Advances in biologging can identify nuanced energetic costs and gains in predators.

Foraging is a key driver of animal movement patterns, with specific challenges for predators which must search for mobile prey. These patterns are increasingly impacted by global changes, principally in land use and climate. Understanding the degree of flexibility in predator foraging and social strategies is pertinent to wildlife conservation under global change, including potential top-down effects on wider ecosystems. Here we propose key future research directions to better understand foraging strategies and social flexibility in predators. In particular, rapid continued advances in biologging technology are helping to record and understand dynamic behavioural and movement responses of animals to environmental changes, and their energetic consequences. Data collection can be optimised by calibrating behavioural interpretation methods in captive settings and strategic tagging decisions within and between social groups. Importantly, many species' social systems are increasingly being found to be more flexible than originally described in the literature, which may be more readily detectable through biologging approaches than behavioural observation. Integrating the effects of the physical landscape and biotic interactions will be key to explaining and predicting animal movements and energetic balance in a changing world.

Value of combining transect counts and telemetry data to determine short-term population trends in a globally threatened species.

To evaluate conservation interventions, it is necessary to obtain reliable population trends for short (<10 years) time scales. Telemetry can be used to estimate short-term survival rates and is a common tool for assessing population trends, but it has limitations and can be biased toward specific behavioral traits of tagged individuals. Encounter rates calculated from transects can be useful for assessing changes across multiple species, but they can have large confidence intervals and be affected by variations in survey conditions. The decline of African vultures has been well-documented, but understanding of recent trends is lacking. To examine population trends, we used survival estimates from telemetry data collected over 6 years (primarily for white-backed vultures [Gyps africanus]) and transect counts conducted over 8 years (for 7 scavenging raptors) in 3 large protected areas in Tanzania. Population trends were estimated using survival analysis combined with the Leslie Lefkovitch matrix model from the telemetry data and using Bayesian mixed effects generalized linear regression models from the transect data. Both methods showed significant declines for white-backed vultures in Ruaha and Nyerere National Parks. Only telemetry estimates suggested significant declines in Katavi National Park. Encounter rates calculated from transects also showed declines in Nyerere National Park for lappet-faced vultures (38% annual declines) and Bateleurs (18%) and in Ruaha National Park for white-headed vultures (Trigonoceps occipitalis) (19%). Mortality rates recorded and inferred from telemetry suggested that poisoning is prevalent. However, only 6 mortalities of the 26 presumed mortalities were confirmed to be caused by poisoning, highlighting the challenges of determining the cause of death when working across large landscapes. Despite declines, our data provide evidence that southern Tanzania has higher current encounter rates of African vultures than elsewhere in East Africa. Preventing further declines will depend greatly on mitigating poisoning. Based on our results, we suggest that the use of multiple techniques improves understanding of population trends over the short term.

