Screening for Gynecologic Conditions With Pelvic Examination US Preventive Services Task Force Recommendation Statement

IMPORTANCE Many conditions that can affect women\u27s health are often evaluated through pelvic examination. Although the pelvic examination is a common part of the physical examination, it is unclear whether performing screening pelvic examinations in asymptomatic women has a significant effect on disease morbidity and mortality. OBJECTIVE To issue a new US Preventive Services Task Force(USPSTF) recommendation on screening for gynecologic conditions with pelvic examination for conditions other than cervical cancer, gonorrhea, and chlamydia, for which the USPSTF has already made specific recommendations. EVIDENCE REVIEW The USPSTF reviewed the evidence on the accuracy, benefits, and potential harms of performing screening pelvic examinations in asymptomatic, nonpregnant adult women 18 years and older who are not at increased risk for any specific gynecologic condition. FINDINGS Overall, the USPSTF found inadequate evidence on screening pelvic examinations for the early detection and treatment of a range of gynecologic conditions in asymptomatic, nonpregnant adult women. CONCLUSIONS AND RECOMMENDATION The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of performing screening pelvic examinations in asymptomatic, nonpregnant adult women. (I statement) This statement does not apply to specific disorders for which the USPSTF already recommends screening (ie, screening for cervical cancer with a Papanicolaou smear, screening for gonorrhea and chlamydia)

Marine macroalgae as food for earthworms: Growth and selection experiments across ecotypes

Historically, subsistence farmers around the Atlantic coast of NW Europe utilised marine algae as a fertiliser in agroecosystems, a practice that continued in small areas and is now considered to have real potential for re-establishing sustainable food production systems on marginal soils. Earthworms form a significant component of soil fauna and their ecosystem services are well documented. Therefore, palatability of marine organic amendments to faunal detritivores of terrestrial systems is of interest. This work aimed to assess the potential for growth of Aporrectodea caliginosa, Lumbricus rubellus and Aporrectodea longa fed with two common macroalgae (seaweeds), Laminaria digitata and Fucus serratus. In addition, choice chambers were constructed to permit earthworm selection of these macroalgae with more conventional organic materials, horse manure (HM) and birch leaves (BL). Over a period of two months, earthworm species showed significantly greater mass gain with conventional food (p<0.05). Laminaria outperformed Fucus, which in turn was superior to soil alone. Similarly, when given a choice, a significant preference (p<0.001) was shown for the more nitrogen-rich HM and BL over the seaweeds. No removal was recorded for A. caliginosa when offered seaweeds only. By contrast, L. rubellus and A. longa showed significant preferences (p<0.001) for Laminaria over Fucus and fresh material over degraded. These results underline an interest to profit from natural resources (seaweeds) to maintain or improve soil biological quality in marginal coastal areas

Using interpretative phenomenological analysis to inform physiotherapy practice: An introduction with reference to the lived experience of cerebellar ataxia

The attached file is a pre-published version of the full and final paper which can be found at the link below.This article has been made available through the Brunel Open Access Publishing Fund.Qualitative research methods that focus on the lived experience of people with health conditions are relatively underutilised in physiotherapy research. This article aims to introduce interpretative phenomenological analysis (IPA), a research methodology oriented toward exploring and understanding the experience of a particular phenomenon (e.g., living with spinal cord injury or chronic pain, or being the carer of someone with a particular health condition). Researchers using IPA try to find out how people make sense of their experiences and the meanings they attach to them. The findings from IPA research are highly nuanced and offer a fine grained understanding that can be used to contextualise existing quantitative research, to inform understanding of novel or underresearched topics or, in their own right, to provoke a reappraisal of what is considered known about a specified phenomenon. We advocate IPA as a useful and accessible approach to qualitative research that can be used in the clinical setting to inform physiotherapy practice and the development of services from the perspective of individuals with particular health conditions.This article is available through the Brunel Open Access Publishing Fund

Primary retroperitoneal mucinous cystadenoma of borderline malignancy in a male patient. Case report and review of the literature

<p>Abstract</p> <p>Background</p> <p>Primary retroperitoneal mucinous cystadenoma of borderline malignancy represents a rare tumor, with unclear histogenesis, concerning almost exclusively women. Only two cases concerning male patients have been reported.</p> <p>Case report</p> <p>We herein report a case of a 37 year old man undergone laparotomy for a sizable retroperitoneal tumor resulting after the histological examination to a primary retroperitoneal mucinous cystadenoma of borderline malignancy.</p> <p>Conclusion</p> <p>This is the third case of primary retroperitoneal mucinous cystadenoma of borderline malignancy in a male patient reported in the literature. The preoperative diagnosis is impossible. Laparotomy constitutes the only diagnostic and curative approach.</p

