Complications of vasectomy: results from a prospective audit of 105 393 procedures.

OBJECTIVES: To provide up-to-date complication rates for vasectomy in the UK using 15 years of data collected by the Association of Surgeons in Primary Care (ASPC). PATIENTS AND METHODS: Data were collected between 2007 and March 2022. A patient questionnaire was completed on the day of surgery and at 4 months postoperatively. Rates of early and late failure, infection, hospital admission or re-admission, haematoma and post-vasectomy pain syndrome (PVPS) were recorded. There were no specific exclusion criteria. Complication rates were compared to those published by major urological organisations. Descriptive statistics were utilised, without formal statistical analysis. RESULTS: Over the 15-year study period, data from 105 393 vasectomies were collected, performed by >150 surgeons. In 2022, 94.4% of surgeons used one test to prove sterility. In all, 65% of patients used a postal sperm test after vasectomy to confirm sterility. Early failure rates were available for 69 500 patients. Early failure occurred in 648 patients (0.93%). Of 99 124 patients, late failure occurred in 41 (0.04%). Of 102 549 vasectomies, postoperative infection was reported in 1250 patients (1.22%), haematoma in 1599 patients (1.56%), and PVPS was reported in 139 patients (0.14%). CONCLUSIONS: Vasectomy remains a safe and reliable contraceptive method. The rates of complication were generally lower than those published by major urological organisations. This large, prospective audit provides accurate, contemporaneous complication rates that can form the basis for pre-vasectomy counselling.

Workplace factors related to health care leader well-being in rural settings.

PURPOSE: To examine which workplace factors contribute to health care leader well-being in rural settings. METHODS: Working with two rurally focused organizations, we administered a Rural Leader Burnout survey to executive leaders. The survey contained 25 questions; 24 were closed-item multiple choice and 1 open-ended question. The survey was based on the Mini Z 10 item burnout survey with 5 additional items for leaders. Logistic regression and qualitative content analysis determined factors associated with job satisfaction, burnout, and intent to leave (ITL). FINDINGS: There were 288 respondents (response rate 22%). Of 272 with complete data, 61.4% were women and 51.8% had worked > 10 years. About 81% reported job satisfaction, 40.2% were burned out, and 49.8% intended to leave their administrative roles within 2 years. Factors statistically associated with satisfaction were work control (OR = 3.0), values alignment with leadership (OR = 2.1), and trust in organization (OR = 2.0). Work control (OR = 0.3), trust in organization (OR = 0.4), and stress (OR = 4.1) were associated with burnout. Trust in organization (OR = 0.5), feeling valued (OR = 0.6), and stress (OR = 1.8) associated with ITL. Qualitative data revealed three themes relevant to rural leaders: (1) industry challenges, (2) daily operational issues, and (3) difficult relationships. CONCLUSIONS: These exploratory analyses demonstrate practical ways to improve work conditions to mitigate burnout and turnover in rural leaders. Promoting thriving in leaders would be an important step in maintaining the rural health care workforce.

How schema knowledge influences memory in older adults: Filling in the gaps, or leading memory astray?

Age-related declines in episodic memory do not affect all types of mnemonic information equally: when to-be-remembered information is in line with one's prior knowledge, or schema-congruent, older adults often show no impairments. There are two major accounts of this effect: One proposes that schemas compensate for memory failures in aging, and the other proposes that schemas instead actively impair older adults' otherwise intact memory for incongruent information. However, the evidence thus far is inconclusive, likely due to methodological constraints in teasing apart these complex underlying dynamics. We developed a paradigm that separately examines the contributions of underlying memory and schema knowledge to a final memory decision, allowing these dynamics to be examined directly. In the present study, healthy older and younger adults first searched for target objects in congruent or incongruent locations within scenes. In a subsequent test, participants indicated where in each scene the target had been located previously, and provided confidence-based recognition memory judgments that indexed underlying memory, in terms of recollection and familiarity, for the background scenes. We found that age-related increases in schema effects on target location spatial recall were predicted and statistically mediated by age-related increases in underlying memory failures, specifically within recollection. We also found that, relative to younger adults, older adults had poorer spatial memory precision within recollected scenes but slightly better precision within familiar scenes-and age increases in schema bias were primarily exhibited within recollected scenes. Interestingly, however, there were also slight age-related increases in schema effects that could not be explained by memory deficits alone, outlining a role for active schema influences as well. Together, these findings support the account that age-related schema effects on memory are compensatory in that they are driven primarily by underlying memory failures, and further suggest that age-related deficits in memory precision may also drive schema effects.

