Obliterative surgery for the treatment of pelvic organ prolapse: A patient survey on reasons for surgery selection and post-operative decision regret and satisfaction

Objectives: To identify patient-reported reasons for selecting obliterative surgery for the purpose of predicting decision regret and satisfaction. Methods: We created a deidentified database of patients who underwent an obliterative procedure for prolapse from 2006 to 2013. Patients were excluded if they declined study participation, were deceased, or had dementia. Participants completed a survey regarding reasons for selecting obliterative surgery and a modified version of validated questionnaires on decision regret (Decision Regret Scale-Pelvic Floor Disorder) and satisfaction (Satisfaction with Decision Scale-Pelvic Floor Disorder). Parsimonious multivariate linear regression models were constructed to determine if any of the reasons given for choosing obliterative surgery were independent predictors of decision regret and satisfaction after controlling for significant sociodemographic, clinical, and surgical outcome data identified by bivariate analysis. Results: Seventy-seven women completed the surveys. "To follow my doctor's recommendations" and "no longer sexually active," and/or "did not plan to be" as reasons for selecting obliterative surgery made the most difference; however, these reasons were not identified as independent predictors of decision regret or satisfaction after controlling for confounders. The regret linear regression models identified preoperative sexual activity rather than the patient-reported reason "no longer sexually active and/or did not plan to be," as the only independent predictor of more decision regret after obliterative surgery (B coefficient 1.68, P < 0.01). The satisfaction linear regression models identified reoperation for any reason as an independent predictor of lower satisfaction ([beta], -0.24; P = 0.04) and the patient-reported reason for choosing obliterative surgery "not interested in pessary" as a predictor of higher satisfaction ([beta], 0.30, P = 0.01). Conclusions: This study advances our knowledge about the obliterative surgical decision making process. Behavioral and educational interventions directed at improving patient and physician communications concerning the dynamics of sexual health issues in an aging population will likely decrease regret when obliterative surgery is chosen. Minimizing reoperation after obliterative surgery through increased experience, knowledge, and improved surgical skills and patient validation when pessary is declined will likely improve satisfaction when obliterative surgery is chosen

Abrasive Weeding as a Vehicle for Precision Fertilizer Management in Organic Vegetable Production

Abrasive weeding is a nonchemical weed control tactic that uses small, gritty materials propelled with compressed air to destroy weed seedlings. Organic fertilizers have been used successfully as abrasive grits to control weeds, but the goal for this study was to explore the effects of fertilizer grit, application rates, and background soil fertility on weeds, plant available nitrogen (N) uptake, and crop yield. Field trials were conducted in organic ‘Carmen’ sweet red pepper (Capsicum annuum) and organic ‘Gypsy’ broccoli (Brassica oleracea var. italica) and treatments included organic fertilizer grit (8N–0.9P–3.3K vs. 3N–3.1P–3.3K), grit application rates (low vs. high), compost amendments (with and without), and weedy and weed-free controls. Weed biomass was harvested at 84 days and 65 days after transplanting for pepper and broccoli, respectively. Simulated total plant available N (nitrate + ammonium) uptake was measured with ion exchange resin stakes between 7 and 49 days after the first of two grit applications. Produce was harvested at maturity, graded for marketability, and weighed. The higher grit application rate, regardless of fertilizer type, reduced the weed biomass by 75% to 89% for pepper and by 86% to 99% for broccoli. By 5 weeks after the first grit application, simulated plant N uptake was greatest following grit application with the 8% N fertilizer, followed by the 3% N fertilizer, and lowest in the weedy control. The high grit application rate of 8% N fertilizer increased pepper yield by 112% compared with the weedy control, but it was similar to that of the weed-free control. Broccoli was less responsive to abrasive grits, with yield changes ranging from no difference to up to a 36% increase (relative to the weedy control) depending on the application rate and compost amendment. This is the first evidence indicating that the nutrient composition of organic fertilizer abrasive grits can influence in-season soil N dynamics, weed competition, and crop yield. The results suggest that abrasive weeding technology could be leveraged to improve the precision of in-season fertilizer management of organic crops

If you could see what we see, would it bother you?

Objective The purpose of our study was to determine whether the anatomic threshold for pelvic organ prolapse (POP) diagnosis and surgical success remains valid when the patient sees what we see on exam. Methods Two hundred participants were assigned, by computer-generated block randomization, to see one of four videos. Each video contained the same six clips representative of various degrees of anterior vaginal wall support. Participants were asked questions immediately after each clip. They were asked: “In your opinion, does this patient have a bulge or something falling out that she can see or feel in the vaginal area?” Similarly, they were asked to give their opinion on surgical outcome on a 4-point Likert scale. Results The proportion of participants who identified the presence of a vaginal bulge increased substantially at the level of early stage 2 prolapse (1 cm above the hymen), with 67 % answering yes to the question regarding bulge. The proportion of participants who felt that surgical outcome was less desirable also increased substantially at early stage 2 prolapse (1 cm above the hymen), with 52 % describing that outcome as “not at all” or “somewhat” successful. Conclusion Early stage 2 POP (1 cm above the hymen) is the anatomic threshold at which women identify both a vaginal bulge and a less desirable surgical outcome when they see what we see on examination

Chandra Observation of the Cluster Environment of a WAT Radio Source in Abell 1446

