies serving as controls. Histochemistry (SP method) was used for HPL detection in all these specimens. Results: In the 30 proven intrauterine pregnancies, decidua and villa were present in all the specimens. Only 24 of the 30 were found to be HPL(+) with 6 HPL negatives (20%). In Group I , 28 of the 35 specimens were found to be HPL(+) and all of 28 were from intrauterine pregnancies: Of the 7 HPL negative cases, 5 were later confirmed as with ectopic pregnancy, the remaining 2 were with intrauterine pregnancy. In Group II, 22 of 30 specimens were HPL(+) and all were from intrauterine pregnancy. Of the 8 HPL negative cases, 6 were later confirmed as with ectopic pregnancy and 2 were with intrauterine pregnancy. Combining the data from Group I and II, we could see that in the total 15 HPL negative cases, 11 were with ectopic pregnancy (11/15=73.3%) and 4 were with intrauterine pregnancy (4/15=26.7%). Conclusion: In specimens of intrauterine contents, demonstration of HPL (+) cells could be regarded as confirmative evidence of intrauterine pregnancy. However, the reverse did not hold true. Many of the HPL negative specimens were from intrauterine pregnancies (in this study 4/15 or 26.7%). Therefore, in HPL negative cases, there was a high possibility of ectopic pregnancy but further examinations were required to ascertain the diagnosis. (authors)
Zeev Blumenfeld M.D.
Full Text Available Background Medical termination of pregnancy [TOP] during the early first trimester is commonly used. However, treatment failure which warrants surgical intervention occurs in small proportion of patients. Our objective was to examine the effectiveness and predictive value of sonographic measurement of endometrial thickness during a follow up visit after medical abortion as an accurate predictor of the necessity of curettage for completion of pregnancy termination. Methods Women who opted for medical TOP where treated by single dose of RU486 followed by a single dose of misoprostol. Endometrial thickness was evaluated by transvaginal U.S. at 14 days after misoprostol tretament. The data was collected prospectively for this cohort study which includes all the women undergoing medical abortion in the first seven weeks of gestation. Results In 34.7% of the patients the endometrial width was > 11 mm on the follow-up visit. Surgical intervention was performed in 18% of these patients, for a failure rate of the medical termination of pregnancy [TOP] of 6.25%, as compared with no failure rate in those with endometrium 12 mm the failure was 5.9%. In cases where the endometrium was 12-13 mm the failure rate was 27.3%, and if >13 mm the failure was 18.9%. When the endometrium was 13-14 mm the failure rate was 10%, and when >14 mm the failure was 23.7%. Half of the 18 patients who had undergone dilatation and curettage [D&C] for completion of the TOP, had endometrium > 14 mm, one to two weeks after the medical abortion. Conclusion Measurement of endometrial width after medical TOP is beneficial in segregating patient to low or high risk for surgical treatment of retained product of conception [POC]. Using a cutoff of 11 mm during the follow-up visit after medical TOP, 18% of the patients may need dilatation and curettage to complete the pregnancy termination, and if it is >14 mm, half of them may need surgical intervention. There is no difference between 11
Full Text Available The article is a preliminary to a modification concept of the sliding watertight bulkhead door used on ships and vessels. Hydraulic or electro-hydraulic drives used to move these doors require complicated and extended pressure installations with large amounts of hydraulic fluid. Well-known operational drawbacks of these installations include high level of noise and possibility of various leaks in the hydraulic system. Being the first in a series, the present article describes and analyses critical states which can take place during evacuation of people through openings in the watertight bulkhead doors on seagoing ships and vessels.
Ganer Herman, Hadas; Kerner, Ram; Gluck, Ohad; Feit, Hagit; Keidar, Ran; Bar, Jacob; Sagiv, Ron
To compare effectiveness and patient satisfaction of different routes of misoprostol for short-term (same day) cervical priming in first trimester surgical abortions. In a blind randomized trial, patients undergoing surgical abortion at a gestational age of 6 + 0-14 + 6 were administered oral, vaginal, or sub-lingual 400 mcg misoprostol, 1.5 to 4 h prior to procedure. Surgeons blinded to patient allocation evaluated cervical priming. The primary outcome was initial cervical dilatation. Secondary outcomes were cervical consistency, ease of dilation, patient discomfort, and side effects. From July 2015 through May 2016, 120 patients were randomized as follows: 40 to oral, 40 to vaginal, and 40 to sublingual misoprostol administration. No differences were noted in patient age, gestational age, curettage indication (termination/delayed miscarriage), past vaginal delivery, and administration to procedure interval. Initial cervical dilatation was similar between the groups, as were cervical consistency and ease of dilation. Patients noted the greatest discomfort and side effects with sublingual administration. The followings were found to be independently associated with cervical dilatation in a linear regression analysis: sublingual administration, gestational age, missed abortion, and previous vaginal delivery. Side effects and administration to procedure interval were found non-significant. The same day cervical priming for first trimester surgical abortion is similarly achieved with all routes of misoprostol administration. In cases of termination of pregnancy with no prior vaginal delivery, sublingual administration may be considered, but entails a higher rate of side effects and patient discomfort.
Full Text Available One of the basic prerequisites for securing the safety of people at large group events is to ensure their evacuation in case of emergencies. This article deals with the approximations of time to initiate the evacuation of persons in case of a fire at large group events organized in outdoor spaces. The solution is based on the principles of determining the period to initiate the evacuation of persons in terms of international ISO standards. Considering the specificities of the given outdoor space and possible related security measures, the article recommends the relevant sufficient amount of time to initiate an evacuation.
Laban Mirjana Đ.
Full Text Available Residential buildings, public and business facilities with large number of occupants are particularly exposed to the risk of event with catastrophic consequences, especially in case of fire. Evacuation routes must be separated fire compartments with surfaces made of non-combustible materials. Safe evacuation of building occupants in case of fire is a crucial requirement for the preservation of human life in building. In our engineering practice, calculation model is usually applied in order to determine the time required for evacuation (SRPS TP 21. However, evacuation simulation models are more present in research papers, contributing to better assessment of flow of evacuation in the real time. These models could provide an efficient way of testing the safety of a building in the face of fire and indicate critical points at the evacuation paths. Computer models enable the development and analysis of multiple various scenarios during a fire event, contributing to defining the measures for improving the safety of the building in case of fire. This paper analyses the fulfilment of technical requirements for the safe evacuation and proposes improvement measures based on a comparative analysis of the time required for occupants' evacuation from the building (Department of Civil Engineering and Geodesy in Novi Sad, obtained by calculation model and by using evacuation simulation software.
Full Text Available More and more high rising buildings emerged in modern cities, but emergency evacuation of tall buildings has been a worldwide difficult problem. In this paper, a new evacuation device for high rising buildings in fire accident was proposed and studied. This device mainly consisted of special spiral slideway and shunt valve. People in this device could fast slide down to the first floor under gravity without any electric power and physical strength, which is suitable for various emergency evacuation including mobility-impaired persons. The plane simulation test has shown that human being in alternative clockwise and counterclockwise movement will not become dizzy. The evacuated people should wear protection pad, which can prevent slider from being injured by surface friction with the slide, and eliminate the friction coefficient difference caused by different clothes and slide surface. The calculation results show that the evacuation speed of the new device is much faster than traditional staircases. Moreover, such new evacuation device can also be used as a means of vertical transportation in high-rise buildings partly. People can take it from any floor to ground floor directly, which not only save time for waiting for the lifts but also save the power. The new evacuation system is of simple structure, easy to use, and suitable for evacuation and partly used as vertical downwards traffic, which shows light on solving world-wide difficulties on fast evacuation in high-rise buildings.
Gumustas, Seyit Ali; Cagırmaz, Talat; Guler, Olcay; Ofluoglu, Onder; Kayahan, Sibel
Background Osteoblastoma is an aggressive benign tumor whose presentation varies with location and size. This rare bone tumor is thus difficult to diagnose particularly when it occurs outside its most common location – the vertebral column and long bones. Case We report a case of osteoblastoma of the fourth distal phalanx of the left hand in an 18-year-old male, presented with pain and swelling and treated with curettage and polymethylmethacrylate filling followed by immobilization by a cast, which was opened 10 days later to start physical therapy. Patient was pain-free, recovered full function of his finger, and remained without pain at one month post-surgery. The finger was monitored closely for two years; sequential films showed a radiopaque interface and no evidence of local recurrence. Conclusion This is the first report of osteoblastoma on the distal phalanx. The possibility of osteoblastoma should be considered in cases of pain and swelling of phalanx, and if diagnosed, curettage and polymethylmethacrylate filling may be the treatment of choice. PMID:26072004
Lee, H J; Min, W K; Kim, J S; Yoon, S D; Kim, D H
To review the outcome of 23 ankle arthrodeses using burring, curettage, multiple drilling, and fixation with 2 retrograde screws through a single lateral incision. Records of 22 consecutive patients aged 39 to 79 (mean, 62.4) years who underwent 23 ankle arthrodeses for end-stage ankle arthritis were reviewed. Through a single lateral incision, articular cartilage was removed using burring and curettage, and multiple holes were drilled using a Kirschner wire, followed by fixation with 2 retrograde screws. The resected distal fibula was fixed to the distal part of the talus and tibia. The position of the ankle and subtalar joint arthrosis was assessed by 2 orthopaedic specialists. Pre- and post-operative American Orthopaedic Foot and Ankle Society (AOFAS) scores were evaluated. The mean operating time was 122 minutes. The mean follow-up period was 41 months. The mean postoperative ankle alignment was suboptimal: 2.7º varus, 6.7º plantar flexion, and 2.9º internal rotation. The mean AOFAS score improved from 30 to 71 (pfixation with 2 retrograde screws achieved a high union rate and acceptable functional score without serious complications.
Louie, Karmen S; Chong, Erica; Tsereteli, Tamar; Avagyan, Gayane; Abrahamyan, Ruzanna; Winikoff, Beverly
The aim of the study was to assess the efficacy and acceptability of a regimen using mifepristone and buccal misoprostol with unlimited dosing for second trimester abortion in Armenia. Women seeking to terminate 13-22 week pregnancies were enrolled in the study. Participants swallowed 200 mg mifepristone in the clinic and were instructed to return to the hospital for induction 24-48 h later. During induction, women were given 400 μg buccal misoprostol every 3 h until the fetus and placenta were expelled. The abortion was considered a success if complete uterine evacuation was achieved without oxytocin or surgery. A total of 120 women with a median gestational age of 18 weeks participated in the study. All women began misoprostol induction around 24 h after taking mifepristone. Complete uterine evacuation was achieved in 119 (99.2%) women. The median induction-to-abortion interval was 10.3 h (range 4-17.4) with a mean of 9.5 ± 2.5 h. A median of four misoprostol doses (range 2-6) with a mean of 4 ± 1 misoprostol doses were administered. The induction-to-abortion interval, number of misoprostol doses, pain score and analgesia use increased as gestational age advanced. Acceptability of the method was high among both patients and providers. The medical abortion regimen of 200 mg mifepristone followed 24 h later by induction with 400 μg buccal misoprostol administered every 3 h, with no limit on the number of doses used for the termination of pregnancies of 13-22 weeks' gestation is an effective and acceptable option for women.
In January 1958 the 1st abortion law was passed in Czechoslovakia. At that time it was a progressive law. However, as time went on and other European countries developed their own abortion policies, the law become more outdated. The main failing was that women were not in charge of the final abortion decision, it had to be made by a commission. As a result, a new law went into effect in January 1987 that was more liberal. This new law allowed abortion twice a year for free unless the woman was more than 8 weeks pregnant. Between 8 and 12 weeks there was a fee of 500 crowns. For women under 16 parental permission is required and for women 16-18 parents are notified after the procedure. After the law was passed there was an increase in reported numbers of abortions, but the figures are not very accurate because of unusual recording methods. Abortion (42-55 days) is contrasted with menstrual regulation (42 days) and the figure of 157,912 also includes extrauterine pregnancies. After the democratic reforms of November 1989, strong anti-choice groups began a campaign to end abortion. To date this has resulted in a Advisory Commission that is charged with the responsibility of looking at the abortion issue with the Federal Deputy Prime minister. The commission's recommendations were: 1) the situation is considered critical (that abortion is still allowed and government funded), 2) absolute prohibition of abortion is not recommended, 3) the majority of citizens should be able to adopt any legal measures, 4) abortion should not be government supported except to save the woman's life or in cases of sexual crimes, 5) the law should also serve an educational function, 6) artificial interruption of pregnancy should be renamed to artificial termination of pregnancy. Finally the commission recommended that longterm preventive measures should focus on education. Public opinion indicates that 61% of citizens recognize a woman's right to abortion, while only 4% favor absolute
The topic of this article is the use of unsafe abortion for unwanted pregnancies among adolescents. The significance of unsafe abortion is identified as a high risk of serious health problems, such as infection, hemorrhage, infertility, and mortality, and as a strain on emergency room services. The World Health Organization estimates that at least 33% of all women seeking hospital care for abortion complications are aged under 20 years. 50 million abortions are estimated to be induced annually, of which 33% are illegal and almost 50% are performed outside the health care system. Complications are identified as occurring due to the procedure itself (perforation of the uterus, cervical lacerations, or hemorrhage) and due to incomplete abortion or introduction of bacteria into the uterus. Long-term complications include an increased risk of ectopic pregnancy, chronic pelvic infection, and infertility. Mortality from unsafe abortion is estimated at 1000/100,000 procedures. Safe abortion mortality is estimated at 0.6/100,000. When infertility results, some cultures ascribe an outcast status or marriages are prevented or prostitution is assured. The risk of complications is considered higher for adolescents. Adolescents tend to delay seeking an abortion, lack knowledge on where to go for a safe procedure, and delay seeking help for complications. Peer advice may be limited or inadequate knowledge. Five studies are cited that illustrate the impact of unsafe abortion on individuals and health care systems. Abortions may be desired due to fear of parental disapproval of the pregnancy, abandonment by the father, financial and emotional responsibilities of child rearing, expulsion from school, or inability to marry if the child is out of wedlock. Medical, legal, and social barriers may prevent women and girls from obtaining safe abortion. Parental permission is sometimes a requirement for safe abortion. Fears of judgmental or callous health personnel may be barriers to
... 28 Judicial Administration 2 2010-07-01 2010-07-01 false Abortion. 551.23 Section 551.23 Judicial..., Pregnancy, Child Placement, and Abortion § 551.23 Abortion. (a) The inmate has the responsibility to decide either to have an abortion or to bear the child. (b) The Warden shall offer to provide each pregnant...
Daniel J. Fonseca
Full Text Available Atlantic hurricanes and severe tropical storms are a serious threat for the communities in the Gulf of Mexico region. Such storms are violent and destructive. In response to these dangers, coastal evacuation may be ordered. This paper describes the development of a simulation model to analyze the movement of vehicles through I-65, a major US Interstate highway that runs north off the coastal City of Mobile, Alabama, towards the State of Tennessee, during a massive evacuation originated by a disastrous event such a hurricane. The constructed simulation platform consists of a primary and two secondary models. The primary model is based on the entry of vehicles from the 20 on-ramps to I-65. The two secondary models assist the primary model with related traffic events such as car breakdowns and accidents, traffic control measures, interarrival signaling, and unforeseen emergency incidents, among others. Statistical testing was performed on the data generated by the simulation model to indentify variation in relevant traffic variables affecting the timely flow of vehicles travelling north. The performed statistical analysis focused on the closing of alternative on-ramps throughout the Interstate.
Kachroo, Pushkin P.E; Al-nasur, Sadeq J; Shende, Apoorva
Effective evacuation of people from closed spaces is an extremely important topic, since it can save real lives in emergency situations that can be brought about by natural and human made disasters. Usually there are static maps posted at various places at buildings that illustrate routes that should be taken during emergencies. However, when disasters happen, some of these routes might not be valid because of structural problems due to the disaster itself and more importantly because of the distribution of congestion of people spread over the area. The average flow of traffic depends on the traffic density. Therefore, if all the people follow the same route, or follow a route without knowing the congestion situation, they can end up being part of the congestion which results in very low flow rate or worse a traffic jam. Hence it becomes extremely important to design evacuations that inform people how fast and in which direction to move based on real-time information obtained about the people distribution usi...
Ricci, Karen A; Griffin, Anne R; Heslin, Kevin C; Kranke, Derrick; Dobalian, Aram
Hospital-evacuation decisions are rarely straightforward in protracted advance-warning events. Previous work provides little insight into the decision-making process around evacuation. This study was conducted to identify factors that most heavily influenced the decisions to evacuate the US Department of Veterans Affairs (VA) New York Harbor Healthcare System's (NYHHS; New York USA) Manhattan Campus before Hurricane Irene in 2011 and before Superstorm Sandy in 2012. Semi-structured interviews with 11 senior leaders were conducted on the processes and factors that influenced the evacuation decisions prior to each event. The most influential factor in the decision to evacuate the Manhattan Campus before Hurricane Irene was New York City's (NYC's) hospital-evacuation mandate. As a federal facility, the Manhattan VA medical center (VAMC) was exempt from the city's order, but decision makers felt compelled to comply. In the case of Superstorm Sandy, corporate memory of a similar 1992 storm that crippled the Manhattan facility drove the decision to evacuate before the storm hit. Results suggest that hospital-evacuation decisions are confounded by political considerations and are influenced by past disaster experience. Greater shared situational awareness among at-risk hospitals, along with a more coordinated approach to evacuation decision making, could reduce pressure on hospitals to make these high-stakes decisions. Systematic mechanisms for collecting, documenting, and sharing lessons learned from past disasters are sorely needed at the institutional, local, and national levels.
Bhatti, Khadijah Z; Nguyen, Antoinette T; Stuart, Gretchen S
Medical abortion is a safe, effective, and acceptable option for patients seeking an early nonsurgical abortion. In 2014, medical abortion accounted for nearly one third (31%) of all abortions performed in the United States. State-level attempts to restrict reproductive and sexual health have recently included bills that require physicians to inform women that a medical abortion is reversible. In this commentary, we will review the history, current evidence-based regimen, and regulation of medical abortion. We will then examine current proposed and existing abortion reversal legislation. The objective of this commentary is to ensure physicians are armed with rigorous evidence to inform patients, communities, and policy makers about the safety of medical abortion. Furthermore, given the current paucity of evidence for medical abortion reversal, physicians and policy makers can dispel bad science and misinformation and advocate against medical abortion reversal legislation. Copyright © 2017 Elsevier Inc. All rights reserved.
Fetters, Tamara; Samandari, Ghazaleh
Although Cambodia now permits elective abortion, scarcity of research on this topic means that information on abortion incidence is limited to regional estimates. This estimation model combines national survey data from Demographic and Health Surveys (DHS) with national prospective data of abortion procedures from government health facilities, collected in 2005 and 2010, to calculate the national incidence of safe and unsafe abortion. According to DHS, the proportion of all induced abortions that took place in a health facility in the five years preceding each survey increased from almost 52% to 60%. Projecting from facility-based abortions to national estimates, the national abortion rate increased from 21 to 28 per 1000 women aged 15-44. The abortion ratio also increased from 19 to 28 per 100 live births. This research quantifies an increase in safely induced abortions in Cambodia and provides a deeper understanding of induced abortion trends in Cambodia.
Full Text Available This essay will analyze some of the debates around abortion in the National Congress due to the Constitutional Amendment Bill – PEC25/95, by Deputy Severino Cavalcanti (PPB/PE, where the main issue was precisely life defense. The discursive blocks that present the debate in relation to pregnancy interruption, the religious principles or biological determinism on which those debates are based, and the ways in which such discourses are maintained will be identified. Distinct understandings of life, as a result of the points used in such discourses, which are aligned with the position of the Catholic Church and the Feminist Movement - the social actors of this debate- are also discussed here.
Di Nucci, Ezio
I argue that it is possible for prospective mothers to wrong prospective fathers by bearing their child; and that lifting paternal liability for child support does not correct the wrong inflicted to fathers. It is therefore sometimes wrong for prospective mothers to bear a child, or so I argue here. I show that my argument for considering the legitimate interests of prospective fathers is not a unique exception to an obvious right to procreate. It is, rather, part of a growing consensus that procreation can be morally problematic and that generally talking of rights in this context might not be warranted. Finally, I argue that giving up a right to procreate does not imply nor suggest giving up on women's absolute right to abort, which I defend. © The Author 2014. Published by Oxford University Press, on behalf of the Journal of Medicine and Philosophy Inc. All rights reserved. For permissions, please e-mail: firstname.lastname@example.org.
