Pessaries have been used for centuries in the management of uterine prolapse. Although surgical repair has been popularized by surgeons and gynecologists for younger women with pelvic relaxation, pessaries remain a useful palliative strategy for patients who refuse surgery or represent higher operative risks. Despite the fact that pessaries are commonly used today, there is scant geriatric literature to describe their use among elderly patients. This article will review the indications and management of pessaries among elderly women with the goal of preventing complications and promoting investigation for their clinical application.
School districts in some urban areas are facing reduced enrollments. Educational and economic considerations dictate closing schools. Parents, on the other hand, often resist closing neighborhood elementary schools and object to having children periodically reassigned. This paper presents an interactive procedure for establishing, under conditions of declining enrollment, boundaries that reflect educational, economic, and parental concerns. The procedure can incorporate a variety of administrative policies and requires inputs from administrators regarding characteristics of the district. The multi-period planning horizon is decomposed by year with coordination taking place through the use of restriction in a linear programming problem that forms the basis for reassignment of districts. The emphasis is not on optimization but rather on the achievement of a solution which satisfies the objectives of each group. Feasibility checks are designed to reduce the number of alternatives that must be considered in detail, and feasible solutions can be compared on the basis of summary statistics.
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