Comparison of a low carbohydrate and low fat diet for weight maintenance in overweight or obese adults enrolled in a clinical weight management program

<p>Abstract</p> <p>Background</p> <p>Recent evidence suggests that a low carbohydrate (LC) diet may be equally or more effective for short-term weight loss than a traditional low fat (LF) diet; however, less is known about how they compare for weight maintenance. The purpose of this study was to compare body weight (BW) for participants in a clinical weight management program, consuming a LC or LF weight maintenance diet for 6 months following weight loss.</p> <p>Methods</p> <p>Fifty-five (29 low carbohydrate diet; 26 low fat diet) overweight/obese middle-aged adults completed a 9 month weight management program that included instruction for behavior, physical activity (PA), and nutrition. For 3 months all participants consumed an identical liquid diet (2177 kJ/day) followed by 1 month of re-feeding with solid foods either low in carbohydrate or low in fat. For the remaining 5 months, participants were prescribed a meal plan low in dietary carbohydrate (~20%) or fat (~30%). BW and carbohydrate or fat grams were collected at each group meeting. Energy and macronutrient intake were assessed at baseline, 3, 6, and 9 months.</p> <p>Results</p> <p>The LC group increased BW from 89.2 ± 14.4 kg at 3 months to 89.3 ± 16.1 kg at 9 months (<it>P </it>= 0.84). The LF group decreased BW from 86.3 ± 12.0 kg at 3 months to 86.0 ± 14.0 kg at 9 months (<it>P </it>= 0.96). BW was not different between groups during weight maintenance (<it>P </it>= 0.87). Fifty-five percent (16/29) and 50% (13/26) of participants for the LC and LF groups, respectively, continued to decrease their body weight during weight maintenance.</p> <p>Conclusion</p> <p>Following a 3 month liquid diet, the LC and LF diet groups were equally effective for BW maintenance over 6 months; however, there was significant variation in weight change within each group.</p

Geographic variation in social organization of Galápagos mockingbirds: ecological correlates of group territoriality and cooperative breeding

To investigate ecological influences on cooperative social organization, I studied the four allopatric species of mockingbirds ( Nesomimus spp.) endemic to the Galápagos archipelago on four islands. On three small, low and arid islands (Genovesa, Champion and Española), mockingbird territories filled all terrestrial habitat, mean group size varied from 4.5 to 14.2 adults, maximum group size ranged from seven to 24 birds, and 70–100% of groups contained more than two birds. San Cristóbal is larger and higher, and it supports a broader range of habitats. At one highland and two coastal sites on this island, mockingbirds did not hold territories in all available habitats, group size averaged 2.2 adults, only 25% of groups were larger than two, and none included more than three adults. Adults dispersed into vacant habitat to establish new territories only on San Cristóbal. Helping behavior has not yet been observed on San Cristóbal, but it occurs on the other three islands. These results support the hypothesis that social groups and cooperative breeding are maintained where limited availability of preferred habitat constrains dispersal. The mechanism relaxing habitat saturation on San Cristóbal, however, remains undetermined. Predation by introduced rats and cats may reduce survival and indirectly reduce group size; these predators are absent from Genovesa, Champion and Española. Differences in food supplies could also affect interand intra-island variation in population density. Variation in social organization among arid coastal sites on the four islands, and similarity between climatically different sites on San Cristóbal, suggest that climatic conditions are less important as determinants of dispersal and breeding. Skews in adult sex ratios also fail to account for inter-island variation in sociality. Although they live in a climatically variable environment, territorial behavior and the physical limits of suitable habitat have an overriding influence on cooperative social organization in Galápagos mockingbirds.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/46894/1/265_2004_Article_BF00302932.pd

Non-invasive management of peripheral arterial disease.