Myran, Daniel T; Carew, Caitlin L; Tang, Jingyang; Whyte, Helena; Fisher, William A
Lack of providers is a barrier to accessing abortion in Canada. The factors influencing the number of abortion providers are poorly understood. In this study, we assessed the attitudes and intentions of medical students towards abortion training and provision to gain insight into the future supply of abortion providers. We surveyed first, second, and third year medical students at an Ontario university to determine their intentions to train in and provide abortion services during different stages of training and in future practice. We assessed students' attitudes and intentions towards training in and providing abortions, their perceptions of social support, their perceived ability to receive training in and to provide abortion services, and their attitudes towards the legality of abortion. Surveys were completed by 337 of 508 potential respondents (66.7%). The responses indicated that the students in the survey held relatively positive attitudes towards the legality and availability of abortion in Canada. Respondents had significantly more positive attitudes towards first trimester medical abortions (and a greater intention to provide them) than towards second trimester surgical abortions. Thirty-five percent of students planned to enter a specialty in which they could perform abortions, but fewer than 30% of these students planned to provide any type of abortion. Intentions to provide abortions were correlated with positive attitudes toward abortion in general and greater perceived social support for abortion provision. A small proportion of students sampled intended both to enter a specialty in which abortion would be within the scope of practice and to provide abortion services. Lack of perceived social support for providing abortions and the perceived inability to obtain abortion training or to logistically provide abortions were identified as two potentially modifiable barriers to abortion provision. We propose increasing education on abortion provision and
Purgina, A.; Shmakova, V.
The problem of abortion now has adopted a special social significance. Many countries has the laws regulating an abortion. In Russia this law exists in a very liberal state. Statistics of abortions is disappointing. It is not only a medical but also a social problem which roots lies in the moral aspect of society. The Church considers the abortion as a mortal sin since ancient times. We tried to consider the history of the fight against abortion and its appropriateness.
Gerdts, Caitlin; DePi?eres, Teresa; Hajri, Selma; Harries, Jane; Hossain, Altaf; Puri, Mahesh; Vohra, Divya; Foster, Diana Greene
Background Factors such as poverty, stigma, lack of knowledge about the legal status of abortion, and geographical distance from a provider may prevent women from accessing safe abortion services, even where abortion is legal. Data on the consequences of abortion denial outside of the US, however, are scarce. Methods In this article we present data from studies among women seeking legal abortion services in four countries (Colombia, Nepal, South Africa and Tunisia) to assess sociodemographic ...
Awoyemi, Bosede O; Novignon, Jacob
Background: While induced abortion is considered to be illegal and socially unacceptable in Nigeria, it is still practiced by many women in the country. Poor family planning and unsafe abortion practices have daunting effects on maternal health. For instance, Nigeria is on the verge of not meeting the Millennium development goals on maternal health due to high maternal mortality ratio, estimated to be about 630 maternal deaths per 100,000 live births. Recent evidences have shown that a major ...
Firouzabadi, Raziah Dehghani; Sekhavat, Leila; Tabatabaii, Afsar; Hamadani, Sedighah
To compare the efficacy of Laminaria tents with Misoprostol for cervical ripening before surgical process in missed abortion. In a prospective study, 70 women with missed abortion were assigned to have either insertion of a 3 mm intracervical Laminaria tent (n = 35) or vaginal Misoprostol 400 μg (n = 35) on the day prior to suction dilation and curettage (D/C). The women were interviewed just prior to the D/C with regard to pain, vaginal bleeding, and cervical dilator preference. Cervical dilation was greater in the Laminaria group but not significantly different from that in the Misoprostol group. However, additional cervical dilation before D/C was required in more patients in the Misoprostol group (45.7 vs 14.3%, P = 0.001). Women who received Laminaria reported significantly more pain at the time of insertion (62.8% in Laminaria group vs 22.8% in Misoprostol group) compared with women who received Misoprostol. Conversely, Misoprostol was associated with more nausea, vomiting, diarrhea and vaginal bleeding. Laminaria tents are more effective cervical dilators than vaginal Misoprostol when inserted the day prior to suction D and C. Vaginal Misoprostol insertion is more comfortable, although it is associated with an increased risk of vaginal bleeding.
... 14 Aeronautics and Space 3 2010-01-01 2010-01-01 false Airplane evacuation capability. 121.570... REQUIREMENTS: DOMESTIC, FLAG, AND SUPPLEMENTAL OPERATIONS Flight Operations § 121.570 Airplane evacuation capability. (a) No person may cause an airplane carrying passengers to be moved on the surface, take off, or...
Carol L. Rice; Ronny J. Coleman; Mike. Price
Communities are becoming increasingly concerned with the variety of choices related to wildfire evacuation. We used ArcView with Network Analyst to evaluate the different options for evacuations during wildfire in a case study community. We tested overlaying fire growth patterns with the road network and population characteristics to determine recommendations for...
Qin, Lin; Furbo, Simon
Four different marketed Chinese evacuated tubular solar collectors have been investigated both theoretically and experimentally. The advantages of the investigated solar collectors compared to normal flat plate collectors were elucidated.......Four different marketed Chinese evacuated tubular solar collectors have been investigated both theoretically and experimentally. The advantages of the investigated solar collectors compared to normal flat plate collectors were elucidated....
Fan, Jianhua; Dragsted, Janne; Furbo, Simon
During three years seven differently designed evacuated tubular collectors (ETCs) utilizing solar radiation from all directions have been investigated experimentally. The evacuated tubular solar collectors investigated include one SLL all-glass ETC from Tshinghua Solar Co. Ltd, four heat pipe ETCs...
...) Involve activation of the fire alarm system; and (3) Include evacuation of all persons from their work... NONMETAL MINE SAFETY AND HEALTH SAFETY AND HEALTH STANDARDS-UNDERGROUND METAL AND NONMETAL MINES Fire Prevention and Control Firefighting Procedures/alarms/drills § 57.4361 Underground evacuation drills. (a) At...
This study developed an abortion attitude scale and abortion knowledge inventory that may be utilized by health educators, counselors, and researchers for assessing attitudes toward abortion and knowledge about it. (SK)
Prevalence of intrauterine adhesions after the application of hyaluronic acid gel after dilatation and curettage in women with at least one previous curettage: short-term outcomes of a multicenter, prospective randomized controlled trial.
Hooker, Angelo B; de Leeuw, Robert; van de Ven, Peter M; Bakkum, Erica A; Thurkow, Andreas L; Vogel, Niels E A; van Vliet, Huib A A M; Bongers, Marlies Y; Emanuel, Mark H; Verdonkschot, Annelies E M; Brölmann, Hans A M; Huirne, Judith A F
To examine whether intrauterine application of auto-crosslinked hyaluronic acid (ACP) gel, after dilatation and curettage (D&C), reduces the incidence of intrauterine adhesions (IUAs). Multicenter; women and assessors blinded prospective randomized trial. University and university-affiliated teaching hospitals. A total of 152 women with a miscarriage of Gynecological Endoscopy classifications systems of adhesions. Intrauterine application of ACP gel after D&C for miscarriage in women with at least one previous D&C seems to reduce the incidence and severity of IUAs but does not eliminate the process of adhesion formation completely. Future studies are needed to confirm our findings and to evaluate the effect of ACP gel on fertility and reproductive outcomes. NTR 3120. Copyright © 2017 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.
Since emergencies including both natural disasters and man-made incidents, are happening more and more : frequently, evacuation, especially transportation evacuation, is becoming a hot research focus in recent years. : Currently, transportation evacu...
The topic of abortion stigma has caught the attention of researchers and activists working on reproductive health and rights around the world. But as research on abortion stigma grows, I fear that the concept is in danger of becoming so large and all-encompassing that it may mask deeply rooted inequalities. In addition, abortion stigma may be seen as too complex and tangled an issue, thereby leading to paralysis. It is important that we become more precise in our understanding of abortion stigma so that we can carry out better research to understand and measure it, design interventions to mitigate it, and evaluate those interventions. Copyright © 2013 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.
Braunschweig, R.; Schott, U.; Starlinger, M.
Evacuation proctography is the most important imaging technique to supplement findings of physical examination, manometry, and endoscopy in patients presenting with pathologies in anorectal morphology and function. Indications for evacuation proctography include obstructed defecation or incomplete evacuation, imaging of ileal pouches following excision of the rectum, and suspected anorectal fistulae. Evacuation proctography with thick barium sulfate is performed under fluoroscopy. Documentation of the study can either be done by single-shot X-rays, video recording, or imaging with a 100-mm spot-film camera. Evacuation proctography shows morphologic changes such as spastic pelvic floor, rectocele, enterocele, intussusception and anal prolapse. Measurements can be performed to obtain the anorectal angle, location and mobility of the pelvic floor, and size as well as importance of a rectocele. Qualitative and quantitative data can only be interpreted along with clinical and manometric data. (orig.) [de
Vikhlayeva, E M; Nikolaeva, E
In Russia, the fact that many women consider abortion their main or only effective means of fertility regulation has led to prevailing high rates of abortion. A pilot study was undertaken, therefore, to determine why this situation exists and how to decrease the incidence of abortion. Physicians gathered data using a standardized questionnaire administered during interviews with 352 women (221 from Moscow and 131 from rural areas) who had just had an abortion. Most women were employed in the labor force as were most husbands (partners) and parents of the women. Most of the women reported early first coitus, and 49% were married before age 20. More than 80% of the women had children, but only a third of all previous pregnancies had been carried to term. Most abortions occurred because women were worried about their ability to afford another child or about their health status or that of their husband. In fact, approximately 40% of the women presented with inflammatory diseases and infections of the vulva, vagina, uterus, or adnexes. Most women received their first contraceptive counseling after their first delivery or abortion, but only 30% of urban women and 18% of the rural women were using modern contraceptives (condoms) at the time of the unwanted conception. Most women received their information about contraceptives from the mass media, from medical personnel, or from friends although they indicated they would have preferred to have received sex education in school. Most women decided on their own to have an abortion, and 76% experienced psychological pain in conjunction with the procedure. However, 42.3% indicated they would resort to abortion in the future. This study concluded that the Ministry of Health should make provision of information on contraception a priority.
The Abortion (Amendment) Bill in the British House of Commons would lower the maximum limit for termination of pregnancy from 28 to 18 weeks. Supporters of the bill assert that Britain allows termination of pregnancy later than any other European country, and that in Britain over 90% of all late abortions are of fetuses without phisical abnormality. The 28-week limit is considered anachronoistic by doctors since neonatal care has made possible survival at 24 weeks. A similar bill in the House of Lords would reduce the limit to 24 weeks. Making early abortions more easily available would help reduce late abortions. Statistics indicate that women who have abortions late in their pregnancies tend to be young. In 1986, 172,286 abortions were performed in England and Wales. Of these, 144,857, or 84%, were performed before the 13th week. A total of 8276 (5%) were performed after 18 weeks. Of these, 3688 (45% of late abortions) were on nonresidents who traveled to Britain because of legal restrictions in their own country. This means that 4594 late abortions were performed on residents of England and Wales in 1986. This was 3% of the total, with 14% of this number on grounds of fetal abnormality. About 40% of the rest were in women under the age of 20, with 6% (239) on girls under 16. A 1984 study concluded that more counseling and information should be provided for young women. Education in contraception for young women is less than ideal and likely to become less available as economic restraints reduce the number of family planning clinics. Postcoital contraception should be taught more as an emergency proceedure. Prompt, dispassionate physician counseling, wider provision of National Health Service facilities, and uniform service in all districts would also be beneficial.
Graziosi, G. C. M.; Bruinse, H. W.; Reuwer, P. J. H.; van Kessel, P. H.; Westerweel, P. E.; Mol, B. W.
BACKGROUND: We aimed to compare patients' health-related quality of life after a misoprostol strategy to a curettage in women with early pregnancy failure after failed expectant management. METHODS: A multicentre randomized clinical trial was performed in The Netherlands. In all, 154 women with
Sørensen, Janne Gress
an increased focus in the past decades enabling everyone to enter buildings but is not an insurance for egressibility. Representative evacuation data for vulnerable subpopulations, including elderly, children and people with disabilities, are lacking in literature. It is known that the fatality rate caused...... and with a special focus on blind and visually impaired people. An experimental program is designed to obtain data on walking speeds horizontally and descending stairs, interaction between participants and their interaction with the building environment. Experiments are conducted in different buildings including....... The interview study revealed that people with disabilities visit all kind of buildings. It is therefore not possible to neglect their presence in buildings while ensuring equal egress for all occupants. It is also found that building elements such as stairs, signage, doors e.t.c., which are essential elements...
Across four decades of political and social action, Nepal changed from a country strongly enforcing oppressive abortion restrictions, causing many poor women's long imprisonment and high rates of abortion-related maternal mortality, into a modern democracy with a liberal abortion law. The medical and public health communities supported women's rights activists in invoking legal principles of equality and non-discrimination as a basis for change. Legislative reform of the criminal ban in 2002 and the adoption of an Interim Constitution recognizing women's reproductive rights as fundamental rights in 2007 inspired the Supreme Court in 2009 to rule that denial of women's access to abortion services because of poverty violated their constitutional rights. The government must now provide services under criteria for access without charge, and services must be decentralized to promote equitable access. A strong legal foundation now exists for progress in social justice to broaden abortion access and reduce abortion stigma. Copyright © 2014 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.
Dundar, B; Dilbaz, B; Karadag, B
A wide spectrum of emotions are experienced during abortion, including anxiety, sadness and grief, guilt, pessimism about future pregnancies, disturbed self-perception and loss of confidence in intimate relationships. This study aimed to compare the short-term effects of legal voluntary termination of pregnancy with uterine evacuation for medical reasons on female sexual function. The study group was comprised of 50 patients admitted to the Family Planning Clinic for legal voluntary termination of pregnancy reasons (e.g. inevitable abortion, incomplete abortion, fetal abnormality and teratogenic drug use). Female sexual function in the two groups was evaluated using the Golombok-Rust Inventory of Sexual Satisfaction (GRISS). GRISS scores immediately before and 3 months after termination of pregnancy were compared within each group and between the two groups. Mean total GRISS scores before and after termination of pregnancy were 5.33 and 8.12 in the study group, and 6.02 and 6.4 in the control group, respectively (pabortion care. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.
Segura, J; Albareda, J; Bueno, A L; Nuez, A; Palanca, D; Seral, F
Curettage and filling with acrylic cement in the treatment of para-articular giant cell tumor (GCT) has multiple advantages as compared to other methods; nonetheless, the possibility of progression in arthrosis is still a drawback. The literature does not report long-term functional results when this method was used. Four cases are presented with a mean long-term follow-up of 13.5 years (minimum 11, maximum 18). Clinical results, evaluated by the Enneking system (18), were excellent, and there were no radiological modifications, so that we believe that this is the method to choose for Campanacci stage I and II GCT (1), and in some stage III cases, as joint function is not compromised in time.
Sutton, Barbara; Borland, Elizabeth
In recent years, there have been calls in activist spaces to 'queer' abortion rights advocacy and to incorporate non-normative notions of gender identity and sexuality into abortion struggles and services. Argentina provides an interesting site in which to examine these developments, since there is a longstanding movement for abortion rights in a context of illegal abortion and a recent ground-breaking Gender Identity Law that recognises key trans rights. In this paper, we analyse public documents from the abortion rights movement's main coalition - the National Campaign for the Right to Legal, Safe and Free Abortion - alongside interviews with 19 Campaign activists to examine shifts and tensions in contemporary abortion rights activism. We trace the incorporation of trans-inclusive language into the newly proposed abortion rights bill and conclude by pointing to contextual factors that may limit or enhance the further queering of abortion rights.
Intracervical application of the nitric oxide donor isosorbide dinitrate for induction of cervical ripening: a randomised controlled trial to determine clinical efficacy and safety prior to first trimester surgical evacuation of retained products of conception.
Arteaga-Troncoso, Gabriel; Villegas-Alvarado, Alejandro; Belmont-Gomez, Aurora; Martinez-Herrera, Francisco J; Villagrana-Zesati, Roberto; Guerra-Infante, Fernando
To determine the therapeutic efficacy and safety of a nitric oxide (NO) isosorbide dinitrate donor to induce cervical ripening of women with missed abortions before surgical evacuation of the uterus. A prospective, randomised, double-blind controlled trial. Tertiary referral maternity teaching hospital. Population Sixty women with missed abortions and no cervical dilation. Women requesting surgical evacuation of the uterus were randomly selected to receive endocervical 80 mg/1.5 mL isosorbide dinitrate gel solution (n= 30) or 400 mug/1.5 mL misoprostol gel solution (n= 30) every 3 hours to a maximum of four doses or until reaching cervical ripening. Vital signs and symptoms were recorded at baseline and then every 3 hours until finishing therapy. Adverse events, such as headache, abdominal pain, pelvic pain, backache, nausea and vomiting, were evaluated. Probability of reaching cervical ripening >8 mm Hegar dilator; evaluated at 3, 6, 9 and 12 hours after application of isosorbide dinitrate or misoprostol. The probabilities of induction of cervical ripening by isosorbide dinitrate and misoprostol after four repeated doses at 3-hour intervals were significantly different (PIntracervical administration of 80 mg isosorbide dinitrate in women with missed abortions appears to be effective for cervical ripening prior to surgical evacuation of the uterus. Differences in the incidence of non-serious adverse events are not likely to be clinically significant.
Gerdts, Caitlin; DePiñeres, Teresa; Hajri, Selma; Harries, Jane; Hossain, Altaf; Puri, Mahesh; Vohra, Divya; Foster, Diana Greene
Factors such as poverty, stigma, lack of knowledge about the legal status of abortion, and geographical distance from a provider may prevent women from accessing safe abortion services, even where abortion is legal. Data on the consequences of abortion denial outside of the US, however, are scarce. In this article we present data from studies among women seeking legal abortion services in four countries (Colombia, Nepal, South Africa and Tunisia) to assess sociodemographic characteristics of legal abortion seekers, as well as the frequency and reasons that women are denied abortion care. The proportion of women denied abortion services and the reasons for which they were denied varied widely by country. In Colombia, 2% of women surveyed did not receive the abortions they were seeking; in South Africa, 45% of women did not receive abortions on the day they were seeking abortion services. In both Tunisia and Nepal, 26% of women were denied their wanted abortions. The denial of legal abortion services may have serious consequences for women's health and wellbeing. Additional evidence on the risk factors for presenting later in pregnancy, predictors of seeking unsafe illegal abortion, and the health consequences of illegal abortion and childbirth after an unwanted pregnancy is needed. Such data would assist the development of programmes and policies aimed at increasing access to and utilisation of safe abortion services where abortion is legal, and harm reduction models for women who are unable to access legal abortion services. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
Janosević, Dragana Radović; Lilić, Vekoslav; Basić, Hakija; Pavlović, Aleksandra Tubić; Stefanović, Milan; Milosević, Jelena
A repeated or habitual miscarriage (PSP) is defined as three or more consecutive losses of pregnancy. In the first three months of pregnancy, habitual miscarriages occur in about 1% of pregnant women, out of which 50% are of an unknown etiology. It is believed that among them, the greatest number is the consequence of an inadequate alloimmune response of a women to the pregnancy. The endocrine and immune systems are in a close interaction during the implantation and maintaining of pregnancy. This communication is the most obvious on endometrium of pregnancy decidua. The aim of the study was to identify the number and the subpopulation distribution of the decidual NK cells in the decidua by using an immunohistochemical method. The research included a group of 30 women who had had two spontaneous miscarriages consecutively in the first three months of their pregnancy, while the curettage after the third spontaneous abortion was histopathologically and immunohistochemically analyzed. The control group consisted of 20 women without a problematic reproductive anamnesis, who had had their pregnancy terminated for social reasons. The criteria for the eliminating from the research were the diagnosed uterus anomalies, positive screening on thrombophilia, as well as women suffering from diabetes melitus and the ones with the thyroid gland function disorder. The number and the phenotype structure of the uterus NK cells were significantly different between the decidua of a normal pregnancy and that in PSP. In the decidua in PSP, there were much more NK cells with the phenotype of the peripheral circulation CD57 and CD56dim, while in the decidua of the control group the dominant cells were the typical uNK cell subpopulation CD56bright. The above mentioned results show that the disregulation of the immunocompetent cells of the decidua, by creating an inadequate cytokine milieu, is one of the mechanism of rejecting the semiallogeneic blastocyst.
Full Text Available Background/Aim. A repeated or habitual miscarriage (PSP is defined as three or more consecutive losses of pregnancy. In the first three months of pregnancy, habitual miscarriages occur in about 1% of pregnant women, out of which 50% are of an unknown etiology. It is believed that among them, the greatest number is the consequence of an inadequate alloimmune response of a women to the pregnancy. The endocrine and immune systems are in a close interaction during the implantation and maintaining of pregnancy. This communication is the most obvious on endometrium of pregnancy decidua. The aim of the study was to identify the number and the subpopulation distribution of the decidual NK cells in the decidua by using an immunohistochemical method. Methods. The research included a group of 30 women who had had two spontaneous miscarriages consecutively in the first three months of their pregnancy, while the curettage after the third spontaneous abortion was histopathologically and immunohistochemically analyzed. The control group consisted of 20 women without a problematic reproductive anamnesis, who had had their pregnancy terminated for social reasons. The criteria for the eliminating from the research were the diagnosed uterus anomalies, positive screening on thrombophilia, as well as women suffering from diabetes melitus and the ones with the thyroid gland function disorder. Results. The number and the phenotype structure of the uterus NK cells were significantly different between the decidua of a normal pregnancy and that in PSP. In the decidua in PSP, there were much more NK cells with the phenotype of the peripheral circulation CD57 and CD56dim, while in the decidua of the control group the dominant cells were the typical uNK cell subpopulation CD56bright. Conclusion. The above mentioned results show that the disregulation of the immunocompetent cells of the decidua, by creating an inadequate cytokine milieu, is one of the mechanism of rejecting
Liu, W.; Deng, Z.; Li, W.; Lin, J.
