Unfulfilled Requests Research Articles

Comparative study of robust optimization model of multimaterial emergency logistics in an uncertain environment

AbstractGiven the significance of objective functions in alleviating human suffering within the humanitarian relief supply chain, it is imperative to consider both logistics costs and the cost of deprivation as ideal targets. This study investigates a multimaterial single‐cycle stochastic mixed integer model, integrating uncertainties about post‐disaster demand, supply survival, and road networks. An innovative heuristic approach is used to solve the stochastic facility location problem, which minimizes unfulfilled requests and response times in lexicographic order. This research also compares the cost‐minimization model of the pre‐positioning problem to an alternative model that maximizes demand satisfaction under resource constraints. Empirical validation through numerous case studies and solutions confirms the effectiveness and feasibility of the alternative model. The results of our experiments consistently demonstrate that the best solution provided by the alternative model not only satisfies the minimum cost model but also surpasses the conventional problem, without compromising performance. Consequently, it is crucial to avoid the cost‐minimization approach at the expense of human suffering.

Unfulfilled Requests for Postpartum Tubal Ligation at a Southern Tertiary Care Center.

BACKGROUND Nationally, multiple barriers lead only 50% of women who request postpartum tubal ligation to receive it prior to discharge. We aimed to identify characteristics associated with unfulfilled requests for postpartum tubal ligation at a tertiary medical center in the South.METHODS We conducted a retrospective chart review of all women delivering a live infant with a documented desire for postpartum sterilization between September 1, 2018, and November 30, 2018. The primary outcome was receipt of postpartum sterilization prior to discharge. We used chi-square and Mann Whitney U tests for descriptive analyses.RESULTS One thousand seventy-two women delivered a live infant at our institution during our sampling frame. One hundred twenty-four had a documented desire for postpartum sterilization (124/1072, 12%). Eighty-one women (81/124, 65%) received their postpartum sterilization and 43 women (43/124, 35%) did not. Women who delivered by cesarean were more likely to receive their postpartum sterilization (63/68; 93%) than if they delivered vaginally (18/56; 32%) (P < .001). Lack of valid Medicaid consent (P = .006) was associated with unfulfilled requests for postpartum sterilization following vaginal delivery while BMI > 40 (P = .158) approached significance.LIMITATIONS Our sample is small and from a single institution. Additionally, the specific reason for tubal ligation nonfulfillment was often not documented.CONCLUSIONS In this Southern institution, women delivering vaginally, those without a valid Medicaid consent form, and women with BMI > 40 were less likely to receive desired postpartum sterilization. Multipronged process changes are needed to fulfill patients' sterilization requests.

Model Integer Linear Programming pada Optimisasi Distribusi Logistik di Daerah Bencana

Logistics distribution in disaster-affected areas includes the delivery of relief goods (food, medicine, and clothing) using three types of vehicles with different carrying capacities for each vehicle. In distributing relief goods, unfulfilled requests can occur in disaster-affected areas. This problem can be modeled in the form of integer linear programming because there is a variable that must be an integer value to minimize unfulfilled demand for all types of relief goods at each point of demand. The branch and bound method can solve this problem's integer linear programming model. The next model is simulated using the LINGO 11.0 programming language. The simulation results show that the system can be considered feasible to use. Thus, the vehicle allocation is also obtained in each period with distribution costs from the point of supply to the point of demand. This distribution process lasts for four periods by showing a change in the number of unfulfilled requests. In the last period, there was no more unfulfilled demand for aid to obtain optimal results.