Importancia de combinar los conteos de transectos y los datos de telemetría para determinar las tendencias poblacionales a corto plazo de especies amenazadas a nivel mundial Resumen Para evaluar las intervenciones de conservación es necesario obtener tendencias poblacionales confiables para escalas temporales cortas (<10 años). La telemetría puede usarse para estimar las tasas de supervivencia a corto plazo, además de que es una herramienta común para analizar las tendencias poblacionales, pero tiene limitantes y puede sesgarse con el comportamiento específico de los individuos marcados. Las tasas de encuentro calculadas a partir de transectos pueden ser útiles para analizar cambios en varias especies, aunque pueden tener intervalos grandes de confianza y verse afectadas por las variantes en las condiciones del censo. La declinación de los buitres africanos está bien documentada, pero hace falta el conocimiento sobre las tendencias recientes. Usamos las estimaciones de supervivencia tomadas de datos telemétricos recolectados durante seis años (principalmente del buitre Gyps africanus) y los conteos de transecto de siete especies carroñeras realizados durante ocho años en tres áreas protegidas en Tanzania. Estimamos las tendencias poblacionales con la combinación de análisis de supervivencia y el modelo de matriz Leslie Lefkovitch hecho con los datos telemétricos y usando modelos bayesianos de regresión lineal generalizada de efectos mixtos hechos con los datos de los transectos. Ambos métodos indicaron declinaciones significativas de Gyps africanus en los Parques Nacionales Ruaha y Nyerere. Sólo las estimaciones telemétricas sugirieron una declinación significativa en el Parque Nacional Katavi. Las tasas de encuentro calculadas a partir de los transectos también indicaron declinaciones de Torgos tracheliotos (38% de declinaciones anuales) y de Terathopius ecaudutus (18%) en el Parque Nacional Nyerere y de Trigonoceps occipitalis (19%) en el Parque Nacional Ruaha. Las muertes registradas e inferidas a partir de la telemetría sugieren que el envenenamiento es prevalente. Sin embargo, sólo se confirmaron seis muertes por envenenamiento de las 26 supuestas, lo que resalta los obstáculos para determinar la causa de muerte cuando se trabaja en paisajes amplios. A pesar de las declinaciones, nuestros datos proporcionan evidencia de que el sur de Tanzania tiene tasas actuales de encuentro con buitres africanos más altas que en cualquier otra parte del occidente de África. La prevención de declinaciones en el futuro dependerá principalmente de evitar el envenenamiento. Con base en nuestros resultados, sugerimos que el uso de técnicas múltiples incrementa el conocimiento sobre las tendencias poblacionales a corto plazo.

Should Penicillin Allergy Testing Be Included as Part of Preoperative Testing?

INTRODUCTION: Penicillin allergy is the most commonly reported drug allergy in the United States. Patients labeled with penicillin allergy are at risk of receiving broad-spectrum antibiotics for surgical site infection prophylaxis, which can lead to increased antibiotic resistance, higher morbidity, suboptimal antibiotic therapy, and higher medical costs. This study aimed to determine the true prevalence of penicillin allergy among surgical patients and to decrease the unnecessary use of broad-spectrum antibiotics. METHODS: A retrospective chart review was performed of patients who underwent urogynecologic surgery in 2017. In 2018, a quality initiative was started, and all patients reporting penicillin allergies were offered antibiotic allergy testing as part of their preoperative testing. RESULTS: In 2017, 15% of patients reported penicillin allergy and 52% of them received surgical prophylaxis with broad-spectrum antibiotics. In 2018, 463 patients underwent surgery, 55 of whom reported penicillin allergy and were offered penicillin allergy testing. 35 (64%) agreed to proceed with testing, and of those tested, 33 (94%) tested negative for penicillin allergy. CONCLUSIONS: 94% of patients with stated penicillin allergy who consented to allergy testing proved to have negative test. Penicillin allergy testing should be considered as part of preoperative management.

Making a greener planet: nature documentaries promote plant awareness.

BACKGROUND AND AIMS: Plants underpin life on Earth and are essential to human existence. Alarmingly, almost 40% of plant species are under threat of extinction, with plants that are not directly useful to humans being particularly vulnerable. Plant diversity and its untapped resources require urgent protection to safeguard our future, but conservation initiatives are biased towards mammals and birds. Plant awareness disparity, formerly known as plant blindness, describes our tendency to ignore plant life and has been suggested to play a crucial role in the bias against funding and support for plant conservation programmes. Previous studies indicate that nature documentaries can generate shifts in audience awareness of animal species by providing vicarious connections to nature. Here, we investigated whether the plant-focused popular BBC show Green Planet had a similar effect for plants and stimulated audience engagement for information after the broadcast. METHODS: Online searches for further information were considered a form of engagement for evaluation of the interest of the audience in plants portrayed in Green Planet episodes. The big data activities (Google search engine and Wikipedia pageviews trends) related to the plants mentioned in Green Planet episodes were examined over the period covering the broadcast of the show in UK. KEY RESULTS: Analyses indicate that Green Planet generated increased awareness and stimulated audience engagement for further information about plants featured in the show, with audience reaction driven by the screen time. CONCLUSIONS: Natural history films can promote plant awareness, and culturomic tools can be used to assess their impact on the general public, potentially also to inform plant conservation strategies. These are promising findings as we strive to increase public awareness of the value of plant life.

