The use of graft materials in vaginal pelvic floor surgery

ObjectiveTo review recent literature on graft materials used in vaginal pelvic floor surgery.MethodsA Pubmed‐search (“anterior vaginal wall” or “cystocele”), (“posterior vaginal wall” or “rectocele”) and (“vaginal vault” or “pelvic prolapse”) and (“mesh” or “erosion” or “graft” or “synthetic”) from 1995 to 2005 was performed; recent reviews [Birch C. The use of prosthetics in pelvic reconstructive surgery. Best Pract Res Clin Obstet Gynaecol 2005;19:979–91 [1]; Maher C, Baessler K. Surgical management of anterior vaginal wall prolapse: an evidence‐based literature review. Int Urogynecol J Pelvic Floor Dysfunct 2005 (May 25) [Electronic Publication] [2]; Maher C, Baessler K. Surgical management of posterior vaginal wall prolapse: an evidence‐based literature review. Int Urogynecol J Pelvic Floor Dysfunct 2006;17:84–8 [3]; Altman D, Mellgren A, Zetterstrom J. Rectocele repair using biomaterial augmentation: current documentation and clinical experience. Obstet Gynecol Surv 2005;60:753–60 [4]] were added.ResultThere are few prospective randomized trials that prove the benefit of implanting grafts in vaginal pelvic floor surgery. Many articles are retrospective case series with small sample sizes or incomplete outcome variables. Serious complications such as erosions are often not mentioned. Inconsistent or unclear criteria for anatomic cure make it difficult to compare outcomes. Quality of life issues such as dyspareunia, urinary or bowel symptoms are often ignored.ConclusionDue to a lack of well‐designed prospective randomized trials, recommendations for using graft materials in vaginal reconstructive surgery cannot be made. At this time, grafts should have limited use in a carefully selected patient population.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/135429/1/ijgo279.pd

Commuting Quantum Circuits with Few Outputs are Unlikely to be Classically Simulatable

We study the classical simulatability of commuting quantum circuits with n input qubits and O(log n) output qubits, where a quantum circuit is classically simulatable if its output probability distribution can be sampled up to an exponentially small additive error in classical polynomial time. First, we show that there exists a commuting quantum circuit that is not classically simulatable unless the polynomial hierarchy collapses to the third level. This is the first formal evidence that a commuting quantum circuit is not classically simulatable even when the number of output qubits is exponentially small. Then, we consider a generalized version of the circuit and clarify the condition under which it is classically simulatable. Lastly, we apply the argument for the above evidence to Clifford circuits in a similar setting and provide evidence that such a circuit augmented by a depth-1 non-Clifford layer is not classically simulatable. These results reveal subtle differences between quantum and classical computation.Comment: 19 pages, 6 figures; v2: Theorems 1 and 3 improved, proofs modifie

On variations in the fine-structure constant and stellar pollution of quasar absorption systems

At redshifts z_abs < 2, quasar absorption-line constraints on space-time variations in the fine-structure constant, alpha, rely on the comparison of MgII and FeII transition wavelengths. One potentially important uncertainty is the relative abundance of Mg isotopes in the absorbers which, if different from solar, can cause spurious shifts in the measured wavelengths and, therefore, alpha. Here we explore chemical evolution models with enhanced populations of intermediate-mass (IM) stars which, in their asymptotic giant branch (AGB) phase, are thought to be the dominant factories for heavy Mg isotopes at the low metallicities typical of quasar absorption systems. By design, these models partially explain recent Keck/HIRES evidence for a smaller alpha in z_abs < 2 absorption clouds than on Earth. However, such models also over-produce N, violating observed abundance trends in high-z_abs damped Lyman-alpha systems (DLAs). Our results do not support the recent claim of Ashenfelter, Mathews & Olive (2004b) that similar models of IM-enhanced initial mass functions (IMFs) may simultaneously explain the HIRES varying-alpha data and DLA N abundances. We explore the effect of the IM-enhanced model on Si, Al and P abundances, finding it to be much-less pronounced than for N. We also show that the 13C/12C ratio, as measured in absorption systems, could constitute a future diagnostic of non-standard models of the high-redshift IMF.Comment: Accepted by MNRAS. 13 pages, 14 ps figure

Using Social Media to Generate and Collect Primary Data: The #ShowsWorkplaceCompassion Twitter Research Campaign

