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Work accident compensation claims
Have you suffered an accident at work?
Home / Personal injury claims / Work accident compensation claims
Why use Boyes Turner's work accident claims solicitors?
Claiming compensation for your injury - FAQs
Previously settled accident at work cases
Claims arising from accidents at work
Employers must take all reasonable steps to protect their employees from foreseeable accidents and injury. This means that those who work for them can expect to work in a safe environment with the necessary training, protective clothing (if needed) and equipment to perform their work. Employers must regularly check their workplace facilities and procedures to identify and reduce the risk of injury. They are responsible for accidents caused by their own failure to protect their workers' safety, and for injury caused by their employees' negligence at work.
Workplace accidents can sometimes be dismissed as carelessness, with the employee encouraged to assume that it was all their fault. However, if the accident was caused, partly or wholly, by the employer's negligence, the injured employee may be entitled to compensation for their injuries and financial loss.
If you or a family member have been severely injured at work but are not sure whether the accident should have been prevented, our expert solicitors can advise you quickly, and confidentially, whether you can claim. It costs nothing to talk to us and find out about your rights, and it might open the door to much-needed rehabilitation, practical support and financial help in meeting the costs which follow a serious injury, as well as the long-term security of substantial compensation.
Why use Boyes Turner for your workplace injury/accident at work compensation claim?
Boyes Turner's specialist serious injury claims lawyers have been helping clients recover compensation and rebuild their lives after accidents and injury in the workplace for over 20 years. We understand the H&S regulations which govern workplace accidents and have the expertise to quickly identify the negligent causes of our clients' injuries. We specialise in claims involving complex and severe injury.
Our clients benefit from: free, clear, straightforward, confidential advice from our experienced solicitors;
no win no fee (CFA) funding arrangements for eligible claims;
early funded rehabilitation, to maximise recovery, with individualised immediate needs assessments (INAs) by specialist case managers;
interim (advance) payments to reduce financial hardship and meet urgent needs;
ongoing support (liaison with multidisciplinary medical, therapeutic and care teams, where needed);
deputyship or personal injury trusts, where needed;
high value settlements, carefully calculated to meet our client's future needs.
Our personal injury lawyers are recognised as experts in their field by Chambers Directory and The Legal 500, APIL (Association of Personal Injury Lawyers), The Law Society's Personal Injury Panel, Headway, Spinal Injuries Association (SIA), the Major Trauma Group, and Mesothelioma UK
Previous claims for accidents at work
£1.1 million settlement for the family of a former welder who had been exposed to asbestos by two employers, in a fatal mesothelioma claim.
£300,000 settlement from the Ministry of Defence (MOD) for a soldier whose pre-existing PTSD was exacerbated when he was redeployed for a second tour of duty in Afghanistan. MOD denied liability but the case settled after their psychiatry expert's report, disclosed in preparation for trial, criticised the assessment by the MOD psychiatrist who had authorised our client's redeployment.
£300,000 compensation for a roofer who fell from a slipping ladder at roof height. He received £26,000 of insurer-funded surgery and rehabilitation and interim payments of £44,500 to help his recovery and relieve his financial hardship whilst we worked on his claim.
£300,000 settlement for a mechanic who suffered a brain injury when he slipped whilst working in an MOT bay which had been left unsafe by another employee.
£300,000 settlement for a man who suffered a moderate head injury, psychological symptoms and at risk of epilepsy after he was hit with a pickaxe by a co-worker whilst working on the road.
£220,000 settlement for a client who suffered soft tissue injuries to his neck and back, chronic pain and a minor head injury with post-concussion syndrome when he was hit on the head by a metal roller shutter door which came down unexpectedly on top of him. We secured Rehabilitation Code funding from the insurers for the defendant (our client's employer) at an early stage to pay for our client to have physiotherapy, steroid injections and CBT treatment.
£188,000 settlement for a telecoms engineer who suffered a moderate head injury in an accident whilst lifting a heavy cabinet down a staircase with a colleague. On our advice, our client rejected an initial settlement offer of £5,000. We negotiated a £188,000 settlement despite the claim being disputed throughout by our client's employer.
£135,000 settlement for a healthcare assistant in her sixties who suffered facial injuries, fibromyalgia and PTSD after being head-butted by a patient at work. Her employer admitted responsibility for the assault and an interim payment helped ease our client's financial hardship and pay for psychological treatment whilst we worked towards settlement of the case.
Who can claim compensation for workplace injuries?
Business owners and employers have a responsibility to provide a safe workplace or business premises to all visitors to their site, not just full-time employees. Claims against an employer or business owner for compensation for workplace injuries caused by negligence or failure to provide a safe working environment can be made by:
full-time or part-time employees;
independent contractors;
temporary or casual staff;
self-employed workers;
agency workers;
visitors;
members of the public.
We can also help recover compensation for UK residents who have been severely injured as a result of their employer's negligence whilst working abroad.
How common are accidents at work and workplace injuries?
142 people died in fatal workplace accidents in Britain in the year 2020 to 2021, according to the Health and Safety Executive (HSE) figures from RIDDOR (Reporting of Injuries Diseases and Dangerous Occurrences Regulations).
HSE figures for workplace deaths in the five years from 2015 to 2020 reveal that:
25% were from falls from height, with over half in the construction industry;
19% arose from being hit by a moving vehicle, mainly in the farm/agricultural/fisheries, transport/storage, and construction industries.
13% were caused by being hit by a moving object;
10% were caused by being trapped by something overturning or collapsing;
8% were from contact with moving machinery;
4% were from being injured by an animal;
3% were from explosions;
3% were from contact with electricity;
2% were from drowning or asphyxiation;
2% were from slips, trips or falls on the same level;
the remaining 10% of causes included:
exposure to fire;
exposure to harmful substances;
striking against something fixed or stationary;
handling, lifting or carrying;
acts of violence.
In the year from 2019 to 2020, 693,000 workers reported to the Labour Force Survey (LSF) that they had suffered non-fatal workplace injuries. Of those, HSE says only 65,427 were reported as employee non-fatal injuries by employers.
Of the reported non-fatal injuries in 2019/2020:
29% were from slips, trips or falls on same level;
19% were from handling, lifting or carrying;
11% were from being struck by a moving object;
9% were from acts of violence;
8% were from falls from a height;
90% of those reported injuries were fractures (broken bones other than fingers, thumbs, toes).
What kinds of employer negligence can lead to a workplace injury compensation claim?
Employers must comply with multiple health and safety (H&S) standards and guidelines and carry out regular risk assessments. They also owe their employees a general duty of care to prevent foreseeable accidents and injury.
The main regulations are set out in:
The Health and Safety at Work Act 1974;
Regulations which set out minimum health and safety requirements for employers to protect their workers from injury. In workplace injury claims, the most commonly used regulations are known as 'The Six Pack'. Where an employer has failed to comply with these regulations, this may help provide evidence of negligence.
Management of Health and Safety at Work Regulations 1999;
Manual Handling Operations Regulations - risk of injury from lifting or handling of heavy loads;
Display Screen Equipment (DSE) Regulations - safe use of computer screens and keyboards;
Workplace (Health, Safety and Welfare) Regulations - working environment (seating, lighting, heating, windows, rest areas, washing facilities, changing rooms, fire escapes);
Provision and Use of Work Equipment Regulations: appropriate, regularly maintained equipment and proper training in its use.
Personal Protective Equipment (PPE) Regulations - protective equipment and training in its use.
Common causes of workplace injuries which lead to compensation claims include:
falls from heights (defective scaffolding, broken ladders, unguarded steep drops, such as rooftops);
falls on same level (into manholes, uncovered drains);
unsafe working environments (asbestos);
unsafe working practices, (heavy lifting, overloaded trolleys or shelving);
dangerous, unguarded or defective machinery and equipment;
burns, electrocution/electric shocks, explosions;
moving vehicle accidents, such as agricultural vehicles, tractors, forklifts, factory vehicles, delivery trucks;
exposure to dangerous substances, toxins, chemicals, asbestos;
slipping hazards (spillages, oil, water, slippery floors);
tripping hazards (trailing wires, raised carpets or paving stones, debris);
falling/moving objects and toppling hazards;
unsafe buildings or premises, occupier's liability;
untrained, unsupervised or negligent co-workers;
violence, such as assault.
Employer health and safety (H&S) negligence which may lead to workplace injury claims
Our specialist personal injury lawyers investigate and carefully consider the circumstances of each client's accident and injury. This means that we can ensure that the correct defendant and their insurers take responsibility for the injury and provide funding for our client's rehabilitation and urgent needs straight away.
Common health and safety failures which lead to accident at work injury claims include:
failing to carry out a proper risk assessment;
failing to inspect, maintain and repair buildings and business premises;
failing to inspect, maintain and repair or replace machinery, vehicles or equipment;
failing to provide protective clothing or safety equipment;
failing to provide adequate training and support;
failing to comply with health and safety guidelines or regulations;
failing to provide safe systems of work;
failing to provide safety guards around hazards, such as:
steep drops (rooftops, scaffolding);
dangerous machinery;
electricity;
risk of falling objects.
lack of safety netting on scaffolding and rooftops;
toppling hazards (unsafe stacking of shelves, trolleys or vehicles, faulty ramps);
failing to warn/sign or remove spillages or slipping hazards (oil, water, slippery floors, stairs);
failing to remove, repair or warn about tripping hazards (trailing wires, raised paving or carpets);
exposing employees to hazardous or toxic substances (chemicals, broken glass);
exposure to asbestos;
failing to train or supervise other employees properly (vicarious liability for co-worker negligence);
road traffic accidents (RTAs) and driver negligence at work;
armed forces/military claims for negligence against the MOD;
violent crime – CICA claims (workplace assaults, claims by injured police, and other criminal injuries).
Who is at risk of suffering an accident at work or workplace injury?
Accidents can take place in any environment where an employer or business owner fails to consider the risks of accidental injuries and take reasonable steps to prevent them. However, some industries or occupations have higher rates of serious injury from workplace accidents. These include:
Construction industry (roofers, builders, building site labourers etc);
Factory and warehouse work;
Farming, agriculture and fishing industry;
Transportation and storage industry;
Manufacturing industry;
Catering/commercial kitchens;
Schools;
Occupations and industries historically linked to asbestos exposure (shipbuilding, carpentry, plumbing);
Military – MOD.
What kind of workplace injuries can lead to an accident at work compensation claim?
Boyes Turner's personal injury team specialise in helping clients who have suffered severe, life-changing injury or permanent disability as a result of someone else's negligence. We can help clients, and their families, after their employer's negligence led to injuries such as:
head injury or skull fracture;
brain injury and neurological damage;
spinal cord injury ( paralysis, paraplegia, tetraplegia) or spinal fracture;
major trauma or multiple injuries;
amputation;
crush injuries;
fractures (broken bones);
burns;
scalds;
degloving injuries (needing skin grafting);
scarring and disfigurement;
internal injuries (damage to major organs);
severe lacerations;
nerve injury;
blindness and sight loss;
deafness and hearing loss;
stabbing/impaling injury;
CRPS and chronic pain conditions;
mesothelioma, asbestosis, pleural thickening and asbestos-related lung cancer;
PTSD and psychological injury;
Death/fatal injury (claims for the bereaved, dependant family).
How much compensation can I claim for a workplace injury?
Each client's claim is carefully calculated to compensate them for their injury, its impact on their life, and to meet their additional needs arising from that injury now and in the future.
Where the injured person's own actions contributed to their accident or injury, they will usually still be entitled to compensation as long as their employer was partly at fault. In these circumstances, their compensation may be reduced in proportion to their own contributory negligence.
Depending on the client's injury, they may receive compensation for:
pain, suffering and disability;
costs of rehabilitation, in addition to rehab funded under the Rehabilitation Code by the defendant, such as ongoing or future rehab, or vocational rehabilitation;
case management costs;
care costs;
therapies, such as:
occupational therapy (OT);
physiotherapy;
speech and language therapy (SALT);
pain management;
psychological treatment and counselling;
assistive technology (IT);
prostheses (if needed after amputation);
earnings and pension loss;
specialist equipment/aids;
extra costs of transport and mobility, such as wheelchairs and adapted vehicles;
increased costs of suitable accommodation or essential home adaptations;
medical or surgical treatment;
immunotherapy treatment costs (for mesothelioma);
Court of Protection deputyship costs;
Fatal injury compensation including loss of dependency claims for the deceased's dependents.
Who pays the compensation in a workplace injury claim?
Employers and business owners are required by law to have insurance in place to cover claims for injury and death. Employers (and their insurers) are also liable for injury caused by the negligence of their employees.
Depending on the circumstances of the accident, the compensation may be paid by the defendant's employer's liability insurance, public liability insurance, motor insurance. Claims against the Ministry of Defence are paid by the MOD (via the Armed Forces Compensation Scheme). Claims arising from violence may be compensated via the CICA (Criminal Injuries Compensation Authority).
Claire Roantree
Martin Anderson
Associate Solicitor
Looking beyond the stats – the impact of workplace accidents on working people's lives
Deaths in the workplace – HSE publishes latest figures
Ladder Association research finds 4 out of 5 telescopic ladders tested were unsafe
£300,000 settlement for roofer who fell from a ladder whilst working at height
£220,000 settlement after accident at work causes neck, back and minor head injuries
Compensation settlement for teacher injured at school fair
Claiming for Personal Injury FAQs
Who can we help make a personal injury claim?
If you have suffered a serious injury as a result of somebody else's negligence (breach of their duty of care), we may be able to help you make a claim for compensation.
Depending on the circumstances of your accident and the severity of your injury, we may also be able to help you claim compensation:
where someone else was responsible for causing the accident but you were also partly to blame;
where your injuries were caused by an untraced driver in a 'hit and run';
where you were the victim of criminal violence.
You can make a claim on behalf of:
yourself – for your own injuries;
an injured child who is under the age of 18 (as their litigation friend);
an injured adult who does not have mental capacity to claim for themselves (as litigation friend);
the estate of someone who suffered a fatal injury (as their personal representative/executor);
for your loss of dependency on someone who suffered fatal injury.
If I make a claim for compensation, will I need to go to court?
The vast majority of our clients' serious injury claims are settled without the need for a court hearing (trial). Our clients very rarely need to go to court.
Our personal injury specialists are highly experienced in investigating and assessing the strength of each client's case. From the outset, and throughout the claim, we advise our clients clearly and honestly about their prospects of success.
Court proceedings are issued (started) in many cases but this does not mean that the case will end in a trial. There are many reasons why court proceedings might be issued:
to protect our client's right to claim compensation if their limitation deadline (time limit for making a claim) is approaching;
to force the defendant (and their insurers) to take the claim seriously;
to push the defendant to admit liability (fault);
to push the defendant (and their insurers) to make an interim payment to our client;
so that we can obtain a court judgment, guaranteeing our client's right to compensation, if liability has been admitted;
