Acceptability of self-collection sampling for HPV-DNA testing in low-resource settings: a mixed methods approach.

BACKGROUND: Vaginal self-sampling with HPV-DNA tests is a promising primary screening method for cervical cancer. However, women's experiences, concerns and the acceptability of such tests in low-resource settings remain unknown. METHODS: In India, Nicaragua, and Uganda, a mixed-method design was used to collect data from surveys (N = 3,863), qualitative interviews (N = 72; 20 providers and 52 women) and focus groups (N = 30 women) on women's and providers' experiences with self-sampling, women's opinions of sampling at home, and their future needs. RESULTS: Among surveyed women, 90% provided a self- collected sample. Of these, 75% reported it was easy, although 52% were initially concerned about hurting themselves and 24% were worried about not getting a good sample. Most surveyed women preferred self-sampling (78%). However it was not clear if they responded to the privacy of self-sampling or the convenience of avoiding a pelvic examination, or both. In follow-up interviews, most women reported that they didn't mind self-sampling, but many preferred to have a provider collect the vaginal sample. Most women also preferred clinic-based screening (as opposed to home-based self-sampling), because the sample could be collected by a provider, women could receive treatment if needed, and the clinic was sanitary and provided privacy. Self-sampling acceptability was higher when providers prepared women through education, allowed women to examine the collection brush, and were present during the self-collection process. Among survey respondents, aids that would facilitate self-sampling in the future were: staff help (53%), additional images in the illustrated instructions (31%), and a chance to practice beforehand with a doll/model (26%). CONCLUSION: Self-and vaginal-sampling are widely acceptable among women in low-resource settings. Providers have a unique opportunity to educate and prepare women for self-sampling and be flexible in accommodating women's preference for self-sampling.

Post-partum voiding dysfunction and urinary retention.

Voiding difficulty and urinary retention is a common phenomenon in the immediate post-partum period. The importance of prompt diagnosis and appropriate management of this condition cannot be over-emphasised as it is the key to ensuring a rapid return to normal bladder function. Despite this, studies revealed a low level of awareness of this problem amongst obstetric units, and there is little information regarding this condition in the published literature. This article aims at reviewing the available literature and providing an informative guide as to the associated risk factors, pathogenesis, clinical presentation and management of this largely overlooked condition.

Short-term clinical and quality-of-life outcomes in women treated by the TVT-Secur procedure.

BACKGROUND: The TVT-Secur (Ethicon, Somerville, NJ, USA) is a minimally invasive suburethral synthetic sling used in the treatment of female stress urinary incontinence. It claims to cause less postoperative pain and to enable performing in an office setting. However, this may be at the expense of a significant learning curve and a higher early failure rate. AIMS: To assess objectively the success rate of the TVT-Secur procedure in the 'U' configuration at six months. Secondary outcomes focussed on subjective success rates, complications, patient satisfaction and quality-of-life (QOL). METHODS: A prospective observational study was undertaken at two tertiary referral urogynaecology centres. A cohort of 42 consecutive patients with urodynamic stress incontinence who underwent the TVT-Secur procedure in the 'U' configuration between November 2006 and August 2007 were followed up for six months. Three standardised QOL questionnaires were completed preoperatively and at six months. A urogenital history, visual analogue score (VAS) for patient satisfaction, uroflow and urinary stress test were performed at six months. RESULTS: Recruitment was ceased prematurely because of a high number of early failures. Objective and subjective success rates at six months were 58.3% and 51.3% respectively. Complications included urinary tract infections, voiding difficulty, groin discomfort, haematoma, vaginal pain, tape erosion and intra-operative dislodgement of tape. Prevalence of de novo urge incontinence was 10.3%. Only symptom-specific QOL scores improved and only 48.6% indicated a high level satisfaction (VAS > or = 80%) with TVT-Secur. CONCLUSION: On the basis of this limited study, we are hesitant to recommend the 'U' configuration of the TVT-Secur over its more established counterparts, the TVT and TVT-O.

Kinematics, hydrodynamics and force production of pleopods suggest jet-assisted walking in the American lobster (Homarus americanus).

