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Although questions will not focus specifically on labeling recommendations latent hiv infection symptoms 500 mg valacyclovir sale, the committee should be prepared to hiv infection rate in botswana 1000mg valacyclovir with amex discuss how the product label should display important efficacy and safety information about subgroup intention-to-treat analyses antiviral research abbreviation valacyclovir 500 mg line. The laboratory reviewed the slides and provided a diagnosis for the purpose of management of the subject natural antiviral herbs safe 1000 mg valacyclovir. The slides prepared by the central laboratory from the cervical biopsy/definitive therapy specimens were submitted to an expert Pathology Panel. This panel, consisting of four pathologists, reviewed these slides for the purpose of providing the official diagnosis for the primary analysis of vaccine efficacy. The consensus diagnosis of the panel represented the final diagnosis for study purposes. It is good clinical practice that the vaccination should be preceded by a review of the medical history (especially with regard to previous vaccination and possible occurrence of undesirable events) and a clinical examination if indicated. All women should continue to follow recommended cervical cancer screening procedures. Prior to administration, the healthcare provider should review the immunization history for possible vaccine hypersensitivity and previous vaccination-related adverse reactions to allow an assessment of benefits and risks. As with any injectable vaccine, appropriate medical treatment and supervision should always be readily available in case of a rare anaphylactic event following the administration of the vaccine. However, the presence of a minor infection, such as a cold, should not result in the deferral of vaccination. Immune As with any vaccine, a protective immune response may not be elicited in all vaccine recipients. Syncope Because vaccinees may develop syncope, sometimes resulting in falling with injury, observation for 15 minutes after administration is recommended. However, it is unknown whether vaccineinduced antibodies are excreted in human breast milk. Safety and effectiveness in pediatric patients younger than 9 years of age have not been established. Adverse drug reactions information from clinical trials is useful for identifying drug-related adverse events for approximating rates. Page 6 of 62 Data on solicited local and general adverse events were collected by subjects or parents using standardized diary cards for 7 consecutive days following each vaccine dose. Unsolicited adverse events were recorded with diary cards for 30 days following each vaccination (day of vaccination and 29 subsequent days). Parents and/or subjects were also asked at each study visit about the occurrence of any adverse events and instructed to immediately report serious adverse events throughout the study period. These studies were conducted in North America, Latin America, Europe, Asia, and Australia. Solicited Adverse Events the reported frequencies of solicited local injection site reactions (pain, redness, and swelling) and general adverse events (fatigue, fever, gastrointestinal symptoms, headache, arthralgia, myalgia, and urticaria) within 7 days after vaccination in females 10 through 25 years of age are presented in Table 1. An analysis of solicited local injection site reactions by dose is presented in Table 2. There was no increase in the frequency of general adverse events with successive doses. The number of subjects included in the analysis is the number of subjects with a documented dose (for Local Adverse Reactions, there was one less subject with a documented dose). Deaths In completed and ongoing studies which enrolled 57,323 females 9 through 72 years of age, 37 deaths were reported during the 7. Causes of death among subjects were consistent with those reported in adolescent and adult female populations. Studies in Females 9 Years of Age In clinical trials, comparable results were found between the safety and reactogenicity in 9 year old subjects and subjects aged 10 to 14 years of age. There were no new or unexpected safety issues following vaccination in females 9 years of age. There were no clinically Page 12 of 62 meaningful differences in overall safety outcomes between treatment groups. In addition, there were no new or unexpected safety issues in women 26 years and older compared to women 15-25 years of age. Because these events are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to vaccination. Immune System Disorders Allergic reactions (including anaphylactic and anaphylactoid reactions), angioedema and erythema multiforme have been rarely reported (fi1/10,000 to <1/1000). Nervous System Disorders Syncope or vasovagal responses to injection (sometimes accompanied by tonic-clonic movements) have been rarely reported (fi1/10,000 to <1/1000). The clinical relevance of the reduced antibody titre and the risk of a substantially reduced immune response to hepatitis B if doses of hepatitis B vaccine are missed are not known. Use with systemic immunosuppressive medications As with other vaccines it may be expected that, in patients receiving immunosuppressive therapy, an adequate response may not be achieved. Page 14 of 62 Drug-Herb Interactions Interactions with herbal products have not been established. Drug-Laboratory Interactions Interactions with laboratory tests have not been established. Drug-Lifestyle Interactions Effects on the ability to drive and use machines No studies on the effects on the ability to drive or use machines have been performed. If flexibility in the vaccination schedule is necessary, the second dose can be administered between 5 and 7 months after the first dose. If flexibility in the vaccination schedule is necessary, the second dose can be administered between 1 month and 2. Do not administer this product intradermally, or subcutaneously and precautions should be taken to avoid intravascular administration. The content of the syringe/vial should be inspected visually both before and after shaking for any foreign particulate matter and/or abnormal physical appearance prior to administration. A fine white deposit with a clear, colourless supernatant may be observed upon storage of the syringe/vial. Page 15 of 62 Any unused product or waste material should be disposed of in accordance with local requirements. Prior to administration, ensure that the plunger rod is firmly attached to the rubber stopper by turning the plunger clockwise until slight resistance is felt. Attach needle by pressing and twisting in a clockwise rotation until secured to the syringe. For management of a suspected drug overdose, contact your regional Poison Control Centre. Cervical cancers begin as asymptomatic precancerous lesions and usually develop gradually over many years. Cervical lesions are described according to the degree of 1 cytopathology found on the Pap smear, with progression in degree of dysplasia. The period between exposure to the infection and the development of a specific lesion is extremely variable, making it virtually impossible for most individuals to determine exactly when, and from whom, they were exposed to the virus. In Canada, cervical cancer affects females of all ages and among females aged 20 to 44, cervical cancer ranks as second most common to breast cancer. The annual rate of new diagnoses of cervical cancer in Canada is 7/100,000 and the annual mortality rate is 2/100,000. The 1 Pap (Papanicolaou test detects abnormal cervical cells) Page 17 of 62 annual rate of new diagnoses of adenocarcinoma of the cervix may be as high as 1. Despite the significant reduction in the burden of disease from cervical cancer since the introduction of cervical cancer screening, new cases and deaths from cervical cancer continue, with approximately 1350 new cases and 390 deaths from cervical cancer estimated in 2012. Overall, incidence and mortality rates due to cervical cancer have shown a steady decline in the past 30 years due to the introduction of Pap screening programs. The reduction has been driven primarily by decreases in the rates of cervical squamous cell carcinomas, the predominant histological type. Rates of adenocarcinoma and adenosquamous carcinomas have increased over this period, particularly in females 20 to 34 years of age. Rates have plateaued in the last 5 years, suggesting that further prevention strategies beyond Pap screening may be necessary. Given that adenocarcinomas occur further in the endocervical canal, they are often more difficult to detect through normal cytological screening. Until recently, cervical cancer screening programs have allowed for detection and removal of precancerous lesions (secondary prevention). Primary prevention of these lesions via vaccination can provide an additional opportunity to prevent cervical cancer by prevention of the infection which initiates the disease process. This included subjects for whom assay results were available for antibodies against at least one study vaccine antigen component after vaccination. Secondary endpoints included an assessment of efficacy in the prevention of 6 month persistent infection and 12 month persistent infection.

