text:
A hand held microsurgical instrument for applying laser energy to selected locations (sites) in an area under the skin (or other exposed translucent tissue) to provide localized photothermolysis of underlying tissue at these sites, is described. The laser energy is focused into a spot within the tissue. This spot is of sufficiently small size so that the energy density is sufficient to provide surgical or treatment effects within the tissue without damaging the surface tissue. In dermatology, for example, the technique can be used to destroy endothelial cells in blood vessels which are desired to be removed, such spider veins (nevi) in the skin, hair follicles to prevent hair growth therefrom, or other microsurgical procedures. The area is visualized while the laser beam is steered, using a deflection system, in X and Y coordinates. A telecentric optical system, in which a mirror of the deflection system is located, directs the laser light essentially perpendicular to the area to be treated as the beam is scanned over the area. The optical system also focuses illumination light reflected from the area to a sensor matrix of a CCD video camera. The reflected illumination light is imaged essentially parallel to the optical axis in the object space thereby providing a precise, high resolution image corresponding to the area. The laser beam may be tracked as it is deflected over the area to the selected locations by visualization thereof on a display or monitor associated with the video camera. The locations are then apparent to the treating physician who can then effect an increase of the beam power or turn the beam on so as to treat the tissue in the selected locations.
1. A method for coagulation of vessels in dermal tissue comprising the steps of:
scanning said tissue with a single laser beam at a wavelength from 700 to 1300 nanometers which propagates through optics to select locations of at least one of said vessels in said tissue;
stopping said laser beam at each of said locations while said scanning step is carried out;
focusing said laser beam through said optics to form a spot to cause coagulation of said vessel at each of said locations while said stopping step is carried out; and
visualizing said laser beam while said scanning step is carried out.
2. The method according to claim 1 wherein said scanning step further comprises the step of scanning step-wise in X-Y coordinates said laser beam over an area of said tissue to select locations of at least one of said vessels in said tissue.
3. The method according to claim 1 further comprising the step of controlling said laser beam to operate within defined operational parameters while said scanning step is carried out.
4. The method according to claim 1 wherein said laser beam is operated at wavelengths translucent to said tissue.
5. A method for microsurgery in translucent tissue by thermolysis of internal lesions with a laser beam which comprises the steps of:
projecting said beam at a wavelength from 700 to 1300 nanometers with energy density less than sufficient to cause thermolysis of said tissue to locate a plurality of locations in an area where treatment is carried out; visualizing said area with a solid-state electronic camera which receives light reflected from said area to track said beam while said projecting step is carried out;
stopping said beam at each of said locations; and
focusing said beam to form a spot of sufficiently small cross-section to cause localized thermolysis of the lesion at said locations in said area;
enabling said laser beam while it is stopped at said locations to radiate said focused spot at said locations with energy density sufficient to cause thermolysis of tissue at said locations.
6. The method according to claim 5 wherein said visualizing step further comprises the step of providing television pictures of said area on a video display connected to said solid-state electronic camera.
7. The method according to claim 5 further comprising the steps of altering the intensity of said beam between a level sufficient for visualization of said area with said beam during said visualizing step and a level which provides a photomedical effect so as to enable said beam to be tracked for finding said locations for treatment, and increasing said level when said locations are found to treat said tissue at said locations.
8. The method according to claim 5 wherein said area is under the surface of the skin and said laser beam is of a wavelength causing scattering of said beam by tissue under the surface essentially in the same direction as the direction of which said beam propagates.
9. The method according to claim 5 wherein said beam is of an infrared (IR) wavelength where said tissue is generally translucent to said beam.
10. The method according to claim 5 wherein said projecting step is carried out by deflecting and focusing said beam to move said spot in X, Y and Z directions to locate said spot at different ones of said locations.
11. A method for microsurgery in translucent tissue by thermolysis of internal lesions with a laser beam which comprises the steps of projecting a single laser beam at a wavelength from 700 to 1300 nanometers with energy density less than sufficient to cause thermolysis of said tissue to locate a plurality of locations in an area where treatment is carried out, visualizing said area to track said beam while said projecting step is carried out, stopping said beam at each of said locations, focusing said beam to form a spot of sufficiently small cross-section to cause localized thermolysis of the lesion at said locations in said area, and enabling said laser beam while it is stopped at said locations to radiate said focused spot at said locations with energy density sufficient to cause thermolysis of tissue at said locations.
12. The method according to claim 11 further comprising the steps of altering the intensity of said beam between a level sufficient for visualization of said area with said beam during said visualizing step and a level which provides a photomedical effect so as to enable said beam to be tracked for finding said locations for treatment, and increasing said level when said locations are found to treat said tissue at said locations.
13. The method according to claim 11 wherein said area is under the surface of the skin and said laser beam is of a wavelength such that scattering of said beam by tissue under the surface is essentially in the same direction as the direction of which said beam propagates.
14. The method according to claim 11 wherein said beam is of an infrared (IR) wavelength where said tissue is generally translucent to said beam.
15. The method according to claim 11 wherein said projecting step is carried out by deflecting and focusing said beam to move said spot in X, Y and Z directions to locate said spot at different ones of said locations.
This is a division of application Ser. No. 08/094,296, filed Jul. 21, 1993 pending.
The present invention relates to a system (method and apparatus) for carrying out microsurgical treatments especially in dermatology and particularly for surgery in selected locations under the surface of the skin or other exposed translucent tissue.
The present invention is especially suitable for providing a hand held instrument from which a laser beam projects. The beam is focused by optics in the instrument at spots within an area selected for treatment and is deflected across the area while the area is visualized using an electronic visualization means which provides, with the beam focusing optics, an image corresponding to the area under treatment. The deflection of the beam is controlled during visualization to place the focus (a spot) at the selected locations. Then the beam power may be increased or the beam turned on, as with a shutter or with means such as filters in the shutter, which can alterably attenuate the beam, while the beam is being located at the treatment sites. These sites may be along the veins such as spider veins which are photothermolyzed and undergo coagulation necrosis. Hair follicles can also be photothermolyzed so as to cause depilation. Other microsurgical procedures, such as to break adhesions between tendons and the surrounding sheath may be carried out using the invention.
Devices for medical treatment have been provided which use laser beams. Also handpieces from which laser beams are projected and manually traced over the skin, which may be compressed under glass slides for protection and heat dissipation purposes, are available. Such devices and treatment techniques generally use laser energy of a wavelength which makes it effective for treatment of lesions, because the lesions selectively absorb that wavelength. The general area containing the lesion is effectively flooded with generally collimated laser light of a wavelength that is highly absorbed by the lesion or the laser beam is moved over the area. Selective absorption of the laser light by the lesion is then responsible for photothermolysis. This technique is called selective photothermolysis and is discussed with respect to the skin in an article by R. R. Anderson and J. A. Parrish which appeared in Science, Vol. 220, p. 524, on Apr. 29, 1983. Also, the wavelengths of the laser illumination for selective photothermolysis are subject to scattering and diffusion by the skin. Accordingly, the area exposed to the radiation is heated and may be subject to collateral damage (i.e. reddened or even burned). This produces discomfort to patients and militates against the use of such laser treatment instruments and techniques.
