Okay, we'll go ahead and get started. Welcome to everyone online and to everyone in the room. I am excited that we are continuing our McLean ethics lecture series, and I always remind people where we are so basically finished our, our autumn and winter quarters, and we are about halfway through our spring quarter. And after Dr. Core speaks today, we will have four left. So it's been a long and successful year of the McLean lecture series. All the recordings are online and we're excited to have Dr. Core joining us today. Next week, I'll just remind you Dr. Valerie Montgomery Rice, the president and CEO of Morehouse School of Medicine will be joining us. Followed by Paula Martin, who works in comparative human development at the college, the University of Chicago will be joining us talking about intervention, ethics and trans youth. And, and then we'll have two after that and then be done for for the year so it's been a very successful year and I am looking forward to hearing Dr. Core's talk today. Let me go ahead and introduce Dr. Core. Dr. Core is an associate professor of obstetrics and gynecology in the section of complex family planning and an assistant director of the McLean Center for Medical Ethics at the University of Chicago. After completing medical school at the University of Chicago's Pritzker School of Medicine, Dr. Core completed her OB and gynecology residency and fellowship in complex family planning and a master's degree in public health at the University of Illinois at Chicago. Dr. Core's academic and clinical work focuses on understanding and addressing barriers that adolescents and young adults face in seeking and obtaining reproductive health care. She has received private foundation and national institutes of health funding on her research. And Dr. Core is also a co editor of the book entire reproductive ethics and clinical practice preventing initiating and managing pregnancy and delivery, and serves on the ethics committees of the International Federation of gynecology and obstetrics, and the end of the American College of Obstetricians and Gynecologists. A dedicated educator Dr. Core serves as a program director for the fellowship in complex family planning, and the assistant director for the University of Chicago's OB gynecology third year medical student clerkship, and also co director for the first year doctor patient relationship course. So thank you for your service and we're looking forward to hearing your talk today. Thank you so much. Another part of my bio is I think Dr. Euler, you were like chief resident when I think I was a fourth year student so I also have had the pleasure of being educated by Dr. Euler so thank you. I have no conflicts of interest with this talk. I do want to make a disclaimer about language. This talk uses the terms woman and women throughout and discussing issues of gender equity.  The terminology that is used in these slides and in this presentation is correlates to the language that is used in the literature that I'll be citing so I use the language that is used in that literature and the research because that's, you know, thinking about surveys and the questions that are actually used in the research that's the language that is used in those in those studies. I will address issues of gender inclusion and exclusion within family planning during this talk, and I will also be focusing on individuals who are assigned female at birth throughout this talk so that's going to be the area of focus from for this lecture. So here is our slide with the CME code. I'm just going to take a pause for a second so people can put in their code get their credit. All good and hopefully someone can put it into the chat as well so it stays there. And by the end of this talk, I anticipate that you'll be able to discuss the role of contraception and abortion access and fostering gender equity. Describe areas for improvement in promoting gender equity within the field of family planning. And anticipate some potential impacts of abortion and contraception restrictions on gender equity and healthcare. And also more of a societal level as well. So we're going to start with a brief history of legal steps in terms of access to contraception abortion in the United States. And I start with this slide. I, this is my 10 year anniversary of being on faculty at the University of Chicago. And very shortly after I started at the University of Chicago, I had the incredible opportunity to hear Justice Ruth Gator, Ruth Gator, Bader Ginsburg, I can't remember, I can't believe I messed that up. But RBG speak at the law school. And this talk or it was more of like a back and forth kind of interview or dialogue has actually been cited quite a bit in terms of Justice Ginsburg's thoughts on abortion, and the role that abortion plays in terms of issues of autonomy and kind of her wishes of how the, how abortion could have been handled by the Supreme Court. And this was marking the 40th anniversary of Roe versus Wade. Justice Ginsburg said that by basing Roe on the rights to privacy rather than equal rights. Roe isn't really about the woman's choice is it. It wasn't about the doctor's freedom to practice, it wasn't woman centered. It was physician centered. So reviewing a bit of Justice Ginsburg's history because really looking at Justice Ginsburg's history. With her involvement in reproductive health law gives us an interesting perspective on the progress of law around reproductive health and equity. So starting out. Oh, no, it's hard because the, I think it's read versus. I can't see the titles. Is there a way to get rid of this. Mark, okay. Yeah. Yeah, would you mind. Awesome. Okay, I thought it was read versus read but I couldn't see in the year I can't remember so 1971. In this case overturned an Ohio law granting men preference as a state administrators. So seemingly kind of not the sexiest of cases. But really this law or this case actually was quite important in that it extended the constitutionals, the Constitution's equal protection guaranteed to women for the first time. Justice Ginsburg, not a justice then but as a younger lawyer. She wrote the brief in that case that came before the Supreme Court. Several years later struck versus Secretary of Defense. This is the case that justice Ginsburg states she wishes had been the first reproductive freedom case to come before the Supreme Court. I wish that or she said that I wish that would have been the first case I think the court would have better understood that this is about women's choice. The case involved captain captain Susan struck who became pregnant while serving as a nurse in the Air Force in Vietnam. And captain struck was given the option of either having an abortion or leaving the Air Force. Captain struck wanted to both continue her pregnancy and remain in the Air Force. And so she sued. Justice Ginsburg argued the case, and the case went to higher courts or district courts didn't make it to the level of the Supreme Court, because the Air Force through throughout this process abandoned the requirement of pregnant people to terminate in and remain in the armed forces. So, this was a great advancement, but didn't quite make it to the level that Justice Ginsburg had hoped. And really she she viewed this because she thought that this would be would have been a great case to bring up the issue of abortion as an equal rights issue. And so that Ginsburg confirmation hearing in 1993 she stated that abortion is something central to a woman's life to her dignity it's a decision that she must make for herself. When government controls that decision for her. She's being treated as less than a fully adult human responsible for her own choices. So though perhaps Justice Ginsburg may not have, you know, thought of herself as an ethicist first and foremost. I think that this really does crystallize some issues around reproductive health reproductive freedom and issues of bodily reproductive autonomy and justice. So I think she really sets the scene for this discussion. So I'm going to take you through some of the key cases and policy changes throughout the past 150 or so years that really lay the groundwork for access to and then restrictions from a use of abortion and contraception in the United States. So in the 1860s in the 1880s there was a an explosion of state level anti abortion legislation prior to that things had really been not so clear there's a lot of there just wasn't very much clarity in terms of kind of legal status of abortion. The AMA actually played a pretty crucial role in this and the committee on criminal abortion led by Horatio store, who was the committee chair and an OBGYN insisted that women must remain within their God given sphere. All states in the United States banned abortion by the eight by the end of the 19th century. The Comstock law, which you may be hearing about recently in relation to the current debate and legal issues around Mipha pristone and medication abortion. The Comstock law at the federal level was passed in 1873. And this was the act for the suppression of trade and circulation of obscene literature and articles of immoral use. And really this law and the subsequent state laws state Comstock laws criminalize the use of the postal service to send contraceptives and abortations. In 1936, the US versus one package, the US Court of Appeals for the second circuit allowed the importation of contraceptives so going against the Comstock laws to us doctors for use by their patients for pregnancy prevention. And in 1960, the FDA, again, kind of at the center of a lot of debate lately around abortion. First approved the oral contraceptive pill and no vid and this was really the first approval of an oral contraceptive or a modern contraceptive in the United States. In 1975, Griswold versus Connecticut, the Supreme Court ruled that the Constitution protects the rights of married couples, very importantly married couples to buy and use contraception without government restriction. And importantly Griswold established the concept of right to privacy and intimate practice. In 1972 and Eisenstadt versus Baird, the Supreme Court established the right of unmarried people to possess and use contraception. And this is based on the fact that the a Massachusetts law that was being brought to court violated again equal protection clauses of the Constitution. So these laws is there being passed to expand access are working around the concepts of privacy and also equal rights, but mostly around privacy. And in 1973 of course is the Roe versus Wade decision and that the Supreme Court ruled that that the Constitution guaranteed the right to abortion, and this was really based on the right to privacy as supported by Griswold and Eisenstadt. I'm skipping over a lot of legal decisions but I want to give you some of the most salient cases that really impact where we are today, and also impact people's access throughout the past few decades. In 1992 Planned Parenthood of Southwest Pennsylvania versus Casey, the Supreme Court decided that after viability a state can forbid abortion as long as it has exceptions for life and health of the pregnant person. But prior to viability states could could not ban abortion, but they can regulate it as long as the regulations do not impose an undue burden. There are many many cases and debates about what constitutes an undue burden, but I'm just going to cut to the chase by going to 2022 because this really largely negates those debates and that's the dobs versus Jackson women's health decision that was made in the summer of 22. The decision overturned Roe versus Wade and stated that abortion is not a federal right protected under the Constitution. Abortion laws and rights are to be determined at the state level. Very importantly, again when