Primary Care Endometrial Sampling for Abnormal Uterine Bleeding: A Pilot Study

Background Most cases of abnormal uterine bleeding (AUB) could potentially be managed in primary care but lack of access to endometrial sampling leads to avoidable referrals to hospital to rule out endometrial hyperplasia and cancer. Aims To design and evaluate a pilot service for primary care endometrial sampling (PCES). Design Retrospective analysis of data from two service evaluations. Setting General practices and the gynaecology department in a large city in the United Kingdom. Methods 1) To design the new service we identified all the endometrial samples taken in the city’s gynaecology department in 2012/13 and estimated the proportion of these with AUB that would be suitable for PCES. 2) To evaluate the new PCES service we analysed data from the first year of activity. Results 1) 1894 endometrial samples were taken in hospital in 2012/13. An estimated 424 (22.4%) of these were from patients with AUB who fitted the criteria for PCES. 2) In the first year of the PCES service 108 samples were taken by GPs. Initial management of these patients was exclusively in primary care in 97.2% (104/108), most patients were treated with Mirena IUS (79/109; 73.1%) and there were no cases of hyperplasia or cancer. Conclusions Most pre-menopausal patients with AUB could potentially be managed in primary care without referral to hospital if ES was made available to appropriately trained and supported GPs. However, this study was limited by it’s retrospective non-interventional design and more research is required to demonstrate safety and cost-effectiveness. Key Message Points Primary care is a crucial part of the care pathway for patients with abnormal uterine bleeding. In the first instance, the majority of patients with AUB can be managed exclusively in primary care without referral to hospital. Primary care management of AUB may be cost effective but an economic model of the care pathway is required to make accurate comparisons between primary care and secondary care

Community capacity building in the designation of the Tortugas Ecological Reserve (abstract)

The remote Tortugas region of the Florida Keys, located over 225 km from the continental United States, is an area of high coral diversity, excellent water quality, and productive fisheries. Located at the juncture of major ocean currents, the Tortugas potentially serves as a source and sink for marine larvae. The Florida Keys National Marine Sanctuary initiated a process in 1998 to create a fully protected ecological reserve in the Tortugas to conserve these resources. Reserve design emphasized community input and consensus-based decision-making. Critical to success was a diverse working group of stakeholders and government agencies. In July 2001, after receiving extensive public comment and the necessary agency approvals for designation, the Sanctuary implemented a 518-km2 Tortugas Ecological Reserve. This fully protected marine reserve is expected to preserve biodiversity, maintain ecosystem integrity, and act as a reference site to discriminate between natural and anthropogenic changes to the ecosystem. The Tortugas Ecological Reserve complements the Sanctuary’s existing network of 23 fully protected zones, instituted in 1997 to protect marine resources from overuse, conserve biodiversity, and separate uses. The Tortugas Ecological Reserve is the largest fully protected marine reserve in the United States

Endometrial sampling in low-risk patients with abnormal uterine bleeding: a systematic review and meta-synthesis

Background: One million women per year seek medical advice for abnormal uterine bleeding (AUB) in the United Kingdom. Many low-risk patients who could be managed exclusively in primary care are referred to hospital based gynaecology services. Performing endometrial sampling (ES) in the community may improve care, reduce the rate of referrals and minimise costs. We aimed to search and synthesise the literature on the effectiveness of ES (Pipelle versus other devices) in managing AUB in low-risk patients. Methods: We undertook an electronic literature search in MEDLINE via OvidSP, Scopus, and Web of Science for relevant English-language articles from 1984 to 2016 using a combination of MeSH and keywords. Two reviewers independently pre-selected 317 articles and agreed on 60 articles reporting data from over 7300 patients. Five themes were identified: sample adequacy, test performance, pain and discomfort, cost-effectiveness, and barriers and complications of office ES. Results: Pipelle seems to perform as well as dilation and curettage and, as well or better than other ES devices in terms of sampling adequacy and sensitivity. It also seems to be better regarding pain/discomfort and costs. However, Pipelle can disrupt the sonographic appearance of the endometrium and may be limited by cervical stenosis, pelvic organ prolapse and endometrial atrophy. Conclusions: The current evidence supports the use of Pipelle in the management of low-risk women presenting in the outpatient setting with symptomatic AUB when combined with clinical assessment and ultrasound scanning. However, the implications of its widespread use in primary care are uncertain and more research is required