Laser beams have been used for ophthalmological surgery. In such cases, the medium is transparent to the laser beam and can be readily observed through the cornea with ophthalmoscopes. The lens of the eye undergoing treatment may be used to focus the laser beam on the retina. Often the laser beam is manually directed and considerable skill and technique is required for such laser surgery especially to avoid damaging tissue around the site to be treated. It is therefore difficult to precisely deliver the laser energy to the desired sites. See Taboda, U.S. Pat. No. 5,112,328 issued May 12, 1992, for an ophthalmological laser surgery instrument.
The difficulties encountered in laser microsurgery include the lack of a natural focusing mechanism in non-ocular tissues. Also, penetration of the beam so that it is focused and not diffused into a ball shape volume of area too large to concentrate the energy to the level necessary for treatment is faced in all non-ophthalmological laser surgery devices. Also, such devices have not been provided with a visualization system operating at a wavelength appropriate for imaging through turbid, translucent tissue such as skin and other non-ocular tissue, and with sufficient resolving power to enable location of the beam at the selected site where treatment is desired. There have been some suggestions in the area of ophthalmological instruments, but a system including an instrument for other non-ocular microsurgical treatments has not been provided.
It is the principal object of the present invention to provide an improved system for laser assisted microsurgical and especially dermatological treatments in which the treatment area can be visualized while the laser beam is being located at sites in the area where treatment is desired.
It is another object of the present invention to provide an improved system for microsurgery which is automatically operative both for visualization and for location of the laser beam at treatment sites in an area under the skin or other exposed translucent tissue.
It is a still further object of the invention to provide an improved system for microsurgical treatment which utilizes optical energy which is not readily scattered and which can be focused into a spot of sufficiently small area to concentrate the laser beam so that it reaches a level sufficient to provide a photomedical treatment effect.
It is a still further object of the present invention to provide an improved system for microsurgery, especially dermatological surgery which enables coagulation necrosis of spider veins, depilation by cauterization of hair follicles and allows adhesions between tendons and the surrounding sheath to be severed.
It is a still further object of the present invention to provide an improved microsurgery and especially dermatological surgery system using a laser beam of a wavelength which is effective for photothermolysis by virtue of being focused at sites where photothermolysis is desired rather than relying upon selective absorption by chromophores which are selectively absorptive of different wavelengths of optical energy, thereby providing a single instrument using a single wavelength laser beam for different microsurgical and dermatological treatments.
It is a still further object of the present invention to provide an improved system for microsurgery in which heating and burning of the skin or other tissue in the general area being treated is minimized.
It is a still further object of the present invention to provide an improved laser surgery instrument in which an accurate high resolution image is obtained for visualizing and enabling the direction of the beam to selected sites in the area being treated.
Briefly described, a system for thermolysis of tissue in an area under the surface of the skin or other tissue with visualization of the area which is provided in accordance with the invention may be embodied in a housing which is sufficiently small to be hand held. A window in the housing provides a port for illumination of the area under treatment as well as through which the treating laser beam projects. The laser beam may be provided by a laser external of the housing which is introduced into the housing through an optical fiber cable, an articulated optical delivery arm or by a laser, such as a solid state laser (e.g. a laser diode) which is mounted in the housing. The housing contains optical means for projecting and focusing the beam at selected locations or sites in the area at spots sufficiently small in cross-section, for the power and duration of the beam, to cause localized thermolysis of the tissue at the sites to be treated. There are means in the housing for deflecting the beam to locate the spot at the selected sites one at a time. The housing also has means for visualizing the area while the beam is being deflected, thereby verifying that the spots are at the selected sites before the beam is turned on or its energy increased to cause thermolysis.
The foregoing and other objects, features and advantages of the invention, as well as presently preferred embodiments thereof, will become more apparent from a reading of the following description in connection with the accompanying drawings in which:
FIG. 1 is a block diagram illustrating a dermatological laser treatment system embodying the invention;
FIG. 2 is an enlarged view of the handpiece (the hand held instrument) of the system shown in FIG. 1;
FIG. 3 is a diagram schematically showing the housing and internals of the handpiece illustrated in FIG. 3 when viewed from the front;
FIG. 4 is a view of the housing and the internals of the handpiece, but taken from the right side of FIG. 3;
FIG. 5 is a top view of the shutter of the instrument shown in FIGS. 3 and 4;
FIG. 6 is a view similar to FIG. 3 wherein a laser diode and associated circuitry is used internally of the housing;
FIG. 7 is a view similar to FIG. 4 of the instrument shown in FIG. 6;
FIG. 8 is a block diagram of the electronics of the handpiece shown in FIG. 2; and
FIG. 9 is an optical ray diagram illustrating the telecentric optical system of the instrument which is shown in the preceding figures, which, because it is telecentric, enables the area which is scanned to receive a beam, the central ray of which is generally parallel to the optical axis and to produce an image precisely corresponding to the area.
Referring to FIG. 1, a handpiece 10 contains the laser beam delivery and visualization means which projects and scans a laser beam 12 over an area 14 below the surface of the skin or other non-ocular tissue 16 of a patient requiring treatment. The beam is focused in the area at localized points to provide spots in the area at sites where photothermolysis treatment is required. This area may be in a plane generally perpendicular to the central ray of the beam 12. The plane is also generally parallel to a window 18 at the lower end of the handpiece 10 through which the beam projects. The beam may be scanned stepwise in rectangular or X-Y coordinates over the area 14 to the selected sites.
A feature of the invention is that the beam is focused, and particularly telecentrically focused using telecentric optics. The focus is in the plane of the area 14. Telecentric focusing insures that the central ray is perpendicular to the plane of the area 14. The ray is also parallel to the optical axis of the telecentric optics. A preferred form of the telecentric optics is described hereinafter in connection with FIGS. 3, 4 and 9.
The beam is preferably of a wavelength from 700 to 1300 nanometers (nm) where skin and other non-ocular tissues are translucent and where scattering occurs in the forward direction. Thus the light does not tend to reflect back into the tissue and pile up at the surface of the tissue. This minimizes collateral damage (reddening and even burning) of the skin or surface tissue outside of the treatment zone.
Focusing of the beam minimizes reddening and burning and limits the sites of photothermolysis to the spots in the area where the beam is focused. With a generally collimated or flooding type beam the upper layer of the skin can get hotter and can burn before a lesion (or other tissue at the treatment site) is affected by the laser energy. By focusing the beam, the energy penetrates the skin surface to the site to be treated without heating up the upper layers of the skin, since the intensity of the beam is lower in such upper layers than at the focal point. Thus heating of tissue which is in the path of the beam is minimized.
A laser 20 external of the handpiece 10 may be used to provide the optical treating energy. An optical fiber cable 22 delivers the energy from the laser to the handpiece.