to encourage the defendant to enter into settlement negotiations;
to avoid unnecessary delay by setting a timetable, which is overseen by the court, for the steps that must be taken to bring the case to a conclusion.
We work hard to prove each client's claim, based on evidence of the circumstances of their accident and the impact of their injury. We encourage cooperation with the defendant's insurers and negotiate the best possible settlements for our clients. On the rare occasions when a claim cannot be settled without a court hearing, this will be because:
there are serious, insurmountable challenges with the evidence, or disagreements between experts in a case, which need to be decided upon by a trial judge;
the defendant's insurers are using the case to test the court's approach to a point of law.
In the following circumstances, the law requires a judge to approve an out-of-court settlement, for the protection of those involved:
where at least one of the injured claimants is a child under the age of 18;
where the claimant does not have mental capacity to manage their own affairs;
where at least one of the claimants in a fatal accident claim is a child or lacks mental capacity.
In these cases, the approval hearing will be a short hearing at which the lawyers for both parties explain the circumstances of the case and the settlement terms to the judge. In most cases our client will be expected to be in court during the hearing, accompanied and fully supported by members of our legal team.
How long do personal injury compensation claims take?
The duration of a serious injury claim depends on the individual circumstances of the client's case. Claims take less time to conclude if:
liability is admitted by the defendant or their insurer;
the injured person's injuries have stabilised and their prognosis (long-term outcome) is clear;
the injured person's needs, the costs of meeting those needs and their other financial losses can easily be assessed;
Claims are more complex and may take longer to resolve where:
the defendant or their insurer disputes that they were negligent or responsible for causing the client's injury;
an injured child's disability and associated needs are expected to change as they grow and develop over time;
the injured person has suffered catastrophic injury, such as severe brain injury, or major trauma and needs rehabilitation;
multiple experts in different disciplines are needed to assess complex injuries and the likely long-term outcome.
Our nationally acclaimed serious injury specialists have helped hundreds of individuals and families whose lives have been devastated by accidents on the roads, at work, abroad or elsewhere. We understand the impact that a sudden, severe injury and its financial consequences can have on an individual and their family.
We work hard to secure cooperation with defendant insurers, to provide immediate needs assessments and timely funded rehabilitation for our clients to maximise their recovery in the all-important period immediately following an injury. Wherever possible we also secure interim payments to ease our clients' financial hardship long before their claims have concluded.
By taking the time that is needed for the client's rehabilitation and the careful assessment of their long-term needs, we can be confident that each client receives the full support and the compensation they deserve.
What compensation can I claim for serious injury?
The amount of compensation that an injured person receives in a personal injury claim depends on a number of individual factors:
the severity of the injury;
the extent of any permanent disability caused by the injury;
the impact that the injury has on their ability to live independently, study, work, or participate in leisure activities;
additional needs arising from their injury, such as care, specialist equipment or an adapted home;
their life circumstances before the accident;
their predicted lifespan;
litigation risk factors, such as contributory negligence.
Depending on the client's injury and the way it affects their life, their claim may include compensation for:
funded directly by the defendant's insurer;
funded from interim payments;
future rehabilitation costs funded from final settlement;
costs of care;
case management;
costs of medical or surgical treatment;
therapies:
psychological counselling;
loss of earnings and pension;
additional costs of adapted accommodation;
prosthetics (after amputation);
specialist equipment and aids;
extra costs of transport or adapted vehicles;
special educational needs (SEN);
Court of Protection deputyship;
funeral costs (fatal cases);
bereavement damages (fatal cases);
loss of dependency on the deceased's income or services (fatal cases).
Compensation is carefully structured to make the best provision for the injured person's needs. There are rules protecting compensation for children or adults who lack mental capacity. Compensation may be paid in one or more of the following ways:
Rehabilitation Code funding – paid directly by the defendant's insurer to pay for the injured person's rehabilitation;
interim (advance) payment whilst the claim is ongoing;
a lump sum settlement;
a periodical payments order (PPO) providing lifelong, annual, tax free, index-linked payments for essential costs, such as care and case management, or Court of Protection fees.
What is an interim payment?
An interim payment is a part-payment of compensation which is paid to the injured person, in advance, whilst the claim is ongoing. We can usually secure an interim payment from the defendant's insurer where they have admitted liability (accepted fault) for our client's injury.
We use interim payments to help the injured person and their family, who may be suffering financial hardship as a result of the injury. Where insurers are not willing to provide Rehabilitation Code funding, we sometimes obtain interim payments to ensure that our client receives the rehabilitation, case management and therapies that they need straight away.
Interim payments may be used to meet any genuine need, but it is important that the injured person and their family understand that the sums that they have already received as interim payments are deducted from their final compensation at the end of the claim.
Depending on the client's injury, an interim payment may help meet their needs for:
rehabilitation;
personal care and assistance;
occupational therapy;
speech and language therapy;
adapted accommodation;
wheelchairs;
transport;
prostheses (after amputation);
assistive technology and other specialist equipment;
trials of supported independent living.
By understanding and targeting provision for our clients' rehabilitation and other essential needs early in the claims process, we help restore our clients' mobility, independence and ability to participate fully in family and social life, long before the claim has concluded.
How do I get started with making a claim?
If you, or someone in your family has been seriously injured in an accident that was somebody else's fault, you may be entitled to make a claim. If this feels daunting, alongside everything else that you are coping with in the aftermath of an accident, it may help to remember that:
our experienced lawyers are here to advise and support you, and deal with the claim on your behalf;
it costs nothing to find out from one of our solicitors whether you have a claim and what it will mean for you;
claims for compensation are not personal, but are usually handled and paid by the defendant's insurers;
our clients often benefit from:
early access to appropriate rehabilitation, treatment and support;
interim (advance) payments to meet urgent financial needs;
expert advice about your injury, your long-term needs and how to meet them in the future;
peace of mind from long-term financial provision.
The easiest way to get started is to talk to one of our friendly, experienced solicitors. You can talk to us free and confidentially about your potential claim, with no obligation, by contacting us here.
If you decide that you want to go ahead with making a claim, we will gather as much evidence as we can to support your claim. This evidence may include:
a statement from you about your recollection of the accident, the effect of your injury and other details relevant to your claim;
statements from any witnesses;
documents and reports relating to the accident (such as police accident report, photographs of the scene, accident book entries etc);
medical evidence (such as medical reports on your injury and any rehabilitation needs, medical records etc);
receipts and other evidence of the additional costs or financial losses as a result of the injury.
We will also contact the defendant and their insurers to begin working towards meeting your immediate needs and settlement of the claim.
How are personal injury claims funded?
It costs nothing to talk to us to find out about making a claim. Our initial advice is free.
When you first contact us we advise you whether we can help you make a claim. We discuss how your claim will be funded, and advise, fully and clearly, how that works and what it will mean for you.
We offer a range of funding options, but the majority of our clients' claims are handled on a conditional fee agreement (CFA) basis, often known as 'no win no fee'. This means that there is nothing to pay at the outset or until the claim is settled and you receive compensation. If you win your claim, the defendant's insurer makes a contribution towards your legal costs. You pay nothing if your claim does not succeed.
What injuries can lead to a personal injury compensation claim?
Our personal injury lawyers are specialists in catastrophic and severe injury compensation claims. Our clients have often suffered life-changing injury resulting in permanent disability. Our aim is to assist their recovery by securing funded rehabilitation whilst supporting them in adjusting to the changes to their lives and securing compensation to meet their needs in the future.
Our clients usually have suffered one or more of the following:
head injury/brain injury;
spinal cord injury (SCI) - paralysis, tetraplegia, paraplegia;
loss of limbs or amputation;
major trauma /multiple injuries;
fractures (broken bones) - spinal fractures, skull fractures, maxillofacial injury;
asbestos-related disease;
musculoskeletal injury;
blindness, deafness or sensory impairment;
electrocution, burns or scalds;
chronic pain conditions, such as CRPS;
stab wounds and severe lacerations;
psychological injury, such as PTSD;
internal injuries, such as damage to organs;
fatal injury/death.
What is a personal injury claim?
A personal injury is an injury to the body. Sometimes the physical injury or the circumstances in which that injury was suffered also leads to a psychiatric or psychological injury.
When someone is injured as a result of another person or organisation's breach of their duty of care (negligence), the injured person may be entitled to claim compensation for their injury and its financial consequences. The claim for compensation is made against the person or organisation that was responsible for the injury and is usually met by their insurer. The legal process of claiming compensation for injuries that are caused by negligence is known as a personal injury claim.
Boyes Turner's personal injury team specialise in claims involving severe or catastrophic injury. Most of our clients have been injured in road traffic accidents (RTAs) and accidents at work.
What are the time limits for making a personal injury claim?
For compensation claims relating to injuries which occurred in England or Wales the general rule is that court proceedings must be issued (formally started) within three years of the date of the injury. In most cases, before a claim can be issued work must be carried out to investigate the claim, notify the defendant and the insurance company against whom the claim is being made and obtain a medical report to support the claim. The sooner you contact us after an injury has occurred, the sooner we can begin to help you, and the better we can investigate and prepare your claim.
Longer time limits apply to children whose three-year time period only begins to run from the age of 18, meaning that their time limit expires when they reach the age of 21. As with adults, however, the sooner you contact us after your child's serious injury, the sooner we can start helping the child and obtain financial help via the claim.
Time limits do not apply for those who lack mental capacity. Where an injured person's mental capacity is uncertain, we work closely with our Court of Protection team to determine whether our client has capacity to bring their own claim. As with other claims, it is always advisable to contact us as soon as possible after the injury, to ensure that evidence can be preserved, rehabilitation started (where needed) and financial help secured via the claim.
In exceptional circumstances the court may extend the time limit (or limitation deadline).
Where the claimant could not have known that an injury had occurred until after the deadline for making the claim, the deadline is three years from the 'date of knowledge' (when the claimant first knew that they had suffered an injury). Asbestos-related disease claims, where symptoms of disease first appear decades after the exposure to asbestos, usually have limitation deadlines based on the 'date of knowledge'.
If the injury occurred in an accident abroad, the law of the country where the accident happened will determine the time limit for making a claim. These time limits vary from country to country and can be much shorter than the deadlines in England and Wales. If you have suffered a serious injury that was not your fault whilst working, travelling, studying or on holiday abroad, you should contact us for advice straight away.
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Boyes Turner's injury claims lawyers have secured a £300,000 compensation settlement for a roofer who suffered a fracture to his heel when he fell from a ladder whilst working at height.
Boyes Turner's personal injury lawyers have secured a settlement for a teacher who was injured when he slipped on a wet grassy slope onto concrete steps.
£128,000 settlement in accident at work claim for delivery driver injured by falling cage
We secured settlement for a healthcare assistant who was left with facial injuries, widespread pain (fibromyalgia) and psychological injuries including PTSD after repeatedly being head-butted by a patient at work.
£347,000 compensation for headmaster exposed to asbestos in Essex school
£1.8 million award in compensation for amputation above the knee
Engineer receives £188,000 following an accident at work. We were instructed on behalf of the claimant, Mr J* in a claim for compensation for personal injuries sustained following an accident at work.
Employer pays £102,500 after employee trips in accident at work. We have been recently representing a client in respect of injuries sustained as a result of an accident at work.
£90,000 compensation for window fitter injured at work. We recovered compensation for a father of two injured whilst fitting windows on a building site in an accident at work.
£78,000 compensation secured after accident at work back injury
£45,000 in compensation for employee after assault at work. Our client was subjected to a terrifying attack in which she was grabbed by the throat and choked, stabbed with a needle, punched and spat on.
£40,000 compensation for warehouse worker injured on the job. Our client injured his spine and back when he lifted a series of computer towers sustaining debilitating spinal and back injuries which resulted in him being unable to work.
Boyes Turner's personal injury lawyers recovered £40,000 in compensation for a man who suffered injuries to his arm and back in a lifting accident at work.
£27,000 accident at work compensation for events organiser. The claim settled out of court and included the cost of future treatment, care and assistance and Smith & Manchester award.
£300,000 compensation for road worker with head injury after co-worker hit him on the head with a pickaxe
Compensation recovered for burns injury victim. We have secured compensation for Sian*, who suffered burns to her back and left arm when working in a clothes shop.
Mr F was exposed to asbestos while incarcerated at St. John' s approved school in Tiffield and again while incarcerated at HMP Borstal in Portland, Dorset.
Compensation for family of former teacher exposed to asbestos in schools. Mrs P unfortunately developed peritoneal mesothelioma which eventually led to her sad death.
Our teams have been nationally recognised over the past decade for their dedication and commitment to securing maximum compensation for our clients
Our clients constantly recognize us as the most experienced, professional, efficient and supportive
"Thanks for everything"
"Thanks for everything. It's been very nice to be able to put it all behind us and try to move forward. I cannot thank you and Boyes Turner for all you have done for me. It goes without saying I would always recommend Boyes Turner. I couldn't have done it without your support."
"You got us the best outcome and I can't thank you enough"
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Forget personal development, women want to be leaders
Women have the ambition and confidence to get ahead in their careers and add value to organisations, but the problem is that few training programmes truly focus on leadership.
That's according to New Zealand-based leadership development expert Dr Sue Watson, who works with public and private sector organisations to grow female talent pipelines.
Watson says that that women are looking for more than just personal development – they want to be leaders.
"What we are hearing is that women want to develop the capabilities that will support them to be better leaders and add value to their organisations," she explains.
But there's a problem. Traditionally, mentoring and training programmes focused on personal skills like assertiveness and confidence. But that's not what women are after.
Watson says there is demand for learning based around leadership capabilities, either through formal training or mentoring and sponsorship.
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redpajama_set_name: RedPajamaCommonCrawl