we're talking kind of in the next section of this, as I go to the next section of this talk. Thomas in his concurring opinion, wrote that in future cases we should reconsider all of this court substantive due process precedents, including Griswold Lawrence and Ogrefeld. Just to remind you Griswold was the case that expanded or allowed the right to to the use of contraception. So just to kind of put that out there and thinking about where the future may go based on this dobs decision. So not surprisingly in the wake of the dobs decision. A lot of dominoes have fallen with regards to legal access to abortion in the United States. So this current map that reflects state laws, you will see that Illinois is excuse me a blueberry in a kind of bowl of red or sea of red. And so this is kind of I'm not going to go through each state, but there have been 18 plus states that have highly restricted or banned abortion. Florida, Florida was in the news, I think just this week. There's a six week ban that was signed by the governor of Florida. But that is kind of on pause until the Supreme Court of Florida decides what they're going to do with another law on the banned abortion at the gestational age of 15 weeks. So this is kind of where we are, you know I started the very beginning of this talk at my, you know, privilege of hearing Justice Ginsburg speak on the 40th anniversary of Roe versus Wade. And here we are 10 years later at the 50th anniversary of Roe versus Wade and the world looks very, very different in terms of access. I'm going to turn more directly to the topic of modern contraception and abortion and its role in supporting gender equity. Some of the outcomes that have been examined with regard to gender equity and the relationship with family planning include educational attainment workforce participation career outcomes and wage gaps. So just thinking about what ways in which abortion and contraception may contribute to gender equity. Smaller cohort size, like a smaller family size maybe associated with increased financial resources for current and subsequent family members and even generationally delaying pregnancy may increase educational attainment and involvement in the workplace. And there's also the concept of the expectation effect, and that is one's ability to time whether and when to parent can inform a person's aspirations in life planning. And so these may impact engagement in the workforce career choices and advancement. And just to give an idea kind of pictorially, you know, sometimes a picture is worth a thousand words right so this is a graph showing, again as I stated, the FDA first approved modern contraception the birth control pill specifically in Novot in 1960. And this is a graph of live first birth rates by age of the pregnant person or mother in this graph. And you can see that the lines of those who are 18 to 24 at first birth really declined precipitously after the the FDA approval of the And then things kind of plateau and straighten out in 1976. And that was the Planned Parenthood of Central Missouri versus Danforth decision, where the Supreme Court ruled against the state's interest in regulating access to contraception based on age alone so really kind of equalizing access to contraception for those married non married, and regardless of age. Another graph that helps to illustrate changes in the wake of access to modern contraception. So this is a representation of age at first birth by cohorts, and you can see the one cohorts are the two cohorts actually that are substantially different from the rest are those who are born in 1955 and those who are born in 1960. And so these are people who grew up with access to birth control modern contraception so birth control pills so you can imagine. These changes had an important impacts on her people's ability to pursue education to engage in the workforce and so we'll look at some of this historic data. As you can imagine there are many challenges to establishing any kind of causal relationship between abortion and contraception and gender equity. In the 1960s and 1970s we didn't just have FDA approval of the birth control pill and row versus Wade. There are a number of legal and policy changes that can impact gender equity. Including 1963 equal pay act and the 1964 equal rights act that expanded legal legal rights in the workplace. 1972 title nine of educational of the educational amendments college and graduate school admissions were enhanced for women. In 1978, the Pregnancy Discrimination Act established the legal rights of women in the workplace who experienced pregnancy or childbirth, right so the kind of the family planning access. Progress was not isolated, it was within this new view of many other advancements at the policy and legal level. Again some challenges to establishing this causal relationship also include confounders. Right there are factors such as socioeconomic status race, ethnicity, age, insurance status, parents education. These are all predictors of fertility related outcomes. Not surprisingly these same factors are also associated with economic outcomes. It's really challenging to isolate the effects of contraception and abortion from socioeconomic demographic factors and legal policy advancements that also contribute to gender equity. So here's where I venture into the world of econometrics and looking at historic data to try to start to tease out the portion that may be attributable to contraception and abortion. So these approaches control for relevant or attempt to control for relevant socioeconomic factors, but they're unable to account for all. They may compare those who continue a pregnancy and those who miscarry, but miscarriage actually may be related to issues of access to care and socioeconomic factors so that's not really a perfect comparison group. As I was examining the implementation of policies that lead to differential access of contraception. I'm really focusing on contraception largely throughout the states and even at the county level. This data allows for comparison of women in same age cohorts with different access to contraception and abortion with likely much less variation with regards to the other kind of federal changes that were happening that may be impacting gender equity. So looking at family planning policy and funding heterogeneity. Some concepts that are really focused on in this literature this economic econometric and historic data is the concept of early legal access. And as I said, one of the first groups that gained access to contraception were married women. Okay, and so most unmarried women under the age of 21 did not have legal access to contraception in the 1960s. The state's legalized access for single women of the ages 18 to 20 over the next two decades. Public funding also very tremendously again from state to state county to county. And these changes rolled out also over the next two decades. So funding data at the state and county level allows for controls to allows one to control for factors and to better isolate this relationship between family planning and economic outcomes. So we're going to focus on a few of these kind of major outcomes so starting with career attainment. One in cats examined the early legal access to birth control pills and found that this actually accounted for about a third of increase in women in professional careers between 1970 and 1990. And this was, you know, a third increase sounds very substantial but actually this this overall was an increase of 5%. And one of the major limitations to their studies that they really only examined college educated women. Steingrim's daughter examined self reported career plans and found that women from more selective colleges increase their expectations for career attainment, more significantly more than those from less selective colleges. So considering early access or legal access to contraception so individuals who are in the more selective colleges felt that the access to birth control pills increase their career prospects, whereas actually individuals from less selective colleges felt that the birth control pill may have had a neutral or even potentially a negative impact on their career prospects. So really it's, it's very mixed data in terms of the impact of birth control pills for the general population so these are very limited studies. Looking at educational attainment, Edlin and Machado examine changes in marriage laws to evaluate minors access to contraception without parental consent and how that impacted educational attainment. Decreasing the minimal age of marriage, the led to increased minor access to contraception, and that accounted for about a 10% increase in the probability of women ever attaining college so people who had access to marriage in turn had access to contraception, their, their kind of data showed that that accounted for about a 10% increase. And it also accounted for about a 20% increase in women pursuing professions, including medicine and the law. And look at the impact of early legal access to contraception on educational outcomes between 1968 and 1976 1979 and found that women with early legal access had about a 12% increase in college enrollment. And they posited that about a quarter of a million women over the age of 30 obtain their bachelor's degree due to access to contraception by the year 2000. Now you can imagine, there are a lot of limitations to this data, but it does give us at least an idea of the relationship between access to contraception and increase engagement in education. You know, as I mentioned in terms of career attainment there is some differential impact based on the nature of the school that people attended. There's also differential impact and with regards to educational attainment based on baseline socioeconomic status. So Bailey and college colleagues looked at college enrollment and found that it was 20% higher for those 20 to 24 years old with early legal access in the early in the late 1960s and early 70s, but this increase was actually the greatest for those who had a baseline lower socioeconomic status. So that is in conflict with an aunt and hunger men's finding that the association with between access to the pill and increases in levels of education impacted less those with a lower socioeconomic status. So really, this just gives you an idea that there's a lot of noise and trying to establish a clear relationship between access to contraception and these outcomes. But there does appear to be some connection between access to contraception at a younger age and increase educational career attainment. Looking at the workforce Bailey looked at the relationship between early legal access and delays and parenting and found that this accounted for about a 15% increase in workforce participation and work hours in women ages 16 and 30, who grew up between 1970 and 1990. Bailey and colleagues subsequently looked at the relationship between early legal access and improved wages and found that individuals who have this early legal access compared to their peers who did not earned more both hourly and yearly, and they found that this attributed to about two thirds of the impact on gender expansion in the workforce, and also about a third of the increase in educational attainment and occupation. So differences in impact of family planning on economic advances. You know just thinking about some challenges again and looking at these outcomes contraception may have less of an impact for those with access to abortion. So there are several studies that show that really when you take into account both contraception and abortion, abortion may actually have had a larger impact on increase engagement in the workforce and educational involvement. The impact on economic outcomes may be less for those