Crowded centers always cause personnel casualties in evacuation operations. Stampede events often occur by hit, squeeze and crush due to panic. It is of vital important to alleviate such situation. With the deepening of personnel evacuation research, more and more researchers are committed to study individual behaviors and self-organization phenomenon in evacuation process. The study mainly includes: 1, enrich the social force model from different facets such as visual, psychological, external force to descript more realistic evacuation; 2, research on causes and effects of self - organization phenomenon. In this paper, we focus on disorder motion that occurs in the crowded indoor publics, especially the narrow channel and safety exits and other special arteries. We put forward the improved social force model to depict pedestrians' behaviors, an orderly speed-stratification evacuation method to solve disorder problem, and shape-changed export to alleviate congestion. The result of this work shows an improvement of evacuation efficiency by 19.5 %. Guiding pedestrians' direction to slow down the influence of social forces has a guidance function in improving the efficiency of indoor emergency evacuation.
Full Text Available Late termination of pregnancy (LTOP is defined as an abortion carried out beyond 24 gestational weeks, when the fetus has arguably attained viability. In Taiwan, the current abortion law, bearing a eugenic title, allows LTOP on certain medical grounds. However, the fetal and maternal conditions that constitute medical grounds are not clarified and remain legally untested. Professional debate on the abortion issue is also lacking in academia in Taiwan, despite societal concerns. With the advent of technology to detect fetal abnormalities, obstetricians are now confronted more frequently with acute dilemmas regarding LTOP. Quite often, they sail in an uncharted sea with no clinical guidelines from their professional societies or affiliated hospitals. Recently, LTOP at 35 gestational weeks for a fetus with Down syndrome, complicated with polyhydramnios and tetralogy of Fallot, triggered media scrutiny and aroused much public attention. Although the clinical decision making for pregnancies with fetal abnormalities entails increasingly balanced information and consideration in terms of the medical, ethical, legal, psychologic, and societal aspects, society at large is unaware of the complexity and intertwined nature of various abortion issues, especially LTOP. Obstetricians are now in a vulnerable position in Taiwanese society, where litigations relevant to the practice of early abortions are not rare. Therefore, a global and in-depth look into abortion issues from legal and ethical dimensions is indispensable for modern obstetric practice. This review considers the core issues in LTOP, including what conditions constitute a “serious” fetal abnormality to justify LTOP, the incidence of LTOP, legislation regarding LTOP in Western countries, and recent research on ambivalent fetal pain. It will also present procedures, some under the auspices of the ethical committee of a Presbyterian hospital in Taiwan, for clinical decision making, particularly
Replies to the request by the Journal of Nursing on readers' positions against induced abortion indicate there is a definite personal position against induced abortion and the assistance in this procedure. Some writers expressed an emotional "no" against induced abortion. Many quoted arguments from the literature, such as a medical dictionary definition as "a premeditated criminally induced abortion." The largest group of writers quoted from the Bible, the tenor always being: "God made man, he made us with his hands; we have no right to make the decision." People with other philosophies also objected. Theosophical viewpoint considers reincarnation and the law of cause and effect (karma). This philosophy holds that induced abortion impedes the appearance of a reincarnated being. The fundamental question in the abortion problem is, "can the fetus be considered a human life?" The German anatomist Professor E. Bleckschmidt points out that from conception there is human life, hence the fertilized cell can only develop into a human being and is not merely a piece of tissue. Professional nursing interpretation is that nursing action directed towards killing of a human being (unborn child) is against the nature and the essence of the nursing profession. A different opinion states that a nurse cares for patients who have decided for the operation. The nurse doesn't judge but respects the individual's decision. Some proabortion viewpoints considered the endangering of the mother's life by the unborn child, and the case of rape. With the arguments against abortion the question arises how to help the woman with unwanted pregnancy. Psychological counseling is emphasized as well as responsible and careful assistance. Referral to the Society for Protection of the Unborn Child (VBOK) is considered as well as other agencies. Further reader comments on this subject are solicited.
Appelbaum, P S
The US Supreme Court's decision in Planned Parenthood v. Casey leaves an uncertain future for abortion as a constitutional right. By a vote of 1, Roe v. Wade could be overturned. Without Roe, the states would be free to legislate their own abortion laws, including the outlawing of abortion except when a pregnancy threatens the life or health of the pregnant woman. Psychiatrists could be thrust into the abortion process to certify the threats to life or health on mental health grounds, as they did more than 2 decades ago before Roe. What should psychiatrists' response be? What little empirical data exists reveals almost no basis for individualized determinations of the likelihood of harm if an abortion is denied. There are obvious situations where psychiatry can play a useful role: 1) for women with histories of postpartum depression or psychosis who may be at high risk for a repetition of those conditions, and 2) for women severely mentally disordered who require medications to control their symptoms and are faced with the prospect of decompensation if they terminate their medication to avoid harming the fetus. Some psychiatrists argue that if psychiatric certification provides the only method to obtain abortions, psychiatrists should assist women in whatever way possible, even if that means being dishonest about the likely consequences of a pregnancy, for abortion would be in the longterm psychosocial interest of the woman. In a democratic society, disregarding the laws means disregarding the will of the people. Personal beliefs about social policy also justifies the denial of mental health claims for the psychiatrist who believes that it is in the best interest of the woman to carry the fetus to term. Roe saved psychiatry from this ethical morass; its demise will be unpleasant.
Dehlendorf, Christine E; Fox, Edith E; Ali, Rose F; Anderson, Nora C; Reed, Reiley D; Lichtenberg, E Steve
To investigate the association between previous cesarean delivery and medication abortion failure and the association between parity and failure. Data were abstracted from 2035 consecutive charts of women who underwent medication abortion in 2011. All women were at 63 days gestation or less and received mifepristone 200mg orally and misoprostol 800 mcg buccally. We used multivariate logistic regression to assess the relationship between failure, defined as requiring either curettage or additional medication, and prior cesarean delivery. We also examined the relationship between failure and parity. Follow-up was available on 1609 (79%) patients. Overall, 4.5% of patients experienced failure. Neither cesarean delivery nor parity was associated with failure; 6.5% of women with prior cesarean delivery experienced failure, compared to 3.7% of nulliparous women [adjusted odds ratio (aOR), 1.79, 95% confidence interval (CI), 0.83-3.87]. With regard to parity, 4.7% of women with two or more previous births experienced failure, compared to 3.7% of nulliparous women (aOR, 1.07, 95% CI, 0.54-2.14). We did not find significant associations between prior cesarean delivery and failure or parity and failure. A previous study of patients who had received a less effective regimen reported significant associations between cesarean delivery and failure and parity and failure. While our results do not rule out the possibility of modest associations due to our limited statistical power, they are reassuring relative to previous findings. Our results suggest that if there are differences in women's odds of medication abortion failure by obstetric history, such differences are unlikely to be large. Providers and patients may factor this information into decision making about methods of pregnancy termination. Copyright © 2015 Elsevier Inc. All rights reserved.
Codd, Patrick J; Venteicher, Andrew S; Agarwalla, Pankaj K; Kahle, Kristopher T; Jho, David H
Acute subdural hematoma evacuations frequently necessitate large craniotomies with extended operative times and high relative blood loss, which can lead to additional morbidity for the patient. While endoscopic minimally invasive approaches to chronic subdural collections have been successfully demonstrated, this technique has not previously been applied to acute subdural hematomas. The authors report their experience with an 87-year-old patient presenting with a large acute right-sided subdural hematoma successfully evacuated via an endoscopic minimally invasive technique. The operative approach is outlined, and the literature on endoscopic subdural collection evacuation reviewed. Copyright © 2013. Published by Elsevier Ltd.
Polis, Chelsea B; Mhango, Chisale; Philbin, Jesse; Chimwaza, Wanangwa; Chipeta, Effie; Msusa, Ausbert
In Malawi, abortion is legal only if performed to save a woman's life; other attempts to procure an abortion are punishable by 7-14 years imprisonment. Most induced abortions in Malawi are performed under unsafe conditions, contributing to Malawi's high maternal mortality ratio. Malawians are currently debating whether to provide additional exceptions under which an abortion may be legally obtained. An estimated 67,300 induced abortions occurred in Malawi in 2009 (equivalent to 23 abortions per 1,000 women aged 15-44), but changes since 2009, including dramatic increases in contraceptive prevalence, may have impacted abortion rates. We conducted a nationally representative survey of health facilities to estimate the number of cases of post-abortion care, as well as a survey of knowledgeable informants to estimate the probability of needing and obtaining post-abortion care following induced abortion. These data were combined with national population and fertility data to determine current estimates of induced abortion and unintended pregnancy in Malawi using the Abortion Incidence Complications Methodology. We estimate that approximately 141,044 (95% CI: 121,161-160,928) induced abortions occurred in Malawi in 2015, translating to a national rate of 38 abortions per 1,000 women aged 15-49 (95% CI: 32 to 43); which varied by geographical zone (range: 28-61). We estimate that 53% of pregnancies in Malawi are unintended, and that 30% of unintended pregnancies end in abortion. Given the challenges of estimating induced abortion, and the assumptions required for calculation, results should be viewed as approximate estimates, rather than exact measures. The estimated abortion rate in 2015 is higher than in 2009 (potentially due to methodological differences), but similar to recent estimates from nearby countries including Tanzania (36), Uganda (39), and regional estimates in Eastern and Southern Africa (34-35). Over half of pregnancies in Malawi are unintended. Our
Li, Xia; Yuan, Feng-Lai; Zhao, Yi-Qing; Chen, Fei-Hu; Lu, Wei-Guo; Li, Cheng-Wan; Li, Jian-Ping
To determine the effect of leonurine hydrochloride (LH) on abnormal bleeding induced by medical abortion. Rats had incomplete abortions induced in early pregnancy using mifepristone in combination with misoprostol. After abortion, rats were treated with LH for 7 days, and the duration and volume of uterine bleeding were observed. Approximately 30min after the last treatment, the animals were killed and the uterine shape was observed. The sinistro-uteri were suspended in organ baths to record the contraction curves, including the frequency and tension for 10min; the dextro-uteri were fixed with formaldehyde for pathologic evaluation. In addition, blood samples were collected from the femoral artery for the measurement of estradiol (E₂) and progesterone (P) levels by radioimmunoassay. In in vivo experiments, compared with the model group, LH treatment markedly reduced the volume of bleeding and intrauterine residual, and significantly shortened the duration of bleeding. From the contraction curve, LH notably reinforced the frequency and tension of uterine contractions. LH remarkably elevated the serum estradiol level in rats, but had no obvious effect on progesterone level. LH has an inhibitory effect on bleeding caused by incomplete abortion; the mechanism may be related to up-regulation of the E₂ level, leading to an increase in uterine contractions and evacuation of intrauterine residuum. Copyright © 2011. Published by Elsevier Ireland Ltd.
Bankole, Akinrinola; Adewole, Isaac F; Hussain, Rubina; Awolude, Olutosin; Singh, Susheela; Akinyemi, Joshua O
Because of Nigeria's low contraceptive prevalence, a substantial number of women have unintended pregnancies, many of which are resolved through clandestine abortion, despite the country's restrictive abortion law. Up-to-date estimates of abortion incidence are needed. A widely used indirect methodology was used to estimate the incidence of abortion and unintended pregnancy in Nigeria in 2012. Data on provision of abortion and postabortion care were collected from a nationally representative sample of 772 health facilities, and estimates of the likelihood that women who have unsafe abortions experience complications and obtain treatment were collected from 194 health care professionals with a broad understanding of the abortion context in Nigeria. An estimated 1.25 million induced abortions occurred in Nigeria in 2012, equivalent to a rate of 33 abortions per 1,000 women aged 15-49. The estimated unintended pregnancy rate was 59 per 1,000 women aged 15-49. Fifty-six percent of unintended pregnancies were resolved by abortion. About 212,000 women were treated for complications of unsafe abortion, representing a treatment rate of 5.6 per 1,000 women of reproductive age, and an additional 285,000 experienced serious health consequences but did not receive the treatment they needed. Levels of unintended pregnancy and unsafe abortion continue to be high in Nigeria. Improvements in access to contraceptive services and in the provision of safe abortion and postabortion care services (as permitted by law) may help reduce maternal morbidity and mortality.
This article talks about the position on abortion held by Catholics for a Free Choice (CFFC). The discussion is based on an electronic mail message sent in response to a question on a Church reform listserve discussion group. CFCC believes that abortion is a serious matter that requires reflection, including dialogue with partners and trusted advisors. In a Catholic theological context and in the realm of morality, respect for women's right to abortion should be based on these facts: 1) there is no firm position within the Catholic Church on when the fetus becomes a person; 2) the principle of probabilism in Roman Catholicism holds that where the Church cannot speak definitively on a matter of fact, the consciences of individual Catholics must be primary and respected; and 3) the absolute prohibition on abortion by the Church is not infallible. For CFFC, a central value in this complex matter is the recognition that women are competent, capable moral agents who must be recognized as having the moral and legal right to make the decision about whether or not to have an abortion with minimal state intervention.
The decision to seek an abortion is never easy. Women have different reasons for choosing an abortion and their social, economic and religious background may influence how they cope. Furthermore, once pregnant, the alternatives of childbirth and adoption or keeping the baby may not be psychologically neutral. Research studies in this area have been hampered by methodological problems, but most of the better-quality studies have shown no increased risk of mental health problems in women having an abortion. A consistent finding has been that of pre-existing mental illness and subsequent mental health problems after either abortion or childbirth. Furthermore, studies have shown that only a minority of women experience any lasting sadness or regret. Risk factors for this include ambivalence about the decision, level of social support and whether or not the pregnancy was originally intended. More robust, definitive research studies are required on mental health after abortion and alternative outcomes such as childbirth. Copyright 2010 Elsevier Ltd. All rights reserved.
J. M. Marrero
Full Text Available Volcanic eruptions are among the most awesome and powerful displays of nature's force, constituting a major natural hazard for society (a single eruption can claim thousands of lives in an instant. Consequently, assessment and management of volcanic risk have become critically important goals of modern volcanology. Over recent years, numerous tools have been developed to evaluate volcanic risk and support volcanic crisis management: probabilistic analysis of future eruptions, hazard and risk maps, event trees, etc. However, there has been little improvement in the tools that may help Civil Defense officials to prepare Emergency Plans. Here we present a new tool for simulating massive evacuation processes during volcanic crisis: the Variable Scale Evacuation Model (VSEM. The main objective of the VSEM software is to optimize the evacuation process of Emergency Plans during volcanic crisis. For this, the VSEM allows the simulation of an evacuation considering different strategies depending on diverse impact scenarios. VSEM is able to calculate the required time for the complete evacuation taking into account diverse evacuation scenarios (number and type of population, infrastructure, road network, etc. and to detect high-risk or "blackspots" of the road network. The program is versatile and can work at different scales, thus being capable of simulating the evacuation of small villages as well as huge cities.
Lithur, Nana Oye
Traditional and cultural values, social perceptions, religious teachings and criminalisation have facilitated stigmatisation of abortion in Ghana. Abortion is illegal in Ghana except in three instances. Though the law allows for performance of abortion in three circumstances, the Ghana reproductive health service policy did not have any induced legal abortion services component to cover the three exceptions until it was revised in 2003. The policy only had 'unsafe and post-abortion' care components, and abortions performed in health facilities operated by the Ghana Health Service were performed under this component. Though the policy has been revised, women and girls who need abortion services in Ghana more often resort to the backstreet dangerous methods and procedures. Criminalisation of abortion and those who perform abortions has contributed to unsafe abortion, the second leading cause of maternal deaths in Ghana. Most of these are performed outside the formal health service structures. Traditionally, abortion is perceived as a shameful act and the community may shun and give a woman who has caused anabortion derogatory names. Would provision of legal abortion services be culturally acceptable within a Ghanaian community? Yes, if they are made aware of the reproductive health benefits of providing safe abortion services. Three major strategies that would help to destigmatise abortion in the community are (1) the liberal interpretation of the three exceptions to the law on abortion; (2) expanding community awareness of its reproductive health benefits; and (3) improving and increasing access to legal abortion services within the formal health facilities.
Duncan, Jack A.; Moffett, Catherine F.
Abortion counseling is now legally within the purview of the school counselor. It is therefore essential that counselors determine their role in abortion counseling, the kind of training necessary, and whether professional organizations should develop counseling guidelines. (RP)
Farfalli, Germán L; Slullitel, Pablo A I; Muscolo, D Luis; Ayerza, Miguel A; Aponte-Tinao, Luis A
Chondroblastoma is an uncommon, benign, but locally aggressive bone tumor that occurs in the apophyses or epiphyses of long bones, primarily in young patients. Although some are treated with large resections, aggressive curettage and bone grafting are more commonly performed to preserve the involved joint. Such intralesional resection may result in damage to the growth plate and articular cartilage, which can result in painful arthritis. Prior studies have focused primarily on oncologic outcomes rather than long-term joint status and functional outcomes. (1) What local complications can be expected after aggressive intralesional curettage of epiphyseal chondroblastoma? (2) What is the joint survival of a joint treated in this way for chondroblastoma? (3) What additional procedures are used in treating symptomatic joint osteoarthritis after treatment of the chondroblastoma? (4) What are the functional outcomes in this group of patients? A retrospective study of our prospectively collected database between 1975 and 2013 was done. We found 64 patients with a diagnosis of chondroblastoma of bone. After applying our selection criteria, 53 patients were involved in this study. We excluded seven patients with tumors initially treated with en bloc resection (five located in the extremities and two in the axial skeleton) and two patients with apophyseal tumors. One patient who underwent nonsurgical treatment and one patient lost to followup were also excluded. The mean age was 18 years (range, 11-39 years); the minimum followup was 2 years with a mean followup 77 months (range, 24-213 months). We analyzed all patients with a diagnosis of epiphyseal chondroblastoma of the limb treated with aggressive curettage and joint preservation surgery. During the period in question, our general indications for curettage were patients with active, painful tumors and those with more aggressive ones that remained intracompartmental, whereas initial wide en bloc resection was indicated in
Anjos, Karla Ferraz dos; Santos, Vanessa Cruz; Souzas, Raquel; Eugênio, Benedito Gonçalves
Discussing the abortion theme in Brazil is highly problematic since it involves ethical, moral and legal precepts. The criminalization of abortion in Brazil favors a clandestine and unsafe practice and can lead to serious consequences to women´s health. In this perspective, this research deals with the legal context in which the abortion problem is inscribed in Brazil, coupled to the specific aims in pinpointing complications caused by the criminalization of clandestine abortion besides deali...
Zeigler, Donald. J.; Johnson, James. H.
The accident at the Three Mile Island nuclear power plant in 1979 provoked an unanticipated and unprecedented spontaneous evacuation of people living in the area. Following the accident, revised and upgraded emergency preparedness and response regulations were issued by the Nuclear Regulatory Commission (NRC) and the Federal Emergency Management Agency. (FEMA). This includes the assumption that public education and awareness will minimise the tendency of people to evacuate spontaneously from the vicinity of an accident. This assumption is challenged. Results of an empirical test of a casual model of emergency evacuation decision-making are given. This test was devised to aid understanding of the public behaviour at the time of the Three Mile Island incident. The emergency plans for the Sizewell-B reactor are subject to brief critical consideration. It is concluded that evacuation plans need to reflect people's natural inclinations to move away from a nuclear hazard. (UK)
During an emergency evacuation, execution time is always critical to the evacuees who are : transit dependent. Transit Signal Priority (TSP) can speed up the transit services by prioritizing : the approaching bus at a signalized intersection. With th...
... evacuation decision-making. To accomplish this, the study provides information on the extent and severity of potential flooding from hurricanes, the associated vulnerable population, capacities of existing public shelters...
Andersen, Niels Gerner; Chabot, Denis; Couturier, C. S.
A mechanistic, prey surface-dependent model was expanded to describe the course and rate of gastric evacuation in predatory fishes feeding on crustacean prey with robust exoskeletons. This was accomplished by adding a layer of higher resistance to the digestive processes outside the inner softer...... parts of a prey cylinder abstraction and splitting up the prey evacuation into two stages: an initial stage where the exoskeleton is cracked and a second where the prey remains are digested and evacuated. The model was parameterized for crustaceans with different levels of armour fed to Atlantic cod...... and Chionoecetes opilio. In accordance with the apparent intraspecific isometric relationship between exoskeleton mass and total body mass, the model described stage duration and rate of evacuation of the crustacean prey independently of meal and prey sizes. The duration of the first stage increased (0-33 h...
