Potential strategies to avoid progestogen-induced premenstrual disorders

Non-hormonal approaches to premenstrual syndrome (PMS) treatment such as selective serotonin reuptake inhibitors are by no means effective for all women and frequently we must resort to endocrine therapy. During many of the hormonal approaches, PMS-like symptoms can be introduced or re-introduced during the necessary cyclical or continuous progestogen component of the therapy. This is seen with combined oral contraception, progestogen only contraception, progestogen therapy for heavy menstrual bleeding and endometriosis, sequential hormone replacement therapy and any therapeutic strategy for premenstrual syndrome where it is necessary to provide endometrial protection, including estrogen suppression of ovulation or add-back during gonadotrophin releasing hormone suppression. The link to progestogen is very often missed by health professionals. When the pattern of symptoms mimics the cyclicity of PMS, it is termed progestogen-induced premenstrual disorder. The need to use progestogen to protect the endometrium from the proliferative actions of estrogen can pose insurmountable difficulties in managing premenstrual disorders. In the absence of any really useful evidence, nearly all practice in this area depends on clinician experience. We cannot afford to wait for adequate research evidence to be produced - it never will - and so we must rely on empirical findings, clinical experience, theoretical strategies and common sense.     

Unaccompanied migrant children and indebted relations: Weaponizing safeguarding

UK statutory guidance for practitioners suggests that indebtedness is an area where safeguarding red flags should be raised and action taken to minimize the risk of exploitation. Yet, our research shows that unaccompanied migrant children have complex indebted relationships, which can range from extractive to connective. Drawing on interviews with unaccompanied children, we show that these indebted relationships can include financial debt to smugglers, responsibilities to support transnational families, as well as social obligations to peers and others. Their accounts present a nuanced understanding of the taboo nature of indebted relationships, not to be shared with the practitioners in their lives. This is due, in part, to the potential threat of reporting to the Home Office, which might jeopardize their immigration status. In response to this weaponization of social care, we demonstrate how children turn to peer networks of support, creating their own alternative forms of social protection. In so doing, we complicate critiques of adultification, which traditionally highlight the ways that racially minoritized children may be treated as adults—to their detriment. In so doing, we show that because indebtedness is normatively linked to adulthood, unaccompanied children's hopes and fears may be rendered unsayable and therefore unsupportable in social care, all in the name of safeguarding.     

Inferactive data analysis

We describe inferactive data analysis, so-named to denote an interactive approach to data analysis with an emphasis on inference after data analysis. Our approach is a compromise between Tukey's exploratory and confirmatory data analysis allowing also for Bayesian data analysis. We see this as a useful step in concrete providing tools (with statistical guarantees) for current data scientists. The basis of inference we use is (a conditional approach to) selective inference, in particular its randomized form. The relevant reference distributions are constructed from what we call a DAG-DAG—a Data Analysis Generative DAG, and a selective change of variables formula is crucial to any practical implementation of inferactive data analysis via sampling these distributions. We discuss a canonical example of an incomplete cross-validation test statistic to discriminate between black box models, and a real HIV dataset example to illustrate inference after making multiple queries on data.     

The ensemble Kalman filter is an ABC algorithm

The ensemble Kalman filter is the method of choice for many difficult high-dimensional filtering problems in meteorology, oceanography, hydrology and other fields. In this note we show that a common variant of the ensemble Kalman filter is an approximate Bayesian computation (ABC) algorithm. This is of interest for a number of reasons. First, the ensemble Kalman filter is an example of an ABC algorithm that predates the development of ABC algorithms. Second, the ensemble Kalman filter is used for very high-dimensional problems, whereas ABC methods are normally applied only in very low-dimensional problems. Third, recent state of the art extensions of the ensemble Kalman filter can also be understood within the ABC framework.     

Evaluation of trace evidence in the form of multivariate data

Summary.  The evaluation of measurements on characteristics of trace evidence found at a crime scene and on a suspect is an important part of forensic science. Five methods of assessment for the value of the evidence for multivariate data are described. Two are based on significance tests and three on the evaluation of likelihood ratios. The likelihood ratio which compares the probability of the measurements on the evidence assuming a common source for the crime scene and suspect evidence with the probability of the measurements on the evidence assuming different sources for the crime scene and suspect evidence is a well-documented measure of the value of the evidence. One of the likelihood ratio approaches transforms the data to a univariate projection based on the first principal component. The other two versions of the likelihood ratio for multivariate data account for correlation among the variables and for two levels of variation: that between sources and that within sources. One version assumes that between-source variability is modelled by a multivariate normal distribution; the other version models the variability with a multivariate kernel density estimate. Results are compared from the analysis of measurements on the elemental composition of glass.     

Validity of work-related assessments

Insufficient evidence of the validity of work-related assessments is frequently reported as a major concern in occupational rehabilitation. Despite this concern, and the continuing development of new and old assessments, no comprehensive evaluation of the evidence has been conducted. OBJECTIVES: The purpose of this study was to first determine the extent and quality of available evidence for the validity of work-related assessments, and then where sufficient evidence was available, determine the level of validity. STUDY DESIGN: This study examined available literature and sources in order to review the extent to which validity has been established for 28 work-related assessments. RESULTS: The levels of evidence and validity are presented for each assessment. Most work-related assessments have limited evidence of validity. Of those that had adequate evidence, validity ranged from poor to good. There was no instrument that demonstrated moderate to good validity in all areas. Very few work-related assessments were able to demonstrate adequate validity in more than one area, or with more than one study, even when contributory evidence was included. CONCLUSION: With this study clinicians will be able to examine their options with regard to the validity of the assessments they choose to use.     

The child welfare response to serious nonaccidental head trauma

Serious nonaccidental head trauma (NHT) can leave permanent neurological damage in children who survive abuse. This study reports on child welfare's handling of NHT cases compared with cases of physical abuse and head trauma due to neglect with regard to placement in foster care, reunification with family, and safety issues. The results show that workers placed children with NHT in foster care immediately after the abuse but treated them no differently than other physically abused children regarding reunification.     

Improving access to health care for foster children: the Illinois model

Children in foster care have lower health status than do their peers and limited access to health care. The Illinois Department of Children and Family Services developed HealthWorks, a separate primary care preferred provider system for children in foster care. This study compared claims data for children in HealthWorks with children not enrolled in HealthWorks and with children in Aid to Families with Dependent Children (AFDC) who had never entered foster care. Children enrolled in HealthWorks were more likely than were other children to receive all of the services except general inpatient hospitalizations. They had greater odds of receiving general exams and physicians' services and were more likely to visit the emergency room than children who were not enrolled. They were more likely to receive all of the measured services when compared with children receiving Medicaid through AFDC.