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Key messages On 21 March 2020, in response to the coronavirus COVID-19 outbreak, the Royal College of Obstetricians and Gynaecologists (RCOG), the Royal College of Midwives (RCM), the Faculty of Sexual and Reproductive Healthcare (FSRH) and the British Society of Abortion Care Providers (BSACP) produced clinical guidance for the provision of abortion care. These guidelines were introduced in order to reduce the risk of transmission of COVID-19 to abortion providers and women seeking abortion while allowing service provision through lockdown.1 As a result, telemedicine was introduced as recommended by NICE guidelines on abortion care.2 Telemedicine utilises information and communication technology to deliver healthcare services at a distance to increase a client’s access to healthcare. This allows healthcare professionals to deliver a service via telephone, video call and the internet. Since the introduction of the COVID-19 restrictions, 85% of abortion consultations are undertaken via telephone or video call in England.3 These conversations need to be conducted remotely in as safe a manner as possible, and additionally there needs to be the flexibility to provide a face-to-face appointment for those clients who may have difficulty accessing telemedicine or who do not have a private space in which to access a telephone or video call. During March 2020, the law changed to allow women to undergo an early medical abortion (EMA) in their own home. This change allowed …

INTRODUCTION The safety and acceptability of medical abortion using mifepristone and misoprostol at home at ≤9+0 weeks' gestation is well established. However, the upper gestational limit at which the procedure remains safe and acceptable at home is not known. To inform a national guideline on abortion care we conducted a systematic review to determine what gestational limit for expulsion at home offers the best balance of benefits and harms for women who are having medical abortion. MATERIAL AND METHODS We searched Embase, MEDLINE, Cochrane Library, Cinahl Plus and Web-of-Science on 2 January 2020 for prospective and retrospective cohort studies with ≥50 women per gestational age group, published in English from 1995 onwards, that included women undergoing medical abortion and compared home expulsion of pregnancies of ≤9+0 weeks' gestational age with pregnancies of 9+1 -10+0 weeks or >10+1 weeks' gestational age, or compared the latter two gestational age groups. We assessed risk-of-bias using the Newcastle-Ottowa scale. All outcomes were meta-analyzed as risk ratios (RR) using the Mantel-Haenszel method. The certainty of the evidence was assessed using GRADE. RESULTS Six studies (n = 3381) were included. The "need for emergency care/admission to hospital" (RR = 0.79, 95% confidence interval [CI] 0.45-1.4), "hemorrhage requiring transfusion/≥500 mL blood loss" (RR = 0.62, 95% CI 0.11-3.55), patient satisfaction (RR = 0.99, 95% CI 0.95-1.03), pain (RR = 0.91, 95% CI 0.82-1.02), and "complete abortion without the need for surgical intervention" (RR = 1.03, 95% CI 1-1.05) did not differ statistically significantly between the ≤9+0 and >9+0 weeks' gestation groups. The rates of vomiting (RR = 0.8, 95% CI 0.69-0.93) and diarrhea (RR = 0.85, 95% CI 0.73-0.99) were statistically significantly lower in the ≤9+0 weeks group but these differences were not considered clinically important. We found no studies comparing pregnancies of 9+1 -10+0 weeks' gestation with pregnancies of >10+0 weeks' gestation. The certainty of this evidence was predominantly low and mainly compromised by low event rates and loss to follow up. CONCLUSIONS Women who are having a medical abortion and will be taking mifepristone up to and including 10+0 weeks' gestation should be offered the option of expulsion at home after they have taken the misoprostol. Further research needs to determine whether the gestational limit for home expulsion can be extended beyond 10+0 weeks.

Very few terminations take place in the final weeks of the second trimester: in 2016 less than 2% of all abortions undertaken in England and Wales were at over 20 weeks. The total number of abortions at all gestations was 185,596.

The Republic of Ireland this month faces a historic referendum on the future of abortion in the country. Michael Nevill and Clare Murphy set out the issues at stake and the implications for the UK

Infection prevention practitioners are required to both provide and deliver infection prevention training but often struggle to resource effective and innovative programmes. The West Midlands branch of the Infection Prevention Society saw the opportunity to develop a training book for its members in the format of ‘recipes’. This book has quick and easy tips for developing and delivering innovative, fun and novel training sessions.