The handpiece visualization means is provided by a video camera having a photoreceptor or sensor, preferably an X-Y matrix of CCD (Charge Couple Device) elements which are in a plane perpendicular to the optical axis of the telecentric optics and in a plane perpendicular to the axis. The central ray of the beam, as focused at the imaging or viewing (visualization) plane in which the photoreceptors are located then arrives perpendicular to the visualization plane. Parallax and similar distortion are avoided and a precise high resolution image is obtained with the video camera in the handpiece 10.
Electronics of the system provides a handpiece controller and video signal processor 24 for the camera. The video signals, after processing, may be displayed on a T.V. monitor 26. A cable 30, containing electrical wires connects the controller and processor 24 to the handpiece 10.
The beam is steered by a beam steering device 28 which may be a joystick, trackball or computer mouse type device. The controller 24 obtains signals from the beam steering device 28 and applies them to a beam deflection system utilizing mirrors and motors which step or steer the beam in X and Y directions. The beam deflection system is described in greater detail hereinafter in connection with FIGS. 3 and 4. The controller applies signals (pulses to the motors of the deflection means) to steer the beam in X and Y to the desired locations in the area 14. Automatically, these locations are focused in the visualization plane and an image is provided by the camera. In addition, the entire area may be flood illuminated, suitably by light containing spectral components of a wavelength which, like the wavelength of the laser beam, penetrates the skin without substantial scattering. The return (retroreflected) light, both from the spot where the laser beam is located and from the illumination, is incident on the visualization plane of the camera and an image of the area as well as of the spot where the beam is focused is obtained. From this image as viewed on the monitor the treating physician can steer the beam to the desired location.
The system is especially suitable for coagulation necrosis of spider veins or spider nevi. The nevi are visualized with visible light and the laser beam is tracked along the veins. The energy is then increased and regions along the vein are subject to photothermolysis. The vein is cut off and the pigment, usually blood, is eventually reabsorbed by the body of the patient.
To epilate using the system, the base of the hair follicle is visualized with an infrared illumination source and video camera and the laser spot positioned over the hair follicle. The laser is then operated, for example a shutter is placed to an open position, and a dose of optical energy of sufficient intensity is delivered at the follicle. With a nominal focal spot of 500 micrometers in diameter and a depth of focus of about 100 micrometers, a dose (or energy density) of about 25 Joules per centimeter squared (J/cm2) is produced and the hair follicle and its adjacent blood vessels are destroyed by the heat produced by the absorbed laser energy (i.e. photothermolysis occurs). Because of the focusing of the beam, areas of tissue adjacent to the follicle are unaffected.
The controls and even video processing circuitry may be included in the handpiece 10. FIG. 2 shows a handpiece where the controls and video processing and even the video display (which provides the T.V. image for monitoring purposes) may be provided in the handpiece. FIG. 8 shows the electronic components for carrying out the control and video processing functions.
As shown in FIG. 2, the handpiece is adapted to be held by its distal or rear end 32 in the hand of the treating physician. This end 32 has a keypad with keys projecting from the surface of the housing for entry of laser control parameters, such as laser power, the duration of the laser bursts or pulses, and depth within the tissue of the focused spot as well as information as to the patient and the treatment afforded. In the position of the fore-finger, there is a trigger button which may operate the laser to turn it on and off and may also operate the shutter which controls the laser energy which is delivered through the window 18 at the proximal end of the handpiece 10. This trigger may be a two step switch which when depressed to the first step turns the laser on and to the second step actuates a motor which moves the shutter out of a position where it normally blocks the beam for safety purposes. The thumb of the operator may be used to manipulate a trackball 36 which operates an encoder of the type in a computer mouse and provides the beam steering control, and sends signals to the motors of the beam deflecting system.
A display such as a liquid crystal display may be used to present the image which is viewed by the camera, if an external monitor such as the monitor 26 is not used. The resolution obtained by such a display is less than may be desired for certain operations. Then an external large screen monitor 26 is more desirable. The display may also show the parameters which are entered by the keyboard such as laser power and pulse duration. A suitable operating laser power of 1/4 watt and a suitable pulse duration (the duration of the burst of CW, IR laser energy) of 1/4 second is indicated on the display 40.
Referring to FIG. 3, FIG. 4 and FIG. 9 there is shown a first lens 42 and a second lens 44 of telecentric optics. The optics has an optical axis 46 which provides a focus at the plane of the photoreceptors (the image or visualization plane) of a video camera 48. This camera is preferably a CCD solid state electronic camera having its matrix (an X-Y matrix) located in the image plane 47. The front or first lens 42 provides a front focus in the plane of the area under treatment (14-FIG. 1) and a rear focus midway between the back plane of the planoconvex lenses 42 and 44 (that is, the surface or side of these lenses which is planar).
The rear lens 44 has its front focus in the visualization plane 47 and its rear focus midway between the planar surfaces of the lenses 42 and 44. The midpoint focus is at 49 and intersects the optical axis 46. The focus 49 is the common rear and front focii of the lenses 42 and 44, respectively. Because the optics are telecentric, the central ray of the focused beam always remains perpendicular to the plane of the treatment area and the visualization plane 47, which are perpendicular to the optical axis 46, even as the beam is scanned over the treatment area. When the beam is retroreflected from the area it is focused in the visualization plane. The visualization plane also receives light which is returned through the telecentric lenses 42 and 44 and which is generated by an annular illuminating ring or lamp 52. This lamp has a broad spectrum of light but may contain a majority of its intensity in the infrared region including the wavelength of the laser light to allow visualization below the surface of the tissue. Then the entire area and even some of the surrounding area is visualized and an image thereof is obtained with the video camera 48.
The lenses 42 and 44 form part of the projection means, as does part of the beam deflection or steering means of the system. This deflection and steering means is provided by a first mirror 54 which has an axis of rotation perpendicular to the optical axis 46 and through mid focal point 49 of the lenses 42 and 44. Preferably, the deflecting or scan mirror 54 is a polarization beam splitter which reflects the incoming laser beam in a direction to propagate out of the handpiece 10 through the window 18. The return light has a component with an opposite sense of polarization and passes through the scan mirror 54 to the visualization plane 47.
The scan mirror 54 provides scanning over a first, say the X coordinate of the cartesian coordinates which define the length and width of the area under treatment. Another scan mirror 56 is rotatable about an axis 58. This mirror is tilted at an angle of approximately 45° such that a ray traveling parallel to the x-axis would be reflected into the plane of the diagram illustrated in FIG. 3.
The mirror 56 is carried by an arm 60 which is turned by the shaft (about the axis 58) of a galvanometer type motor 62, which may be a stepper motor. A similar motor 64 rotates the first scan mirror 54. The scan mirror 56 deflects the laser beam 12 along the other or Y coordinate. By controlling the motors 62 and 64, the beam may be located at any selected site in the treatment area and an image of the spot at the site is created at the visualization plane 47 of the camera 48. Thus, both steering and visualization is accomplished simultaneously and automatically. The two mirror steering or deflection system is generally of the type described in U.S. Pat. No. 5,048,904 issued Sep. 17, 1991 to J. I. Montague, which shows a two mirror scanner.
