How TikTok is being used to talk about abortion post-Roe: A content analysis of the most liked abortion TikToks.

OBJECTIVES: Access to information about abortion is essential for ensuring reproductive autonomy, particularly post-Roe. TikTok, a popular video-sharing application, may be a source of information about abortion, yet little is known about the tone and content of such videos. To fill this gap, we analyze the most liked abortion videos on TikTok three months following the U.S. Supreme Court decision Dobbs v. Jackson Women's Health Organization. STUDY DESIGN: We downloaded the top 200 most liked, publicly available TikTok videos when searching "abortion" on September 26, 2022 and recorded and summarized key video characteristics. We then qualitatively analyzed for content, tone, and common themes. RESULTS: The top 200 most liked TikTok videos collectively had approximately 164 million likes, nearly 10 million shares, and 4 million comments. Most videos expressed support for abortion and presented information that was political or personal in nature. Only two videos contained health information about obtaining or completing an abortion, and only five videos featured or were created by a medical provider. CONCLUSIONS: Findings reveal the far reach of TikTok, which underscores the importance of analyzing online sources of information about abortion. However, our mixed-methods analysis indicates that the most liked TikToks are a source of abortion news, political opinion, personal stories, and debate rather than a source of health information for abortion seekers. IMPLICATIONS: Our analysis finds that the top 200 most liked TikTok videos three months post-Dobbs are primarily political in nature. Relatively few videos provided practical information about accessing abortion care, presenting an opportunity for healthcare providers, public health advocates, and activists to improve access and awareness of new pathways to care. The most popular TikTok videos appear to disseminate news and political information rather than health information about abortion.

Experiences with misoprostol-only used for self-managed abortion and acquired from an online or retail pharmacy in the United States.

OBJECTIVES: This study aimed to understand individual experiences with medication abortion using misoprostol-only among people living in the United States. STUDY DESIGN: We conducted 31 semistructured anonymous in-depth interviews with individuals who used misoprostol-only for self-managed medication abortion. Participants were recruited from Aid Access, an online telemedicine organization that provided prescriptions for misoprostol to eligible people in all 50 states in May and June 2020 when a combined mifepristone and misoprostol regimen was unavailable. We coded transcripts with a flexible coding approach and focused on perceptions and experiences with use. RESULTS: Participants were knowledgeable about misoprostol. Previous abortion experiences shaped perceptions of misoprostol-only by allowing comparison to the mifepristone and misoprostol regimen. Most participants expressed an unwavering desire for an effective abortion method, regardless of the medications or regimen. Individual physical experiences with misoprostol, including bleeding, cramping, nausea, and diarrhea, varied in intensity and duration. Participants proactively managed symptoms with self-care strategies and drew extensively from their prior experiences with menstruation, miscarriage, abortion, and childbirth. Clear instructions and information on potential complications and what to expect throughout the abortion fostered a sense of preparedness, and personalized interactions with an online help desk brought comfort. CONCLUSIONS: Misoprostol offered an essential abortion method for study participants. This regimen was physically challenging for some, and there is potentially a greater need for communication and support for individuals using misoprostol-only regimens. Prior reproductive experiences informed participant's knowledge, preparedness, pain management, and ability to both recognize and manage potential complications. IMPLICATIONS: As restrictions on mifepristone continue, more people may use misoprostol-only regimens. All regimens can be supported with detailed instructions, clear expectations, information on signs of potential complications, and personalized support. To achieve reproductive autonomy, people must have access to a range of abortion care options that meet their needs.

Factors Associated With Knowledge and Experience of Self-managed Abortion Among Patients Seeking Care at 49 US Abortion Clinics.

