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A Latvian designer named Kaspars Jursons is trying to help solve European water shortages by redesigning the men’s restroom. His new urinal design includes a tap and sink right over it.

“It’s not just a fancy piece of art,” he says. “The idea is about function and consumption. You are washing your hands in the sink on top of the urinal, and the same water that’s running is also used to flush. You don’t have to use water twice, like when you use the urinal and wash your hands in separate sink.”

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The Stand sink-urinal sells for about $590.

The design, called Stand, sells for about $590 per unit. They’re getting manufactured on a small production line and have already sold to buyers in Norway, Germany, Russia, Poland and Jursons’ home country, Latvia.

Several sink-urinals are currently installed in a concert venue in Riga, Latvia, where Jursons reports they have worked smoothly and saved thousands of liters of water.

The tap is hands-free and sensor-activated, and Jursons says having the sink right over the urinal gives it another feature: an in-your-face reminder to wash your hands.

When asked whether folks might find the sink and the urinal a little too close for comfort, Jursons says, “It is more suitable for hygiene than just a urinal and then guys who don’t wash [their] hands.”

Ladies, if you think your restrooms deserve new design concepts too, stay tuned. Jursons says his next concept is a sink-toilet combo that not only saves water, but saves a lot of bathroom space.


Texas just passed one of the strictest abortion laws in the country.

The state’s Senate adopted a bill close to midnight on Friday that bans abortions after 20 weeks and will force the closure of all but a handful of the clinics that perform them.

The law’s 20-week ban is based on the idea that a fetus feels pain after that time. That not only flies in the face of the Supreme Court’s landmark Roe v. Wade decision, which says abortions are permissible until a fetus is viable outside the womb, typically around 24 weeks, but it’s disputed by many doctors.

Sen. Wendy Davis and a bevy of protesters successfully filibustered the bill last month, but Republican Gov. Rick Perry called another special session so Republican lawmakers could vote on the bill again.

This time they won. And women’s rights organizations say there will be some dire consequences.

Perry and other Republicans have said the law is necessary to protect innocent lives. But organizations like Planned Parenthood counter the law will harm women. And not just women seeking abortions.

Low-income and minority women are disproportionately more likely to lack health insurance, and many rely on healthcare clinics that also perform abortions for things like STD testing and cancer screenings.

The problem is, with the bill’s requirements that abortion-performing clinics have admitting privileges at nearby hospitals and meet the same standards as surgical centers, many of those clinics will be forced to close.

Many simply cannot afford to make the changes, like widening hallways and setting up waiting rooms. While they could stop performing abortions to avoid the changes, Kathryn Hearns, a Planned Parenthood worker in Hidalgo County, told ABC News-Univision earlier this month that abortions are a vital part of what they offer.

She fears more women will go to Mexico for illegal and often unsafe abortions. Women in rural areas will be particularly disadvantaged, since the only clinics that currently meet the strict standards are in urban areas.

As Bloomberg News noted, some women who aren’t near an abortion clinic or are too poor to afford one already turn to black market abortion-inducing pills at flea markets. Opponents of the bill worry that number could now increase.

Republican Sen. Glenn Hegar, the bill’s author, said on the Senate floor Friday that it was not his intention for women to travel to Mexico or a flea market for an abortion.

“Any situation like that is deplorable and that is what we do not want to have,” he said. “This legislation is not doing that because they’re already doing that.”

Women’s rights organizations immediately decried the ruling and the way in which it was passed during a special session.

People entering the Capitol reported that state troopers stationed at the entrance confiscated tampons, maxi pads and other things that could be used as projectiles. Registered guns, on the other hand, were allowed.

Opponents have vowed to take the new law to court, where it may not stand up. Courts have already blocked restrictive laws in states like Georgia and Arizona. The ACLU and Planned Parenthood have challenged laws in others. But restrictive laws remain in place where they have not been challenged, often in direct contradiction to Roe v. Wade.

While Texas does skew more conservative than much of the nation when it comes to abortions, according to a University of Texas/Texas Tribune poll, just 38 percent of Texans want to make abortion laws stricter. But they also bristle at the idea of restricting abortion access severely.