The effects of grain shape and frustration in a granular column near jamming

We investigate the full phase diagram of a column of grains near jamming, as a function of varying levels of frustration. Frustration is modelled by the effect of two opposing fields on a grain, due respectively to grains above and below it. The resulting four dynamical regimes (ballistic, logarithmic, activated and glassy) are characterised by means of the jamming time of zero-temperature dynamics, and of the statistics of attractors reached by the latter. Shape effects are most pronounced in the cases of strong and weak frustration, and essentially disappear around a mean-field point.Comment: 17 pages, 19 figure

Lognormal Properties of SGR 1806-20 and Implications for Other SGR Sources

The time interval between successive bursts from SGR 1806-20 and the intensity of these bursts are both consistent with lognormal distributions. Monte Carlo simulations of lognormal burst models with a range of distribution parameters have been investigated. The main conclusions are that while most sources like SGR 1806-20 should be detected in a time interval of 25 years, sources with means about 100 times longer have a probability of about 5\% of being detected in the same interval. A new breed of experiments that operate for long periods are required to search for sources with mean recurrence intervals much longer than SGR 1806-20.Comment: 4 pages, latex with seperate file containing 2 uuencoded, gzip'ed, tarred, .eps figures. Replaced with file that does not use kluwer.sty to allow automatic postscript generation. To appear in proceedings of ESLAB 2

Loss of Pde1 function acts as an evolutionary gateway to penicillin resistance in Streptococcus pneumoniae

Streptococcus pneumoniae is a major human pathogen and rising resistance to β-lactam antibiotics, such as penicillin, is a significant threat to global public health. Mutations occurring in the penicillin-binding proteins (PBPs) can confer high-level penicillin resistance but other poorly understood genetic factors are also important. Here, we combined strictly controlled laboratory experiments and population analyses to identify a new penicillin resistance pathway that is independent of PBP modification. Initial laboratory selection experiments identified high-frequency pde1 mutations conferring S. pneumoniae penicillin resistance. The importance of variation at the pde1 locus was confirmed in natural and clinical populations in an analysis of >7,200 S. pneumoniae genomes. The pde1 mutations identified by these approaches reduce the hydrolytic activity of the Pde1 enzyme in bacterial cells and thereby elevate levels of cyclic-di-adenosine monophosphate and penicillin resistance. Our results reveal rapid de novo loss of function mutations in pde1 as an evolutionary gateway conferring low-level penicillin resistance. This relatively simple genomic change allows cells to persist in populations on an adaptive evolutionary pathway to acquire further genetic changes and high-level penicillin resistance

Closed Strings with Low Harmonics and Kinks

Low-harmonic formulas for closed relativistic strings are given. General parametrizations are presented for the addition of second- and third-harmonic waves to the fundamental wave. The method of determination of the parametrizations is based upon a product representation found for the finite Fourier series of string motion in which the constraints are automatically satisfied. The construction of strings with kinks is discussed, including examples. A procedure is laid out for the representation of kinks that arise from self-intersection, and subsequent intercommutation, for harmonically parametrized cosmic strings.Comment: 39, CWRUTH-93-

Optomechanical Ground-State Cooling in a Continuous and Efficient Electro-Optic Transducer

The demonstration of a quantum link between microwave and optical frequencies would be an important step toward the realization of a quantum network of superconducting processors. A major impediment to quantum electro-optic transduction in all platforms explored to date is noise added by thermal occupation of modes involved in the transduction process, and it has proved difficult to realize low thermal occupancy concurrently with other desirable features like high duty cycle and high efficiency. In this work, we present an efficient and continuously operating electro-optomechanical transducer whose mechanical mode has been optically sideband cooled to its quantum ground state. The transducer achieves a maximum efficiency of 47% and minimum input-referred added noise of 3.2 photons in upconversion. Moreover, the thermal occupancy of the transducer&rsquo;s microwave mode is minimally affected by continuous laser illumination with power more than 2 orders of magnitude greater than that required for optomechanical ground-state cooling. &nbsp;</p

Advances in multispectral and hyperspectral imaging for archaeology and art conservation

Multispectral imaging has been applied to the field of art conservation and art history since the early 1990s. It is attractive as a noninvasive imaging technique because it is fast and hence capable of imaging large areas of an object giving both spatial and spectral information. This paper gives an overview of the different instrumental designs, image processing techniques and various applications of multispectral and hyperspectral imaging to art conservation, art history and archaeology. Recent advances in the development of remote and versatile multispectral and hyperspectral imaging as well as techniques in pigment identification will be presented. Future prospects including combination of spectral imaging with other noninvasive imaging and analytical techniques will be discussed