New study shows safety of Internet telemedicine for medical abortion in Ireland

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Many women live in areas where abortion is not available. Women on Web (WoW) is a non-profit organization that provides online telemedicine for medical abortion up to 10 weeks of gestation.

It works like this. Women fill out a form, it is reviewed by a doctor, and if they meet the guidelines the misoprostol and mifepristone is mailed. There is a multilingual help desk for real-time support. Women pay what they can. but if they can’t afford anything the medical and support services are free. Four weeks later WoW asks for follow-up information via an e-mail request. 

Is it effective and is it safe?

In a new study (BMJ) reserachers reviewed the data from use of this service by women in Ireland (both the North and the Republic). They used data from the request forms and the follow-up e-mail as well as any information sought from the help desk. They reviewed data from two years. During this time frame 1,636 women in Ireland were sent the medications and feedback was obtained from 1,181 women. There was no follow-up whatsoever from 431 women, so it was unknown if they even received the medications and if they did whether they used them or not. Another 24 confirmed they received the medication although no further follow up was provided so it is unknown if they took the medication.

Of the 1,181 women who confirmed that they received the medication and provided follow-up 1,023 actually used the pills. The ones who did not either miscarried in the intervening time frame, sought abortion by other means, or decided to not have an abortion. One had an ectopic pregnancy so did not use the medication. There were 1,000 women who used the medication for whom follow-up data was available.

The success rate of the mailed medication in ending the pregnancies was 94.7%. Another 4.5% needed a surgical procedure to complete their abortion. Symptoms of complications were reported by 9.3% of women and 3.1% required some kind of treatment for a complication (most were antibiotics but a few needed a blood transfusion). Complications were slightly more common in the 7-9 week gestational age group versus < 7 weeks. 

As the outcome was self-reported it is hard to know if the complication rate is accurate. In addition, women who experienced complications or thought they were having a complication may not have disclosed their medication use and were likely to be seen by someone with little direct experience with medical abortion. This could have led to over or under treatment. In addition it is not known how many of the 455 women who provided no feedback took the medication and if so if they experienced complications.

Even with those limitations in mind the complication rates for women who provided follow up were fairly similar to those reported by formal telemedicine studies in countries where abortion is not illegal. For example, approximately 3-5% of the time medical abortion fails and a surgical procedure is needed and this happened to 4.5% of women in the WoW study. The blood transfusion rate and antibiotic rate were slightly higher than expected, but still very low (0.7% and 2.5% respectively).

This Internet-based telemedicine approach from another country appears safe for women who live in Ireland and who are willing to use the help desk and seek follow-up for complications. This experience cannot be translated to women accessing the medication from unknown sources with no guidance. When women use unknown sources for medication they may not be getting the right medication or dose. There are many sites selling fake abortion pills. Lack of formal support is also a concern with a DIY approach. This experience also can‘t be translated to countries where mail service may be scrutinized (in fact many women in the Republic had their medications shipped to the North for that very reason) or where accessing medical care may be harder due to lack of local resources, finances, or fear of prosecution. 

Telemedicine is so safe for medical abortion that as long as women have access to a surgical procedure (D & C) for back up, antibiotics, blood (in the rare case) and an emergency room the success rate approaches 95%. While it is never ideal for women to need clandestine sources the approach offered by WoW is much safer medically than any do-it-yourself procedure or illegal provider and an Internet-based telemedicine abortion service can offer almost the same outcomes for medical abortion as in person clinics.






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ProbablyWrong
167 days ago
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US Choropleth Map by County per State – a 4th Option

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Another option to display a Choropleth Map of the United States by County for one user-selected state in Microsoft Excel

The previous post presented three different options to implement a US Choropleth Map by County per State in Microsoft Excel. One approach showed the entire map of the United States and highlighted the selected state (option 2), whereas option 3 filtered the data and only plotted the counties of the selected state.

