Thứ Ba, 31 tháng 1, 2017

Waching daily Feb 1 2017

For more infomation >> Trump Picks Religious-Rights Backer Gorsuch for High Court - Radio NetNEWS - Duration: 10:35.

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PSA for Haru Abuse - Duration: 3:45.

Have you ever

Felt Tired

Depressed

Having your OCs Sexualized?

Have you ever felt like

I need a sad commercial in my life

This has happended to the almighty

Magnificent

Glorious

Horu?

Haru?

Laru?

Is it Haru or Horu?

Haru could use your help

With a small amount of

of pizza

tads

Mortemae fan art

and Hyper Fries fan art

You cold help your local

neighborhood freelancing

Haru

from becoming

this

(Derpy Sad cat face

to this

Haru's profile picture

Now you may be asking yourself

Why me,Why give money to pizza eater,cupid that sit down and draws purple alien and 3 eyed little girl

Well Vladmir

You fat greedy bastard

You can give Haru a

an income

Some food

Some Shipping name

Continue Mortmae jokes

and Phil

She'll probably do that anyway

This can also,you know

Help a 22 year old keep her dreams

You fat russian

What was that

American Cunt

Oh nothing Vladmir

Anyway, you can also

stop Haru from being sad

by giving Pizza hut dinnerbox

Everyone adores those dinnerboxes

except the people who don't like pizzahut

What 'bout that ginger who has chicken with antlers that has OC for some reason

Themaedeer?

Yea,what about her?

Well

Did you just

don't care about her

Lengend how could you

You landed 4th place on twitter friend list

how could you greedy bastard

I think you've been reading

too many fanfics

and making too many assumptions

Wanna hear joke,Lengend?

Sure

I hate pizza and chick-fil-a

and that purple alien playboy that drinks weak Sake

and I hate red

For more infomation >> PSA for Haru Abuse - Duration: 3:45.

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Angry crowd calls for shutdown of Mass. nuke plant - Duration: 1:21.

HEM THE PLANT IS

SAFE.

>> WE WANT YOU TO SHUT PILGRIM

DOWN.

JOHN DOZENS CAME TO CONFRONT THE

: NUCLEAR REGULATORY COMMISSION,

BUT THEY DID NOT GET THE ANSWER

THEY WANTED.

BASED ON WHAT I KNOW TODAY, WE

ARE ALLOWING REFUELING

>> NO.

JOHN REGULATORS TOLD THE ANGRY

: CROWD THEY BELIEVE THE PLANT

IS SAFE DESPITE FINDING SEVERAL

PROBLEMS DURING RECENT

INSPECTIONS.

AND THEY SAY DISCUSSION OF A

"SAFETY CULTURE PROBLEM" IN AN

INTERNAL MEMO THAT WAS

ACCIDENTALLY EMAILED OUT WAS A

PRELIMINARY ASSESSMENT OF

CONDITIONS

>> YOU CAN WHITEWASH IT ALL YOU

WANT, BUT EVERY PARAGRAPH IN

THAT EMAIL IS DISTURBING ON SO

MANY LEVELS.

JOHN REGULATORS RATE PILGRIM AS

: ONE OF THE WORST PERFORMING

NUCLEAR PLANTS IN THE COUNTRY,

BUT THEY SAY PLANT OWNER ENTERGY

CORPORATION IS ADDRESSING SAFETY

CONCERNS AT THE FACILITY WHICH

WILL BE DECOMMISSIONED IN 2019.

>> A LOT OF PEOPLE WONDERING WHY

ENTERGY WOULD HAVE ANY INCENTIVE

TO INVEST IN PLANT IF IT'

SHUTTING DOWN IN TWO YEARS?

FIX WE HAVE MADE A COMMITMENT TO

THE GRID THAT WE WOULD OPERATE

THROUGH 2019, MAY 31 AND WE ARE

HONORING THAT COMMITMENT.

For more infomation >> Angry crowd calls for shutdown of Mass. nuke plant - Duration: 1:21.

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How to kill Invoker for 1 SEC - NEW Dark Moon TRICK! - Duration: 1:10.

For more infomation >> How to kill Invoker for 1 SEC - NEW Dark Moon TRICK! - Duration: 1:10.

-------------------------------------------

Trump Tells Drug Companies To Get Prices Down - Duration: 5:52.

DONALD TRUMP HAD A MEETING WITH SOME OF THE LARGEST

PHARMACEUTICAL COMPANIES, AND HE WAGGED HIS FINGER, MUCH LIKE

HILLARY CLINTON WAGGED HER FINGER AT THE NEW YORK STOCK

EXCHANGE, AND TOLD THEM YOU HAVE TO CUT IT OUT, THESE DRUG PRICES

ARE JUST TOO HIGH.

HE HAD PREVIOUSLY MADE STATEMENTS ABOUT

THIS, AND FACTORING HIS FIRST PRESS CONFERENCE AFTER HE HAD

BEEN ELECTED PRESIDENT HE SAID THE FOLLOWING --

>>THE DRUG INDUSTRY HAS BEEN DISASTROUS, THEY ARE LEAVING

LEFT AND RIGHT.

THE OTHER THING WE HAVE TO DO IS CREATE NEW

BIDDING PROCEDURES FOR THE DRUG INDUSTRY, BECAUSE THEY ARE

GETTING WAY WITH MURDER.

>>THAT STATEMENT IS TOTALLY FINE, I DON'T KNOW WHY HE SAYS

"INDUSTRIES" LIKE THAT, BUT I LIKE THAT HE'S TACKLING THIS

ISSUE, HE DESERVES CREDIT THERE.

BUT WAGGING YOUR FINGERS AT

PHARMACEUTICAL COMPANIES PROBABLY WON'T DO MUCH.

HE SAYS

THE FOLLOWING TO THEM -- YOU FOLKS HAVE DONE A TREMENDOUS JOB

BUT WE HAVE TO GET PRICES DOWN, WE ARE GOING TO CUT REGULATION

AT A LEVEL NO ONE HAS SEEN BEFORE, YOU CAN'T GET APPROVAL

FOR THE PLANT AND THEN YOU CAN'T GET APPROVAL TO MAKE THE DRUG,

OTHER THAN THAT YOU ARE DOING FANTASTIC.

SO THOSE WERE HIS

STATEMENTS WHILE HE HAD THESE MEETINGS.

YOU CAN'T GET APPROVAL

FOR THE PLANT -- ARE YOU TALKING ABOUT MARIJUANA?

BECAUSE IT

SEEMS LIKE PEOPLE LIKE JEFF SESSIONS HAVE BEEN IN FAVOR OF

KEEPING IT AS A SCHEDULE ONE DRUG, BUT I LIKE THAT HE WANTS

TO TACKLE THIS ISSUE.

WE WILL SEE WHETHER HE WANTS TO FOLLOW

THROUGH AND WHETHER OR NOT THESE PHARMACEUTICAL COMPANIES WILL

FOLLOW SUIT.

>>HERE IS MY TAKE, I LIKE THIS A LOT.

I DON'T KNOW WHAT HE'S

GOING TO DO, THERE IS FAIR SKEPTICISM ON YOUR PART, IT IS

NICE TO HUFF AND PUFF BUT IF HE DOES THIS I WILL GIVE HIM

CREDIT.

IF HE DID THIS HE COULD BE POPULAR AND MAYBE EVEN WIN

REELECTION.

BUT HE WOULD HAVE TO NOT DO ALL THE OTHER CRAZY

THINGS HE DOES.

THIS IS A POPULIST MOVE, TO SAY WAIT A

MINUTE, WHY CAN'T MEDICARE NEGOTIATE DRUG PRICES WITH THE

DRUG COMPANIES?

THEY ARE THE LARGEST BUYER OF DRUGS.

WE

LITERALLY PASSED A LAW SAYING THAT THE DRUG COMPANIES RULE IS

ALL.

WE ARE NOT EVEN ALLOWED TO NEGOTIATE WITH THEM.

