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Contraceptive methods have been there for thousands of years but in the last fifty years the methods of contraception have increased tremendously. Different contraceptions work in different ways. There are hormonal methods like the pill, barrier method like the cervical cap, Intrauterine devices and sterilization. There is also the emergency pill. Most contraceptives work in different ways such as preventing release of the egg, blocking the sperm from reaching the egg , blocking the functioning of the reproductive organs or ensuring the fertilized egg from implantation (Committee on Contraceptive Development 134). A fertile woman who is sexually active has many options to family planning but should bear in mind that no method is 100% effective against sexually transmitted diseases except abstinence from sex.
There are two types of hormonal contraception.
The differences involve the type of hormone contained, the amount of hormone that is used and how that hormone is administered in the woman’s body. The hormone of use is usually progesterone or estrogen and can be taken orally, injected into the skin, implanted in the body, absorbed from a patch or placed in the vagina (Darney 68). How the hormone is delivered determines how effective it is and if the exposure is continuous or not.
All the hormonal methods are very effective and reversible but do not protect against sexually transmitted diseases. The pill is made from synthetic hormones and is one of the most effective barrier methods. It comes in two forms one is the combined form which contains estrogen and progestin, it works by preventing the ovaries from reaching maturity interfering with ovulation. When there is no ovulation there is no egg to be fertilsed. The pill is packed in small caps of either 21 days or 28 days.
The second type is the mini pill; it has only one hormone progestin which works by thickening the cervical mucus preventing the sperm from going through the cervix. It also makes the uterine lining less receptive to an egg that has been fertilized and has to be taken every day. The pill cannot protect against sexually transmitted diseases. The pill needs discipline when taking it for it to be effective (Mastroianni 98).
The mini pill is recommended for women who need to avoid estrogen due to medical reasons such as liver disease and some types of blood clots in the veins. It is also best for nursing mothers since it has no effects on breastfeeding. The pill may lose its effectiveness when taken with drugs like tetracycline. It might also lessen its effects when a woman vomits or diarrhea. Symptoms such as spotting or vaginal bleeding, tender breasts or nausea can be expected within the first three months after use.
Studies show there is no significant weight gain while on the pill contrary to popular belief. Mood swings, pigmented skin, melasma may occur with contraceptives. There is also possibility of amenorrhea which is rare. Using the hormonal pill does not increase possibility of birth defects in babies though a nursing mother should not use combination contraceptives because it can limit the milk and proteins in the milk and the hormone also gets into the breastmilk. Female smokers using pill risk getting a stroke or a heart disease contrary to non smoking females on the pill.
Blood clots are frequent with low dose oral pills but at a low risk as compared to pregnant women. The pill is not for women with clotting tendencies. Female smokers over 35 years should not be using contraceptives. When a woman experiences cramps in the legs, blurred vision or loss and flashing lights, shortness of breath, pain in the abdomen, coughing blood or swelling in the leg, they should contact a doctor immediately (Darney 123). The benefits of taking the pill apart from being highly effective is that it can influence regular menstruation, it can reduce the menstrual flow and cramps.
Researchers have evidence that the pill might protect against pelvic inflammatory disease (PID) and anemia. Combination pill can reduce t acne, cysts in breast and ovaries and ectopic pregnancy, uterine and ovarian cyst. Women on the pill are unlikely to develop rheumatoid arthritis and osteoporosis (Committee on Contraceptive Development 102). The patch is worn on the skin on the low part of the abdomen, buttocks or upper part of the body except the breast. It releases estrogen to the blood. One patch can be used for a week and is not worn during menstruation.
The vaginal ring also releases progestin and estrogen and is worn for about three weeks inside the vagina. It is also taken out during menstruation and a new ring inserted. Emergency contraception is not like the other methods of birth control. It is used after sex if the chosen birth control method fails like a condom burst. The implant also offers a long term protection against and can stay for up to three years and offers no protection from STI’s. It also contains progestin which is released daily and has same effects as the pill. A nurse or a doctor inserts it in the arm and is more effective than the pill due to lack of human error.