The laser energy is delivered by the optical fiber cable 22 to a fiber ferrule or coupler 66 from which the incoming beam projects and is focused by a lens 68. Lens 68 nominally collimates the beam. A focus mechanism 69, which may be either manual or electromechanical, sets the depth below the surface that the laser light is focused. The focus mechanism 69 moves lens 68 in the z direction relative to ferrule 66. The beam is folded at a fold mirror 70 and is directed to the polarization sensitive scan mirror 54. The beam is then focused by the front lens 42 of the telecentric optics to a spot in the area being treated which may be referred to as the treatment plane.
Focusing the beam increases the irradiance of the beam as it propagates to its nominal focus at the spot in the treatment plane. The half angle of convergence is equal to the arc sign of the numerical aperture of the lens 42 sin-1 (NA) where NA is the numerical aperture of the focused beam. After transmission through the window the half angle of convergence is reduced to sin-1 (NA/n), where n is the refractive index of the tissue. It may be desirable to use the window 18 as a contact plate. Then the material of the window is desirably of high thermal conductivity and is approximately matched to the refractive index of the skin or other tissue (n in the range of approximately 1.35 to 1.55).
Consider the case where the laser has a wavelength of 950 nm, the absorption coefficient of the tissue in the layers under the surface to the treatment area is μ's which is 0.1 mm-1, the scattering coefficient μ's is 10 mm-1. The tissue may have a anisotropy factor g of 0.985. The reduced scattering coefficient μs is then 0.15 (i.e. the reduced scattering coefficent μs =μs (1-g). If the treatment area is 3 mm below the surface of the skin the approximate spot size considering scattering is about 500 micrometers. This is a size which is within the diameter of spider veins and approximately equal to the region at the base of a hair follicle. For a numerical aperture of the focused beam of 0.3, approximately 40% of the incident power from the coupler 66 is delivered in the treatment area. Because of the half angle of convergence the intensity is spread over a much larger area between the surface of the skin and the treatment area. It is believed that the safety margin for avoiding excessive heating which might cause surface tissue damage is 33% of the power delivered from the coupler 66, the beam focused with a lens having a numerical aperture of 0.3 provides a intensity or laser dose (i.e., energy density) above the depth of focus at the treatment area (and the treatment plane) which is sufficient to avoid damage to the tissue above the treatment sites, in the foregoing example.
For personnel safety, protection of the camera 48 and for visualization a shutter 72 is provided by an arm which is rotated in a plane perpendicular to the optical axis 46 by a motor 74, which may be similar to the motors 62 and 64. This shutter 72 is shown in plan view in FIG. 5. The shutter has two sets (a, b, c and 1, 2, 3) of three regions which provide different transmisivity during different modes or stages of operation of the system. The normal or unpowered position of the shutter is with the region 1 in the path of the retroreflective light to the visualization plane 47 in the camera and with the region a (a dense block or no hole at all through the shutter) intercepting the output beam from the coupler 66. This dense block may preferably include a photodetector used to monitor the beam power eminating from ferrule 66. Then the illumination from the lamp 52 can be turned on and the area viewed. This mode or stage of operation may be used to move the instrument to find the desired area without any laser illumination.
When the area has been found the shutter is moved so that the incoming beam is intercepted at region b, containing a neutral density filter which attenuates the laser beam in the path of the output beam from the coupler 66. The region 2 is then in the path of the return light from the spot where the laser beam is focused in the treatment plane. The region 2 may be an open hole. This permits both visible viewing and viewing of the infrared (700 to 1300 nm wavelength illumination) due to the laser beam. In this position of the shutter the system utilizes the laser beam as a spotter or tracking beam to locate the sites to be treated, say a hair follicle or a part of a spider vein to be coagulated, or an adhesion between a tendon and its sheath.
Finally, the shutter is moved to its furtherest position (in a counter clockwise direction in FIG. 5) about the axis 70 of rotation of the shaft 75 of the motor 74. Then, the output beam 66 passes through an open hole c, while a neutral density filter (region 3) is interposed in the return path to protect the television camera (especially the CCD sensor array) during the treatment pulse.
Referring to FIGS. 6 and 7, a hand piece 100 is shown which is identical so far as its visualization and beam projection system is concerned and like parts are identified by like referenced numerals. An external laser is not used. Rather a laser diode 102 is used to produce the infrared radiation. The output of the diode is nominally colliminated by a lens 104 to provide a beam to the fold mirror 70 and thence to the deflection mirrors 56 and 54. The lens 104 mounted to focus mechanism 105, which may be manual or electromechanical, sets the depth below the surface of the tissue to which the laser light is focused. The electronics on which the laser diode 102 may be mounted and also which contains the controller and video processing circuitry is a printed circuit board 106. The components of the circuitry will be more apparent from FIG. 8.
From the foregoing description it will be apparent that there has been provided an improved system (method and apparatus) for microsurgical and especially dermatological treatment which enables visualization of the area being treated as well as provide safety for the patient and the user of the system. Variations and modifications in the herein described system, within the scope of the invention, and numerous other microsurgical procedures than described herein, will undoubtedly suggest themselves to those skilled in the art. Accordingly, the foregoing description should be taken as illustrative and not in a limiting sense.
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Studly Adventurer
Joined: Mar 2007
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Originally Posted by
640 Armageddon
I guess the advantage of having an HDPE roadbook is only because it is cheaper. The flexibility is lost due to the geometry (an open box). So it will not give room (or not give as much as you would think) in order to try something like that. I would prefer the frame to take the blow and give away in case of an accident. Making the equipment itself flexible will not help as much.
A roadbook from composite materials will be lighter, you dont have the Aluminium welds as well but all in all it may be more expensive. touratech did not sell but then again Touratech did not sell well even with its Aluminium unit
The other thing that needs to be considered is that, let's say in Paul's design (because we have seen how it works, no offence Paul) say that the tower goes forward. That means that the fairing will most probable break and then the tower itself will be exposed. I am with safety here and I would prefer 1oo% to buy new equipment than to imprint my chest onto the roadbook but it needs some calculations so it does not break with blows that may not hurt you in the first place
Gany, post some pics!!!!!!
Another HPDE fairing is not far away. That may solve some of the problems with breakages. Also, can someone measure the thickness of the alloy on the F2R roadbook and let me know?
If ignorance is bliss, why aren´t more people happy?????
tileman screwed with this post 09-05-2012 at
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ApplianceWhirlpool Washer
Level of DifficultyEasy
Time to do repair1- 2 hours
Age of ApplianceMore than 10 years
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I simply watched the video that was on YouTube for this site. It was dead on with my washer and super easy to do. The step by step was just awesome and easy to follow. The repair took just over an hour and I even cleaned the entire inside of this 12 year old washer which was pretty cruddy. The washer now spins great and works like new again. All for about $50. Thanks.
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posted: Friday June 28th - 12:26pm
Put the Brakes on Bad Driving
My 17-year-old daughter, who has ADHD, got a speeding ticket this weekend. How can I help her drive more safely?
posted: Friday June 28th - 12:19pm
Herbal Help for ADHD
What is a good herbal supplement for smaller children with ADHD?