It was again Leonid Koyfman (who else?), who provided me with an interesting idea for another alternative: Leonid suggested in this comment to combine options 2 and 3 and show both maps in one view. This requires more real estate on the dashboard, but it also combines the advantages of both approaches: it provides a zoomed map of the selected state and keeps the context of this state on the map of the entire USA.

Since the technique will certainly be most useful on a dashboard showing more than just the maps, I created an example visualization with two additional views:

US Choropleth Map by County per State Dashboard - click to enlarge

  • On the left side of the dashboard the two maps (zoomed selected state and USA) are displayed
  • At top right of the visualization a table lists 10 selected counties of the current state: the 10 counties with the highest or lowest unemployment rates. A small new VBA routine assigns the according bin color to each of the 10 counties in the narrow column right to the table
  • The band chart at bottom right visualizes minimum, maximum and (unweighted) average of unemployment rates of all counties in the selected state over time

This is just one example how the technique of visualizing maps for a user selected state could be integrated in a more complex dashboard.

If you want to use this on your own dashboard, you may want to play around with the size of the maps and where they are located. Size and position of the zoomed state map are defined by the named range “myMapView”. You can adjust the zoomed map by simply changing the cell reference of this name. As for the map of the USA, you have to group all shapes of the US map first, then resize and reposition this group and finally ungroup it again.

The major disadvantage remains, though: the zoomed map of the selected state makes the distortions visible. These distortions are inevitable in the process of converting SVG-files to freeform shapes in Excel. Well, at least I couldn't find a way to avoid them. The problem depends on the size of the selected state: Texas and California, for instance, still look good as a zoomed map. Rhode Island and Connecticut definitely don’t. A crucial downside, no doubt about it. Unfortunately I do not have a solution for this. A map would be needed which will not be distorted in the ungrouping process, but I couldn’t find a better map than the one used here.

If you are interested, here is the link to download the zipped Excel workbook:

Download US Choropleth County Map per State (zipped Excel workbook, 2.4 MB)

Many thanks go to Leonid for the idea.

Stay tuned.

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ProbablyWrong
171 days ago
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Please quit teaching people how to make county choropleth maps. They distort more than they reveal.
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Nearly 20% of McDonald’s will have electronic kiosks by the end of 2017

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McDonald’s hits all-time high as Wall Street cheers replacement of cashiers with kiosks:

Andrew Charles from Cowen cited plans for the restaurant chain to roll out mobile ordering across 14,000 U.S. locations by the end of 2017. The technology upgrades, part of what McDonald’s calls “Experience of the Future,” includes digital ordering kiosks that will be offered in 2,500 restaurants by the end of the year and table delivery.

There are 14,500 locations. Right now 500 stores have kiosks.

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ProbablyWrong
172 days ago
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Minimum wage, payroll tax, employer health insurance mandate = disappearing low skill jobs.
mokelly
172 days ago
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Teen Sex, Pregnancy Continue Gradual Decades-Long Decline

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More teens are also using contraception when they do have sex.
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ProbablyWrong
174 days ago
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Conservatives literally want you to die in a fire

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Oh for shit's sake.
"A few days ago fire swept through Grenfell Tower, a large apartment building in London. It's not yet known what caused the fire, and we aren't conclusively sure how it spread so quickly, consuming the entire 24-story building. Nor is it known how many died in the fire; as of Friday, the count is at least 30 [and as of today, it's about 80]...

People who died in the Grenfell fire might be alive today if regulators had required sprinkler systems. This does not play well for the Tories.

But before we start hanging them in effigy, there are a couple of things we should consider."
Are we really doing this? Are we really doing this? Glibertarian hack Megan McArdle can't just for once agree that it's bad when people die in an easily preventable apartment fire? Unfuckingbelievable.
"If it costs more to build buildings, then rents will rise. People will be forced to live in smaller spaces, perhaps farther away. Some of them, in fact, may be forced to commute by automobile, and then die in a car accident."
UNFUCKINGBELIEVABLE.
"When it comes to many regulations, it is best to leave such calculations of benefit and cost to the market, rather than the government. People can make their own assessments of the risks, and the price they're willing to pay to allay them, rather than substituting the judgment of some politician or bureaucrat who will not receive the benefit or pay the cost."
That's easy for McArdle to say. She's not the one who died in a fucking fire.