“This will not prevent abortions,” wrote one woman on the comment section of the Texas Tribune’s livestream of the Senate’s debate, “it will only prevent safe abortions.”


Almost two years ago, pregnant with my daughter, I paid my first visit to the Cambridge Birth Center. Located inside an old Victorian house, the facility is hard to distinguish from a modestly appointed home, with blond wood floors and three spacious bedrooms, each attached to a bathroom with a large tub. If the interior is comforting, so is the view: the Cambridge Hospital, part of the same campus, is visible through most windows. Should you need to get there in a hurry, the trip would take about ten seconds.

Like most of my fellow patients, I chose the birth center because I wanted to avoid the high-tech approach typical of hospitals, but I didn’t feel entirely at ease with the idea of a home birth. The birth center hit the sweet spot. I loved the cozy environment designed expressly with birth in mind. I adored my unflappable midwife, Heidi, a genius at deflating anxieties. And when in labor, I benefited from the warmth and expertise of the midwife on call, Connie, who calmly coached me through delivery.

But I didn’t realize until later that there were other reasons to love birth centers—namely, hard economics. In light of this week’s big Times article on the staggering costs of maternity care in the United States, it’s time that birth centers receive the recognition they deserve as a viable alternative. A recent major study confirmed that for low-risk pregnancies, birth centers provide equally safe care for much lower costs than hospitals. Even the Affordable Care Act acknowledges their value; a little-noticed provision of the law mandates that Medicaid cover birth center services. Yet, thanks to a combination of unfriendly laws in some states, insurer resistance, and lack of public awareness, far too few American women have access to this form of excellent, cost-effective maternity care.

First, to clarify the terminology: a free-standing birth center is a homelike, midwife-led facility that offers prenatal care and delivery services and has emergency arrangements with a hospital. It can be located inside a hospital, but it must be separate from the acute obstetric care unit. (Some hospitals use the term “birth center” to describe conventional units, which has caused confusion.) Distance from the hospital varies. I must admit I would have felt much less comfortable with a more remote hospital. But in some rural areas, women live hours away from the nearest one, and it may be preferable to have a facility closer to their homes than to the hospital. All birth centers monitor patients throughout pregnancy to ensure that they are low-risk; if not, they are referred to hospitals.

According to the American Association of Birth Centers, the facilities operate according to the “wellness model” of pregnancy and birth, as opposed to the medical model that sometimes seems to treat these events like illnesses. As AABC executive director Kate Bauer told me, “In a hospital, all women are treated as if they are high-risk. In a birth center, every woman is seen as low-risk, unless her risk level is elevated…It’s appropriate use of resources.” You can’t get an epidural at a birth center. They rely on low-tech pain-management techniques such as warm baths and changing position, though some do offer conservative doses of Demerol and nitrous oxide.

That birth centers offer safe, economical care is not news. A landmark 1989 New England Journal of Medicine study reviewed records of 11,814 women at 84 birth centers and found that there were no maternal deaths, while the neonatal mortality rate was similar to that of low-risk hospital births. The rate of cesarean sections (which involved transfers to hospitals) was 4.4 percent. The article concluded, “Few innovations in health service promise lower cost, greater availability, and a high degree of satisfaction with a comparable degree of safety. The results of this study suggest that modern birth centers can identify women who are at low risk of obstetrical complications and can care for them in a way that provides these benefits.” (The authors emphasized that all of the birth centers in the study were accredited; the safety of unaccredited centers is uncertain.)

A new study published in January in the Journal of Midwifery & Women’s Health ratified those results. Because safety is such a concern, allow me to dwell again on the numbers. This study reviewed the records of 15,574 women at 79 birth centers from 2007 to 2010. Again there were no maternal deaths, and again the neonatal mortality was comparable to low-risk births in hospitals. Just 6 percent of the women ended up having cesareans at affiliated hospitals, compared with about 25 percent of low-risk women who started out at hospitals. (The total nationwide rate of cesareans in 2010 was 32.8 percent.) The study estimated that given the lower cost of the facilities, and the much less frequent interventions, these birth-center deliveries saved approximately $30 million.

