Placenta Encapsulation

Placentophagy, or consumption of the placenta, has been reported for decades to help stop the baby blues and diminish postpartum fatigue. Some women have mixed it into a smoothie or even taken it raw to tap into its powerful effects. For many who feel squeamish about this or want to reap the benefits of placenta for more than just a day or two, there is another option:
Placenta Encapsulation.

Powdered placenta has been used in Traditional Chinese Medicine for centuries. The placenta’s hormonal makeup is completely unique to the mother.

The benefits include:
• Preventing and lessening the risk of postpartum depression or “baby blues”
• Replenishing iron from blood loss during birth and prevention of post birth anaemia in the mother
• Lending a consistent flow of Oxytocin (the love hormone) long after the birth euphoria ends
• Provides the HPL hormone to help establish early and healthy milk supply for breastfeeding
• Stabilizes constantly fluctuating hormones post birth
• Replenishes B vitamins and energy that was used during the labour and birth process
• Protection from infection and bleeding due to retained placental tissue or membranes

 

The placenta is composed of beneficial hormones, chemicals, iron, and proteins. These healing substances include

• Estrogen, Progesterone, Testosterone: Contributes to mammary gland development in preparation for lactation; stabilizes postpartum mood; regulates post-birth uterine cramping; decreases depression; normalizes and stimulates libido.
• Prolactin: Promotes lactation; increases milk supply; enhances the mothering instinct.
• Oxytocin: Decreases pain and increases bonding in mother and infant; counteracts the production of stress hormones such as Cortisol; greatly reduces postpartum bleeding; enhances the breastfeeding let-down reflex.
• Placental Opioid-Enhancing Factor (POEF): Stimulates the production of your body’s natural opioids, including endorphins; reduces pain; increases well-being.
• Thyroid Stimulating Hormone: Regulates the thyroid gland; boosts energy and supports recovery from stressful events.
• Corticotropin Releasing Hormone (CRH): Low levels of CRH are implicated in postpartum depression. Regulation of CRH helps prevent depression.
• Cortisone: Reduces inflammation and swelling; promotes healing.
• Interferon: Triggers the protective defenses of the immune system to fight infection.
• Prostaglandins: Regulates contractions in the uterus after birth; helps uterus return to its pre-pregnancy size. Anti-inflammatory effects.
• Iron: Replenishes maternal iron stores to combat anemia, a common postpartum condition. Increases energy; decreases fatigue and depression.
• Hemoglobin: Oxygen-carrying molecule which provides a boost in energy.
• Urokinase Inhibiting Factor and Factor XIII: stops bleeding and enhances wound healing.
• Immunoglobulin G (IgG): Antibody molecules which support the immune system.
• Human Placental Lactogen (hPL): This hormone has lactogenic and growth-promoting properties; promotes mammary gland growth in preparation for lactation in the mother. It also regulates maternal glucose, protein, and fat levels.

Studies, Books and Articles

Placentophagy protocol in management of postpartum care
‎”Giving…placenta to a new mother following birth has become standard protocol among a growing number of midwives in the United States. By nourishing the blood and fluids, endocrine glands and organs, Placenta will …reduce or stop postpartum bleeding, speed up recovery, boost energy and relieve postpartum blues.” Homes, Peter. 1993. Jade Remedies, Snow Lotus Press, 352.

The Effect of Ingestion of Desiccated (dried) Placenta on Milk Production
“All patients were given desiccated placenta prepared as previously described (C.A. II, 2492) in doses of 10 grains in a capsule 3 times a day. Only those mothers were chosen for the study whose parturition was normal and only the weights of those infants were recorded whose soul source of nourishment was mothers milk. The growth of 177 infants was studied. The rate of growth is increased by the ingestion of placenta by the mother… the maternal ingestion of dried placenta tissue so stimulates the tissues of the infants feeding on the milk produced during this time, that unit weight is able to add on greater increments of matter, from day to day, than can unit weight of infants feeding on milk from mothers not ingesting this substance.” Hammett, Frederick. S. 1918. The Journal of Biological Chemistry, 36. American Society of Biological Chemists, Rockefeller Institute for Medical Research, original press: Harvard University.