As Matt Bruenig says about this whole shitshow,
"if this is true, then it is true of fireproofing in general. The Kensington mansions that have substantial fireproofing also have the exact same detrimental effect on rents. And so if it can be determined that those effects are so negative that fireproofing is net harmful, then fireproofing should be banned...

Indeed, if you are worried about the higher rents caused by fireproofing, you should also be worried about the higher rents caused by high-end amenities in general. Ban granite countertops. Ban exposed brick. Ban everything else that about a housing unit that gets rich people excited enough to pay higher rents. You can live with a laminate countertop. Others literally will not live if you install a granite one...

If it is a waste to use some of the country's scarce work hours and scarce raw materials to put a sprinkler system into a public housing complex, then it is just as much of a waste to use those same hours and materials to put the system into a private housing complex. The wastefulness of a particular unit of production does not change just because the income of its consumer is higher...

[And somehow, a]fter just saying that unnecessary fireproofing will kill other human beings, McArdle bizarrely reaches the conclusion that individuals should be able to decide on their own whether to do it (i.e. whether to kill other human beings). Even though there is nothing in her argument that supports the idea that fireproofing might be a wise way to allocate resources for the dwellings of the rich but not a wise way to allocate them for the dwellings of the poor, the upshot of her ultimate policy preference is precisely that: the rich will generally be safe from fire, but the poor will not."
Which is what I've been saying: if you're rich, then congratulations - you're in good hands with conservatives. But if you're not rich - and I'm gonna take a wild guess and say that you're not - then they're trying to kill you. They're trying to take away your health care so that you die from easily preventable and/or treatable diseases. They're trying to take away the safety measures in your workplace so that you die from an easily preventable accident or from an easily preventable disease that's related to your job (e.g. black lung). They're trying to take away all of the safety features in your home so that you die in an easily preventable fire. If they could, they would take all the seatbelts and the airbags out of cars; they'd take the safeties off of guns; they'd take the filters out of the water treatment system; they'd take the food out of your mouth. They are trying to kill you. To kill you. To end your life. To erase you from the planet. They are trying to kiiiiiiiiiiill yoooooooooou.

So, seriously, if you're not going to vote for liberals (moderate or otherwise) out of love for their platforms (which, I freely admit, are far from perfect) or out of adulation for their public personas (which, again, are usually heavily flawed), the very least you could do is vote for liberals out of self-defense.
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jhamill
175 days ago
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Conservatives think the Free Market know better than the Government but, don't seem to recognize the fact that companies will literally kill you for more profit if they can.
California
ProbablyWrong
175 days ago
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Castile-Yanez case: It's not over yet

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The release to the public of the 10-minute, 15-second dash-cam audio-video of the slaying of Philando Castile by police officer Jeronimo Yanez, which raised "reasonable doubt" in the jury that acquitted the officer of manslaughter and related criminal charges last week, leaves only one doubtful issue for the imminent civil lawsuit by Castile's heirs: how many millions of dollars will be recovered from the insurance carrier for the two cities for which Yanez was working.

Marshall H. Tanick
MinnPost photo by Jana Freiband
Marshall H. Tanick

The acquittal by the jury in St. Paul last week does not, of course, immunize Yanez or the two cities, St. Anthony, which employed him, or Falcon Heights, which contracted for his services and where the shooting occurred, from civil liability. The O.J. Simpson litigation teaches that an acquittal in a criminal case can be followed by a sizable verdict ($33.5 million) in a civil lawsuit, with a lesser burden of proof for claimants, a preponderance or majority of evidence, rather than the high criminal bar of beyond a reasonable doubt.

