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

A sensorimotor control framework for understanding emotional communication and regulation

Action Contro

Differential cross section and recoil polarization measurements for the gamma p to K+ Lambda reaction using CLAS at Jefferson Lab

We present measurements of the differential cross section and Lambda recoil polarization for the gamma p to K+ Lambda reaction made using the CLAS detector at Jefferson Lab. These measurements cover the center-of-mass energy range from 1.62 to 2.84 GeV and a wide range of center-of-mass K+ production angles. Independent analyses were performed using the K+ p pi- and K+ p (missing pi -) final-state topologies; results from these analyses were found to exhibit good agreement. These differential cross section measurements show excellent agreement with previous CLAS and LEPS results and offer increased precision and a 300 MeV increase in energy coverage. The recoil polarization data agree well with previous results and offer a large increase in precision and a 500 MeV extension in energy range. The increased center-of-mass energy range that these data represent will allow for independent study of non-resonant K+ Lambda photoproduction mechanisms at all production angles.Comment: 22 pages, 16 figure

Measurement of the Nucleon Structure Function F2 in the Nuclear Medium and Evaluation of its Moments

We report on the measurement of inclusive electron scattering off a carbon target performed with CLAS at Jefferson Laboratory. A combination of three different beam energies 1.161, 2.261 and 4.461 GeV allowed us to reach an invariant mass of the final-state hadronic system W~2.4 GeV with four-momentum transfers Q2 ranging from 0.2 to 5 GeV2. These data, together with previous measurements of the inclusive electron scattering off proton and deuteron, which cover a similar continuous two-dimensional region of Q2 and Bjorken variable x, permit the study of nuclear modifications of the nucleon structure. By using these, as well as other world data, we evaluated the F2 structure function and its moments. Using an OPE-based twist expansion, we studied the Q2-evolution of the moments, obtaining a separation of the leading-twist and the total higher-twist terms. The carbon-to-deuteron ratio of the leading-twist contributions to the F2 moments exhibits the well known EMC effect, compatible with that discovered previously in x-space. The total higher-twist term in the carbon nucleus appears, although with large systematic uncertainites, to be smaller with respect to the deuteron case for n<7, suggesting partial parton deconfinement in nuclear matter. We speculate that the spatial extension of the nucleon is changed when it is immersed in the nuclear medium.Comment: 37 pages, 15 figure

First measurement of direct f0(980)f_0(980) photoproduction on the proton

We report on the results of the first measurement of exclusive $f_0(980)$ meson photoproduction on protons for $E_\gamma=3.0 - 3.8$ GeV and $-t = 0.4-1.0$ GeV$^2$. Data were collected with the CLAS detector at the Thomas Jefferson National Accelerator Facility. The resonance was detected via its decay in the $\pi^+ \pi^-$ channel by performing a partial wave analysis of the reaction $\gamma p \to p \pi^+ \pi^-$. Clear evidence of the $f_0(980)$ meson was found in the interference between $P$ and $S$ waves at $M_{\pi^+ \pi^-}\sim 1$ GeV. The $S$-wave differential cross section integrated in the mass range of the $f_0(980)$ was found to be a factor of 50 smaller than the cross section for the $\rho$ meson. This is the first time the $f_0(980)$ meson has been measured in a photoproduction experiment

ATP synthase: from single molecule to human bioenergetics

ATP synthase (FoF1) consists of an ATP-driven motor (F1) and a H+-driven motor (Fo), which rotate in opposite directions. FoF1 reconstituted into a lipid membrane is capable of ATP synthesis driven by H+ flux. As the basic structures of F1 (α3β3γδε) and Fo (ab2c10) are ubiquitous, stable thermophilic FoF1 (TFoF1) has been used to elucidate molecular mechanisms, while human F1Fo (HF1Fo) has been used to study biomedical significance. Among F1s, only thermophilic F1 (TF1) can be analyzed simultaneously by reconstitution, crystallography, mutagenesis and nanotechnology for torque-driven ATP synthesis using elastic coupling mechanisms. In contrast to the single operon of TFoF1, HFoF1 is encoded by both nuclear DNA with introns and mitochondrial DNA. The regulatory mechanism, tissue specificity and physiopathology of HFoF1 were elucidated by proteomics, RNA interference, cytoplasts and transgenic mice. The ATP synthesized daily by HFoF1 is in the order of tens of kilograms, and is primarily controlled by the brain in response to fluctuations in activity

Partial wave analysis of the reaction gamma p -> p omega$ and the search for nucleon resonances

An event-based partial wave analysis (PWA) of the reaction gamma p -> p omega has been performed on a high-statistics dataset obtained using the CLAS at Jefferson Lab for center-of-mass energies from threshold up to 2.4 GeV. This analysis benefits from access to the world's first high precision spin density matrix element measurements, available to the event-based PWA through the decay distribution of omega-> pi+ pi - pi0. The data confirm the dominance of the t-channel pi0 exchange amplitude in the forward direction. The dominant resonance contributions are consistent with the previously identified states F[15](1680) and D[13](1700) near threshold, as well as the G[17](2190) at higher energies. Suggestive evidence for the presence of a J(P)=5/2(+) state around 2 GeV, a "missing" state, has also been found. Evidence for other states is inconclusive