There is limited evidence that supports using herbs in treating ADHD. I do use valerian a lot. It calms hyperactivity, but it doesn't improve concentration. Valerian also helps with sleep problems and lessens the "rebound effect" that some kids experience when stimulants wear off. There is a small study that shows that a combination of ginseng and ginkgo helps manage ADHD symptoms, but I do not...
Continue Reading »
posted: Friday June 28th - 12:02pm
School Services — Demystified!
I am trying to get my son an IEP at school, but I am confused by the terminology. What are the differences between "adaptations," "accommodations," and "modifications"?
posted: Wednesday June 26th - 10:55am
Is Brain Imaging a Good Diagnostic Tool?
Can brain imaging help in diagnosing my daughter? We think she has ADHD, and the doctor recommended an MRI. Does this make sense?
posted: Monday June 24th - 10:48am
What's the Right Fish Oil Dosage for My Child?
How much fish oil should my eight-year-old son be getting daily in order to manage his ADHD symptoms? I can't find any information on this.
We have not determined exact dosages for kids. The studies done on omega-3s for ADHD have used a wide range of doses. I base my dosage on the total amounts of EPA and DHA in the fish oil product. You can almost always find this listed in the ingredients section. For younger children, between four and eight years old, I recommend a dose of 1,000-1,500 milligrams...
Continue Reading »
posted: Monday June 17th - 12:15pm
I'll Lose My Job If I Don't Stay Motivated!
I love my job, and I know if I don't do it well, I will lose it. Still, my ADHD makes it hard for me to stay motivated. Can you help?
posted: Monday June 17th - 12:01pm
Is My ADHD Husband Lazy?
When I work late at night, I often return home to find that my ADHD spouse didn't put the kids to bed. They're asleep on the couch, still dressed. He seems too lazy to get up, read to them, and get them under the covers. What do I do?
posted: Monday June 17th - 11:48am
How to Form Good Habits with Adult ADHD
I have ADHD, and I find it hard to turn goals into habits. How long does it take for an ADDer to do that?
It takes someone about three months to form a habit, whether they have ADHD or not. The best way to form a habit is to create a "ritual" — an activity or set of activities that you keep doing the same way. Say you're always losing your keys in your house because you put them down in different places. Create a ritual set of behaviors: 1) walk in;...
Continue Reading »
posted: Monday June 17th - 11:32am
Should I Tell My Parents They Have ADHD?
Now that I know about my ADHD, I think that my parents, both in their 80s, also have it. I wonder if I should bring this to their attention?
posted: Monday June 17th - 11:15am« The Experts's blog
Appointment Help for ADHD Adults
I am a business owner with ADHD. Can you recommend a gadget, app, or computer program that will help me avoid being late for meetings?
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Garden gnomes Gnomeo (voice of James McAvoy) and Juliet (voice of Emily Blunt) have as many obstacles to overcome as their quasi namesakes when they are caught up in a feud between neighbors. But with plastic pink flamingos and lawnmower races in the mix, can this young couple find lasting happiness?
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[December 03, 2012]
Evzdrop's Mobile App and Web Platform Now Allow Businesses to Communicate with Users in Real Time
Chicago, IL, Dec 03, 2012 (PRWeb.com via COMTEX) -- Evzdrop, a Chicago-based tech startup that connects people to places in real time, released today version 1.1 of its iPhone app and Web platform. Among Evzdrop's key enhancements is the ability for businesses to become a part of the conversation and communicate with customers at their location and those nearby through uniquely identified 'green Drops.' The location-based app allows users to "eavesdrop" on places through people on site who post, or "Drop," about their experience. Location-verified users can Drop real-time reviews of up to 140 characters, with or without a photo, from stores, restaurants, bars, stadiums, hotels or other venues. When a user comments, their Drop falls onto the Evzdrop Radar, or map, as a pin and is highlighted in red for 10 minutes before changing to blue. With Evzdrop 1.1, businesses can now join the conversation as authorized users and create their own content that will be distinguished from customers' Drops by being highlighted in green.
"Many businesses continue to be frustrated by the traditional review site process, so giving them the ability to have a voice in the conversation in real time is invaluable," said David Rush, Evzdrop's co-founder and CEO.
For example, if an Evzdrop user visits a store and Drops that an item is out of stock, the business will be instantly alerted and can inform the Evzdrop community when it is restocked. "We wanted to give businesses a new way to access real-time sentiment to improve the overall customer experience," Rush said. Businesses can also take advantage of Evzdrop's business platform to deploy custom campaigns that intelligently target users through push notifications based on demographic, time of day, sentiment, location and other criteria.
"We're excited about the possibilities that working with Evzdrop presents," said Gina Veneziano, marketing and media manager at Berghoff Catering & Restaurant Group. "Being able to listen to our guests' feedback in real time makes us that much more in-tune with what they want and what we can do to ensure an awesome dining experience for everyone." Businesses can also issue green Drops to draw a customer's attention to a flash sale or time-based promotion. Users will see the Drop fall on the Radar in real time if they are within 10 miles of the business and receive a push notification if they are "Listening" to the place. "We are giving businesses more control over the parameters of well-timed promotions to drive in-store traffic and promote new services or products," Rush said.
Evzdrop is already working with several businesses across different verticals to deliver real-time custom campaigns and insights. These businesses include Chicago hotels such as Fairmont Chicago, Millennium Park, dana hotel and spa, ACME Hotel Company and InterContinental Chicago Magnificent Mile and well-known Chicago restaurants including The Berghoff Restaurant, Piccolo Sogno, aria restaurant and bar, and Koi. In addition, iconic Chicago attractions such as the Chicago Architecture Foundation and Blue Man Group are now on board in leveraging Evzdrop's platform and app to better engage their audience and customer base.
"Feedback from our customers is vital to ensure that we are providing the best possible service, as well as delicious food," said Sandy Chen, owner of Koi. "With Evzdrop, we're able to see trends and listen to what our customers are saying in real time. The ability to create flash specials and offers helps us reach both our loyal customers and local visitors." Businesses can unlock their analytics and set up customer campaigns on the Evzdrop website. The app is available for free in the iTunes App Store. An Android version of Evzdrop is currently in development. For more information about Evzdrop, visit
or contact Evzdrop at info(at)evzdrop(dot)com.
About Evzdrop Evzdrop is a Chicago-based tech startup and location-based interest network that allows people stay connected to what's happening at places in real time. The free mobile app and Web platform allow users to "eavesdrop" to get an inside look at any place they're interested in through the people who are present and posting about what's going on at any given moment. Businesses can take advantage of Evzdrop's custom campaigns and analytics dashboard to impact in-store experience, engagement and overall customer satisfaction. Evzdrop has seen more than 6,500 downloads and Drops from more than 3,600 unique places around the world since its September launch. For more information, visit
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text:
FIG. 1 is a top, heel end, perspective view of a right foot component of a pair of slippers, embodying my new design, the left component has not been shown for ease of illustration;
FIG. 2 is a top plan view thereof;
FIG. 3 is a bottom plan view thereof;
FIG. 4 is a right side elevational view thereof;
FIG. 5 is a left side elevational view thereof;
FIG. 6 is a toe end elevational view thereof; and,
FIG. 7 is a heel end elevational thereof.