Rosen, L.C.; Lawver, B.S.; Buckley, D.W.; Finn, S.P.; Swenson, J.B.
A Federal Emergency Management Agency (FEMA) sponsored project to develop a coupled set of models between those of the Lawrence Livermore National Laboratory (LLNL) Atmospheric Release Advisory Capability (ARAC) system and candidate evacuation models is discussed herein. This report describes the ARAC system and discusses the rapid computer code developed and the coupling with ARAC output. The computer code is adapted to the use of color graphics as a means to display and convey the dynamics of an emergency evacuation. The model is applied to a specific case of an emergency evacuation of individuals surrounding the Rancho Seco Nuclear Power Plant, located approximately 25 miles southeast of Sacramento, California. The graphics available to the model user for the Rancho Seco example are displayed and noted in detail. Suggestions for future, potential improvements to the emergency evacuation model are presented
Through the development of four Harvard Kennedy School case studies, this project explored the policy and institutional dimensions of emergency evacuation planning and implementation in two major metropolitan areas Houston and New Orleans. By pro...
Johnson, J.H. Jr.
The Federal Emergency Management Agency's (FEMA's) radiological emergency preparedness program ignores the potential problem of spontaneous evacuation during a nuclear reactor accident. To show the importance of incorporating the emergency spatial behaviors of the population at risk in radiological emergency preparedness and response plans, this article presents empirical evidence that demonstrates the potential magnitude and geographic extent of spontaneous evacuation in the event of an accident at the Long Island Lighting Company's Shoreham Nuclear Power Station. The results indicate that, on the average, 39% of the population of Long Island is likely to evacuate spontaneously and thus to cast an evacuation shadow extending at least 25 miles beyond the plant. On the basis of these findings, necessary revisions to FEMA's radiological emergency preparedness program are outlined
Vesicovaginal fistula complicating uterine evacuation: a case report. MA Ijaiya, AP Aboyeji, GA Fawole, AAG Jimoh, OO Alabi, AO Olarinoye, OL Akintade, OK Ogah, DNC Nwachukwu, OA Alabi, SA Esuga, ZB Ijaiya ...
Yunarto, Y.; Sari, A. M.
Tsunami in Indonesia is defined as local tsunami due to its occurrences which are within a distance of 200 km from the epicenter of the earthquake. A local tsunami can be caused by an earthquake, landslide, or volcanic eruption. Tsunami arrival time in Indonesia is generally between 10-60 minutes. As the estimated time of the tsunami waves to reach the coast is 30 minutes after the earthquake, the community should go to the vertical or horizontal evacuation in less than 30 minutes. In an evacuation, the city frequently does the evacuation after obtaining official directions from the authorities. Otherwise, they perform an independent evacuation without correct instructions from the authorities. Both of these ways have several strengths and limitations. This study analyzes these methods regarding time as well as the number of people expected to be saved.
Qin, Lin; Furbo, Simon
Recently different designed evacuated tubular solar collectors were introduced on the market by different Chinese companies. In the present study, investigations on the performance of four different Chinese evacuated tubular collectors and of solar heating systems using these collectors were...... carried out, employing both laboratory test and theoretical calculations. The collectors were tested in a small solar domestic hot water (SDHW) system in a laboratory test facility under realistic conditions. The yearly thermal performance of solar heating systems with these evacuated tubular collectors......, as well as with normal flat-plate collectors was calculated under Danish weather conditions. It is found that, for small SDHW systems with a combi tank design, an increase of 25% -55% net utilized solar energy can be achieved by using these evacuated tubular collectors instead of normal flat...
A bi-level, two-stage, binary stochastic program with equilibrium constraints, and three variants, are presented that : support the planning and design of shelters and exits, along with hallway fortification strategies and associated : evacuation pat...
Bhattacharjee, Sanjoy; Petrolia, Daniel R.; Hanson, Terrill R.
In this study, we investigate the link between hurricane characteristics, demographics of the Coastal Gulf of Mexico residents, including their household location, and their respective evacuation behavior. Our study is significantly different from the previously made studies on hurricane evacuation behavior in two ways. At first, the research data is collected through recording responses to a series of hypothetical situations which are quite identical to the set of information that people are...
Article 3. DATES COVERED (From – To) Jan 2013 – Dec 2014 4. TITLE AND SUBTITLE Records Review of Musculoskeletal Injuries in Aeromedical Evacuation...aeromedical evacuation, providers, ergonomics Published in Am J Prev Med, 2015; 48(4):365-371 From the D 711th Hum Medicine; th Peerless Tec Dayton, Ohi...designed for AE, but rather retrofit with equipment and fixtures to successfully carry out the mission, ergonomic challenges are likely to arise
Chan, W.; Armenakis, C.
The most common building evacuation approach currently applied is to have evacuation routes planned prior to these emergency events. These routes are usually the shortest and most practical path from each building room to the closest exit. The problem with this approach is that it is not adaptive. It is not responsively configurable relative to the type, intensity, or location of the emergency risk. Moreover, it does not provide any information to the affected persons or to the emergency responders while not allowing for the review of simulated hazard scenarios and alternative evacuation routes. In this paper we address two main tasks. The first is the modelling of the spatial risk caused by a hazardous event leading to choosing the optimal evacuation route for a set of options. The second is to generate a 3D visual representation of the model output. A multicriteria decision making (MCDM) approach is used to model the risk aiming at finding the optimal evacuation route. This is achieved by using the analytical hierarchy process (AHP) on the criteria describing the different alternative evacuation routes. The best route is then chosen to be the alternative with the least cost. The 3D visual representation of the model displays the building, the surrounding environment, the evacuee's location, the hazard location, the risk areas and the optimal evacuation pathway to the target safety location. The work has been performed using ESRI's ArcGIS. Using the developed models, the user can input the location of the hazard and the location of the evacuee. The system then determines the optimum evacuation route and displays it in 3D.
Mabula Joseph B
Full Text Available Abstract Background Bowel perforation though rarely reported is a serious complication of induced abortion, which is often performed illegally by persons without any medical training in developing countries. A sudden increase in the number of patients in our centre in recent years prompted the authors to analyze this problem. The study was conducted to describe our own experiences in the surgical management of these patients. Methods This was a retrospective study involving patients who were jointly managed by the surgical and gynecological teams at Bugando Medical Centre (BMC for bowel perforation secondary to illegally induced abortion from January 2002 to December 2011. The statistical analysis was performed using SPSS version 17.0. Results A total of 68 patients (representing 4.2% of cases were enrolled in the study. Their ages ranged from 14 to 45 years with a median age of 21 years. Majority of patients were, secondary school students/leavers (70.6%, unmarried (88.2%, nulliparous (80.9%, unemployed (82.4% and most of them were dependent member of the family. Previous history of contraceptive use was reported in only 14.7% of cases. The majority of patients (79.4% had procured the abortion in the 2nd trimester. Dilatation and curettage (82.4% was the most common reported method used in procuring abortion. The interval from termination of pregnancy to presentation in hospital ranged from 1 to 14 days (median 6 days . The ileum (51.5% and sigmoid colon (22.1% was the most common portions of the bowel affected. Resection and anastomosis with uterine repair was the most common (86.8% surgical procedure performed. Complication and mortality rates were 47.1% and 10.3% respectively. According to multivariate logistic regression analysis, gestational age at termination of pregnancy, delayed presentation, delayed surgical treatment and presence of complications were significantly associated with mortality (P Conclusion Bowel perforation following
Levandowski, Brooke A; Mhango, Chisale; Kuchingale, Edgar; Lunguzi, Juliana; Katengeza, Hans; Gebreselassie, Hailemichael; Singh, Susheela
Abortion is legally restricted in Malawi, and no data are available on the incidence of the procedure. The Abortion Incidence Complications Methodology was used to estimate levels of induced abortion in Malawi in 2009. Data on provision of postabortion care were collected from 166 public, nongovernmental and private health facilities, and estimates of the likelihood that women who have abortions experience complications and seek care were obtained from 56 key informants. Data from these surveys and from the 2010 Malawi Demographic and Health Survey were used to calculate abortion rates and ratios, and rates of pregnancy and unintended pregnancy. Approximately 18,700 women in Malawi were treated in health facilities for complications of induced abortion in 2009. An estimated 67,300 induced abortions were performed, equivalent to a rate of 23 abortions per 1,000 women aged 15-44 and an abortion ratio of 12 per 100 live births. The abortion rate was higher in the North (35 per 1,000) than in the Central region or the South (20-23 per 1,000). The unintended pregnancy rate in 2010 was 139 per 1,000 women aged 15-44, and an estimated 52% of all pregnancies were unintended. Unsafe abortion is common in Malawi. Interventions are needed to help women and couples avoid unwanted pregnancy, reduce the need for unsafe abortion and decrease maternal mortality.
60% of more than 2000 women surveyed by the Picker Institute who underwent induced abortion procedures rated the quality of their care as excellent. Another third reported their care as being either very good or good. The survey also found that the quality of abortion care is comparable to other outpatient surgery. However, the high quality of care women receive from abortion providers is lost in the hostile anti-abortion climate created by threatening protesters outside of clinics and the murder of 7 clinic workers and physicians who performed abortions. Abortion opponents fail to acknowledge that legal abortion is a medical procedure which protects women's health and saves their lives. Before abortion was legalized in the US, countless women were either rendered unable to reproduce or died from abortion-related complications. Efforts to outlaw abortion persist despite it being widely recognized by medical experts as one of the most safe medical procedures currently performed in the US. When state legislatures target abortion providers with unduly strict regulations, abortion becomes prohibitively expensive and difficult to obtain.
Van Heerden (1964) successfully reduced the abortion rate of a flock, where no system of selection against aborters was practised, by eliminating. Table I. Reproduction dota of normally reproducing and aborting Angora goat does and their progeny. Normal Dams. Aborline Dams. Danr. Progcny l)arn. Progeny. Number of ...
Major, Brenda; Appelbaum, Mark; Beckman, Linda; Dutton, Mary Ann; Russo, Nancy Felipe; West, Carolyn
The authors evaluated empirical research addressing the relationship between induced abortion and women's mental health. Two issues were addressed: (a) the relative risks associated with abortion compared with the risks associated with its alternatives and (b) sources of variability in women's responses following abortion. This article reflects…
Bardis, Panos D.
This report hypothesized that Indian university students approve of abortion, that religiosity neutralizes the influence of education in abortion attitudes, and that Indian students are more liberal in their attitudes on abortion than American Catholic students. To test these hypotheses, the author collected data from 150 students from two…
AJRH Managing Editor
Mifepristone and misoprostol, the two main abortion pills are widely available in Nigeria and have been reported to be highly effective in Nigerian women6. However, the extent to which women use abortion pills to self-induce abortions has not yet been investigated in Nigeria. We believe this would be sizeable in view of the ...
May 1, 2001 ... magnitude of abortion and abortion-related complications as a reﬂection of the fertility behaviour of the population impose a great burden on the meagre available resources and poorly functioning health delivery systems. The major complication of both induced and spontaneous abortion is incompleteness ...
Traditional and cultural values, social perceptions, religious teachings and criminalisation have facilitated stigmatisation of abortion in Ghana. Abortion is illegal in Ghana except in three instances. Though the law allows for performance of abortion in three circumstances, the Ghana reproductive health service policy did not ...
knew the health hazards of abortion, and 69% were not aware of contraceptive methods. Almost 35% had no information on legal issues of induced abortion, 20.72% wished induced abortion be legalized while 67.4% opposed. Based on the study findings, intensification of sex education, and provision of family planning ...
Allgeier, A.R.; And Others
Students (N=118) were classified as pro-choice, anti-abortion, or mixed on the basis of their responses to 10 fictitious case histories of women who requested abortion. Attitudinal differences are discussed in the context of the public controversy over abortion. (Author/CM)
Gipson, Jessica D; Becker, Davida; Mishtal, Joanna Z; Norris, Alison H
Nearly 20% of the 208 million pregnancies that occur annually are aborted. More than half of these (21.6 million) are unsafe, resulting in 47,000 abortion-related deaths each year. Accurate reports on the prevalence of abortion, the conditions under which it occurs, and the experiences women have in obtaining abortions are essential to addressing unsafe abortion globally. It is difficult, however, to obtain accurate and reliable reports of attitudes and practices given that abortion is often controversial and stigmatized, even in settings where it is legal. To improve the understanding and measurement of abortion, specific considerations are needed throughout all stages of the planning, design, and implementation of research on abortion: Establishment of strong local partnerships, knowledge of local culture, integration of innovative methodologies, and approaches that may facilitate better reporting. This paper draws on the authors' collaborative research experiences conducting abortion-related studies using clinic- and community-based samples in five diverse settings (Poland, Zanzibar, Mexico City, the Philippines, and Bangladesh). The purpose of this paper is to share insights and lessons learned with new and established researchers to inform the development and implementation of abortion-related research. The paper discusses the unique challenges of conducting abortion-related research and key considerations for the design and implementation of abortion research, both to maximize data quality and to frame inferences from this research appropriately. Copyright © 2011 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.
Background: Research has demonstrated the effectiveness of misoprostol for treatment of incomplete abortion. However, few studies have focused on the feasibility of treating incomplete abortion with misoprostol at the rural clinic level in sub-Saharan Africa. Objective: To determine the effectiveness, safety and acceptability ...
Zeigler, D.J.; Johnson, J.H. Jr.
During the emergency at the Three Mile Island generating station in the United States, evacuation became a common adaptive response among the local population. The planning for nuclear emergencies in the US has proceeded as if there were no significant differences between nuclear and other types of disasters requiring evacuation. In the United Kingdom, emergency planning for a new generation of pressurized water reactors, about which there is legitimate safety concern, has been influenced not at all by the experience with the Three Mile Island PWR in 1979. The TMI accident has been the US's most serious experience with a nuclear plant accident and therefore is an appropriate analogy for predicting the evacuation response to future nuclear emergencies. In this light, the authors accept the need to develop models that will enable them to predict the magnitude of the evacuation shadow phenomenon around other nuclear power sites and estimate its impact on our plans to remove the threatened population from the hazard zone in the minimum amount of time. Rather than depend on education and information control to stifle evacuation response, the authors believe that evacuation plans need to build on people's natural behavioural inclinations to protect themselves in response to the nuclear hazard
Serres, Jennifer L; Fouts, Brittany L; Dukes, Susan F; Maupin, Genny M; Wade, Molly E
Aeromedical evacuation providers care for patients during air transport. By applying standard medical practices, oftentimes developed for ground care, these practitioners perform their mission duties under additional physical stress in this unique medical environment. Awkward postures and excessive forces are common occurrences among personnel operating in this domain. Additionally, anecdotal reports highlight the risk of developing musculoskeletal injuries for these providers. Currently, there is limited research focusing on musculoskeletal injuries in aeromedical evacuation providers. To determine the prevalence of musculoskeletal injuries and associated symptoms in aeromedical evacuation providers to understand the risk and burden of these injuries to military personnel. This study utilized a retrospective review of military medical records containing ICD-9 codes to investigate the incidence of musculoskeletal injuries within flight nurses and medical technicians compared to their non-flying counterparts from 2006 through 2011. Data were analyzed from 2013 through 2014. Although musculoskeletal injuries were identified within the test populations, results showed fewer injuries for aeromedical evacuation populations compared to non-aeromedical evacuation counterparts. One contributing factor may be a potential under-reporting of musculoskeletal injuries resulting from the fear of being placed on limited flying status. As flyers, aeromedical evacuation personnel must undergo yearly medical examinations and complete training courses that emphasize proper lifting techniques and physical requirements necessary for the safe and efficient transport of patients on various platforms. These additional requirements may create a healthy worker effect, likely contributing to lower musculoskeletal injuries. Published by Elsevier Inc.
Kusdiantara, R.; Hadianti, R.; Badri Kusuma, M. S.; Soewono, E.
Tsunami is a series of wave trains which travels with high speed on the sea surface. This traveling wave is caused by the displacement of a large volume of water after the occurrence of an underwater earthquake or volcano eruptions. The speed of tsunami decreases when it reaches the sea shore along with the increase of its amplitudes. Two large tsunamis had occurred in the last decades in Indonesia with huge casualties and large damages. Indonesian Tsunami Early Warning System has been installed along the west coast of Sumatra. This early warning system will give about 10-15 minutes to evacuate people from high risk regions to the safe areas. Here in this paper, a mathematical model for Tsunami evacuation is presented with the city of Padang as a study case. In the model, the safe areas are chosen from the existing and selected high rise buildings, low risk region with relatively high altitude and (proposed to be built) a flyover ring road. Each gathering points are located in the radius of approximately 1 km from the ring road. The model is formulated as an optimization problem with the total normalized evacuation time as the objective function. The constraints consist of maximum allowable evacuation time in each route, maximum capacity of each safe area, and the number of people to be evacuated. The optimization problem is solved numerically using linear programming method with Matlab. Numerical results are shown for various evacuation scenarios for the city of Padang.
Yueping Fang; Eames, P.C.; Hyde, T.J. [University of Ulster, Newtonabbey (United Kingdom). Centre for Sustainable Technologies; Norton, B. [Dublin Institute of Technology, Dublin (Ireland)
The thermal performance of a complex multimaterial frame consisting of an exoskeleton framework and cavities filled with insulant materials enclosing an evacuated glazing was simulated using a two-dimensional finite element model and the results were validated experimentally using a guarded hot box calorimeter. The analysed 0.5 m by 0.5 m evacuated glazing consisted of two low-emittance film coated glass panes supported by an array of 0.32 mm diameter pillars spaced 25 mm apart, contiguously sealed by a 10 mm wide metal edge seal. Thermal performance of windows employing evacuated glazing set in various complex multimaterial frames were analysed in detail. Very good agreement was found between simulations and experimental measurements of surface temperatures of the evacuated glazing window system. The heat loss from a window with an evacuated glazing and a complex multimaterial frame is about 80% of that for a window comprised of an evacuated glazing set in a single material solid frame. (author)
Fang, Yueping; Eames, Philip C.; Hyde, Trevor J. [Centre for Sustainable Technologies, School of the Built Environment, University of Ulster, Newtownabbey, N. Ireland BT37 0QB (United Kingdom); Norton, Brian [Dublin Institute of Technology, Aungier Street, Dublin 2 (Ireland)
The thermal performance of a complex multimaterial frame consisting of an exoskeleton framework and cavities filled with insulant materials enclosing an evacuated glazing was simulated using a two-dimensional finite element model and the results were validated experimentally using a guarded hot box calorimeter. The analysed 0.5m by 0.5m evacuated glazing consisted of two low-emittance film coated glass panes supported by an array of 0.32mm diameter pillars spaced 25mm apart, contiguously sealed by a 10mm wide metal edge seal. Thermal performance of windows employing evacuated glazing set in various complex multimaterial frames were analysed in detail. Very good agreement was found between simulations and experimental measurements of surface temperatures of the evacuated glazing window system. The heat loss from a window with an evacuated glazing and a complex multimaterial frame is about 80% of that for a window comprised of an evacuated glazing set in a single material solid frame. (author)
Gamble, Sonya B; Strauss, Lilo T; Parker, Wilda Y; Cook, Douglas A; Zane, Suzanne B; Hamdan, Saeed
CDC began abortion surveillance in 1969 to document the number and characteristics of women obtaining legal induced abortions. This report summarizes and describes data voluntarily reported to CDC regarding legal induced abortions obtained in the United States in 2005. For each year since 1969, CDC has compiled abortion data by state or area of occurrence. Information is requested each year from all 50 states, New York City, and the District of Columbia. For 2005, data were received from 49 reporting areas: New York City, District of Columbia, and all states except California, Louisiana, and New Hampshire. For the purpose of trends analysis, data were evaluated from the 46 reporting areas that have been consistently reported since 1995. A total of 820,151 legal induced abortions were reported to CDC for 2005 from 49 reporting areas, the abortion ratio (number of abortions per 1,000 live births) was 233, and the abortion rate was 15 per 1,000 women aged 15--44 years. For the 46 reporting areas that have consistently reported since 1995, the abortion rate declined during 1995--2000 but has remained unchanged since 2000. For 2005, the highest percentages of reported abortions were for women who were known to be unmarried (81%), white (53%), and aged abortions for which gestational age was reported, 62% were performed at abortions were first collected) through 2005, the percentage of abortions performed at abortions occurred at >15 weeks' gestation (3.7% at 16--20 weeks and 1.3% at >/=21 weeks). A total of 35 reporting areas submitted data stating that they performed and enumerated medical (nonsurgical) procedures, making up 9.9% of all known reported procedures from the 45 areas with adequate reporting on type of procedure. In 2004 (the most recent years for which data are available), seven women died as a result of complications from known legal induced abortion. One death was associated with known illegal abortion. For the 46 reporting areas that have consistently
Keogh, Sarah C; Kimaro, Godfather; Muganyizi, Projestine; Philbin, Jesse; Kahwa, Amos; Ngadaya, Esther; Bankole, Akinrinola
Tanzania has one of the highest maternal mortality ratios in the world, and unsafe abortion is one of its leading causes. Yet little is known about its incidence. To provide the first ever estimates of the incidence of unsafe abortion in Tanzania, at the national level and for each of the 8 geopolitical zones (7 in Mainland plus Zanzibar). A nationally representative survey of health facilities was conducted to determine the number of induced abortion complications treated in facilities. A survey of experts on abortion was conducted to estimate the likelihood of women experiencing complications and obtaining treatment. These surveys were complemented with population and fertility data to obtain abortion numbers, rates and ratios, using the Abortion Incidence Complications Methodology. In Tanzania, women obtained just over 405,000 induced abortions in 2013, for a national rate of 36 abortions per 1,000 women age 15-49 and a ratio of 21 abortions per 100 live births. For each woman treated in a facility for induced abortion complications, 6 times as many women had an abortion but did not receive care. Abortion rates vary widely by zone, from 10.7 in Zanzibar to 50.7 in the Lake zone. The abortion rate is similar to that of other countries in the region. Variations by zone are explained mainly by differences in fertility and contraceptive prevalence. Measures to reduce the incidence of unsafe abortion and associated maternal mortality include expanding access to post-abortion care and contraceptive services to prevent unintended pregnancies.
