Shorter time interval treatments for early medical abortions: a mixed methods research approach

Purpose This dissertation focuses at assessing the efficacy of shorter time intervals in the treatment of medical abortions along with the use of various follow up methods. Methods This initial part of dissertation was carried out as an extensive study of literature, followed by observational study on shorter time intervals and follow up methods for the feasibility of the study. The main dissertation met its research aims through an RCT of 121 women comparing shorter to standard time intervals and assessing the various follow up methods at the end of 2 weeks. The qualitative component of the study was achieved by conducting in-depth interviews of women undergoing medical abortion on various aspects of medical abortions with emphasis on shorter time intervals and follow up. Findings This research produced a number of key findings: the RCT showed that both treatments have equal efficacy and acceptability with minor differences in their side effects however the sample size was small to generalise the findings; the follow up methods showed varied responses with preference to confirmatory investigations at 2 weeks follow up. Conclusions The main conclusions drawn from this research were that shorter time intervals can be offered as an alternative to standard treatment intervals in well informed women, however a larger RCT is needed. In order to provide these treatments as outpatient robust follow up methods will need to be incorporated into the abortion services

International Journal of Medical Students - Year 2015 - Volume 3 - Supplement 1

International Journal of Medical Students - Year 2015 - Volume 3 - Supplement

The Historical Influence of Politics and Society on Women\u27s Experiences of Abortion

One out of every three women in the United States will experience abortion (Guttmacher Institute, 2008). The purposes of this feminist qualitative research were to: 1) examine historically the context of legal abortion in the United States, 2) describe and explore women\u27s experiences of abortion and 3) better understand the historical impact of the sociopolitical climate on women\u27s perceptions of their abortion experiences. An historical review of political, legislative, and social contexts surrounding legal abortion revealed an increasingly hostile environment toward women seeking abortion since 1973. By challenging existing abortion laws in state and federal courts, anti-abortion legislators have removed federal and state funding for abortions, including insurance coverage. States have imposed mandatory waiting periods, biased counseling and consent procedures, parental involvement and/or notification for minors, and bans on funding and insurance coverage. All of these intrusions on women\u27s right to choose abortion have resulted in the need for more than one clinic visit and delays in obtaining abortion services. Through violence, intimidation, and harassment, pro-life activists and extremists have successfully driven medical personnel out of the practice of abortion and intimidated women seeking abortion by exposing them to fetal images, calling them baby killers , and forcing them to believe that life begins at conception. Within this historical context, a purposive sampling of ten women, recruited via snowballing techniques, participated in repeated in-depth interviews. A multi-stage narrative strategy was used to analyze textual data. Participants\u27 narrative summaries emphasized dismay at being pregnant, telling others, and making the decision for abortion. Women thoughtfully made the decision for abortion based on the circumstances of their lives at the time of the unintended pregnancy. Seventy percent of participants experienced abortion in the 1980s and recalled the ways in which religion, politics, and society have imposed shame, guilt, and judgement on them, constraining them from talking about their abortion experiences. Silenced, women only revealed their abortion when forced to do so by circumstances or to gain acceptance and understanding from others. Participation in the study allowed women an opportunity to talk about their abortion experiences, initiating conversations with friends, and raising consciousness

Characterization of alar ligament on 3.0T MRI: a cross-sectional study in IIUM Medical Centre, Kuantan

INTRODUCTION: The main purpose of the study is to compare the normal anatomy of alar ligament on MRI between male and female. The specific objectives are to assess the prevalence of alar ligament visualized on MRI, to describe its characteristics in term of its course, shape and signal homogeneity and to find differences in alar ligament signal intensity between male and female. This study also aims to determine the association between the heights of respondents with alar ligament signal intensity and dimensions. MATERIALS & METHODS: 50 healthy volunteers were studied on 3.0T MR scanner Siemens Magnetom Spectra using 2-mm proton density, T2 and fat-suppression sequences. Alar ligament is depicted in 3 planes and the visualization and variability of the ligament courses, shapes and signal intensity characteristics were determined. The alar ligament dimensions were also measured. RESULTS: Alar ligament was best depicted in coronal plane, followed by sagittal and axial planes. The orientations were laterally ascending in most of the subjects (60%), predominantly oval in shaped (54%) and 67% showed inhomogenous signal. No significant difference of alar ligament signal intensity between male and female respondents. No significant association was found between the heights of the respondents with alar ligament signal intensity and dimensions. CONCLUSION: Employing a 3.0T MR scanner, the alar ligament is best portrayed on coronal plane, followed by sagittal and axial planes. However, tremendous variability of alar ligament as depicted in our data shows that caution needs to be exercised when evaluating alar ligament, especially during circumstances of injury

Case series of breast fillers and how things may go wrong: radiology point of view