Importance: Patients attending US abortion clinics may consider or try self-managing their abortion before coming to the clinic, yet little is known about the factors associated with self-management behavior. Objective: To examine the prevalence and factors associated with considering or attempting a self-managed abortion before attending a clinic. Design, Setting, and Participants: This survey study included patients obtaining an abortion at 49 independent, Planned Parenthood, and academic-affiliated clinics chosen to maximize diversity in geographic, state policy, and demographic context in 29 states between December 2018 and May 2020. Data were analyzed from December 2020 to July 2021. Exposures: Obtaining an abortion at a clinic. Main Outcomes and Measures: Knowledge of medications used to self-manage an abortion, having considered medication self-management before attending the clinic, having considered any method of self-management before attending the clinic, and having tried any method of self-management before attending the clinic. Results: The study included 19 830 patients, of which 99.6.% (17 823 patients) identified as female; 60.9% (11 834 patients) were aged 20 to 29 years; 29.6% (5824 patients) identified as Black, 19.3% (3799 patients) as Hispanic, and 36.0% (7095 patients) as non-Hispanic White; 44.1% (8252 patients) received social services; and 78.3% (15 197 patients) were 10 weeks pregnant or less. Approximately 1 in 3 (34%) knew about self-managed medication abortion, and among this subsample of 6750 patients, 1 in 6 (1079 patients [16.1%]) had considered using medications to self-manage before attending the clinic. Among the full sample, 1 in 8 (11.7%) considered self-managing using any method before clinic attendance, and among this subsample of 2328 patients, almost 1 in 3 (670 patients [28.8%]) attempted to do so. Preference for at-home abortion care was associated with considering medication self-management (odds ratio [OR], 3.52; 95% CI, 2.94-4.21), considering any method of self-management (OR, 2.80; 95% CI, 2.50-3.13), and attempting any method of self-management (OR, 1.37; 95% CI, 1.10-1.69). Experiencing clinic access barriers was also associated with considering medication self-management (OR, 1.98; 95% CI, 1.69-2.32) and considering any method of self-management (OR, 2.09; 95% CI, 1.89-2.32). Conclusions and Relevance: In this survey study, considering self-managed abortion was common before accessing in-clinic care, particularly among those on the margins of access or with a preference for at-home care. These findings suggest a need for expanded access to telemedicine and other decentralized abortion care models.

Safety and effectiveness of self-managed abortion using misoprostol alone acquired from an online telemedicine service in the United States.

OBJECTIVES: To evaluate self-reported outcomes and serious adverse events following self-managed medication abortion using misoprostol alone provided from an online service. STUDY DESIGN: We conducted a retrospective record review of self-managed abortion outcomes using misoprostol obtained from Aid Access, an online telemedicine organization serving United States (US) residents, between June 1, 2020, and June 30, 2020. The main outcomes were the proportion of people who reported ending their pregnancy without instrumentation intervention and the proportion who received treatment for serious adverse events. RESULTS: During the study period, 1016 people received prescriptions for misoprostol. We obtained follow-up information for 610 (60%) of whom 568 confirmed use of the medication and 42 confirmed non-use. When taking the medication, 96% were at or less than 10 weeks' gestation and 4% were more than 10 weeks. Overall, 88% (95% CI: 84.6-90.2) reported successfully ending their pregnancy without instrumentation intervention. Of the 568 who took the misoprostol, 12 (2%) reported experiencing one or more serious adverse events and 20 (4%) reported experiencing a symptom of a potential complication. CONCLUSIONS: Self-managed medication abortion using misoprostol provided by an online telemedicine service has a high rate of effectiveness and a low rate of serious adverse events. Outcomes compare favorably to other service delivery models using a similar regimen. As mifepristone continues to be over-regulated and the 2022 US Supreme Court ruling allows states to severely restrict access to in-clinic abortion care, this regimen is a promising option for self-managed abortion in the US.

U.S. Abortion Care Providers' Perspectives on Self-Managed Abortion.

State-level restrictions on abortion access may prompt greater numbers of people to self-manage their abortion. The few studies exploring perspectives of providers towards self-managed abortion are focused on physicians and advanced practice clinicians. Little is known about the wider spectrum of abortion care providers who encounter self-managed abortion in their clinic-based work. To gain a deeper understanding of this issue and inform future care delivery, we conducted in-depth interviews with 46 individuals working in a range of positions in 46 abortion clinics across 29 states. Our interpretative analysis resulted in themes shaped by beliefs about safety and autonomy, and a tension between the two: that self-managed abortion is too great a risk, that people are capable of self-managing an abortion, and that people have a right to a self-managed abortion. Our findings highlight the importance of increasing knowledge and clarifying values among all abortion care providers, including clinic staff.