from lower socioeconomic backgrounds as I said, as I showed there are some studies that really conflict in terms of, of how contraception helped those from lower socio economic status compared to higher economic status. And importantly costs remains a barrier to access for many, both thinking about contraception and abortion. There's very limited data in terms of examining differences by race and race and ethnicity. And there's very inconsistent data when we look at actually the effect of teen pregnancy on educational and career attainment. So, again, you know this is really looking at historic data which we know is limited by nature. And recognizing that there are tremendous number of individual level confounders and also policy and legal confounders. So, you know we have some broad strokes thinking they're demonstrating that there is some positive relationship between access to contraception abortion and workplace outcomes. How about some prospective data because that's really what we always want right. And some of the best contemporary data is looking at the relationship between abortion and outcomes including economic outcomes and socioeconomic attainment. The turn away study is really a game changer in terms of looking at access to abortion specifically and long term outcomes. The turn away studies a five year longitudinal study of women presenting for abortion in the United States from 2008 to 2010. This study has a number of spin off papers looking at health outcomes, relationship outcomes so a number of outcomes but they also include socioeconomic outcomes. The three cohorts in the study include the near limits, and those are individuals who presented within two weeks under the gestational age limit of that clinic that they presented to. That was about 450 individuals. The turn aways were within three weeks above the gestational age limit at the clinic that they presented to who are not able to obtain their desired pregnancy termination. And there's a cohort of individuals in the first trimester who obtained their abortions. So compared to those who were able to obtain their desired abortion, those who are unable to obtain their abortion, looking at six months post denial of their abortion. Those who were not able to access their abortion had a higher odds of living in poverty. That's likely to be employed, more likely to receive public assistance, and these differences actually remained after four years. So again, thinking about the impact of access to methods of determining whether and when one can become pregnant and parents. I think these are probably the most concrete and methodologically the soundest data to show the role of pregnancy planning and being able to determine when wants to and is ready to parent and how that impacts engagement in the workforce. Okay, so I'm going to shift gears on this talk is entitled family planning and gender equity but I'm also going to look at gender equity within family planning. Most data and all the data that I presented thus far has really focused on the experiences and outcomes of cisgendered females and their use of contraception and abortion. So it's important to recognize and say out loud transgender non binary and gender expansive people who are signed female at birth do have sex that puts them at risk of pregnancy, of course, not everyone, but there are pregnancy risks amongst this population. So it's important for us to do some self reflection as family planners and ask, how are we providing care for transgender and gender expansive patients who are signed female at birth. There are some important unique contraception and abortion considerations for these patients. I'm just going to go through a few of some of the most notable, but use of testosterone frequently most commonly results in amenorrhea so no men's ease. This does not mean that people who are on testosterone cannot become pregnant. This is not a contraceptive. The use of transgender patients assigned female at birth found that about, you know, 15 to 30% believe that use of testosterone is a safe method or an effective method of contraception. And about 6 to 9% report being told by their provider that being on testosterone will prevent pregnancy. There are also some potential teratogenic effects to being on testosterone if one conceives while on testosterone. There are potentially gender discordant and potentially concordant effects of being on hormonal contraception. And the invasive nature of some of contraception and abortion procedures may be particularly challenging for patients who may feel alienated by their their anatomy. So any contraception is used by transgender men so about 20 depending on the studies between 20 and 60% of transgender men do report having used or using contraception. Transgender non binary individuals also do experience pregnancy. Dr. Josephson and colleagues conducted the probably the largest survey. Looking at reproductive health outcomes amongst transgender and gender expansive participants, including 1700 respondents of those they documented 433 pregnancies and that was about 12% of the study population. About 40% of those were unintended about 40% were resulted in my birth, a third resulted in miscarriage and about 20 resulted in abortion. And importantly, one in five respondents consider themselves at risk of getting pregnant when they did not want to be or were unsure of their pregnancy risk. So let's kind of focus a little bit more directly on abortion amongst transgender and gender expansive patients. There's a 2017 survey of all known abortion providing facilities in the United States. And from those results, they estimate that about 500 abortions are performed annually for transgender non binary patients. This is probably a a gross underestimation. Abortion clinics there's some later data but abortion clinics, you know, you will only know what your data is if you're asking the right questions right until a lot of clinics are not asking the right questions to get an accounting of the gender identity of their patients. But again, returning to Moses and study. And amongst those respondents 92 abortions were documented about 60% were surgical 30% were medical. And of all the respondents, there was a strong three to one preference for medication abortion, if they needed to pursue abortion in the future. Some respondents indicated that they would prefer medication abortion because it was less invasive and more private. Some respondents also said that they did not want to have to engage with the medical system out of concerns for discrimination, and being misgendered. So let's think about provider training comfort with regards to caring for our transgender non binary patients. Looking kind of the broader kind of broader scope of reproductive health providers, only about a third or less of OB guidelines who are surveyed reported being comfortable providing care for trans masculine patients. And as I indicated, only about a quarter of abortion clinics are really focused on care for transgender patients, and only a quarter provides specific transgender care. So that means that about 30% of abortion patients only receive their care in clinics that really provide transgender specific care. So what are our patients experiences with family planning providers are transgender non binary patients experiences Gomez and colleagues performed a qualitative study of 20 transgender non binary young adults were assigned female at birth. The participants described lack of knowledge amongst both themselves and providers about the impact of testosterone and pregnancy risk and interactions with contraception. They also described interactions where providers were unfamiliar with the needs of transgender non binary patients made assumptions about anatomy, gender and sexual identities, and lack knowledge to counsel individuals about contraception. One participant reported, they asked how I got pregnant, how it works, how do other lesbians do it, where do you find sperm and I was like, well, don't you work with pregnant people all day. She was well meaning but the questions she was asked in the questions that she was asking because she wanted to be a better provider but at the same time, it's not my job to teach her. So just clarifying some more specific barriers for transgender and non binary patients when trying to access contraception and abortion care. Fix that all conducted a qualitative study of sexual reproductive healthcare stakeholders, including five patients who had experienced either abortion or contraception care and 22 clinicians researchers advocates. Identify the following barriers to contraception abortion care specifically lack of gender affirming clinicians gendered healthcare environments. There's a lot of language about women and female in abortion clinics and family planning clinics being misgender discrimination and insurance coverage.  Insurance coverage for abortion specifically is very hit or miss. And of course insurance coverage for transgender care is equally kind of spotty. And also once someone has legally and officially change their gender within the medical record that oftentimes can lead to challenges accessing care deemed women's care with regard to their insurance so so this can be a major major burden. And here's just one quote from the website we testify which is. I highly recommend going to the site there's a lot of really illustrative examples but one quote is it that as a non binary person I've been misgendered and healthcare settings. So if I ever have an abortion again, I would still prefer to self manage so this is someone who would self manage their abortion in the past, again out of concerns of having issues with regards to discrimination and being misgendered when coming into contact with reproductive health care. And so that clearly impacts how they engage with abortion care. Some recommendations from the study participants in terms of how to improve contraception and abortion care for a transgender non binary patients. Making sure their intake forms are gender neutral and gender affirming and affirming of all sexual orientations. And this I think can apply to most health care. Using gender gender neutral language by staff creation of evidence based and gender affirming patient education materials specifically around contraception and abortion which are very much lacking medical education continuing medical education around gender affirming care in the family planning context. Partnering with transgender non binary communities to ensure that changes that are being made in practice center the needs of this community, seeking to have staff that reflects the diversity of patients seeking care and family planning. And empowering those staff who do identify as transgender non binary to help lead shift in patients service delivery and culture, and advocating for comprehensive contraception abortion and gender affirming care coverage. Okay, so now I'm going to make another shift and try to move along expeditiously on family planning and gender equity and medicine specifically. Obviously was stated, access to contraception and abortion has been linked to increasing participation within the workforce and in the professions and specifically including medicine delays and childbearing during training and beyond in medicine imply that there is a use of contraception and abortion amongst physicians and training and physicians in practice. There is a paucity of literature looking at contraception and abortion use among us physicians. An older study, looking at the women's health study in 1993 to 94, include about 4500 participants. Female physicians were more likely to use contraception compared to the general reproductive age population, and to women who are matched by socioeconomic status with nearly three quarters of us physicians using contraception. And the body were more likely to use IUDs and barrier methods and less likely to use permanent contraception, compared to the general population and those matched by socioeconomic status. Thinking about my cohort of family planning providers and our contraceptive use. This is not going to be surprising to anyone who's ever talked to a family planning provider a 2013 survey of nearly 500 providers ages 25 to 44 compared to the 2011 to 2013 National Survey of Family Growth Respondents in the same age group. Family planners had a higher percentage of using contraception and were significantly more likely to use IUDs implants in the contraceptive ring. LARC use so use of IUDs and implants was about 42% compared to 12% in the general population. This reflects likely both differential preferences but also recognizing our access to contraception. Let's talk about our OB-GYN residents and their use of contraception. 