Referral for menstrual problems:cross sectional survey of symptoms, reasons for referral, and management

OBJECTIVES: To describe the menstrual experience of women referred for menstrual problems, in particular menorrhagia (excessive menstrual loss), and to assess associations with reasons for referral given by their general practitioners, the women's understanding of the reasons for their attendance at the hospital clinics, and clinic outcome. DESIGN: Questionnaire survey, with partial review of case notes after 8 months. SETTING: Three hospital gynaecology clinics in Glasgow and Edinburgh. PARTICIPANTS: 952 women completed the questionnaire, and the first 665 were reviewed. OUTCOME MEASURES: Reason for referral, women's reported menstrual problems and reason for clinic attendance, diagnosis, and treatment. RESULTS: Only 38% (95% confidence interval 34% to 41%) of women reported excessive menstrual loss as a severe problem. However 60% (57-63%) gave it as reason for attending a clinic, and 76% (73-79%) of general practitioners gave it as reason for referral. Reason for referral was significantly biased towards bleeding (McNemar odds ratio 4.01, 3.0 to 5.3, P<0.001) and against pain (0.54, 0.4 to 0.7, P<0.001). Dysfunctional uterine bleeding was diagnosed in 37% (31-42%) of the 259 women who gave as reason for attendance something other than bleeding. Women who were economically disadvantaged differed in prevalence of the main diagnoses and were more likely to fail to reattend. Hysterectomy was associated with referral for bleeding (relative risk 4.9, 1.6 to 15.6, P<0.001) but not with the patient stating bleeding as the reason for clinic attendance. CONCLUSIONS: Intolerance of the volume of their bleeding is not a key feature among women attending clinics for bleeding problems. Broad menstrual complaint tends to be reframed as excessive bleeding at referral and during management. This may result in women receiving inappropriate care. Conceptualisation and assessment of menorrhagia requires reconsideration

Flowing with Eight Supersymmetries in M-Theory and F-theory

We consider holographic RG flow solutions with eight supersymmetries and study the geometry transverse to the brane. For both M2-branes and for D3-branes in F-theory this leads to an eight-manifold with only a four-form flux. In both settings there is a natural four-dimensional hyper-Kahler slice that appears on the Coulomb branch. In the IIB theory this hyper-Kahler manifold encodes the Seiberg-Witten coupling over the Coulomb branch of a U(1) probe theory. We focus primarily upon a new flow solution in M-theory. This solution is first obtained using gauged supergravity and then lifted to eleven dimensions. In this new solution, the brane probes have an Eguchi-Hanson moduli space with the M2-branes spread over the non-trivial 2-sphere. It is also shown that the new solution is valid for a class of orbifold theories. We discuss how the hyper-Kahler structure on the slice extends to some form of G-structure in the eight-manifold, and describe how this can be computed.Comment: 29 pages, 1 figure, harvma

On the Connection between N=2 Minimal String and (1,n) Bosonic Minimal String

We study the scattering amplitudes in the N=2 minimal string or equivalently in the N=4 topological string on ALE spaces. We find an interesting connection between the tree level amplitudes of the N=2 minimal string and those of the (1,n) minimal bosonic string. In particular we show that the four and five-point functions of the N=2 string can be directly rewritten in terms of those of the latter theory. This relation offers a map of physical states between these two string theories. Finally we propose a possible matrix model dual for the N=2 minimal string in the light of this connection.Comment: 40 pages, one figure, harvmac, minor corrections, references adde

Using the infrastructure of a conditional cash transfer program to deliver a scalable integrated early child development program in Colombia : cluster randomized controlled trial