text:
package org.apache.jackrabbit.core.security.user;

import org.apache.jackrabbit.spi.Name;
import org.apache.jackrabbit.spi.NameFactory;
import org.apache.jackrabbit.spi.commons.name.NameFactoryImpl;

/**
 * UserConstants...
 */
interface UserConstants {

    NameFactory NF = NameFactoryImpl.getInstance();

    /**
     * root-path to security related content e.g. principals
     */
    String SECURITY_ROOT_PATH = "/rep:security";
    String AUTHORIZABLES_PATH = SECURITY_ROOT_PATH + "/rep:authorizables";
    String USERS_PATH = AUTHORIZABLES_PATH + "/rep:users";
    String GROUPS_PATH = AUTHORIZABLES_PATH + "/rep:groups";

    /**
     * Configuration key and default value for the the name of the
     * 'UserAdmin' group-principal.
     */
    String USER_ADMIN_GROUP_NAME = "UserAdmin";
    /**
     * Configuration key and default value for the the name of the
     * 'GroupAdmin' group-principal
     */
    String GROUP_ADMIN_GROUP_NAME = "GroupAdmin";

    Name P_PRINCIPAL_NAME = NF.create(Name.NS_REP_URI, "principalName");
    /**
     * @deprecated As of 2.0 the id-hash is stored with the jcr:uuid making the
     * rep:userId property redundant. It has been removed from the node type
     * definition.
     */
    Name P_USERID = NF.create(Name.NS_REP_URI, "userId");
    Name P_PASSWORD = NF.create(Name.NS_REP_URI, "password");
    Name P_DISABLED = NF.create(Name.NS_REP_URI, "disabled");

    /**
     * @deprecated As of 2.0 group membership is stored with the group node.
     * @see #P_MEMBERS
     */
    Name P_GROUPS = NF.create(Name.NS_REP_URI, "groups");

    Name P_MEMBERS = NF.create(Name.NS_REP_URI, "members");
    Name N_MEMBERS = NF.create(Name.NS_REP_URI, "members");

    /**
     * Name of the user property containing the principal names of those allowed
     * to impersonate.
     */
    Name P_IMPERSONATORS = NF.create(Name.NS_REP_URI, "impersonators");

    Name NT_REP_AUTHORIZABLE = NF.create(Name.NS_REP_URI, "Authorizable");
    Name NT_REP_AUTHORIZABLE_FOLDER = NF.create(Name.NS_REP_URI, "AuthorizableFolder");
    Name NT_REP_USER = NF.create(Name.NS_REP_URI, "User");
    Name NT_REP_GROUP = NF.create(Name.NS_REP_URI, "Group");
    Name NT_REP_MEMBERS = NF.create(Name.NS_REP_URI, "Members");
    Name MIX_REP_IMPERSONATABLE = NF.create(Name.NS_REP_URI, "Impersonatable");
}