Strong immunogenicity & protection in mice with PlaCCine: A COVID-19 DNA vaccine formulated with a functional polymer.

DNA- based vaccines have demonstrated the potential as a safe and effective modality. PlaCCine, a DNA-based vaccine approach described subsequently relies on a synthetic DNA delivery system and is independent of virus or device. The synthetic functionalized polymer combined with DNA demonstrated stability over 12 months at 4C and for one month at 25C. Transfection efficiency compared to naked DNA increased by 5-15-fold in murine skeletal muscle. Studies of DNA vaccines expressing spike proteins from variants D614G (pVAC15), Delta (pVAC16), or a D614G + Delta combination (pVAC17) were conducted. Mice immunized intramuscular injection (IM) with pVAC15, pVAC16 or pVAC17 formulated with functionalized polymer and adjuvant resulted in induction of spike-specific humoral and cellular responses. Antibody responses were observed after one immunization. And endpoint IgG titers increased to greater than 1x 105 two weeks after the second injection. Neutralizing antibodies as determined by a pseudovirus competition assay were observed following vaccination with pVAC15, pVAC16 or pVAC17. Spike specific T cell immune responses were also observed following vaccination and flow cytometry analysis demonstrated the cellular immune responses included both CD4 and CD8 spike specific T cells. The immune responses in vaccinated mice were maintained for up to 14 months after vaccination. In an immunization and challenge study of K18 hACE2 transgenic mice pVAC15, pVAC16 and pVAC17 induced immune responses lead to decreased lung viral loads by greater than 90 % along with improved clinical score. These findings suggest that PlaCCine DNA vaccines are effective and stable and further development against emerging SARS-CoV-2 variants is warranted.

Implantable Hemodynamic Monitors Improve Survival in Patients With Heart Failure and Reduced Ejection Fraction.

BACKGROUND: Trials evaluating implantable hemodynamic monitors to manage patients with heart failure (HF) have shown reductions in HF hospitalizations but not mortality. Prior meta-analyses assessing mortality have been limited in construct because of an absence of patient-level data, short-term follow-up duration, and evaluation across the combined spectrum of ejection fractions. OBJECTIVES: The purpose of this meta-analysis was to determine whether management with implantable hemodynamic monitors reduces mortality in patients with heart failure and reduced ejection fraction (HFrEF) and to confirm the effect of hemodynamic-monitoring guided management on HF hospitalization reduction reported in previous studies. METHODS: The patient-level pooled meta-analysis used 3 randomized studies (GUIDE-HF [Hemodynamic-Guided Management of Heart Failure], CHAMPION [CardioMEMS Heart Sensor Allows Monitoring of Pressure to Improve Outcomes in NYHA Class III Heart Failure Patients], and LAPTOP-HF [Left Atrial Pressure Monitoring to Optimize Heart Failure Therapy]) of implantable hemodynamic monitors (2 measuring pulmonary artery pressures and 1 measuring left atrial pressure) to assess the effect on all-cause mortality and HF hospitalizations. RESULTS: A total of 1,350 patients with HFrEF were included. Hemodynamic-monitoring guided management significantly reduced overall mortality with an HR of 0.75 (95% CI: 0.57-0.99); P = 0.043. HF hospitalizations were significantly reduced with an HR of 0.64 (95% CI: 0.55-0.76); P < 0.0001. CONCLUSIONS: Management of patients with HFrEF using an implantable hemodynamic monitor significantly reduces both mortality and HF hospitalizations. The reduction in HF hospitalizations is seen early in the first year of monitoring and mortality benefits occur after the first year.

The use of a systems approach to increase NAD+ in human participants.

Reversal or mitigation against an age-related decline in NAD+ has likely benefits, and this premise has driven academic and commercial endeavour to develop dietary supplements that achieve this outcome. We used a systems-based approach to improve on current supplements by targeting multiple points in the NAD+ salvage pathway. In a double-blind, randomised, crossover trial, the supplement - Nuchido TIME+® (NT) - increased NAD+ concentration in whole blood. This was associated with an increase in SIRT1 and an increase in nicotinamide phosphoribosyltransferase (NAMPT) in peripheral blood mononucleocytes, lower concentrations of pro-inflammatory cytokines in plasma, including a reduction in interleukin 2 (IL2), a reduction in glycated serum protein and a shift in the glycosylation profile of immunoglobulin G (IgG) toward a younger biological age, all of which are likely to promote a healthier ageing trajectory.