Accessibility to postpartum tubal ligation after a vaginal delivery: When the Medicaid policy is not a limiting factor

To describe rates of postpartum sterilization and indications for unfulfilled requests when Medicaid policy is not a limiting factor. We conducted a single-institution, retrospective review. Women who requested postpartum tubal ligation after vaginal delivery from August 2015 to March 2019 were studied. Select demographic characteristics were compared between those who did and did not undergo the procedure. Reasons for why the procedure was cancelled, alternate contraceptive plans, and subsequent pregnancies were collected. Statistical analysis included the t test and chi-squared test, with p < 0.05 considered significant. A total of 4103 patients requested postpartum tubal ligation following vaginal delivery. About 3670 (89.4%) procedures were performed and 433 (10.6%) were canceled. Of the 433, 423 (98%) were not performed at patient request; 10 (2 %) were cancelled based on physician recommendation. Of these, 3 were due to significant maternal anemia in the setting of refusal of blood products, 1 due to anesthesia concerns, 1 for increased body mass index, and 1 due to delivery events. Alternative contraception methods were offered; 72 (28% of patients not receiving a tubal ligation) received Depo Provera prior to discharge. One-fourth (n=110, 25.4%) did not keep the postpartum follow-up appointment. 83 (19.2%) of the 433 patients had at least one subsequent pregnancy. Although over half expressed interest at the time of discharge in long-acting reversible contraceptives, only 20% obtained this method at the postpartum visit. Postpartum sterilization was predominantly achieved, among women whose requests were unfulfilled, the majority (98%) were at patient request with a minority by physician recommendation. When the availability of postpartum tubal ligation is independent of Medicaid reimbursement and the hospital system and providers are organized to support timely access to permanent postpartum contraception, the majority of tubal ligations requests can be fulfilled following vaginal delivery.

Postpartum permanent contraception: updates on policy and access.

To describe barriers to provision of postpartum permanent contraception at patient, hospital, and insurance levels. Permanent contraception remains the most commonly used form of contraception in the United States with the majority of procedures performed during birth-hospitalization. Many people live in regions with a high Catholic hospital market share where individual contraceptive plans may be refused based on religious doctrine. Obesity should not preclude an individual from receiving a postpartum tubal ligation as recent studies find that operative time is clinically similar with no increased risk of complications in obese compared with nonobese people. The largest barrier to provision of permanent contraception remains the federally mandated consent for sterilization for those with Medicaid insurance. State variation in enforcement of the Medicaid policy additionally contributes to unequal access and physician reimbursement. Although significant barriers exist in policy that will take time to improve, hospital-based interventions, such as listing postpartum tubal ligation as an 'urgent' procedure or scheduling interval laparoscopic salpingectomy prior to birth-hospitalization discharge can make a significant impact in actualization of desired permanent contraception for patients. Unfulfilled requests for permanent contraception result in higher rates of unintended pregnancies, loss of self-efficacy, and higher costs. Hospital and federal policy should protect vulnerable populations while not preventing provision of desired contraception.

Barriers and outcomes associated with unfulfilled requests for permanent contraception following vaginal delivery

ObjectivesTo identify barriers to postpartum permanent contraception procedures after vaginal delivery and to explore contraceptive and reproductive outcomes of women who experience unfulfilled requests. Study designWe performed a retrospective cohort study of women requesting postpartum permanent contraception after vaginal delivery from 7/1/11 to 6/30/14 at Strong Memorial Hospital in Rochester, NY. We ascertained patient characteristics and outcomes through electronic medical records and birth certificate data search. ResultsOf 189 women in our sample, 78 (41.3%) had a postpartum permanent contraception procedure. Factors associated with unfulfilled requests in adjusted analysis included BMI ≥40 (OR 3.71, 95% CI 1.46–9.48 compared to BMI <35), federal sterilization consent signed ≥36 weeks (OR 5.10, 95% CI 1.64–15.86 compared to <36 weeks) and delivery in the latter half of the week (Wednesday–Saturday) (OR 2.02, 95% CI 1.08–3.79). Documented reasons for unfulfilled permanent contraception requests included patient changing her mind related to procedural issues (21, 18.9%), invalid consent (20, 18.0%), maternal obesity (17, 15.3%), lack of operating room availability (14, 12.6%) and ambivalence about permanent contraception (5, 4.5%). Of 57 women who planned for interval permanent contraception and had institutional follow-up over the subsequent year, 14 (24.6%) had a procedure, 8 (14.0%) initiated long-acting reversible contraception, and 13 (22.8%) became pregnant. ConclusionsFewer than half of women obtained desired postpartum permanent contraception after vaginal delivery, with logistical issues and obesity being the most common reported barriers. Health care providers should advocate for access to postpartum permanent contraception, as well as discuss prenatally the individualized probability of nonfulfillment and importance of alternative contraceptive plans. ImplicationsLogistical barriers and inappropriate antenatal preparation contribute to the fact that over half of women do not obtain desired postpartum permanent contraception after vaginal delivery. To respect reproductive autonomy and improve care, clinicians and other health officials should eliminate barriers to immediate postpartum permanent contraception while increasing access to alternative options.