INTRODUCTION: Breast augmentation is a procedure opted by women to overcome sagging breast due to breastfeeding or aging as well as small breast size. Recent years have shown the emergence of a variety of injectable materials on market as breast fillers. These injectable breast fillers have swiftly gained popularity among women, considering the minimal invasiveness of the procedure, nullifying the need for terrifying surgery. Little do they know that the procedure may pose detrimental complications, while visualization of breast parenchyma infiltrated by these fillers is also deemed substandard; posing diagnostic challenges. We present a case series of three patients with prior history of hyaluronic acid and collagen breast injections. REPORT: The first patient is a 37-year-old lady who presented to casualty with worsening shortness of breath, non-productive cough, central chest pain; associated with fever and chills for 2-weeks duration. The second patient is a 34-year-old lady who complained of cough, fever and haemoptysis; associated with shortness of breath for 1-week duration. CT in these cases revealed non thrombotic wedge-shaped peripheral air-space densities. The third patient is a 37‐year‐old female with right breast pain, swelling and redness for 2- weeks duration. Previous collagen breast injection performed 1 year ago had impeded sonographic visualization of the breast parenchyma. MRI breasts showed multiple non- enhancing round and oval shaped lesions exhibiting fat intensity. CONCLUSION: Radiologists should be familiar with the potential risks and hazards as well as limitations of imaging posed by breast fillers such that MRI is required as problem-solving tool

Invisible Labours

REVIEWS“In this original and conceptually sophisticated project Middlemiss handles incredibly difficult interview material with extraordinary sensitivity and care. She does not shy away from difficult details but makes these often very raw stories more understandable through serious analytic work.” • Linda L. Layne, University of Cambridge“This is an excellent book … As someone working in the field of reproduction/family studies (though not specifically on pregnancy loss), this book has expanded my thinking regarding how legal, medical, kinship systems and cultures come together in defining our understandings of life/death, personhood and relatedness.” • Leah Gilman, University of Manchester“This is an excellent, well-written, well researched manuscript on an important and timely issue. The book successfully introduces nuance, contestation, and diversity into constructions of personhood in the English context through detailed exploration of second trimester pregnancy loss.” • Susie Kilshaw, University College LondonDESCRIPTIONTracing women’s experiences of miscarriage and termination for foetal anomaly in the second trimester, before legal viability, shows how such events are positioned as less ‘real’ or significant when the foetal being does not, or will not, survive. Invisible Labours describes the reproductive politics of this category of pregnancy loss in England. It shows how second trimester pregnancy loss produces specific medical and social experiences, revealing an underlying teleological ontology of pregnancy. Some women then resist these interpretations when they understand their pregnancy through kinship with the unborn baby

Infertility: Medical and Social Choices

This report illustrates a range of options for congressional action in nine principal areas of public policy related to infertility: collecting data on reproductive health; preventing infertility; information to inform and protect consumers; providing access to infertility services; reproductive health of veterans; transfer of human eggs, sperm, and embryos; recordkeeping; surrogate motherhood; and reproductive research

Why and how financial inclusion policy develop? A case study from Indonesia

Financial inclusion policy aims to improve access to mainstream financial products for marginalised groups. It has been promoted onto the global agenda and strategies have been adopted by many nations since 2010, including Indonesia. This study examines the complex development of financial inclusion strategy in Indonesia – including the involvement of international development partners, the intertwined domestic interests, and different beliefs on the role of finance. Using in-depth interviews with 34 critical informants as the primary data source and utilising the Advocacy Coalition Framework (ACF) to guide the analysis, the study shows the development of financial inclusion strategy in Indonesia was produced from the combination of seven critical events, political-symbolic learning, and antagonistic coordination between bankers, regulators, and government. The study found there was little deliberation in the policy-making process and no consultation with consumers as the primary beneficiaries of the policy. As a result, financial inclusion policy developed in ways that potentially benefits those within the financial sector at the expense of the general public. This study also makes a methodological and theoretical contribution to knowledge by tracing ACF’s multiple primary pathways and employing its various concepts for explaining policy change in the financial sector in a developing nation. This study extends our understanding of the role of events and policy actors and proposes the new Policy Learning Spectrum and Collaboration Spectrum as two analytical frameworks to enhance ACF’s explanatory power

The trials of homeopathy : a critical historical account of the origins, structure and development of Hahnemann's scientific therapeutics and two systematic reviews of homeopathic clinical trials, 1821-1953 and 1940-1998

The controversial discipline of homeopathy is examined from three original perspectives. Conceptual background The structure and presentation of Hahnemann's research programme is contrasted with philosophical assumptions about medical science and emerging theoretical structures in German academic medicine circa 1800, and the subsequent rift between homeopathy and alfopathy is explained at this level. The sources of homeopathic theory and method are located in mainstream eighteenth-century experiment. Alleged relationships to alchemical medicine are discounted, with the exception of certain pharmacy techniques introduced after 1816. Divergent schools and approaches within homeopathy are traced to their sources, and mapped onto a unified therapeutic field. Historical importance A systematic review of prospective clinical evaluations of homeopathy, 1821-1953, contends that these played an important but neglected part in the evolution of the clinical trial. Placebocontrolled trials by sceptics most probably originated in prior Hahnemannian use of within-patient placebo controls. Pragmatic trials of homeopathy versus allopathy in the mid nineteenth century show that judgements of homeopathic inefficacy made by influential nineteenth-century opponents, which have coloured debate ever since, were not evidence-based. Early twentieth-century clinical trials by homeopaths were methodologically in advance of biomedical trials in some respects. Clinical relevance A systematic review of 205 prospective controlled clinical trials published since 1940 found evidence of homeopathy's safety, and specific and global efficacy in trials of high internal validity. Implications for clinical research and practice are considered, founded on analysis of intrahomeopathic differences and trends. On the basis of trial evidence, the relative merits of placebo-controlled and pragmatic evaluations of homeopathy are discussed. Clinical relevance was found particularly in areas that pose problems for biomedicine, and proposals for pragmatic trials of homeopathy versus standard treatment are made in the following conditions: unexplained female infertility; postviral fatigue syndrome; influenza; atopy