Despite these positive outcomes, only a tiny minority of women (.3 percent in 2010, according to the CDC) give birth in such centers. The AABC estimates that if just 10 percent of the 4 million women who give birth annually did so in birth centers, the savings would come to at least $2.6 billion. The provision in the Affordable Care Act—stipulating that Medicaid programs reimburse birth centers—was included because it was projected to save money.

By some indications, trends are favoring birth centers. According to the AABC, their numbers have grown from 170 in 2004 to 251 today. Forty-one states license birth centers, the American Public Health Association has issued guidelines for licensure, an entity called the Commission for the Accreditation of Birth Centers does what its name suggests, and the AABC also has standards for members. All of this constitutes what the recent journal article calls an “infrastructure of standards, accreditation, and licensure” that contributes to the safety and reliability of accredited centers.

Historically, tensions have simmered between the midwife community and ob-gyns, but even the American College of Obstetricians and Gynecologists has endorsed birth centers—albeit in a somewhat roundabout manner. In a 2008 statement reiterating their strong opposition to home births, ACOG asserted that delivery “in a hospital or accredited birthing center is essential” (emphasis mine).

Birth center advocates were also thrilled by the Medicaid provision in the health care reform law, sponsored by Senator Barbara Boxer: not only should it mean expanded birth center coverage for low-income women, but private insurance often takes its cues from the federal programs, so a ripple effect is conceivable. Now, despite the potential savings, private insurance often resists covering birth centers. (I was fortunate on this front: my total out-of-pocket expenditure was a $15 co-payment for my first prenatal appointment.)

But amid this progress, serious gaps remain. Nine states do not license birth centers, and the Medicaid provision applies only to those who do. The AABC claims, too, that some states have not properly implemented this part of the law. State laws vary widely, with some much more hospitable to birth centers than others. These differences don’t always break down according to familiar patterns: In Texas, for instance, birth centers flourish, while Maine does not license them.

As a result, many women who would prefer birth centers don’t have the option—and many of these end up having c-sections and other interventions in hospitals. I blame not greed or evil but the so-called law of the instrument: the tendency to rely on the tools you have. The debate about childbirth is particularly polarized—with some convinced that pregnancy should not be treated as a medical condition—but not unique. Take mental health. If you suffer from anxiety and you go to a psychiatrist, you will likely leave with a prescription in hand. Some people know they want Zoloft, but others would like to try a less medical approach first.

A final obstacle for birth centers in reaching their full potential is cultural. The majority of women seem to think that birth centers are a risky option for a hippie fringe, one step removed from giving birth in a field under a full moon, orgasmically. Granted, birth centers will never be right for everyone. I know women who don’t see the point of trying to give birth without an epidural. (As writer Anne Lamott memorably put it: “I have girlfriends who had their babies through natural childbirth—no drugs, no spinal, no nothing—and they secretly think they had a more honest birth experience, but I think the epidural is right up there with the most important breakthroughs in the West, like the Salk polio vaccine and salad bars in supermarkets.”) Then there are women who wouldn’t consider leaving the privacy and comfort of their own home to have a baby. But there’s a good-sized contingent that wants to try for a low-tech birth in a relaxed setting that’s been proven safe. Birth centers are more likely to provide this experience than hospitals are. They should be seen not as sites for New-Age-y, hazardous adventures, but as places that offer mainstream, high-quality maternity care.

One last advantage of birth centers: the parties. The Cambridge Birth Center has thrown two afternoon shindigs for families since my daughter was born last July. She got to meet the midwife who listened to her heartbeat in utero, and the one who delivered her, as well as other kids who were born there. And I got to return again to the place I’d visited so frequently, this time eating chips and salsa.

From Rebecca Tuhus-Dubrow


Dr Kermit Gosnell began as a pillar of his community. Now, he’s a national disgrace. For years, officials knew of problems at his clinic but did nothing about them. Some say a new law passed in response to the scandal is putting patients at further risk.

Dr Kermit Gosnell is no longer a danger to others. He spends his days writing poetry, learning Spanish and jogging on the spot. At 72, he keeps active. But he’s disappointed. He really thought he could beat the murder charges.