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These are Textured substrates can be porous or nonporous and presthe conditions of the surface (substrate) being touched hiv infection latency order valacyclovir 500mg free shipping, ent the problem of incomplete contact between the fricincluding texture hiv symptoms two weeks after infection discount 500mg valacyclovir with visa, surface area how long from hiv infection to symptoms 1000mg valacyclovir sale, surface curvature or shape hiv infection rates los angeles order 1000 mg valacyclovir amex, tion ridge skin and the surface being touched. These methods are often specifc to either porous protects the evidence from contamination and the user or nonporous substrates; however, some techniques have from exposure to pathogens or hazardous chemicals. Deviation from the recommended does not, however, guarantee that latent prints will be preorder could render subsequent processes ineffective. To prevent damage to fngerprints 105–179) for a recent review that includes many fngerprint on these surfaces, evidence should be handled in areas not development techniques. The following general procedures normally touched or on surfaces incapable of yielding viable are appropriate during a systematic search for latent fngerfngerprints. Under no circumstances print deposition should fllers such as shredded paper, wood shavings, or packing peanuts be used inside the package with the • Length of time since evidence was touched evidence because they may easily wipe off fragile fngerprints. Once evidence is secured, the packare secreted onto the surface of friction ridge skin. Readers are sion of reference to a particular technique does not indicate directed to Ramotowski (2001, pp 63–104) for more detail. Several formulations for various chemical solutions have the total area of skin on the body exceeds 2 m2; yet, on been collected in Section 7. In this stratum, eleiden is converted to fed hundreds of compounds present in human sweat keratin, which is continually sloughed off the surface of the (Bernier et al. This layer also contains the two for comparison purposes, this information does not accumajor sudoriferous and sebaceous glands. These are the sudoriferous glands (eccrine and apofully visualized, a thorough understanding of these changes crine) and the sebaceous glands. Several million of Table 7–1 these glands are distributed throughout the body, most Relative abundance of amino acids in sweat. Of Leucine 9 primary importance to the development of latent print Glutamic acid 8 ridge detail are the amino acids. Table 7–1 summarizes the average values of abundance for the amino acids listed (HaIsoleucine 7 dorn et al. Proteins are Tyrosine 5 also found in eccrine sweat (Nakayashiki, 1990, pp 25–31; Uyttendaele et al. There is person’s sweat a day after taking the medication (Mong et some diffculty in accurately determining the amounts of al. These sweat glands are associated with the coarse of both fatty acids and sterol compounds (Boysen et al. One of the few published phetamine and its metabolite L methamphetamine had studies of apocrine secretions described them as milky in been detected (Vree et al. Ethanol has appearance and stated that they dried to a plasticlike solid, also been detected in eccrine sweat (Naitoh et al. Sebaceous glands are relatively small saclike organs and Sterol esters are thought to be produced secondarily by can be found in the dermis layer of skin. This value decreased to 38% in infants (1 month to the approximate percentage of lipids in 2 years of age). The concentration then determined that the composition of latent print residue can slowly begins to rise in children 4–8 years in age (7. The amount of material by some of the Home Offce Forensic Science Service contained in a latent print deposit is rather small, typically laboratories and several Department of Energy National less than 10 fig, and has an average thickness of about Laboratories. The results obtained from the aging experiments were No other observable trends were detected for the other generally as expected. Samples were analyzed at selected hypothesized that these low molecular weight compounds intervals and stored in either light or dark conditions at would either break down further or evaporate. This study focused on what changes occur tributed fatty acids to the residue before the compounds as lipids in the print begin to age. Similar trends were observed for determine whether any of the breakdown products would samples stored in the dark; however, the decreases were be suitable for visualization by chemical reagents. One experiment that looked at the components of the residue to migrate into the chip. Fingerprint dusting is relatively simple and relies on the adherence of powder to the latent print residue to provide 7. Latent the chemistry of latent print residue is very complex, print powder has an affnity for moisture and preferentially yet its physical characteristics and properties are due to clings to the residue deposited by friction ridge skin. It more than just the hundreds (or potentially thousands) of is well accepted that the mechanical attraction between chemical compounds that comprise the residue. These these particles and the moisture and oily components in compounds form a complex three-dimensional matrix, an a print causes adhesion, with absorption being a factor emulsion of water and organic and inorganic compounds. These changes can Most commercial powders rely on at least two essential explain why some reagents, like powders, and iodine elements to provide adhesion to latent print residue withfuming, tend to work on relatively fresh prints, whereas a out “painting” the substrate. Such data will also assist in