THAT'S

INSANE.

BUSH WAS THE FIRST TO DO THAT, I WAS YELLING AND

SCREAMING WHEN HE DID.

OBAMA CONTINUED THAT POLICY AND I LOST

IT.

SOMETIMES RIGHT-WINGERS SAY WERE YOU WHEN OBAMA WAS DOING

THAT -- I WAS RIGHT HERE, YELLING AT HIM AT THE TOP OF MY

LUNGS.

IF HE TAKES IT AWAY, ENCOURAGES REPUBLICANS IN

CONGRESS TO PASS A LAW REPEALING THAT, SAYING OF COURSE WE GET TO

NEGOTIATE, THAT WOULD BE PERFECT FOR TRUMP.

THAT THE ART OF THE

DEAL, HE LOVES TO NEGOTIATE, HERE HE WOULD BE STRONG AND SAY

THE DRUG COMPANIES, GO AHEAD AND BUILD ANY PLANT YOU LIKE, I WILL

TAKE AWAY ALL THE REGULATIONS AND LET YOU RUN ROUGHSHOD -- BUT

WE ARE GOING TO NEGOTIATE PRICES.

THAT'S A STRONG,

POPULIST MOVE, AND IT IS LOGICAL.

THERE IS NOTHING WRONG

WITH THAT AND I HOPE HE GETS IT DONE.

PEOPLE SAY YOU ARE JUST

ATTACKING TRUMP BECAUSE YOU DON'T LIKE HIM -- NO, I DON'T

LIKE HIS ACTIONS.

IF I LIKE HIS ACTIONS, LET'S DO THAT DEAL.

>>IT'S HILARIOUS HOW DIFFERENTLY WE INTERPRET THE

SAME STATEMENT.

WHEN HE SAID THE PLANT, I THOUGHT HE MEANT THE

PLANT YOU WOULD USE AS AN INGREDIENT IN A DRUG.

SO CENK IS RIGHT.

>>I'M RIGHT, BUT SINCE TRUMP SPEAK LIKE A THIRD GRADER IT'S

HARD TO UNDERSTAND HIM.

OBAMA WOULD'VE TAKEN A HALF HOUR TO

SAY THAT, AND THAT WAS HIS DOWNSIDE.

HE WOULD'VE BEEN LIKE,

THE FACTORIES IN THE MIDWEST YOU ARE SPECIFICALLY MAKING ABOUT,

WE ARE GOING TO --

>>AND HE SOMEHOW MIRACULOUSLY FOUND A PRESS SECRETARY,

EARNEST, WHO SPOKE EVEN SLOWER THAN OBAMA DID.

>>BECAUSE THEY ARE BUREAUCRATS.

THAT'S WHAT I'M SAYING IS THE

UPSIDE OF TRUMP -- HE'S LIKE, YOU GET THE PLANT, BUT WE GET

A LOWER PRICE.

LOW PRICE, BIG PLANT.

LET'S GO. AND THERE IS

SOME DEGREE OF SIMPLICITY FOR MARKETING PURPOSES WHICH

REGISTERS WITH PEOPLE.

OBAMA, AFTER THE FIERY SPEECHES ON THE

CAMPAIGN TRAIL, IT WAS LIKE A FOUR-YEAR SLEEPER HOLD.

>>BEN CARSON SYNDROME HIT HIM.

>>PEOPLE WERE LIKE, WHAT DID OBAMA SAY?

JAYAR COULD BARELY

KEEP HIS EYES OPEN AS HE CUT OBAMA TAPE.

HE MADE US MISS THE BUSH YEARS WHEN WE WOULD CUT BUSH TAPE

AND IT WOULD AT LEAST BE FUN.

>>BY THE WAY, YES, IF HE DOES MANAGE TO DECREASE DRUG PRICES

THAT WOULD BE AMAZING, PHENOMENAL, AND HE WOULD GET

CREDIT FOR THAT.

AT THE SAME TIME, THOUGH, HE DID PROMISE TO

CUT REGULATIONS FOR PHARMACEUTICAL COMPANIES, AND I

THINK THAT WOULD BE DISASTROUS.

JUST TO GIVE YOU AN EXAMPLE OF A

FAIRLY RECENT FEDERAL REGULATION OF PHARMACEUTICAL COMPANIES,

THERE IS THE ISSUE OF OPIOID ADDICTION IN THE UNITED STATES,

AND THAT IS BECAUSE SO MANY DOCTORS ARE OVERPRESCRIBING IT,

AND MANY OF THEM WERE OVERPRESCRIBING IT BECAUSE THEY

WOULD GO ON THESE RETREATS WITH PHARMACEUTICAL COMPANIES AND GET

CONVINCED TO GIVE THIS DRUG TO PEOPLE WHO DON'T NECESSARILY

NEED IT.

THE FEDERAL GOVERNMENT REALIZES THERE ARE SO MANY

PEOPLE ADDICTED TO PAINKILLERS, WE NEED TO DO SOMETHING.

SO THEY

CHANGED THE WAY THE DRUG IS MADE.

SO FOR INSTANCE YOU CAN'T

SNORT IT, OR IT'S LESS ADDICTIVE, UNFORTUNATELY THAT

HAD UNINTENDED CONSEQUENCES OF PEOPLE TURNING TO THE BLACK

MARKET AND USING HEROIN, BUT THESE ARE PEOPLE WHO WERE

ALREADY ADDICTED.

AT LEAST IT WAS A REGULATION TO PREVENT

FUTURE ADDICTIONS FROM OCCURRING.

THAT KIND OF

REGULATION IS IMPORTANT, IT'S SUPER IMPORTANT, AND SAYING I'M

GOING TO GET RID OF THESE REGULATIONS IS DANGEROUS.

SO

THIS IS A LITTLE BIT OF -- THERE IS GRADATIONS IN THE STORY.

>>I HEAR YOU, BUT I'LL GIVE TRUMP ONE MORE PIECE OF CREDIT,

ESPECIALLY VIS A VIS OBAMA, I WILL DRIVE SOME DEMOCRATS CRAZY

WITH THIS BUT IT'S REALITY.

OBAMA ON THIS NEGOTIATING PRICES

WITH THE DRUG COMPANIES, HE SAID IT'S NUANCED AND COMPLICATED BUT

I NEED TO MAKE THE DRUG COMPANIES HAPPY SO I CAN PASS

THE AFFORDABLE CARE ACT, I'M PLAYING THREE-DIMENSIONAL CHESS

-- THERE'S GOOD TRUTH IN THAT, BUT AT SOME POINT YOU COULD JUST

DO WHAT TRUMP DOES AND PROCEED FROM STRENGTH AND GO, OH YEAH,

HERE'S YOUR CHESS.

WHAT THE HELL ARE YOU DOING?

OF COURSE I CAN

NEGOTIATE PRICES WITH YOU, ON THE GOVERNMENT, I'M THE BIGGEST

BUYER OF DRUGS.

WHAT ARE YOU GOING TO DO ABOUT IT?

THAT'S NOT

IN OBAMA'S DNA, HE WOULD NEVER DO THAT, AND THAT LED TO

DEMOCRATS NOT MAKING THEIR CASE AND KIND OF BEING MEALYMOUTHED

ABOUT IT, NEXT THING YOU KNOW THEY GOT DESTROYED DRUG THE

COUNTRY IN THE ELECTIONS.

SO THERE'S A GOOD REASON FOR

STRENGTH.

I WISH TRUMP WOULD USE IT FOR GOOD A LOT MORE, HE USES

IT LIKE 5% OF THE TIME FOR EVERYBODY ELSE'S GOOD, AND 95%

OF THE TIME FOR THE GOOD OF HIM AND THE BILLIONAIRE BUDDIES IN

HIS CABINET.

For more infomation >> Trump Tells Drug Companies To Get Prices Down - Duration: 5:52.

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The NATIONAL for Tuesday January 31, 2017 - Duration: 59:58.

