Nurse-Midwives’ Knowledge and Promotion of Lactational Amenorrhea and Other Natural Family-Planning Methods for Child Spacing

The purpose of this study was to describe and assess certified nurse-midwives’ (CNMs) knowledge and promotion of two modalities for child spacing, natural family-planning (NFP) and the lactational amenorrhea method (LAM). One thousand two hundred CNMs were randomly selected from a national membership list and mailed a 24-item questionnaire on NFP and LAM. Of the 514 respondents (42.8% return rate), 450 (87.5%) were currently practicing as CNMs. Respondents had an average age of 46 years, with an average of 10 years of practice. CNMs ranked NFP as the ninth most used and the eighth most effective family-planning method in their practice, with an average perceived method-effectiveness of 88% and use-effectiveness of 70%. Although most respondents felt somewhat prepared during their education program to provide NFP, only 22% would offer NFP as a family-planning option for child spacing

Defending Fair Use in the Age of the Digital Millennium Copyright Act

This article describes the efforts of the authors to challenge the limits placed on Fair Use by the anti-circumvention provision of the Digital Millennium Copyright Act (DMCA). Increasing DMCA-backed corporate control over the use of digital media has limited educators\u27 ability to teach effectively. The DMCA allows for a triennial challenge to the restrictions on copying media, an elaborate process which the authors successfully negotiated in order to secure an exemption. Communication, film studies, and media studies professors may now circumvent encryption on DVDs and other digital media in their departmental libraries for use in teaching. Narrow as this exemption may be, it nevertheless joins efforts of educators and filmmakers to protect fair use

Microbiome, Infection and Inflammation in Infertility

The implantation mechanism and process are very complex and require a precise interaction between the embryo and endometrium. The failure to implant is thought to be due to implantation environment factors or embryonic factors

Re-evaluation of the Indication and Limitation of Laparoscopic Salpingotomy for Tubal Pregnancy

Objective. We investigated the outcome of laparoscopic salpingotomy for tubal pregnancy by follow-up hysterosalpingography (HSG) or second look laparoscopy (SLL) and reexamined the indication and limitation of this conservative surgery.Study Design. From April 1991 to December 2003, we treated one hundred and eighty one cases of tubal pregnancy by laparoscopic salpingotomy. The tubal patency was assessed by either HSG or SLL performed at three months post-surgery. The successful patients at initial operation and the confirmed ipsilateral patent tubes at follow-up were classified as true successful cases (Group I). Even after successful operation, if the treated tubes were found occluded, they were considered as failure cases. Therefore, unsuccessful cases at initial surgery as well as at follow-up were categorized as Group II.Results. One hundred thirty four cases (74%) were successfully treated by salpingotomy at initial laparoscopy and also 85 of them (63.4%) were found truly successful at follow-up (Group I). The remaining 47 cases (26.0%) were unsuccessful at initial surgery and 18 (13.4%) cases at follow-up (Group II). Other patients who refused to accept a tubal patency test or not examined as a result of personal reason or lost follow-up comprised 31 cases. No difference in surgical outcome was observed with gestational age, intra-operative hemorrhage, size or anatomic location of pregnancy mass, and preoperative adhesions of the fallopian tube between these two groups of patients. However, pre-operative serum levels of hCG were significantly higher in Group II compared with Group I. In addition, the failure cases were more frequently associated with positive fetal heart beat (FHB), tubal rupture and a preoperative serum levels of hCG of more than 10,000 IU/L (p<0.05, χ2 test). The Log-rank test indicated a higher success in achieving pregnancy in Group I (p<0.05) than in Group II who desired for future pregnancy.Conclusion. Laparoscopic salpingotomy can be equally practiced as a conservative surgery for also proximal ectopic pregnancy and gestational mass size is not so much important and not a relative contraindication for conservative laparoscopic surgery as previously reported. Low preoperative hCG levels, absence of FHB, absence of tubal rupture initially or minimal rupture may be considered as suitable parameters for successful surgery and achieving future pregnancy.Without Figures and Table