better powders offer enough adhesion to be used individually. Sometimes powders are combined for effectiveness on both light and dark substrates. This technique is one of the oldest and most can be overcome by tagging a single type of pigment common methods of latent print detection, with one of particle with a fuorescent dye stain, thus creating a the earliest references dating back to 1891 (Forgeot, 1891, particle with dual uses rather than combining different pp 387–404). Although commercial suppliers of latent print carbon), lamp black, talc, kaolin, aluminum, metal fake, powder have discontinued using known hazardous ingreand dolomite (Lee and Gaensslen, 2001, pp 108–109), dients such as lead, mercury, and cadmium, it is strongly among others. Good binders include iron powder (Lee and recommended that the practitioner wear a dust mask or Gaennslen, 2001, pp 108–109), lycopodium, corn starch, work on a downdraft table as minimum precautions while rosin, and gum arabic (Menzel, 1999, p 143). The softness of the bristles is pargray-black image that can be visualized on varying colored ticularly important to prevent damage to fragile latent print surfaces. Latent prints with a high moisture or oil content black surfaces, conversely appearing light in color (Cowger, are easily damaged by a brush that is too stiff or is used 1983, pp 79–80). Conventional brushes are typically also be prepared or “tagged” with a fuorescent dye stain made with animal hair, fberglass flaments, or sometimes (Thornton, 1978, pp 536–538), giving it the dual purpose as feathers. The low density of this also sometimes tend to “paint” the substrate more than powder also allows it to easily become airborne during the nonfake particles do. To apply fngerprint powder with a consurface area of the fake relative to the weight of the ventional brush, the flament tips are lightly dipped into a particle contributes to this powder’s adhesion. It appears sterile, wide-mouth container holding a small amount of that commercially available fake powder with a mean powder. Another study powdering and slowly building to heavier applications to indicated that a range of fake metals produced optimum minimize fngerprint damage. Probably the most common lift is of black fngerprint powder placed on a white backing card. This type of powder can be light, dark, or fuoopaque adhesive gel lifters, typically black or white; and rescent and utilizes the ferromagnetic properties of iron silicon-type materials that are spread onto the surface powder mixed with pigment powders. Magnetic powders are usually less effective on ferromagnetic Another type of powder that produces excellent results substrates such as steel or nickel and are therefore not recon a wide variety of surfaces is fuorescent powder. It is important to test tape and lift cards used (Crown, 1969, pp 258–264; Friedman and Williams, 1974, with fuorescent powders for any inherent fuorescence pp 267–280). Conventional small-particle Ruhemann’s purple and other by-products of the ninhydrin reagent, for developing fngerprints on wet, nonporous and amino-acid reaction were also used to quantitatively surfaces, uses molybdenum disulphide in suspension, but measure amino acid content of samples (Yemm et al. The technique Ruhemann mistakenly prepared the compound (Ruheis now amongst the most popular methods for fngerprint mann, 1910a, pp 1438–1449). Several of these analogues were highly 1911c, pp 1486–1492), today known as Ruhemann’s purple, successful. Ninhydrin is a crystalline averaging about 250 ng per fngerprint (Hansen and Joullie, solid that is colorless to pale yellow in color and is highly 2005, pp 408–417). Although uncontrollable variables (such the presence of any water but will assume a triketone strucas the total amount of sweat deposited by the fnger, the ture in anhydrous conditions (Hansen and Joullie, 2005, amino acid concentration of the individual’s excretions, and pp 408–417). Subsequent studies indicated that the with paper, these amino acids impregnate the surface of purple color resulted from the reaction between ninhydrin the paper, where they are retained by their high affnity for and amino acids and described the product of this reaction cellulose (Champod et al. Ninhydrin is one of many chemicals that acts as a nonspecifc amino acid reagent and is, therefore, highly suitable 7–15 C H A P T E R 7 Latent Print Development Structural studies of the reaction product have confrmed 7. With the complexes have identifed the structure in Figure 7–4 current ubiquity of forensic light sources, both absorption (Lennard et al. Several ninhydrin formucadmium, cobalt, and copper was used in a biochemical lations have been reported in the literature (Crown, 1969, context to preserve ninhydrin spots on chromatograms pp 258–264; Oden and van Hofsten, 1954, pp 449–450; (Kawerau and Wieland, 1951, pp 77–78). The lighter hue tions are typically prepared in two steps: frst, a stock solumay provide a greater contrast against a dark-colored backtion is prepared that has a high proportion of polar solvent ground, especially when observed at 490–510 nm, where to facilitate the stability of the mixture; second, a portion the metal–Ruhemann’s purple complex has an absorption of the stock solution is diluted with a nonpolar carrier maximum (Stoilovic et al. If ambient humidthe document in liquid nitrogen, a glass plate being placed ity is low, development in a specialized, humidity-controlled between the sample and the light source and camera, and a fngerprint development chamber may be necessary (Almog, heat source to prevent condensation on the glass (Kobus et 2001, pp 177–209). Steaming can be achieved by holding a steam iron above the exhibit; heat can be delivered in a 7.