For more infomation >> The NATIONAL for Tuesday January 31, 2017 - Duration: 59:58.

-------------------------------------------

Prospective Randomized Trial Of Oxytocin Administration For Active Management Of The Third Stage Of - Duration: 13:38.

Hello.

We'll be talking

about the prospective randomized

trial of oxytocin administration

for active management

of the third stage of labor.

First off, what

is active management

of third stage of labor?

It is composed

of the administration

of uterotonic drugs,

controlled cord traction,

uterine massage after delivery

of placenta,

and delayed cord clamping.

Postpartum hemorrhage is defined

by more than 500 mills of blood

loss within the first 24 hours

postpartum for vaginal delivery

and more than one liter

within the first 24 hours

postpartum for cesarean

delivery.

The significance of this

is that postpartum hemorrhage is

responsible for 25%

of maternal deaths worldwide.

The main causes of PPH include

the Four T's-- tone, tissue,

thrombin, and trauma.

Tone is the leading cause

of postpartum hemorrhage.

The main causes of atony

include uterine inversion,

distension,

and exhausted myometrium.

For the treatment of atony,

we can divide it

into mechanical,

pharmacological,

or surgical interventions.

The main pharmacological

intervention

is the administration

of oxytocin, which we'll

be talking about today.

Oxytocin is usually given in 10

units in either an IV infusion

or intramuscularly.

It is given on site

of the anterior shoulder

after delivery of head

or after delivery of the neonate

and cord clamping

or after the delivery

of placenta.

The aims of the study

were to determine the most

effective route of oxytocin

administration-- IV or IM--

and to determine the timing

of oxytocin administration

either on site of the anterior

shoulder or after cord clamping.

The parameters measured were

duration of the third stage

of labor, blood loss

during first hour of delivery,

comparison of the hemoglobin

and hematocrit changes,

and comparing the need

for additional interventions.

For the materials and methods,

600 women with singleton

pregnancy of more than 37 weeks'

duration were selected,

normal live vaginal delivery

with cephalic presentation,

and they were in active labor.

There were four treatment arms.

All arms received 10 units

of oxytocin.

Group IVA received oxytocin IV

at 1 ML per minute

after delivery of the fetus

and after clamping of the cord.

Group IVB received oxytocin IV

at 1 mill per minute

when anterior shoulder was seen

and after the head was

delivered.

Group IMA received IM oxytocin

after delivery of fetus

and after clamping of the cord.

Group IMB received IM oxytocin

when anterior shoulder was seen

after the head was delivered.

It was

a blind, randomized trial.

Participants were randomly

allocated via a random number

table.

And members who carried out

the measurements of blood loss

were masked to the allocated

groups.

For the evaluation of treatment

arms, participants were

evaluated by taking

a medical and obstetric history.

General and pelvic examinations

were done.

Blood samples were taken

before delivery for hemoglobin

and hematocrit.

Duration of labor augmentation

with oxytocin was recorded.

And vital signs, hemoglobin,

and hematocrit were recorded

after the end of the first hour

postpartum.

For data collection and analysis

to investigate the effect

of duration of labor

augmentation

on postpartum blood loss

within the first hour,

the amount of bleeding

was compared between women who

received induction for four

hours or longer to those who

received induction for less

than four hours.

Women were followed up for one

hour in the delivery room

for measurement of postpartum

blood loss.

For data collection

and analysis, data and analysis

for statistical evaluation

was performed via SPSS.

The difference in amount

of bleeding was compared

among the groups using

independent sample t-test

and one-way analysis

of variance.

The results and discussion are

as follows.

This is a table

on the demographic data

and treatment arms.

As you can see, the demographics

are not significantly different

and hemoglobin and hematocrit

are not significantly different.

However, the duration

of the third stage of labor

was significantly different.

For the table on comparison

of bleeding, hemoglobin,

and hematocrit levels

in treatment arms,

the mean postpartum blood loss

was not significantly

different between groups.

However, changes in hemoglobin

and hematocrit were the smallest

in Group IVB.

Postpartum blood loss, incidence

of high postpartum blood loss,

and hemoglobin and hematocrit

levels at admission

and after delivery

were similar in all groups.

However, Group IVB-- the women

who received oxytocin

after delivery

of the fetal head--

had lower changes in hemoglobin

and hematocrit.

And postpartum blood loss

was likely lower, although not

significantly different.

For the results on blood loss

by incidence of augmentation,

women with no induction

had significantly less amount

of blood loss in Group IVB.

However, for women who had

induction

there were no differences

between the groups.

Within groups, postpartum blood

loss was greater in those

in the groups who had

augmentation except in Group

IVA.

This demonstrates that there is

a negative impact of labor

induction on postpartum blood

loss.

For the data on blood loss

by duration of labor

augmentation,

for women who received

augmentation with oxytocin

for four hours or more

postpartum blood loss

was greater in all groups,

significant in all groups

except for Group IMB.

Women who received augmentation

with oxytocin for less than four

hours, the lowest postpartum

blood loss was in a Group IVA.

This shows that there is

a possible negative impact

of longer labor augmentation.

For blood loss by incidence

of episiotomy,

women who underwent episiotomy

had higher postpartum blood loss

in all groups as

compared to women who did not

undergo episiotomy.

There's a significant difference

only in the Group IVB.

There is

no significant difference

in postpartum blood loss

between women who did not

and did have an episiotomy.

Blood loss seems less in women

who did not have an episiotomy

but not significantly different

except in Group IVB.

The author's conclusions are as

follows.

Postpartum blood loss was

similar in all groups.

And the mode and timing

of oxytocin administration

did not have

a significant effect

on postpartum blood loss.

However, IV administration--

especially after delivery

of the fetal head, IVB-- might

seem favorable.

The duration of the third stage

of labor

and changes in hemoglobin

and hematocrit

were significantly reduced

in Group IVB.

Postpartum blood loss was

significantly lower in Group IVB

among women not exposed

to oxytocin before delivery.

And labor augmentation

was related

to significantly-increased

postpartum blood loss

in all groups except IVA.

However, the observed effects

were clinically insignificant

and had no marked impact

on postpartum blood loss.

The definition of clinically

significant in this paper

was reduction of 25%

of the total amount of blood

loss.

The limitations of this paper

includes no patient received

the other components

of active management

of third stage of labor.

The study was performed

at a tertiary hospital.

Therefore, present results

cannot be generalized

to patients who receive complete

AMTSL and warrant verification

by future studies among larger

patient groups

and different-level health care

facilities.

For current literature

whether IM or IV is favorable,

theoretically IV is risky,

especially if given in bolus,

due to effects

such as maternal hypertension

and tachycardia.

IM is relatively safer,

has less risks,

is faster and more convenient,

and requires less skill.

However, there are currently

no randomized controlled trials

or scientific evidence to say

which is better in terms

of postpartum hemorrhage,

maternal morbidity,

and mortality.

However, there's a trial ongoing

now to determine which route is

favorable.

NICE guidelines, World Health

Organization, and ICM-FIGO

recommend IM administration

of oxytocin.

As for the timing of oxytocin,

there are studies that compare

the outcomes in giving IM

oxytocin on seeing the anterior

shoulder versus seeing

the placenta.

Both are similar based

on current literature in terms

of postpartum hemorrhage

incidence

and other factors

like the necessity

for further intervention

and outcomes

like retained placenta.

Different groups make

different recommendations.

The American College

of Obstetricians

and Gynecologists

makes

no specific recommendations

in terms of timing

of administration of oxytocin.

The American Association

of Family Physicians

recommends that oxytocin be

given after delivery

of placenta.

And World Health Organization

says that oxytocin should be

given within one minute

of delivery of the baby.

As for the timing of oxytocin

upon seeing the anterior shorter

versus after delivery

of the neonate and clamping,

there is currently

in the literature comparing

the outcomes.

Therefore, we conclude in terms

of IM versus IV oxytocin

the studies show

that the administration of IV

oxytocin upon delivery

of the anterior shoulder

reduces postpartum blood loss.