The American journal of obstetrics and diseases of women and children
‎”It has been shown that the feeding of desiccated placenta to women during the first eleven days after parturition causes an increase in the protein and lactose percent of the milk… All the mothers were receiving the same diet, and to the second set 0.6mg of desiccated placenta was fed three times a day throughout the period. Certain definite differences in the progress of growth of the two sets of infants are to be observed. It is evident that the recovery from the postnatal decline in weight is hastened by the consumption of milk produced under the influence of maternally ingested placenta.” McNeile, Lyle G. 1918. The American journal of obstetrics and diseases of women and children, 77. W.A. Townsend & Adams, original press: University of Michigan.

Placenta as Lactagagon
“Powdered Placenta Hominis was used for 57 cases of insufficient lactation. Within
4 days, 48 women had markedly increased milk production, with the remainder
following suit over the next three days.” Bensky/Gamble. 1997. Materia Medica, Eastland Press, 549.
“An attempt was made to increase milk secretion in mothers by administration of dried placenta per os. Of 210 controlled cases only 29 (13.8%) gave negative results; 181 women (86.2%) reacted positively to the treatment, 117 (55.7%) with good and 64 (30.5%) with very good results. It could be shown by similar experiments with a beef preparation that the effective substance in placenta is not protein. Nor does the lyofilised placenta act as a biogenic stimulator so that the good results of placenta administration cannot be explained as a form of tissue therapy per os. The question of a hormonal influence remains open. So far it could be shown that progesterone is probably not active in increasing lactation after administration of dried placenta. This method of treating hypogalactia seems worth noting since the placenta preparation is easily obtained, has not so far been utilized and in our experience is successful in the majority of women.” Soykova-Pachnerova E, et. al.(1954). Gynaecologia 138(6):617-627.

Placentophagia: A Biobehavioral Enigma
KRISTAL, M. B. NEUROSCI. BIOBEHAV. REV. 4(2) 141-150, 1980.
“Although ingestion of the afterbirth during delivery is a reliable component of parturitional behavior of mothers in most mammalian species, we know almost nothing of the direct causes or consequences of the act. Traditional explanations of placentophagia, such as general or specific hunger, are discussed and evaluated in light of recent experimental results. Next, research is reviewed which has attempted to distinguish between placentophagia as a maternal behavior and placentophagia as an ingestive behavior. Finally, consequences of the behavior, which may also be viewed as ultimate causes in an evolutionary sense, are considered, such as the possibility of beneficial effects on maternal behavior or reproductive competence, on protection against predators, and on immunological protection afforded either the mother or the young.”

Placenta for Pain Relief
Placenta ingestion by rats enhances y- and n-opioid antinociception, but suppresses A-opioid antinociception
Jean M. DiPirro*, Mark B. Kristal

Ingestion of placenta or amniotic fluid produces a dramatic enhancement of centrally mediated opioid antinociception in the rat. The present experiments investigated the role of each opioid receptor type (A, y, n) in the antinociception-modulating effects of Placental Opioid-Enhancing Factor (POEF—presumably the active substance). Antinociception was measured on a 52 jC hotplate in adult, female rats after they ingested placenta or control substance (1.0 g) and after they received an intracerebroventricular injection of a y-specific ([D-Pen2,D-Pen5]enkephalin (DPDPE); 0, 30, 50, 62, or 70 nmol), A-specific ([D-Ala2,N-MePhe4,Gly5-ol]enkephalin (DAMGO); 0, 0.21, 0.29, or 0.39 nmol), or n-specific (U-62066; spiradoline; 0, 100, 150, or 200 nmol) opioid receptor agonist. The results showed that ingestion of placenta potentiated y- and n-opioid antinociception, but attenuated A-opioid antinociception. This finding of POEF action as both opioid receptor-specific and complex provides an important basis for understanding the intrinsic pain-suppression mechanisms that are activated during parturition and modified by placentophagia, and important information for the possible use of POEF as an adjunct to opioids in pain management.
D 2004 Elsevier B.V. All rights reserved.