“He still believes, despite what the jury found, that he never killed a live baby,” says his lawyer, Jack McMahon.

Gosnell performed some 16,000 abortions over 31 years at his clinic in west Philadelphia – a poor neighbourhood in one of the poorest big cities in the United States.

According to those responsible for regulating abortion clinics, his practice was fine. But they hadn’t checked. Or listened to complaints from doctors and other professionals. Or done anything after two women died from treatment there.

Gosnell was only stopped in 2010, when police executing a drug warrant entered the clinic and found feet in jars, bones in drains and foetuses stored in freezers above refrigerators that held workers’ lunches.

The gruesome details – including the dangerous, even lethal practice of using untrained staff to sedate women – are catalogued in the grand jury report. Last month a judge sentenced Gosnell to three consecutive life sentences for killing three newborns by snipping their spinal cords at the neck.

“Children were being born alive… they breathed and moved, they cried, and he severed their spinal cords and murdered them”

Seth Williams

District Attorney Seth Williams

Jack McMahon says in 35 years as an attorney, he’s never seen such a backlash against a client, who was widely termed a “monster”. His own cousin told him, “I love you, but I hope you don’t win,” McMahon says.

That strength of feeling is now driving the debate about abortion in the United States.

Kermit Gosnell is the son of a prominent African-American family in west Philadelphia. He attended one of the city’s top high schools before going on to study medicine locally at Thomas Jefferson University.

“He was probably at that time the only African-American medical student there,” says Joe Slobodzian, who has covered Gosnell for the Philadelphia Inquirer. “And from every indication, he excelled.”

Kermit Gosnell's clinic, The Women's Medical Society
Several former clinic employees pleaded guilty to murder

In 1979, Gosnell opened the Women’s Medical Society in his old neighbourhood, at 3801 Lancaster Avenue. Pete Wilson, a local political activist with an office just up the road, says people used to look up to him.

“I guess he did the best he could for the community he lived in. Initially, he thought he was helping people, 13, 14, 15-year-old girls that had made mistakes, their parents bought them in.”

Wilson says the rooms inside were small and dimly lit. “It just didn’t seem like it was the kind of medical situation you would want to be in – not unless you were desperate. Because the abortions weren’t expensive. He was cheap. So that brought people who couldn’t afford to go anywhere but to him.”

It’s estimated Gosnell was making $1.8m (£1.1m) a year. He saved money by hiring unqualified staff. One “anaesthetist” had never finished high school.

District attorney Seth Williams ties Gosnell’s attitude to money directly to the murders. In a legal abortion, the foetus is injected with a lethal drug before the mother gives birth – but Gosnell didn’t do this.

“That takes money and it was cheaper for him to just induce labour and then murder the child,” Williams says.

Abortion has been legal in the United States since 1973. Each state sets limits on when abortions can be done, up to a national maximum of 24 weeks. The average pregnancy lasts 38 weeks. In Pennsylvania, where Gosnell practiced, the limit is 24 weeks.

“He was known in the community for doing abortions – didn’t matter what the gestation was,” says Pennsylvania State Representative Margo Davidson. Her cousin died following an abortion at Gosnell’s clinic in 2000. “You could get it done quickly, you could get it done cheaply, without any questions asked.”

Joe Slobodzian says Gosnell had gained a reputation as “the abortion doctor of last resort” across the east coast of the United States.

Now, his notoriety has spread nationwide. Pro-life organisations, which see any abortion as the murder of a child, have put great emphasis on the Gosnell case. One says it has put abortion itself on trial.

“There are a lot of people thinking very differently because of this case than they ever thought before,” says Dr Day Gardner, president of the National Black Pro-Life Union.

“There are many member of Congress who are saying, ‘We need to change the laws.’”

Shortly after that interview, members of Congress proved her right. They said “Gosnell” 63 times in a 60-minute debate last week, which ended in a vote to approve a Republican bill, H.R. 1797, that would ban abortions nationwide after 20 weeks.