The role of local meaning in infants' fixations of natural scenes.

As infants view visual scenes every day, they must shift their eye gaze and visual attention from location to location, sampling information to process and learn. Like adults, infants' gaze when viewing natural scenes (i.e., photographs of everyday scenes) is influenced by the physical features of the scene image and a general bias to look more centrally in a scene. However, it is unknown how infants' gaze while viewing such scenes is influenced by the semantic content of the scenes. Here, we tested the relative influence of local meaning, controlling for physical salience and center bias, on the eye gaze of 4- to 12-month-old infants (N = 92) as they viewed natural scenes. Overall, infants were more likely to fixate scene regions rated as higher in meaning, indicating that, like adults, the semantic content, or local meaning, of scenes influences where they look. More importantly, the effect of meaning on infant attention increased with age, providing the first evidence for an age-related increase in the impact of local meaning on infants' eye movements while viewing natural scenes.

Spatiotemporal jump detection during continuous film viewing: Insights from a flicker paradigm.

We investigated how sensitive visual processing is to spatiotemporal disruptions in ongoing visual events. Prior work has demonstrated that participants often miss spatiotemporal disruptions in videos presented in the form of scene edits or disruptions during saccades. Here, we asked whether this phenomenon generalizes to spatiotemporal disruptions that are not tied to saccades. In two flicker paradigm experiments, participants were instructed to identify spatiotemporal disruptions created when videos either jumped forward or backward in time. Participants often missed the jumps, and forward jumps were reported less frequently compared with backward jumps, demonstrating that a flicker paradigm produces effects similar to a saccade contingent disruption paradigm. These results suggest that difficulty detecting spatiotemporal disruptions is a general phenomenon that extends beyond trans-saccadic events.

The presence and significance of large multinucleated cells in leprosy

The occurrence of large multinucleated cells in leprosy is described together with the clinical appearances of thetypes of lesions in which this phenomenon is seen. An attempt is made to explain the possible origin of these cells and to estimate their significance in the course of the disease.My thanks are due to Dr. Muir, in charge of Leprosy Research at the School of Tropical Medicine, Calcutta, for permission to publish this note.

The depigmented patch in leprosy: a clinical and pathological study

In this paper an attempt has been made to present a description of the depigmentated patch in leprosy from the clinical and pathological view points. The relationship of this particular type of lesion to the disease as a whole is discussed. The different clinical varieties of patch are then dealt with together with a brief reference to certain attributes of this type of lesion. The histological changes are next reviewed and lastly an attempt is made to correlate the clinical picture with the histological findings.My thanks are due to LIEUT.-COL.H.W. Actom, I.M.M., the Director, the School of Tropical Medicine and Hygiene, Calcutta for helpful suggestions during the course of this investigation and to Dr. E. MUIR, M.D., F.R.C.S. (Edin.), in change of Leprosy search for permission to publish this paper.

The presence and significance of large multinucleated cells in leprosy

The occurrence of large multinucleated cells in leprosy is described together with the clinical appearances of thetypes of lesions in which this phenomenon is seen. An attempt is made to explain the possible origin of these cells and to estimate their significance in the course of the disease.My thanks are due to Dr. Muir, in charge of Leprosy Research at the School of Tropical Medicine, Calcutta, for permission to publish this note.

The depigmented patch in leprosy: a clinical and pathological study

In this paper an attempt has been made to present a description of the depigmentated patch in leprosy from the clinical and pathological view points. The relationship of this particular type of lesion to the disease as a whole is discussed. The different clinical varieties of patch are then dealt with together with a brief reference to certain attributes of this type of lesion. The histological changes are next reviewed and lastly an attempt is made to correlate the clinical picture with the histological findings.My thanks are due to LIEUT.-COL.H.W. Actom, I.M.M., the Director, the School of Tropical Medicine and Hygiene, Calcutta for helpful suggestions during the course of this investigation and to Dr. E. MUIR, M.D., F.R.C.S. (Edin.), in change of Leprosy search for permission to publish this paper.