However, due to limitations,

larger trials should be

conducted to determine which

group of administration

is favorable.

Despite this, IM is still

favorable due to ease

of administration

and based on current guidelines

and decreased theoretical risk

of maternal hemodynamic effects.

As for whether to give it

upon seeing the anterior

shoulder

or upon delivery of the neonate

clamping, the study showed

that administration of IV

oxytocin upon delivery

of the anterior shoulder

reduces postpartum blood loss.

However, literature shows

that outcomes are

comparable in administration

of oxytocin

upon seeing anterior shorter

versus after placental delivery.

That is the end

of our presentation.

These are the references.

For more infomation >> Prospective Randomized Trial Of Oxytocin Administration For Active Management Of The Third Stage Of - Duration: 13:38.

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Northampton student's request for gender neutral bathrooms granted - Duration: 1:29.

POLICE.

NEW SINCE SIX

STUDENT REQUESTS FOR GENDER

NEAUTRAL BATHROOMS WERE

GRANTED AT THE J.F.K MIDDLE

SCHOOL IN NORTHAMPTON.

NORTHAMPTON'S SUPERINTENDENT OF

SCHOOLS TOLD 22NEWS REPORTER

HAYLEY CROMBLEHOLME IT SUPPORTS

SOME OF THE SCHOOL'S OLDER

STUDENTS.

"OUR PRACTICE OF PROVIDING

GENDER

NEUTRAL BATHROOMS HAS BEEN A

PART OF MAKING SURE THAT ALL

STUDENTS AND STAFF ARE RESPECTED

AND HONORED,"

NORTHAMPTON SCHOOL

SUPERINTENDANT JOHN PROVOST TOLD

22NEWS THERE ARE NOW GENDER

NEUTRAL BATHROOMS IN ALL SIX

NORTHAMPTON SCHOOLS.

PROVOST SAID THE SCHOOLS HAVE

HAD THESE SINGLE STALL BATHROOMS

SINCE HE

ARRIVED IN THE DISTRICT TWO

YEARS AGO.

NOW J.F.K MIDDLE SCHOOL WILL BE

ADDING TWO GENDER NEUTRAL

BATHROOMS

ON THE SECOND FLOOR.

"IT DEFINITELY HAS BECOME THE

NORM FOR STUDENTS

AND STAFF. AS I SAID I'VE BEEN

IN THE DISTRICT FOR TWO YEARS,

THE DISTRICT HAS HAD GENDER

NEUTRAL

BATHROOMS FOR THAT ENTIRE TIME,

AND I'VE NEVER HAD A SINGLE

COMPLAINT."

"THE SCHOOL SUPERINTENDENT SAID

THE

DECISION TO ADD ADDITIONAL

GENDER- NEUTRAL BATHROOMS TO THE

MIDDLE SCHOOL CAME

FROM THE STUDENTS THEMSELVES. HE

SAID A STUDENT GROUP SUGGESTED

THE IDEA TO

THE SCHOOL."

ONE NORTHAMPTON PARENTS SAID

SHE'S IMPRESSED BY THE STUDENTS.

"I THINK IT REALLY SAYS A LOT

THAT THE IDEA WAS

INSPIRED BY THE STUDENTS AND NOT

BY THE ADULTS, I THINK THAT'S

VERY TELLING OF THE GENERATIONS

THAT ARE YOUNG NOW COMING UP

THAT TOTALLY SEE THIS THING AS A

NON-ISSUE." SEPARATE

GENDER-SPECIFIC RESTROOMS AS

WELL AS FACULTY RESTROOMS ARE

STILL LOCATED IN THE SCHOOLS.

IN NORTHAMPTON, HALEY

For more infomation >> Northampton student's request for gender neutral bathrooms granted - Duration: 1:29.

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FOOD FROM THE FUTURE IN SPACE AND ON EARTH - SPACE DOCUMENTARY - Duration: 35:14.