A prospective, randomized trial comparing intravesical dimethyl sulfoxide (DMSO) to bupivacaine, triamcinolone, and heparin (BTH), for newly diagnosed interstitial cystitis/painful bladder syndrome (IC/PBS).

INTRODUCTION AND HYPOTHESIS: The primary aim of this study was to compare the effect of bladder instillations using dimethyl sulfoxide (DMSO) with triamcinolone versus bupivacaine, triamcinolone, and heparin (BTH) in women with newly diagnosed interstitial cystitis/painful bladder syndrome. The primary outcome was improvement in symptoms measured using the O'Leary-Sant Interstitial Cystitis Symptoms Index (ICSI) score. Secondary comparisons included changes in urinary frequency, nocturia, and bladder capacity. MATERIALS AND METHODS: This was a prospective, randomized study. Patients with a recent diagnosis of interstitial cystitis/painful bladder syndrome (IC/PBS) were randomized 1:1 to treatment with either 6 weekly bladder instillations of DMSO with triamcinolone or BTH. During follow-up visits, patients completed the ICSI questionnaire, and bladder capacity was determined through the retrograde filling of the bladder. The χ2 test or Student's t test were used for data analysis. RESULTS: A total of 83 patients were randomized, and final analysis included 70 participants who completed the 6 weekly instillations (42 DMSO, 28 BTH). The groups were similar in baseline demographics and clinical characteristics, except for cystometric maximum capacity (DMSO 338.62± 139.44 mL, BTH 447.43 ± 180.38 mL, p = 0.01). In the DMSO group, 63% of patients had a greater than 29.5% reduction in total ICSI score versus 43% in the BTH group (p = 0.15). Nocturia and pain were significantly reduced in the DMSO group. There was a significant increase from baseline in bladder capacity for both groups. CONCLUSION: In women with newly diagnosed IC/PBS, bladder instillations with DMSO and triamcinolone provide greater improvement in pain and nocturia compared to BTH.

Amending the literature through version control.

The ideal of self-correction in science is not well served by the current culture and system surrounding amendments to published literature. Here we describe our view of how amendments could and should work by drawing on the idea of an author-led version control system. We report a survey (n = 132) that highlights academics' dissatisfaction with the status quo and their support for such an alternative approach. Authors would include a link in their published manuscripts to an updatable website (e.g. a GitHub repository) that could be disseminated in the event of any amendment. Such a system is already in place for computer code and requires nothing but buy-in from the scientific community-a community that is already evolving towards open science frameworks. This would remove a number of frictions that discourage amendments leading to an improved scientific literature and a healthier academic climate.

Long term surgical outcomes of vaginal colposuspension using the Uphold Lite™ mesh system vs. vaginal vault uterosacral ligament suspension for treatment of apical prolapse.

OBJECTIVE: The aim of this study is to compare long-term outcomes (7-10 years) between vaginal hysterectomy with uterosacral ligament suspension (VHUSLS) and sacrospinous hysteropexy with the Uphold™ Lite mesh System (SHU) for management of apical prolapse. METHODS: Patients undergoing VHUSLS or SHU from 2008 to 2012 at a single tertiary referral center were included. Patients were contacted, asked to return for physical examination, and to complete the Pelvic Floor Distress Inventory (PFDI-20) questionnaire. Our primary outcome was anatomic failure defined as Stage 2 POP or higher of any compartment. The secondary outcome was subjective changes in symptoms based upon PFDI-20 responses. RESULTS: Two-hundred and two women were identified to have undergone the index surgeries from 2008 to 2012. Sixty-three agreed to return for follow up symptom evaluation and examination (30 VHUSLS and 33 SHU). Baseline characteristics were similar between groups. Clinical cure was high for both groups reaching 93.4 % and 94.0 % for the VHUSLS and SHU groups, respectively (p = 0.721). Anatomical success was lower with 44.7 % and 66.7 % of patients in the VHUSLS and SHU groups, respectively, meeting criteria for success (p = 0.138). There were no mesh complications among patients returning for exams. However, two patients who were contacted and were not interested in this study reported mesh complications and need for additional surgeries. Anterior vaginal wall support was noted to be significantly better supported for SHU (Ba -2.03 ± 0.75 vs -1.42 ± 0.92, p = 0.008). There were no differences between groups for overall PFDI-20 scores postoperatively. However, SHU patients reported higher rates of stress urinary incontinence compared to VHUSLS patients. CONCLUSION: In women with apical prolapse, VHUSLS and SHU afford similar long-term outcomes. SHU patients reported higher rates of stress urinary incontinence.