Experiences seeking, sourcing, and using abortion pills at home in the United States through an online telemedicine service.

A growing number of people in the United States seek to self-manage their abortions by self-sourcing abortion medications online. Prior research focuses on people's motivations for seeking self-management of abortion and experiences trying to obtain medications. However, little is known about the experiences of people in the U.S. who actually complete a self-managed abortion using medications they self-sourced online. We conducted anonymous in-depth interviews with 80 individuals who sought abortion medications through Aid Access, the only online telemedicine service that provides abortion medications in all 50 U.S. states. Through grounded theory analysis we identified five key themes: 1) participants viewed Aid Access as a "godsend"; 2) Fears of scams, shipping delays, and surveillance made ordering pills online a "nerve-racking" experience; 3) a "personal touch" calmed fears and fostered trust in Aid Access; 4) participants were worried about the "what ifs" of the self-managed abortion experience; and 5) overall, participants felt that online telemedicine met their important needs. Our findings demonstrate that online telemedicine provided by Aid Access not only provided a critical service, but also offered care that participants deemed legitimate and trustworthy.

The economic context of pursuing online medication abortion in the United States.

Access to in-clinic abortion has become increasingly restricted in the U.S. and for many, the high cost of care is a significant barrier. However, little is known about how financial circumstances shape the alternate pathways to abortion care people seek when the clinic is out of reach. In a unique sample of people who used medication abortion pills from Aid Access, a non-profit telemedicine service, we examine the impact of economic circumstances on abortion care pathway decision-making and experiences seeking care. Between June and August 2019, we conducted 80 anonymous, semi-structured in-depth interviews with U.S. residents who self-managed their own abortions using medication abortion pills from Aid Access. Participants were asked about their experiences seeking abortion, and their motivations for using the service. We coded interviews using an iteratively developed coding guide and performed thematic analyses to identify key themes. The unaffordable cost of in-clinic abortion was a key reason why participants sought care using online telemedicine. Experiences of personal financial hardship exacerbated by restrictive policies impacted participants' ability to access the clinic. For participants with children, their financial decisions were further guided by the concerns of providing economic stability for their family. Although telemedicine was considered more affordable than in-clinic care, for some, the suggested donation of $90 still posed a financial burden and accessing pills at no cost or a reduced cost was necessary. The availability of affordable telemedicine and policy interventions addressing Medicaid and insurance coverage for abortion would democratize abortion access for populations with low incomes.

Improved Sentinel Method for Surveillance and Collection of Filth Fly Parasitoids.

Parasitoids are important natural enemies of house flies and other muscoid flies. The two most commonly used methods for collecting fly parasitoids from the field have distinct advantages and disadvantages. Collections of wild puparia depend on the ability to find puparia in sufficient numbers and are prone to localized distortions in relative species abundance because of the overrepresentation of samples from hot spots of fly larval activity. Placement and retrieval of sentinel puparia is convenient and allows consistent sampling over time but is strongly biased in favor of Muscidifurax spp. over Spalangia spp. An improved sentinel method is described that combines some of the advantages of these two methods. Fly medium containing larvae is placed in containers, topped with a screen mesh bag of puparia, and placed in vertebrate-proof wire cages. Cages are placed at sites of actual or potential fly breeding and retrieved 3-7 d later. The modified method collected species profiles that more closely resembled those of collections of wild puparia than those from sentinel pupal bags. A method is also described for isolating puparia individually in 96-well tissue culture plates for parasitoid emergence. Use of the plate method provided a substantial saving of time and labor over the use of individual gelatin capsules for pupal isolation. Puparia from the collections that were housed individually in the wells of tissue culture plates had a higher proportion of emerged Spalangia species than puparia that were held in groups.

Beauveria bassiana Culturing and Harvesting for Bioassays With House Flies.