redpajama_set_name: RedPajamaGithub


text:
Kylie Miller1, Jessical Konal2, Kelly Brown1, Maria Demma Cabral1
1Department of Pediatrics and Adolescent Medicine, 2Department of Obstetrics and Gynecology, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
Contributions: (I) Conception and design: All authors (II) Administrative support: All authors; (III) Provision of study materials or patients: None; (IV) Collection and assembly of data: All authors; (V) Data analysis and interpretation: All authors; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors.
Correspondence to: Maria Demma Cabral, MD. Department of Pediatrics and Adolescent Medicine, Western Michigan University Homer Stryker M.D. School of Medicine, 1000 Oakland Drive, Kalamazoo, MI 49008, USA. Email: mariademma.cabral@med.wmich.edu.
Abstract: Abnormal uterine bleeding (AUB) is a common, yet urgent gynecological complaint in the adolescent population. The prolonged, heavy, and/or unpredictable pattern of AUB can pose significant health risks if not treated appropriately. Understanding normal menstrual physiology forms the basis for identifying plausible causes of AUB, and a systematic approach to evaluation of AUB can aid in recognizing the acuity of the condition. Evaluation starts with obtaining a thorough history with complete physical exam, followed by appropriate testing with or without pelvic imaging. Severity and acuity of the underlying causes of AUB dictate treatment approaches with hopes to prevent costly and time-consuming hospitalizations. The best preventive measure is educating the patient and caregivers on monitoring menstrual cycles and recognizing when help is necessary.
Keywords: Abnormal uterine bleeding (AUB); adolescent, anemia; menstrual cycle
Received: 05 June 2019; Accepted: 17 June 2019; Published: 02 July 2019.
Onset of menstruation is a memorable event in all female adolescents. Menstrual cycles that become unpredictable, with presence of prolonged and excessive blood flow, can be appropriately concerning to an adolescent and their parent or caregiver. However, abnormal uterine bleeding (AUB) is a very common gynecological complaint, and often evaluation and management can be urgent. The purpose of this article is to review the prevalence and significance of AUB, discuss common etiologies, and evaluation and management approaches of AUB in the adolescent population. Additionally, we will review how to provide education to adolescents regarding AUB.
Normal menstrual cycle
During adolescent development, menarche most often occurs within 3 years of thelarche, or breast budding, which is typically the first symptom of pubertal development in young women. Though there are variations across the globe, the median age of onset for menarche has remained stable, and occurs typically between ages 12–13 years in developed nations and well-nourished populations (1).
Menstrual cycles are often irregular during adolescence, particularly within the 2 years after their first cycle. Often young women have anovulatory cycles due to the immaturity of their hypothalamic-pituitary-ovarian (HPO) axis, causing relatively long cycles. By the third year after menarche, 60–80% of young women would have reached a typical adult cycle length with their cycles lasting 21–34 days from the first day of one period to the first day of the subsequent period (1). During first 2–3 years post-menarche, the cycle length may vary, and can range from 21 to 45 days. The duration of blood flow can range between 3 and 7 days with median blood loss between 30 and 40 milliliters. Counting number of soaked pads or tampons used per day is one way to estimate the menstrual blood loss; however, in adolescents this may not always be accurate. Typically, 6 or fewer soaked pads during menses is consistent with normal blood loss (2-4).
AUB is the current preferred term by the International Federation of Gynecology and Obstetrics (FIGO) and is defined as "bleeding from the uterine corpus that is abnormal in duration, volume, frequency, and/or regularity and has been present for the majority of the previous six months" (5). Knowledge of normal parameters is important when identifying AUB based on the definition provided. Historically, non-specific and outdated terms such as "menorrhagia", "dysfunctional uterine bleeding", or "menometrorrhagia" have been used to describe "abnormal" uterine bleeding. For this reason, as well as the wide range of severity and etiologies for AUB, the FIGO system for nomenclature has been put in place to aid in the replacement of these terms with a standardized tool to measure frequency, duration, regularity, and flow volume of a woman's menses (5).
Heavy menstrual bleeding (HMB) is currently defined by the FIGO to be a subjective excessive blood loss that interferes with the woman's social, physical, material, and emotional quality of life (6). When quantified, HMB is defined by ≥80 mL of blood loss, estimated to be soaking a pad or tampon every 1–2 hours, or consistent clotting greater than the size of a quarter (1,7). In adolescent females, HMB is a relatively common complaint with current prevalence rates widely ranging from 12.1–37% (8-10). Disorders of menstruation not only have physical effects on women, but also impose psychological and social impacts on adolescent females with AUB.
Thus, it is important for health care providers (HCPs) to be aware of broader impacts on an adolescent patient's quality of life. For this reason, during a comprehensive evaluation of adolescents who present with HMB, HCPs should be assessing involvement in sports and social activities, school performance, as well as attendance issues that the adolescent may be having in relation to her HMB (6).
The second of two FIGO systems is the classification of the causes of abnormal bleeding during reproductive years; consisting of 9 categories and described using the acronym PALM-COEIN. These categories are Polyp; Adenomyosis; Leiomyoma; Malignancy and hyperplasia; Coagulopathy; Ovulatory Disorders; Endometrium; Iatrogenic; and Not otherwise classified. PALM categories define the structural causes of abnormal bleeding, while the COEIN categories separate non-structural causes (5). This popular classification is a useful guide for initial evaluation of AUB, however it is important to remember that the major causes of AUB in the adolescent population differ from those in the adult population.
While the FIGO system for nomenclature has helped with categorizing AUB for all pre- and post-menopausal women, it is important to identify if there are certain etiologies more commonly found in adolescent females. In adolescents, AUB is most commonly caused by non-structural causes, primarily immaturity of the HPO axis causing anovulatory cycles resulting in menstrual irregularities (1,6). Often, HMB related to HPO axis immaturity results in anovulatory cycles leading to longer, heavier menses when they do occur. According to endocrinological studies, 50% of menstrual cycles are ovulatory during the first 2 years after menarche, increasing to 75% at 5 years and eventually reaching a plateau of 80% (11). On average, menses become regular cycles 20 months post-menarche (7).
Bleeding disorders are also recognized as common causes for HMB in adolescents. A population-based study of almost 1,000 healthy adolescent females was done to assess for prevalence of HMB. In this study, almost 40% had self-identified HMB (defined as >6 pads or tampons in a 24-hour period). Of the 40% of adolescents who had experienced HMB, 20% reported that they had an underlying bleeding disorder (6).
Additionally, a retrospective study done by Alaqzam et al. looked at adolescent women under the age of 21 with identified HMB attending an adolescent hematologic/gynecologic clinic. From this group, 73 women were tested for a coagulopathy on the basis of medical history, after which 47% (n=34) of those women were formally diagnosed with a bleeding disorder [26 of the 34 diagnosed with von Willebrand Disease (VWD), and 8 of the 34 diagnosed with a platelet dysfunction (PFD)]. The remaining 53% (n=39) of women had HMB due to other causes such as anovulation (n=28), immune-mediated thrombocytopenic purpura (ITP) (n=6), or an unidentified cause (n=5) (7).
A high prevalence of VWD and PFD were found in adolescent women with identified HMB. Data is relatively limited regarding the prevalence of bleeding disorders among adolescents with HMB, but currently suggests that the prevalence of coagulopathies in adolescents is at least as likely as it is in adult women with HMB (12).
Other common presentations include amenorrhea greater than 90 days between menses (even for one cycle), and intermenstrual bleeding (IMB) that can occur secondary to rapid weight changes, stress, or endocrinopathies (1). Less likely causes of AUB in the adolescent population include structural causes and endometrial cancer. Structural causes are responsible for less than 2% of AUB in the adolescent population (6,11). Endometrial cancer risk in patients younger than 20 years old is 0.2 per 100,000 women (13).
The clinical presentation of AUB in adolescents is most often subjective, self-identified, and reported by patients or their caregivers. One's perception may differ in terms of amount of menstrual bleeding that is soaking through pads or tampons, and how often these should be changed. In extreme cases, the patient or caregiver reports experiencing symptoms indicative of significant blood loss resulting in symptomatic anemia, such as fatigue, dizziness, and pallor that are more pronounced during menses.
When evaluating AUB, we must consider that AUB can be identified by HMB (AUB/HMB) or IMB (AUB/IMB) and can be classified as either acute or chronic. It can also be caused by a variety of etiologies; ranging from structural abnormalities, disorders of hemostasis, dysregulation of endocrine signaling, or premalignant disease. Table 1 summarizes the differential diagnosis in evaluating causes for AUB.
Table 1 Differential diagnosis of AUB in adolescents
Workup and diagnosis of AUB in adolescents should focus heavily on the history and physical exam. It is imperative that the patient history is taken with and without parents/guardians present to allow for open communication and confidentiality. A thorough menstrual history should include age of menarche, menstrual regularity, duration, flow and number of pads/tampons used per day, and first day of last menstrual period (LMP). The number of pads/tampons per day allows for objective quantification of menstrual flow (Figure 1) (14).
Figure 1 A method for the patient to record and estimate soaked pads or tampons. Available for free download: https://www.cdc.gov/ncbddd/blooddisorders/women/menorrhagia.html.
Another tool for quantifying blood loss during menses is a pictorial bleeding assessment chart with different versions available online. This chart allows the adolescent to visually identify the saturation of female hygiene products. It may also be beneficial for the patient to complete a menstrual journal that includes associated symptomatology over a period of time in order to establish a pattern or lack thereof. Smart phone applications are also available and may be a convenient way for an adolescent to track menstrual cycles.
Clinicians should obtain relevant review of systems including constitutional symptoms (appetite change, weight change, fatigue, change in activity), symptoms relating to any endocrinopathies (heat/cold intolerance, hirsutism), infectious diseases (fever, rash), and hematologic disorders (gum bleeding, prolonged bleeding after minor injury, easy bruising). Additionally, past medical and surgical history, family history (menstrual history of female family members, bleeding or clotting disorders), social history (diet/nutrition, exercise, sexual history), and current medications (short-term prescriptions, vitamins/supplements, contraceptives) should be reviewed.
