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Short and long term clinical outcomes following endometrial ablation in women with heavy menstrual bleeding. Randomised trials evaluating second generation endometrial ablation techniques are discussed and critically reviewed in this thesis. Patterns of referral, socio-demographic and clinical details, primary care treatment, of women referred with heavy menstrual loss are also considered as are three randomised trials of surgical treatments for the treatment of heavy menstrual bleeding. Microwave endometrial ablation (MEATM) and thermal balloon ablation (TBall) both achieved high levels of satisfaction (-1%, 95% CI (-11, 9)). Microwave had a significantly shorter operating time, reduced usage of anti-emetics and opiate analgesia, increased discharge by six hours and fewer device failures. Comparing MEA™ in the postmenstrual phase to MEA™ following standard drug based endometrial preparation there was no significant difference at five years in menstrual outcomes, health related quality of life, or need for subsequent treatment Ten years following MEATM or transcervical resection of the endometrium (TCRE), the hysterectomy rate after ten years was significantly different with 17% in the MEATM and 28% in the TCRE arm (95% CI -0.21, -0.13). In conclusion primary care guidelines should be followed whilst establishing patient preference prior to referral to secondary care. Microwave ablation has been shown to be an effective treatment in the short, medium and long-term. It can successfully be performed in an outpatient setting in the post menstrual phase and is acceptable under local anaesthesia.

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The present study expanded the story recognition and inference literature by investigating age differences within the older age range, differences as a result of mild cognitive impairment (MCI), and extending the focus of the investigation into the consistency of responding. 304 older adults completed a story recognition task across five different occasions. Old-old (00) adults and those with more severe MCI showed poorer ability to accurately recognize inferences, and less sensitivity to discriminate between statement types. Intraindividual variability was positively correlated with increasing age and cognitive impairment, and interactions revealed the greatest inconsistency involved the false, rather than inferred statements. The findings support our proposal that participants used two different recognition strategies, and their episodic memory ability defined the efficiency and frequency of use of the strategies. 00 and MCI adults may be less able to recognize that something plausible and consistent with an event may not have actually occurred.

Current classification systems for identifying individuals at the earliest stages of dementia, based primarily on cognitive measures, may be limited in scope. The present study examined physical functioning in a sample of 304 nondemented, older adults, classified based on presence and severity of mild cognitive impairment. In general, lower levels of physical functioning and greater inconsistency in physical functioning were found in older participants and in participants with increasing severity of cognitive impairment. Evaluation of the combined and unique contributions of level of and inconsistency in physical functioning to predicting cognitive status group membership revealed that, for some physical measures, inconsistency in physical functioning provided unique information beyond level of performance. These results are consistent with the notion that inconsistency in performance may be a behavioural marker of compromised neurological functioning and that information regarding physical functioning may prove useful for identifying individuals at the earliest stages of dementia.

Previous studies have associated stuttering with increased levels of self-stigma. Prior research has shown that high levels of self-stigma may relate to increased medication usage. Therefore, in the present study, the authors sought to determine an association between levels of self-stigma and medication usage among adults who stutter. Results suggest that although there is not a significant difference for lifetime medication use between AWS versus AWNS, the self-imposed stigma by AWS could predict the likelihood of medication use. Findings provide insight into additional pharmacological factors to consider during clinical intervention, and highlight the importance of stigmatized beliefs when addressing the needs of a client who stutters.

The present study was designed to describe and quantify patterns of pronoun use by African American English (AAE)-speaking children with specific language impairment (SLI) relative to their AAE-speaking typically developing (TD) peers. Pronouns were of interest because: they are produced frequently in everyday speech, they are often targeted when a childs language abilities are evaluated by a speech-language pathologist, and limited pronoun data exists for AAE-speaking children. The data were language samples that had been elicited from 96 children (35 SLI, 61 TD) enrolled in kindergarten. The samples were searched for 11 different pronoun forms, and these were coded as either mainstream or nonmainstream forms. In addition, the childrens use of different types of appositive pronouns was examined. Results showed that the majority of the childrens pronouns reflected mainstream forms that were consistent with General American English (GAE). Of those classified as nonmainstream, three patterns (i.e., subjective for genitive, objective for genitive, and objective for subjective) were classified as productive because they were produced by more than 10% of the children. Although both groups of children produced these three pronoun patterns, those with SLI produced them at higher rates, and higher rates of objective for genitive pronouns accounted for the group difference. Specifically, the patterns them for their and him for his were produced more frequently per target context by children with SLI than TD children. Both groups also produced appositive pronouns; the frequency of these were low (.5%), and the most frequent were appositives involving she, he, and they. These findings suggest that both TD children and children with SLI who speak AAE produce various pronoun patterns that can be considered nonmainstream. However, the majority of their pronouns reflect mainstream forms. Differences between those with and without SLI were minimal, with the former producing more objective for genitive pronouns than the latter. If replicated, the findings suggest that current assessment tools should be modified to specifically target genitive forms. If this is done, multiple items targeting genitive pronouns should be included to capture rate-based differences in their use between children with and without SLI.