Enhancement of Opioid-Mediated Analgesia: A Solution to the Enigma of Placentophagia.
KRISTAL, M.B. NEUROSCI BIOBEHAV REV 15(3) 425-435, 1991.
Two major consequences of placentophagia, the ingestion of afterbirth materials that occurs usually during mammalian parturition, have been uncovered in the past several years. The first is that increased contact, associated with ingesting placenta and amniotic fluid from the surface of the young, causes an accelerated onset of maternal behavior toward those young. The second, which probably has importance for a broader range of mammalian taxa than the first, is that ingestion of afterbirth materials produces enhancement of ongoing opioid-mediated analgesia. The active substance in placenta and amniotic fluid has been named POEF, for Placental Opioid-Enhancing Factor. Recent research on both consequences is summarized, with particular attention to POEF, the generalizability of the enhancement phenomenon, its locus and mode of action, and its significance for new approaches to the management of pain and addiction.

“The placenta contains high levels of prostaglandin which stimulates involution (an inward curvature or penetration, or, a shrinking or return to a former size) of the uterus, in effect cleaning the uterus out. The placenta also contains small amounts of oxytocin which eases birth stress and causes the smooth muscles around the mammary cells to contract and eject milk. The most general benefit of placentophagy, according to recent research, is that placenta and amniotic fluid contain a molecule (POEF, Placental Opioid-Enhancing Factor) that modifies the activity of endogenous opioids in such a way that produces an enhancement of the natural reduction in pain that occurs shortly after and during delivery.”

Effects of placentophagy on serum prolactin and progesterone concentrations in rats after parturition or superovulation
Blank MS, Friesen HG.: J Reprod Fertil. 1980 Nov;60(2):273-8.
In rats that were allowed to eat the placentae after parturition concentrations of serum prolactin were elevated on Day 1 but concentrations of serum progesterone were depressed on Days 6 and 8 post partum when compared to those of rats prevented from eating the placentae. In rats treated with PMSG to induce superovulation serum prolactin and progesterone values were significantly (P < 0.05) elevated on Days 3 and 5 respectively, after being fed 2 g rat placenta/day for 2 days. However, feeding each rat 4 g placenta/day significantly (P < 0.02) lowered serum progesterone on Day 5. Oestrogen injections or bovine or human placenta in the diet had no effect. The organic phase of a petroleum ether extract of rat placenta (2 g-equivalents/day) lowered peripheral concentrations of progesterone on Day 5, but other extracts were ineffective. We conclude that the rat placenta contains orally-active substance(s) which modify blood levels of pituitary and ovarian hormones.

SEX, TIME AND POWER – HOW WOMEN’S SEXUALITY SHAPED HUMAN EVOLUTION
Leonard Shlain
”The fifth major cause of iron depletion in Gyna sapiens is not so obvious as the previous four but nontheless significantly increases her risk of developing an iron-deficiency anemia. The transfer and loss of iron associated with gestation and brith exist to a lesser degree in other mammalian mothers but still pose a problem. To counter it, Mother Nature equipped females of the other mammalian species with a vital instinct-an urgent hunger driving them to consume their offspring’s placenta. A plump souffle of meaty iron, amino acids and essential fats, the placenta is the consummate first meal a mother should partake of immediately after the ordeal of delivery. It is the perfect replacement for the very nutrients she lost just minutes earlier, because a freshly expelled placenta contains the iron equivalent of one to two blood transfusions. Gyna sapiens have lost her craving for this delicacy. Our closest relatives, chimpanzees, dine with gusto on their afterbirth immediately after delivering their infants.” pg. 28-29.

BIRTH – THE SURPRISING HISTORY OF HOW WE ARE BORN
Tina Cassidy
“In the 1970’s, placentophagy became part of radical home birth customs, particularly in the San Francisco area. One 1980 estimate in Scientific Digest said 5 percent of such West Coast deliveries involved consuming the afterbirth; the East Coast rate among home-birthers was about 1 or 2 percent. It is unclear how many of the placentophagists were vegetarians, but probably many were. They considered the placenta to be sacred, and, of course, because the organ gave life and nothing was killed to put it on the table, it was considered an honor to consume it.” pg. 218

PLACENTA: THE GIFT OF LIFE
Cornelia Enning
“Throughout the world generations have passed down knowledge of how ingesting placenta helps a mother’s postpartum recovery. Women using placenta remedies after birth feel stronger, are happier and can breastfeed more easily….Many conditions during birth, the postpartum period and nursing would not arise if we returned to the old custom of applying placenta remedies.”