A Prospective Study on the Effects of Medicaid Regulation and Other Barriers to Obtaining Postpartum Sterilization.

This study aimed to assess unfulfilled sterilization requests, specifically regarding issues with the Medicaid consent for sterilization, and determine the proportion of women who subsequently received interval sterilization by 3 months postpartum. The authors conducted a prospective observational cohort study of women who gave birth over an 8-month period and requested immediate postpartum sterilization. Records of women with unfulfilled requests were reviewed up to 3 months postpartum to determine rates of postpartum follow-up and interval sterilization. Primary analysis examined unfulfilled sterilization requests associated with the Medicaid consent form and, secondarily, all other reasons for unfulfilled requests, as well as alternative contraceptive methods chosen. Of the 334 women who requested immediate postpartum sterilization, 173 (52%) received the requested sterilization and 161 (48%) did not. Among those whose request was unfulfilled, 91 (56.5%) still wanted the procedure, and of those women, more than two-thirds were unable to receive it because of Medicaid consent issues. Within this group, only 6 received interval sterilization by 3 months postpartum; more than one-third received a form of long-acting reversible contraception, and 24.6% did not receive postpartum care. A sizable proportion of women requesting postpartum sterilization have unfulfilled requests because of an issue with the Medicaid consent and also have a low likelihood of receiving interval sterilization by 3 months postpartum. The Medicaid consent may create barriers for women requesting postpartum sterilization, the vast majority of whom face subsequent barriers obtaining interval sterilization, thereby increasing the risk for unintended pregnancy in an at-risk population. This has important implications for reproductive justice efforts to protect vulnerable populations while minimizing barriers to desired care.

Optimal-Cost Scheduling of Electrical Vehicle Charging Under Uncertainty

Electric vehicle (EV) charging stations are increasingly set up to meet the recharge demand of EVs, and the stations equipped with local renewable energy generation need to optimize their charging. A basic challenge for the optimization stems from inherent uncertainties such as intermittent renewable generation that is hard to predict accurately. In this paper, we consider a charging station for EVs that have deadline constraints for their requests and aim to minimize its supply cost. We use Lyapunov optimization to minimize the time-average cost under unknown renewable supply, EV mobility, and grid electricity prices. We model the unfulfilled energy requests as a novel system of queues, based on whose evolution we define the Lyapunov drift and minimize it asymptotically. We prove that our algorithm achieves at most ${O({1}/{V})}$ more than the optimal cost, where the parameter ${V}$ trades off cost against unfulfilled requests by their deadlines, and its time complexity is linear in the number of EVs. Simulation results driven by real-world traces of wind power, EV mobility, and electricity prices show that, compared with a state-of-the-art scheduling algorithm, our algorithm reduces the respective charging costs by 12.48% and 51.98% for two scenarios.

