Gender bias in nineteenth-century England: Evidence from factory children.

Gender bias against girls in nineteenth-century England has received much interest but establishing its existence has proved difficult. We utilise data on heights of 16,402 children working in northern textile factories in 1837 to examine whether gender bias was evident. Current interpretations argue against any difference. Here our comparisons with modern height standards reveal greater deprivation for girls than for boys. Discrimination is measured in girls' height-for-age score (HAZ) falling eight standard errors below boys' at ages 11, 11.5 and 12 years of age, capturing the very poor performance of factory girls. But this result cannot be taken at face value. We query whether modern standards require adjustment to account for the later timing of puberty in historical populations and develop an alternative. We also test the validity of the age data, considering whether parents were more prone to lie about the ages of their daughters, and question whether the supply of girls was fundamentally different from that of boys. We conclude that neither proposition is justified. Disadvantage to girls remains, although its absence amongst younger children precludes an indictment of culturally founded gender bias. The height data must remain mute on the source of this discrimination but we utilise additional information to examine some hypotheses: occupational sorting, differential susceptibility to disease, poorer nutrition for girls, disproportionate stunting from the effects of nutritional deprivation, and type and amount of work undertaken. Of these we suggest that girls had to do arduous physical labour in the home alongside their factory work. The only (unsubstantiated) alternative is that girls were more likely than boys to be put into factory work below the legal age limit. Both represent forms of gender bias.‘Author’ was supported by a Leverhulme Major Research Fellowship. The Leverhulme Trust had no involvement in any aspect of the research design, implementation or analysis of this work.This is the author accepted manuscript. It is currently under an indefinite embargo pending publication by Elsevier

Capturing two elements in unavoidable minors of 3-connected binary matroids

Let M be a 3-connected binary matroid and let n be an integer exceeding 2. Ding, Oporowski, Oxley, and Vertigan proved that there is an integer f(n) so that if |E(M)|\u3ef(n), then M has a minor isomorphic to one of the rank-n wheel, the rank-n tipless binary spike, or the cycle or bond matroid of K3 n. This result was recently extended by Chun, Oxley, and Whittle to show that there is an integer g(n) so that if |E(M)|\u3eg(n) and xεE(M), then x is an element of a minor of M isomorphic to one of the rank-n wheel, the rank-n binary spike with a tip and a cotip, or the cycle or bond matroid of K11,1,n. In this paper, we prove that, for each i in {2,3}, there is an integer hi(n) so that if |E(M)|\u3ehi(n) and Z is an i-element rank-2 subset of M, then M has a minor from the last list whose ground set contains Z. © 2012 Elsevier Inc

Capturing matroid elements in unavoidable 3-connected minors

A result of Ding, Oporowski, Oxley, and Vertigan reveals that a large 3-connected matroid M has unavoidable structure. For every n\u3e2, there is an integer f(n) so that if {pipe}E(M){pipe}\u3ef(n), then M has a minor isomorphic to the rank-n wheel or whirl, a rank-n spike, the cycle or bond matroid of K 3,n, or U 2,n or U n-2,n. In this paper, we build on this result to determine what can be said about a large structure using a specified element e of M. In particular, we prove that, for every integer n exceeding two, there is an integer g(n) so that if {pipe}E(M){pipe}\u3eg(n), then e is an element of a minor of M isomorphic to the rank-n wheel or whirl, a rank-n spike, the cycle or bond matroid of K 1,1,1,n, a specific single-element extension of M(K 3,n) or the dual of this extension, or U 2,n or U n-2,n. © 2012 Elsevier Ltd

Quality standards for the management of alcohol-related liver disease: consensus recommendations from the British Association for the Study of the Liver and British Society of Gastroenterology ARLD special interest group

Objective Alcohol-related liver disease (ALD) is the most common cause of liver-related ill health and liver-related deaths in the UK, and deaths from ALD have doubled in the last decade. The management of ALD requires treatment of both liver disease and alcohol use; this necessitates effective and constructive multidisciplinary working. To support this, we have developed quality standard recommendations for the management of ALD, based on evidence and consensus expert opinion, with the aim of improving patient care.Design A multidisciplinary group of experts from the British Association for the Study of the Liver and British Society of Gastroenterology ALD Special Interest Group developed the quality standards, with input from the British Liver Trust and patient representatives.Results The standards cover three broad themes: the recognition and diagnosis of people with ALD in primary care and the liver outpatient clinic; the management of acutely decompensated ALD including acute alcohol-related hepatitis and the posthospital care of people with advanced liver disease due to ALD. Draft quality standards were initially developed by smaller working groups and then an anonymous modified Delphi voting process was conducted by the entire group to assess the level of agreement with each statement. Statements were included when agreement was 85% or greater. Twenty-four quality standards were produced from this process which support best practice. From the final list of statements, a smaller number of auditable key performance indicators were selected to allow services to benchmark their practice and an audit tool provided.Conclusion It is hoped that services will review their practice against these recommendations and key performance indicators and institute service development where needed to improve the care of patients with ALD

