Investigation and management of subfertility

Subfertility affects one in seven couples and is defined as the inability to conceive after 1 year of regular unprotected intercourse. This article describes the initial clinical evaluation and investigation to guide diagnosis and management. The primary assessment of subfertility is to establish the presence of ovulation, normal uterine cavity and patent fallopian tubes in women, and normal semen parameters in men. Ovulation is supported by a history of regular menstrual cycles (21–35 days) and confirmed by a serum progesterone >30 nmol/L during the luteal phase of the menstrual cycle. Common causes of anovulation include polycystic ovary syndrome (PCOS), hypothalamic amenorrhoea (HA) and premature ovarian insufficiency (POI). Tubal patency is assessed by hysterosalpingography, hystero-contrast sonography, or more invasively by laparoscopy and dye test. The presence of clinical or biochemical hyperandrogenism, serum gonadotrophins (luteinising hormone/follicle stimulating hormone) / oestradiol, pelvic ultrasound to assess ovarian morphology / antral follicle count, can help establish the cause of anovulation. Ovulation can be restored in women with PCOS using letrozole (an aromatase inhibitor), clomifene citrate (an oestrogen antagonist) or exogenous gonadotrophin administration. If available, pulsatile gonadotrophin releasing hormone therapy is the preferred option for restoring ovulation in HA. Spermatogenesis can be induced in men with hypogonadotrophic hypogonadism with exogenous gonadotrophins. Unexplained subfertility can be treated with in vitro fertilisation after 2 years of trying to conceive. Involuntary childlessness is associated with significant psychological morbidity; hence, expert assessment and prompt treatment are necessary to support such couples

Exact Topological Quantum Order in D=3 and Beyond: Branyons and Brane-Net Condensates

We construct an exactly solvable Hamiltonian acting on a 3-dimensional lattice of spin-$\frac 1 2$ systems that exhibits topological quantum order. The ground state is a string-net and a membrane-net condensate. Excitations appear in the form of quasiparticles and fluxes, as the boundaries of strings and membranes, respectively. The degeneracy of the ground state depends upon the homology of the 3-manifold. We generalize the system to $D\geq 4$, were different topological phases may occur. The whole construction is based on certain special complexes that we call colexes.Comment: Revtex4 file, color figures, minor correction

Geophysical characteristics and crustal structure of greenstone terranes: Canadian Shield

Geophysical studies in the Canadian Shield have provided some insights into the tectonic setting of greenstone belts. Greenstone belts are not rooted in deep crustal structures. Geophysical techniques consistently indicate that greenstones are restricted to the uppermost 10 km or so of crust and are underlain by geophysically normal crust. Gravity models suggest that granitic elements are similarly restricted, although magnetic modelling suggests possible downward extension to the intermediate discontinuity around approx. 18 km. Seismic evidence demonstrates that steeply-dipping structure, which can be associated with the belts in the upper crust, is not present in the lower crust. Horizontal intermediate discontinuities mapped under adjacent greenstone and granitic components are not noticeably disrupted in the boundary zone. Geophysical evidence points to the presence of discontinuities between greenhouse-granite and adjacent metasedimentary erranes. Measured stratigraphic thicknesses of greenstone belts are often twice or more the vertical thicknesses determined from gravity modelling. Explantations advanced for the discrepancy include stratigraphy repeated by thrust faulting and/or listric normal faulting, mechanisms which are consistent with certain aspects of conceptual models of greenstone development. Where repetition is not a factor the gravity evidence points to removal of the root zones of greenstone belts. For one region, this has been attributed to magmatic stopping during resurgent caldera activity

Expansive homeomorphisms of the plane

This article tackles the problem of the classification of expansive homeomorphisms of the plane. Necessary and sufficient conditions for a homeomorphism to be conjugate to a linear hyperbolic automorphism will be presented. The techniques involve topological and metric aspects of the plane. The use of a Lyapunov metric function which defines the same topology as the one induced by the usual metric but that, in general, is not equivalent to it is an example of such techniques. The discovery of a hypothesis about the behavior of Lyapunov functions at infinity allows us to generalize some results that are valid in the compact context. Additional local properties allow us to obtain another classification theorem.Comment: 29 pages, 22 figure

Parabolic groups acting on one-dimensional compact spaces

Given a class of compact spaces, we ask which groups can be maximal parabolic subgroups of a relatively hyperbolic group whose boundary is in the class. We investigate the class of 1-dimensional connected boundaries. We get that any non-torsion infinite f.g. group is a maximal parabolic subgroup of some relatively hyperbolic group with connected one-dimensional boundary without global cut point. For boundaries homeomorphic to a Sierpinski carpet or a 2-sphere, the only maximal parabolic subgroups allowed are virtual surface groups (hyperbolic, or virtually $\mathbb{Z} + \mathbb{Z}$).Comment: 10 pages. Added a precision on local connectedness for Lemma 2.3, thanks to B. Bowditc

Hormonal Regulation of Glucocorticoid Inactivation and Reactivation in aT3-1 and LßT2 Gonadotroph Cells

