Orion European Service Module (ESM) Development, Integration and Qualification Status

Following the very successful series of five Automated Transfer Vehicle (ATV) missions to the International Space Station (ISS) which were completed in 2015, ESA and NASA jointly decided to partially offset the European obligations deriving from the extension of the ISS Programme until the end of 2020 with different means. The selected barter option was a new development : the provision by ESA of the European Service Module (ESM) for NASA's new Orion human exploration spacecraft as part of the Exploration Mission 1 (EM-1). This development and production was entrusted to the prime contractor of the ATV, Airbus Defence and Space in Bremen, Germany

Medicine is patriarchal, but alternative medicine is not the answer

Women are over-represented within alternative medicine, both as consumers and as service providers. In this paper, I show that the appeal of alternative medicine to women relates to the neglect of women’s health needs within scientific medicine. This is concerning because alternative medicine is severely limited in its therapeutic effects; therefore, those who choose alternative therapies are liable to experience inadequate healthcare. I argue that while many patients seek greater autonomy in alternative medicine, the absence of an evidence base and plausible mechanisms of action leaves patients unable to realize meaningful autonomy. This seems morally troubling, especially given that the neglect of women’s needs within scientific medicine seems to contribute to preferences for alternative medicine. I conclude that the liberatory credentials of alternative medicine should be questioned and make recommendations to render scientific medicine better able to meet the needs of typical alternative medicine consumers

229 Female Cosmetic Genital Surgery: Complications

ABSTRACT Introduction Female cosmetic genital surgery is rapidly gaining popularity and acceptance as both the aesthetic and functional benefits of these procedures are becoming more and more appreciated and reachable. World Health Organization (WHO) defines health as „a state of complete physical, mental and social well-being and not merely absence of disease or infirmity”. Plastic surgeons and doctors of aesthetic medicine noticed that self-perception of the body image, beauty and physique strongly influences a woman's mental and social well-being. Cosmetic surgery is considered ethical and beneficial when intervention is able to improve the quality of life (QoL) and well-being of the patient. In recent years, however, a new aesthetic medicine concept has been developed into gynecological practice: correction and/or modifying the genital anatomy in the absence of a specific organic problem or disease with the objective of improving a woman's health perception. Objective Female cosmetic genital surgery refers to non-medically indicated cosmetic surgical procedures which change the structure and appearance of the healthy female genitalia. There are a number of procedures including: labiaplasty, vaginoplasty, perineoplasty, clitoral hood reduction, hymenoplasty and G-spot bulking. Complications of cosmetic female cosmetic surgeries are low, estimated between 2-4% and they vary depending on the procedure. Methods This systematic review will provide an assessment of complications associated with female cosmetic genital surgeries. The following databases has been searched from the study inception to July 2021: the Cochrane Central Register of Controlled Trials (Cochrane Library), PubMed, MEDLINE, Embase, Scopus, Web Of Science, ProQuest, ScienceDirect, UpToDate, Polish Medical Bibliography and consultations of Polish specialists and discussion forums of patients have been used. Results Woman's search for a „perfect” vagina and vulva is very often stimulated via the Internet promotional articles and advertisements offering and promising extraordinary cosmetic and functional improvements that are supposed to be achieved due to female cosmetic surgery. Many of these procedures, while elective, are not limited to aesthetic goal alone, e.g. the majority of women seeking labiaplasty also have a concomitant functional issue, whether it is discomfort from clothing or dyspareunia. Women should be carefully advised and screened pre-operatively for underlying psychological problems and sexual dysfunction. Female cosmetic genital surgeries should ideally be provided by a multidisciplinary team of healthcare professionals, including: surgeons, psychologists, psychosexual therapists, physiotherapists, with relevant training, demonstrated competence and with the required clinical governance arrangements in place. Conclusions Female cosmetic genital surgery is a rapidly expanding and poorly regulated field of cosmetic surgery. Despite the controversies, the relevant professional bodies should attempt to regulate training and standardize terminology. Well-designed prospective studies with long-term follow-up are needed. Patients should be carefully counselled and selected pre-operatively ideally by a multidisciplinary team. The request for female cosmetic genital surgery may be reasonable and whilst we respect an individual's right to choose, there needs to be increased regulation in this controversial area of medicine. Disclosure Work supported by industry: no. </jats:sec

267 Vaginismus: An Overview

ABSTRACT Introduction Vaginismus is defined as a penetration disorder in which any form of vaginal penetration is often painful or impossible. It has traditionally been referred to as an involuntary contraction of the pelvic floor muscles due to actual or anticipated pain associated with vaginal penetration. Vaginismus is predominantly unknown among clinicians and women. Vaginismus causes women to feel pain, fear and anxiety with penetration attempts. It is a poorly understood and underdiagnosed condition, for which many women do not gain support. This is due to the lack of knowledge of the condition, for the shame and embarrassment felt by vaginismus sufferers which means many do not discuss the issue. Objective Vaginismus is commonly experienced medical issue, affecting about 1-7% of the female population worldwide. Female pain is often viewed not as a medical fact, but as a misimpression or misinterpretation of bodily events. Vaginismus is not the only condition that has been placed in context of neglect. Other sexual pain disorders, such as vestibulodynia, vulvodynia and dyspareunia, have also been met with doubt and disbelief. An examination of the disbelief surrounding female reportage of their own bodily events will not only be beneficial in terms of perception of vaginismus, but also for general women's health. Methods This systematic review will provide an assessment of the current state of vaginismus. The following databases has been searched from the study inception to July 2021: the Cochrane Central Register of Controlled Trials (Cochrane Library), PubMed, MEDLINE, Embase, Scopus, Web Of Science, ProQuest, ScienceDirect, UpToDate, Polish Medical Bibliography and consultations of Polish specialists and discussion forums of patients have been used. Results Vaginismus influences the quality of life, in the most serious form it can result in unconsumated marriage, sterility and thus can lead to the separation of a couple. When adequately approached, the problem can mostly be solved. Conclusions Vaginismus is a common and significant sexual problem that causes distress and frustration for both partners. There are women for whom vaginismus is a serious problem and who are not able to cope with the situation without professional help of specialists. Deepening the specialists knowledge in this field is essential for successful treatment. Vaginismus is a well recognized clinical condition associated with non-consummation and considerable distress in women. It has received little scientific attention, and further well designed studies are needed. Disclosure Work supported by industry: no. </jats:sec