The aim of this study was to determine the incidence of surgical site infection (SSI) after vasectomy and to identify associated patient and perioperative risk factors, including the operating room environment (non-ventilated treatment room or ventilated operating theatre). This study used an active 30-day surveillance follow-up programme with telephone interviews and home visits. Patients were recruited over an 18 month period. Demographics, patient details and perioperative procedures were documented on the day of surgery. Patients were telephoned 10 and 30 days post procedure. Of 1,155 patients enrolled, 994 (86%) completed the full 30-day follow-up. Of these, 25 (2.5%) developed an SSI. The mean number of days until presentation with an SSI was 13. No statistically significant difference was found in rates of SSI when vasectomies were undertaken in either ventilated operating theatres or non-ventilated treatment rooms.

Young men experiencing abortion often have feelings of relief but can also suffer from emotional distress and feelings of powerlessness. It is important that they too have access to information and emotional support.

Tokyo is an amazing capital city, just as you would expect: tall buildings, bright lights, overcrowded and fast paced. Japan was a bit of a culture shock at first, but things have settled down since I learned a few key Japanese phrases for such questions as 'Can I have... ?' and 'Where is... ?' There are many places to visit in this city of almost 15 million people. Getting around is straightforward, as there is an efficient underground system with the station names in English as well as Japanese. The trains are on time and fully air-conditioned, but during rush hours it can get very uncomfortable with so many people squashed inside the carriages. The food ranges from inexpensive pavement cafes serving batter-fried octopus to exclusive sushi restaurants. Every type of food is available in the many restaurants, but I enjoy trying traditional Japanese dishes. The food is always fresh, well presented and tasty. Some of the more unusual dishes include raw horse, raw eggs, sea urchins and live fish. I have been taken to a karaoke bar by my work colleagues and it was great, but very different from what I had expected. You only sing to the people you are with and there are a number of rooms in the bar, depending on how many of you there are, which reduces the public humiliation factor.

Tokyo is an amazing capital city, just as you would expect: tall buildings, bright lights, overcrowded and fast paced. Japan was a bit of a culture shock at first, but things have settled down since I learned a few key Japanese phrases for such questions as 'Can I have... ?' and 'Where is... ?' There are many places to visit in this city of almost 15 million people. Getting around is straightforward, as there is an efficient underground system with the station names in English as well as Japanese. The trains are on time and fully air-conditioned, but during rush hours it can get very uncomfortable with so many people squashed inside the carriages. The food ranges from inexpensive pavement cafes serving batter-fried octopus to exclusive sushi restaurants. Every type of food is available in the many restaurants, but I enjoy trying traditional Japanese dishes. The food is always fresh, well presented and tasty. Some of the more unusual dishes include raw horse, raw eggs, sea urchins and live fish. I have been taken to a karaoke bar by my work colleagues and it was great, but very different from what I had expected. You only sing to the people you are with and there are a number of rooms in the bar, depending on how many of you there are, which reduces the public humiliation factor.

Through the functionalization strategy of multi-walled carbon nanotubes (MWCNTs) with polyvinyl acetate (PVAc), dampening material for acoustic devices was sought. In this paper, we investigated the effect of polymer grafting of MWCNTs on the frequency response based on a mechanistic basis. We have found that vibration reduction ability of the MWCNTs incoporated polymer has a maximum increase of 70% compared with pure polymer. Composites with pristine MWCNTs and polymer grafted MWCNTs were found to exhibit similar dynamic mechanical behavior in the frequency above 1000 Hz.

An auxiliary bass radiator unit is disclosed for mounting in an aperture in a loudspeaker enclosure. The unit comprises a substantially rigid panel member (10) mounted on a flexible surround member (12) so as to allow the panel member, when mounted, in use, in the said aperture to move in sympathy with sound waves within the enclosure. The flexible surround member includes a hinge portion (14) mounting the panel member for movement as a hinged flap. By that means movement of the panel member in twisting and other undesirable modes is substantially avoided.