“No Baker’s dozen was her taste”: Rhode Island, Ratification, and Rhetoric in American Constitutional History

In 1787, Rhode Island refused to send any delegates to the Constitutional Convention in Philadelphia, becoming the only state to do so. From its early colonial beginnings, Rhode Island\u27s unique status gave its residents the opportunity to develop equally unique attitudes about the nature of government. These attitudes, however, also made the colony particularly susceptible to criticism from outside commentators. Over time, this criticism hardened Rhode Island\u27s individualist, self-reliant determination to resist outside control, which ultimately resulted in the refusal to send delegates to the Convention and later continued refusal to ratify the Constitution until 1790. As Rhode Island\u27s dissidence calcified, outside criticism also intensified, resulting in a dramatic debate over the nature of government, freedom, and even of good and evil

Combined condom and contraceptive use among South African women

Women across sub-Saharan Africa face multiple threats to their sexual and reproductive health. In South Africa, almost 20% of pregnancies are unwanted and an additional 36% are unintended at the time of conception, highlighting problems in access to and effective use of contraception. The heavy burden of sexually transmitted infections (STIs), including HIV/AIDS, presents a further challenge to women’s health. In this context there is growing recognition of the importance of dual-method use, defined as the simultaneous use of condoms and a non-barrier contraceptive, as an important strategy for promoting reproductive health. While condoms alone do protect against both pregnancy and STI, condom use over the long term may lead to unacceptable contraceptive failure rates. Therefore, combining condom use with an effective non-barrier contraceptive, usually a hormonal method, helps to ensure effective prevention of both unwanted pregnancy and STI

Social epidemiology

Social epidemiology is the branch of epidemiology concerned with understanding how social and economic characteristics influence states of health in populations. There has been a resurgence recently in interest among epidemiologists about the roles that social and economic factors play in determining health, leading to valuable synergies with the social sciences. The determinants of health commonly studied in social epidemiology include absolute poverty, income inequality, as well as race and discrimination. Recently, social epidemiologists have been at the forefront of conceptual developments within the discipline that view the determinants of health at different levels of social organization. © 2008 Copyright © 2008 Elsevier Inc. All rights reserved

Supporting the sexual and reproductive rights of HIV-infected individuals

The past 10 years have seen major advances in health care policy and services that support sexual and reproductive rights in South Africa. Significant milestones include the legalisation of termination of pregnancy (TOP) and the provision of free public sector services for maternal and child health (MCH) and contraception.1 At the same time the HIV epidemic has expanded rapidly during the last decade, and today an estimated 29% of women of reproductive age (15 - 49 years) in South Africa are HIV-infected.2 Despite these parallel developments, little attention has been paid to the way in which advances in sexual and reproductive rights in South Africa are extended to HIV-infected individuals

Failed contraception?

The frequency, cost and harms of the procedure must have been weighed up by the British National Health Service (NHS) — usually pretty sensible about their medical recommendations — which proposed 3-yearly screening for women aged between 50 and 64 years. Obviously more cancers would be discovered by 2-yearly rather than 3-yearly screening, and yet more by annual screening. Six-monthly screening, in turn, would clearly yield more cancers than annual screening. This would fit well with Dr Whitehorn’s ‘simple arithmetic’. However a balance has to be found between benefits and harms, and we chose the NHS one. The following organised screening programmes recommend 2- yearly mammography, most of them for women between 50 and 69 years: Australia, Finland, Iceland, Israel, Netherlands, France, Belgium, Canada, Denmark, Ireland, Italy, Norway, Portugal and Greece. Annual mammography, and mammography at an early age are the usual recommendations of interest groups. They are also the recommendation of the correspondence printed above. Like Dr Paul Sneider, we conclude with a quote from Boyle: ‘Every woman has a right to participate in an organised screening program . . .’. This right, alas, does not apply to this country, where other health care priorities make an organised programme an impossibility. However, should a woman have the privilege of medical aid, or be able to afford mammography, it is her choice to undergo it, a choice open to only a minority of South Africans. The majority of South African women would, in our opinion, be well served by an organised programme of ‘breast awareness’, a proposal that Dr Russell Whitehorn finds difficult to fathom

Concomitant contraceptive implant and efavirenz use in women living with HIV: perspectives on current evidence and policy implications for family planning and HIV treatment guidelines.

IntroductionPreventing unintended pregnancies is important among all women, including those living with HIV. Increasing numbers of women, including HIV-positive women, choose progestin-containing subdermal implants, which are one of the most effective forms of contraception. However, drug-drug interactions between contraceptive hormones and efavirenz-based antiretroviral therapy (ART) may reduce implant effectiveness. We present four inter-related perspectives on this issue.DiscussionFirst, as a case study, we discuss how limited data prompted country-level guidance against the use of implants among women concomitantly using efavirenz in South Africa and its subsequent negative effects on the use of implants in general. Second, we discuss the existing clinical data on this topic, including the observational study from Kenya showing women using implants plus efavirenz-based ART had three-fold higher rates of pregnancy than women using implants plus nevirapine-based ART. However, the higher rates of pregnancy in the implant plus efavirenz group were still lower than the pregnancy rates among women using common alternative contraceptive methods, such as injectables. Third, we discuss the four pharmacokinetic studies that show 50-70% reductions in plasma progestin concentrations in women concurrently using efavirenz-based ART as compared to women not on any ART. These pharmacokinetic studies provide the biologic basis for the clinical findings. Fourth, we discuss how data on this topic have marked implications for both family planning and HIV programmes and policies globally.ConclusionThis controversy underlines the importance of integrating family planning services into routine HIV care, counselling women appropriately on increased risk of pregnancy with concomitant implant and efavirenz use, and expanding contraceptive method mix for all women. As global access to ART expands, greater research is needed to explore implant effectiveness when used concomitantly with newer ART regimens. Data on how HIV-positive women and their partners choose contraceptives, as well as information from providers on how they present and counsel patients on contraceptive options are needed to help guide policy and service delivery. Lastly, greater collaboration between HIV and reproductive health experts at all levels are needed to develop successful strategies to ensure the best HIV and reproductive health outcomes for women living with HIV

Knowledge of the abortion legislation among South African women: a cross-sectional study

BACKGROUND: In order to ensure that legalized abortion in South Africa improves reproductive health, women must know that abortion is a legal option in the case of unwanted pregnancy. This study investigated knowledge of abortion legislation eight years after the introduction of legal abortion services in one province of South Africa. METHODS: In 2004/2005, we conducted a cross-sectional study among 831 sexually-active women attending 26 public health clinics in one urban and one rural health region of the Western Cape Province. RESULTS: Thirty-two percent of women did not know that abortion is currently legal. Among those who knew of legal abortion, few had knowledge of the time restrictions involved. CONCLUSION: In South Africa there is an unmet need among women for information on abortion. Strategies should be developed to address this gap so that women are fully informed of their rights to a safe and legal termination of pregnancy

La SVD e la Decomposizione Polare. Analisi e applicazioni.

Questa tesi presenta due decomposizioni matriciali utili in molteplici applicazioni:la Decomposizione ai Valori Singolari e la Decomposizione Polare. Vengono mostrati l'esistenza della Decomposizione ai Valori Singolari, varie proprietà e alcuni aspetti computazionali, quindi viene trattata l'esistenza della Decomposizione Polare e le proprietà fondamentali, con particolare attenzione al fattore ortogonale della decomposizione. Si introduce poi l'analisi di Procuste e viene mostrato come le decomposizioni matriciali discusse si applicano ad essa. Si conclude con un esempio pratico di analisi di Procuste, che illustra anche l'algoritmo MATLAB utilizzato