A Prospective Study on the Effects of Medicaid Regulation and Other Barriers to Immediate Postpartum Sterilization [14F

INTRODUCTION: To assess the rate of and reasons for unfulfilled sterilization requests, specifically regarding issues with the Medicaid Consent for sterilization, and to determine the proportion of patients who subsequenstly receive interval sterilization by 3 months postpartum. METHODS: Prospective observational cohort study of women delivering over an 8 month period and requesting immediate postpartum sterilization. Records of women with unfulfilled requests were reviewed up to 3 months postpartum to determine rates of postpartum follow up and interval sterilization. Primary analysis examined unfulfilled sterilization requests associated with the Medicaid Consent form and secondarily all other reasons for unfulfilled requests and alternative contraceptive methods chosen. Bivariate analyses were performed to evaluate the relationship between unfulfilled sterilization and sociodemographic characteristics. RESULTS: 334 women delivered and requested immediate postpartum sterilization. 173 women (52%) received requested sterilization while 161 women (48%) did not. Medicaid Consent was the primary reason for unfulfilled request for 61 women (37.9%). Within this group, six women (9.8%) received interval sterilization by 3 months postpartum, while the remaining 90.2% were still awaiting interval sterilization (14.8%), had chosen an alternative contraceptive method (52.5%), or did not receive postpartum care (23.0%). Of the sociodemographic factors assessed, only advanced age was associated with increased sterilization (p=0.02). CONCLUSION: A sizable proportion of women requesting postpartum sterilization continue to have unfulfilled requests due to an issue with the Medicaid Consent and they have a low likelihood of receiving interval sterilization. This has important implications for ongoing reproductive justice efforts to protect vulnerable populations while minimizing barriers to desired sterilization.

When do women decide to undergo sterilization? A qualitative study to evaluate the utility of the federally mandated Medicaid waiting period

Objectives: We sought to compare the decision-making process between women with Medicaid and those with private insurance undergoing postpartum sterilization. To prevent involuntary sterilizations, regulations require that Medicaid-insured women wait 30 days between signing a consent form and undergoing this surgery. This waiting period has been associated with unfulfilled requests for postpartum sterilization procedures and, in turn, increased risk of unintended pregnancy. In light of this policy's potential benefits and harms, we explored how the waiting period affects women's decision making. Methods: We completed semistructured qualitative interviews with 25 women (15 with Medicaid insurance, 10 with private insurance) who underwent postpartum sterilization at an urban tertiary care hospital. We used an iterative consensus coding process with multiple coders to identify themes in the data. Results: Decision-making timeline, influences and process were similar between women insured through Medicaid and women with private insurance. Some women were certain of their desire for sterilization upon discovering their pregnancy, and nearly all had considered the option before their third trimester. All respondents, regardless of insurance type, received similar levels of counseling from a health care provider. Many participants recognized at least one potential benefit of the mandated 30-day waiting period; however, women who experienced this waiting period reported that they did not personally derive benefit from it. Conclusions: The mandated 30-day waiting period did not appear to dictate when women considered and finalized their decision to undergo sterilization. Women who experienced the waiting period did not cite personal benefits. The utility of the mandated waiting period should be further evaluated.

A Review on the Role of Media in Increasing Materialism among Children

This paper reviews the literature to investigate the role of media in increasing materialism among children. It also studies the consequence of rising materialism on the development of children. Due to their enhanced role in family purchase decisions marketers are making children sufferers of materialistic world. Marketers know that children easily get fascinated towards unrealistic belongings endorsed by their promotional offers and persuade their parents to purchase those belongings. However, the unfulfilled requests of children for materialistic things make them dissatisfied and unhappy, which later on cause conflicting situation in family. The exposure of children to media at small age also makes them susceptible towards external environment by generating materialism. This materialism is leading to excessive consumption and impulsive purchase by children. To deal with these issues, sufficient attention needs to be given by parents to divert child's attention from materialistic to the real world. Thus, the role of guidance provided by parents has been found very significant in mitigating the effect of materialism among children.