Congresswoman Marsha Blackburn called it “an appropriate response to Kermit Gosnell’s house of horrors.” Opponents noted that murdering babies was already illegal – it’s just that in Gosnell’s case, no one was enforcing the law.

“It was a total failure of the governmental entities that have oversight over these facilities,” says District Attorney Seth Williams. He found that Gosnell’s clinic was last inspected in 1993.

“There was more inspection and oversight over public pools than over abortion clinics unfortunately in the commonwealth of Pennsylvania.”

Pennsylvania Governor Tom Corbett has said bureaucrats simply weren’t doing their jobs, and some have been fired. No-one from the health departments of the City of Philadelphia and the State of Pennsylvania would agree to be interviewed by the BBC. But a lawyer for the state Department of Health, Kenneth Brody, is quoted in a grand jury report into Gosnell, saying that a decision was taken to not regularly inspect clinics.

“There was a concern that if they did routine inspections, that they might find a lot of these facilities didn’t meet [the standards]… and then there would be less abortion facilities, less access to women having abortion”, he said.

The political reaction in Pennsylvania was swift.

A new law, Act 122, came into force last year and since then the State Department of Health has spent “1,500 man hours” inspecting abortion facilities, a spokeswoman told the BBC in an email.

“Our dedication to tougher oversight and ensuring full compliance with the law will continue far beyond Gosnell. We have a responsibility to create safer environments for women and to hold facilities accountable to higher standards and we will continue to fulfil that responsibility.”

This debate about standards is happening in many states, most notably in Texas – where pro-Life campaigners have branded one clinic providing abortions “another Gosnell”.

Wendy Davis
State senator Wendy Davis spoke for 10 hours to block a 20-week limit in Texas

But those who provide abortions say some of the higher standards have nothing to do with Gosnell, or even making women safer.

The Philadelphia Women’s Center is the city’s oldest abortion provider, part of the National Abortion Federation, an industry body which regularly inspects member clinics. (Gosnell’s clinic, of course, was not a member.) It’s always been clean and airy, says director Elizabeth Barnes, but recently installed a new heating and cooling system to comply with Act 122.

“We actually had to cut through the roof of our building, through the business of the floor above us and hire a crane to bring in the units which were brought in from the Midwest, because there was nowhere local that even made them,” Barnes says.

Her overall bill for complying with Act 122 is almost $500,000 (£326,000). Money wasted, she says, because it doesn’t make things safer “in any meaningful way”.

In fact, she says, by driving up the cost, Act 122 is putting clinics out of business and making it prohibitive for new ones to open.

“Gosnell was able to stay open because there was a need and no-one was filling it in his community,” she says. “And what we would hope for is that a good provider would rise in the place to fill the need. But if there is no way to make a facility financially viable, then facilities will not open.”

The result in that case, she says, will be “more Gosnells” – more unsafe abortions.

There were 24 abortion clinics in Pennsylvania before Act 122. Today, there are 19. Demand for abortion, based on calls to Philadelphia’s sexual health hotline, Choice, has not changed.

It’s hard to say what that means. It could mean existing clinics are picking up the slack. Women could be going to other states, or underground. Or it could mean there will be fewer abortions. Official figures for the number of abortions performed in 2012 won’t be published for months.

But State Representative Margo Davidson, who made an emotional appeal for Act 122 during a debate in the State legislature, telling the story of her 22-year-old cousin – who died “a gruelling and painful death” after an abortion at Gosnell’s clinic – says it’s crazy to think women today are less safe because of the new law.

“I was a poor black woman and I was a poor black girl, so if there was a need for an abortion even in my circle of friends, we came up with the money.

“As long as there are clinics that are providing safe services, poor women will find a way to terminate a pregnancy if they feel that they desperately need to do so.”

A cartoon showing pro-life and pro-choice campaigners nailing closed the door to Gosnell's clinic

It’s been three years since officers first raided Gosnell’s clinic. After his conviction in April, DA Seth Williams was given a framed cartoon, which he keeps on his desk.

“Why it’s funny is that both political extremes will argue that they were victorious with this conviction. I just try to continue to tell people that our investigation and our prosecution had nothing to do with the political or the moral decision of whether or not abortions are correct.