Those opposing hormonal contraceptive use usually argue that is not right, is anti life and not natural. They also say it is the same as abortion and separates sex from its intended purpose of reproduction. This is a problem for Muslims and Christians who believe life starts at contraception. They also argue that hormonal contraception has consequences such as health risk because of the side effects it carries and it also raises many questions among the medical fraternity of how it really works because it allows conception to take place and then makes the uterus a hostile place. Hormonal contraceptives do not prevent sexually transmitted diseases and allows people to have multiple sex partners and also unlike barrier methods offers no protection against these diseases (Darney 67).
They say it gives rise to a dangerous contraceptive culture. Those opposing contraception argue that it is against humanity because potential humans are not born and can be used as eugenic. Sometimes types of hormonal contraception are mistaken for population mass control for certain races. There are also beliefs that contraception leads to depopulation. Some form of contraception like pills are prone to human error and therefore might lack to fulfill the intended purpose of preventing pregnancy.
Contraception gives rise to a culture of sexual immorality because it makes it easier for unmarried people to have sex and not have children. It allows people to have sex purely for fun. This makes immoral behavior less risky and undermines public view on morality making it easy for people to cheat on their partners and in the process might weaken family ties.
Committee on Contraceptive Development. Developing New Contraceptives: Obstacles and Opportunities. New York: National Academies Press, 2000. Print.
Darney, Philip D. A Clinical Guide for Contraception. New York: Lippincott Williams & Wilkins, 2010. Print.
Mastroianni, Luigi. Developing New Contraceptives: Obstacles and Opportunities. New York: National Academies, 2000. Print.
1. Penta Stent
a. MRI Safety
In non-clinical testing, Penta Stent has shown to be MRI safe immediately after its implantation. The MRI test conditions, which have been used to evaluate this stent, are for magnetic field interactions and a static magnetic field strength of 3 Tesla that has a maximum of a spatial gradient of 3.3 tesla/meter magnetic field; that is related to the MRI heating. The maximum whole body averaged a specific absorption rate (SAR) of 2.0 W/Kg a period of 15 minutes of MR imaging.
However, even though a single stent is expected to produce a temperature increase of 0.6 degree Celsius while remaining intact within its position, the response of stents that are either overlapping or fractured is not yet known. Non- clinical testing have not been conducted to rule out any possibility of stent migration after being exposed to field strengths of more than three Tesla. Findings have also recently shown that the MR image quality will be part of it if the area of imaging is the same exact area (or if it is relatively close) to the position of the stent (Sasao, Hotta & Ogata, 2005).
b. Use for Implant
The Penta Stent is an implant designed to cure atherosclerosis (the hardening and narrowing of the coronary arteries over time) by improving the coronary luminal diameter. The stent particularly used for patients who are suffering from symptomatic ischemic heart disease due to the discrete de novo or the restenosis native coronary artery lesions that have a length of 25mm or less. In this case, the stent corrects vessel diameters that are within the range of 3.0mm and 4.0 mm.
The Penta Stent is also used to treat patients with symptomatic the ischemic heart condition that is brought about by lesions that have a length of 35mm or less in the saphenous vein bypass grafts. It should be in reference to vessel diameters that range from 3.0mm to 4.00 mm. The implant is also applicable to patients who are under treatment for abrupt or threatened abrupt closure in patients who have a failed interventional therapy in lesions that are 35mm or less. It is in reference to vessel diameters that range from 2.5mm to 4.00 mm.
It is used to reinstate coronary flow in patients who are ailing from acute myocardial infarction with the confirmation by an ST segment elevation or angiographic findings. As long as the patient is presented for treatment within 12hours of the symptom onset while having coronary artery lesions of a length of 35mm or less. It should be in reference to the vessel diameter range of 2.5mm to 4.0 mm (Abbott, 2007).
