Multidisciplinary approach to the management of children with female genital mutilation (FGM) or suspected FGM: service description and case series

OBJECTIVE: To describe the first dedicated clinic in the UK for children with suspected or confirmed female genital mutilation (FGM) including referral patterns, clinical findings and subsequent management. DESIGN AND SETTING: A prospective study of all children seen in a dedicated multidisciplinary FGM clinic for children over a 1-year period. POPULATION: Patients aged under 18 years referred for clinical assessment or for a second opinion on Digital Versatile Disc (DVD) images. METHODS AND MAIN OUTCOME MEASURES: Data were collected on reasons for referral, demography, genital examination findings including FGM type, and clinical recommendations. RESULTS: 38 children were referred of whom 18 (47%) had confirmed FGM; most frequently type 4 (61%). Social care and police referred 78% of cases. According to UK law FGM had been performed illegally in three cases. Anonymous information given to the police led to the referral of six children, none of whom had had FGM. CONCLUSIONS: Mandatory reporting and increased media attention may increase the numbers of referrals of children with suspected FGM. This patient group have complex needs and management in a dedicated multidisciplinary service is essential. Paediatricians and gynaecologists should have the skills to carry out the consultation and detect all types of FGM including type 4 which was the most common type seen in this series. This is the first dedicated FGM service for children in the UK and similar clinics in high-prevalence areas should be established

Coming of age? Women's sexual and reproductive health after twenty-one years of democracy in South Africa

This paper is a sequel to a 2004 article thet reviewed South Africa's introduction of new sexual and reproductive health (SRH) and rights, laws, policies and programmes, a decade into democracy. Similarly to the previous article this paper focuses on key areas of women's SRH: contraception and fertility abortion maternal health HIV cervical and breast cancer and sexual violence. In the last decade South Africa has retained and expanded its sexual and reproductive health and rights (SRHR) policies in the areas of abortion contraception youth and HIV treatment (with the largest antiretroviral treatment programme in the world). These are positive examples within the SRHR policy arena. These improvements include fewer unsafe abortions AIDS deaths and vertical HIV transmission as well as the public provision of a human papillomavirus vaccine to prevent cervical cancer. However persistent socio-economic inequities and gender inequality continue to profoundly affect South African women's SRHR. The state shows mixed success over the past two decades in advancing measurable SRH social justice outcomes and in confronting and ameliorating social norms that undermine SRHR

Light Induced Increase of Electron Diffusion Length in a p n Junction Type CH3NH3PbBr3 Perovskite Solar Cell

High band gap, high open circuit voltage solar cells with methylammonium lead tribromide MAPbBr3 perovskite absorbers are of interest for spectral splitting and photoelectrochemical applications, because of their good performance and ease of processing. The physical origin of high performance in these and similar perovskite based devices remains only partially understood. Using cross sectional electron beaminduced current EBIC measurements, we find an increase in carrier diffusion length in MAPbBr3 Cl based solar cells upon low intensity a few percent of 1 sun intensity blue laser illumination. Comparing dark and illuminated conditions, the minority carrier electron diffusion length increases about 3.5 times from Ln 100 50 nm to 360 22 nm. The EBIC cross section profile indicates a p amp; 8722;n structure between the n FTO TiO2 and p perovskite, rather than the p amp; 8722;i amp; 8722;n structure, reported for the iodide derivative. On the basis of the variation in space charge region width with varying bias, measured by EBIC and capacitance amp; 8722;voltage measurements, we estimate the net doping concentration in MAPbBr3 Cl to be 3 amp; 8722;6 1017 cm amp; 8722;

Quantum line bundles on noncommutative sphere

Noncommutative (NC) sphere is introduced as a quotient of the enveloping algebra of the Lie algebra su(2). Using the Cayley-Hamilton identities we introduce projective modules which are analogues of line bundles on the usual sphere (we call them quantum line bundles) and define a multiplicative structure in their family. Also, we compute a pairing between certain quantum line bundles and finite dimensional representations of the NC sphere in the spirit of the NC index theorem. A new approach to constructing the differential calculus on a NC sphere is suggested. The approach makes use of the projective modules in question and gives rise to a NC de Rham complex being a deformation of the classical one.Comment: LaTeX file, 15 pp, no figures. Some clarifying remarks are added at the beginning of section 2 and into section

From comprehensive medicine to public health at the University of Cape Town: a 40-year journey

We explore the history of the School of Public Health at the University of Cape Town and its relationship to changes in the understanding of the role of public health both nationally and internationally. We draw from primary and secondary sources to trace the emergence, growth and development of the School, and to situate these processes within the socio-political, clinical and public health contexts in South Africa and internationally

Epidemiological surveillance study of female genital mutilation in the UK

OBJECTIVES: Describe cases of female genital mutilation (FGM) presenting to consultant paediatricians and sexual assault referral centres (SARCs), including demographics, medical symptoms, examination findings and outcome. DESIGN: The well-established epidemiological surveillance study performed through the British Paediatric Surveillance Unit included FGM on the monthly returns. SETTING: All consultant paediatricians and relevant SARC leads across the UK and Ireland. PATIENTS: Under 16 years old with FGM. INTERVENTIONS: Data on cases from November 2015 to November 2017 and 12 months later meeting the case definition of FGM. MAIN OUTCOMES MEASURES: Returns included 146 cases, 103 (71%) had confirmed FGM and 43 (29%) did not meet the case definition. There were none from Northern Ireland. RESULTS: The mean reported age was 3 years. Using the WHO classification of FGM, 58% (n=60) had either type 1 or type 2, 8% (n=8) had type 3 and 21% (n=22) had type 4. 13% (n=13) of the cases were not classified and none had piercings or labiaplasty. The majority, 70% had FGM performed in Africa with others from Europe, Middle East and South-East Asia. There were few physical and mental health symptoms. Only one case resulted in a successful prosecution. CONCLUSIONS: There were low numbers of children presenting with FGM and in the 2 years there was only one prosecution. The findings may be consistent with attitude changes in FGM practising communities and those at risk should be protected and supported by culturally competent national policie

Evaluation of machine-learning methods for ligand-based virtual screening

Machine-learning methods can be used for virtual screening by analysing the structural characteristics of molecules of known (in)activity, and we here discuss the use of kernel discrimination and naive Bayesian classifier (NBC) methods for this purpose. We report a kernel method that allows the processing of molecules represented by binary, integer and real-valued descriptors, and show that it is little different in screening performance from a previously described kernel that had been developed specifically for the analysis of binary fingerprint representations of molecular structure. We then evaluate the performance of an NBC when the training-set contains only a very few active molecules. In such cases, a simpler approach based on group fusion would appear to provide superior screening performance, especially when structurally heterogeneous datasets are to be processed