The regulation of reproductive function by glucocorticoids occurs at all levels of the hypothalamo-pituitary-gonadal axis. Within the pituitary, glucocorticoids have been shown to directly alter gene expression in gonadotrophs, indicating that these cell types are sensitive to regulation by the glucocorticoid receptor. Whilst the major glucocorticoid metabolising enzymes, 11β-hydroxysteroid dehydrogenase (11βHSD; HSD11B1 and HSD11B2), have been described in human pituitary adenomas, the activity of these enzymes within different pituitary cell types has not been reported. Radiometric conversion assays were performed in αT3-1, LβT2 (gonadotrophs), AtT-20 (corticotrophs) and GH3 (somatolactotrophs) anterior pituitary cell lines, using tritiated cortisol, corticosterone, cortisone or 11-dehydrocorticosterone as substrates. The net oxidation of cortisol/corticosterone and net reduction of cortisone/11-dehydrocorticosterone were significantly higher in the two gonadotroph cells lines compared with the AtT-20 and GH3 cells after 4 h. Whilst these enzyme activities remained the same in αT3-1 and LβT2 cells over a 24 h period, there was a significant increase in glucocorticoid metabolism in both AtT-20 and GH3 cells over this same period, suggesting cell-type specific activity of the 11βHSD enzyme(s). Stimulation of both gonadotroph cell lines with either 100 nM GnRH or PACAP (known physiological regulators of gonadotrophs) resulted in significantly increased 11β-dehydrogenase (11βDH) and 11-ketosteroid reductase (11KSR) activities, over both 4 and 24 h. These data reveal that gonadotroph 11βHSD enzyme activity can act to regulate local glucocorticoid availability to mediate the influence of the HPA axis on gonadotroph function

B812: Dairy Farmer Indebtedness in Maine

The dairy industry in Maine is an important contributor to the agricultural sector and general economy. In 1982 there were 750 employees processing dairy products in Maine drawing a 12 million dollar payroll (Maine Bureau of Labor). The 1983 farm-gate value of milk produced in Maine totaled 108 million dollars, higher than any other single commodity\u27s farm-gate value (Maine Department of Agriculture, Food and Rural Resources). For the past several years the farm level price of milk has remained fairly steady while production costs inflated. This price-cost squeeze worsened in 1983 with a 50 cent per hundredweight decrease in the price received by farmers which was authorized by the Dairy and Tobacco Adjustment Act of 1983. Limited public information is available concerning the financial health of Maine\u27s dairy farming sector. This aspect is of crucial concern to policy makers in the state. Toward this end the Maine Dairy Industry Association requested that the University of Maine at Orono, in cooperation with the Maine Department of Agriculture, Food and Rural Resources, conduct a study to provide an accurate overall picture of the financial structure and business management practices of Maine\u27s dairy farms.https://digitalcommons.library.umaine.edu/aes_bulletin/1111/thumbnail.jp

Circles in the Sky: Finding Topology with the Microwave Background Radiation

If the universe is finite and smaller than the distance to the surface of last scatter, then the signature of the topology of the universe is writ large on the microwave background sky. We show that the microwave background will be identified at the intersections of the surface of last scattering as seen by different ``copies'' of the observer. Since the surface of last scattering is a two-sphere, these intersections will be circles, regardless of the background geometry or topology. We therefore propose a statistic that is sensitive to all small, locally homogeneous topologies. Here, small means that the distance to the surface of last scatter is smaller than the ``topology scale'' of the universe.Comment: 14 pages, 10 figures, IOP format. This paper is a direct descendant of gr-qc/9602039. To appear in a special proceedings issue of Class. Quant. Grav. covering the Cleveland Topology & Cosmology Worksho

On bipartite Rokhsar-Kivelson points and Cantor deconfinement

Quantum dimer models on bipartite lattices exhibit Rokhsar-Kivelson (RK) points with exactly known critical ground states and deconfined spinons. We examine generic, weak, perturbations around these points. In d=2+1 we find a first order transition between a ``plaquette'' valence bond crystal and a region with a devil's staircase of commensurate and incommensurate valence bond crystals. In the part of the phase diagram where the staircase is incomplete, the incommensurate states exhibit a gapless photon and deconfined spinons on a set of finite measure, almost but not quite a deconfined phase in a compact U(1) gauge theory in d=2+1! In d=3+1 we find a continuous transition between the U(1) resonating valence bond (RVB) phase and a deconfined staggered valence bond crystal. In an appendix we comment on analogous phenomena in quantum vertex models, most notably the existence of a continuous transition on the triangular lattice in d=2+1.Comment: 9 pages; expanded version to appear in Phys. Rev. B; presentation improve

Diagnosing students' difficulties in learning mathematics

This study considers the results of a diagnostic test of student difficulty and contrasts the difference in performance between the lower attaining quartile and the higher quartile. It illustrates a difference in qualitative thinking between those who succeed and those who fail in mathematics, illustrating a theory that those who fail are performing a more difficult type of mathematics (coordinating procedures) than those who succeed (manipulating concepts). Students who have to coordinate or reverse processes in time will encounter far greater difficulty than those who can manipulate symbols in a flexible way. The consequences of such a dichotomy and implications for remediation are then considered