2016 survey of OB-GYN residents at the time of their in training exam had an 86% response rate, 83% of those identified as women and more than half are married. The third of the respondents were using contraception or had a partner using contraception and again, the use of IUDs was five times higher than the general population. And amongst noliparous female participants, nearly about a third of them used IUDs and that's eight times higher than the national level. And again, this represents both increase in access financially, but also access to knowledge. Physicians and use of abortion. Just at the national level one in four people who can become pregnant will experience an abortion by the end of their reproductive years. There's really little known about US physician use of abortion. The first survey conducted by a number of individuals including our very own Vinnie Arora, Dr. Vinnie Arora, surveyed 3,800 US physicians and physicians in training with an impressive 82% completion rate. I mean they found that 11.5 of those who responded reported. But 11.5 of those who experienced pregnancy had had one or more abortions. And those who reported having had an abortion were more likely to have also reported delaying childbearing for training. So clearly abortion is common amongst us physicians, though it is a little less it is less common than the general population of 25%. So thinking about you know recognizing again family planning and use of contraception and abortion. So Vinnie plays a role in terms of how physicians and physicians and training, navigate the balance between family building and career attainment. What might the dobs decision that I spoke about earlier on this talk, how might that impact the physician workforce. The number of US residency programs are located within 18 states with banned or severely restricted abortion since dogs. Abortion restrictions and bands also impact management of miscarriage, ectopic pregnancy and infertility. This is especially relevant to physicians both in training as and beyond. Childbearing and strenuous work conditions that physicians experience are associated with increased risk of pregnancy complications now. This is this holds for many, many, many fields but you know we in this room are physicians and so that's why I'm focusing on on the outcomes of physicians, but the rates of complications and need for care for anomalies is quite striking amongst us physicians. Access to contraception and abortion has allowed physicians and physicians and training to plan their lives for 50 years. Impact of dobs on physician workforce is really three fold. As learners, it's going to impact educational content, medical school matriculation and residency ranking preferences. Dr. Euler Euler and I were just talking about the match this year. And, you know, I think we're still going to get more data on this but certainly anecdotally, dobs had a huge impact on how medical students ranked programs nationally. As providers, the changes in what can and cannot be offered and providing reproductive health care within the fields of OB-GYN and family medicine but also throughout internal medicine, pediatric surgery. This, these changes cause moral distress lead to moral injury burnout and career may impact career longevity for some in the workforce. Finally, as patients, these laws and the changes in access to abortion and potentially contraception on that's actually not that far off are going to have an impact on personal or family health and physical and psychosocial health. So, this is an ethics series, and I do think that we need to bring these issues back, kind of hone them into ethical principles, and thinking again back to Justice Ginsburg's words about where abortion fits within regulating one's own life and decisions. Clearly, these issues are tied very closely to both bodily and reproductive autonomy and undermine the principles of justice and access to both regulating one's life and life course but also impacting access and engagement with education and the workforce. So, the principles that are fundamental to safe evidence based provision of contraception and abortion are very much under attack. This is in addition to gender firming care for minors and adults and these are not coincidences. The people who are legislating or creating legislation that is resulting in abortion bans throughout the states are the same people who are creating legislation that is limiting access to gender firming care for children and now even adults. These concerted efforts threaten advances in gender equity that have been made over the past 50 years. So, I propose that it's an ethical imperative for us to advocate on behalf of patients, and especially those who are greatest risk. So in conclusion, access to contraception and abortion is contributed to gender equity, as measured through economic outcomes, not all genders receive equitable family planning care and that's an issue that we very much need to address. Use of contraception and abortion is highly prevalent amongst us position and helps find a foster gender equity in medicine and threats to access to abortion and contraception are threats to bodily autonomy and justice and undermine gender equity, both within our field of practice and beyond. Okay. And now I have eight minutes for questions. Wonderful so we're open to questions from the room. I was just reflecting as you were talking about, I was wondering if there are best practice from our international colleagues and like how that it will impact like this future in the United States going forward so any thoughts about, you know, either good or bad influences there. Yeah, you know it's interesting. A couple of years ago. At the National Abortion Federation. We had panels talking about self managed abortion and really we were learning from our colleagues in South America, where abortion had been banned countries that interestingly enough, many of whom are moving towards legalization of abortion. The United States is moving towards banning and restricting abortion. So there are a lot of best practices, but even with those best practices from countries that have long dealt with abortion and really predominantly abortion being illegal. We know that even within kind of application of those best practices, there are significantly negative health and economic outcomes when abortion is restricted and let alone contraception. So yes there are certainly many best practices, but it's just the idea that we have to reach out to countries where this has been illegal for decades is pretty striking. Any other questions in the room. So, I'm the question from Dr Siaki who is talking about this concept of women's health that has been advocated for a long time and how to address that in the current setting of gender affirming care. I hope I paraphrased that well okay. Yeah. You know there. That also that question takes me back to another conference where there was very heated vigorous debate and there have been really notable ruptures in organizations and kind of academic discussions around this topic. We're focusing on kind of expanding or kind of broadening the pool and using more gender neutral language undermines kind of issues that that have been identified as women's issues. And, you know, I think that my language really is shifted to focus around reproductive health and recognizing that that can be applied to people who are assigned male at birth. But, again, for me my language is focusing on more about reproductive health and quite honestly, to me what's most important is what the patient in front of me the language that the patient in front of me is using, is asking them what language they're comfortable with whether it be with anatomy or procedures or. So I think to me the very most important thing is at the individual level but yes absolutely when someone walks into a clinic and everything is women women women. It's challenging and so I don't think that we've arrived at like a single best practice, but I think focusing on reproductive health and more gender neutral terminology I think is more welcoming to more people. There's a couple questions in the zoom chat one is how is family planning and reproductive care for TGE patients being taught at University of Chicago for students and residents to ensure graduates are able to take care of these patients well. Great question and you know in terms of undergraduate medical education. You know I think that that is certainly something that is going to be a component that we focus on in terms of curricular reform, and certainly there is discussion, you know, I'm director of the ethics course and we had a session around ethical care for transgender and gender expansive patients. But I think that we need to actually get very much into the nitty gritty of practical aspects of providing this care. And so that certainly will be a focus as we are working on the curricular form in terms of clinical skills and more concrete. And so we have some approaches and DPR and those other courses in resident education. We have some, some leaders who are focusing on that Andrew Fisher, being one of them and so we are certainly very actively thinking about how best to do this but we are not, we certainly are not perfect and we are continuing to to work to integrate this into the curricular changes. So looking at socio demographic, you know, we have. Oh, I'm sorry, the question is about the turn away study and the two cohorts those, the turnaways and those who obtain their abortion were those, you know, were the two cohorts very different in terms of, are there some factors that made them more likely or less likely to make it to the clinic. Prior to their gestational age cut off those groups are actually quite similar in abortion care we've had a lot of challenges trying to identify what is the best comparison group right because people with unwanted pregnancies sorry my eyes watering people with unwanted pregnancies who continue a pregnancy are very different than people with unwanted pregnancies who terminate. So it's been a real challenge but this actually in terms of the two cohorts are quite well matched in most of the demographics that were collected so this study actually from a methodologic perspective in terms of really isolating the abortion as being our ability to obtain their abortion as the main difference was quite sound. I think we'll end here we'll stop the recording and, and then we'll just ask the ethics fellows to come down for our final discussion. Do you want me to end it right here. Do you want to stop the recording. That was signed in when I know when I was. So I wasn't hallucinating with. I know that's not ideal. Yeah. That's just great. Okay. Okay, well then. It still hurts. I think it was like, it was like minimized or yeah. Oh, super.