Escalating the conflict? Intersex genetic correlations influence adaptation to environmental change in facultatively migratory populations.

Males and females are often subject to different and even opposing selection pressures. When a given trait has a shared genetic basis between the sexes, sexual conflict (antagonism) can arise. This can result in significant individual-level fitness consequences that might also affect population performance, whilst anthropogenic environmental change can further exacerbate maladaptation in one or both sexes driven by sexual antagonism. Here, we develop a genetically explicit eco-evolutionary model using an agent-based framework to explore how a population of a facultatively migratory fish species (brown trout Salmo trutta) adapts to environmental change across a range of intersex genetic correlations for migration propensity, which influence the magnitude of sexual conflict. Our modelled focal trait represents a condition threshold governing whether individuals adopt a resident or anadromous (sea migration) tactic. Anadromy affords potential size-mediated reproductive advantages to both males and females due to improved feeding opportunities at sea, but these can be undermined by high background marine mortality and survival/growth costs imposed by marine parasites (sea lice). We show that migration tactic frequency for a given set of environmental conditions is strongly influenced by the intersex genetic correlation, such that one sex can be dragged off its optimum more than the other. When this occurred in females in our model, population productivity was substantially reduced, but eco-evolutionary outcomes were altered by allowing for sneaking behaviour in males. We discuss real-world implications of our work given that anadromous salmonids are regularly challenged by sea lice infestations, which might act synergistically with other stressors such as climate change or fishing that impact marine performance, driving populations towards residency and potentially reduced resilience.

Methenamine hippurate compared with trimethoprim for the prevention of recurrent urinary tract infections: a randomized clinical trial.

INTRODUCTION AND HYPOTHESIS: The objective was to find an alternative treatment to a low-dose antibiotic for the prevention of recurrent urinary tract infections (UTI) and to evaluate the difference in rates of reinfection within 1 year when treated with methenamine hippurate for prophylaxis compared with trimethoprim. METHODS: We present a non-blinded randomized trial comparing methenamine hippurate with trimethoprim for the prevention of recurrent UTI at 12 months after starting treatment. Women over 18 who had at least two culture-positive UTI in the prior 6 months or three in the prior year were included. Ninety-two patients met enrollment criteria and were randomized to receive daily prophylaxis with methenamine hippurate or trimethoprim for a minimum of 6 months. Both intent-to-treat and per-protocol analyses if patients received the alternative drug after randomization were analyzed using Student's t test, Mann-Whitney U test, Kaplan-Meier curves, log-rank test, and a logistic and multivariate regression model. The primary outcome of this study was culture-proven UTI recurrence by 12 months after initiating prophylaxis. RESULTS: In the intent-to-treat analysis, we found no difference between groups in recurrent UTI, with a 65% (28 out of 43) recurrence in the trimethoprim group versus 65% (28 out of 43) in the methenamine hippurate group (p = 1.00). In the per-protocol analysis, 65% (26 out of 40) versus 65% (30 out of 46) of patients had UTI recurrences in the trimethoprim group versus the methenamine hippurate group (p = 0.98). CONCLUSIONS: Methenamine hippurate may be an alternative for the prevention of recurrent UTI, with similar rates of recurrence and adverse effects to trimethoprim.