In the majority of cases, sexual history should be obtained confidentially. The adolescent should be asked about coitarche, current and last sexual activity, number of partners, sex or gender of partners, nature of sexual activity (oral, vaginal, or anal), contraception method including barrier methods and use of emergency contraception and history of treated or untreated sexually transmitted infections (STI). Adolescent patients may be unwilling to answer or admit to sexual activity in the presence of parents/guardians, therefore reassuring confidentiality is crucial while taking a separate history with the patient alone.
Physical exam should be broad, covering all systems, including vital signs (hemodynamic stability), general appearance (body habitus, fatigue, distress), endocrine (thyroid/goiter, neuropathy, acanthosis nigricans, acne, facial and body hair distribution, stretch marks, moon facies, or buffalo hump), hematologic (pallor, bruising, rash, lymph nodes), external genitalia (secondary sex characteristics), and speculum exam in select cases. Basic organ systems must also be covered including cardiac, pulmonary, gastrointestinal, and psychiatric exams.
Laboratory testing should include the following studies at minimum: beta-human chorionic gonadotropin (beta-hCG) and complete blood count (CBC). Additional workup may include blood glucose, thyroid studies, peripheral blood smear, iron studies, and STI testing (in sexually active patients), as guided by history, physical exam findings, and differential diagnosis. In patients with family history or personal history of clotting or bleeding disorders including HMB, testing a von Willebrand (vW) profile is justifiable because adolescents with HMB are 10–20 times more likely to have VWD. The profile includes testing for vW factor (vWF) antigen and activity, multimer analysis and factor VIII levels (7).
External pelvic imaging may be warranted in cases where structural abnormality is suspected and if speculum exam and/or transvaginal ultrasound is not desired or possible. It is important to know the LMP prior to ordering pelvic ultrasound, otherwise endometrial thickness without correlation to the specific phase of the menstrual cycle may not be useful. For patients with risk factors for endometrial cancer, such as obesity and at least 2–3 years of untreated AUB, it is reasonable to obtain an endometrial biopsy when other causes of AUB have been ruled out (7,15).
The management approaches to AUB are dependent on the underlying etiology and severity of bleeding. For AUB not caused by an underlying medical disorder, i.e., anovulatory bleeding, the mainstay of treatment includes combined oral contraceptives (COCs) and nonsteroidal anti-inflammatory drugs (NSAIDs) for pain relief. Depending on hemoglobin levels, iron may or may not be added as a supplement (11). Table 2 summarizes the classification based on severity and recommended treatment approaches as discussed below.
Table 2 Abnormal uterine bleeding severity classification
Mild bleeding
The majority of anovulatory uterine bleeding can be managed on an outpatient basis. For mild cases of anovulatory bleeding with hemoglobin >12 g/dL, observation and NSAIDs are widely accepted as the treatment plan. The patient should be encouraged to keep a menstrual journal, ideally before and after treatment, to document efficacy or failure of treatment. In patients with mild anovulatory bleeding with hemoglobin between 10–12 g/dL, iron supplementation (usually 60 mg daily) may be added to prevent symptomatic anemia. Patients may also opt to increase dietary iron if supplementation is not desired (11,13).
Moderate bleeding
For moderate cases of anovulatory bleeding treatment, iron supplementation and hormonal therapy, specifically monophasic COCs are recommended. In anemic patients with acute bleeding, low-dose COCs containing 20–35 mcg of ethinyl estradiol (EE) can be given every 8–12 hours until bleeding ceases, then the same pill can be continued for 21 days followed by 7 days of placebo or medication pause (11,13).
If bleeding restarts while on initial COC treatment, the pill may be taken twice daily for 21 days total followed by 7 days of placebo or medication pause. Higher amounts of estrogen can cause nausea, so it is recommended to provide a prescription for antiemetics while on the twice daily dose of COCs. The COC prescription should be continued for 3–6 months until hemoglobin level reaches at least 12 g/dL (11,13).
In patients who have contraindications to taking estrogen or those who are not actively bleeding, oral progestin given for 12 days per month followed by a withdrawal bleed 2–7 days after the 12th day can be an effective alternative treatment (11,13).
Severe bleeding
In patients with severe anovulatory bleeding classified by hemoglobin level <7 or <10 g/dL and are symptomatic with active bleeding, hospitalization may be required for a more aggressive treatment approach. Patients who are asymptomatic, hemodynamically stable with a hemoglobin level of 8–10 g/dL, and who are reliable to return for follow-up may be treated in the outpatient setting with monophasic COC (30–50 µg EE) taper and iron supplementation (60–120 mg).
As stated before, antiemetics should be provided to treat nausea/vomiting from the higher doses of EE. An example of a COC taper is taking 1 pill every 6 hours for 2–4 days, then 1 pill every 8 hours for 3 days, then 1 pill every 12 hours for 14 days. Again, follow-up in the outpatient setting is essential to prevent recurrence and address efficacy (11,13).
Hospitalization is necessary in cases of severe bleeding when the patient is hemodynamically unstable or symptomatic. Treatment involves a COC taper similar to the one presented above with additional levels of tapering. For example, take 1 COC every 4 hours until bleeding slows, then gradually taper to every 6, 8 and then 12 hours. COCs should be continued for an additional 21 days or until hemoglobin level is above 10 g/dL. Figure 2 demonstrates this taper dosing that the patient can use as a guide outpatient.
Figure 2 Example of COC taper dosing for patients to follow. COC, combined oral contraceptives.
If treatment fails in the first 24 hours and the patient continues to bleed heavily, or if patient is unable to take oral medications, intravenous conjugated estrogen (25 mg) can be given every 4–6 hours for 24 hours transitioning to the COC taper after bleeding has slowed/ceased. Other medications to be considered in refractory bleeding include medroxyprogesterone acetate 20 mg orally 3 times per day for 7 days, or tranexamic acid, a commonly used antifibrinolytic in trauma and surgical patients, given orally or intravenously, 3 times per day for 5 days (15).
Mechanical intrauterine tamponade with a Foley catheter may also be used to control bleeding that has failed medical treatment. Surgery is the most drastic treatment for unrelenting bleeding and should only be considered for the most refractory cases due to potential problems, including intraoperative complications and future infertility. It is important to note that adolescents who require hospitalization or blood transfusion for heavy bleeding have a 20–30% risk of coagulopathy. VWD is usually the most common etiology in these women with likely a bleeding disorder (13).
It is recommended that HCPs begin anticipatory guidance with respect to pubertal development and menstrual cycles before the child reaches these milestones, usually beginning around the ages of 7 and 8 years. The young adolescent should be educated on the normal ranges of acceptable variations in patterns of menstrual bleeding. Providing expectations to adolescents and their parents/guardians about what is considered "abnormal" or "irregular" bleeding is key to preventing unnecessary anxiety and worry. The adolescent should be asked about their menstrual patterns, with accurate documentation of the first day of LMP especially during wellness visits (1). It is important to remind the adolescent female that menstrual cycles become regular in 60–80% of young females by the third year after menarche (1,11).
AUB is one of the most common gynecological complaints that brings adolescent patients to the emergency department. Such an experience may cause anxiety and costs money and time. Patients that feel supported by their physician and office staff will be more likely to contact their HCPs with questions prior to making a trip to the urgent care or the emergency department. It can be beneficial for the young adolescent to chart her menses when menstrual history is vague, or if unable to recall accurate data.
The psychological effects of AUB specific to adolescents include negative impact on quality of life secondary to missing school or social events, fatigue from anemia, and frustration with constant menstrual hygiene. It is important to give emotional support to the young adolescent and in return, establish a strong physician-patient relationship that will facilitate more open and honest conversations in the future.
AUB is a common gynecological complaint in the adolescent population and warrants appropriate evaluation and treatment. A thorough history with complete physical exam, followed by appropriate testing should be obtained in a timely fashion. AUB can be identified by HMB (AUB/HMB) or IMB (AUB/IMB) and can be classified as either acute or chronic. AUB can also be caused by a variety of etiologies and in adolescents, most commonly is caused by immaturity of the HPO axis causing anovulatory cycles and menstrual irregularities. The differential for AUB is broad, and both severity and acuity of the underlying cause dictate treatment approach. The best preventive measure is education of the patient and caregivers on monitoring menstrual cycles and knowing when help is necessary.
Conflicts of Interest: The authors have no conflicts of interest to declare.
Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
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Upadhya KK, Sucato GS. Menstrual problems. In: Kliegman R, St. Geme J. editors. Nelson Textbook of Pediatrics. Philadelphia: Elsevier, 21st edition, 2019:1058-9.
Greydanus DE, Sorrel S, Omar HA. Menstrual disorders in the female adolescent. In: Greydanus DE, Patel DR, Omar HA, et al. editors. Adolescent Medicine: Pharmacotherapeutics in General, Mental and Sexual Health. Berlin: Walter de Gruyter, 2012:301-30.
Munro MG. Practical aspects of the two FIGO systems for management of abnormal uterine bleeding in the reproductive years. Best Pract Res Clin Obstet Gynaecol 2017;40:3-22. [Crossref] [PubMed]
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Friberg B, Ornö AK, Lindgren A, et al. Bleeding disorders among young women: a population-based prevalence study. Acta Obstet Gynecol Scand 2006;85:200-6. [Crossref] [PubMed]
Barr F, Brabin L, Agbaje S, et al. Reducing iron deficiency anaemia due to heavy menstrual blood loss in Nigerian rural adolescents. Public Health Nutr 1998;1:249-57. [Crossref] [PubMed]
James AH. Women and bleeding disorders. Haemophilia 2010;16 Suppl 5:160-7. [Crossref] [PubMed]
Mullins TL, Miller RJ, Mullins ES. Evaluation and Management of Adolescents with Abnormal Uterine Bleeding. Pediatr Ann 2015;44:e218-22. [Crossref] [PubMed]
Elmaoğulları S, Aycan Z. Abnormal Uterine Bleeding in Adolescents. J Clin Res Pediatr Endocrinol 2018;10:191-7. [Crossref] [PubMed]
Committee on Practice Bulletins—Gynecology. Practice bulletin no. 136: management of abnormal uterine bleeding associated with ovulatory dysfunction. Obstet Gynecol 2013;122:176-85. [Crossref] [PubMed]
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Cite this article as: Miller K, Konal J, Brown K, Cabral MD. Abnormal uterine bleeding. Pediatr Med 2019;2:27.