the history of food is to history of

humanity a lot of our social life is

organized around food

it's a story that is continued his man

has ventured into space the iron content

of the astronauts diet should be lower

than the diet on earth in space

I just hated sweet my mother gave me a

coffee with sugar

I couldn't actually don't think one of

the Apollo astronauts very proud that he

was the only human who has ever the

spaghetti on the moon surface as we've

got longer missions and future voyages

of exploration research into food and

nutrition is at the forefront of the

effort to travel to build bases on other

planets in our solar system the target

foremast mission is to be able to

recycle of the forty percent of the food

most of us in Europe are lucky enough to

take food for granted

yet if you really think about it we

still spend a great deal of our lives

getting preparing and of course eating

stuff

in fact for most of human history the

majority of people spent all their lives

just producing the food they needed to

survive and in many parts of the world

this is still the way

millions of people live it was only in

the nineteenth and twentieth centuries

that many of us left fields and migrated

to towns and cities to work in the

factories and offices of the modern

world's

the reason that food is such an integral

part of our lives is because it provides

the fuel that we convert into energy

this tractor needs fuel to work but

instead of running on diesel our bodies

unlock the energy we need from the food

that we eat this makes food and eating a

huge part of our lives

but food is much more than just fuel

from the moment you were conceived and

begin to develop your mother's womb your

body has been getting most of the raw

material needs to build and repair

itself from nutrients in food and it's

exactly the same space to spend more

than a few hours in space we have to

take supplies of food and water with us

I'm alive scientists working for the

european space agency easa it's either

there are thousands of scientists and

engineers involved in research into how

we can live in space we have a big

challenge ahead of us as we permissions

to other planets we have to find ways of

building space forms and actually

producing food and water in space

many of these projects are being tested

on International Space Station the ISS

the ISS has been built form of

kilometers above our heads in

international effort of research and

space exploration traveling at 28,000

kilometers per hour

it always the earth 16 times every day

but to really understand food and

nutrition in space

let's find out exactly why we need food

and how we converted into the fuel and

other essentials for life

for any physical or mental activity

that's a little competing on this course

our bodies need energy every time we

speak link and even dream we use energy

the cells in our bodies use the energy

stored in food for everything from

building proteins copying genetic

information and of course moving or

muscles believe you're not our brains

use more energy than any other single

organ in your body just thinking uses

twenty percent of the energy we need

house energy stored improved in the

first place

food is mostly made up from three groups

of chemical compounds carbohydrates fats

and proteins carbohydrates and fats are

mostly used for energy most protease are

the building blocks for every cell in

our bodies

but what foods do we need to eat to get

these essential ingredients foods like

bread and pasta are full of

carbohydrates we get fats for milk

cheese and vegetable products such as

oil and we get proteins again from

animal products for some vegetables such

as soy food also gives us the important

minerals and vitamins that our body's

needs to rebuild themselves and control

vital chemical reactions like the crude

oil that is popped out of the ground

then converted into the petrol and

diesel for our cars our bodies have to

process foods to get to the stored

energy that is chemically locked up in

food the first part of this process is

digestion as soon as food has entered

the math and effects

proteins and carbohydrates have begun

the journey through the body the process

of digestion begins

suggestions a process that requires food

and gifts of heat and energy

it does this by breaking down the

complex molecules of food into simply

more readily absorbed molecules

digestion happens as the food travels

along the elementary canal or are got

the gut is a muscular tube that uses

peristaltic action to squeeze the food

from my mouth to our anus fire stomach

and intestines during its passage

nutrients are extracted from food in

several processes this starts in the

mouth where food is broken into small

pieces biomechanical acts of chewing our

library plans also get to work and for

use an enzyme called amylase which

breaks a chemical bonds and

carbohydrates releasing shooters the

partially digested food isn't

transported to the surface into the

stomach the journey action of the

stomach further breaks and food and

mixes it with gastric juice the stomach

is a muscular sack when empty it's the

size of a sausage but it stretches to

the size of a large melon when full food

remains in stomach for between 30

minutes and four hours in stomach

Simon cells secrete pepsi no gene which

is converted in the protein speeding

enzyme pepsin the gastric juice and a

stomach is mostly hydrochloric acid is

about 1 million times more acidic than

tap water

it provides the optimum ph for pepsin

and also Dean ages proteins into

polypeptides and softens connective

tissue in meet the next stage of

digestion happens in the small intestine

but further enzymes break down the

polypeptide chains into amino acids

carbohydrates into glucose and fats into

fatty acids and glycerol these are end

products of digestion

these simple molecules together with

vitamins minerals and water are then

absorbed into the bloodstream in the

small intestine and transported to where

they are needed in the body the most

important Angie molecule that the

digestive system extracts from food and

transfers through the bloodstream is

closed commonly known as blood sugar if

you have low blood sugar levels you will

have a lack of energy excess glucose

distorted flies gin in the muscles and

the liver and converted back into

clothes when required

glucose is supplied her body cells by

the bloodstream but ourselves cannot get

the energy directly from cucos the

converted into a form that they can use

the molecule ATP glucose molecules are

broken down by a process known as

cellular respiration this process

consists of three of lives most

important biochemical reactions

psychosis the kreb cycle and the

electron transport chain collectively

the system converts each glucose

molecule into approximately thirteen

molecules of ATP it's an extraordinary

fact that the billions of cells in our

bodies produce half of our own body

weight of ATP every day and then burn it

for energy after the digestive system

has extracted all these vital

ingredients from the food we eat what's

left passes to the large intestine where

water is extracted and waste materials

produced which eventually passes out of

our bodies so that's how our bodies

digest food but exactly how much and

what kind of food should be eating to

stay healthy

we've seen how our body get the energy

and the building materials at our bodies

need from the food that we eat but

exactly how much food do we need to

understand this we have to carefully

calculate how much energy is contained

in food one way of measuring this is

with a bomb calorimeter the energy food

is counted in kilocalories common usage

has shortened kilocalories to calorie

one calorie response to the amount of

food that when burned erase a

temperature of 1 prime of water by one

degree Celsius the average grown man its

approximately 2,500 people calories a

day and women about 2,000 a lot of the

calories we consume are needed just to

keep us alive before we do any work

this is called the basal metabolic rate

and we use between a tonic and 1,400

calories to keep her brain heart and

other organs taking over a balanced diet

that supplies the correct amount of

calories and nutrients is fundamental

for a healthy body and a healthy life

our nutritional needs depend directly on

the amount of work our bodies do the

sports person its many more calories

than someone who spends all day in an

office or classroom getting very little

exercise if you consume more food than

your body actually uses for energy it is

stored as fat our bodies have evolved to

store excess energy supplies in facts in

case we needed for the future when there

is a food shortage

the trouble is that for most of us in

the developed world we usually have

plenty of food and don't need to rely on

stored fats

in the last two decades sedentary

lifestyles and unhealthy diets has led

to the problem of many overweight adults

and children worldwide being overweight

is a major contributor to serious

diseases such as high blood pressure

cardiovascular disease and type 2

diabetes if we eat more than our body's

needs our diet is set to be unbalanced

in space and asteroids food intake has

to be the ultimate balanced diet they

have to give top performances every day

in the most hostile environment in which

human beings can survive so their food

has to be both nutritionally balanced

and tasty but weigh as little as

possible wrong estimate of the

nutritional needs may be harmful to your

health it can lead to tiredness muscular

atrophy and cardiovascular problems so

the essence diet is carefully monitored

whilst in space by flight surgeons like

dr. philippe longer all the nutritional

intake is monitored in the sense that we

know what has been both on board for

that astronaut so we're able to know in

terms of nutrients and in terms of

calories what the astronaut is going to

eat and that choice has been made on the

basis of the needs of the asteroid has

that has been calculated on earth

including of course the physical

exercise on the space station the asset

is exercised in a couple of hours per

day so there's a lot of calories that

are burned just by physical exercise

extensive research has shown that

estimates actually use slightly fewer

calories when in space

it's not just calorie intake that needs

to be monitored in space is a

nutritionist have discovered some

important differences between a balanced

diet on earth and a balanced diet for an

astronaut in space the iron intake in

its face should be lower than on earth

because in space the astronaut has a

lower classmen volume and the lower

Earth aside William so at the beginning

of space rock there's a breakdown of the

democracy in which contains the island

so more iron is available so that's one

of the exceptions the iron content of

the astronauts diet should be lower than

the diet on earth

vitamin D is also very important for

healthy bones our bodies usually make

vitamin D when our skin is exposed to

sunlight spacecraft are shielded to

protect the astronauts from harmful

radiation and access sunlight astronauts

in space on the in the ISS don't have

that much sunlight so they don't have

that constant the size ytmnd so what we

right now add is about 800 international

units of vitamin D with the space hood

but it's not just about what we eat when

we eat can also dress it improve

performance

this is where astronauts can learn from

the field of sports science

well there are many powers and what the

physician is doing together with the

astronaut is very similar to what the

culture or a medical doctor does

together with the athlete the so is

really improving optimizing his level of

health from a mental and physical

perspective here telling Thames some of

the world's top rowers train to achieve

the optimum physical and mental

performance Olympic rower Tony carpet

knows all about getting the optimum

performance out of his body

how important is a balanced diet for

anything like you to keep fit through

training what i find it really important

to make sure you eat correctly the big

thing over door where I guess

carbohydrates because without the

glycogen stores which are which is what

stored in the muscle that is absolutely

key if you get that wrong you're gonna

be in trouble why advise people really

is to try and look at what they call

complex carbohydrates which is brand

porridge oats homebred gives you the

energy for a little bit longer so you

don't have the dips in energy that's the

dips in performance when we go into more

side weight based training i always try

and think about having more protein as

well I'm so combine the two together and

they've done some recent study too so

that actually taking on protein and

carbohydrate after hard strenuous

exercise within the 20-minute window

health recuperate the body but it's

actually quite a natural balance diet

really is quite simple stuff we're just

making sure that you're having it evenly

spaced out throughout the day were in

regular intervals so we've heard of food

can be used to optimize an individual's

physical performance but there's a lot

more to food and simply its effect on

the body

as important as food days is the fuel

and the raw material bodies needs it's