Tatum, Carrie E; Garcia, Sandra G; Yam, Eileen A; Becker, Davida
In Mexico, abortion is legal only in limited, specific circumstances and unsafe abortion complications are estimated to be the fourth leading cause of maternal mortality. Our study sought to understand the opinions Mexicans hold about abortion and sexuality and to learn about their fears and hopes about more liberalized abortion laws in Mexico. We carried out 12 focus groups with a total of 87 women and men, aged 18-24. Six focus groups took place in Mexico City and six in Merida, Yucatan. One reader thematically analyzed and coded discussion transcripts. Participants favoring highly restrictive abortion laws generally felt that pregnant women should "face the consequences" of having a baby, whereas those who favored less restrictive laws focused less on culpability and more on the woman's right to control her future. Mexico City participants generally had more liberal abortion opinions. Most Merida participants thought abortion was never legal, despite the fact that their state has the country's most liberal abortion laws. Many felt that, if abortion were legal, there would be more abortions but that it would likely be a safer procedure. Merida participants' more conservative attitudes may be a reflection of their lower educational levels and largerproportion of Catholic participants compared to the Mexico City groups. It is critical to introduce more balanced information that emphasizes the safety of abortions performed under legal conditions and address fears of greatly elevated abortion rates if abortion laws were liberalized. Mexican young adults need more scientific, balanced sources of information on abortion and abortion law.
Chen, Melissa J; Creinin, Mitchell D
To summarize clinical outcomes and adverse effects of medical abortion regimens consisting of mifepristone followed by buccal misoprostol in pregnancies through 70 days of gestation. We used PubMed, ClinicalTrials.gov, and reference lists from published reports to identify relevant studies published between November 2005 and January 2015 using the search terms "mifepristone and medical abortion" and "buccal and misoprostol." Studies were included if they presented clinical outcomes of medical abortion using mifepristone and buccal misoprostol through 70 days of gestation. Studies with duplicate data were excluded. We included 20 studies with a total of 33,846 women through 70 days of gestation. We abstracted efficacy and ongoing pregnancy rates as an overall rate and by gestational age in days in reference to completed weeks (eg, 49 days or less, 50-56 days, 57-63 days, 64-70 days) and adverse effects when reported. The overall efficacy of mifepristone followed by buccal misoprostol is 96.7% (95% confidence interval [CI] 96.5-96.8%) and the continuing pregnancy rate is 0.8% (95% CI 0.7-0.9%) in approximately 33,000 pregnancies through 63 days of gestation. Only 332 women with pregnancies between 64 and 70 days of gestation are reported in the literature with an overall efficacy of 93.1% (95% CI 89.6-95.5%) and a continuing pregnancy rate of 2.9% (95% CI 1.4-5.7%). Currently available data suggest that regimens with a 24-hour time interval between mifepristone and buccal misoprostol administration are slightly less effective than those with a 24- to 48-hour interval. Rates of surgical evacuation for reasons other than ongoing pregnancy range from 1.8% to 4.2%. Severe adverse events like blood transfusion (0.03-0.6%) and hospitalization (0.04-0.9%) are uncommon. Outpatient medical abortion regimens with mifepristone followed in 24-48 hours by buccal misoprostol are highly effective for pregnancy termination through 63 days of gestation. More data are needed to
Sirimai, Korakot; Lertbunnaphong, Tripop; Malakorn, Kitti; Warnnissorn, Malee
To study the correlation of endometrial pathology, which were derived from manual vacuum aspiration (MVA) and sharp metal curettage (SMC). Women aged over 35 years old who presented with abnormal uterine bleeding were enrolled. Endometrial biopsy using MVA and sharp metal curettage under paracervical nerve block were performed, respectively. Correlation of endometrial pathology from both methods and correlation between endometrial pathology from MVA and the most severe pathology were analyzed using Kappa statistics. One hundred and thirty two women were enrolled Nine cases were drop out because of inability to pass the MVA's cannula through the cervical os. Mean age was 49.3 ± 8.5 years old. Mean BMI was 25.1 ± 4 kg/m². Pathological correspondence between tissue obtained from MVA and sharp metal curette was 64.2% and the Kappa agreement was 0.56 (K0 = 0.56, p-value abnormal uterine bleeding.
Christensen, Anne Vinggaard; Petersson, Birgit
Internationale undersøgelser viser, at sene provokerede aborter skaber en større bekymring hos sundhedspersonale end tidlige aborter. Den største bekymring er risikoen for, at det aborterede foster udviser livstegn efter fødslen. Undersøgelser peger desuden på, at indikationen for abort, religiøs...... tilknytning og fagligt tilhørsforhold påvirker holdningerne. Antallet af sene provokerede aborter stiger i takt med, at fosterdiagnostikken udvikles, og der er derfor behov for forskning, der kan kaste lys over, hvordan det danske sundhedspersonale forholder sig til sene provokerede aborter....
Background The study aimed to describe the overall and age-specific trends of induced abortions from 1996 to 2011 with an emphasis on socio-demographic characteristics and contraceptive use of women having had repeat abortions in Estonia. Methods Data were retrieved from the Estonian Medical Birth and Abortion Registry and Statistics Estonia. Total induced abortion numbers, rates, ratios and age-specific rates are presented for 1996–2011. The percentage change in the number of repeat abortions within selected socio-demographic subgroups, contraception use and distribution of induced abortions among Estonians and non-Estonians for the first, second, third, fourth and subsequent abortions were calculated for the periods 1996–2003 and 2004–2011. Results Observed trends over the 16-year study period indicated a considerable decline in induced abortions with a reduction in abortion rate of 57.1%, which was mainly attributed to younger cohorts. The percentage of women undergoing repeat abortions fell steadily from 63.8% during 1996–2003 to 58.0% during 2004–2011. The percentage of women undergoing repeat abortions significantly decreased over the 16 years within all selected socio-demographic subgroups except among women with low educational attainment and students. Within each time period, a greater percentage of non-Estonians than Estonians underwent repeat abortions and obtained third and subsequent abortions. Most women did not use any contraceptive method prior to their first or subsequent abortion. Conclusion A high percentage of women obtaining repeat abortions reflects a high historical abortion rate. If current trends continue, a rapid decline in repeat abortions may be predicted. To decrease the burden of sexual ill health, routine contraceptive counselling, as standard care in the abortion process, should be seriously addressed with an emphasis on those groups - non-Estonians, women with lower educational attainment, students and women with children
Melton, Gary B.
Legislators often have established special procedures for judicial or parental involvement in adolescent abortion decisions. While ostensibly protecting pregnant minors' psychological health, and increasing the competency of decision making, judicial bypass and parental notification promote neither goal. At best, they are benign but costly and…
In 'After-birth abortion: why should the baby live?', Giubilini and Minerva argue that infanticide should be permitted for the same reasons as abortion. In particular, they argue that infanticide should be permitted even for reasons that do not primarily serve the interests (or would-be best interests) of the newborn. They claim that abortion is permissible for reasons that do not primarily serve the interests (or would-be interests) of the fetus because fetuses lack a right to life. They argue that newborns also lack a right to life, and they conclude that therefore, the same reasons that justify abortion can justify infanticide. This conclusion does not follow. The lack of a right to life is not decisive. Furthermore, the justificatory power of a given reason is a function of moral context. Generalisations about reasons across dissimilar moral contexts are invalid. However, a similar conclusion does follow-that fetus-killing and newborn-killing are morally identical in identical moral contexts-but this conclusion is trivial, since fetuses and newborns are never in identical moral contexts.
Gupta, Som P; Garg, Gaurav
Thorough curettage and cement augmentation is the procedure of choice for treating giant cell tumor lesions, particularly those associated with large defects. Its association with pathological fractures has not been studied to a great extent, although a pathological fracture following a giant cell tumor is not a contraindication to treatment by curettage and cementation. We present our experience of bone cementation following intralesional curettage for treatment of giant cell tumors of the long bones of lower limbs with associated pathological fractures. A total of 38 patients who had undergone a procedure in the weight-bearing long bones of lower limbs were included in the study. The age of the patients ranged from 18-79 years with a mean age of 38.57 years. The average follow-up was 102.42 months (8.5 years) ranging from 60-186 months (5-15.5 years). Results were based on serial radiographs showing consolidation of the lesion along with a subjective clinical examination and Enneking functional evaluation noted in the patient's records. Approximately 76 % of the lesions occurred around the knee. The results were graded as excellent (72 %), good (12.82 %) fair (10.25 %) and poor (5.12 %). Four cases developed a recurrence. Apart from a few documented complications, the lesions showed good consolidation and healed well. Giant cell tumors of the long bones of lower limbs with an associated pathological fracture at diagnosis can be managed with thorough curettage and cement augmentation of the bone defect with a satisfactory outcome. Level IV.
Wahyudi, A.; Jacky, M.; Mudzakkir, M.; Deprita, R.
An on-going debate of whether or not to legalize abortion has not stopped the number of abortion cases decreases. New practices of abortion such as online abortion has been a growing trend among teenagers. This study aims to determine how teenagers use social media such as Facebook, YouTube and Wikipedia for the practice of abortion. This study adopted online research methods (ORMs), a qualitative approach 2.0 by hacking analytical perspective developed. This study establishes online teen abortion as a research subject. This study finds patterns of online abortions among teenagers covering characteristics of teenagers as perpetrators, styles of communication, and their implication toward policy, particularly Electronic Transaction Information (ETI) regulation. Implications for online abortion behavior among teenagers through social media. The potential abortion client especially girls find practical, fast, effective, and efficient solutions that keep their secret. One of prevention patterns that has been done by some people who care about humanity and anti-abortion in the online world is posting a anti-abortion text, video or picture, anti-sex-free (anti -free intercourse before marriage) in an interesting, educative, and friendly ways.
Laursen, Laura; Stumbras, Katrina; Lewnard, Irene; Haider, Sadia
This study sought to compare contraception provided to patients after medication and surgical abortion. Women who underwent first trimester induced abortion at a university-based urban clinic between May 2009 and May 2014 were identified. Medical records were reviewed to determine the method of contraception provided by the clinic to patients after medication and surgical abortion. Postabortal contraception was defined as any contraception administered or prescribed from our health system within 4 weeks of surgical abortion or mifepristone administration. We reviewed 824 women who were 9 weeks gestational age or less and able to choose between medication and surgical termination of pregnancy. Overall, 587 (71.1%) had a surgical abortion and 237 (28.9%) had a medication abortion. Women who had surgical abortions were more likely to initiate long-acting reversible contraception (41.9% vs. 23.2%; p abortion was 71.7%. Women who had surgical abortions had a greater odds of receiving long-acting reversible contraception than those who had medication abortions. Surgical abortion patients were also more likely to be provided contraception overall. Further prospective research is needed to determine the reasons for this difference and to ensure that all patients obtain the contraception that they desire. Copyright © 2017 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.
O'Neil, Mary Lou
Despite the existence of a liberal law on abortion in Turkey, there is growing evidence that actually securing an abortion in Istanbul may prove difficult. This study aimed to determine whether or not state hospitals and private hospitals that accept state health insurance in Istanbul are providing abortion services and for what indications. Between October and December 2015, a mystery patient telephone survey of 154 hospitals, 43 public and 111 private, in Istanbul was conducted. 14% of the state hospitals in Istanbul perform abortions without restriction as to reason provided in the current law while 60% provide the service if there is a medical necessity. A quarter of state hospitals in Istanbul do not provide abortion services at all. 48.6% of private hospitals that accept the state health insurance also provide for abortion without restriction while 10% do not provide abortion services under any circumstances. State and private hospitals in Istanbul are not providing abortion services to the full extent allowed under the law. The low numbers of state hospitals offering abortions without restriction indicates a de facto privatization of the service. This same trend is also visible in many private hospitals partnering with the state that do not provide abortion care. While many women may choose a private provider, the lack of provision of abortion care at state hospitals and those private hospitals working with the state leaves women little option but to purchase these services from private providers at some times subtantial costs.
Acmaz, Gökhan; Bayraktar, Evrim; Aksoy, Hüseyin; Başer, Mürvet; Yilmaz, Mustafa Oğuz; Müderris, İptisam İpek
Patients frequently experience pain of moderate to severe degree during gynaecologic procedures. This prospective, randomized, placebo-controlled trial was aimed to investigate the analgesic efficacy of preoperative oral dexketoprofen trometamol, intravenous paracetamol, lidocaine spray, pethidine and diclofenac sodium on fractional curettage procedure. A total of 144 multiparous women were randomly allocated to one of the six groups. The first group (control group) consisted of 22 participants and they did not receive any treatment. The second group had 26 participants receiving oral 25 mg dexketoprofen trometamol. The 23 participants of the third group received two puff lidocaine sprays on cervical mucosa. t0 he forth group consisted of 25 participants receiving 100 mg pethidine. In the fifth group, the 23 participants received 1000 mg intravenous paracetamol and the sixth group consisted of 25 participants receiving diclofenac sodium. Pethidine was the best choice for reducing pain score during curettage procedure (t2:intra-operative). All analgesic procedures were significantly effective in reducing pain during postoperative period (t3). Significant pain reduction was achieved for both intra- and postoperative period by using analgesics. The results of our study showed that lidocaine puffs provided the best pain relief than the other analgesics used. Therefore, lidocaine may be considered as the first choice analgesic in fractional curettage (NCT ID: 01993589).
An historical review of the use of induced abortion is presented, beginning with early eras. The Chinese were the 1st to record the practice of induced abortion, with this operation being administered to royal concubines recorded at 500-515 B.C. Induced abortion was not used in ancient Greece, either for criminal or ethical reason. However, the ancient Greeks did utilize compulsory abortion for serious economic indications, as a means of controlling natural growth. Greek medical, gyneoclogigcal instruments for adminsitering abortions were described by Hippocrates. The Greek moral attitudes on abortion were largely adopted by the Romans, which were later altered by the appearance of Christianity and new ethical ideas. These ideas dominated European attitudes, along with the Church of Rome, limiting induced abortion to cases where the life of the mother was threatened. This attitude has existed until the present century, when these moral ideas are being challanged seriously for the 1st time in modern history.
Horvath, Sarah; Schreiber, Courtney A
The early medical literature on mental health outcomes following abortion is fraught with methodological flaws that can improperly influence clinical practice. Our goal is to review the current medical literature on depression and other mental health outcomes for women obtaining abortions. The Turnaway Study prospectively enrolled 956 women seeking abortion in the USA and followed their mental health outcomes for 5 years. The control group was comprised of women denied abortions based on gestational age limits, thereby circumventing the major methodological flaw that had plagued earlier studies on the topic. Rates of depression are not significantly different between women obtaining abortion and those denied abortion. Rates of anxiety are initially higher in women denied abortion care. Counseling on decision-making for women with unintended pregnancies should reflect these findings.
Savage, Wendy Diane; Francome, Colin
We aimed to ascertain the attitude of consultant gynaecologists towards the working of the 1967 Abortion Act, women's choice and decriminalisation of abortion, and whether they had requests on the grounds of foetal sex in the last five years. A postal questionnaire was sent to a 20% random sample of NHS gynaecologists, coded and analysed using SPSS. 286 doctors replied, 78%. 60% considered the abortion act was working satisfactorily. Ninety percent thought the woman should decide whether to continue the pregnancy in consultation with her doctor. However, 15% thought it too easy to obtain. Fifty-six percent of those with an opinion agreed that abortion should be decriminalised and treated like any other medical procedure. It is time to consider decriminalisation of abortion. About half performed abortions and 152 (97%) had never had a request for an abortion on the grounds of foetal sex. Sex selection is not a major problem in the UK.
Allgeier, A R; Allgeier, E R; Rywick, T
Students (N = 118) were classified as pro-choice, anti-abortion, or mixed on the basis of their responses to ten fictitious case histories of females who requested abortion. The distribution of participants on the abortion issue was quite similar to the results of a 1979 national survey. As expected, these groups differed on attitudes toward abortion as murder, the legalization of abortion, and the morality of premarital sex. The groups differed significantly in levels of sex guilt, but did not exhibit significant differences in levels of sexual knowledge. The results were discussed within the context of the public controversy over abortion. It was suggested that the affective messages accompanying the sexual socialization of children and adolescents may be more predictive of orientations toward abortion than the weight of intellectual arguments regarding the rights of the fetus, the point at which a fetus becomes viable, or a woman's right to have control over her own body.
Dadlez, E M; Andrews, William L
The contention that abortion harms women constitutes a new strategy employed by the pro-life movement to supplement arguments about fetal rights. David C. Reardon is a prominent promoter of this strategy. Post-abortion syndrome purports to establish that abortion psychologically harms women and, indeed, can harm persons associated with women who have abortions. Thus, harms that abortion is alleged to produce are multiplied. Claims of repression are employed to complicate efforts to disprove the existence of psychological harm and causal antecedents of trauma are only selectively investigated. We argue that there is no such thing as post-abortion syndrome and that the psychological harms Reardon and others claim abortion inflicts on women can usually be ascribed to different causes. We question the evidence accumulated by Reardon and his analysis of data accumulated by others. Most importantly, we question whether the conclusions Reardon has drawn follow from the evidence he cites. © 2009 Blackwell Publishing Ltd.
Nasr, Marwan W; Jabbour, Samer F; Haber, Roger N; Kechichian, Elio G; El Hachem, Lena
Primary focal axillary hyperhidrosis is a disorder of excessive sweating that can strongly impact quality of life. The objective if this study was to compare microwave ablation (MA), botulinum toxin (BT) injection, and liposuction-curettage (LC) in the treatment of primary axillary hyperhidrosis based on subjective and objective criteria. A systematic review of the literature published in French or English between 1 January 1991 and 1 February 2015 was completed using PubMed and Embase databases. 16 of 775 articles were selected based on relevance and criteria of inclusion and exclusion. The three methods proved to be efficient and safe; however, MA and BT had better results when compared to LC in the short term. Both MA and LC showed longer lasting results when compared to BT. However, in the long term, MA was superior to LC. MA, LC, and BT injections are safe and efficient minimally invasive alternatives for the treatment of axillary hyperhidrosis. Well-designed randomized controlled trials are needed to further compare the efficacy of these techniques.
Full Text Available Virtual reality (VR is a promising tool to study evacuation behavior as it allows experimentally controlled, safe simulation of otherwise dangerous situations. However, validation studies comparing evacuation behavior in real and virtual environments are still scarce. We compare the decision to evacuate in response to a fire alarm in matched physical and virtual environments. 150 participants were tested individually in a one-trial experiment in one of three conditions. In the Control condition, the fire alarm sounded while the participant performed a bogus perceptual matching task. In the Passive bystander condition, the participant performed the task together with a confederate who ignored the fire alarm. In the Active bystander condition, the confederate left the room when the fire alarm went off. Half of the participants in each condition experienced the scenario in the real laboratory, and the other half in a matched virtual environment with a virtual bystander, presented in a head-mounted display. The active bystander group was more likely to evacuate, and the passive bystander group less likely to evacuate, than the control group. This pattern of social influence was observed in both the real and virtual environments, although the overall response to the virtual alarm was reduced; positive influence was comparable, whereas negative influence was weaker in VR. We found no reliable gender effects for the participant or the bystander. These findings extend the bystander effect to the decision to evacuate, revealing a positive as well as the previous negative social influence. The results support the ecological validity of VR as a research tool to study evacuation behavior in emergency situations, with the caveat that effect sizes may be smaller in VR.