Can patients independently identify their urinary incontinence symptoms?

INTRODUCTION AND HYPOTHESIS: The objective of our study is to compare patient self-reported urinary incontinence symptoms based on the International Consultation on Incontinence Questionnaire- Short Form (ICIQ-SF) question number 6 (When does urine leak?) with physician-assessed interpretation of the patient's urinary incontinence symptoms. METHODS: This trial is a cross-sectional study of patients who presented to a tertiary urogynecology center with symptoms of urinary incontinence between January 2014 and August 2016. We compared patient-reported symptoms on the ICIQ-SF with physician interpretation of urinary complaints during their initial visit. The urinary incontinence symptoms included stress urinary incontinence (SUI), urgency urinary incontinence (UUI), insensible urine loss, nocturnal enuresis, and post-micturition dribbling. RESULTS: A total of 432 patients with a mean age of 61 were included in this evaluation. The most common urinary incontinence symptoms according to the physician were UUI (n = 357, 83%), followed by SUI (n = 308, 71%). Of the patients who were diagnosed by a physician with the symptom of UUI, only 61% self-identified as having this symptom based on the ICIQ-SF, and for SUI, only 66% self-identified as having SUI symptoms based on the ICIQ-SF. Overall UUI (κ = 0.30) appears to have poor agreement, as does nocturnal enuresis (κ = 0.39), when compared with physician historical assessment. CONCLUSION: There is a discrepancy between patient-reported urinary incontinence symptoms on the ICIQ-SF and physician-assessed symptoms. Symptomatology entered into electronic medical records by patients is often inaccurate. Physician validation is essential in understanding the underlying the precise symptomatology.

An introduction to agent-based models as an accessible surrogate to field-based research and teaching.

There are many barriers to fieldwork including cost, time, and physical ability. Unfortunately, these barriers disproportionately affect minority communities and create a disparity in access to fieldwork in the natural sciences. Travel restrictions, concerns about our carbon footprint, and the global lockdown have extended this barrier to fieldwork across the community and led to increased anxiety about gaps in productivity, especially among graduate students and early-career researchers. In this paper, we discuss agent-based modeling as an open-source, accessible, and inclusive resource to substitute for lost fieldwork during COVID-19 and for future scenarios of travel restrictions such as climate change and economic downturn. We describe the benefits of Agent-Based models as a teaching and training resource for students across education levels. We discuss how and why educators and research scientists can implement them with examples from the literature on how agent-based models can be applied broadly across life science research. We aim to amplify awareness and adoption of this technique to broaden the diversity and size of the agent-based modeling community in ecology and evolutionary research. Finally, we discuss the challenges facing agent-based modeling and discuss how quantitative ecology can work in tandem with traditional field ecology to improve both methods.

Natural history films raise species awareness-A big data approach.

In urbanized societies that are increasingly disconnected from nature, communicating ecological and species awareness is crucial to revert the global environmental crisis. However, our understanding of the effectiveness of this process is limited. We present a framework for describing how such awareness may be transferred and test it on the popular BBC show Planet Earth 2 by analyzing Twitter and Wikipedia big data activity. Despite lacking explicit conservation themes, this show generated species awareness, stimulating audience engagement for information at magnitudes comparable to those achieved by other conservation-focused campaigns. Results suggest that natural history films can provide vicarious connections to nature and can generate durable shifts in audience awareness beyond the broadcast of the show-key factors for changing environmental attitudes. More broadly, this study underscores how open-source big data analysis can inform effective dissemination of ecological awareness and provides a framework for future research for investigating behavioral change.

A Comparison of Sacrospinous Hysteropexy Augmented With Polypropylene Mesh Versus Human Dermis at 12-Month Follow-up: An Ambidirectional Study.