Welcome to All Hands Update, and these are today's headlines from around the fleet. Military leaders from across 40 countries including Africa, Europe, and the Americas attended the Secretary of the Navy's Gulf of Guinea Maritime Security Dialogue 2015 at the U.S. Naval Academy in Annapolis, Maryland. The event focused on collaborative maritime security operations in the region. During the event, BCNL Michelle Howard received Francis Highest Award. As sailors and Marines, your health is mission critical. Heart disease is currently the number one killer of men and women in the U.S. Take time to learn about the risk factors and lifestyle choices that could lead to heart disease and your ability to serve. Your life may depend on it. For more information about heart health, visit the Navy Medicine Blog. You can read more about what's happening around your Navy at navy.mil.


Okay, so, sorry everyone and hello again, thank you for participating in this webinar offered by the European School Education Platform, the European Commission's platform that brings together all the stakeholders of the educational sector. So today you will get an insight on the project SKATE, which is a project about the use of technology in inclusive early childhood education. And I would like to introduce you our speakers. So Dr. Xanthippe Aristidu, or Xanthia, she's a senior project manager at the CARDET and research associate at the European University of Cyprus. Her research interests include many educational fields, such as multicultural education, inclusive education and early childhood education. And our second speaker is Dr. Katerina Mavru, she's an associate professor also at the European University of Cyprus. Her research interests focus on the different fields of education with the focus on the use of assistive technology for inclusive education. Also before I give the floor to our speakers, I would like to remind you that you can use the chat to post any questions or thoughts. And moreover, at the end of the webinar, we will serve with you a five minute feedback survey. Your opinion and your comments are always welcomed and much appreciated. So please take some time after the webinar to fill in the survey. So Xanthia, the floor is yours now. Hi, Maria Elena. Hi to everyone. Thank you so much for participating in this webinar. Give me a second to share my presentation. When you see the presentation. Yes, Xanthia, it's. Yes, yes, we can see it perfectly. OK. So hello, everyone. My name is Xanthia Ristido and also Maria Elena mentioned at the beginning I'm a research fellow and currently working at the Project Skate, which is an Erasmus Plus program at the European University of Cyprus. In this presentation, you can call it Katerina Mavru. We will talk about the ways of empowering early childhood education teachers for inclusive tech driven education. It is also important to highlight here that the work presented in this webinar is the outcome of a collaboration between all the partners involved in the Project Skate. So in today's seminar, we will mention we will provide a brief description of two part one. We will provide the background and rationale providing also an introduction to the Skate project and looking at projects aims and activities. In this part, we will also discuss the importance of using information and communications technologies and assistive technology in early childhood education and care while explaining first what is ICTAT in brief and why teachers need to be trained on how to incorporate ICTAT in their teaching practices. In part two, we have practical implications, looking at inclusive pedagogies and approaches as well as how teachers can design their lessons with the use of ICTAT. So let's start first with introduction to the project. First, we need to clarify what is Skate? What does Skate means? Skate stands for skills and knowledge on assistive technology in early childhood inclusive education. The project is co-funded by the Erasmus-Plasian Union. Our aims in the project are to foster new skills and knowledge of teachers and educators for the appropriate use of technology and digital solutions to increase the quality of early childhood education and care by promoting an early intervention with appropriate assistive technology for children with special needs or at risk of exclusion as well as to create an increasingly inclusive learning environment. In addition to the project, there is a collaboration between academic and professional institutions and specifically this includes the Thomas More University, which is the project coordinator, the European University Cyprus, the AS Bologna enlas in Italy, Dominic Xavier in Belgium and Open the Windows in the Republic of North Macedonia. The Skate project has three main outputs, which we will very briefly discuss here. In output one, our aim was to map and assess innovative approaches on inclusive technology for ECEC. In order to do so, we have conducted a literature review and analysis about technology supported learning in early childhood education. The review and analysis of literature specifically concerned issues of inclusive education in early childhood, full of educator practices in using technology in order to define the best strategies, barriers, factors of success and failure through case studies and other research evidence. This also included teachers and parents interviews aiming to identify the current situation of technology deployment strategies in ECEC, such as mapping the practices, opportunities, barriers and needs. Also, we analyzed in-depth a number of reported in-signal childhood education in all partner countries. For the second output, we focused in developing guidelines for inclusive classrooms for ECEC teachers. The guidelines were drafted by a means of a Delphi procedure involving project partners as well as representative stakeholders and teachers. For those who may not know, the Delphi method is a robust approach for structuring a group communication process so that the process is effective in allowing a group of individuals as a whole to build consensus over a topic. Through this, we made an overview on the role of technology in universally designed learning programs, types of technologies as well as implementation of technologies. We also identified the main pillars of content and knowledge. We developed guidelines with indications for the low role of assistive technology in specifically empowering children with communication, motor, sensorial or intellectual disabilities. In output 3, a toolkit was developed including a competency framework, learning programs and assessment technologies. The competency framework provides core competencies for teachers, educators, necessary for successfully working with technology in inclusive early childhood education. This allowed the elaboration of learning outcomes in different areas of knowledge, skills and attitudes and defined the learning programs enabling the development of the core curricula and materials. The learning programs on the one hand responded to the needs expressed by the teachers and educators involved in the projects as well as served as examples of the applications of the competency framework to guide the professional development. After the development of the learning programs for teachers, educators, within the partner countries, they were also localized and validated through piloting in all partner conflicts. Geo, Cyprus, Italy and North Macedonia. One of the derivatives of the project that we will provide a brief presentation in this webinar was the preparation of the guidelines. The skate guidelines on inclusive classrooms for early childhood education and care teachers aims to provide the main theoretical aspects of the content and the focus of the learning programs developed in the skate projects. The guidelines provide an overview of the following components for the appropriate use of digital technologies in inclusive educational settings for young learners such as an overview of the main concepts of disability, digital technology and inclusive education, an overview of the basic theoretical principles for creativity and learning in the notion of inclusive easy easy, an overview on the role of technology in universally designed learning programs as well as how the use of high and low tech technology can empower children with especially individual needs or emerging special needs where the educational activities cannot be made fully and permanently inclusive. We also provide an overview of the implementation on the implementation of technologies through the use of mainstream tools such as tablets as well as emerging such as robotics, kinematics, safety wearable devices, simulated environments, smart toys as well as high tech technologies as low tech technology strategies which are sold as educational technology in their broader sense aiming to foster the development of cognitive intellectual communication and social competencies. We also provide an overview and indications for the role of low and high tech assistive technology in specifically empowering children with communication, motors, sensorial or intellectual disabilities. These guidelines have been drafted, validated and consolidated with the involvement of all partners and through the involvement of local, easy, services and stakeholders. Following this process as well as the Delfin method that we described earlier the consortium team identified the main areas of interest to be elaborated in the guidelines document as well as the main issues to be highlighted as additional materials, resources and tips. In these slides we provide an outline of the main components of the SCAPE guidelines whereas the full version of the guidelines can be downloaded from our website. So therefore in section one focus on inclusive education we provide the basics of inclusive educations which are as analyzed in subsections such as that we explain what is inclusive education, we provide some definitions, constructions and main models of disability, we explain what is inclusive education and what is not as well as we provide a description on how and what is inclusive education in early childhood educational settings. In this section we also provide some examples, practices of applying inclusive pedagogies in classroom by first explaining what is inclusive pedagogy as well as providing a description and a focus on the universal design for learning and differentiation and finally this section ends with mapping some challenges and opportunities inclusive education by drawing on research evidence on the practices and attitudes. In the second section or thematic area we focus on early childhood education we describe first what's in an early childhood education by providing definitions and explaining the setting as well as we provide some guidelines and the curricula for ECEC. We also explain the basic pedagogical principles for of ECEC by for example focusing on creativity and play theories and approaches to children social relations in educations as well as provide some practical strategies and approaches on specifically creativity and play. In the third thematic area we focused on technology which focuses both on mainstream and digital assistive technology and it's used to early childhood education which is explained in in in subsections such as using early learners with main reference to the use of mainstream learning technologies and their benefits in early childhood education such as looking at technology and has learning benefits types and technology as supporting creativity creative thinking and play. We also focus on using ICTAT with early learnings with specific reference to the use of assistive technologies and their benefits in early years of education so in this section we focus specific use of assistive technology. In the fourth and the final thematic area we try to bring the previous thematic areas together and then provide and describe how we can create digital inclusive education in early education settings. So first we map the main goals of digital inclusive education in early education which define the main objectives of digital inclusive education in early years. We focus specifically on universal design for learning in practice where UDL is connected with the use of ICT and AT. We also explain how we can use UDL meaning universal design for learning and mainstream technology and how universal design for learning can be used in the process of learning as well as use of ICT and AT. In this section we also have a subsection on collaboration with involved stakeholders noting the