Real-time marketing is not a new phenomenon, but has become increasingly popular thanks to the rise of social media and mobile marketing. The term real-time marketing can be used to incorporate many things, but is usually understood as the ability to interact with customers anywhere, any time. The focus of real-time is on the here and now, which from a brand's point of view means having the data and technology in place to hold a deep understanding of the customer journey and the touchpoints where interaction could make or break a sale.
One of the key aims when it comes to real-time marketing is to drive engagement with your brand. A recent whitepaper by analytics and data management software company SAS (distributed by Marketing Week) discusses how real-time data, real-time decisioning engines (RTDs) and an awareness of customer context can combine to better create personalised offers and heighten engagement.
The whitepaper gives an example of a banking customer and a bank which wants to run a "next best offer" campaign. The bank holds real-time data on the customer, including their customer profile, their history of contacts and responses and a number of pre-optimised offers, for example a discount on a loan. This customer data is then used by the real-time decisioning engine to send the most appropriate offer to the customer at the most appropriate time, for example when the customer logs in to the bank's mobile app.
The example given by SAS' whitepaper demonstrates the need for real-time to operate in the right place at the right time, but also to understand the context in which the customer is initiating interactions with the organisation. Of course, this use of real-time requires having the mechanisms and platform integration in place in order to act upon the vast amount of data available on any given customer. While this does not happen overnight, investing time and money into building these processes will better enable brands to use real-time to foster engagement.
Although most real-time marketing relies on technology in some form, this does not mean that it should not be used to enhance a customer's experience in bricks-and-mortar stores.
CMS Wire points to the use of Beacon Technology (technology that allows any venue that has beacons in place to detect where a customer is at any given moment via their mobile device) in real-time marketing in a retail context. By using this technology, retailers are able to send push notifications to promote products and send useful information related to the customer's in-store experience. This could be in the form of offers and discounts on specific products, offering coupons or announcing sales items.
Yet when it comes to ecommerce, is this potential for real-time marketing lost? Not according to CMS Wire. Thanks to the rise of smart home devices like Amazon's Alexa and Google Home, CMS Wire believes that retailers' capacity for real-time marketing has in fact increased and they have been graced with a valuable opportunity many other industries could only dream of. If the retailer in question can successfully integrate their ecommerce and in-store real-time marketing by mining data effectively and making the most of the technology available, the prospects for the trend are profound.
If you would like to know more, please contact us on 0113 2162820.