The broken lines shown at the end of the solid lines in FIG. 1 represent the bounds of the claimed design while all other broken lines are directed to environment and are for illustrative purposes only; the broken lines form no part of the claimed design.


text:
I am writing a program to better learn to program and I wish to use RSpec so that I can learn that as well. However, as is, the code isn't particularly RSpec friendly, so I need to break it up into methods so that I can test it.
I don't need anyone to write the code for me, but perhaps explain how I can break it up. I am new to programming and this kind of thing (breaking things up into methods) is a really difficult concept for me.
Here's what I have:
if params[:url] != ''
url = params[:url] #line created so I can return url more easily (or, in general)
words = params[:word].gsub("\n", ",").delete("\r").split(",") #.delete redundant?
return "#{words}", "#{url}" #so that I can return url, not sure how to do that yet
The code is a SERP checker, it takes a url and keywords and checks their location in the search engines.
For url, it'll just be the url of the website the user wishes to check... for word, it would be the keywords they wish to check their site against in Google.. a user may fill out the input form like so:
Corn on the cob,
Chat, Meta, About
Ask Question


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Mon September 9, 2013
Sailor Proposes To Girlfriend Among Flash Mob Dancers
By editor
Originally published on Mon September 9, 2013 4:25 am
Good morning, I'm Steve Inskeep with congratulations to Michael Turner. He's a sailor on a guided missile destroyer. He wanted to propose to Jamie Story before he was deployed, so he invited her to dinner in Virginia Beach. And according to the Virginian-Pilot, that's when the flash mob appeared. Mr. Turner arranged for 50 dancers to do synchronized steps on the street as he proposed. Luckily, she said yes, 'cause otherwise it would have been awkward.
It's MORNING EDITION. Transcript provided by NPR, Copyright NPR.


text:
ences, 1989). At over 50 kg per day per American, even the rough profile developed here demonstrates the need for meshing environmental and materials research. Metrics highlight the locations and relative urgency of incorporating environmental goals into materials research programs. Significantly, these goals often overlap with factors affecting the bottom line such as reducing inputs, improving efficiency, recycling, and complying with environmental regulations.
Future materials fluxes, including both products and by-products, may even exceed contemporary ones in size. To make them environmentally compatible, we need better methods for analyzing their current condition and anticipating future changes. To achieve the goal of a more circular economy, society needs to consider its materials legacy as a dowry to future generations, rich in valuable ore. By capitalizing on the "mines above ground" or scrap piles for materials, wastes from extraction and disposal grow dispensable. We can imagine an industrial ecosystem in which emissions, including carbon and water vapor, are captured and complex waste streams are separated to recover the value and utility of their components. The discipline of creating national materials metrics is a useful start to creating a consistent, realistic long-range technical vision.
We are indebted to Donald Rogich, Jim Lemons, and Grecia Matos at the Bureau of Mines for data and ideas on materials taxonomy.
In this paper we draw on other work by the authors (Wernick and Ausubel, 1995) that contains detailed data supporting the metrics presented here.
Domestic stock refers to materials embedded in structures and products not discarded for a period longer than 1 year.
We include atmospheric nitrogen fixed into NOx emissions as well as for ammonia production. We omit estimates of the mass of soil eroded during agricultural operations.
A clear example of this is annual total U.S. dioxin and furan emissions, which are counted in kilograms rather than tons, yet have considerable environmental impact (Thomas and Spiro, 1995).
A complete net carbon balance for forests includes annual carbon flows in trees, soil, forest floor, and understory vegetation. Since 1952, the amount of carbon stored in U.S. forests has grown 38 percent, adding about 9 billion metric tons of carbon (Birdsey et al., 1993).
Agarwal, J. C. 1990. Minerals, energy, and the environment. Pp. 389-395 in Energy and the Environment in the 21st Century, J. W. Tester, D. O. Wood, and N. A. Ferrari, eds. Proceedings of a conference held at Massachusetts Institute of Technology, Cambridge, Mass., March 26-28, 1990.


text:
This paper reviews current legislative provisions for young people to access sexual health services and sexual health education in New Zealand. The paper focuses specifically on access to contraceptive and abortion services, and school-based sexual health education. Current legislation is considered in light of its consistency in recognising the rights of young people to express their views and have these views considered.
The sexual health of young people is of concern to policy makers around the world. In most countries, access to sexual health services and sexual health education are strongly contested areas of social policy. Strategies to improve adolescent sexual health have varied in their focus and breadth. In Britain, which has the highest rate of teenage pregnancy in Western Europe, the focus has been on reducing teenage pregnancy. A comprehensive action plan, which is part of a strategic agenda to reduce social exclusion, is designed to halve the British teenage pregnancy rate in 10 years' time (Social Exclusion Unit 1999). The action plan has a strong emphasis on the need to provide young people with clear and consistent messages on matters relating to sexual health.
The New Zealand Government is currently preparing a strategy to improve the sexual and reproductive health of all New Zealanders. The development and implementation of such a strategy, particularly components relating to young people, are likely to be contentious. In the past, much of the controversy has focused on the extent to which young people's sexual activity should be acknowledged and responded to, as well as the rights of young people to access sexual health services and education without their parents' knowledge or consent.
This paper outlines current legislative provisions for young people's access to sexual health services and school-based sexual health education. It suggests that current legislation is inconsistent and that this has potential to send mixed messages to young people.
Studies of adolescent sexual activity in New Zealand indicate that by age 15, 8.5% of New Zealand adolescents have had sexual intercourse, and in one third of cases this is unprotected. Girls aged 15 or less are more likely than boys of the same age to have had sex (Lynskey and Fergusson 1993). By 18 years of age, 58% of males and 68% of females report having sexual intercourse in the past 12 months. Sixteen per cent of these report intercourse before they were 15, and 30% before they turned 16 (Dickson et al. 1998).
Contraceptive use in adolescence tends to be erratic. When contraceptives are used, they are often methods that are less effective in preventing pregnancy. As a result, sexual activity results in pregnancy for many young women. In 1998, there were 34 births to women aged 14 or under, and 3,879 to those aged 15-19 (Statistics New Zealand 1999). In addition, many adolescent pregnancies are terminated by abortion. Of the 15,029 induced abortions in 1998, 2,897 (19.3%) were for young women aged 12-19 years (Abortion Supervisory Committee 1999). Between 1986 and 1995, the ratio of induced abortions to live births for those under 15 years of age was approximately 1:1 (Ministry of Health 1998). Within the OECD, New Zealand's birth rate in the 15-19 years age group is second only to the USA.
These data suggest that New Zealand has an urgent need to develop clear and consistent policies to reduce the adverse health, education and welfare consequences of adolescent sexual activity.
This section provides a brief review of legislative provisions for young people to access sexual health services and sexual health education in New Zealand.
