-------------------------------------------
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
-------------------------------------------
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.
-------------------------------------------
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.
-------------------------------------------
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.
-------------------------------------------
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
-------------------------------------------
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
-------------------------------------------
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
-------------------------------------------
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.
-------------------------------------------
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.
-------------------------------------------
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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