The entomopathogenic fungus Beauveria bassiana (Balsamo) Vuillemin (Hypocreales: Cordycipitaceae) has been widely studied against a wide range of arthropod pests, including many of medical and veterinary importance. New investigators must sort through a wide array of published methods for the production, harvest, storage, and bioassay methods for this pathogen. Simplified methods for production of conidia using Sabouraud dextrose agar with yeast (SDYA) plates and two conidial harvesting methods are described. Dry harvesting yields conidia that are ready to incorporate into dusts and food baits, but the fungal product includes mycelial debris that can hamper quantification and introduces variable amounts of unwanted bulk. Wet harvesting with filtration produces a cleaner product that is immediately ready for testing in liquid formulations. Examples of bioassays with house flies are presented that include conidia applied topically to the dorsal thorax for dose-mortality assays and conidial suspensions applied to filter paper disks for concentration mortality assays.

Knowledge, interest, and motivations surrounding self-managed medication abortion among patients at three Texas clinics.

BACKGROUND: A rapid increase in restrictive abortion legislation in the United States has sparked renewed interest in self-managed abortion as a response to clinic access barriers. Yet little is known about knowledge of, interest in, and experiences of self-managed medication abortion among patients who obtain abortion care in a clinic. OBJECTIVES: We examined patients' knowledge of, interest in, and experience with self-managed medication abortion before presenting to the clinic. We characterized the clinic- and person-level factors associated with these measures. Finally, we examined the reasons why patients express an interest in or consider self-management before attending the clinic. MATERIALS AND METHODS: We surveyed 1502 abortion patients at 3 Texas clinics in McAllen, San Antonio, and Fort Worth. All individuals seeking abortion care who could complete the survey in English or Spanish were invited to participate in an anonymous survey conducted using iPads. The overall response rate was 90%. We examined the prevalence of 4 outcome variables, both overall and separately by site: (1) knowledge of self-managed medication abortion; (2) having considered self-managing using medications before attending the clinic; (3) interest in medication self-management as an alternative to accessing care at the clinic; and (4) having sought or tried any method of self-management before attending the clinic. We used binary logistic regression models to explore the clinic- and patient-level factors associated with these outcome variables. Finally, we analyzed the reasons reported by those who had considered medication self-management before attending the clinic, as well as the reasons reported by those who would be interested in medication self-management as an alternative to in-clinic care. RESULTS: Among all respondents, 30% knew about abortion medications available outside the clinic setting (37% in Fort Worth, 33% in McAllen, 19% in San Antonio, P < .001), and among those with prior knowledge, 28% had considered using this option before coming to the clinic (36% in McAllen, 25% in Fort Worth, 21% in San Antonio, P = .028). Among those without prior knowledge of self-management, 39% expressed interest in this option instead of coming to the clinic (54% in San Antonio, 30% in McAllen, 29% in Fort Worth, P < .001). Overall, 13% had sought out or tried any method of self-management before presenting to the clinic (16% in McAllen and 15% in Fort Worth vs 9% in San Antonio, P < .001). Experiencing barriers to clinic access was associated with having considered medication self-management (odds ratio, 2.2; 95% confidence interval, 1.7-3.0) and with seeking or trying any method of self-management before attending the clinic (odds ratio, 1.9; 95% confidence interval, 1.3-2.7). Difficulty affording the cost of in-clinic care was the most commonly cited reason for having considering medication self-management before attending the clinic. Reasons for interest in medication self-management as an alternative to clinic care included both access barriers and preferences for the privacy and comfort of home. CONCLUSION: Considering or attempting self-managed abortion may be part of the pathway to seeking in-clinic care, particularly among those experiencing access barriers. However, considerable interest in medication self-management as an alternative to the clinic also suggests a demand for more autonomous abortion care options.

Demand for Self-Managed Medication Abortion Through an Online Telemedicine Service in the United States.