Hello gamers. Winter Fantasy starts in less than two weeks and for those who are going to be attending there are some interesting, educational, and fun events going on outside of the gaming you can do. Every one of these events will be held in the seminar area in the main hall.
Heralds Guild of DM's Member Meeting (5pm-6pm): Come join us for what exciting plans the Heralds Guild has in store for 2017 and beyond. We will also be announcing our DM's that have been voted into Level 4 status by their peers, our DM of the Year award, and more. Finish your afternoon game, grab some food, and bring it back for a fun hour of watching Dave can company squirm up on stage.
Election in Phlan (5:30pm – 6:30pm): Come listen to those characters vying for election to the position of Chancellor of Phlan and cast your vote for the NPC you think will be the best new leader of Phlan. Those with the proper certificate from the Phlan Trilogy need to register their intentions to run for Chancellor of Phlan. You will need to do this at HQ no later than Noon on Saturday. The first 30 minutes of this event will be opening statements from candidates vying for election. After this anyone is free to speak for any of the three candidates for the leader of Phlan. An open vote will follow with all present. There are two ways to vote.
If you have played in the PHLAN 1-1 to 1-3 trilogy with any character you may cast a vote directly.
If you have not played but are physically present you may cast your vote via someone who has by standing with them when the vote is called.
Charity Raffle (Slot 6, 8 & 10): We will also be holding a charity raffle onsite only for exclusive DDAO tickets in Slot 6, 8, and 10. Basically you buy a raffle ticket, and at the start of each slot we draw one and that person's normal ticket magically becomes a ticket to one of the DDAO events.
All proceeds benefit The American Cancer Society in honor of Jamie Tachiyama.
If you'd like to stay in touch you can register for our mailing list & news letter here. We'll see you in less that two weeks at Winter Fantasy for all kinds of great games, gatherings of old friends and new, and as much fun as we pack into a long weekend.


This is Kevin Vandecar's Typepad Profile.
3ds Max SDK Specialist needed!
Join US! for M&E DevDay events in multiple locations!
An online event with an opportunity to receive up to US $100 per app published and win one of eight iPad minis!
Autodesk is hiring a Media and Entertainment API evangelist!


Getting used to being in my home, as a holiday location, has been diffilcukl but actually easier than I thought.
The sky is low and heavy but the temperature is warm and calm. The old mans back is getting better by the day, but the daughter is in the most frightful pain. She has a dead leg, cant do anything very much, walking ,breathing, writing, everything is a difficult negotiation. BUT we have the best people working on her and all being well by the weekend she will be standing up straight and feeling her foot again.
Not being able to heal her instanty is hard for me as I am Mrs. Fix-It. So it's a lesson in patience for us all.
I did my work out in piano room. Jim was back-braced up and B was lying on the floor with an ice pack on her spine. As I sweated through my routine both of them watched me. Will they ever be able to work their bodies again? I trust they will..
Then I went for a walk. I am having to look at my environment differently. Get into the groove of living in a part of the country that others come on holiday to.
Down the hill and there was a golden field of wheat, or maybe corn or it could be oats. I'm really bad with my grains I'll have to nick a stalk and get the old git to tell me what it is. The East End did not prepare me for farming crops.
Walking through the outdoor persuit centre always makes me think of Canada. The trees are tall and very North American. The only sound was the wind rustling through the trees and chasing through the fields. It sounded like a thousand cicadas I stopped and listened to the oats/corn/wheat chattering in he breeze.
Climbers were climbing. A couple from Germany slowly edged their way up the sheer face, two from the Home Counties were roped together as they guffawed there way up to the summit. A pile of Northern gents with white beards stood, hand on hips, surveying their route, I half expected them to pull out a pint and sing a good old North country folk song. A party of tattooed, nut brown boys, hopped and skipped over the boulders, gave a whole new meaning to getting stoned By the time I got to the top of the hill I had got my heart rate up. Then past the ski slope, which was empty. Not a skier in sight, and then into the Avenue.
I marched up to my tree. I could barely see its trunk. I wove my way through the overgrown branches and my lipstick mark, long gone, was an indicator of how long it had been. I hugged it, kissed it, had a chat, shed a few tears, then waved good bye. I will get back everyday until I go back to work.
All in all its a time of recouping. If I can do anything to get the two broke-back babies back together I will. I am already working out where to go on holiday in the future, but today being in my home is A-OK something I would never have thought I would hear myself.
Great to read you're enjoying time at the cottage. Just think of all the money you'll be saving by not going overseas. Can't believe it's a year since you wrote about your last holiday adventures. Enjoy the rest of the holiday.
A good place to re-charge. No travel stress. Enjoy your home and relax. I am sure that Jim and B are both glad you are near. Hope they get well very soon. Will chat when you are back in circulation.