BACKGROUND: Suture-based hysteropexy is performed for pelvic organ prolapse with varying results. Graft augmentation may improve outcomes. OBJECTIVE: The aim of this study was to determine whether vaginal hysteropexy with mesh reduces recurrence at 1-year postoperative examination compared with hysteropexy with allograft. METHODS: Data were collected for patients who underwent vaginal hysteropexy with either mesh "Uphold" (referred to as "mesh") or a cadaveric allograft "Axis or Repliform" (referred to as "dermal"). The primary outcome was anatomic success defined as no prolapse Pelvic Organ Prolapse Quantification System stage II or less at 12 months postoperative. The secondary outcomes were recurrence to the hymen and a composite score (any positive response to the 20-item Pelvic Floor Distress Inventory question 3 and cervix ≥ -1/2 total vaginal length at rest or as reference point 3 cm proximal to or above the hymenal ring anteriorly [Ba] ≥0) measured at 12 months. RESULTS: Two hundred seventy-four patients returned for their 1-year postoperative examination: 93.5% of the mesh group (231/247 subjects) and 95.5% of the dermal group (43/45 subjects). The mesh group had fewer recurrences to or beyond Pelvic Organ Prolapse Quantification System stage II (mesh 18% vs dermal 29%, P = 0.03), to the hymen (2.6% vs 9.3%, P = 0.007), or based on composite score (19 vs 33%, P = 0.007). Questionnaire data improved more in the mesh group (P < 0.0001). The exposure rate was 5.75% (13/247) in the mesh group. Reoperation rate was greater in the dermal group (mesh 4.3%vs dermal 7.3%, P = 02). CONCLUSIONS: Hysteropexy augmented with mesh reduced the recurrence at 1 year compared with hysteropexy with allograft. Fewer patients in the mesh group felt a bulge at 1 year (4.5% vs 20.9%, P < 0.0001). These findings need to be weighed against the mesh exposure rate of 5.75%.

Cognitive changes in women starting anticholinergic medications for overactive bladder: a prospective study.

INTRODUCTION AND HYPOTHESIS: To assess cognitive changes in women 12 months after starting anticholinergic medications for overactive bladder syndrome (OAB). METHODS: We present a prospective cohort study assessing changes in cognition in women seen in a referral urogynecology practice. We compared women who started anticholinergic OAB medications with women not on anticholinergic OAB medications. The primary outcome was change over time on the Montreal Cognitive Assessment (MOCA) screening score. At enrollment, women completed a baseline MOCA screening, a Geriatric Depression Screen (GDS), and an assessment of medications to create an anticholinergic burden score (ACB). At 3, 6, 9, and 12 months after enrollment women were administered the MOCA, GDS, and a review of their medications and medical problems. Statistical analysis was performed using a linear mixed effects model taking into account correlated error terms given multiple MOCA assessments at various time points per patient. RESULTS: A total of 106 women were enrolled, 60 in the OAB medication group and 46 in the control (non-OAB medication) group. The mean age was 77 years, 93% of women were Caucasian, and 98% completed high school, with no difference between groups. Over time there was no difference in change of MOCA score between the OAB and control groups when controlling for age, GDS score, and ACB score (p = 0.78). This association did not change when women with a neurological diagnosis were excluded (n = 6). On average MOCA scores for the OAB group increased by 0.76 over 12 months and the control group increased 0.39, with no difference between the groups (p = 0.53). CONCLUSIONS: We found no changes in MOCA scores between OAB medication and control groups after controlling for age, depression, and polypharmacy after 12 months of follow-up.

Evolutionary stasis of a heritable morphological trait in a wild fish population despite apparent directional selection.

Comparing observed versus theoretically expected evolutionary responses is important for our understanding of the evolutionary process, and for assessing how species may cope with anthropogenic change. Here, we document directional selection for larger female size in Atlantic salmon, using pedigree-derived estimates of lifetime reproductive success as a fitness measure. We show the trait is heritable and, thus, capable of responding to selection. The Breeder's Equation, which predicts microevolution as the product of phenotypic selection and heritability, predicted evolution of larger size. This was at odds, however, with the observed lack of either phenotypic or genetic temporal trends in body size, a so-called "paradox of stasis." To investigate this paradox, we estimated the additive genetic covariance between trait and fitness, which provides a prediction of evolutionary change according to Robertson's secondary theorem of selection (STS) that is unbiased by missing variables. The STS prediction was consistent with the observed stasis. Decomposition of phenotypic selection gradients into genetic and environmental components revealed a potential upward bias, implying unmeasured factors that covary with trait and fitness. These results showcase the power of pedigreed, wild population studies-which have largely been limited to birds and mammals-to study evolutionary processes on contemporary timescales.