Understanding and Improving Piece-Related Algorithms in the BitTorrent Protocol

Piece-related algorithms, including piece revelation, selection, and queuing, play a crucial role in the BitTorrent (BT) protocol, because the BT system can be viewed as a market where peers trade their pieces with one another. During the piece exchanging, a peer selects some pieces revealed by neighbors, and queues them up for downloading. In this paper, we provide a deep understanding of these algorithms, and also propose some improvements to them. Previous study has shown that the piece revelation strategy is vulnerable to under-reporting. We provide a game-theoretic analysis for this selfish gaming, and propose a distributed credit method to prevent it. Existing piece selection strategies, though long believed to be good enough, may fail to balance piece supply and demand. We propose a unified strategy to shorten the download time of peers by applying utility theory. The design of the piece queuing algorithm has a conflict with that of piece selection strategy, because it is not possible to assume that the queued requests for a selected piece can always be available on multiple neighbors. We give a possible fix to address the conflict by allowing peers to dynamically manage their unfulfilled requests. To evaluate the performance of the proposed algorithms, we run several experiments in a live swarm. Our primary results show that they can achieve fast individual and system-wide download time.

Committee Opinion No. 530

Postpartum tubal sterilization is one of the safest and most effective methods of contraception. Women who desire this type of sterilization typically undergo thorough counseling and informed consent during prenatal care and reiterate their desire for postpartum sterilization at the time of their hospital admission. Not all women who desire postpartum sterilization actually undergo the surgical procedure, and women with unfulfilled requests for postpartum sterilization have a high rate of repeat pregnancy (approaching 50%) within the following year. Potentially correctable barriers to obtaining postpartum sterilization include patient and health care provider factors, as well as hospital and health care system issues. Given the consequences of a missed procedure and the limited time frame in which it may be performed, postpartum sterilization should be considered an urgent surgical procedure. In addition, women with government insurance face barriers to sterilization procedures based on cumbersome consent requirements. The differences in the requirements surrounding consent for sterilization procedures based on the type of insurance a patient has must be addressed in order to establish fair and equitable access to sterilization procedures for all women. Policies and procedures that remove barriers to and increase efficiency in performing postpartum sterilization could reduce cancellations of the procedure. Improving consistency in accomplishing desired postpartum sterilization is an important strategy to reduce high rates of unintended pregnancy in the United States.

Implementation of an Electronic Medical Information Request System for Field-Generated Information Inquiries

The use of computer-based information storage, tracking, and retrieval has become common across all health care practices. We describe the variables and key considerations that must be addressed to transition from a paper-based medical information request fulfillment system to an electronic capture and fulfillment process. We also address factors such as training and regulatory considerations as well as key metrics both before and after implementation of the electronic capture and fulfillment process. The application of the program described allows a medical information team to provide timely information to customers upon request while minimizing lost or unfulfilled requests. Such a program also improves the quality of the end product produced based on indirect measures.

The Optimal Resource Discovery and Allocation Algorithm for One hop Using Anonymous Arbitrary Topology

A distributed system consists of, possibly heterogeneous, computing nodes connected by communication network that do not share memory or clock. One of the main benefits of distributed systems is resource sharing which speeds up computation, enhances data availability and reliability. However resources must be discovered and allocated before they can be shared. Virtual caching is a new caching scheme which allows a host node to grant authority of caching pages in some fraction of its own cache to nearby nodes. However the virtual caching protocol doesn't mentions how a client node obtains virtual cache from remote host. To address this problem we formulate a resource discovery and allocation problem. We are focusing our attention on how to locate resources-surplus donor nodes and to determine how much of the request for resources of deficient nodes will be satisfied, efficiently in a connected network especially within a finite hop of the resource deficient node. We intend to minimize the amount of unfulfilled request of deficient nodes. Virtual cache allocation can be changed any time depending upon the requirement. Hence the proposed heuristics are efficient both in terms of time and amount of communication performed. We also estimate the quality of distribution achieved by comparing the distribution yielded by the heuristics and by the solution of ILP formulation of the problem. We propose and compare few heuristics for minimizing the amount of unfulfilled request for resources, of deficient nodes when nodes look for resources within finite hops. In this paper we are restricting ourselves to single hop only. For the bounded hops we restrict ourselves to the resource distribution within one hop. By using non-anonymous arbitrary topology with sequence number of request to resolve deadlocks and distributing resources over the original arbitrary network. Sequence number of the request is the unique ID of sender node. We proposed a heuristic to distribute resources over anonymous arbitrary topology by passing a token . The token is privilege to distribute the resources. Each resource surplus node is giving its extra nodes in such a way so that it itself doesn't becomes resource-deficient in the process. Load is not infinitely divisible. We are focusing our attention only to determine how much of the request of each resource deficient node will be satisfied.