“Just that what he did was criminal. Children were being born alive, that they breathed and moved, they cried, and he severed their spinal cords and murdered them.”


Women doctors are piling a ‘tremendous burden’ on the NHS by working part-time, a female Conservative MP has said in comments supported by a health minister. Conservative MP Anne McIntosh told the House of Commons that the increased numbers of women GPs caused a strain on the NHS because they took time off to raise children.

The comments were supported by health minister Anna Soubry, who said the MP raised an important point about the ‘unintended consequences’ of more women training to be doctors.

In the debate on the NHS 111 phone line yesterday, Ms McIntosh said female medical students are likely to want to marry, start, families and then work part-time.

She said: ‘It’s a controversial thing to say, but perhaps I as a woman can say this – 70% of medical students currently are women and they are very well educated and very well qualified.

‘When they go into practice and then in the normal course of events will marry and have children, they often want to go part-time and it is obviously a tremendous burden training what effectively might be two GPs working part-time where they are ladies.’

Ms Soubry agreed and said: ‘Could I just say very quickly you make an important point when you talk about, rightly, the good number of women who are training to be doctors, but the unintended consequences.’

doctor-woman-wheelchair

The Government’s five-year mandate to Health Education England commits the body to ensure that half of of medical training places to go to GPs by 2018.

GPC member Dr Beth McCarron-Nash said: ‘This is a very outdated view of women in the modern workplace. Having a family or choosing to work flexibly should not be perceived as a negative career option, for women or men.

‘The NHS needs to adapt its workforce planning to reflect the changing working patterns in society.’

 


My husband, Bruce, was a Democratic member of the U.S. House of Representatives until October 10th, 2000 when he died of pleural mesothelioma––a rare disease caused by asbestos exposure. He was exposed during his work as a laborer, a job he took so he could put himself through college. While many only know of asbestos cancers like mesothelioma from late-night television commercials, there are a growing number of people experiencing the real fate this deadly disease carries.

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Mesothelioma is known as being a fast mover after diagnosis, taking most victims’ lives just four to eighteen months later. Asbestos victims rely on compensation from personal injury trusts through asbestos claims to cover their insurmountable medical expenses, but sadly many victims only receive a small percentage of what companies owe them. This places a huge burden on the victims and their families.

Recently, asbestos companies are using their political influence to push a new bill in Congress, led by the American Legislative Exchange Council (ALEC). It is called the “Furthering Asbestos Claim Transparency (FACT) Act.” In short, these companies want to use this bill as a means to delay medical payments, which results in most victims dying before they seek justice. The parties in support of this bill are hiding behind this notion of “transparency”, but the reality is this bill places burdensome reporting requirements on victims applying to the bankruptcy trusts. This requirement is not two-sided, however. The same companies who are to blame won’t have comparable requirements, creating a one-sided and unfair bill designed to debilitate those who have already been injured. Personally identifiable information such as the last four digits of social security numbers, private work history, and personal information of children exposed at an early age would become public, making victims vulnerable to identity theft and discrimination.

This is just the latest attempt by big companies and individuals like the Koch brothers to avoid responsibility for their heinous wrongdoings. Just last week the House Judiciary Committee began fast-tracking this bill. Even though the Committee promised to hold a public hearing to provide an opportunity for a patient and two widows to testify, they instead sent the bill to a full committee markup and vote without bothering to hear the victims’ side of the story.

The time is now for us to take a stand. I am a spokesperson for the Asbestos Cancer Victims’ Rights Campaign. The ACVRC is a national campaign dedicated to protecting the rights and privacy of asbestos victims and their families.  By joining our fight, you can help us defeat this unfair legislation and the potentially dangerous precedent it sets.

I work with the ACVRC to honor Bruce’s legacy as well as do what I can to help other patients and families protect their legal and constitutional rights. While awareness and information surrounding mesothelioma have improved considerably, we need to continue raising our voices. Starting with signing our petition, I encourage you to join our effort. With your help, we can put a stop to this legislation. Together, we can work towards building a better tomorrow and truly make a lasting difference.

Susan Vento of Cancer Victims Rights