Factors associated with overactive bladder symptom improvement after 1 year of monthly percutaneous tibial nerve stimulation therapy.

AIMS: To investigate patient characteristics associated with overactive bladder (OAB) symptom improvement after 1 year of monthly percutaneous tibial nerve stimulation (PTNS) therapy. METHODS: This was a retrospective chart review of women who underwent PTNS for refractory OAB symptoms between January 2011 and December 2017 in our tertiary center. Patients who received 12 monthly PTNS maintenance treatments after achieving success with 12 weekly PTNS treatments were included in the study. Reports on subjective changes in urinary frequency, nocturia, and urgency urinary incontinence were submitted at each visit. Patients were categorized to symptom improve and no improve groups. A multivariate analysis was performed to identify patient characteristics that predicted symptomatic improvement. RESULTS: Sixty-six patients were identified. Average subjective improvement after 12 monthly sessions compared with 12 weekly sessions was 5.2% on a scale of -100% to +100%. A history of urogynecologic surgery remained a significant negative predictor of symptom change from 12 weekly sessions to 12 monthly treatment sessions (odds ratio, 0.19; P = .01). CONCLUSIONS: OAB symptoms remain relatively stable after 12 monthly treatments of PTNS, as compared with the 12-week time point. A history of urogynecologic surgery was a negative predictor of OAB symptom improvement in patients receiving monthly PTNS for at least 12 months.

Anterior Colporrhaphy With and Without Dermal Allograft: A Randomized Control Trial With Long-Term Follow-Up.

OBJECTIVE: The objective of this study was to determine whether anterior colporrhaphy plus insertion of anterior dermal allograft reduces anterior prolapse recurrence at 1 and 7 to 10 years postoperatively compared with anterior colporrhaphy alone. METHODS: We present a nonblinded randomized controlled trial with 1- and 7- to 10-year follow-up. Subjects were randomized between 2005 and 2008 to anterior colporrhaphy or ultralateral anterior colporrhaphy plus insertion of a dermal allograft spanning the anterior compartment between the arcus tendineus fascia pelvis on each side. Eligible subjects had anterior prolapse to the hymen or beyond, were bothered by their prolapse, and were planning to undergo surgical correction. Subjects completed a pelvic organ prolapse quantification system (POPQ) examination and Pelvic Floor Distress Inventory (PFDI)/PFDI-20 before surgery; a POPQ, PFDI, and Pelvic Organ Prolapse/Incontinence Sexual Questionnaire at 1 year postoperatively; and a POPQ, PFDI-20, Pelvic Organ Prolapse/Incontinence Sexual Questionnaire, Revised, and Patient-reported Global Impression of Improvement Inventory at 7 to 10 years postoperatively. Our primary outcome was anatomic anterior prolapse recurrence at 1 or 7 to 10 years defined as Aa or Ba greater than or equal to -1. Our secondary outcome was a composite score of anterior prolapse recurrence at 1 or 7 to 10 years defined as anatomic recurrence (Aa or Ba ≥ 0), retreatment for cystocele, or answering yes to PFDI-20 question 3 (subjective report of vaginal bulge). RESULTS: A total of 114 subjects were randomized, 70 to anterior colporrhaphy and 44 to anterior colporrhaphy plus dermal allograft. About 92% of subjects underwent concomitant apical suspension, 98% in the graft group and 89% in the nongraft group. Eighty-nine subjects (32 graft [73%], 57 nongraft [81%]) returned for 1-year follow-up. Fifty-three patients (19 graft [48%], 34 nongraft [49%]) returned for 7- to 10-year follow-up. The primary outcome was met by 8 (18%) graft and 22 (31%) nongraft subjects at 1 year postoperatively (P = 0.26) and by 10 (23%) graft and 24 (34%) nongraft subjects at 7 to 10 years postoperatively (P = 0.37). The secondary outcome was met by 8 (18%) graft and 15 (21%) nongraft subjects at 1 year postoperatively (P = 0.74) and by 13 (30%) graft and 21 (30.0%) nongraft subjects at 7 to 10 years postoperatively (P = 0.99). CONCLUSIONS: We cannot conclude whether there is a difference in anterior recurrence for anterior colporrhaphy with and without dermal allograft and do not recommend changes in clinical practice based on these results.