Objectives. To examine demand for abortion medications through an online telemedicine service in the United States.Methods. We examined requests from US residents to the online telemedicine abortion service Women on Web (WoW) between October 15, 2017, and August 15, 2018. We calculated the population-adjusted rate of requests by state and examined the demographics, clinical characteristics, and motivations of those seeking services, comparing those in states with hostile versus supportive abortion policy climates.Results. Over 10 months, WoW received 6022 requests from US residents; 76% from hostile states. Mississippi had the highest rate of requests (24.9 per 100 000 women of reproductive age). In both hostile and supportive states, a majority (60%) reported a combination of barriers to clinic access and preferences for self-management. Cost was the most common barrier (71% in hostile states; 63% in supportive states; P < .001). Privacy was the most common preference (49% in both hostile and supportive states; P = .66).Conclusions. Demand for self-managed medication abortion through online telemedicine is prevalent in the United States. There is a public health justification to make these abortions as safe, effective, and supported as possible.

Abortion Need among U.S. Servicewomen: Evidence from an Internet Service.

INTRODUCTION: U.S. servicewomen have high rates of unintended pregnancy, but federal policy prohibits abortion provision at military treatment facilities and military insurance coverage of abortion, except in cases of rape, incest, or a life-endangering pregnancy. Such restrictions pose challenges to abortion access for servicemembers, particularly during deployment. We aimed to explore the experiences of U.S. servicewomen when accessing abortion during overseas tours and deployment. METHODS: We reviewed de-identified data from email inquiries and online consultation forms from U.S. servicewomen or military spouses seeking medication abortion from the telemedicine service Women on Web between January 2010 and December 2017. We used descriptive statistics and inductively coded textual responses to describe client characteristics, circumstances of pregnancy, reasons for abortion, and barriers to abortion care. RESULTS: Our sample included data for 323 individuals. Reasons for abortion related to military service included disruption of deployment, fear of military reprimand, and potential career impacts. Additionally, servicemembers faced barriers to abortion access related to overseas military deployment or tour, including a lack of legal abortion in-country, limited financial resources, language barriers, travel restrictions, and a lack of confidentiality. CONCLUSIONS: U.S. military servicewomen stationed in countries where safe, legal abortion is restricted or unavailable face deployment-related barriers to abortion care, which compound those barriers they may face regardless of deployment status. Removal of federal bans on the provision and coverage of abortion care and improved education about existing regulations could improve access to timely abortion care and in some cases allow servicewomen who wish to obtain abortion care to remain deployed.

Effect of Fluctuating High Temperatures on House Flies (Diptera: Muscidae) and Their Principal Parasitoids (Muscidifurax spp. and Spalangia spp. [Hymenoptera: Pteromalidae]) From the United States.

Colonies of house flies (Musca domestica L. [Diptera: Muscidae]) and four species of parasitoids (Muscidifurax raptor Girault and Sanders, Muscidifurax zaraptor Kogan and Legner, Spalangia cameroni Perkins and Spalangia endius Walker) were established by making collections from dairy farms near Bell, FL, Beatrice, NE, Minneapolis, MN, and San Jacinto, CA. Colonies were assessed for heat tolerance by comparing life history parameters at 25-27°C and fluctuating hot (26.7-41.7°C) temperatures. Muscidifurax raptor, S. cameroni, and S. endius produced 24-28% as many progeny under hot conditions as at 25°C. Colonies of M. zaraptor were more heat-tolerant and produced an average 46.9% as many progeny under the hot regime compared with moderate conditions. There was little evidence for higher heat tolerance in parasitoid populations from historically hot locations (CA desert and FL). Colonies of M. raptor and S. endius that had been in culture for 24 yr were the least heat-tolerant with regard to progeny production. House flies collected from the same locations varied little in longevity, fecundity, or egg-to-adult survival under either hot or moderate regimes. Flies reared under hot conditions laid about half as many eggs (89/female) and had about half the egg-adult survival rate (47.3%) under hot compared with moderate conditions, indicating that heat stress had less effect on flies than on all of the parasitoids except M. zaraptor. An attempt to select for heat tolerance in flies by subjecting them to incremental increases in rearing temperatures for 20 generations resulted in little change in tolerance among the selected flies.

Mortality Effects of Three Bacterial Pathogens and Beauveria bassiana When Topically Applied or Injected Into House Flies (Diptera: Muscidae).