PLACENTA – THE FORGOTTEN CHAKRA
Robin Lim
“The placenta, the root of your origin, is a miraculous organ that shares and protects your life. It is the conductor that unites you with your mother and serves as the control panel of the womb-ship that sustains you until you are born. It was conceived at the moment of your genesis. Your placenta is genetically identical to you. Though you share some of your parents’ genetic identity, unless you have a monozygotic (identical) twin, no one, except your placenta, has ever been so perfectly, exactly you. Sexual reproduction, the act of creating new life, only works because of the placenta. As mammals, we reproduce sexually, so sex is the reddest, hottest tile in the mosaic of our earthly lives, and the placenta is the mandala in the center of this miracle. Historically, our creation stories tell of the Earth Mother birthing the world: her amniotic fluid became the oceans, the placenta became the Tree of Life. This demonstrates how essential the placenta is to our survival and how embedded it is in our psyche. According to Chaos Theory, dynamic systems are sensitive to start up conditions. Human beings are extremely dynamic systems, and our survival hinges on the strength of our individual immune systems. The placenta is the commander-in-chief of the baby’s immune system during embryonic development (i.e. condition of start-up). Thus, we must protect our offspring’s placentas by being gentle during the transition of birth, to give our children the best possible start and protect the very foundation of their immune systems.”

Raw Encapsulation – The placenta is prepared and dehydrated from a raw state. This maintains the integrity of the enzymes, vitamins and hormones that are destroyed by heat in the TCM process. Dehydration is done at a low temperature over a longer period. This is the most common choice for mothers.

TCM Encapsulation – The placenta is prepared in the Traditional Chinese Medicine method which includes steaming with ginger, chilli and lemon. This destroys many of the heat sensitive benefits, but some mothers prefer the “warming” aspect of this preparation and the fact that it is cooked.

Placenta Powder – Either method can be chosen and just the powder is prepared, in other words not in capsules.
Placenta Tincture – This is a homoepathic mother tincture that can be used from 6 weeks post-partum (it takes that long to steep and be ready for use). This can be used once the capsules are finished for times of stress – such as returning to work or low milk supply. It can also be used for the baby for teething, sleeplessness and even the first day of school. The tincture can only be ordered if either Raw or TCM encapsulation is part of the service to you.

Placenta Salve – A salve or balm made of your placenta and a variety of healing oils offers healing properties to csection scars once they are closed, haemorrhoids, perineal tearing/episiotomy scars, cracked or blistered nipples, eczema, sun burn, nappy rash, skin irritation and more.

Yes, you can still use your placenta if you have a caesarean or medicated birth as long as your placenta has not been sent to pathology prior to our collection. The placenta is a part of an advanced filtering system. Nutrients from the mother get passed to the baby via the placenta, which tries to filter out anything harmful to the baby before letting it get through. The baby passes waste back to the mother through the placenta, which the mother’s body can then remove, just as her body removes all the other waste products in her system. The placenta is not a filter that traps everything that can’t get through, like an air filter. Those waste products and other things that the baby can’t use are generally sent back out to the mother for removal. We recommend you to have a leak proof container ready to store your placenta after birth. If you are on any other type of medication during your pregnancy, we ask you to seek advice from your Placenta Specialist before deciding on placenta encapsulation.

If you have taken antibiotics for Strep-B, GBS or any other vaginal infection, you would still be able to do Raw encapsulation. We may do TCM (Traditional Chinese Medicine) capsules as a precautionary measure. This will be discussed at the time.

Premature births are often associated with problems in pregnancy. As long as your placenta is examined and cleared from any type of abnormality after birth we are happy to help you with our placenta services.

The equipment to process the placenta is very expensive and it takes an extended period of time to pay this off before we start making any profit. We also use hospital grade cleansers, sterilizers and other equipment which is fairly expensive. It takes between 5-6 hours hands-on work just to process just one placenta, without doing tinctures or any other added services. The service you are receiving from Organic Birth is professional one and we are available at any time to talk about dosage, storage or any questions or concerns you have, no matter how long your capsules may last. In the States placenta encapsulation charges range from R3 000 – 5 500 excluding collection. In the UK charges range between R3 000 – 4 500, and over R1 200 for a tincture preparation.

Yes, you can do both. We advise parents to let the hospital know and ensure their midwife or doctor knows that they wish to have both services. The placenta should be put into the placenta container after birth and stored safely in a cooler bag or fridge.

If your placenta has been sent to pathology in hospital for any reason we cannot process your placenta into capsules because it may have been contaminated while in the pathology department. You can request the hospital to take just a small piece of your placenta for examination in this instance.