not the only reason we eat another very

important role who plays in our lives is

a psychological one eating and sharing

food with other people is probably

always communal act that we know it's no

exaggeration to say that the society we

live in today at the beginnings in the

act of obtaining and sharing food in

groups you can see this in all social

animals long before we start farming we

work together hunting and gathering food

the eating and sharing food from the

basis of societies throughout the animal

kingdom

nowadays this is of course changed and

we get most of our food from the

supermarket and we eat alone a lot more

than our ancestors but eating together

is still a fundamental part of our daily

lives and the importance of it is

recognized by asteroids psychologies

professor determines I if you want to

socialize his friends with other family

members even with its people we do not

know where we well we make appointments

for a common dinner or a common lunch we

have work lunches so that a lot of our

social life is organized around

the ISS is thick enough that may be

astronauts do not need too much during

the day so what we have decided for the

ISS program is that we want the crew at

least once a day to have a common meal

we make sure that the dinner at night is

made or together so we have the time of

the dinner at the time after you can

talk together at the social event

discuss have drugged and this is

important for the cohesion of the crew

we want at least to give them

possibilities to communicate and

formally together and this is highly

valued I think for my point is it's

psychologist whatever is very small 4-6

mature to to find a way to be or

together and to prepare your food then

you the special food for Christmas or

birthday we bring some food for a nice

chef in Europe and this is really

appreciated by our own astronaut but

also by the old community of estimates

food is also a kind of national thing so

to get food from your home country which

probably most fit to your personal

preferences i think is very important

from time to time

we've seen how cruise on the ISS to

change from a range of foods particular

to their own personal taste and culture

this demonstrates a huge diversity of

foods the different cultures have as

part of their staple diet however is

that versus the food we've grown up with

is and is now available for cruising

space it wasn't always so

the food that the first estimates

experience is a testament to the

pioneering spirit they had to end your

cubes of called the hydrated food that

relies on her own saliva to rehydrate

and taste the space squeezed out of

toothpaste like tubes

the food was on advertising and not

surprisingly they're really this like

squeezing it out of troops directly into

the mouth by the time of the Apollo moon

missions in the late 1960s the quality

and variety of food and improved

enormously the Apollo spacecraft had hot

water which made rehydrating foods

easier and improve the taste and for the

first time estimates were able to enjoy

the food in space one of the Apollo

astronauts very proud that he would be

on human has ever the eating spaghetti

on the moon surface in the 50 years

since we first put humans in space space

food went from unappetizing concoctions

23 * dishes papers of the world's most

renowned chefs either has cooperated

with European ships to provide

high-quality space food

they also created special meals for

estimates to celebrate New Year

birthdays in the arrival of a new crew

over 200 recipes are now available

during training astronauts are invited

to choose which means they would like to

eat on their next mission dishes range

from chicken teriyaki to fruit salads

beef stroganoff and butterscotch pudding

a few months before the mission they

make you choose between the something

like 500 different males and you test

food not in one day because you have so

you do that in a different days and you

you can say i prefer this food and you

can say I don't like this food but the

nutrition are looking at your foot in

terms of a balance of vitamins and and

the quality for your body so even if you

don't like the type of food you might

have it in your package remember for my

flight for instance i was surprised

because for for breakfast I had fish we

have costs on cafe but do not have fish

so you have to get used to it it's not

just the ordinary surprise in the food

package that estimates have to look out

for it seems to spending time and space

affects the astronauts sense of taste

what astronaut anecdotally tell us is

that they use taste and smell sensations

in space and that's probably one of the

reasons why the space was so high in

sodium content because more sort of food

tastes better than other food from me i

really like sorted food but in space i

wanted even more fully functional and

on-the-ground I don't like too much

sweet but in space I just hated sweet my

mother gave me a coffee with sugar

I couldn't I couldn't drink coffee we

should have because it was too much

sugar so you your test as a complete to

change a little bit in space compared to

the ground

having created this fantastic range of

foods for astronauts the next

consideration is how to get into space

even gracious food has to be preserved

before it's taken into space food

scientist Mike Lewis is responsible for

developing techniques that will preserve

astronauts food but he is just the

latest practitioner of techniques that

were used for millennia mankind is being

preserving food in lots of ways going

back 4,000 years salting sugar

preserving food preservation is very

very old and very traditional the main

purpose of preserving foods is to

inactivate the microorganisms or

microbes are naturally present or

preservation methods involve preventing

the growth of bacteria foggy and other

microorganisms as well as regarding the

oxidization of fats which caused from

city in today's high-tech food industry

a variety of techniques are used to

preserve food many of which we may not

even be aware of foods that we buy may

have been killed disaffected or

irradiated in order to slow down

microbial action most of the food

consumed by astronauts in space has been

preserved in some way the two most

common methods of preserving space food

for sterilization where food is heated

to 121 degrees centigrade in a sealed

can and dehydration where water is

removed during the development of

microbes and reducing the volume of the

food

but whatever technique is used to

preserve food for use in space the

original properties of the food are

inevitably altered and George Grimble is

researching the consequences of this

does food preservation degrade the

quality of food and degrade its

nutritional value and the answer has to

be that it depends on the process that's

being used to preserve the food a lot of

researchers gone on to try and minimize

nutritional changes during food

processing for example peas

um if you buy them they've been on the

market stall for two days would have

lost a considerable amount of their

vitamin C and one of the advantages for

example of quick freezing is to minimize

those sorts of changes what you'll often

find is that particularly sensitive

components in food for example vitamin A

or this mini can be degraded by

atmospheric oxygen and what this means

is that you have to take into account

during the processing the amount of

vitamin was degraded and then add an

amount back into the food to make sure

it reaches the right level

astronauts don't have to rely only on

preserved food the ISS has resupplied

every few months so estimates are

patiently enjoy fresh food when a

resupply craft has just arrived the

biggest differences between space food

and food on earth our packaging methods

space food must be carefully contained

so it doesn't float around in the free

for environment the fullest to be kept

in kind of source if it is too dry

likely to rise to divide the rise with

file use food particles on board the ISS

could cause serious problems not only

for the machinery of the spaceship

itself but for the astronauts health

this is dr. because you can't keep your

highs with morrigan you can bring it and

you can put in your life and it is very

bad for this reason things as common as

salt and pepper have to be provided in a

liquid form but liquids can float away

as well so drinks like coffee fruit

juice and tea packages powders and

sealed in squeezable containers as much

just add water to drink to rehydrate

them and bring them with straws the isis

has a kitchen that is equipped with food

storage compartments food warmers the

food preparation area a table with

restraints

so the estimates don't float away was

eating and metal trays that stopped the

food packages from floating away but

this all depends on food that is

regularly resupplied from Earth in the

next section I'm going to find out how

either plans to feed astronauts on

missions lasting as long as three years

here on international space station the

next meal is only supply ship away but

how do we feed the crew of six

astronauts on a three-year mission to

Mars iza and the other international

space agencies are planning manned

missions to the Moon and Mars in the

future for that length of time the crew

of six will need many tons of food and

drinking water let alone all the other

vital supplies that they would require

scientists are researching how to extend

the shelf life of food for up to five

years while maintaining a variety of

great tasting foods

however the most powerful rocket in the

world today can only carry a payload of

a few times into space and a trip to

Mars we need many tons of food and

supplies the only practical way to

supply long term missions is to Lord the

equivalent of a farm into space and grow

at least some food while recycling water

and waste to supply the crew for long

periods of time when we started with

bases on the moon and mars we also have

to grow food and recycle waste to an

able to stay on these distant planets

for years at a time

Issa has a number of research project

for growing and recycle food into space

easy societies is a piña works on one

of these the melissa project the

minister project addresses actually the

supply of air water and food for the for

the crew in a close to ready originality

of system in the sense that we take

actually the waist which are produced by

air by the crew being about physical

material urine that we degrade and from

that young regenerate and the water the

air and we produce as well

food today the target for mass missions

is to be able to recycle every forty

percent of the food why 40-percent of

the food because if you recycle produce

forty percent of the food of the cool

directly you produce and what percent of

oxygen and on what portion of the water

cool we'll need the question of which

foodstuffs to actually grow in the

precious reclaim resources is not simply

a scientific one there is another

criteria which is very important is the

quality of the food you will need to

produce you can feel the requirement

devil nutritions with with only but you

have to consider the acceptance and if

we feed the cool with only with of

course we will have had some

difficulties you just want to get a

fresh tomato or fresh cucumber or fresh

fruit

melissa is already successfully trialed

a close water recycling system but this

technology is not just applicable in

space you know that today everybody is

challenged by the environmental issue

and global warming issues specifically

the water quality is your quality

contaminants and everything and we know

already because we have some success at

the minister technology is applicable to

us which are already used in the test

your application and I think it's

important that people realize this is

the beginnings of the exploration of

space there have been many technological

spin-offs from advanced composite

materials to gps that we all use in our

phones and set

lives every day and in a world of

increasing population and decreasing

resources systems such as Melissa

developed for space travel could be the

most invaluable spin-off yet we've seen

in this program that food is literally

the fuel of life on earth and in space

ensuring adequate supplies of food

always has and always will be the most

important activity that all living

things from plankton to planetary

explorers do as we've seen the logistics

of long-term spaceflight require huge

technological innovations to supply

cruise with the food they need both for

the physiological and psychological

well-being SE travel to distant planets

the earth is a self-sustaining ecosystem

a man spacecraft that will be away from

its homecoming for years will also have

to be a self-sustaining ecosystem or to

put it another way a miniature planet

Earth in many ways the technological

challenges for ensuring future crude

supplies on earth are the same as in

space

ok

ok

ok

ok

person around it doesn't have TV

coverage of the things that man got the

black up now you're gonna feel started

getting a TV picture never fail us we

are getting a

your picture

one bad way

For more infomation >> FOOD FROM THE FUTURE IN SPACE AND ON EARTH - SPACE DOCUMENTARY - Duration: 35:14.