The house fly, Musca domestica L., is a global pest of public health and agricultural importance. The efficacy of conventional management has been waning due to increasing insecticide resistance. A potential management tool is the entomopathogenic fungus, Beauveria bassiana Vuillemin (Hypocreales: Cordycipitaceae) (strain L90), although time-to-death is slower than desired by potential users. This research investigated the effectiveness of three gram-negative bacteria (Pseudomonas protegens Ramette (Psuedomonadales: Pseudomonadaceae) pf-5, Photorhabdus temperata Fischer-Le Saux (Enterobacteriales: Enterobacteriaceae) NC19, and Serratia marcescens Bizio (Enterobacteriales: Enterobacteriaceae) DB11) on house fly mortality when topically applied, compared to B. bassiana. Each pathogen's virulence was measured by injection into adult female house flies or by topical applications to their thorax. All bacterial strains were highly virulent after injection with 1 × 104 colony forming units (cfu), causing fly mortality within 24 h. Beauveria bassiana resulted in high mortality, 3 d postinjection at the high dose of 1 × 104 conidia/µl. Mortality due to topical treatments of P. temperata and S. marcescens was low even at the highest dose of 1 × 106 cfu/µl. Mortality after topical treatments with P. protegens was evident 4 d after application of 1 × 106 cfu/µl. Mortality from B. bassiana was low at 4 d but increased at 5 d. These results imply that P. protegens holds great potential as a biological control agent for incorporation into an integrated pest management program against adult house flies.

Experiences of women in Ireland who accessed abortion by travelling abroad or by using abortion medication at home: a qualitative study.

BACKGROUND: The Republic of Ireland has one of the world's most restrictive abortion laws, allowing abortion only to preserve a pregnant woman's life. We examined the impact of the law on women's options for accessing abortion, their decision-making regarding whichpathway to follow, and their experiences with their chosen approach. METHODS: We conducted semi-structured in-depth interviews with 38 women who had either travelled abroad to access abortion in a clinic or had self-managed a medical abortion at home using online telemedicine, between 2010 and 2017. We coded interview transcripts according to an iteratively developed coding guide and performed a thematic analysis to identify key themes. RESULTS: We identified four key themes: (1) self-managing a medical abortion at home using online telemedicine can be a preference over travelling abroad to access abortion services; (2) regardless of the pathway chosen, women experience a lack of pre- and post-abortion support in the Irish healthcare system; (3) feelings of desperation while searching for safe abortion care can lead to considering or attempting dangerous methods; and (4) Irish abortion law and attitudes have impacts beyond physical health considerations, engendering shame and stigma. CONCLUSIONS: Despite the country's restrictive abortion law, women in Ireland do obtain abortions, using methods that are legal and safe elsewhere. However, the law negatively impacts women's ability to discuss their options with their healthcare professionals and to seek follow-up care, and can have serious implications for their physical and emotional health. This study's findings provide evidence to inform public and policy discourse on Ireland's abortion laws.

Motivations and Experiences of People Seeking Medication Abortion Online in the United States.

CONTEXT: State legislation restricting access to abortion in the clinic setting raises the possibility that an increasing number of individuals in the United States will self-manage their abortion at home. Medications sourced online represent a potential pathway to abortion self-management. Yet, very little is known about the reasons U.S. residents may seek abortion online or their experiences finding medications and information. METHODS: In January-June 2017, anonymous in-depth interviews were conducted with 32 people from 20 states who sought abortion medications online (30 women and two men seeking medications for their partners). Participants were asked about their (or their partners') motivations for considering self-managed abortion, the sources of medications they identified and any other methods they considered. Transcripts were coded and analyzed according to the principles of grounded theory. RESULTS: The analysis revealed four key themes: Seeking abortion medications online can be a response to clinic access barriers both in states with and in ones without restrictive abortion laws; self-managed abortion can be a preference over clinical care; online options offer either information or medications, but not both; and the lack of trusted online options can delay care and lead to consideration of ineffective or unsafe alternatives. CONCLUSION: Current online options for abortion medications leave many important needs unmet, particularly for women who encounter barriers to obtaining clinic-based abortion services. There is a public health justification to reduce clinic access barriers and to make medication abortion that is sourced online and managed at home as safe and supported as possible.