Shantanu (Shan) Bhide has joined the SoftWriters team as the VP of Technology. In this role, Shan will lead the Product Management, Development, and Quality Assurance functions at SoftWriters.
Shan is a passionate change promoter and thought leader at the intersection of business and technology. He has more than 20 years of experience delivering software products and solutions to a broad range of customers, and he brings incredible knowledge and energy to the SoftWriters team.
Shan spent the majority of his career at ANSYS Inc., an advanced engineering simulation software company. At ANSYS, Shan was instrumental in creating and promoting cloud, web, and mobile interface-based simulation software products that allow blue-chip companies to collaborate, share, design, analyze, and simulate product performance. In this capacity, he owned the full product management lifecycle. After his stint at ANSYS Inc., he joined Ness USA, a leading custom software and services company that serves clients across multiple industries and domains. Shan led the Ness Connected Labs initiative to setup software innovation centers across the global development and product management teams. Through his leadership, these labs offered clients the opportunity to discover cutting-edge technical trends with guidance on how to turn disruptive technologies into new revenue streams.
Shan holds M.S. degrees in Design Engineering from IIT Mumbai, India and IT Management from Robert Morris University, Pittsburgh.
Shan's arrival will help further our commitment to updating our product management, quality assurance, and development processes. He will be working closely with our customers to solicit ideas and direction and he looks forward to meeting with each and every one of you through this process.
Shan will be attending the MHA Business Summit this March, so please stop by to say hello!


Our brains were genetically modified by the Annunaki so that we are veiled form our true origins so that we can be easily controlled and manipulated. The human body was created to serve the Annunaki but the one thing that cannot be controlled is the soul that occupies it.
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• Stonehenge Beneath The Waters of Lake Michigan?
• The Archons - "Who Wrote the Reptilian Agenda?"


Welcome to Lausanne, the Olympic Capital. Here, we support international sport federations and organisations and help them grow by providing them with exclusive benefits.
Some four years ago, FIBA decided to take on a major challenge: position 3x3 basketball as the No. 1 urban sport and turn it into an Olympic discipline. After Mexico city, Utsunomiya and Prague, Lausanne will this year be hosting one round of the 3x3 World Tour Masters at its main venue.The competition features the best 3x3 teams in the world and promises plenty of thrills and spills. And once the competition over, the party begins – with DJ sounds late into the night.
More than 59 International Sports Federations and organisations call Lausanne their home!
A series of eight seminars are open to staff from International Federations based in the Canton de Vaud.
We are Olympians, and You?
Une cinquantaine d'athlètes témoignent de l'esprit olympique!
Living in Lausanne, the Olympic Capital, offers the unique opportunity to be part of a tremendous and active sport community.
I moved from abroad directly to the Maison du Sport International (MSI) 10 years ago, right after it was built up. This is the ideal place to share best practices and advice!
Born in the Olympic Capital and raised through sport, I always wanted to work in a sport organisation.
The International Masters Games Association (IMGA) has been based in the Olympic Capital and the MSI for the past 10 years.
Having arrived in Lausanne, The Olympic Capital, 15 years ago I am well placed to share how much it has developed and become the home of choice to sports organisations!


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An adaptation of F. Scott Fitzgerald's Long Island-set novel, where Midwesterner Nick Carraway is lured into the lavish world of his neighbor, Jay Gatsby. Soon enough, however, Carraway will see…
Café de Flore
Jacqueline is a young mother living in 1960s Paris with her disabled son Laurent. Abandoned by her husband, Jacqueline sacrifices everything to care for her son and vows to give…
Rikka is a ninja descendant. Her grandfather Hyoe is the last chief of their ninja clan and her father is a cyborg researcher. Both are killed when a weapons' company…
Genre: Drama, Science Fiction
After losing contact with Earth, Astronaut Lee Miller becomes stranded in orbit alone aboard the International Space Station. As time passes and life support systems dwindle, Lee battles to maintain…
American car designer Carroll Shelby and the British-born driver Ken Miles work together to battle corporate interference, the laws of physics, and their own personal demons to build a revolutionary…
Collin must make it through his final three days of probation for a chance at a new beginning. He and his troublemaking childhood best friend, Miles, work as movers, and…
L.O.R.D: Legend of Ravaging Dynasties
Based on the novel of the same name, the film depicts the endless battles of four kingdoms as they fight for power and domination of the one ultimate realm.Based on…
Country: China, Cambodia
Genre: Drama, Fantasy, Science Fiction
Biopic about 1970s Welsh marijuana trafficker Howard Marks, whose inventive smuggling schemes made him a huge success in the drug trade, as well as leading to dealings with both the…
Country: United Kingdom, Spain
Welcome to the Rileys
Years after their teenage daughter's death, Lois and Doug Riley, an upstanding Indiana couple, are frozen by estranging grief. Doug escapes to New Orleans on a business trip. Compelled by…
In the Name of the King 2: Two Worlds
Granger, an ex-Special Forces soldier gets thrown back to medieval times to fulfill an ancient prophecy. Venturing through the now war torn Kingdom of Ehb, he teams up with an…
Country: Germany, Canada
Trouble with the Curve
Slowed by age and failing eyesight, crack baseball scout Gus Lobel takes his grown daughter along as he checks out the final prospect of his career. Along the way, the…
In 1968, Donald Crowhurst, an amateur sailor, endangers the fate of his family and business, and his own life, blinded by his ambition to compete in the Sunday Times Golden…
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Microsoft Windows Server 2016 Essentials Edition
New Features and Enhancements in Storage
QoS or Storage Quality of Service
With the use of Storage Quality of Service, you can now centrally monitor the all-around storage performance. This allows you to create policies using CSV and Hyper-V clusters in this version of Windows Server.
Storage-agnostic, synchronous replication between servers, block-level, synchronous replication between clusters for disaster recovery, and stretching of a failover cluster between sites; these are now enabled through the use of Storage Replica. This allows mirror copying of data in physical sites w/ crash consistent volumes to ensure a zero data loss in the file system. The opposite of this replication method permits site extension outside metropolitan range but with the probability of data loss.
It enables you to build highly scalable and available storage using servers with the local storage system. It streamlines the management and deployment of software defined systems of storage. It also unlocks the utilization of new classes of disk devices (NVMe and SATA SSD) which were not possible in the previous versions using shared disks in Clustered storage spaces.
New Networking Capabilities and Improvements
TCP Performance Improvements
TFO or TCP Fast Open has also been applied. The default ICW or Initial Congestion Window has been increased to 10. The TCP Fast Open decreases the time needed to create a TCP connection. Then, the larger ICW allows bigger objects to be transported in the initial burst. This mixed method will ultimately reduce the time needed for the transmission of Internet object between the cloud and the client.
Using this new capability, you may now route and mirror traffic to new and current virtual appliances. Coupled with Network security groups and spread out firewall, it allows you to easily secure and segment workloads in a method which is similar to Azure.
Using the System Center Virtual Machine Manager, you can now manage and deploy the whole SDN or Software-Defined Networking stack. You can associate SDN policies with VMs and containers, plus manage the windows server container networking by using Docker.
Computer Area
It has an upgrade on its module in constructing Nano Server images, as well as separation of a physical host, and the guest VM functions and support for various Windows Server editions.
A lot has been improved in the Recovery console, which includes separation of outbound and inbound firewall rules and also the capability to repair the structure of WinRM
There are various done in Hyper-V Time Synchronization Service and in Wind32 Time. With these enhancements, there is a great benefit for the virtual and physical machines because of better time accuracy. The latest server operating system can now host the services which are compliant with the regulation that requires a 1ms accurate when it comes to UTC.
You can leverage from the Azure SQL database when you can deploy a highly available RDS deployment, which is for RD connection brokers in higher availability mode. To do this, you must use Azure SQL DB for the Remote Desktop connection broker in high availability environment.
Windows Containers
There are new features and improvements in the container support of this new version of Windows Server. This will give an enhanced performance, simplify network management, and will support the containers on Windows 10.
Product Code: MS16ESS