Sternberg, Ernest; Lee, George C; Huard, Danial
To investigate the relative distribution of hazards causing hospital evacuations, thereby to provide rudimentary risk information for hospital disaster planning. Cases of hospital evacuations were retrieved from newspaper and publication databases and classified according to hazard type, proximate and original cause, duration, and casualties. Both partial and full evacuations were included. The total number of evacuation incidents for all hazards were compared to the total number of hospital incidents for the one hazard, fire, for which national data is available. There were 275 reported evacuation incidents from 1971-1999, with an annual average of 21 in the 1990s, the period for which databases were more reliable. The most, 33, were recorded in 1994, the year of the Northridge Earthquake. Of all incidents, 63 (23%) were attributable primarily to internal fire, followed by internal hazardous materials (HazMat) events (18%), hurricane (14%), human threat (13%), earthquake (9%), external fire (6%), flood (6%), utility failure (5%), and external HazMat (4%). More than 50% of the hospital evacuations occurred because of hazards originating in the hospital facility itself or from human intruders. While natural disasters were not the preponderant causes of evacuations, they caused severe problems when multiple hospitals in the same urban area were incapacitated simultaneously. Clearly, as hospitals are vulnerable to many hazards, mitigation investments should be assessed not in terms of single-hazard risk-cost-benefit analysis, but in terms of capacity to mitigate multiple hazards. In view of the many qualifications and limitations of the dataset used here, but value of such data for disaster planning, hospitals should be asked to submit standardized incident reports to permit national data gathering on major disruptions.
Jones, J. M.; Ng, P.; Henry, K.; Peters, J.; Wood, N. J.
Hazard evacuation planning requires robust modeling tools and techniques, such as least cost distance or agent-based modeling, to gain an understanding of a community's potential to reach safety before event (e.g. tsunami) arrival. Least cost distance modeling provides a static view of the evacuation landscape with an estimate of travel times to safety from each location in the hazard space. With this information, practitioners can assess a community's overall ability for timely evacuation. More information may be needed if evacuee congestion creates bottlenecks in the flow patterns. Dynamic movement patterns are best explored with agent-based models that simulate movement of and interaction between individual agents as evacuees through the hazard space, reacting to potential congestion areas along the evacuation route. The multi-agent transport simulation model MATSim is an agent-based modeling framework that can be applied to hazard evacuation planning. Developed jointly by universities in Switzerland and Germany, MATSim is open-source software written in Java and freely available for modification or enhancement. We successfully used MATSim to illustrate tsunami evacuation challenges in two island communities in California, USA, that are impacted by limited escape routes. However, working with MATSim's data preparation, simulation, and visualization modules in an integrated development environment requires a significant investment of time to develop the software expertise to link the modules and run a simulation. To facilitate our evacuation research, we packaged the MATSim modules into a single application tailored to the needs of the hazards community. By exposing the modeling parameters of interest to researchers in an intuitive user interface and hiding the software complexities, we bring agent-based modeling closer to practitioners and provide access to the powerful visual and analytic information that this modeling can provide.
Singh, Susheela; Prada, Elena; Kestler, Edgar
Although Guatemalan law permits induced abortion only to save a woman's life, many women obtain abortions, often under unsafe conditions and in response to an unintended pregnancy. Recent studies indicate that unsafe abortion is a key factor contributing to maternal morbidity and mortality in the country, but no national data on the incidence of abortion exist. Surveys of all hospitals that treat women for postabortion complications and of 74 professionals who are knowledgeable about the conditions of abortion provision in Guatemala were conducted in 2003. Indirect estimation techniques were used to calculate the number of induced abortions performed annually. Abortion rates and ratios and the level of unintended pregnancy were calculated for the nation and its eight regions. Nearly 65,000 induced abortions are performed annually in Guatemala, and about 21,600 women are hospitalized for treatment of complications. Abortions occur at a rate of 24 per 1,000 women aged 15-49, and there is one abortion for every six births. The abortion rate is higher than average in the Southwest (less developed, mainly indigenous population) and Metropolitan (more developed, mainly nonindigenous population) regions (29-30 per 1,000 women). Over a quarter of all births are unplanned; combining unplanned births with abortions yields estimates that 32% of pregnancies in Guatemala are unintended, with an unintended pregnancy rate of 66 per 1,000 women. Unsafe abortion has a significant impact on women's health in Guatemala. Comprehensive government programs are needed to address the issues of unintended pregnancy and unsafe abortion, with attention to regional differences.
Dabash, Rasha; Chelli, Héla; Hajri, Selma; Shochet, Tara; Raghavan, Sheila; Winikoff, Beverly
To assess differences in outcomes of misoprostol with or without mifepristone for second-trimester abortion. A randomized, double-blind, placebo-controlled trial of buccal misoprostol following placebo or 200mg mifepristone was done in Tunisia among women presenting for abortions at 14-21 weeks of pregnancy between August 2009 and December 2011. Women with a live fetus, a closed cervical os, no cervical bleeding, and no contraindications to study drugs were eligible and underwent randomization (block size 10). Participants returned 24 hours later to receive 400 μg buccal misoprostol every 3 hours until complete fetal and placental expulsion (maximum 10 doses, five per 24-hour period). The primary outcomes were rates of complete uterine evacuation at 48 hours and time to expulsion. A total of 120 women were evenly randomized to treatment. Complete uterine evacuation at 48 hours was recorded in 55 (91.7%) women in the combined group versus 43 (71.7%) in the misoprostol alone group (relative risk 1.28; 95% confidence interval 1.07-1.53). Mean time to complete abortion was 10.4±6.6 hours in the group who received mifepristone versus 20.6±9.7 hours in the misoprostol alone group (Pmisoprostol can improve the quality of second-trimester abortion care by making the process faster. Copyright © 2015 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.
Kundu, Zile Singh; Sen, Rajeev; Dhiman, Ankur; Sharma, Pankaj; Siwach, Ramchander; Rana, Parveen
Giant cell tumor (GCT) of the bone is known for its locally aggressive behavior and tendency to recur. It is an admixture of rounded or spindle-shaped mononuclear neoplastic stromal cells and multinucleated osteoclast-like giant cells with their proportionate dispersion among the former. Zoledronic acid (a bisphosphonate) is being used in various cancers such as myelomas and metastasis, for osteoporosis with an aim to reduce the resorption of bone, and as an adjuvant treatment for the management of GCT of bone for reduction of local recurrence. We have carried out a prospective comparative study to assess the effect of intravenous infusion of zoledronic acid on histopathology and recurrence of GCT of bone. The study was carried out in the biopsy proven GCTs in 37 patients; 15 males and 22 females, in the age range from 17 to 55 years. They were treated with extended curettage. Of these 37 patients, 18 were given three doses of 4 mg zoledronic acid infusion at 3-week intervals and extended curettage was performed 2 weeks after the last infusion whereas the other 19 were treated with extended curettage without zoledronic infusion. The post infusion histopathology of the curetted material was compared with the histopathology of initial biopsy. All the patients were evaluated at 3-month intervals for the first 2 years and then six monthly thereafter, for local recurrence and functional outcome of limb using the Musculoskeletal Tumor Society (MSTS) score. In postzoledronic infusion cases, the histopathology of samples showed abnormal stromal cells secreting matrix leading to fibrosis and calcification. The type of fibrosis and calcification was different from pathological calcification and fibrosis what is usually observed. There was a good marginalization and solidification of tumors which made surgical curettage easier in six cases in the study group. There was noticeable reduction in the number of giant cells and alteration in morphology of stromal cells to the
Wang, Jinhuan; Zhang, Lei; Shi, Qiongyu; Yang, Peng; Hu, Xiaoming
A new multi-agent based congestion evacuation model incorporating panic behavior is proposed in this paper for simulating pedestrian evacuation in public places such as a stadium. Different from the existing results, pedestrians in this model are divided into four classes and each pedestrian's status can be either normal, being overtaken, or casualty. The direction of action for each individual is affected by competitive ability, distance to the exits as well as number and density of occupants within the view field of the agent. Our simulations exhibit that during the evacuation process: (1) The agents gather in front of the exits spontaneously and present arched shapes close to the exits. (2) Under the panic state the agents cohere closely and almost do not change the target exit. So other alternative exits are ignored. (3) For the case without obstacle, the casualties under panic increase greatly. But if there are obstacles (chairs), the congestion can be alleviated. Thus the casualties are reduced. (4) If certain exit is partly clogged, the evacuation becomes more efficient when adding a virtual leader. The overall simulation results show that the proposed model can reproduce the real evacuation process in a stadium quite well.
Koch, Daniel B [ORNL; Payne, Patricia W [ORNL
Although modeling and simulation of mass evacuations during a natural or man-made disaster is an on-going and vigorous area of study, tool adoption by front-line first responders is uneven. Some of the factors that account for this situation include cost and complexity of the software. For several years, Oak Ridge National Laboratory has been actively developing the free Incident Management Preparedness and Coordination Toolkit (IMPACT) to address these issues. One of the components of IMPACT is a multi-agent simulation module for area-based and path-based evacuations. The user interface is designed so that anyone familiar with typical computer drawing tools can quickly author a geospatially-correct evacuation visualization suitable for table-top exercises. Since IMPACT is designed for use in the field where network communications may not be available, quick on-site evacuation alternatives can be evaluated to keep pace with a fluid threat situation. Realism is enhanced by incorporating collision avoidance into the simulation. Statistics are gathered as the simulation unfolds, including most importantly time-to-evacuate, to help first responders choose the best course of action.
Full Text Available Multiobjective evacuation routes optimization problem is defined to find out optimal evacuation routes for a group of evacuees under multiple evacuation objectives. For improving the evacuation efficiency, we abstracted the evacuation zone as a superposed potential field network (SPFN, and we presented SPFN-based ACO algorithm (SPFN-ACO to solve this problem based on the proposed model. In Wuhan Sports Center case, we compared SPFN-ACO algorithm with HMERP-ACO algorithm and traditional ACO algorithm under three evacuation objectives, namely, total evacuation time, total evacuation route length, and cumulative congestion degree. The experimental results show that SPFN-ACO algorithm has a better performance while comparing with HMERP-ACO algorithm and traditional ACO algorithm for solving multi-objective evacuation routes optimization problem.
York, Sloane L; McGaghie, William C; Kiley, Jessica; Hammond, Cassing
To evaluate obstetrics and gynecology resident physicians' performance following a simulation curriculum on dilation and evacuation (D&E) procedures. This study included two phases: simulation curriculum development and resident physician performance evaluation following training on a D&E simulator. Trainees participated in two evaluations. Simulation training evaluated participants performing six cases on a D&E simulator, measuring procedural time and a 26-step checklist of D&E steps. The operative training portion evaluated residents' performance after training on the simulator using mastery learning techniques. Intra-operative evaluation was based on a 21-step checklist score, Objective Structured Assessment of Technical Skills (OSATS), and percentage of cases completed. Twenty-two residents participated in simulation training, demonstrating improved performance from cases one and two to cases five and six, as measured by checklist score and procedural time (pcurriculum improves resident technical skills. Simulation training with mastery learning techniques transferred to high level of performance in OR using checklist. The OSATS measured skills and showed improvement in performance with subsequent cases. Implementation of a D&E simulation curriculum offers potential for improved surgical training and abortion provision. Copyright © 2016 Elsevier Inc. All rights reserved.
Jilozian, Ann; Agadjanian, Victor
As in other post-Soviet settings, induced abortion has been widely used in Armenia. However, recent national survey data point to a substantial drop in abortion rates with no commensurate increase in modern contraceptive prevalence and no change in fertility levels. We use data from in-depth interviews with women of reproductive age and health providers in rural Armenia to explore possible underreporting of both contraceptive use and abortion. While we find no evidence that women understate their use of modern contraception, the analysis suggests that induced abortion might indeed be underreported. The potential for underreporting is particularly high for sex-selective abortions, for which there is growing public backlash, and medical abortion, a practice that is typically self-administered outside any professional supervision. Possible underreporting of induced abortion calls for refinement of both abortion registration and relevant survey instruments. Better measurement of abortion dynamics is necessary for successful promotion of effective modern contraceptive methods and reduction of unsafe abortion practices. © 2016 The Population Council, Inc.
Hagen, Gunn Helen; Hage, Christine Ødegaard; Magelssen, Morten; Nortvedt, Per
It is not known whether the attitudes of Norwegian medical students towards abortion change in the course of their studies, or whether the attitudes differ among the four Norwegian medical schools. We have investigated attitudes towards abortion and the right to conscientious objection among medical students early and late in their studies at the four medical schools. Student satisfaction with the teaching on abortion was also surveyed. A questionnaire survey was carried out among medical students at the four Norwegian medical schools, first year and fourth/fifth year students respectively. 514 students (58.3 % of the students in the chosen classes) responded. 87.5 % approved of abortion on demand. The students at NTNU were the most liberal (93.5 %). Fourth/fifth year students were more liberal than first year students (91.3 % vs. 84.7 %, p = 0.027). 27.3 % would want to exercise their right to conscientious objection. 41.5 % had been present at a surgical abortion. Of those who had not been present at a surgical abortion, 84.1 % would want to see an abortion being carried out if given the opportunity. 29 % agreed that the teaching did not adequately cover the ethical aspects of abortion. Abortion on demand has wide approval among Norwegian medical students. However, many students would consider exercising their right to conscientious objection. More fourth/fifth year students than first year students approved of abortion.
The Soviet legacy of widespread reliance on induced abortion is of critical importance to reproductive trends and policies in post-Soviet nations, especially as they strive to substitute contraception for abortion. Using data from two Demographic and Health Surveys conducted in 1995 and 1999, this study analyzes and compares trends in abortion and contraception, women's attitudes toward abortion, and their perceptions of problems associated with abortion and contraception in Kazakhstan. Despite an overall decline in abortion and an increase in contraceptive use since Kazakhstan's independence in 1991, abortion has remained a prominent part of the country's reproductive culture and practices. This study shows how abortion-related views reflect the long-standing ethnocultural differences between the indigenous Kazakhs and Kazakhstan's residents of European roots, as the latter continue to have significantly higher levels of abortion. The study, however, also reveals the internal diversity among Kazakhs with respect to abortion experiences and views, stemming from decades of the Soviet sociocultural influence in Kazakhstan. In addition, the analysis points to some generational differences in views concerning abortion and contraception. Finally, the study demonstrates parallels in attitudes toward abortion and toward contraception, thereby questioning straightforward assumptions about the replacement of abortion with contraception.
Reproductive governance operates through calculating demographic statistics that offer selective truths about reproductive practices, bodies, and subjectivities. Post-abortion care, a global reproductive health intervention, represents a transnational reproductive regime that establishes motherhood as women's primary legitimate reproductive status. Drawing on ethnographic fieldwork conducted in Senegal between 2010 and 2011, I illustrate how post-abortion care accomplishes reproductive governance in a context where abortion is prohibited altogether and the US is the primary bilateral donor of population aid. Reproductive governance unfolds in hospital gynecological wards and the national health information system through the mobilization and interpretation of post-abortion care data. Although health workers search women's bodies and behavior for signs of illegal abortion, they minimize police intervention in the hospital by classifying most post-abortion care cases as miscarriage. Health authorities deploy this account of post-abortion care to align the intervention with national and global maternal health policies that valorize motherhood. Although post-abortion care offers life-saving care to women with complications of illegal abortion, it institutionalizes abortion stigma by scrutinizing women's bodies and masking induced abortion within and beyond the hospital. Post-abortion care reinforces reproductive inequities by withholding safe, affordable obstetric care from women until after they have resorted to unsafe abortion.
Jones, Rachel K; Jerman, Jenna
To assess the prevalence of abortion among population groups and changes in rates between 2008 and 2014. We used secondary data from the Abortion Patient Survey, the American Community Survey, and the National Survey of Family Growth to estimate abortion rates. We used information from the Abortion Patient Survey to estimate the lifetime incidence of abortion. Between 2008 and 2014, the abortion rate declined 25%, from 19.4 to 14.6 per 1000 women aged 15 to 44 years. The abortion rate for adolescents aged 15 to 19 years declined 46%, the largest of any group. Abortion rates declined for all racial and ethnic groups but were larger for non-White women than for non-Hispanic White women. Although the abortion rate decreased 26% for women with incomes less than 100% of the federal poverty level, this population had the highest abortion rate of all the groups examined: 36.6. If the 2014 age-specific abortion rates prevail, 24% of women aged 15 to 44 years in that year will have an abortion by age 45 years. The decline in abortion was not uniform across all population groups.
Abortion is a common and widespread form of fertility regulation the world over. Legal and illegal abortion is very common throughout the developing countries. Since abortions are often not legal in the developing countries, unsafe abortions are an important cause of female mortality. The widespread incidence of abortions ...
Healy, J; Otsea, K; Benson, J
Maternal mortality reduction has been a focus of major international initiatives for the past two decades. Widespread provision of emergency obstetric care (EmOC) has been shown to be an important strategy for addressing many of the complications that might otherwise lead to maternal death. However, unsafe abortion is one of the major causes of pregnancy-related deaths, and will be only partially addressed by EmOC. This manuscript presents a comprehensive approach to measuring whether abortion-related needs are met. We propose a set of indicators for monitoring the implementation of safe abortion care (SAC) interventions. We build on the model developed for monitoring the availability and use of Emergency Obstetric (EmOC) services. We describe the critical elements ("signal functions") of SAC - including treatment of abortion complications, legal, induced abortion and postabortion contraception - and define the indicators necessary to assess the availability, utilization and quality of abortion-related services. Data from 5 countries suggest there are sufficient service delivery points to provide decentralized abortion care, but that the full range of necessary abortion care services may not be provided at all these sites. Studies from several countries also show that many women receiving services for the treatment of abortion complications accept contraceptive methods when offered prior to discharge. This is an important strategy for reducing unwanted pregnancy, repeat unsafe abortion and risk for abortion-related mortality. Both findings suggest there are considerable opportunities within the present facilities to improve the delivery of abortion care services. This article recommends that the proposed model undergo field-testing on its own or in conjunction with the EmOC indicators, and encourages increased support for this important but often neglected aspect of pregnancy-related health.
Jevtić Radoje B.
Full Text Available One of the most important and the most complex tasks in human protection and human safety in objects is the projecting of the object evacuation. There are many factors that could effect on the opportune living of object such as object assignment, arrangement of rooms, arrangement of furniture, arrangement of exits, occupant speed and many other that human lives and material properties depend on. This is very important for objects with great number of humans, such as high residential objects, shopping centers, schools, hospitals etc. This paper has written to show the possible evacuation situations and calculate minimal time for evacuation in case of the shopping center 'Zona I' in Niš.
DREES, A.; AHRENS, L.; III FLILLER, R.; GASSNER, D.; MCINTYRE, G.T.; MICHNOFF, R.; TRBOJEVIC, D.
During the RHIC Au-run in 2001 the 200 MHz storage cavity system was used for the first time. The rebucketing procedure caused significant beam debunching in addition to amplifying debunching due to other mechanisms. At the end of a four hour store, debunched beam could account for approximately 30%-40% of the total beam intensity. Some of it will be in the abort gap. In order to minimize the risk of magnet quenching due to uncontrolled beam losses at the time of a beam dump, a combination of a fast transverse kicker and copper collimators were used to clean the abort gap. This report gives an overview of the gap cleaning procedure and the achieved performance
Sz Makó, Hajnalka; Veszprémi, Béla
The present paper, based on the results of international studies, is focused on the reconsideration of the psychological aspects of induced abortion. By presenting a narrow cross-section of the Hungarian demographic data, we would like to emphasise the necessity and the significance of a deeper understanding of the subject. Factors behind the decision-making, short- and long term outcomes of the intervention influencing primarily the mental health of women and partner-relationship aspects are discussed in details. While acknowledging the complexity of the subject deriving from the legal, ethical, moral, religious, medical, social and sociological concerns, our aim is to call attention to the psychological aspects of induced abortion and the importance of psychological care of women undergoing surgical operation.