Your placenta should be put into one or two medical plastic bags and inserted into a clean, leak proof container after birth and stored in a cooler bag on ice or in a safe refrigerator. You should contact your Placenta Specialist during your labour and soon after your birth to ensure your placenta is collected within 48 hours.

We highly recommend all mothers to choose delayed cord clamping for the benefit of their newborn. Delayed cord clamping involves leaving the umbilical cord intact for at least 3-10 minutes after birth, longer if possible. During this time the cord is still pumping up to 150ml of iron and stem cell rich blood to your baby which has been scientifically proven to have lifelong benefits to your baby. Delayed cord clamping does not affect placenta encapsulation in any way.

Your placenta acted as the life supply for your baby during pregnancy and if it were full of toxins this would make a very dangerous organ for your baby to be fed from, so in fact it is not possible for the placenta to be ‘full of waste’. The placenta acted as a gateway for nutrient supply to your baby and waste from your baby to be passed back to your body to be filtered through your organs. There are small amounts of heavy metals in the placenta, however scientifically proven, these levels are no greater than normal levels of heavy metals found in the body and in mother’s colostrum and breast milk.

We always advise mothers to make use of their placenta sooner rather than later. However, if circumstances arise where this preparation cannot take place within 5 days after birth, placentas are only safe to be stored in the fridge for up to 5 days and must then be transferred to the home freezer. We can prepare placenta remedies up to a year later or even longer if the placenta has been stored correctly.

Of course; however nature has intended for your placenta to be consumed as soon as possible after birth, so we believe ‘the sooner the better’. We advise you read the storage guidelines above. Keep your placenta between 6-16 degrees Celsius after birth using ice packs and cooler bag and transfer the placenta to a safe refrigerator as soon as possible. Contact your local Placenta Specialist as soon as possible to ensure you start benefiting from your placenta sooner rather than later. You can also store your placenta in the freezer for up to a year.

Even if you decide not to encapsulate your placenta, we encourage mothers to keep their placenta anyway. Most hospitals sell on your placenta to pharmaceutical companies for product development and sale. You could have a placenta burial ceremony in your garden to honour the work this sacred organ has done in helping to grow your baby.

Organic Birth Placenta Specialists do not include any other ingredients when preparing placenta capsules. When preparing Traditional Chinese Medicine style capsules we do steam the placenta with lemon (for grounding), ginger (for circulation) and chilli (for heat) which are added to the water when steaming. If you are vegan, please advise your Placenta Specialist so that we use vegetable based capsules and not gelatin capsules.

We recommend taking between 2-6 capsules a day for as long as needed after birth. In our experience placenta capsules have supported many of our clients through many months of successful breastfeeding. Many of our clients notice their milk ‘comes in’ much quicker than expected and remains consistent without problems for weeks postbirth. Those who are choosing placenta encapsulation to prevent the baby blues should contact their local Placenta Specialist during their pregnancy to ensure a specialist is available to start the process within 48 hours after birth. The baby blues often hits mothers between days 3-5 after birth. Most specialists will encourage new mothers to contact them as soon as possible after birth to ensure mothers receive their capsules by day 3-5 after birth in the aim to prevent the baby blues. Remember where possible – early latching, no dummies and bottles, and no scheduling of feeds is the most important when it comes to a successful breastfeeding relationship.

If swallowed normally like any tablet or capsule, you will not notice any taste or smell.

TCM placenta capsules can be stored in the jar provided in a cold, dark place for up to a year, then transferred to a freezer for later use. Raw dried placenta capsules should be consumed within 6-12 months and are stored in a cool, dark place. Placenta Tincture and Salve should be stored in a cool, dark place.

We use size ’0′ capsules when preparing placenta pills. These measure roughly 2cm in length and 0.7cm in width, the size of an average vitamin or herbal supplement. Placentas make between 90-200 capsules depending on the type of method you choose and the size of your placenta. They will generally last between 4-6 weeks. You can also store some in the freezer for your first post-partum period or weaning.

We do not recommend anyone consumes placenta capsules other than the mother who made the placenta however there will be no harm to immediate family members if the mother chooses to share her placenta capsules.