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He or she will be there to hiv infection from woman to man purchase valacyclovir 1000mg mastercard share in your enjoyment and offer support to stages of hiv infection and treatment valacyclovir 500mg on-line all parties as needed stages of hiv infection seroconversion valacyclovir 500 mg with amex. Typically antiviral drugs for aids discount valacyclovir 500 mg on line, the baby will remain in the hospital for approximately 48 hours after birth. Once the baby has received medical clearance, the couple will leave the hospital with their baby. Your attorneys will assist you in obtaining a birth certificate and passport (if needed) at this time. Once all fees to your surrogate, medical facility, and any other expenses have been paid, the Director of Escrow will return the remainder of your funds. Step 9: Postpartum the delivery of a surrogate child can be the most amazing experience of a Surrogate’s life. Most of our staff are prior surrogates and can relate to the Surrogate’s experience. We are happy that you have become new parents and wish you and your family the very best! Most Intended Parents choose to share photos with their Surrogate after the birth of their child. Receiving a picture of the Intended Parent(s) and their new baby, can help to reinforce the wonderful decision the surrogate has made to carry your child. The Surrogate Mother has no genetic relationship to the child born from a Gestational Surrogacy. The Surrogate has no genetic relationship to the child born from a Gestational Surrogacy. The screening encompasses a review of their detailed medical history, a physical exam, comprehensive laboratory testing, psychological assessment and medical screening. Multidisciplinary consultations with internists and specialists, psychologists and/or counselors, geneticists may also be required. Intended Parent(s) Screening Your primary physician may have already performed the work-up of the Intended Parent(s) referred for surrogacy. The philosophy at Simple Surrogacy is not to duplicate testing, thus, Intended Parent(s) are encouraged to obtain copies of their previous testing to avoid duplication. Testing for the Intended Parents may include but is not limited to psychological evaluation, std testing, hysteroscopy, mock transfer, mock cycle, and blood work. Counseling ensures that everyone is confident and comfortable with their participation and trusts each other. Counseling also minimizes foreseeable risks, thereby avoiding the placement of unacceptable burdens on any of the parties, including the future child. This assessment, or test, was designed to help identify personal, social, and behavioral problems in psychiatric patients. The test helps provide relevant information to aid in problem identification, diagnosis, and treatment planning for the patient. Gestational Surrogate/Intended Parent(s) Suggestions During the treatment cycle both the Surrogate and Intended Parent(s) should: · Be open and honest regarding expectations and hopes throughout the process. Cycling Once the contracts are complete and testing has finished, the Surrogate and the Egg Donor (who can be the Intended Mother or a donor) synchronize their cycles. About 14 days into the birth control pills, both Surrogate and Egg Donor will start Lupron. When the menstrual cycle starts while on Lupron, the Lupron dose is usually decreased by half and the Surrogate will start adding Estrogen replacement to the mix (in the form of pills, patches, or shots depending on the doctor). Some doctors have you take other medications as well (Dexamethasone to suppress male hormones to increase implantation, antibiotics to guard against any infection that might have gone undiagnosed, etc. The Egg Donor is checked about 3 times a week via ultrasound and blood tests to determine her response to the drugs. The eggs retrieved are fertilized with sperm from either the Intended Father or a sperm donor and incubated for 2-5 days. Progesterone replacement (most often in the form of intramuscular injections, but sometimes with suppositories or Crinone gel) starts the day of the retrieval and continues until the 12th week