Moeller, M.P.; Desrosiers, A.E.; Urbanik, T. II
This paper describes the methodology and application of the computer model CLEAR (Calculates Logical Evacuation And Response) which estimates the time required for a specific population density and distribution to evacuate an area using a specific transportation network. The CLEAR model simulates vehicle departure and movement on a transportation network according to the conditions and consequences of traffic flow. These include handling vehicles at intersecting road segments, calculating the velocity of travel on a road segment as a function of its vehicle density, and accounting for the delay of vehicles in traffic queues. The program also models the distribution of times required by individuals to prepare for an evacuation. In order to test its accuracy, the CLEAR model was used to estimate evacuation times for the emergency planning zone surrounding the Beaver Valley Nuclear Power Plant. The Beaver Valley site was selected because evacuation time estimates had previously been prepared by the licensee, Duquesne Light, as well as by the Federal Emergency Management Agency and the Pennsylvania Emergency Management Agency. A lack of documentation prevented a detailed comparison of the estimates based on the CLEAR model and those obtained by Duquesne Light. However, the CLEAR model results compared favorably with the estimates prepared by the other two agencies. (author)
For many years, illegal abortion has been denounced in Spain. The estimate of 300,000 abortions annually is widely quoted but poorly founded in fact. Weekend "charters" to London and Amsterdam for women seeking abortions have been commented upon, denounced, and caricatured. The evidence indicates that abortions occur in Spain despite their illegality, just as they occur in every other country and have always occurred. Poor women abort in a poor way, with traditional healers, while rich women abort in a rich way, with physicians. "Charters" are the solution of the middle class. Proposed legislation in Spain would permit abortion on 3 grounds: rape, fetal malformation, and risk to the woman's life if the pregnancy continued. Excesses have been committed both by those opposing abortion and by those struggling for liberalization of laws. Defenders of abortion, such as radical feminists, appear to forget that abortion is a medical procedure with possible dangerous psychophysical consequences, and that preventive measures such as sex education and diffusion of contraception or social measures such as assistance for unwed mothers and their children would be preferrable to abortion. There is the question of whether medical personnel should be excused from assisting in abortions on grounds of conscience and whether those who do assist in abortions automatically become "progressive" by doing so. The staunchest defenders of fetal life are not moved to contribute anything beyond words to improvement of the plight of the many millions of already born who live in miserable conditions of hunger and want. Abortion is a violent act against the fetus and the pregnant woman. Its criminalization is a violent act against the woman and a social intrusion into matters better left to personal ethics. The government which proposes abortion on a few grounds fails to initiate a program to promote life through social protection of single mothers and their children or of families in general
Mhango, Chisale; Philbin, Jesse; Chimwaza, Wanangwa; Chipeta, Effie; Msusa, Ausbert
Background In Malawi, abortion is legal only if performed to save a woman’s life; other attempts to procure an abortion are punishable by 7–14 years imprisonment. Most induced abortions in Malawi are performed under unsafe conditions, contributing to Malawi’s high maternal mortality ratio. Malawians are currently debating whether to provide additional exceptions under which an abortion may be legally obtained. An estimated 67,300 induced abortions occurred in Malawi in 2009 (equivalent to 23 abortions per 1,000 women aged 15–44), but changes since 2009, including dramatic increases in contraceptive prevalence, may have impacted abortion rates. Methods We conducted a nationally representative survey of health facilities to estimate the number of cases of post-abortion care, as well as a survey of knowledgeable informants to estimate the probability of needing and obtaining post-abortion care following induced abortion. These data were combined with national population and fertility data to determine current estimates of induced abortion and unintended pregnancy in Malawi using the Abortion Incidence Complications Methodology. Results We estimate that approximately 141,044 (95% CI: 121,161–160,928) induced abortions occurred in Malawi in 2015, translating to a national rate of 38 abortions per 1,000 women aged 15–49 (95% CI: 32 to 43); which varied by geographical zone (range: 28–61). We estimate that 53% of pregnancies in Malawi are unintended, and that 30% of unintended pregnancies end in abortion. Given the challenges of estimating induced abortion, and the assumptions required for calculation, results should be viewed as approximate estimates, rather than exact measures. Conclusions The estimated abortion rate in 2015 is higher than in 2009 (potentially due to methodological differences), but similar to recent estimates from nearby countries including Tanzania (36), Uganda (39), and regional estimates in Eastern and Southern Africa (34–35). Over
Full Text Available The preparedness phase is crucial in the emergency management process for reaching an adequate level of readiness to react to potential threats and hazards. During this phase, emergency plans are developed to establish, among other procedures, evacuation and emergency escape routes. Information and Communication Technologies (ICT can support and improve these procedures providing appropriate, updated and accessible information to all people in the affected zone. Current emergency management and evacuation systems do not adapt information to the context and the profile of each person, so messages received in the emergency might be useless. In this paper, we propose a set of criteria that ICT-based systems could achieve in order to avoid this problem adapting emergency alerts and evacuation routes to different situations and people. Moreover, in order to prove the applicability of such criteria, we define a mechanism that can be used as a complement of traditional evacuation systems to provide personalized alerts and evacuation routes to all kinds of people during emergency situations in working places. This mechanism is composed by three main components: CAP-ONES for notifying emergency alerts, NERES for defining emergency plans and generating personalized evacuation routes, and iNeres as the interface to receive and visualize these routes on smartphones. The usability and understandability of proposed interface has been assessed through a user study performed in a fire simulation in an indoor environment. This evaluation demonstrated that users considered iNeres easy to understand, to learn and to use, and they also found very innovative the idea to use smartphones as a support for escaping instead of static signals on walls and doors.
Karthik, Rajasekar [ORNL; Lu, Wei [ORNL
Critical infrastructure disruption, caused by severe weather events, natural disasters, terrorist attacks, etc., has significant impacts on urban transportation systems. We built a computational framework to simulate urban transportation systems under critical infrastructure disruption in order to aid real-time emergency evacuation. This framework will use large scale datasets to provide a scalable tool for emergency planning and management. Our framework, World-Wide Emergency Evacuation (WWEE), integrates population distribution and urban infrastructure networks to model travel demand in emergency situations at global level. Also, a computational model of agent-based traffic simulation is used to provide an optimal evacuation plan for traffic operation purpose . In addition, our framework provides a web-based high resolution visualization tool for emergency evacuation modelers and practitioners. We have successfully tested our framework with scenarios in both United States (Alexandria, VA) and Europe (Berlin, Germany) . However, there are still some major drawbacks for scaling this framework to handle big data workloads in real time. On our back-end, lack of proper infrastructure limits us in ability to process large amounts of data, run the simulation efficiently and quickly, and provide fast retrieval and serving of data. On the front-end, the visualization performance of microscopic evacuation results is still not efficient enough due to high volume data communication between server and client. We are addressing these drawbacks by using cloud computing and next-generation web technologies, namely Node.js, NoSQL, WebGL, Open Layers 3 and HTML5 technologies. We will describe briefly about each one and how we are using and leveraging these technologies to provide an efficient tool for emergency management organizations. Our early experimentation demonstrates that using above technologies is a promising approach to build a scalable and high performance urban
Krishnan, Shweta; Dalvie, Suchitra
Although unsafe abortion continues to be a leading cause of maternal mortality in many countries in Asia, the right to safe abortion remains highly stigmatized across the region. The Asia Safe Abortion Partnership, a regional network advocating for safe abortion, produced an animated short film entitled From Unwanted Pregnancy to Safe Abortion to show in conferences, schools and meetings in order to share knowledge about the barriers to safe abortion in Asia and to facilitate conversations on the right to safe abortion. This paper describes the making of this film, its objectives, content, dissemination and how it has been used. Our experience highlights the advantages of using animated films in addressing highly politicized and sensitive issues like abortion. Animation helped to create powerful advocacy material that does not homogenize the experiences of women across a diverse region, and at the same time emphasize the need for joint activities that express solidarity. Copyright © 2015. Published by Elsevier Ltd.
Turnbull, Robert J.; Foster, Christopher A.; Hendricks, Charles D.
A method is provided for producing solid, evacuated microspheres comprised of hydrogen. The spheres are produced by forming a jet of liquid hydrogen and exciting mechanical waves on the jet of appropriate frequency so that the jet breaks up into drops with a bubble formed in each drop by cavitation. The drops are exposed to a pressure less than the vapor pressure of the liquid hydrogen so that the bubble which is formed within each drop expands. The drops which contain bubbles are exposed to an environment having a pressure just below the triple point of liquid hydrogen and they thereby freeze giving solid, evacuated spheres of hydrogen.
Turnbull, R.J.; Foster, C.A.; Hendricks, C.D.
A method is provided for producing solid, evacuated microspheres comprised of hydrogen. The spheres are produced by forming a jet of liquid hydrogen and exciting mechanical waves on the jet of appropriate frequency so that the jet breaks up into drops with a bubble formed in each drop by cavitation. The drops are exposed to a pressure less than the vapor pressure of the liquid hydrogen so that the bubble which is formed within each drop expands. The drops which contain bubbles are exposed to an environment having a pressure just below the triple point of liquid hydrogen and they hereby freeze giving solid, evacuated spheres of hydrogen. 4 claims, 1 fig
Jones, Jeanne M.; Wood, Nathan J.; Gordon, Leslie C.
Scientists at the U.S. Geological Survey (USGS) have developed a new mapping tool, the Pedestrian Evacuation Analyst, for use by researchers and emergency managers to estimate how long it would take for someone to travel on foot out of a tsunami-hazard zone. The ArcGIS software extension, released in September 2014, allows the user to create maps showing travel times out of hazard zones and to determine the number of people that may or may not have enough time to evacuate. The maps take into account the elevation changes and the different types of land cover that a person would encounter along the way.
Andersen, Louise B; Dechend, Ralf; Karumanchi, S Ananth
BACKGROUND: Spontaneous abortion is the most commonly observed adverse pregnancy outcome. The angiogenic factors soluble Fms-like kinase 1 and placental growth factor are critical for normal pregnancy and may be associated to spontaneous abortion. OBJECTIVE: We investigated the association between...... maternal serum concentrations of soluble Fms-like kinase 1 and placental growth factor, and subsequent spontaneous abortion. STUDY DESIGN: In the prospective observational Odense Child Cohort, 1676 pregnant women donated serum in early pregnancy, gestational week ..., interquartile range 71-103). Concentrations of soluble Fms-like kinase 1 and placental growth factor were determined with novel automated assays. Spontaneous abortion was defined as complete or incomplete spontaneous abortion, missed abortion, or blighted ovum
Strauss, Lilo T; Gamble, Sonya B; Parker, Wilda Y; Cook, Douglas A; Zane, Suzanne B; Hamdan, Saeed
CDC began abortion surveillance in 1969 to document the number and characteristics of women obtaining legal induced abortions. This report summarizes and describes data voluntarily reported to CDC regarding legal induced abortions obtained in the United States in 2003. For each year since 1969, CDC has compiled abortion data by state or area of occurrence. During 1973-1997, data were received from or estimated for 52 reporting areas in the United States: 50 states, the District of Columbia, and New York City. In 1998 and 1999, CDC compiled abortion data from 48 reporting areas. Alaska, California, New Hampshire, and Oklahoma did not report, and data for these states were not estimated. During 2000-2002, Oklahoma again reported these data, increasing the number of reporting areas to 49, and for 2003, Alaska again reported and West Virginia did not, maintaining the number of reporting areas at 49. A total of 848,163 legal induced abortions were reported to CDC for 2003 from 49 reporting areas, representing a 0.7% decline from the 854,122 legal induced abortions reported by 49 reporting areas for 2002. The abortion ratio, defined as the number of abortions per 1,000 live births, was 241 in 2003, a decrease from the 246 in 2002. The abortion rate was 16 per 1,000 women aged 15-44 years for 2003, the same as for 2002. For the same 47 reporting areas, the abortion rate remained relatively constant during 1998-2003. During 2001-2002 (the most recent years for which data are available), 15 women died as a result of complications from known legal induced abortion. One death was associated with known illegal abortion. The highest percentages of reported abortions were for women who were unmarried (82%), white (55%), and aged abortions for which gestational age was reported, 61% were performed at abortions were first collected) through 2002, steady increases have occurred in the percentage of abortions performed at abortions were obtained at >15 weeks' gestation, including 4
Taylor, Diana; Upadhyay, Ushma D; Fjerstad, Mary; Battistelli, Molly F; Weitz, Tracy A; Paul, Maureen E
To develop and validate standardized criteria for assessing abortion-related incidents (adverse events, morbidities, near misses) for first-trimester aspiration abortion procedures and to demonstrate the utility of a standardized framework [the Procedural Abortion Incident Reporting & Surveillance (PAIRS) Framework] for estimating serious abortion-related adverse events. As part of a California-based study of early aspiration abortion provision conducted between 2007 and 2013, we developed and validated a standardized framework for defining and monitoring first-trimester (≤14weeks) aspiration abortion morbidity and adverse events using multiple methods: a literature review, framework criteria testing with empirical data, repeated expert reviews and data-based revisions to the framework. The final framework distinguishes incidents resulting from procedural abortion care (adverse events) from morbidity related to pregnancy, the abortion process and other nonabortion related conditions. It further classifies incidents by diagnosis (confirmatory data, etiology, risk factors), management (treatment type and location), timing (immediate or delayed), seriousness (minor or major) and outcome. Empirical validation of the framework using data from 19,673 women receiving aspiration abortions revealed almost an equal proportion of total adverse events (n=205, 1.04%) and total abortion- or pregnancy-related morbidity (n=194, 0.99%). The majority of adverse events were due to retained products of conception (0.37%), failed attempted abortion (0.15%) and postabortion infection (0.17%). Serious or major adverse events were rare (n=11, 0.06%). Distinguishing morbidity diagnoses from adverse events using a standardized, empirically tested framework confirms the very low frequency of serious adverse events related to clinic-based abortion care. The PAIRS Framework provides a useful set of tools to systematically classify and monitor abortion-related incidents for first
Gelman, Amanda; Rosenfeld, Elian A; Nikolajski, Cara; Freedman, Lori R; Steinberg, Julia R; Borrero, Sonya
Abortion stigma may cause psychological distress in women who are considering having an abortion or have had one. This phenomenon has been relatively underexplored in low-income women, who may already be at an increased risk for poor abortion-related outcomes because of difficulties accessing timely and safe abortion services. A qualitative study conducted between 2010 and 2013 used semistructured interviews to explore pregnancy intentions among low-income women recruited from six reproductive health clinics in Western Pennsylvania. Transcripts from interviews with 19 participants who were planning to terminate a pregnancy or had had an abortion in the last two weeks were examined through content analysis to identify the range of attitudes they encountered that could contribute to or reflect abortion stigma, the sources of these attitudes and women's responses to them. Women commonly reported that partners, family members and they themselves held antiabortion attitudes. Such attitudes communicated that abortion is morally reprehensible, a rejection of motherhood, rare and thus potentially deviant, detrimental to future fertility and an irresponsible choice. Women reacted to external and internal negative attitudes by distinguishing themselves from other women who obtain abortions, experiencing negative emotions, and concealing or delaying their abortions. Women's reactions to antiabortion attitudes may perpetuate abortion stigma. Further research is needed to inform interventions to address abortion stigma and improve women's abortion experiences. Copyright © 2016 by the Guttmacher Institute.
Marie-Louise H. Hansen
Full Text Available Background: Whereas the effects of various socio-demographic determinants on a woman's risk of having an abortion are relatively well-documented, less attention has been given to the effect of previous abortions and births. Objective: To study the effect of previous abortions and births on Danish women's risk of an abortion, in addition to a number of demographic and personal characteristics. Data and methods: From the Fertility of Women and Couples Dataset we obtained data on the number of live births and induced abortions by year (1981-2001, age (16-39, county of residence and marital status. Logistic regression analysis was used to estimate the influence of the explanatory variables on the probability of having an abortion in a relevant year. Main findings and conclusion: A woman's risk of having an abortion increases with the number of previous births and previous abortions. Some interactions were was found in the way a woman's risk of abortion varies with calendar year, age and parity. The risk of an abortion for women with no children decreases while the risk of an abortion for women with children increases over time. Furthermore, the risk of an abortion decreases with age, but relatively more so for women with children compared to childless women. Trends for teenagers are discussed in a separate section.
Pawde, Anuya A; Ambadkar, Arun; Chauhan, Anahita R
Medical method of abortion (MMA) is a safe, efficient, and affordable method of abortion. However, incomplete abortion is a known side effect. To study incomplete abortion due to medication abortion and compare to spontaneous incomplete abortion and to study referral practices and prescriptions in cases of incomplete abortion following MMA. Prospective observational study of 100 women with first trimester incomplete abortion, divided into two groups (spontaneous or following MMA), was administered a questionnaire which included information regarding onset of bleeding, treatment received, use of medications for abortion, its prescription, and administration. Comparison of two groups was done using Fisher exact test (SPSS 21.0 software). Thirty percent of incomplete abortions were seen following MMA; possible reasons being self-administration or prescription by unregistered practitioners, lack of examination, incorrect dosage and drugs, and lack of follow-up. Complications such as collapse, blood requirement, and fever were significantly higher in these patients compared to spontaneous abortion group. The side effects of incomplete abortions following MMA can be avoided by the following standard guidelines. Self medication, over- the-counter use, and prescription by unregistered doctors should be discouraged and reported, and need of follow-up should be emphasized.
Wiegerinck, Melanie M. J.; Jones, Heidi E.; O'Connell, Katharine; Lichtenberg, E. Steve; Paul, Maureen; Westhoff, Carolyn L.
Background: Little is known about clinical implementation of medical abortion in the United States following approval of mifepristone as an abortifacient by the Food and Drug Administration (FDA) in 2000. We collected information regarding medical abortion practices of National Abortion Federation
Wiegerinck, Melanie M. J.; Jones, Heidi E.; O'Connell, Katharine; Lichtenberg, E. Steve; Paul, Maureen; Westhoff, Carolyn L.
Little is known about clinical implementation of medical abortion in the United States following approval of mifepristone as an abortifacient by the Food and Drug Administration (FDA) in 2000. We collected information regarding medical abortion practices of National Abortion Federation (NAF) members
Decision ambivalence is a key concept in abortion literature, but has been poorly operationalised. This study explored the concept of decision ambivalence via an Abortion Decision Balance Sheet (ADBS) articulating reasons both for and against terminating an unintended pregnancy. Ninety-six women undergoing an early abortion for psychosocial…
Center for Disease Control (DHEW/PHS), Atlanta, GA.
This report summarizes information received from collaborators in state health departments, hospitals, and other pertinent sources regarding abortions reported to the Center for Disease Control for the April-June quarter of 1971. Data in tabular and narrative form are given for abortion ratios by state, reported abortions by menstrual weeks of…
Payne, Carolyn M; Debbink, Michelle Precourt; Steele, Ellen A; Buck, Caroline T; Martin, Lisa A; Hassinger, Jane A; Harris, Lisa H
In Ghana, despite the availability of safe, legally permissible abortion services, high rates of morbidity and mortality from unsafe abortion persist. Through interviews with Ghanaian physicians on the front lines of abortion provision, we begin to describe major barriers to widespread safe abortion. Their stories illustrate the life-threatening impact that stigma, financial restraints, and confusion regarding abortion law have on the women of Ghana who seek abortion. They posit that the vast majority of serious abortion complications arise in the setting of clandestine or self-induced second trimester attempts, suggesting that training greater numbers of physicians to perform second trimester abortion is prerequisite to reducing maternal mortality. They also recognized that an adequate supply of abortion providers alone is a necessary but insufficient step toward reducing death from unsafe abortion. Rather, improved accessibility and cultural acceptability of abortion are integral to the actual utilization of safe services. Their insights suggest that any comprehensive plan aimed at reducing maternal mortality must consider avenues that address the multiple dimensions which influence the practice and utilization of safe abortion, especially in the second trimester.
Buga, G A B
Unsafe abortion causes 13% of maternal deaths worldwide. Safe abortion can only be offered under conditions where legislation has been passed for legal termination of unwanted pregnancy. Where such legislation exists, accessibility of safe abortion depends on the attitudes of doctors and other healthcare workers to induced abortion. Medical students as future doctors may have attitudes to abortion that will affect the provision of safe abortion. Little is known about the attitudes of South African medical students to abortion. To assess sexual practices and attitudes of medical students to induced abortion and to determine some of the factors that may influence these attitudes. A cross-sectional analytic study involving the self-administration of an anonymous questionnaire. The questionnaire was administered to medical students at a small, but growing, medical school situated in rural South Africa. Demographic data, sexual practices and attitudes to induced abortion. Two hundred and forty seven out of 300 (82.3%) medical students responded. Their mean age was 21.81 +/- 3.36 (SD) years, and 78.8% were Christians, 17.1% Hindus and 2.6% Muslims. Although 95% of the respondents were single, 68.6% were already sexually experienced, and their mean age at coitarche was 17.24+/-3.14 (SD) years. Although overall 61.2% of the respondents felt abortion is murder either at conception or later, the majority (87.2%) would perform or refer a woman for abortion under certain circumstances. These circumstances, in descending order of frequency, include: threat to mother's life (74.1%), in case of rape (62.3%), the baby is severely malformed (59.5%), threat to mother's mental health (53.8%) and parental incompetence (21.0%). Only 12.5% of respondents would perform or refer for abortion on demand, 12.8% would neither perform nor refer for abortion under any circumstances. Religious affiliation and service attendance significantly influenced some of these attitudes and beliefs
In the 1984 election, Ronald Reagan, the Republican presidential incumbent and an opponent of legal abortion, defeated Walter Mondale, a prochoice Democrat, by a wide margin. Despite Reagan's sweep of 49 states, however, conservatives lost a little ground in the Senate, where four of the seven new senators elected take a prochoice position on abortion. On the other hand, antiabortion forces registered some gains in the House of Representatives. The voting groups were more divided over the abortion issue in 1984 than they had been in 1980: In 1980, Reagan voters and Carter voters did not differ significantly in their attitudes toward abortion, but in 1984, Reagan voters were significantly more likely to be opposed to abortion than were Mondale voters. Nevertheless, only a small minority of voters considered abortion to be a major national issue, and the two voter groups were far more divided on several other issues than they were on abortion. There was no antiabortion consensus among the electorate as a whole, or among Reagan voters in particular. The level of approval for legalized abortion has, in fact, remained quite stable since 1973, and a popular base in favor of banning abortion seems to be lacking.