En: British Medical Journal No. 349, doi: http://dx.doi.org/10.1136/bmj.g5785Objective: To assess the effectiveness of an integrated early child development intervention, combining stimulation and micronutrient supplementation and delivered on a large scale in Colombia, for children’s development, growth, and hemoglobin levels. Design Cluster randomized controlled trial, using a 2×2 factorial design, with municipalities assigned to one of four groups: psychosocial stimulation, micronutrient supplementation, combined intervention, or control. Setting 96 municipalities in Colombia, located across eight of its 32 departments. Participants: 1420 children aged 12-24 months and their primary carers. Intervention Psychosocial stimulation (weekly home visits with play demonstrations), micronutrient sprinkles given daily, and both combined. All delivered by female community leaders for 18 months. Main outcome measures Cognitive, receptive and expressive language, and fine and gross motor scores on the Bayley scales of infant development-III; height, weight, and hemoglobin levels measured at the baseline and end of intervention. Results Stimulation improved cognitive scores (adjusted for age, sex, testers, and baseline levels of outcomes) by 0.26 of a standard deviation (P=0.002). Stimulation also increased receptive language by 0.22 of a standard deviation (P=0.032). Micronutrient supplementation had no significant effect on any outcome and there was no interaction between the interventions. No intervention affected height, weight, or hemoglobin levels. Conclusions: Using the infrastructure of a national welfare program we implemented the integrated early child development intervention on a large scale and showed its potential for improving children’s cognitive development. We found no effect of supplementation on developmental or health outcomes. Moreover, supplementation did not interact with stimulation. The implementation model for delivering stimulation suggests that it may serve as a promising blueprint for future policy on early childhood development

Agricultural climate change mitigation : Carbon calculators as a guide for decision making

This is an Accepted Manuscript of an article published by Taylor & Francis Group in International Journal of Agricultural Sustainability on 9 November 2017, available online: https://doi.org/10.1080/14735903.2017.1398628. Under embargo. Embargo end date: 9 November 2018.The dairy industry is receiving considerable attention in relation to both its significant greenhouse gas (GHG) emissions, and it’s potential for reducing those emissions, contributing towards meeting national targets and driving the industry towards sustainable intensification. However, the extent to which improvements can be made is dependent on the decision making processes of individual producers, so there has been a proliferation of carbon accounting tools seeking to influence those processes. This paper evaluates the suitability of such tools for driving environmental change by influencing on-farm management decisions. Seven tools suitable for the European dairy industry were identified, their characteristics evaluated, and used to process data relating to six scenario farms, emulating process undertaken in real farm management situations. As a result of the range of approaches taken by the tools, there was limited agreement between them as to GHG emissions magnitude, and no consistent pattern as to which tools resulted in the highest/lowest results. Despite this it is argued, that as there was agreement as to the farm activities responsible for the greatest emissions, the more complex tools were still capable of performing a ‘decision support’ role, and guiding management decisions, whilst others could merely focus attention on key issues.Peer reviewe

Conformal Affine Toda Soliton and Moduli of IIB Superstring on AdS5×S5AdS_5\times S^5

In this paper we interpret the hidden symmetry of the moduli space of IIB superstring on $AdS_{5}\times S^{5}$ in terms of the chiral embedding in $AdS_{5}$, which turns to be the $\mathbb{CP}^{3}$ conformal affine Toda model. We review how the position $\mu$ of poles in the Riemann-Hilbert formulation of dressing transformation and how the value of loop parameters $\mu$ in the vertex operator of affine algebra determines the moduli space of the soliton solutions, which describes the moduli space of the Green-Schwarz superstring. We show also how this affine SU(4) symmetry affinize the conformal symmetry in the twistor space, and how a soliton string corresponds to a Robinson congruence with twist and dilation spin coefficients $\mu$ of twistor.Comment: Final version, Misprints corrected, Note adde

The matrix factorisations of the D-model

The fundamental matrix factorisations of the D-model superpotential are found and identified with the boundary states of the corresponding conformal field theory. The analysis is performed for both GSO-projections. We also comment on the relation of this analysis to the theory of surface singularities and their orbifold description.Comment: 23 pages, LaTe

Rapid progression of prostate cancer in men with a BRCA2 mutation.

Men with BRCA2 mutations have been found to be at increased risk of developing prostate cancer. There is a recent report that BRCA2 carriers with prostate cancer have poorer survival than noncarrier prostate cancer patients. In this study, we compared survival of men with a BRCA2 mutation and prostate cancer with that of men with a BRCA1 mutation and prostate cancer. We obtained the age at diagnosis, age at death or current age from 182 men with prostate cancer from families with a BRCA2 mutation and from 119 men with prostate cancer from families with a BRCA1 mutation. The median survival from diagnosis was 4.0 years for men with a BRCA2 mutation vs 8.0 years for men with a BRCA1 mutation, and the difference was highly significant (P&lt;0.01). It may be important to develop targeted chemotherapies to treat prostate cancer in men with a BRCA2 mutation