importance of teamwork as well as collaboration between vital stakeholders highlighting some methods of bringing together stakeholders such as communities of practice as well as ways of supporting professional learning through self-reflection practices and strategies for educators. In addition to the main themes that compose the core skate guidelines as outlined previously, the participants who of the study who designed the skate guidelines also identify issues that they considered important for the development of a coherent training for educators in technology enhanced inclusive education in ECEC. These additional issues were connected to the main themes of the guidelines and have been included in the annexes sections of the deliverable as sets of tips, checkpoints and further information. Each annex is cited in the main text of the guidelines and it's linked to the content of both the guidelines as well as the learning programs that were developed based of both the guidelines and the competency framework. So in this section we provide values, tips, practical strategies and resources that a teacher can easily use for his or her teaching. Overall the skate guidelines were developed through the means of a Delfin method by having consultation and mutual agreement among participants for the finalization of the main themes which were elaborated in the guidelines. Delfin method participants, teachers as well as external stakeholders were involved in other phases of the design, the delivery and evaluation of the learning programs. Feedback from stakeholders noted to develop the guidelines document and the guidelines document consists the basis for the contact development of the skate learning program. The skate and guidelines document is still in process and it will be finalized by having additional examples of scenarios by educators who participated in the validation of the learning programs. The guidelines document as mentioned previously is open to the public for additional feedback and reflection and the final evaluation of the pilots is also expected to provide feedback not only from educators but also from trainers, learners and parents. So a big activity of the skate program project was the the development of the guidelines. Another activity of the skate project was a development of the competency framework. Its goal is to provide a comprehensive overview of skills and competencies related to different areas of professional development necessary to successfully design, develop, implement and assess inclusive educational activities by means of digital technologies. In order to develop in order to develop this activity we consulted and adapted existing frameworks such as the index for inclusion, universal design for learning, the entails plus competencies framework as well as the KPT guidelines for lifelong learning in assistive technology. The competency framework and following the focus of the project in inclusive early chart propagation and care using iFocus is therefore on the below components including inclusive education and inclusive pedagogies such as differentiation and universal design for learning, digital assistive technology competencies and digital inclusion as well as inclusive early childhood education and care. So here we will provide a very brief overview of the main areas of competencies. This can into consideration the pedagogical aspect of the educator professional development, the digital competencies aspects as well as the leadership aspect of the educators. Therefore the first competence focuses on the design of curriculum and learning process, looking at competencies for learning design such as assessment of needs and barriers, setting objectives, learning act ones, how to plan, design activities appropriate for easy that are you consider in the presentation and the second area focus on the implementation of teaching and learning strategies and this include competencies on how to implement inclusive pedagogies by integrating ICTAT in the learning process as well as implementing UDL guidelines. The third area focus on resources, how looking at the knowledge that the teacher educator may have on ICTAT. So a teacher educator may select, modify, create and use of basic resources and educators own digital competencies. And the last area focused on classroom management and collaboration, collaborations, looking at parents and learners involvement, collaborative teaching and the possibilities for having a collaboration in a broader sense and bringing some more practical management issues such as ways of setting up the equipment. These levels of competencies were developed across three levels of proficiency where a teacher educator may select at which level he or she may be currently is. So therefore we have the beginner level which is the beginner level, the intermediate and the advanced level. So here we'll provide an example of the first and we have the same statements, similar statements highlighting specific issues and these are modified across the three different levels. For example if I can read the first statement, at the beginner level a teacher may consider that they can, teachers may consider that they can identify the importance of participation for all which this is classified as a beginner level. At the same, the same sentence statement is modified on teachers being able to seek and remove barriers to learning and participation in all aspects of the curriculum and lesson design and that the advanced level teachers may be able to identify individual children's skills and needs and compare them with the actual learning objectives. This also is available in our website so any one of you can be able to download it and have a look and overall the Skate Competency framework was used to assist the Skate team and involved stakeholders in the design and development of the learning programs for the training of educators. During the after the implementation of the pilots, teachers, participants map their practices as examples and scenarios. This framework which will also be added to the final version and the Skate Learning Program based on the guidelines and the competency framework and we developed the Skate Learning Program and focused on the four modules for the learning program by incorporating various teaching methods, case studies and examples proposed by the participants. So the learning program was tried to draw examples, references, teaching methods and theory from the Skate guidelines and the competency framework to train teachers on how to create digital inclusive in early childhood education settings. Therefore one module focused on inclusive education and early childhood education, the second module focused on technology, enabling two teachers on how to use ICT with early learners, the third module focused on technology, on using ICT and AT with early learners, as well as the final for a module focused on assisting on training teachers on how to create digital inclusive education in early childhood education settings. After developing these four modules by all partner countries these were localized and adapted in each partner country. I will give the floor to my colleague Katerina Mavru and Katerina, you may start and let me know when you wish to start the video. Thank you very much, thank you Xanthia for an excellent introduction to the project. Just to say hello to everyone and then say how happy I am to see so many people connected and also to see people from countries that have been benefited specifically from this guide. Not only the four partner countries but before I proceed to some practical examples and some connections with inclusive education and assistive technology just to say that this project has been the basis on which a very recent project of UNICEF has been developed, a development of a guide for the use of assistive technology in inclusive education for teachers and school teams, for countries that I see specifically here and greetings from colleagues from countries of Eastern Europe countries like Bonzi Argo Ezegovina, Armenia, Olsenworth Macedonia and of course all countries but the guide was very much focused on Eastern Europe and countries that represented here. So it's so great to make this connection and parts of what you've seen today will be included and are included actually in that guide that will be very soon published by UNICEF in 2023 probably before the beginning of December so keep an eye on it. So on this second part I'll try to make a connection with first of all just just raise our concerns on why do we need ICT information communication technology and assistive technology in early childhood education and why this specific emphasis on the assistive technology aspect particularly. So if we just have a very short introduction with this video Santia please? Yes. You should not have used the technology. I'm additional native. Do computers scare you? Are you afraid to use them? Have you been on Facebook? Have you been surfing? Do you even know what's on the internet? Are you going to be my teacher? Or just that test book? Because I want to know what the world has to offer and if you're not on land and don't know nothing about computers You can't be my teacher. I said you can't be my teacher. The maker or someone who knows how to use the internet. Are you saying I'm going to be ready? Are you saying I'm going to be ready? I wouldn't be able to explain that better than the kids himself so and it's not just about the internet. So this is the idea of this project how to empower teachers to be able to teach these children that consider themselves digital natives and not only. So we are now nowadays in the digital era not only the internet era and also we are nowadays in the period that everybody talks about inclusiveness about equal opportunities. So what does it bring together what we call digital education and digital inclusive education? It's an all inclusive education. It's a paradigm shift. It's a paradigm shift where we have to take into consideration design on one hand designing learning center situations learning center environments based on learning communities on the other hand if we want to have inclusive education is designing universal design for learning. So it's a it's a matter of learning design. The use of technology on one hand we're talking about digital education so we're talking about the potential of technology and the internet and other digital technologies that provides to education and at the same time we're talking about technology that provides accessibility and digital inclusion so it's education for all in the digital era. So the technology is the second aspect and of course participation to be digitally included we need participation and engagement in the learning process and for children with disabilities or other vulnerable groups the importance and children that face challenges the importance is to use technology to provide the differentiation equal opportunities for participation and engagement so participation is the third aspect of our design learning processes digitally inclusive. Can we go to the next slide please? Thank you. So when we're talking about ICT and AT what do we actually mean? Here the main concepts refer to accessible technologies which is the technology that is that includes embedded accessibility so the smartphones we have our computers our laptops they all have embedded accessibility that benefit also learners with disabilities the magnifiers the voiceover on our on our smartphones the narrator on our Windows computer provide what we call accessible technologies. In addition we talk about assistive technologies we talk about technologies that are designed specifically to address the needs of persons with disabilities so these are technologies that may not be embedded in the mainstream technology in the general technology but acquired separately but be compatible with assistive technologies. So it's communication devices for learners that do not have verbal communication switch users that cannot use that have limitations in using the conventional keyboards or mice alternative mice alternative keyboards and so on and of course to make accessible and assistive technology useful for participation we need accessible digital content so the content that is accessed by persons with disabilities by learners with disabilities in our situation needs to be accessible in order to have a meaning for using to have a sense for using our assistive or accessible technologies. Next slide please. Thank you. So why so much emphasis on the role of the teacher because the teacher is