Contraceptive Services
Until 1990, legislation in New Zealand restricted access to contraceptives and contraceptive services by people under 16 years of age. Section 3 of the Contraception, Sterilisation and Abortion Act 1977 had made it illegal to provide contraceptives or contraceptive advice to anyone under the age of 16 years, although the legislation included a number of people who were exempt from this restriction. These people included parents or guardians, registered medical practitioners, authorised representatives of any family planning clinic, pharmacists actioning prescriptions, social workers, counsellors and, in the case of a school, any person approved by a principal after agreement with the board of governors or school committee.
The 1990 repeal of Section 3 of the Contraception, Sterilisation and Abortion Act 1977 removed all restrictions on the advice and supply of contraceptives to those under 16 years of age. Young people of any age now have the right to access information about contraception and to be supplied with contraceptive products without parental consent.
Abortion Services
Legislation regarding young people's rights to access abortion services is contained in the Contraception, Sterilisation and Abortion Act 1977, and a 1977 amendment to the Guardianship Act 1968.
Section 32 of the Contraception, Sterilisation and Abortion Act 1977 outlines the procedure that must be followed when a woman of any age seeks an abortion. The law requires two certifying consultants (both of whom must be registered medical practitioners and at least one of whom must be a practising obstetrician or gynaecologist) to consider each woman's case, and agree that her case fits the criteria for abortion outlined in Section 187A of the Crimes Act 1964.
Section 32 (7) of the Contraception, Sterilisation and Abortion Act 1977 notes:
Every certifying consultant may, in considering any case, with the consent of the patient, consult with any other person (whether or not a registered medical practitioner) as he (sic) thinks fit in order to assist him in his consideration of the case, but he shall not disclose that patient's identity without her consent.
In the case of a young woman, this means that a certifying consultant may consult with the young woman's parents only if the young woman agrees. While in most cases practitioners would encourage a young woman to discuss these matters with her parents or other adults, the law provides young women with the right to choose not to involve them.
Further direction on young people's rights regarding abortion services is contained in the Guardianship Act 1968. A 1977 amendment inserted Section 25A (Consent to abortions). This section states:
a female child (of whatever age) may -- a) Consent to the carrying out on her of any medical or surgical procedure for the purposes of terminating her pregnancy by a person professionally qualified to carry it out: or b) Refuse her consent to the carrying out on her of any such procedure, -- and her consent or refusal to consent shall have the same effect as if she were of full age.
The Guardianship Act therefore provides young women with legislated rights to decide whether or not to proceed with an abortion. Regardless of age, parental consent is not required.
School-based Sexual Health Education
While legislation provides young people with rights to make their own decisions on accessing contraceptive and abortion services, without parental consent, a contrary stance is adopted in legislation governing access to school-based sexual health education.
Section 105D, entitled "Parents and guardians may require students to be excluded from health education classes", is a 1985 amendment to the Education Act 1964. Subsection 1 reads:
A parent or guardian of a student enrolled at a State primary or secondary school may at any time, by notice in writing to the principal of that school, require that student to be excluded from every class in which any element of the health education syllabus at that school which is sex education is being taught; and may similarly withdraw such notice.
Subsection 2 reads:
For so long as a notice under subsection (1) of this section is in force, the principal of the school concerned shall ensure that the student concerned is excluded accordingly.
The Education Act 1964 applies to all students of school age. Potentially, the wishes of a 17- or 18-year-old could be overridden by those of a parent or guardian. Further, the written notice may be prepared by the parent when the student is young and, unless withdrawn, will still be in force when the student is older. Principals are required to follow the wishes of parents, as the Act contains no provisions for the needs or wishes of a young person of any age to be considered.
One might expect that if there were to be constraints on young people's rights to access contraception and abortion services, and sexual health education, an escalating level of risk might be matched by an escalating level of constraint. In fact, the reverse is true. Young people have rights to consent (or not consent) to the performing of an abortion, and to decide whether to access contraception. But they have no rights to access school-based sexual health education if their parents require their withdrawal from classes.
Some might argue that while contraception and abortion are essentially private matters, school-based sexual health education occurs in a more public environment. But the irony is that the Education Act 1964 provisions have the potential to restrict the access of young people to information that may delay the initiation of sexual activity (and thus of contraceptive use) and prevent the need for access to abortion services. The current legislation has the effect of sending mixed messages to young people on issues regarding sexual health.
Historical Context of the Legislation
A brief background to the development of Section 105D of the Education Act 1964 will aid understanding of the climate within which these provisions were made. Section 105D (together with Section 105C which requires schools to consult parents on the treatment of the health syllabus) was added in 1985 as the legislative underpinning to the introduction of the syllabus Health Education in Primary and Secondary Schools (Department of Education 1985). This syllabus contained specific provision for sexual health education beginning at Form 1 Level (Year 7), while supporting the development of knowledge, skills and attitudes to enhance relationships, care for the body and keep safe, at levels below this. The 1985 syllabus replaced one developed in 1945 which contained no provision for the inclusion of group or class instruction in sexual health education at primary school. The development of the 1985 syllabus with its provision for group and class instruction in sexual health education was contentious. It is likely that if clauses relating to parental rights to withdraw their child from sexual health classes had not been included, the introduction of the entire syllabus would have been delayed or its implementation restricted.
Fifteen years later, however, much has changed. Social attitudes to sexual health have become more liberal, other legislative changes have helped to clarify the rights of children and young people in New Zealand, and New Zealand has ratified the United Nations Convention on the Rights of the Child.
More liberal societal attitudes, precipitated in part by responsiveness to the AIDS pandemic, have resulted in greater acceptance of the need for young people to have access to knowledge, skills and services to keep themselves and others healthy. This period has also seen the removal of restrictions on access to contraceptives following the 1990 repeal of Section 3 of the Contraception, Sterilisation and Abortion Act 1977. In addition, a new syllabus for primary and secondary schools, Health and Physical Education in the New Zealand Curriculum (Ministry of Education 1999), includes specific provision for sexual health education from Year 1 (new entrants at primary school).
Extensions of the Rights of Children and Young People
The last 15 years have also seen the enactment of new legislation in New Zealand providing an extension of the rights of children and young people. The Children, Young Persons and their Families Act (1989) includes as one of its guiding principles that:
... consideration should be given to the wishes of the child or young person, so far as those wishes can reasonably be ascertained, and that those wishes should be given such weight as is appropriate in the circumstances, having regard to the age, maturity, and culture of the child or young person. (Section 5d)
This principle recognises that children and young people have a right to express their wishes and to have those wishes considered.
The Bill of Rights Act 1990 has also come into force. Section 14 of this Act, relating to freedom of expression, notes that:
Everyone has the right to freedom of expression, including the freedom to seek, receive and impart information and opinions of any kind and in any form.
While this Act does not override inconsistent legislation and applies only to those over 16 years of age, it signals that seeking and receiving information is a fundamental right.
New provisions have also been added to the Education Act 1989. A 1991 amendment to this Act inserted Section 25A, which deals with release from tuition on religious or cultural grounds. Section 25A does not override the provisions of Section 105D of the Education Act 1964, and schools are still bound by the latter when issues relating to sexual health education arise. In common with Section 105D of the Education Act 1964, Section 25A of the Education Act 1989 allows a parent of a student in a State school to write to the principal of that school regarding the release of the student from tuition.