Pro-Life Science: The Production and Circulation of Reproductive Knowledge in North American Anti-Abortion Movements, 1968-2003

My work shows the inextricability of what I call “pro-life science” from religious, moral, and violent anti-abortion activism. While activists tried to distinguish their scientific pro-life work from “other” kinds of activism, these research programs were built on and then reinforced the movements pro-life scientists tried to distance themselves from. This project spans the three turbulent decades of pro-life activism that bridges the liberalization of American abortion laws to twenty-first century abortion restrictions. The dissertation begins in the years preceding Roe v. Wade, as anti-abortion activists created pro-life reproductive health centers. After the 1973 decision to legalize abortion in the United States, anti-abortion movements renegotiated the goals, methods, and arguments underpinning their pro-life stances. Some activists grounded pro-life arguments in science, developing research programs and rhetorical strategies. By studying the evolution of a science that was largely published and circulated outside of the scientific mainstream, but that nevertheless had profound political impacts, this study provides insight into the development of authority claims that are so prominent in our current moment (such as “alternative facts,” and “fake news”). In short, this project uses anti-abortion activism to show how “alternative facts” came to have such cultural and political power. The first two chapters of this dissertation center the Crisis Pregnancy Centers that equipped activists with technological and rhetorical expertise and disseminated anti-abortion information. My first chapter traces the historical evolution of the CPC, founded in Toronto, Canada in the late 1960s by pro-life activist Louise Summerhill. This chapter argues that the CPC foregrounded the relationship between clinic operations, ideology, authority, and patient experience, providing a political blueprint for the legitimacy claims of other pro-life thinkers. Chapter Two takes up the mobilization and increasing radicalization of CPCs, particularly through a close examination of The Pearson Manual, a guidebook by Hawaii activist Robert Pearson for operating such centers, instructing volunteers how to run pregnancy tests, and counsel (and sometimes deceive) women. This was a site where the pro-life movement became professional, medical, and developed compelling rhetoric about maternal and fetal health. In these first two chapters, I also set up an analytic tool that I call the “pro-life narrative,” a genre which strategically employs tropes about gender, race, and personhood to frame abortion as unthinkable. Chapters Three and Four focus on psychological harm and trauma. These chapters follow the CPC logic about maternal health, specifically the anti-abortion diagnosis of post-abortion syndrome (PAS), demonstrating how PAS counseling reinforced gender essentialism and anti-abortion understandings of fetal life, and created new ways of pathologizing abortion. Professional and amateur counselors worked through confessional group therapy sessions that taught women how to heal from trauma by explicitly embracing a pro-life point of view. Chapter Five looks at the use and legitimization of PAS in court, as pro-life activists worked to establish pro-life jurisprudence by training and placing pro-life experts in as many court cases as possible. This coalescence of experts exemplified how anti-abortion activists strategically used technological and medical expertise developed in CPCs to effect political change. Chapter Six focuses on the personal and professional narratives of pro-life physicians Beverly McMillan, Bernard Nathanson, and Mildred Jefferson. These three physicians have different life stories with common elements: they discussed the vocation of a physician and how that related to their thinking about life, they discussed the ways that medical technology shaped their pro-life views, and they rooted their emotional and spiritual well-beings in their pro-life work. This chapter explicates the connections between vocation, emotion, and medicine by thinking about the interactions of physicians and pro-life science, and examines the ideological and religious diversity within anti-abortion movements, how ideas of whiteness shaped anti-abortion thinking, and how Black activists challenged these norms. The final chapter of my dissertation examines the Partial Birth Abortion Ban, debated and vetoed twice during the Clinton presidency until being put into effect under George W. Bush. The story of “Partial Birth Abortion” is the story of an effective implementation of pro-life science: pro-life physicians and experts reframed the procedure and ultimately changed the possibilities for reproductive health care in the United States. My final chapters excavate how the political implementation of pro-life science was enmeshed in the emotional and spiritual commitments of activist clinicians and researchers. The project’s epilogue ties my historical work more explicitly to twenty-first century applications of pro-life science. As twenty-first century political debates increasingly question the stability of “facts,” public health practices are increasingly polarized, and reproductive rights are decimated, the epilogue connects recent developments in pro-life science to its historical origins