The Penta Stent implant comprise of a pre-mounted 316L stainless steel, which has the components of nickel, iron, chromium, molybdenum stent. It has two radiopaque markers that are located beneath the balloon. These markers fluoroscopically mark the working length of the balloon within which the stent is laced. Two proximal delivery system shaft markers are between 95cm and 105cm from the distal tip. They are to indicate the relative position of the delivery system towards the end of a femoral guide catheter or at the end of a brachial.
The Guidant Corporation manufactures Penta Stent (NYSE and PCX: GDT). Guidant is a world leader in the management of the coronary artery disease.
e. Wait Period
Penta stent is MRI safe to use immediately after its implementation. There is, therefore, no period necessitated to elapse for a patient to go through MR imaging.
2. Enterra 3116 Therapy System
a. MRI Safety
It is not safe to use MR imaging on a patient who has an implant of Enterra 3116 treatment system. The potential exposure to the electromagnetic fields produced by magnetic resonance imaging may result in a system failure or dislocation of the implanted device. Exposure to MRI may also cause induced voltages in the neurotransmitter or the lead. This induced voltage may result into uncomfortable jolting levels of stimulation on the patient. The magnetic and radio frequency fields produced by MRI also known to change the neurotransmitter settings of the Enterra 3116 therapy implant. As such, it may activate the device and injure the patient.
b. Use of the implant
The Enterra 3116 therapy system is a neuro-stimulation system used for the treatment of patients who have chronic drug refractory (intractable) nausea, vomiting and malnutrition that is secondary to the gastric paresis of diabetic or idiopathic etiology. The therapy uses mild electrical pulses gently to stimulate and ‘calm’ the stomach for patients aged 18- 70 years old. This electrically induced stimulation helps to control the symptoms associated with gastric paresis such as nausea and vomiting. This implant is however limited to the treatment of patients on which the conventional treatment regimens of drug therapy and diet have failed to control the symptoms of vomiting and nausea. Usually it is due to the possible risks that exist with the implantation of this device.
The Enterra therapy system uses a high frequency and low energy stimulation (HFS) neurotransmitter. The stimulus frequency that it yields is higher than the frequency of the intrinsic gastric wave that is slow at HFS 12 cycles per minute and a pulse of range of 33ms. The implant operates on a pulse generator that is battery powered. The generator is a Medtronic ITREL 3Model 7425 G and 3116 Neurostimulator; the implant is approximately 6cm long (2.5 inches) 5cm wide (2 inches) and 12 mm thick (0.5 inches). The stimulating electrodes are inserted at one centimeter from each other into the stomach wall. Theses leads or electrodes are secured with satures and small silicone discs, and the end of each lead is connected to the stimulator. Adjustments can be done on the electrical stimulation of the gastric tissues with an external programmer system by placing the programmer on the skin over the implanted pulse generator. The pulse generator is set to be on for a period of 0.1 seconds and then off again for a period of 5 seconds depending on how strong the stimulations should be in order to control the symptoms. The pulse generator has a life span of 5 to 10 years, where replacement is through another surgical procedure (Moga & Harstall, 2006).
Enterra Therapy 3116 is manufactured by Medtronic Inc. in Minneapolis, MN
e. Wait Period
The patient should not be subjected to MR imaging while still having an Enterra Therapy 3116 implanted in him.
Abbot Vascular (2007). Guidant Multi Link Penta Coronary Stent Systems Information for Prescribers. Retrieved on 16th September from: http://www.rad.pitt.edu/public/mrrc- docs/MULTI-LINK_PENTA_Coronary_Stent_System.pdf
Moga, C & Harstall, C (2006). Gastric Electrical Stimulation Enterra Therapy system for the treatment of Gastroparesis. Retrieved on 16th September from: http://www.ihe.ca/documents/HTA_Report_37.pdf
Sasao,H., Ogata,H & Hotta,D.(2005). Clinical and angiographic outcomes after multi-link PENTA stent implantation in Japanese patients with coronary artery disease. International Heart Journal. 46(6):997-1006.
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