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Trump nominates Neil Gorsuch for Supreme Court justice - Duration: 2:18.

(MM)

WE'RE ALSO WORKING

DEVELOPNIG NEWS OUT

OF OUR NATION'S

CAPITAL--

PRESIDENT DONALD

TRUMP ANNOUNCING HIS

PICK--

FOR SUPREME COURT

JUSTICE TONIGHT--

TO FILL THE SEAT OF THE

LATE ANTONIN SCALIA.

(HE)

THE PRESIDENT

NOMINATED JUDGE NEIL

GORSUCH OF THE U-S

COURT OF APPEALS FOR

THE POSITION--

FULFILLING A CAMPAIGN

PROMISE --- TO FILL THE

SEAT IMMEDIATELY.

EYEWITNESS NEWS

REPORTER KIM KALUNIAN

IS LIVE IN STUDIO NOW

WITH MORE.

MIKE, SHANNON -- THE

FUTURE OF THE SUPREME

COURT WAS ONE OF THE

BIGGEST ISSUES IN LAST

YEAR'S PRESIDENTIAL

CAMPAIGN,

BOTH CANDIDATES

WARNED THAT ON ISSUES

FROM ABORTION AND GAY

RIGHTS TO THE

ENVIRONMENT... FUTURE

RULINGS WERE ON THE

LINE.

Judge Neil Gorsuch

PRESIDENT TRUMP

ANNOUNCES HIS PICK FOR THE

SUPREME COURT, FEDERAL

APPEALS COURT JUDGE NEIL

GORSUCH

Judge Gorsuch has oustanding

legal skills, a brilliant mind,

tremendous dicipline.

IF CONFIRMED, THE 49-YEAR-

OLD FROM COLORADO WOULD

SUCCEED JUDGE ANTONIN

SCALIA, WHO DIED NEARLY ONE

YEAR AGO.

Standing here in a houe of

history I

am acutely aware of my own

imperfections, I pledge that if

I am

confirmed I will do all my

powers

permit to be a faithful servant

in the

constitutial laws of this

country.

BECAUSE GORSUCH WOULD

REPLACE A FELLOW

CONSERVATIVE, EXPERTS SAY

HIS APPOINTMENT WOULDN'T

TIP THE COURT'S BALANCE OF

POWER.

TO BREAK A DEMOCRATIC

FILLIBUSTER IN THE SENATE,

GORSUCH WOULD NEED TO

EARN 60 VOTES, WHICH MEANS

HE'D NEED THE SUPPORT OF

EIGHT SENATE DEMOCRATS...

SENATOR SHELDON

WHITEHOUSE SERVES ON THE

SENATE JUDICIARY COMMITTEE

AND RELEASED A STATEMENT

SAYING IN PART:

"For years, a gang of five

Republican appointees took

direction from big right-wing

lobbies.

. . . This has to stop, and

Judge

Gorsuch must pledge to stop it."

When we judges don our robes it

doesnt make us any smarter but

it

does serve as a reminder of

what's

expected of us: impartiality and

independence, collegiality and

courage.

AND RHODE ISLAND'S

OTHER SENATOR, JACK

REED, TWEETED QUOTE "I

am concerned that #Gorsuch

has a tendency to favor the

interests of big corporations &

special interests over every

day Americans." KIM

KALUNIAN

For more infomation >> Trump nominates Neil Gorsuch for Supreme Court justice - Duration: 2:18.

-------------------------------------------

C# Fundamentals Important Update! - Duration: 3:48.

For more infomation >> C# Fundamentals Important Update! - Duration: 3:48.

-------------------------------------------

Effective tips for pink lips II गुलाबी होंठो के लिए असरदायक नुस्खे II By Roma Bali II - Duration: 2:05.

Hi friends & Welcome to Roma's Creation.

My name is Roma & today again i have come your to tell you about my new

Recipe for beauty tip

So, today i am going to tell you about dark lips

Some people have dark lips and they kind of apply lot of things on their lips but it doesn't make any difference

This spent lot of money and still its not working

So, try this what i am going to tell you & its very easy You can do it every day. right?

You can

use some drops of lemon

and some honey

how much ever you want.You can make it in a

large quantity and keep it your fridge, so that its very easy for you

to apply it everyday

So, i have done this and like and i have taken little bit of honey in this

1/2 a tbsp and then add i am mixing a little bit of lemon drops in this

Just mix them together

like this

and just apply it on your lips

like this

you can do this process everyday also and

so, it doesn't taste very bad, its kind of like

yummy.... and apply it everyday for one hour

and you will definitely see the differnce

so, friends if you like this video and it helps you

Do subscribe my channel & leave your comments in my comment section box.

so, stay fit and stay beautiful till we meet again. Bye.

For more infomation >> Effective tips for pink lips II गुलाबी होंठो के लिए असरदायक नुस्खे II By Roma Bali II - Duration: 2:05.

-------------------------------------------

VIDEO: Man wanted for fatal shooting at Tulsa bar - Duration: 2:08.

TULSA POLICE WANT TO FIND A

MAN ACCUSED OF MURDERING TWO

PEOPLE.

THEY HAVE NOW NAMED A SUSPECT.

THEY BELIEVE THAT ROBERTO

PURECO HAD BEEN DRINKING AT A

BAR WHEN HE SHOT TO OTHERS .

KATIE HIGGINS TALK TO POLICE

AND HIS LIVE WITH WHY THEY NEED

YOUR HELP.

Reporter: POLICE SAY THAT

ROBERTO PURECO SHOT AND KILLED

THE TWO BAR OWNERS AT THEIR BAR

ON OCTOBER 10.

THESE WERE THE 56 AND 57 MURDER

VICTIMS IN 2016.

THE LIGHTS ARE OFF AT THIS BAR

ON NORTH LEWIS.

THE TWO OWNERS, SAIRA VASQUEZ

AND ADAN DURAN, ARE DEAD AND

THIS MAN HAS BEEN CHARGED WITH

KILLING THEM . IT IS BEEN MORE

THAN THREE MONTHS SINCE THE

KILLING.

WE FOUND REMNANTS OF A MEMORIAL

AT THE BAR.

BUT LET'S GO BACK TO OCTOBER

10, 2016.

THE GENTLEMAN WAS PRESENT

FOR PRETTY MUCH THE EVENING.

THEY SAY HE WAS CONVERSING AND

DRINKING AND GOT DRUNK.

HE WAS SITTING ON ONE OF THE

BARTENDERS. Reporter: HE SAID

THE BARTENDER WASN'T HAVING IT

AND THE OWNERS KICKED HIM OUT.

HE LEFT AND WENT INTO THE

PARKING LOT.

THEN HE CAME BACK.

THERE WAS ANOTHER CONFRONTATION

AND HE SHOOTS SAIRA VASQUEZ

AND ADAN DURAN MULTIPLE TIMES.

Reporter: HE UNLOADED SIX

BULLETS WHILE THE BARTENDER HIT

AND THEN HE RAN AWAY.

NOW POLICE NEED TO FIND HIM.

I CHECKED AND ROGBERTO

DIDN'T HAVE ANY CHARGES AGAINST

HIM IN 2016.

For more infomation >> VIDEO: Man wanted for fatal shooting at Tulsa bar - Duration: 2:08.

-------------------------------------------

Fertility Outcomes Post Uterine Sparing Surgeries for Post Partum Hemorrhage - Duration: 11:08.

Today we're going to talk

about fertility outcomes

in post uterine-sparing

surgeries for postpartum

hemorrhage, or PPH.

Our discussion will focus

on the literature review

and discussion.

And the group members are Eric,

Daniel, Alfred, myself.

We are supervised by Dr. T. C.

Tan as well as Dr. Sonali.