Mortality of the House Fly (Diptera: Muscidae) After Exposure to Combinations of Beauveria bassiana (Hypocreales: Clavicipitaceae) With the Polyol Sweeteners Erythritol and Xylitol.

Documented resistance to traditional insecticides in the house fly, Musca domestica L. (Diptera: Muscidae), has expedited a need for alternative forms of control. One such method is the use of biological control organisms, such as the entomopathogenic fungus, Beauveria bassiana (Balsamo - Crivelli) Vuillemin (Hypocreales: Clavicipitaceae). Administering B. bassiana with a calorically rich phagostimulant such as sucrose may have the unintended effect of increasing fly vitality and thus reproduction before mortality sets in. Therefore, finding a phagostimulant with lower caloric value that can replace sucrose is valuable. Here B. bassiana was combined with the sweeteners erythritol and xylitol as potential low-calorie substitutes for sucrose. Female flies consumed as much xylitol alone as they did sucrose alone, but less erythritol than both. After 24 h of exposure, B. bassiana administered at 1 mg in erythritol and in sucrose were equally effective at reducing survival and better than xylitol. B. bassiana administered at 10 mg worked equally well at reducing survival in all three sweeteners. When exposed to 10 mg of B. bassiana in sweetener for 1 h, sucrose reduced survival more than in erythritol or xylitol, but mortality was still in excess of 97% after 8 d in all three sweeteners. Each sweetener mixed with B. bassiana worked as well in an environment with additional food sources and stimuli as they did in an environment lacking these additions. Erythritol and xylitol appear to be strong candidates to replace sucrose in baits formulated around B. bassiana.

Feasibility of water purification technology in rural areas of developing countries.

Water scarcity is threatening social and economic growth in rural areas of developing countries. There are potential markets for water purification technologies in these regions. The main focus of this article is to evaluate the social, economic and political feasibilities of providing water purification technologies to rural areas of developing countries. The findings of this research can serve as the basis for private investors interested in entering this market. Four representative regions were selected for the study. Economic, demographic, and environmental variables of each region were collected and analyzed along with domestic markets and political information. Rural areas of the developing world are populated with poor people unable to fulfill the basic needs for clean water and sanitation. These people represent an important group of potential users. Due to economic, social, and political risks in these areas, it is difficult to build a strong case for any business or organization focusing on immediate returns on capital investment. A plausible business strategy would be to approach the water purification market as a corporate responsibility and social investing in the short term. This would allow an organization to be well positioned once the economic ability of individuals, governments, and donor agencies are better aligned.

Endoscopic study of mechanisms of failure of endotracheal tube advancement into the trachea during awake fiberoptic orotracheal intubation.

BACKGROUND: Advancing the endotracheal tube (ETT) over a flexible bronchoscope (FB) during awake fiberoptic orotracheal intubation is often impeded. The goal of this study was to identify the sites and mechanisms that inhibit the passing of the ETT into the trachea. METHODS: Forty-five consenting patients underwent a clinically indicated awake fiberoptic orotracheal intubation. After topical anesthesia, nerve block, or both, an awake fiberoptic orotracheal intubation was performed. The placement of the FB and advancement of the ETT over the FB were videotaped using a second nasally inserted FB. An otolaryngologist later reviewed the videotaped data. RESULTS: The right arytenoid or the interarytenoid soft tissues inhibited advancement of the ETT in 42 and 11% of all patients, respectively. In all cases in which the FB was located on the right side of the larynx, failure of ETT advancement almost always occurred at the right arytenoid. Withdrawing the ETT and rotating it 90 degrees counterclockwise resulted in successful intubation on the second, third, and fourth attempts in 26.6, 20, and 0.7% of patients, respectively. CONCLUSION: The right arytenoid frequently inhibits advancement of the ETT over the FB into the trachea during awake fiberoptic orotracheal intubation. The FB position in the larynx before tube advancement and the orientation of the ETT are relevant factors in failure of advancement of the ETT into the trachea. The authors recommend positioning the FB in the center of the larynx and orienting the bevel of the ETT to face posteriorly during the first attempt at intubation.