But Section 25A of the Education Act 1989 and Section 105D of the Education Act 1964 contain some significant differences. Section 25A, relating to release from tuition on religious or cultural grounds, indicates that such a letter will "request" that the student be excluded. Section 105D, relating to release from sex education classes, indicates that such a letter will "require" the student to be excluded from every class in which sex education is taught. Further, Section 25A imposes an age limit. Parents can request this exclusion only for students under 18 years of age. There is no upper age limit in Section 105D. While the overwhelming majority of school students are under 18 years of age, some are older than this, and so could be affected by the provisions of Section 105D.
Most importantly, Section 25A requires the principal to ascertain the student's views on being released from tuition. In doing this, the principal is required to consider the student's age, maturity and ability to express views, as well as any views that the student actually expresses. Only then can the principal consider the release of the student from tuition. There is no provision in Section 105D for the principal to listen to or consider the views of the student in relation to sexual health education.
In the international arena there have also been a number of changes. A landmark case in young people's rights and sexual health is that of Gillick v West Norfolk and Wisbech Area Health Authority [1986]. In this case a parent objected to the Area Health Authority's advice that contraceptive advice and devices could be provided to young people without consulting their parents or gaining parental consent. The House of Lords decided that parents have a "dwindling right" to control a child who is a minor and that the child's maturity, intelligence and understanding are relevant factors to be considered. While decisions such as these are not binding in New Zealand, they provide important markers of legal thinking on children's and young people's rights.
There is also growing international recognition of the legal and social rights of children and young people. Paternalistic attitudes, which see adults as always knowing what is best, are being replaced with a growing recognition of the rights of young people to have a voice on issues that affect them. This is reflected most clearly in the 1989 United Nations Convention on the Rights of the Child(2), which New Zealand ratified in 1993. Article 12 of the Convention notes:
State Parties shall assure to the child who is capable of forming his or her own views the right to express those views freely in all matters affecting the child, the views of the child being given due weight in accordance with the age and maturity of the child.
Section 105D of the Education Act 1964 appears contrary to this Article. When a country ratifies a United Nations Convention it is obliged under international law to comply with the Convention's principles and standards. It appears that New Zealand could revisit Section 105D in terms of its obligations under this Convention.
Issues raised in this paper indicate that New Zealand legislation relating to the provision of sexual health information and services to young people is inconsistent. Section 105D of the Education Act 1964 is not only out of step with other sexual health legislation in New Zealand, but it is also out of step with international developments on children's and young people's rights.
Section 105D of the Education Act 1964 is also inconsistent with Section 25A of the Education Act 1989. Section 25A not only respects the rights of parents to request the exclusion of their children from class, but also provides children and young people with rights to express their views and have these views considered. Although its "under 18 years of age" provisions may be wider than should be sought, it is a preferable alternative to Section 105D which contains no provision for young people's views to be considered.
Section 105D of the Education Act 1964 needs to be repealed because its continuing existence leaves young people without a voice on an issue that fundamentally affects them.
A discussion paper on the review of the Guardianship Act 1968 was released in August 2000 (Ministry of Justice 2000). Issues relating to young women's access to abortion services are not covered in this discussion document. Nevertheless it is likely that some may see the review as providing an opportunity to recommend the removal of Section 25A provisions allowing young women to agree or not agree to the performing of an abortion without parental consent.
Those who oppose these provisions often suggest that young women make such decisions in the absence of adult input. In fact the Section 32 provisions of the Contraception, Sterilisation and Abortion Act 1977, which require all those seeking an abortion to meet with two certifying consultants, ensure that all women discuss pregnancy options with at least two other adults. In addition, women will have been counselled by a (non-certifying consultant) GP, a nurse, a counsellor or other health professional. All of these adults are trained to assess young people's competence to make decisions.
Requirements for adolescents to have parental consent or for parents to receive pre-abortion notification have been enacted in some areas of the USA. All such laws are required to be accompanied by provision for judicial bypass. A review of these laws indicates that they place greater stress on adolescents and can result in health-compromising delays in seeking abortion. They also place time-consuming requirements on adolescents, health service providers, and courts (Cartoof and Lerman 1986). Comparisons of the effects of such laws in Minnesota, which has mandated parental notification, and Wisconsin which does not, found that similar proportions of adolescents chose to notify or not notify parents of their pregnancy decision. The factor that most determined whether an adolescent notified her parents was her perception of the quality of communication in the home, not the presence of a law requiring parental notification (Blum et al 1990, 1987).
These experiences suggest that any reversal of the current law in New Zealand would have detrimental effects on adolescent health.
The development of a reproductive and sexual health strategy provides policy makers with opportunities to improve the health of young New Zealanders. Opportunities for coordination, clarity and consistency are more likely to be realised if policy makers address the current legislative inconsistencies.
(1) This paper is based on one presented to the Third Pacific Rim Conference of the International Association for Adolescent Health held at Lincoln University, Christchurch 25-28 June 2000.
(2) The Convention defines "child" as a person below the age of 18 years.
Abortion Supervisory Committee (1999) Report of the Abortion Supervisory Committee for 1998, Abortion Supervisory Committee, Wellington.
Blum, R.W., M.D. Resnick and T.A. Stark (1990) "Factors associated with the use of court bypass by minors to obtain abortions" Family Planning Perspectives, 22(4):158-160.
Blum, R.W., M.D. Resnick and T.A. Stark (1987) "The impact of parental notification law on adolescent abortion decision making" American Journal of Public Health, 77:619-620.
Cartoof, V., and L. Lerman (1986) "Parent consent for abortion: Impact of the Massachusetts law" American Journal of Public Health, 76:397-400.
Department of Education (1985) Health Education in Primary and Secondary Schools, Department of Education, Wellington.
Dickson, N., C. Paul, P. Herbison and P. Silva (1998) "First sexual intercourse: age, coercion, and later regrets reported by a birth cohort" British Medical Journal, 316:29-33.
Lynskey, M.T., and D.M. Fergusson (1993) "Sexual Activity and Contraceptive Use Amongst Teenagers under the Age of 15 Years" New Zealand Medical Journal, 106:511-514.
Ministry of Education (1999) Health and Physical Education in the New Zealand Curriculum, Learning Media, Wellington.
Ministry of Health (1998) Our Children's Health: Key Findings on the Health of New Zealand Children, Ministry of Health, Wellington.
Ministry of Justice (2000) "Responsibilities for children, especially when parents part: The laws about guardianship, custody and access" Discussion Paper, Ministry of Justice, Wellington.
Social Exclusion Unit, Cabinet Office (1999) Teenage Pregnancy, The Stationery Office, London.
Statistics New Zealand (1999) Demographic Trends 1998, Statistics New Zealand, Wellington.
United Nations (1989) United Nations Convention on the Rights of the Child, United Nations, Geneva.
Barbara Collins PhD Candidate Department of Sociology and Social Policy Victoria University of Wellington
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