Today, for our presentation,

we are going to give

a brief introduction

of the topic

as well as provide

the patient case scenario,

followed by the actual critique

of the article

based on the systematic review.

We are also going talk

about the KK experience

as well as the study conducted

in KKH on postpartum hemorrhage,

followed by conclusion.

Now, introduction.

Why is the topic of fertility

outcomes

in post-uterine intervention

important?

Because health is not just

a concept but a state

of complete physical, mental,

and social well-being.

And not just simply

about the absence of disease.

The case we are presenting

is the case of Mrs. P, who

is a 29-year-old G2P1 female

at 29 weeks gestation.

She basically present

PV bleeding associated

with abdominal pain.

The bleeding was noted to be

fresh, without clots.

She had

no prior provisional bleeding

during her pregnancy.

Routine antenatal blots were

normal.

Currently she has no fever,

headache, or hematemesis.

She also has no history of falls

or trauma.

Obstetric history-wise, includes

intra-uterine fetal demise

at 24 weeks gestation

previously, delivered by lower

segment Cesarean section

for preeclampsia three years

ago, complicated by PPH.

Code Green was activated three

hours after admission based

non-reassuring fetal status.

The baby was 1.3 kilograms,

delivered by LSCS, complicated

by a tear in the bladder serosa,

with significant PPH and a blood

loss of 2.5 liters.

Following which are uterine

compressions and B-lynch suture

was done.

Post-op-wise, her recovery

was uncomplicated.

The patient was discharged well

post-op day 5.

Now, based on the case,

what are the considerations

that a patient might have?

Of course, the patient might

definitely think about

whether she can get pregnant

again, the risk

to her pregnancies, especially

subsequent pregnancies

after this episode of postpartum

hemorrhage, which

is a complication of pregnancy.

And if possible,

when is the best time to get

pregnant again?

So the article we're talking

about is actually this article

on "Menstrual and Fertility

Outcomes Following the Surgical

Management of Postpartum

Hemorrhage-- a Systematic

Review."

For the article, they used study

selection and literature search

involving the following

databases.

Data extraction-wise, they've

studied the characteristics

of trial participants, the types

of intervention, the time

of follow up,

outcomes, complications,

as well as a quality assessment

of the procedures done.

Now, basically, this slide

is the most important slide

of the whole article.

Mainly the focus on three

procedures,

which is pelvic and uterine

artery embolization,

uterine devascularization, and

uterine compression sutures.

If you note, normal resumption

of menstruation

was 460 of 503 patients, which

was 91%.

Out of which 168 women desired

future pregnancies.

And the number of patients who

actually got pregnant

was 126, which is 25%.

Patiently

with recurrent postpartum

hemorrhage is 18.

For the next procedure,

uterine devascularization,

28 out of 32, which

is close to 88%,

had normal resumption

of menstruation

within six months,

out of which 39 desired

pregnancies, but only 33

actually achieved pregnancies.

For the uterine compression

sutures, 65 out of 71, which

is 90.27%, had normal resumption

of menstruation

within six months.

Out of which 28 desired

pregnancies and 24 actually

achieved pregnancies.

If you look at this slide,

it seems that the number

of patients who have

post-procedure complications

is the lowest

in the uterine compression

sutures, where there are

actually no complications

in terms of preterm

labor, early pregnancy loss,

as well as recurrent postpartum

hemorrhage.

However, the data does suggest

that pelvic uterine embolization

is the most studied procedure

in this paper.

But we actually noted

that patients who actually

undergo this procedure

are patients who actually need

to be stable,

because such procedures are

interventional radiological

techniques,

and require the expertise

of an interventional radiologist

on standby.

As for the reported

complications and associations,

we are going to look

at embolization

and devascularization

techniques,

as well as uterine compression

suture, or the B-lynch suture.

For uterine artery embolization

or pelvic devascularization,

complications included

endometritis as well as

endometrial ischemia,

uterine synechiae

and amenorrhea, otherwise known

as Asherman's syndrome,

increased risk

of abnormal presentation

in subsequent pregnancies.

For uterine compression sutures,

which is the B-lynch suture,

complications

such as uterine synechiae

and amenorrhea,

or Asherman's syndrome,

have been reported.

The article basically reported

that most women do not have

adverse menstrual and fertility

outcomes following

surgical intervention

of severe postpartum hemorrhage,

as shown in the slides.

The strengths of this paper,

generally, was that a wide range

of studies

were reviewed because it was

a literature review.

The studies were prospective as

well as retrospective.

They were drawn from all

around the world, and did not

focus only

on the British journals,

but also to a majority

of articles from Europe as well.

The use of common endpoints

to compare each study

was also a strength

of this paper.

The authors provided

a good discussion on limitations

of studies done,

as well as some conclusions.

However the weaknesses

for these people

are that the quality assessment

of selection was subjective,

because the endpoints were not

really very clear.

No randomized controlled trials

were done in the papers

reviewed, but only prospective

as well as retrospective studies

based on the complications.

There was

insufficient representation

of compression procedures

in the meta analysis,

such as the compression sutures.

We are now going to talk

about the experience and study

in KKH.

Complications and pregnancy

outcomes following

uterine compression

suture for postpartum

hemorrhage, a single center

experience.

Basically, the KK people studied

59,655 deliveries over a four

year period,

starting from first January,

2008 to 31st December, 2012.

Out of which 23 deliveries

required B-lynch sutures to be

performed as a result

of postpartum hemorrhage,

and out of which only three

pregnancies were achieved

following B-lynch compression

sutures.

As mentioned, there were only

three pregnancies in two

patients

reported from this study.

For Patient 1,

she had a miscarriage

in the first trimester.

The second successful pregnancy

was a 39-week pregnancy, which

was delivered

by elective Cesarean section

due to a placenta previa as well

as a transverse lie.

For Patient 2, it was also

an elective Cesarean section

for a term baby at 39 weeks.

If you look at the picture

in this slide, it shows that

for Patient 2,

following B-lynch compression

sutures.

This picture was basically taken

at the Cesarean delivery

of the second baby,

following

the B-lynch compression suture

of the first pregnancy

as a result of postpartum

hemorrhage.

This picture basically shows

fundal distortion, which

is a complication noted

for B-lynch compression sutures.

So basically,

uterine compression sutures

have been shown to be

effective at preserving

the uterus as compared

to procedures

such as hysterectomy.

The risk of loss of fertility

and subsequent pregnancy

outcomes remains.

And the total risk remains

unknown.

So while adverse pregnancy

outcomes have been reported,

there have still been

successful conceptions

and deliveries following

compression sutures,

such as the two

successful pregnancies reported

in this paper.

The low rate of successful term

pregnancies following

compression sutures

may be related to factors which

are non-medical,

such as psychological stress

from traumatic delivery causing

mothers to choose not to have

subsequent pregnancies.

Most women do not have

adverse menstrual or fertility

outcomes in the long term

after uterine-sparing surgical

procedures due to postpartum

hemorrhages, basically from all

the papers we have seen.

Data from the 2014 paper

from KK, which studied fertility

outcomes after B-lynch suture,

are

consistent

with the other studies.

Adverse outcomes

in subsequent pregnancies

remain restricted to isolated

case reports.

And the study and follow-up

for this cohort of women

remains very important.

So now, going back

to the Conclusions slide.

The questions frequently asked

by women.

Can they get pregnant again?

The answer is definitely yes.

Because such procedures aim

to preserve the uterus,

and that more women actually

resume menstruation as chosen

to be an endpoint or parameter

to measure fertility.

In terms of risk

to the pregnancy,

it seems to be

comparable with patients

with past abdominal pelvic

surgery,

basically because all procedures

done have complications,

and they are no different or no

higher than patients undergoing

normal pelvic surgery.

As to the question of,

when is the best possible time

to get pregnant again?

There are basically

no guidelines as of yet.

But anecdotal advice is to wait

one year or more to allow

for healing of the uterus

to prevent

possible complications.

Thank you.

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