But there is another kind of immunity that comes into play. The U.S. Supreme Court has made it increasingly difficult in recent years for claimants to prevail in police fatality shooting cases. It has held in a number of cases that police and the jurisdictions for which they work have "qualified immunity" from civil lawsuits for damages. Under this principle, they cannot be successfully sued unless the officer’s conduct violates "clearly established" constitutional rights. This, too, is a very high bar and difficult for most claimants to hurdle.

Large settlements

Nevertheless, family members of decedents unjustifiably shot by police have received large settlements from governmental bodies or their insurance carriers, often multimillions of dollars. The cities or their carriers recognize the large financial exposure they face from civil jurors in theses cases, coupled with political considerations and desire to avoid further adverse publicity within their communities. 

The Castile civil case for unlawful police conduct, which his mother's lawyers have promised is forthcoming soon, is likely to yield a comparable result for similar reasons. The critical 42 seconds of the video showing Yanez pumping seven shorts into the obscured driver of the vehicle stopped for a back tail light transgression, has the quality of the Zapruder film, the 26-second recording of the assassination of President Kennedy in the motorcade in downtown Dallas; like a Rorschach test, how one regards the recording depends, in part, on their predisposed views of the subject. 

On one level, it seems to be a shocking illustration of a police officer run amok, which is why Yanez was fired immediately following the verdict that exonerated him from criminality. But it also can be viewed, as did the law-enforcement-practices expert used by the criminal defense team, as a textbook example of proper police response to life-threatening furtive behavior by Castile in remarking that he carried a gun and, according to Yanez, was reaching for it.

Some of the other themes that ran through the criminal case — the smoking of marijuana by Castile and his passenger, his girlfriend, Diamond Reynolds, along with the presence of the drug in the vehicle — are likely to be unfurled again in defense of Yanez. Meanwhile, the claimant will probably emphasize the conflicting statements made by Yanez in an interview in the immediate aftermath of the shooting and his trial testimony whether he saw Castile pulling a handgun from his pants, a contradiction that was handled poorly by the prosecutors in the criminal trial.

But the upshot of the shooting is likely to be a substantial settlement. How much? The sky's the limit, but the standard established in other comparable cases suggests a seven-figure amount. As a matter of poetic justice, the lawyers might ask for $7 million, 1 million for each of the seven shots that claimed Castile's life.

Closest kin is Castile's mother

The money, though, will not be widely disbursed. Under the law in Minnesota, compensation recovered in a wrongful death civil lawsuit like Castile's case, goes to the heirs of the decedent. In the absence of a will, the proceeds are awarded to the closest next-of-kin, who happens to be Castile’s mother.

His other next-family member, his sister, who has joined her mother as vocal critics of the jury verdict, is not legally entitled to any of the amount recovered — although her mother could, of course, share it with whomever she chooses, including charitable causes relating to the incident, such as scholarships, educational conferences, and other worthwhile contributions.

Although Reynolds, who memorably recorded the immediate aftermath of the shooting on her cellphone in the vehicle, is not legally entitled to any portion of the likely settlement, she is not devoid of a remedy.

Reynolds could also bring suit

She, too, could bring a civil lawsuit for damages. The case could be based on the legal doctrine of infliction of emotional distress, a doctrine that allows bystanders to recover if they harbor a reasonable fear of safety because they are in the "zone of danger" of imminent physical harm to themselves, as she probably was while seated in the passenger seat of the vehicle next to her boyfriend.

But that lawsuit is not assured of success. Most of the cases that have recognized this principle have involved claims by family members or close relatives, and Reynolds was neither.

She can, however, probably overcome that barrier due to her close relationship with Castile and proximity to the barrel of the gun used by Yanez to kill him.

So, as the controversy continues to swirl around this horrific incident, more litigation is likely. One thing that seems beyond doubt is, as that legal sage Yogi Berra, once remarked: "It ain't over 'til it's over."

 Marshall H. Tanick is a Twin Cities constitutional law attorney.

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ProbablyWrong
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