in the center of the provision of technology and also the use of technology in this slide is a specific framework we're not going to focus on the framework is used that is often implemented for the assessment of children with disabilities or learners with disabilities for obtaining their individual assistive technologies however we consider this important to present here because it's actually assessing or actually observing what we need to have in mind when designing for learners for all learners the students so what is what are the what is the background what's the learning profile what are the specific competencies of the student the learning environment so anything around the student that needs to be considered when using technology in learning the tasks what are the students expected to do and of course the tools that the students are going to use the teacher's role in this process is very important because the teacher is a source of information in identifying as our competency framework that that's something I presented a highlight that as teachers we need to identify the barriers we need to identify the accessibility requirements of the learners we need to identify the participation requirements so the teacher is a source of information in the process of identifying those needs and identifying the barriers also the teacher is the person that is going to plan the lesson apply and evaluate the learning process and at the same time it's a collaborator in deciding the learning activities the learning tools the learning materials so not that everything is expected from the teacher but has the teachers have a main role a core role in the whole process thank you so what do we do in the skate project and not only for empowering teachers to actually implement the use of ICT and AT in education first of all we identified as identified in the guidelines inclusive pedagogies what is learning for all when we're talking about inclusive pedagogies we're also we are actually talking about the design of the curriculum the learning activities the classroom environment the instructional materials the teaching techniques and assessment procedures that would be flexible in order to include every child every every learner in our classroom and this we have to observe and decide how these are available on to our learners and how they are grounded comprehensively in the pedagogy this is very much can we go to the next slide thank you this is very much relevant to the provision of options so what is important and inclusive education and early childhood education have very common aspects in the in especially in the provision of flexibility and options and early childhood education is a very good start for experimenting with inclusive education pedagogies and why is that because teachers in early childhood education even if we don't have any training in inclusive education specifically early childhood education talks about options stations of learning and breakdown of knowledge and learning processes into small achievable tasks construction of learning in in kinds of differentiation and integrated curricula and programs that are not very much specific only on the discipline but also on the children's interests and profiles so this is how inclusive education inclusive pedagogy and early childhood education come together the main idea is a provision of choices and options can we go to the next slide thank you so this brings us to the universal design for learning the universal design for learning that may be familiar to most of you it's it focuses on the idea that we need to engage learners in learning we need to provide various ways of representing the information and learning and we need to provide various options for students to act and express on their express themselves on their own learning I think the next slide it's more yes it's clear it was very small the diagram in the first the the first the previous slide actually it's a screenshot from the cast the center that developed the learning and the universal design for learning and this is why we used it it's it's the map of the principles and the guidelines of universal design for learning here is a more simplistic presentation that will be easier to understand and follow so one thing the first principle of universal design for learning is learners engagement in order to engage learners into the learning process according to the universal design for learning we need to provide options that activate learners interest motivation and expectations regardless disabilities regardless learning profiles regardless cultural background or other background the third the the second principle the second guideline of the principle of engagement talks about sustaining effort and persistence so it's not only about motivating the learners but it's also about sustaining this effort and persist during the learning process so maintaining this interest and the third guideline talks about self-regulation providing options for learners to act on their own learning understand how they learn and regulate the sense throughout the process the second principle of universal design for learning talks about representation this mainly refers to the way we perceive information so a lot of learners maybe visual learners maybe learners that prefer auditory information learners that prefer that have a different language background or are more visual in the sense of using symbols this is for example very relevant for children that are migrants children that have severe learning disabilities children that use AAC devices documented in alternative communication devices also another guideline of representation talks about the way we understand we process the information and this about has to do with comprehension the way that information is organized and presented to the learners so universal design for learning cares about how we help learners to organize their own understanding of the information provided for the knowledge of the learners provided and the third guideline refers to the way learner act upon their own learning the way we participate so how physical action so for example if all learners are about to cut something draw something read something verbally express something we need options we need options for learners with mobility limitations learner with communication difficulties but also children that may need or won't wish to express themselves alternatively than the conventional way that teachers expect and this has to do with expression communication and of course with the executive functions of critical thinking experimenting and analyzing the information so this is more or less a very very fast the framework of the universal design for learning that is very relevant to the use of technology here's an example of how this leveling through the universal design for learning can be applied with Bloom's taxonomy so if we talk about executive functions and the use we and the way that learners are acting upon their learning or processing the way information is represented as well as getting engaged if we get an example of storytelling for example more or less the example we have here in the level of remembering uh through the Bloom's taxonomy we're talking about remember something know something recall or define so providing options means ask children to match or label or name so uh change the way children act on this learning and presenting or reaching the learning outcome it's very important and having that and doing so technology has an essential role because I'm a bit conscious of time I will not go through uh each level of the Bloom taxonomies but uh this is just to say that how this is just give me a second it seems that I have a battery issue on my computer okay I hope I don't get out of or run out of battery so and so if we move to the next one this is very much connected to the summer model the summer model it's uh it's a model identified for the for the integration of technology uh in general not only assistive technology and it shows how we integrate technology in various levels so integrating technology just to substitute a conventional so we have a projector instead of a whiteboard or to augment so we have an interactive whiteboard so it gives some functional improvement but modification means we have an interactive whiteboard but with online connection that gives access to students that probably are not in the classroom if we bring back the memories of the covid pandemic and redefinition in that interactive whiteboard with online gives also interaction to students that are away and participation uh equal participation so this is the redefinition and transformation of learning and if we put this together with the universal design for learning we see that the two pressure levels are aligned with the representation and action of an expression where the engagement level goes into the redefinition and modification of the learning environment and can you please go to the next Sampian so in terms now of assistive technology and Chris Abbott in 2007 tried to present the taxonomy of assistive technology so if we think that we're using assistive technology just for training which is sometimes interesting and important so training it's through a more medical approach to disability so the idea that we train children in using specific assistive technology for substituting one of the skills that we think impairment takes away so someone cannot see we use technology to augment to have magnification or have a voice recognition and we have this kind of accessibility if we move forward to assist learning if we use this kind of technology to also include the child in a classroom and be able to have access to the visual information we assist learning a step further and in enabling learning if this technology is used to transform the learning experience and provide opportunities for collaboration for access online for getting engaged into the learning process so if we match Abbott's taxonomy with the two frameworks that were presented earlier can we go to the next slide please we have this representation so modification and redefinition means engagement and engagement means actually enabling learning and this is the optimal we need to reach as educators with the use of assistive and assistive technology and ICT in education next slide thank you so what about the learning design in the learning design we need to we're all educators I guess here all have an education background or some knowledge so identifying the barriers and opportunities for the participation in the classroom is one of the main first steps identifying the barriers for accessing technology in the classroom and assessing existing needs is the next step so to help us identify the resources we want to do resources in terms of human resources in terms of artifacts the technology per se this is the first step in planning and then if we want to put this into lesson planning using the principles of universal design for learning then we a good this is a table it's not it's not the only solution but it's a table that helps educators and has been used in the skate project as well as in the unicef guide to guide educators on how we can think our lesson planning so taking one by one the learn the the universal design for learning principles we then think of which of the learning activities we can use and how this can be designed so for engagement for example we need to use meaningful activities that are linked to current issues or to our learners interests we use the relevant digital competences that students have so we don't present we avoid presenting a technology that's totally unknown if it's a new technology that we want to introduce it's important to link that with the learners existing knowledge digital competences as well as our own existing learning and digital competences and then we choose the tools and technology and something else that is missing in this table is the added value a fourth thing we need to think we need to consider is what is the added value of the tools that we are using in terms of reflecting and responding to the principles of universal design for learning and how are these integrated in the learning activities for example in the provide options for representation we are thinking of physical accessibility we talk about children with mobility mobility limitations or children with no verbal communication what are the alternative means that we're using to present our information the knowledge and what are the tools we are going to use so I won't continue as I said I'm conscious of time but