Ansprüche an den Rollstuhlkomfort und -anpassungsprozess

BACKGROUND: Within the scope of an optimal device supply the right choice and adjustment of a wheelchair play a vital role in order to provide the user with long-lasting driving comfort and best possible mobility. In this context technical development, range of variety and adjustment as well as the wide range of offered wheelchairs are on the one hand appreciated but on the other hand adjustment deficiencies are pointed out and appropriate and justified improvements are demanded. OBJECTIVE: The objective of this survey was to determine the specific unfulfilled requests and requirements of the people concerned in regards to driving comfort and wheelchair adaptation. METHOD: A quantitative questionnaire analysis was employed. The sample comprised wheelchair users (n = 86), primary supporters (n = 35), carers/nurses (n = 24), therapists (n = 12), specialist trade (n = 21) and wheelchair manufacturers (n = 14). RESULTS: The survey showed that wheelchair users demand high ergonomic and flexibility standards of the system wheelchair and wheelchair comfort. The demands of the other occupational groups in regards to product profile did not differ much from those of wheelchair users. The analysis revealed remarkable results of specialist trade who assessed the user’s adaptation phase during wheelchair supply process as less important compared to the other groups. CONCLUSIONS: The specialist trade’s attitude towards customer focus is not congruent to the wheelchair user’s requests and requirements. There is need for appropriate intervention to improve the specialist trade’s customer focus.

A qualitative study of barriers to postpartum sterilization and women's attitudes toward unfulfilled sterilization requests

Background This longitudinal, qualitative study explores barriers to postpartum sterilization from the perspective of low-income minority women. We examine women's feelings and attitudes regarding a canceled or postponed procedure over time. Study Design We conducted structured, in-depth baseline interviews with 34 postpartum women with unfulfilled sterilization requests in a university hospital setting. Follow-up phone interviews were conducted at 6 weeks and 6 months postpartum. Results Reasons for unfulfilled sterilization requests included last-minute misgivings, maternal medical complications, lack of a valid Medicaid consent form, fear of the procedure and provider influence. Sense of autonomy regarding sterilization decision making and ability to obtain interval sterilization or initiate and/or successfully use reversible contraception influenced subsequent attitudes regarding an unfulfilled request. Conclusions Sterilization counseling should include comprehensive information regarding the surgical procedure and associated risks and the development of a backup contraceptive plan, with particular emphasis on increasing contraceptive self-efficacy and autonomy in sterilization decision making.

Patient trust in the physician: relationship to patient requests.