Latham, Stephen R
On the fourth day of his presidency, Donald Trump reinstated and greatly expanded the "Mexico City policy," which imposes antiabortion restrictions on U.S. foreign health aid. In general, the policy has prohibited U.S. funding of any family-planning groups that use even non-U.S. funds to perform abortions; prohibited aid recipients from lobbying (again, even with non-U.S. money) for liberalization of abortion laws; prohibited nongovernment organizations from creating educational materials on abortion as a family-planning method; and prohibited health workers from referring patients for legal abortions in any cases other than rape, incest, or to save the life of the mother. The policy's prohibition on giving aid to any organization that performs abortions is aimed at limiting alleged indirect funding of abortions. The argument is that if U.S. money is used to fund nonabortion programs of an abortion-providing NGO, then the NGO can simply shift the money thus saved into its abortion budget. Outside the context of abortion, we do not reason this way. And the policy's remaining three prohibitions are deeply troubling. © 2017 The Hastings Center.
Abbasi, Mahmoud; Shamsi Gooshki, Ehsan; Allahbedashti, Neda
Abortion traditionally means, "to miscarry" and is still known as a problem which societies has been trying to reduce its rate by using legal means. Despite the pregnant women and fetuses have being historically supported; abortion was firstly criminalized in 1926 in Iran, 20 years after establishment of modern legal system. During next 53 years this situation changed dramatically, so in 1979, the time of Islamic Revolution, aborting fetuses before 12 weeks and therapeutic abortion (TA) during all the pregnancy length was legitimate, based on regulations that used medical justification. After 1979 the situation changed into a totally conservative and restrictive approach and new Islamic concepts as "Blood Money" and "Ensoulment" entered the legal debates around abortion. During the next 33 years, again a trend of decriminalization for the act of abortion has been continuing. Reduction of punishments and omitting retaliation for criminal abortions, recognizing fetal and maternal medical indications including some immunologic problems as legitimate reasons for aborting fetuses before 4 months and omitting the fathers' consent as a necessary condition for TA are among these changes. The start point for this decriminalization process was public and professional need, which was responded by religious government, firstly by issuing juristic rulings (Fatwas) as a non-official way, followed by ratification of "Therapeutic Abortion Act" (TAA) and other regulations as an official pathway. Here, we have reviewed this trend of decriminalization, the role of public and professional request in initiating such process and the rule-based language of TAA.
Many people believe human fetuses have the same moral status as adult human persons, that it is wrong to allow harm to befall things with this moral status, and thus voluntary, induced abortion is seriously morally wrong. Recently, many prochoice theorists have argued that this antiabortion stance is inconsistent; approximately 60% of human fetuses die from spontaneous abortion, far more than die from induced abortion, so if antiabortion theorists really believe that human fetuses have significant moral status, they have strong moral obligations to oppose spontaneous abortion. Yet, few antiabortion theorists devote any effort to doing so. Many prochoice theorists argue that to resolve this inconsistency, antiabortion theorists should abandon their opposition to induced abortion. Here, I argue that those who do not abandon their opposition to induced abortion but continue to neglect spontaneous abortion act immorally. Aristotle argues that moral responsibility requires both control and awareness; I argue that once an antiabortion theorist becomes aware of the frequency of spontaneous abortion, they have a strong moral obligation to redirect their efforts towards combating spontaneous abortion; failure to do so is morally monstrous. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
Johansson, A; Nga, N T; Huy, T Q; Dat, D D; Holmgren, K
This study analyzes the involvement of men in abortion in Vietnam, where induced abortion is legal and abortion rates are among the highest in the world. Twenty men were interviewed in 1996 about the role they played in their wives' abortions and about their feelings and ethical views concerning the procedure. The results showed that both husbands and wives considered the husband to be the main decisionmaker regarding family size, which included the decision to have an abortion, but that, in fact, some women had undergone an abortion without consulting their husbands in advance. Parents and in-laws were usually not consulted; the couples thought they might object to the decision on moral grounds. Respondents' ethical perspectives on abortion are discussed. When faced with an unwanted pregnancy, the husbands adopted an ethics of care and responsibility toward family and children, although some felt that abortion was immoral. The study highlights the importance of understanding husbands' perspectives on their responsibilities and rights in reproductive decisionmaking and their ethical and other concerns related to abortion.
Surgical abortion has been provided liberally in Australia since the early 1970s, mainly in privately owned specialist clinics. The introduction of medical abortion, however, was deliberately obstructed and consequently significantly delayed when compared to similar countries. Mifepristone was approved for commercial import only in 2012 and listed as a government subsidised medicine in 2013. Despite optimism from those who seek to improve women's access to abortion, the increased availability of medical abortion has not yet addressed the disadvantage experienced by poor and non-metropolitan women. After telling the story of medical abortion in Australia, this paper considers the context through which it has become available since 2013. It argues that the integration of medical abortion into primary health care, which would locate abortion provision in new settings and expand women's access, has been constrained by the stigma attached to abortion, overly cautious institutionalised frameworks, and the lack of public health responsibility for abortion services. The paper draws on documentary sources and oral history interviews conducted in 2013 and 2015. Copyright © 2015 Elsevier Inc. All rights reserved.
Thapa, Shyam; Neupane, Shailes
To examine the incidence of and risk factors for repeat abortion in Nepal. Data were analyzed from a survey of 1172 women who had surgical abortions between December 2009 and March 2010 in 2 clinics in Kathmandu, Nepal. Bivariate and multivariate logistic regressions were performed to estimate odds ratios for the risk factors. Among the respondents, 32.3% (95% confidence interval, 29.6-34.9) had repeat abortions. This incidence rose sharply with age and parity, and was higher among those with no intention of having a future child, those attaining primary or secondary level education, and those attending the non-governmental sector clinic. Women with repeat abortion were similar to those with 1 abortion in terms of contraceptive practice. Among women not using contraceptives at the time of the unintended pregnancy, the 3 most commonly cited reasons were ill health, non-compliance with the method intended for use, and dislike of the method. Women with repeat abortion showed a pattern of contraceptive acceptance immediately after the procedure similar to that of women who had 1 abortion. Repeat abortion is emerging as a major public health issue in Nepal, with implications for counseling and provision of abortion, and for family planning services. Copyright © 2012 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.
Meddahi, M; Boccardi, A; Butterworth, A; Fisher, A S; Gianfelice-Wendt, E; Goddard, B; Hemelsoet, G H; Höfle, W; Jacquet, D; Jaussi, M; Kain, V; Lefevre, T; Shaposhnikova, E; Uythoven, J; Valuch, D
Unbunched beam is a potentially serious issue in the LHC as it may quench the superconducting magnets during a beam abort. Unbunched particles, either not captured by the RF system at injection or leaking out of the RF bucket, will be removed by using the existing damper kickers to excite resonantly the particles in the abort gap. Following beam simulations, a strategy for cleaning the abort gap at different energies was proposed. The plans for the commissioning of the beam abort gap cleaning are described and first results from the beam commissioning are presented.
Faúndes, Anibal; Shah, Iqbal H
Unsafe abortion continues to be a major cause of maternal death; it accounts for 14.5% of all maternal deaths globally and almost all of these deaths occur in countries with restrictive abortion laws. A strong body of accumulated evidence shows that the simple means to drastically reduce unsafe abortion-related maternal deaths and morbidity is to make abortion legal and institutional termination of pregnancy broadly accessible. Despite this evidence, abortion is denied even when the legal condition for abortion is met. The present article aims to contribute to a better understanding that one can be in favor of greater access to safe abortion services, while at the same time not be "in favor of abortion," by reviewing the evidence that indicates that criminalization of abortion only increases mortality and morbidity without decreasing the incidence of induced abortion, and that decriminalization rapidly reduces abortion-related mortality and does not increase abortion rates. Copyright © 2015. Published by Elsevier Ireland Ltd.
Access to safe abortion hinges upon the availability of trained abortion providers. The American College of Obstetricians and Gynecologists supports education for students in health care fields as well as clinical training for residents and advanced practice clinicians in abortion care in order to increase the availability of trained abortion providers. The American College of Obstetricians and Gynecologists supports the expansion of abortion education and an increase in the number and types of trained abortion providers in order to ensure women's access to safe abortions. Integrated medical education and universal opt-out training policies help to lessen the stigma of abortion provision and improve access by increasing the number of abortion providers. This Committee Opinion reviews the current status of abortion education, describes initiatives to ensure the availability of appropriate and up-to-date abortion training, and recommends efforts for integrating and improving abortion education in medical schools, residency programs, and advanced practice clinician training programs.
This study seeks to address real-time operational needs in the context of the evacuation response problem by providing a capability to dynamically route vehicles under evacuation, thereby being responsive to the actual conditions unfolding in real-ti...
Couturier, C. S.; Andersen, N. G.; Audet, C.
This study examined the effects of prey exoskeleton characteristics on gastric evacuation patterns in Atlantic cod Gadus morhua. Three distinct stages were highlighted in the gastric evacuation of crustacean prey characterized by a robust exoskeleton. The experiments confirmed that the three shrimp...... of the prey exoskeleton all affected gastric evacuation: duration of initial delay, overall evacuation rate and a decreased evacuation rate at the end of the process. The power exponential function (PEF), with its shape parameter, described the course of evacuation for these prey types well, especially...... the initial delay. The PEF does not, however, allow describing evacuation by the current stomach content mass independent of meal size, which limits its usefulness in estimating consumption rates of wild G. morhua. To predict and describe gastric evacuation of prey with a robust exoskeleton, it is therefore...
nurses should be based on: “educational and experiential background, technical and clinical competence, leadership skills , critical thinking skills ...aeromedical evacuation squadron, military flight nurses have limited opportunities to maintain their clinical skills . This results in attempting to...method to improve the clinical skills of military flight nurses . 1 INTRODUCTION A lack of registered nurses has plagued the nursing profession
Guo, Xiwei; Chen, Jianqiao; Zheng, Yaochen; Wei, Junhong
Based on the cellular automata method (CA model) and the mobile lattice gas model (MLG model), we have developed a heterogeneous lattice gas model for simulating pedestrian evacuation processes in an emergency. A local population density concept is introduced first. The update rule in the new model depends on the local population density and the exit crowded degree factor. The drift D, which is one of the key parameters influencing the evacuation process, is allowed to change according to the local population density of the pedestrians. Interactions including attraction, repulsion, and friction between every two pedestrians and those between a pedestrian and the building wall are described by a nonlinear function of the corresponding distance, and the repulsion forces increase sharply as the distances get small. A critical force of injury is introduced into the model, and its effects on the evacuation process are investigated. The model proposed has heterogeneous features as compared to the MLG model or the basic CA model. Numerical examples show that the model proposed can capture the basic features of pedestrian evacuation, such as clogging and arching phenomena.
Mol, Antonio C.; Grecco, Claudio H.S.; Santos, Isaac J.A.L.; Carvalho, Paulo V.R.; Jorge, Carlos A.F.; Sales, Douglas S.; Couto, Pedro M.; Botelho, Felipe M.; Bastos, Felipe R.
This work is a preliminary study of the use of a free game-engine as a tool to build and to navigate in virtual environments, with a good degree of realism, for virtual simulations of evacuation from building and risk zones. To achieve this goal, some adjustments in the game engine have been implemented. A real building with four floors, consisting of some rooms with furniture and people, has been virtually implemented. Simulations of simple different evacuation scenarios have been performed, measuring the total time spent in each case. The measured times have been compared with their corresponding real evacuation times, measured in the real building. The first results have demonstrated that the virtual environment building with the free game engine is capable to reproduce the real situation with a satisfactory level. However, it is important to emphasize that such virtual simulations serve only as an aid in the planning of real evacuation simulations, and as such must never substitute the later. (author)
EVOLUTION DE LA FREQUENCE ET DES PROBLEMES LIES AUX. EVACUATIONS SANITAIRES VERS LE SERVICE DE GYNECOLOGIE-OBS-. TETRIQUE DE L'HOPITAL COMMUNAUTAIRE DE BANGUI. SEPOU A.1; GODDOT M.1; NGBALE R.1;GAUNEFET C.E.1; DOMANDE-MODANGA Z.1;. FANDEMA E.1 ...
Hondo, Hideki; Matsumoto, Keizo
Recent advancement of CT system provides not only definite diagnosis and location of intracerebral hematoma but also coordinates of the center of the hematoma. Trials of stereotactic evacuation of the hematoma have been reported by some authors in the cases of subacute or chronic stages of hypertensive intracerebral hemorrhage. In this series, similar surgery has been performed in 33 cases of hypertensive intracerebral hematoma including 22 cases in acute stage, and 2 cases of traumatic hematoma. Clinical outcomes were investigated and the results were considered to be equivalent or rather better in the conventional microsurgery with evacuation of hematoma under direct vision. However, there still remained controversial problems in the cases of threatened herniation signs, because in these cases regular surgery with total evacuation of the hematoma at one time might have been preferable. The benefits of this CT guided stereotactic approach for the evacuation of the hematoma were thought to be as follow: 1) the procedure is simple and safe, 2) operation is readily performed under local anesthesia, and 3) the hematoma was drained out totally by means of urokinase activity. It is our impression that this surgery not only is indicated as emergency treatment for the patients of high-age or in high risk, but also can institute as a routine surgery for the intracerebral hematomas in patients showing no herniation sign. (J.P.N.)
conduct processing, screening, and logistic functions associated with emergency evacuation. ECCs are typically collocated with an airfield or seaport ... hotels , stadiums, and other locations where NCEs can stay until transportation to the United States is available (Joint Chiefs of Staff 2007). NCEs
Boer, L.C.; Skjong, R.
The paper presents some conclusions from the EU basic research project "MEPdesign" relevant for design of ship interiors. The findings are discussed with regard to passenger flow as a function of design parameters. The paper explains that current evacuation analyses may be overly optimistic. The
Hitesh N Panchal; Shah, P. K.
Solar still is a very simple device, which is used for solar distillation process. In this research work, double basin solar still is made from locally available materials. Double basin solar still is made in such a way that, outer basin is exposed to sun and lower side of inner basin is directly connected with evacuated tubes to increase distillate output and reducing heat losses of a solar still. The overall size of the lower basin is about 1006 mm x 325 mm x 380 mm, the outer basin is about 1006 mm x 536 mm x 100 mm Black granite gravel is used to increase distillate output by reducing quantity of brackish or saline water in the both basins. Several experiments have conducted to determine the performance of a solar still in climate conditions of Mehsana (latitude of 23 degree 59' and longitude of 72 degree 38'), Gujarat, like a double basin solar still alone, double basin solar still with different size black granite gravel, double basin solar still with evacuated tubes and double basin solar still with evacuated tubes and different size black granite gravel. Experimental results show that, connecting evacuated tubes with the lower side of the inner basin increases daily distillate output of 56% and is increased by 60%, 63% and 67% with average 10 mm, 20 mm and 30 mm size black granite gravel. Economic analysis of present double basin solar still is 195 days. (authors)
Regional evacuation modeling is treated as a five step process: involving vehicle trip generation, trip departure time, trip destination, and trip route selection modeling, supplemented by plan set-up and analysis procedures. Progress under each of these headings is reviewed and gaps in the process identified. The potential for emergency planners to make use of real time traffic data, resulting from the recent technical and economic revolutions in telecommunications and infrared traffic sensing, is identified as the single greatest opportunity for the near future; and some beginnings in the development of real time dynamic traffic modeling specifically geared to evacuation planning are highlighted. Significant data problems associated with the time of day location of large urban populations represent a second area requiring extensive research. A third area requiring much additional effort is the translation of the considerable knowledge we have on evacuee behavior in times of crisis into reliable quantitative measures of the timing of evacuee mobilization, notably by distance from the source of the hazard. Specific evacuation models are referenced and categorized by method. Incorporation of evacuation model findings into the definition of emergency planning zone boundaries is also discussed.
Viswanathan, V.; Lee, C.E.; Lees, M.H.; Cheong, S.A.; Sloot, P.M.A.
Crowd simulation is rapidly becoming a standard tool for evacuation planning and evaluation. However, the many crowd models in the literature are structurally different, and few have been rigorously calibrated against real-world egress data, especially in emergency situations. In this paper we
Hurd, William W; Montminy, Richard J; De Lorenzo, Robert A; Burd, Lawrence T; Goldman, Brad S; Loftus, Thomas J
Physicians play an increasingly important role in the critical medical process of aeromedical evacuation (AE). Incomplete or inappropriate preparation for AE can result in increased patient discomfort, and in the worst cases, potentially serious or insurmountable in-flight medical problems. During military operations and in response to natural disasters, physicians are responsible for four processes necessary for a successful AE mission. These include: 1) AE screening, including determination of appropriate classification, precedence, and special medical requirements; 2) validation; 3) medical preparation; and 4) clearance. Physicians responsible for preparing patients for AE need to understand both the patient evacuation system and the unique medical aspects associated with AE. The U.S. military patient evacuation system is comprised of three principal transportation phases: casualty evacuation; inter-theater AE; and intra-theater AE. Important elements of the USAF AE system are patient movement requirements centers, the validating flight surgeon, aeromedical staging facilities, AE liaison teams, aeromedical crews, and critical care air transport (CCAT) teams. Important medical aspects unique to AE include the effects of flight physiology on medical conditions, oxygen limitations, and distinctive medication and supplies requirements.
Erwina, N.; Aldila, D.; Soewono, E.
Evacuation of residents and diarrhea disease outbreak in evacuation zone have become serious problem that frequently happened during flood periods. Limited clean water supply and infrastructure in evacuation zone contribute to a critical spread of diarrhea. Transmission of diarrhea disease can be reduced by controlling clean water supply and treating diarrhea patients properly. These treatments require significant amount of budget, which may not be fulfilled in the fields. In his paper, transmission of diarrhea disease in evacuation zone using SIRS model is presented as control optimum problem with clean water supply and rate of treated patients as input controls. Existence and stability of equilibrium points and sensitivity analysis are investigated analytically for constant input controls. Optimum clean water supply and rate of treatment are found using optimum control technique. Optimal results for transmission of diarrhea and the corresponding controls during the period of observation are simulated numerically. The optimum result shows that transmission of diarrhea disease can be controlled with proper combination of water supply and rate of treatment within allowable budget.
Full Text Available The lonelier evacuees find themselves, the riskier become their wayfinding decisions. This research supports single evacuees in a dynamically changing environment with risk-aware guidance. It deploys the concept of decentralized evacuation, where evacuees are guided by smartphones acquiring environmental knowledge and risk information via exploration and knowledge sharing by peer-to-peer communication. Peer-to-peer communication, however, relies on the chance that people come into communication range with each other. This chance can be low. To bridge between people being not at the same time at the same places, this paper suggests information depositories at strategic locations to improve information sharing. Information depositories collect the knowledge acquired by the smartphones of evacuees passing by, maintain this information, and convey it to other passing-by evacuees. Multi-agent simulation implementing these depositories in an indoor environment shows that integrating depositories improves evacuation performance: It enhances the risk awareness and consequently increases the chance that people survive and reduces their evacuation time. For evacuating dynamic events, deploying depositories at staircases has been shown more effective than deploying them in corridors.
Lacan's psycho-analytic evacuation of the rainbow nation identity [English] Given the increasing displacement of the essentialist racial categories of the past and the emergence of often-superficial theorisations of race in terms of the diverse South African experiences of difference and Otherness, this article seeks to ...
Full Text Available A fire in an enclosed space, such as a room in a building, is generally called a compartment fire. To prevent the compartment fire, a sprinkler for first-aid fire-fighting is installed in rooms. However, it is difficult to determine the degree to which smoke generation and the fire spreading will be inhibited when sprinklers are on. In particular, demonstrating evacuation behavior assuming an actual fire is impossible. In this study, we evaluated an effectiveness of the sprinkler by numerical simulations. To consider evacuation dynamics, a real-coded cellular automata (RCA was used, where we can freely set the direction and velocity of an evacuee based on a floor field model. To consider the situation in the room fire, we used a simulator called Fire Dynamics Simulator (FDS. Two cases with and without the sprinkler were compared to see the validity of the sprinkler on evacuation dynamics. The effect of smoke and the expansion of the fire-spreading region were discussed. Results show that, since the fire-spreading region disappears when the sprinkler is actuated, the evacuation time decreases. Even though the sprinkler is actuated, the smoke generated at the beginning of a fire diffuses inside the whole room. However, the duration of evacuees being overwhelmed by smoke is less, because the amount of smoke generated by the pyrolysis reaction is much decreased.