The American lobster (Homarus americanus) displays a diverse set of locomotory behaviours that includes tail flips, walking and paddling. Paddling is carried out by the four pairs of paddle-shaped pleopods on the ventral abdomen. Although it is recognized that pleopod-generated fluid flows have some locomotory role in adults, reports on their relative importance in locomotion are inconsistent. This paper integrates experimental kinematics and hydrodynamics of lobster pleopod beating to determine the mechanism and magnitude of pleopod force production. A kinematic analysis of pleopod beating in live lobsters showed that the pleopods execute an adlocomotory metachronal beating pattern. We modelled in vivo pleopod kinematics with a set of simple trigonometric functions, and used these functions to program a mechanical lobster model consisting of motor-driven pleopods on a lobster abdomen exoskeleton. Based on flow visualizations obtained from applying particle image velocimetry to the lobster model, we propose that the unsteady metachronal kinematics of the pleopods can maximize thrust by exploiting forces arising from individual pleopod activity and interactions among adjacent pairs. The pleopods continuously entrain fluid surrounding the lobster and create a caudally directed fluid jet oriented parallel to the substratum. Inputting wake morphology and velocity data into a simplified model for steady jet thrust showed that the pleopods of the lobster model produced 27-54 mN of thrust, which is comparable to the propulsive forces generated by other proficient swimmers. These results suggest that lobster pleopods are capable of producing forces of a magnitude that could assist the walking legs in forward propulsion.

Safety of a new transobturator suburethral synthetic sling (TVT-O) procedure during the training phase.

OBJECTIVE: The TVT-O (Ethicon, Somerville, NJ) is a new transobturator suburethral synthetic sling used in the treatment of female stress urinary incontinence (SUI). This study aimed to evaluate the complication rates and procedural times associated with performing this procedure during a period of transition from the retropubic tension-free vaginal tape (TVT) procedure to the transobturator TVT-O procedure. METHODS: We performed a retrospective analysis of the first 50 patients to undergo the TVT-O procedure in one gynaecologist's practice. All patients had SUI or mixed urinary incontinence. Operative times and intraoperative and perioperative complications were recorded. At the two-week and six- to eight-week postoperative reviews, a urogenital history and examination were performed. RESULTS: The only complications encountered were two cases (4%) of urinary tract infection and one case (2%) of superficial wound infection. There were no cases of postoperative voiding difficulty, hemorrhage, hematoma, persistent groin pain, or vascular or visceral injuries. The mean procedural time was 21 minutes. CONCLUSION: These preliminary results indicate that the TVT-O procedure is a safe treatment for female SUI even during the training phase. In light of the safety and the ease of transition to this technique, this finding is encouraging for surgeons who are making the transition from other surgical procedures for female SUI to the transobturator TVT-O.

Mechanisms of anguilliform locomotion in fishes studied using simple three-dimensional physical models.

Physical models enable researchers to systematically examine complex and dynamic mechanisms of underwater locomotion in ways that would be challenging with freely swimming animals. Previous research on undulatory locomotion, for example, has used rectangular flexible panels that are effectively two-dimensional as proxies for the propulsive surfaces of swimming fishes, but these bear little resemblance to the bodies of elongate eel-like swimming animals. In this paper we use a polyurethane rod (round cross-section) and bar (square cross-section) to represent the body of a swimming Pacific hagfish (Eptatretus stoutii). We actuated the rod and bar in both heave and pitch using a mechanical controller to generate a propulsive wave at frequencies between 0.5 and 2.5 Hz. We present data on (1) how kinematic swimming patterns change with driving frequency in these elongate fish-like models, (2) the thrust-generating capability of these simple models, (3) how forces and work done during propulsion compare between cross-sectional shapes, (4) the wake flow patterns in these swimming models using particle image velocimetry. We also contrast kinematic and hydrodynamic patterns produced by bar and rod models to comparable new experimental data on kinematics and wake flow patterns from freely swimming hagfish. Increasing the driving frequency of bar and rod models reduced trailing edge amplitude and wavelength, and above 2 Hz a nodal point appeared in the kinematic wave. Above 1 Hz, both the rod and bar generated net thrust, with the work per cycle reaching a minimum at 1.5 Hz, and the bar always requiring more work per cycle than the rod. Wake flow patterns generated by the swimming rod and bar included clearly visible lateral jets, but not the caudolaterally directed flows seen in the wakes from freely swimming hagfish.