Patient trust is a key component of the patient-physician relationship. A previous qualitative study has suggested that a low level of trust is associated with unfulfilled requests. Our aim was to test the hypothesis that patients with a low level of trust will be more likely to report that requested or needed services were not provided during an office visit. An observational study was carried out of office visits by 732 patients of 45 physicians (16 family physicians, 18 general internists and 11 cardiologists), within two managed care settings. Participants were consecutive, English-speaking patients, age 18 and older who had a significant health concern. Visit questionnaires were completed by 68% of patients known to be eligible. Post-visit measures included services requested (information, examination, prescription, test or referral); services provided; and requested or needed services not provided during the visit. Measures at 2-week follow-up included patient satisfaction, intended adherence to advice, interval contacts with the health system and symptom improvement. After adjustment for patient and physician characteristics, patient trust in the physician was not associated with the likelihood that a service was requested or provided during the visit, with the exception that prescription of a new medication was more frequent among patients with higher trust. In contrast, patients with low trust prior to the visit consistently were more likely to report that a needed or requested service was not provided (P < 0.001 for all services). Patients with a low level of trust were less satisfied with their care (P < 0.001), were less likely to intend to follow the doctor's advice (P < 0.001) and were less likely to report symptom improvement at 2 weeks (P = 0.03). Patients with a lower level of trust in their physician are more likely to report that requested or needed services are not provided. Understanding this relationship may lead to better ways of responding to patient requests that preserve or enhance patient trust, leading to better outcomes.

Clinical Impact of Quality Assurance in an Organized Cervical Screening Program

To increase the efficiency of the population-based cervical screening program that has been in place in a small rural district of Sweden since 1971, the procedures for handling abnormal cytologic results were revised in 1991. This article compares the findings from the 5 years preceding institution of the new guidelines with those from the first 5-year period under the new procedures. A preliminary study had found that neglected low-grade positive smears, or unfulfilled requests for new smears, were seen 10 times more often in the clinical history of women with cancer than in healthy women. A history of an equivocal smear was seen in about 30 percent of both groups of women. In 1991, the referral protocols for colposcopy were revised to include women with positive cervical smears who had not been examined by colposcopy. The clinical history of each woman who had a cervical smear, with a focus on previous smears, cervical biopsies, and treatments, automatically accompanied each cytology report. Women with previously neglected low-grade positive smears were thus identified and referred for colposcopy. Women with invasive cervical cancer from 1987 to 1992 served as control subjects. The case histories of these women were compared with those of women with cancer diagnosed between 1992 and 1997. All records were reviewed for information about squamous or other epithelial histologic findings, previously treated cervical intraepithelial neoplasia, age at diagnosis, time since and age at last smear, neglected positive or equivocal smears, stage, and death within 18 months of diagnosis. There was a significant reduction, from 18 per 100,000 women screened to 11 per 100,000 women screened, in the incidence of invasive cancer with the introduction of monitoring of screening history (P = .014). The incidence of squamous cell cancer fell from 16.6 per 100,000 to 8.0 per 100,000 (P = .001). Because there were no neglected positive or equivocal smears in the second period, the number of women under age 50 diagnosed with squamous cell cancer decreased by more than one-third, from 38 in the first period to only 11 in the second period (P < .001). The decline among older women (more than 53 years of age) was less. In 1996, the screening age limit was increased from 50 to 59 years. Women who were presenting for their first-ever cervical smear or who had not had a cervical smear taken for at least 3 years had a significantly greater incidence of cancer in the first study period than in the second period (P = .037). Only 3 of the 33 cases of advanced or aggressive squamous cancers found in this study occurred in women who had ever been screened. In the first period, 18 of the 22 stage II to stage IV squamous cell cancers were in women who had no recent or previous smears. In the second period, all 11 women with squamous cell cancer were having a cervical smear for the first time ever. The incidence of adenocarcinoma did not change significantly in the two study periods. In this study of 123 women with cervical cancer, 20 adenocarcinomas were seen.

The Study of African Languages in the United Kingdom: Part II

The first part of this review covered the growth of African language studies in the United Kingdom from 1895 to 1970, by which time the Department of the Languages and Cultures of Africa at SOAS (Department of Africa) represented the largest group of African language specialists in the world.This expansion had been due in large part to the recommendations of the Scarbrough Commission in 1947, although that same commission was also responsible for the confinement of African language studies to a single British institution. The Scarbrough request for a regular review of Oriental and African studies has been disregarded by successive governments, and even the solitary Hayter review, undertaken in 1961 by the UGC, largely ignored the field of African language studies (apart from an unfulfilled request that they be pursued at Oxford as well as at SOAS).