of pregnancy or a negative pregnancy test. Estrogen replacement also continues until the th th 7 12 week of pregnancy (when the placenta takes over hormone production). Because the Surrogate was on Lupron and had natural hormones were suppressed, the Surrogate will need to take external sources of these very important hormones in order to maintain any pregnancy that occurs. When the fertilized embryos are at the proper stage, they are loaded into a special syringe with a thin flexible catheter at the end. Most doctors will only transfer three to four 2-day old embryos or two 5-day embryos. Bed rest of anywhere from 2 hours to 3 days is usually required immediately following embryo transfer. Usually during this time, hormone levels are checked several times to ensure that the proper levels are being maintained to ensure the pregnancy continues. Once the placenta starts taking over the hormone production, the Surrogate is weaned off the hormone replacements. This explains why 2 cells are often biopsied rather than one and why in the hands of the inexperienced, there is a greater potential to traumatize surrounding blastomeres and compromise the embryo. Humans have an inordinately high incidence of egg aneuploidy which occurs primarily during meiosis which takes place in the hours leading up to ovulation or egg retrieval. In addition we have observed that the complexity of the oocyte aneuploidy increases (involving a greater number of chromosome pairs. Taking embryos to the blastocyst stage automatically culls out many severely aneuploid embryos in the process. Because of the inevitability of an age-related increase in the incidence of egg aneuploidy, women with advancing age beyond 39Y are far less likely to have multiple pregnancies and the likelihood of high order multiple pregnancy (triplets or greater) is negligible beyond the age of 40Y regardless of the number of (unselected) embryos transferred. It is a fact that the full karyotyping of a single day 3 blastomere will not completely exclude the possibility of aneuploidy in the other blastomeres of that embryo. So, a single mitotically aneuploid cell might in fact be a “loner” with the remaining cells being euploid. Mosaicism commonly arises in blastocysts and in further advanced healthy concepti. In such cases it affects a small percentage of the total number of cells and the aneuploidy usually proves to be harmless. Perhaps such mitotically aneuploid cells (“overwhelmed” by the majority of its euploid neighbor cells) undergo accelerated death (apoptosis) and are so kept in check. What is true and indeed relevant is that the detection of a single euploid single cell in the 3 day embryo provides valuable and irrefutable evidence that: · the egg of origin was euploid · the fertilizing sperm was euploid and, · Fertilization took place in an orderly fashion. Against this background, it is important to understand that the diagnosis of “embryo competency based upon single cell (blastomere) full karyotyping. Furthermore, even if the embryo is fully euploid throughout uterine receptivity and technical prowess in performing the embryo transfer, can preclude a successful pregnancy. Cases where there are >5, 6-9 cell day 3 embryos (derived from egg providers <39Y) available. In selected cases of unexplained recurrent pregnancy loss; to differentiate between an implantation versus an embryo factor 4. For egg donation at a distance where the recipient prefers to limit the time away from home. During the consult we will address your personal needs and concerns regarding the surrogacy process. If you have a significant other, they will need to participate in the consultation. You will then fill out our Intended Parent Profile and review the Program Information. You will need to complete the Intended Parent Profile and email it back along with a picture of you and your spouse (if applicable). Before acceptance into our program, you will need to pass a state/federal criminal background check. Once you have been accepted into our program and you have chosen to retain Simple Surrogacy, you will need to sign our Retainer Agreement and pay the program fee for the program you wish to utilize.