Wide-angle tail (WAT) radio sources are often found in the centers of galaxy clusters where intracluster medium (ICM) ram pressure may bend the lobes into their characteristic C-shape. We examine the low redshift (z=0.1035) cluster Abell 1446, host to the WAT radio source 1159+583. The cluster exhibits possible evidence for a small-scale cluster-subcluster merger as a cause of the WAT radio source morphology. This evidence includes the presence of temperature and pressure substructure along the line that bisects the WAT as well as a possible wake of stripped interstellar material or a disrupted cool core to the southeast of the host galaxy. A filament to the north may represent cool, infalling gas that's contributing to the WAT bending while spectroscopically determined redshifts of member galaxies may indicate some component of a merger occurring along the line-of-sight. The WAT model of high flow velocity and low lobe density is examined as another scenario for the bending of 1159+583. It has been argued that such a model would allow the ram pressure due to the galaxy's slow motion through the ICM to shape the WAT source. A temperature profile shows that the cluster is isothermal (kT= 4.0 keV) in a series of annuli reaching a radius of 400 kpc. There is no evidence of an ongoing cooling flow. Temperature, abundance, pressure, density, and mass profiles, as well as two-dimensional maps of temperature and pressure are presented.Comment: 40 AASTeX pages including 15 postscript figures; accepted for publication in Ap

The relationship between the Dark Triad and attitudes towards feminism

The Dark Triad traits are considered a male-centric framework of personality with women generally scoring lower on narcissism, Machiavellianism, and psychopathy. Research has examined the drivers behind this relationship attributing effects mostly to biological or evolutionary reasons with less work understanding environmental factors. To date, no research has examined the relationship between the Dark Triad and attitudes towards feminism. Three hundred and forty-three participants completed self-report measures of the Dark Triad and feminist attitudes. Results reported no differences between men and women on feminist attitudes, but men scored higher on the Dark Triad. Multiple linear regression indicated a negative association between the Dark Triad and feminist attitudes with all three traits significantly negatively contributing to the model. In all cases, this effect was stronger in men. These findings suggest that whilst men and women hold similar feminist attitudes, Dark Triad traits may facilitate a disregard for feminism

Clinical and Administrative Steps to the ECMO Program Development

Extra-corporeal membrane oxygenation (ECMO) is a rapidly evolving therapy for acute lung and/or heart failure. ECMO, from a technical standpoint, is conceptually simple—however, it can be very challenging to implement therapy at the individual patient level as well as at hospital (or healthcare system) level. ECMO program development involves engagement of key stake-holders including physicians, nursing, and administrative leadership. The goal of this chapter is to outline some of the crucial steps in developing a successful ECMO program including highlighting the necessary resources, team members and structure, and basic program structure and function

Middle pleistocene glaciation in Patagonia dated by cosmogenic-nuclide measurements on outwash gravels

The well-preserved glacial record in Argentine Patagonia offers a ~ 1 Ma archive of terrestrial climate extremes in southern South America. These glacial deposits remain largely undated beyond the range of radiocarbon dating at ca. 40 ka. Dating old glacial deposits (> several 105 a) by cosmogenic surface exposure methods is problematic because of the uncertainty in moraine degradation and boulder erosion rates. Here, we show that cobbles on outwash terraces can reliably date ‘old’ glacial deposits in the Lago Pueyrredón valley, 47.5° S, Argentina. Favorable environmental conditions (e.g., aridity and strong winds) have enabled continuous surface exposure of cobbles and preservation of outwash terraces. The data demonstrate that nuclide inheritance is negligible and we therefore use the oldest surface cobbles to date the deposit. 10Be concentrations in outwash cobbles reveal a major glacial advance at ca. 260 ka, concurrent with Marine Isotope Stage 8 (MIS 8) and dust peaks in Antarctic ice cores. A 10Be concentration depth-profile in the outwash terrace supports the age and suggests a low terrace erosion rate of ca. 0.5 mm ka− 1. We compare these data to exposure ages obtained from associated moraines and find that surface boulders underestimate the age of the glaciation by ~ 100 ka; thus the oldest boulders in this area do not date closely moraine deposition. The 10Be concentration in moraine cobbles help to constrain moraine degradation rates. These data together with constraints from measured 26Al/10Be ratios suggest that all moraine boulders were likely exhumed after original deposition. We determine the local Last Glacial Maximum (LGM) occurred at ~ 27–25 ka, consistent with the maximum LGM in other parts of Patagonia

Different paths to the modern state in Europe: the interaction between domestic political economy and interstate competition

Theoretical work on state formation and capacity has focused mostly on early modern Europe and on the experience of western European states during this period. While a number of European states monopolized domestic tax collection and achieved gains in state capacity during the early modern era, for others revenues stagnated or even declined, and these variations motivated alternative hypotheses for determinants of fiscal and state capacity. In this study we test the basic hypotheses in the existing literature making use of the large date set we have compiled for all of the leading states across the continent. We find strong empirical support for two prevailing threads in the literature, arguing respectively that interstate wars and changes in economic structure towards an urbanized economy had positive fiscal impact. Regarding the main point of contention in the theoretical literature, whether it was representative or authoritarian political regimes that facilitated the gains in fiscal capacity, we do not find conclusive evidence that one performed better than the other. Instead, the empirical evidence we have gathered lends supports to the hypothesis that when under pressure of war, the fiscal performance of representative regimes was better in the more urbanized-commercial economies and the fiscal performance of authoritarian regimes was better in rural-agrarian economie