We follow strict regulations and use hospital grade cleansers and sterilisers to ensure our services meet all international placenta encapsulation guidelines. Our Placenta Specialists are all trained in sterile technique and food hygiene.

A lotus birth is when the placenta is left attached to the baby until it detaches on its own, generally after several days. In lotus birth, it is common to salt or otherwise help the placenta dry out more quickly. While traditional lotus birth is a beautiful ceremony honouring the connection between placenta and baby, it renders the placenta unsuitable for consumption.
If lotus birth is important to you, a modified version could be performed while still encapsulating the placenta.
a) The placenta could stay connected to the baby for up to three or four hours. This would give the baby a gentle transition to the world, and the placenta would still be fit for consumption after this amount of time. Do not exceed four hours before separating the placenta and refrigerating it.
b) Another option at four hours postpartum is to sever the portion of placenta that you desire to encapsulate, and place it into the refrigerator. The remainder of the placenta can stay intact, along with the cord to baby until it falls off naturally. This allows a modified version of both lotus and encapsulation while understanding you are not receiving either in full – resulting in fewer capsules, no cord keepsake, and some will be severed (not full lotus.)
Remember that we would like start the encapsulation process within 24 to 48 hours of the birth. We do this because the hormones within the placenta will begin to metabolize and change.

According to other international Placenta Specialists, apparently the mother might feel like she is on a caffeine “high” and in this case it is recommended to cut down on the dosage. Normal post-partum symptoms such as headaches, body aches, swelling etc. are not associated with placenta consumption. If you have any doubt though, you can stop taking them for a couple of days and see if the symptoms stop.

If you would like to order a placenta tincture or extend the use of your current one, be sure to keep at least 3 placenta capsules and be in touch with your Placenta Specialist. However unfortunately we cannot make more supply if you do run out. Our advice is to use your remedies when you feel you need them the most.

Unfortunately, we cannot offer any other services to support mothers who run out of their placenta capsules. There are online sources that offer sheep’s placenta capsules however we highly recommend you research these companies before committing to any type of animal placenta treatment.

You can take your placenta capsules for as long as you feel you need them or intermittently if you are going through a time of stress, or returning to work to maintain your milk supply.

Many of our clients say they simply feel ‘good’ while taking their capsules but are unsure if that’s just the way it would have been had they not consumed their placenta. Try skipping a day or dose and see if you feel any different, then you’ll know if there really is a change or not.

The placenta is designed to help the body recover after childbirth and composes of hormones which may contract the uterus. To prevent any possible contraction of the uterus due to the oxytocin hormone, we advise mothers not to take placenta capsules while pregnant.

There has been and there are ongoing studies at the moment. Please see some information below.
The American journal of obstetrics and diseases of women and children: “It has been shown that the feeding of desiccated placenta to women during the first eleven days after parturition causes an increase in the protein and lactose percent of the milk… All the mothers were receiving the same diet, and to the second set 0.6mg of desiccated placenta was fed three times a day throughout the period. Certain definite differences in the progress of growth of the two sets of infants are to be observed. It is evident that the recovery from the postnatal decline in weight is hastened by the consumption of milk produced under the influence of maternally ingested placenta.” McNeile, Lyle G. 1918.
The American journal of obstetrics and diseases of women and children, 77. W.A. Townsend & Adams, original press: University of Michigan.
Placenta as Lactagagon Soykova-Pachnerova E, et. al.(1954). Gynaecologia 138(6):617-627.An attempt was made to increase milk secretion in mothers by administration of dried placenta per os. Of 210 controlled cases only 29 (13.8%) gave negative results; 181 women (86.2%) reacted positively to the treatment, 117 (55.7%) with good and 64 (30.5%) with very good results. It could be shown by similar experiments with a beef preparation that the effective substance in placenta is not protein. Nor does the lyofilised placenta act as a biogenic stimulator so that the good results of placenta administration cannot be explained as a form of tissue therapy per os. The question of a hormonal influence remains open. So far it could be shown that progesterone is probably not active in increasing lactation after administration of dried placenta. This method of treating hypogalactia seems worth noting since the placenta preparation is easily obtained, has not so far been utilized and in our experience is successful in the majority of women.

Further reading
http://www.placentawise.com/research-studies-supporting-placenta-encapsulation/,
http://www.aaanet.org/mtgs/dev/viewDetail.cfm?itemtype=paper_poster&matchid=24586