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Finally she’ll give the child a letter and then says “now go and sit in that little area for five minutes” antiviral yiyecekler proven 500mg valacyclovir, ten minutes whatever stories about hiv infection purchase valacyclovir 1000mg fast delivery, “until you’re told to antiviral herbs valacyclovir 1000mg on-line go back to antiviral youwatch buy valacyclovir 1000mg mastercard class. The two stories above, from Mary and Ainsley, are taken from my research materials. This has involved individual research conversations, telephone research conversations, a focus group, small group discussions, home visits and young women’s diaries. The research locations I visited were varied and included areas in the North West of England, North Wales, London and South East England, West Yorkshire and the Borders of Scotland. Chapter One will outline explicitly the methods and research materials gathered, but for now I continue with a brief insight into Mary and Ainsley’s experiences. Mary is not the School Health Advisor for ‘Wendy Chicken Shop’ school (but coordinates the vaccinations across many schools in the North West of England) but despite this their accounts both describe similar processes of the vaccine’s administration. Both Mary and Ainsley also make reference to the questions that the nurses ask the young women prior to the vaccination. Whilst for Mary this is an ordinary part of the process and thereby given a cursory mention (excluding the question regarding pregnancy), Ainsley has provided a 1 As detailed in Chapter One, ‘Wendy Chicken Shop’ is the name given to the school by the young women 20 script of the interaction and describes her shock at being asked if she could be 2 pregnant. I am interested in these accounts as someone who has spent many years working with young women and girls in informal education settings, through my role as a professional youth and community worker. First I will introduce my research as an extension of my professional youth work experience in sexual health settings. I outline the ways in which I understand and will be approaching this category as part of my research. Finally, I provide an introduction to scholarship surrounding young women’s sexualities. Academic research as an extension of my youth and community work practice As both a feminist activist and a professional youth and community worker I was confident when I began the PhD research that the professional principles and values of social justice and anti-discriminatory practice would assist me in my academic researcher role (Bradford and Cullen, 2012; Sapin, 2009; Davies, 2010). This is based upon my previous experiences of having delivered several years of informal education in community settings with a commitment to liberatory education through various activity based work (Richardson and Wolfe, 2001; Batsleer, 2008; Bastleer & Davies, 2010; Sapin, 2009; Bradford and Cullen, 2010). Kate Sapin, the programme director of Community and Youth Work courses at the University of Manchester, defines the role of youth workers as follows: A youth worker’s role in addressing the purpose of youth work [] is to promote social, educational and political change at various levels. Youth workers provide information and other support to effect changes in attitudes and practice within young people, services, communities and society as a whole in order to enable young people to have a say in the issues that affect them. I am interested in four main concerns that were born out of the unease I felt before, during and since I started this research project. Are young women expected to behave in ways that are compliant, unproblematic, health seeking, future-orientated and as responsible for othersfi Each chapter will address these concerns by using relevant scholarship and, primarily, empirical research materials. The term I use to gather these issues is that of ‘practices’ (in relation to identities, femininities, health activism, ‘difficult’/citizenship and everyday activism). The term resonates through my professional youth and community work; there are many books, articles and university modules that explore and teach ‘youth work practice’. I opt for the term ‘practices’ and utilise this throughout 3 the thesis when analysing the research materials. Other key terms I explore and use are in the thesis are: successful femininity (Holland, Ramazanoglu, Sharpe and Thomson, 2004), neoliberal post-feminism (Gill and Scharff, 2013; Penny, 2014; McRobbie, 2009), young sexualities (Robinson, 2012; Allen, 2007; Cacchioni, 2015; Holland et al. This has particularly been the case since the large-scale outsourcing and commissioning of local authority youth services to third sector providers. This can often lead to situations where professional youth and community workers are employed by organisations with a specific focus such as careers guidance, alcohol and drug misuse, or in my case, sexual health. Professional challenges arose when the agendas of the commissioners, Brook’s mission statements and the values and principles of professional youth and community work were at odds. I was often in a position where the delivery of my work was hindered or constrained by the narrow focus of the commissioner’s requests and the organisation’s eagerness to satisfy them. It is only through applying a feminist critique to the vaccine, as I had done with other such offerings. I am interested in the ways that young women may or may not question, critique or comply with the programme. My project is part of a wider research project into four pharmaceutical drugs funded by the European Research Council, grant agreement no 263657. From ‘A Woman’s Disease’ to Human Papillomavirus (and its vaccine) Vaccinations have been likened to the introduction of clean and sanitary water in terms of their population-level impact on improving the health of individuals (Sarraci, 2010). However, vaccinating entire populations is deemed to be necessary in order to build herd immunity: Whereby the chain of transmission of an infectious disease like measles is interrupted, bringing down to almost nil (or nil) the risk for the totality of the population. Between the ages of two months and four years a child’s parents will be encouraged to accept 12 26 vaccinations for them, with other vaccinations being offered to children deemed to be at a higher risk of infection or exposure to, for example hepatitis B and tuberculosis. This would be undertaken so to evidence that the drug on trial is better than a placebo drug. This was set against a backdrop of controversies and competing agendas from policy-makers, pharmaceutical companies, parents and abstinence groups to name but a few (Wailoo et al. The vaccination administered between 2009 and 2014 comprised three separate doses via intramuscular upper arm injections. I think that was the, one of the reasons why we were able to do the catch up programme to the age of eighteen, so it was a mathematical thing. This, once again, provides fruitful grounds for feminist critiques of the vaccine and the programme. What information do women now receive in relation to the health interventions available to themfi In her 2011 book A Woman’s Disease: the history of cervical cancer Ilana Lowy provides an account of the developing medical descriptions of cervical cancer starting from the nineteenth and into the twentieth and twenty-first centuries. These medical descriptions have seen great variance – in the 1970s cervical cancer had been linked with the Human Papillomavirus – and have often reflected changing social attitudes. Despite the term cervical cancer not being used at this time, descriptions of Lovelace’s symptoms and disease are now thought to be cancer of the uterine cervix, or cervical cancer. The physicians of the mid-nineteenth century, who diagnosed and treated Lovelace, disagreed amongst themselves and withheld information regarding the severity of her condition from her, instead choosing to inform her husband of her disease. This example serves to highlight the dominant historical account of medical attitudes towards cervical disease. The secrecy practiced by medical professionals was cemented through their position as experts and intellectuals. Furthermore, I explore more specifically how the programme has been promoted with minimal information, exclusion of full information about risks, 30 the use of fear, and through obscuring the implications of the programme for young women’s sexualities. Therefore incidence rates are reported as being highest in lower-income and less developed countries such as “Latin America and the Caribbean, sub-Saharan Africa, Melanesia, and south-central and South-Eastern Asia” (2009: 199). My starting point is my interest and experience in sexual health and 32 young sexualities, along with the range of disciplinary fields including health studies, youth studies and sexualities studies that prove to be useful in my research. The intersection of these disciplines provides useful inclusions to my thesis as a whole, and my research can make for interesting and insightful contributions to these fields. In Chapter Three I explore whether the success of the vaccination programme and practicing successful femininity rely upon each other; is this relationship intimately connectedfi And as such, I use the term ‘successful femininity’ and detail this scholarship in Chapter Two and Three. Initially it was Mary who gave me this leaflet but I came to receive it many times at different stages during the research as it is ubiquitous within the programme. It is given to young women through schools and is also made available through youth projects and sexual health services. Utilising the flower symbols above the ‘i’ letters in the ‘arm against cervical cancer’ copies a style of handwriting common amongst young women whereby they replace the dot of the ‘i’ with lovehearts, flowers or stars. Pink and purple are used which are colours commonly perceived to be, and often are, favoured by girls and women and are seen to be warm, soft and caring colours. She is endorsing the vaccination through the assertion that the “jab” was “no probs”. This is followed by the assertion of the vaccine as being “for their own good” (Ehrenreich and English, 2005) through the statement that, collectively, young women and the nurses who administer the vaccine will be “beating cervical cancer”. Indeed, it celebrates the vaccine as not only fighting ‘cervical cancer’ but as beating it. If you are shocked by this failure, voice 34 your outrage to the Department of Health. However they go on to challenge the decision by stating “Brook believes that the choice of vaccine for the programme should be reconsidered” (2010: 1). During my time working to deliver sexual health education for Brook (in the late 2000s and early 2010s) young people often discussed receiving information about personal and social relationships and sex education that is too biological in nature (see also Ingham, 2005) and focussed upon negative consequences in relation to broader themes of sexual health and relationships.

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References:

  • https://oncolife.com.ua/doc/nccn/Cervical_Cancer.pdf
  • https://www.aapm.org/pubs/reports/rpt_104.pdf
  • https://canceradvocacy.org/wp-content/uploads/2014/10/Ubel-Abernethy-and-Zafar-Full-Disclosure.pdf
  • http://meak.org/science/Jennifer-Lynn-Gars/buy-online-eriacta-cheap-no-rx/