BACKGROUND: Peripheral arterial disease (PAD) is common and symptoms can be debilitating and lethal. Risk management, exercise, radiological and surgical intervention are all valuable therapies, but morbidity and mortality rates from this disease are increasing. Circulatory enhancement can be achieved using simple medical electronic devices, with claims of minimal adverse side effects. The evidence for these is variable, prompting a review of the available literature. METHODS: Embase and Medline were interrogated for full text articles in humans and written in English. Any external medical devices used in the management of peripheral arterial disease were included if they had objective outcome data. RESULTS: Thirty-one papers met inclusion criteria, but protocols were heterogenous. The medical devices reported were intermittent pneumatic compression (IPC), electronic nerve (NMES) or muscle stimulators (EMS), and galvanic electrical dressings. In patients with intermittent claudication, IPC devices increase popliteal artery velocity (49-70 %) and flow (49-84 %). Gastrocnemius EMS increased superficial femoral artery flow by 140 %. Over 4.5-6 months IPC increased intermittent claudication distance (ICD) (97-150 %) and absolute walking distance (AWD) (84-112 %), with an associated increase in quality of life. NMES of the calf increased ICD and AWD by 82 % and 61-150 % at 4 weeks, and 26 % and 34 % at 8 weeks. In patients with critical limb ischaemia IPC reduced rest pain in 40-100 % and was associated with ulcer healing rates of 26 %. IPC had an early limb salvage rate of 58-83 % at 1-3 months, and 58-94 % at 1.5-3.5 years. No studies have reported the use of EMS or NMES in the management of CLI. CONCLUSION: There is evidence to support the use of IPC in the management of claudication and CLI. There is a building body of literature to support the use of electrical stimulators in PAD, but this is low level to date. Devices may be of special benefit to those with limited exercise capacity, and in non-reconstructable critical limb ischaemia. Galvanic stimulation is not recommended

Observation and study of baryonic B decays: B -> D(*) p pbar, D(*) p pbar pi, and D(*) p pbar pi pi

We present a study of ten B-meson decays to a D(*), a proton-antiproton pair, and a system of up to two pions using BaBar's data set of 455x10^6 BBbar pairs. Four of the modes (B0bar -> D0 p anti-p, B0bar -> D*0 p anti-p, B0bar -> D+ p anti-p pi-, B0bar -> D*+ p anti-p pi-) are studied with improved statistics compared to previous measurements; six of the modes (B- -> D0 p anti-p pi-, B- -> D*0 p anti-p pi-, B0bar -> D0 p anti-p pi- pi+, B0bar -> D*0 p anti-p pi- pi+, B- -> D+ p anti-p pi- pi-, B- -> D*+ p anti-p pi- pi-) are first observations. The branching fractions for 3- and 5-body decays are suppressed compared to 4-body decays. Kinematic distributions for 3-body decays show non-overlapping threshold enhancements in m(p anti-p) and m(D(*)0 p) in the Dalitz plots. For 4-body decays, m(p pi-) mass projections show a narrow peak with mass and full width of (1497.4 +- 3.0 +- 0.9) MeV/c2, and (47 +- 12 +- 4) MeV/c2, respectively, where the first (second) errors are statistical (systematic). For 5-body decays, mass projections are similar to phase space expectations. All results are preliminary.Comment: 28 pages, 90 postscript figures, submitted to LP0

Evidence for the h_b(1P) meson in the decay Upsilon(3S) --> pi0 h_b(1P)

Using a sample of 122 million Upsilon(3S) events recorded with the BaBar detector at the PEP-II asymmetric-energy e+e- collider at SLAC, we search for the $h_b(1P)$ spin-singlet partner of the P-wave chi_{bJ}(1P) states in the sequential decay Upsilon(3S) --> pi0 h_b(1P), h_b(1P) --> gamma eta_b(1S). We observe an excess of events above background in the distribution of the recoil mass against the pi0 at mass 9902 +/- 4(stat.) +/- 2(syst.) MeV/c^2. The width of the observed signal is consistent with experimental resolution, and its significance is 3.1sigma, including systematic uncertainties. We obtain the value (4.3 +/- 1.1(stat.) +/- 0.9(syst.)) x 10^{-4} for the product branching fraction BF(Upsilon(3S)-->pi0 h_b) x BF(h_b-->gamma eta_b).Comment: 8 pages, 4 postscript figures, submitted to Phys. Rev. D (Rapid Communications

Structure-based mutagenesis reveals the albumin-binding site of the neonatal Fc receptor

Albumin is the most abundant protein in blood where it has a pivotal role as a transporter of fatty acids and drugs. Like IgG, albumin has long serum half-life, protected from degradation by pH-dependent recycling mediated by interaction with the neonatal Fc receptor, FcRn. Although the FcRn interaction with IgG is well characterized at the atomic level, its interaction with albumin is not. Here we present structure-based modelling of the FcRn–albumin complex, supported by binding analysis of site-specific mutants, providing mechanistic evidence for the presence of pH-sensitive ionic networks at the interaction interface. These networks involve conserved histidines in both FcRn and albumin domain III. Histidines also contribute to intramolecular interactions that stabilize the otherwise flexible loops at both the interacting surfaces. Molecular details of the FcRn–albumin complex may guide the development of novel albumin variants with altered serum half-life as carriers of drugs