The influence of mixing on stratospheric age of air changes in the 21st century.

Climate models consistently predict an acceleration of the Brewer-Dobson circulation (BDC) due to climate change in the 21st century. However, the strength of this acceleration varies considerably among individual models, which constitutes a notable source of uncertainty for future climate projections. To shed more light upon the magnitude of this uncertainty and on its causes, we analyze the stratospheric mean age of air (AoA) of 10 climate projection simulations from the Chemistry Climate Model Initiative phase 1 (CCMI-I), covering the period between 1960 and 2100. In agreement with previous multi-model studies, we find a large model spread in the magnitude of the AoA trend over the simulation period. Differences between future and past AoA are found to be predominantly due to differences in mixing (reduced aging by mixing and recirculation) rather than differences in residual mean transport. We furthermore analyze the mixing efficiency, a measure of the relative strength of mixing for given residual mean transport, which was previously hypothesized to be a model constant. Here, the mixing efficiency is found to vary not only across models, but also over time in all models. Changes in mixing efficiency are shown to be closely related to changes in AoA and quantified to roughly contribute 10% to the long-term AoA decrease over the 21st century. Additionally, mixing efficiency variations are shown to considerably enhance model spread in AoA changes. To understand these mixing efficiency variations, we also present a consistent dynamical framework based on diffusive closure, which highlights the role of basic state potential vorticity gradients in controlling mixing efficiency and therefore aging by mixing.

Subjective and objective responses to PTNS and predictors for success: a retrospective cohort study of percutaneous tibial nerve stimulation for overactive bladder.

INTRODUCTION AND HYPOTHESIS: We investigated the objective improvements in overactive bladder (OAB) symptoms in patients undergoing percutaneous tibial nerve stimulation (PTNS) and predictive factors of patient satisfaction. METHODS: In this single-center retrospective cohort study at a tertiary urogynecology center, we identified all female patients who underwent PTNS therapy from 1 October 2007 - 1 January 2016 and followed them from their initial visit through medication therapy and PTNS treatments. Patients who tried at least one medication prior to starting PTNS therapy and completed at least one PTNS visit were included. Baseline demographic data, urinary data, and details of medication and PTNS therapy sessions were collected from records through chart review. Paired or two-sample t-tests were used to compare changes over time or groups. Bivariate and multivariable logistic regression were performed. RESULTS: Two hundred thirteen patients underwent PTNS therapy and 183 patients met the criteria. Overall patients were able to decrease voiding frequency by 1 h, decrease nocturia episodes by 0.8, and decrease urge incontinence episodes with PTNS therapy by ten episodes per week (p = 0.02). Patients who continued OAB medications did not have additional improvements compared with patients who did not continue OAB medications during PTNS. Overall, 25.4% (43/169) patients reported ≥ 75% improvement during PTNS therapy, and 61.5% (104/169) reported ≥ 50% improvement. When evaluating predictive factors of ≥ 50% overall improvement, the number of PTNS sessions increased odds of subjective success (OR = 1.8, p = 0.004). Other factors were not significant predictors of subjective PTNS success. CONCLUSIONS: PTNS can provide both objective and subjective improvements for patients who do not respond to OAB medication therapy.