this is the main idea and as a final step what we need to consider actually this is a step before implementing before designing the lesson but it's it's it comes to the last part of our guidelines as presented by a give me a second apologies I will need to turn on the power please accept my apologies there was something going wrong with my computer cable it all said thank you so the the final step is oh my god it's going to get me off really really accept my apologies oh my power is off and it shows okay hope now it's okay ah sorry okay so this is the final step of the implementation and you can still hear me right okay apologies again the implementation plan we need to set a time time schedule for this we also need to define the setting so we know which kind of environment we're using we need to set the objectives to be clearly set and decide on the activities identify the persons involved the most important part of identifying the persons involved is because we're not working alone in the classroom so what is important is to identify which are the other stakeholders that means who are the other stakeholders the parents so skate places and places more emphasis on the involvement of parents and the collaboration with teachers also what are the training needs who needs to get trained so it's is it the teacher is it this school assistant is it all of them the parents as well what competencies that do the children need to develop for using ICT and also assistive their own assistive technology so an implementation plan will help the school team and this is very much linked to the second to the final part of the guidelines to stop xante can you please go back to the previous one yes so we involved the whole school approach the collaborations that are identified into the final part of the guidelines and the competency framework and work in a whole school approach and this is why the competency framework was also part of it was also based on the index of inclusion because the index of inclusion emphasizes very much in the whole school approach of inclusive education now we can go to the next one this is just a screenshot of an activity building template that is provided in this gate project of course teachers can use their own activity building schools have their own schools and educational system have have their own templates for lesson planning and activity activity building but this is what was provided by skate so after we have the implementation plan for the school whole school approach after we have the lesson plan for the planning of objectives and activities then we have specific templates for designing each activity in the lesson plan and at the end of the template we have a section of reflection so it's a good suggestion of the skate team is that for each activity teachers need to reflect on how this worked how technology was integrated what needs to be improved for the next implementation of a similar activity or a built-on activity this is another template that is used in one of the annexes of the guidelines that is what was presented actually in the examples of the tables earlier so for each learning objective if we want to break the tasks even further for each learning objective of each activity we can also break down our approach to the universal design of learning principles and to the technology we use of course the technology doesn't need to be different I mean for engagement it shouldn't be a different activity a technology of for representation or action expression it can be different it can be the same the important thing is to be able to make the link of how the technology we use responds to what we need to implement in terms of the universal design for learning guidelines and what is the approach we employ for integrating that technology into the learning process in order to respond to our learning objectives and lead and reach our learning outcomes here is an example of an activity that is built within an accessible software so we can see the example is in Greek it was taken from a greek school and we have greek colleagues here so that makes sense but this is how an activity was built in order to provide visual representation both images and videos the videos of the kitten it's a video and then images also children have the opportunity to listen to the story read and change pages with the use of a switch so it was also accessible for children with physical limitations that cannot use a touchscreen or the the conventionery mouse and they needed clicking for changing their pages or selecting an interact with the screen so here we can reflect on how this software provides the opportunity to provide different means of presentation different means of action and expression so using the switch and also engagement of the learners and this is just a screenshot of of the whole text of the textbook of I think it's third graders in primary education this one and that's all this is our contact details I know I'm a bit for I had we have 45 minutes we used an hour but just to say that this QR code and then we can also copy and paste the link into the chat it's if you have time to go through the documents of the skate project we would appreciate your feedback and if you go through this questionnaire at the end of it you can access the full learning module the four learning modules of the skate project with all the materials so please we would like to have your feedback I know that this was a very short presentation but feel free to provide some feedback and also access the material thank you very much and apologies are getting for my technology issues whenever I have a presentation on technology I have a technology concern it happens it happens during live sessions all the time so it was a very insightful presentation I have to admit and thank you very much thank you everyone for participating we have already served with you in the chat the survey we would like you to fill in and also the link to the skate project Katerina has started with you earlier thank you very much for participating and thank you very much Xantia and Katerina again for accepting our invitation thank you thank you for the invitation it was our pleasure so I hope to see you everyone in our future webinars thank you again and have a nice evening thank you too bye bye everyone


There have been a number of bark beetles plaguing Wyoming's forests in recent years. Receiving the most press is the mountain pine beetle, but others include the Douglas fir and spruce beetle. You don't have to drive far to see entire landscapes of red and brown dead and dying trees. The recent pine beetle epidemic has been generated by the combined factors of aging forests, warmer winters, and an extended drought, resulting in weak trees that make an ideal habitat for bark beetles. Beetles drill into the bark, lay eggs, and hatch larvae that eat away at the living growth layer of a tree. The mountain pine beetle is unique in that it actually injects a fungus into pine trees, thus stopping the tree's flow of nutrients. Although the beetle epidemic is impossible to completely control, land managers are taking steps to lessen the impacts. High value trees can be protected by chemicals and biological controls, or by removing recently infested trees. Forests can deter bark beetles by thinning out dense stands, promoting diversity of tree species in age classes, and by removing newly infested areas. Bark beetles are a natural cyclic forest process. Once the mature beetles run out of trees to infest, or the beetle larvae die off in an unusually cold Wyoming winter, the forest will begin to rejuvenate and come back to a healthy state. From the University of Wyoming Extension, I'm Mae Smith, Exploring the Nature of Wyoming.


I guess I only left a couple of minutes here, but I'm certainly happy to take any questions. And I'm gonna open up the Q&A and see if anything's here. All right, so our first question, is it possible we use diagnostic pheochromosatoma with F-18, eftopa, and go on therapy with MIBG, both tracers on the same mechanism of uptake and kind of cold mean metabolism? I think that's a really interesting idea. And I don't disagree that you can potentially confirm a target expression with something that may be different than the actual agent that you're treating with. And I think we maybe even see that with say the PSMA agents. Chemically, something like F-18, DCFP, YL is distinctly different than something like lutecium dotitate, although they have one sort of moiety in common and that moiety drives the binding of both. So yeah, I don't think we necessarily have to feel kind of chemically constrained to have the exact same molecule. My concern would be more what our source of I131 MIBG is going to be going forward. So that may be kind of more of the problem than what we select with. And then a second question, in your experience, the best time for an F-18 PSMA scan, 90 or 120 minutes, we have issues of bladder and ureter uptake. Yeah, so a couple of things I'm packed there. So there is some data that as you go to later and later time points post injection, you can potentially find subtle things that may have missed at earlier time points. I will say the label in the US is, I think anywhere from 45 up to 90 minutes, I may not have those numbers exactly right. We do tend to scan at one hour at my institution, only because it fits in very neatly with the F-18 FDG workflow that sort of dominates our oncology practice. So I think there are sort of practical advantages to one hour. I do think you may find some subtle things as you go out to those later time points. And I wish I had the flexibility of my pet center to potentially go to those later time points. And in terms of bladder and ureter, yeah, absolutely, it can be tough to read around those. So there are places that give Lasix. We don't, and that's partly because, particularly our patients who are post-prostatectomy, they're already having trouble holding their urine. You hit them, wallop them with a dose of Lasix and you're gonna wind up with a lot of radioactive urine on your pet scanner, all likelihood. So we don't do that, although people do and I don't think it's unreasonable. There have been cities then where patients are catheterized. I can tell you if you take most minimal prostate cancer, they're not gonna want you to put a catheter in them. So we kind of just do our best. We have the patient void right before they get on the table and then we started our acquisition from the bed thighs. So hopefully we're only a couple of minutes, a couple of minutes post their last urination by the time we hit the pelvis. And hopefully that minimizes the amount of, at least urine in the bladder that you have to contend with. With the ureters, it can be challenging. I think it's very incumbent upon us in terms of anatomy to make sure we've got the anatomy right. And then you can potentially, if you're really stuck on ureter versus a lymph node, if you have the flexibility, you could also go and reacquire the pelvis to kind of make sure that if it moves, it must have been ureter. And if it's still there, it's probably a lymph node. Couple more questions and I'll try to get through these fairly quickly. So is it might be G more sensitive than gallium dodetate and neuroblastoma? I don't believe so. I think gallium dodetate is what we're eventually, eventually going to all be doing, although that is not the guidelines recommendation in the U.S. right now. I think in Europe, a lot of those patients are now in an issue with dodetate. And then one last question. Any thoughts on FAPI agents and their promise? Yes, I think FAPI as a diagnostic tool is definitely on the horizon and I hope we have widespread access to it in the very near future. I remain unsure what its ultimate therapeutic applications might be. I fear that when we go and we basically wipe out the cancer associated fibroblasts, that at least some of those cancer associated fibroblasts may be kind of holding the tumor at bay and we don't necessarily understand enough about the biology to know if that's a good thing or a bad thing. So those all remains to be seen, but I agree the fibroblast activating protein, both inhibitors and other things that bind to that, I think are super promising. I do apologize. I think we're a minute or two over time. So I think I'll probably have to kind of stop answering questions, but I really appreciate everyone logging in and it was really a pleasure to speak with you all today and hope to see you back here in the not too distant future. So thank you all again. Hope everyone has a great day.