Ten-year mortality, disease progression, and treatment-related side effects in men with localised prostate cancer from the ProtecT randomised controlled trial according to treatment received

Background The ProtecT trial reported intention-to-treat analysis of men with localised prostate cancer randomly allocated to active monitoring (AM), radical prostatectomy, and external beam radiotherapy. Objective To report outcomes according to treatment received in men in randomised and treatment choice cohorts. Design, setting, and participants This study focuses on secondary care. Men with clinically localised prostate cancer at one of nine UK centres were invited to participate in the treatment trial comparing AM, radical prostatectomy, and radiotherapy. Intervention Two cohorts included 1643 men who agreed to be randomised and 997 who declined randomisation and chose treatment. Outcome measurements and statistical analysis Analysis was carried out to assess mortality, metastasis and progression and health-related quality of life impacts on urinary, bowel, and sexual function using patient-reported outcome measures. Analysis was based on comparisons between groups defined by treatment received for both randomised and treatment choice cohorts in turn, with pooled estimates of intervention effect obtained using meta-analysis. Differences were estimated with adjustment for known prognostic factors using propensity scores. Results and limitations According to treatment received, more men receiving AM died of PCa (AM 1.85%, surgery 0.67%, radiotherapy 0.73%), whilst this difference remained consistent with chance in the randomised cohort (p = 0.08); stronger evidence was found in the exploratory analyses (randomised plus choice cohort) when AM was compared with the combined radical treatment group (p = 0.003). There was also strong evidence that metastasis (AM 5.6%, surgery 2.4%, radiotherapy 2.7%) and disease progression (AM 20.35%, surgery 5.87%, radiotherapy 6.62%) were more common in the AM group. Compared with AM, there were higher risks of sexual dysfunction (95% at 6 mo) and urinary incontinence (55% at 6 mo) after surgery, and of sexual dysfunction (88% at 6 mo) and bowel dysfunction (5% at 6 mo) after radiotherapy. The key limitations are the potential for bias when comparing groups defined by treatment received and changes in the protocol for AM during the lengthy follow-up required in trials of screen-detected PCa. Conclusions Analyses according to treatment received showed increased rates of disease-related events and lower rates of patient-reported harms in men managed by AM compared with men managed by radical treatment, and stronger evidence of greater PCa mortality in the AM group. Patient summary More than 95 out of every 100 men with low or intermediate risk localised prostate cancer do not die of prostate cancer within 10 yr, irrespective of whether treatment is by means of monitoring, surgery, or radiotherapy. Side effects on sexual and bladder function are better after active monitoring, but the risks of spreading of prostate cancer are more common

Functional and quality of life outcomes of localised prostate cancer treatments (prostate testing for cancer and treatment [ProtecT] study)

Objective To investigate the functional and quality of life (QoL) outcomes of treatments for localised prostate cancer and inform treatment decision-making. Patients and Methods Men aged 50–69 years diagnosed with localised prostate cancer by prostate-specific antigen testing and biopsies at nine UK centres in the Prostate Testing for Cancer and Treatment (ProtecT) trial were randomised to, or chose one of, three treatments. Of 2565 participants, 1135 men received active monitoring (AM), 750 a radical prostatectomy (RP), 603 external-beam radiotherapy (EBRT) with concurrent androgen-deprivation therapy (ADT) and 77 low-dose-rate brachytherapy (BT, not a randomised treatment). Patient-reported outcome measures (PROMs) completed annually for 6 years were analysed by initial treatment and censored for subsequent treatments. Mixed effects models were adjusted for baseline characteristics using propensity scores. Results Treatment-received analyses revealed different impacts of treatments over 6 years. Men remaining on AM experienced gradual declines in sexual and urinary function with age (e.g., increases in erectile dysfunction from 35% of men at baseline to 53% at 6 years and nocturia similarly from 20% to 38%). Radical treatment impacts were immediate and continued over 6 years. After RP, 95% of men reported erectile dysfunction persisting for 85% at 6 years, and after EBRT this was reported by 69% and 74%, respectively (P < 0.001 compared with AM). After RP, 36% of men reported urinary leakage requiring at least 1 pad/day, persisting for 20% at 6 years, compared with no change in men receiving EBRT or AM (P < 0.001). Worse bowel function and bother (e.g., bloody stools 6% at 6 years and faecal incontinence 10%) was experienced by men after EBRT than after RP or AM (P < 0.001) with lesser effects after BT. No treatment affected mental or physical QoL. Conclusion Treatment decision-making for localised prostate cancer can be informed by these 6-year functional and QoL outcomes