BACKGROUND: Compassion is a core value embedded in the concept of quality in healthcare. The need for compassion toward healthcare staff in the workplace, for their own health and well-being and also to enable staff to deliver compassionate care for patients, is increasingly understood. However, we do not currently know how healthcare staff understand and characterize compassion toward themselves as opposed to patients. OBJECTIVE: The aim of this study was to use social media for the generation and collection of primary data to gain understanding of the concept of workplace compassion. METHODS: Tweets that contained the hashtag #ShowsWorkplaceCompassion were collected from Twitter and analyzed. The study took place between April 21 and May 21, 2016. Participants were self-selecting users of the social media service Twitter. The study was promoted by a number of routes: the National Health Service (NHS) England website, the personal Twitter accounts of the research team, internal NHS England communications, and via social media sharing. Participants were asked to contribute their views about what activities, actions, policies, philosophies or approaches demonstrate workplace compassion in healthcare using the hashtag #ShowsWorkplaceCompassion. All tweets including the research hashtag #ShowsWorkplaceCompassion were extracted from Twitter and studied using content analysis. Data concerning the frequency, nature, origin, and location of Web-based engagement with the research campaign were collected using Bitly (Bitly, Inc, USA) and Symplur (Symplur LLC, USA) software. RESULTS: A total of 260 tweets were analyzed. Of the 251 statements within the tweets that were coded, 37.8% (95/251) of the statements concerned Leadership and Management aspects of workplace compassion, 29.5% (74/251) were grouped under the theme related to Values and Culture, 17.5% (44/251) of the statements related to Personalized Policies and Procedures that support workplace compassion, and 15.2% (38/251) of the statements concerned Activities and Actions that show workplace compassion. Content analysis showed that small acts of kindness, an embedded organizational culture of caring for one another, and recognition of the emotional and physical impact of healthcare work were the most frequently mentioned characteristics of workplace compassion in healthcare. CONCLUSIONS: This study presents a new and innovative research approach using Twitter. Although previous research has analyzed the nature and pattern of tweets retrospectively, this study used Twitter to both recruit participants and collect primary data

Computer model for the cardiovascular system: development of an e-learning tool for teaching of medical students

BACKGROUND: This study combined themes in cardiovascular modelling, clinical cardiology and e-learning to create an on-line environment that would assist undergraduate medical students in understanding key physiological and pathophysiological processes in the cardiovascular system. METHODS: An interactive on-line environment was developed incorporating a lumped-parameter mathematical model of the human cardiovascular system. The model outputs were used to characterise the progression of key disease processes and allowed students to classify disease severity with the aim of improving their understanding of abnormal physiology in a clinical context. Access to the on-line environment was offered to students at all stages of undergraduate training as an adjunct to routine lectures and tutorials in cardiac pathophysiology. Student feedback was collected on this novel on-line material in the course of routine audits of teaching delivery. RESULTS: Medical students, irrespective of their stage of undergraduate training, reported that they found the models and the environment interesting and a positive experience. After exposure to the environment, there was a statistically significant improvement in student performance on a series of 6 questions based on cardiovascular medicine, with a 33% and 22% increase in the number of questions answered correctly, p < 0.0001 and p < 0.001 respectively. CONCLUSIONS: Considerable improvement was found in students' knowledge and understanding during assessment after exposure to the e-learning environment. Opportunities exist for development of similar environments in other fields of medicine, refinement of the existing environment and further engagement with student cohorts. This work combines some exciting and developing fields in medical education, but routine adoption of these types of tool will be possible only with the engagement of all stake-holders, from educationalists, clinicians, modellers to, most importantly, medical students

Algorithms for computing parsimonious evolutionary scenarios for genome evolution, the last universal common ancestor and dominance of horizontal gene transfer in the evolution of prokaryotes

BACKGROUND: Comparative analysis of sequenced genomes reveals numerous instances of apparent horizontal gene transfer (HGT), at least in prokaryotes, and indicates that lineage-specific gene loss might have been even more common in evolution. This complicates the notion of a species tree, which needs to be re-interpreted as a prevailing evolutionary trend, rather than the full depiction of evolution, and makes reconstruction of ancestral genomes a non-trivial task. RESULTS: We addressed the problem of constructing parsimonious scenarios for individual sets of orthologous genes given a species tree. The orthologous sets were taken from the database of Clusters of Orthologous Groups of proteins (COGs). We show that the phyletic patterns (patterns of presence-absence in completely sequenced genomes) of almost 90% of the COGs are inconsistent with the hypothetical species tree. Algorithms were developed to reconcile the phyletic patterns with the species tree by postulating gene loss, COG emergence and HGT (the latter two classes of events were collectively treated as gene gains). We prove that each of these algorithms produces a parsimonious evolutionary scenario, which can be represented as mapping of loss and gain events on the species tree. The distribution of the evolutionary events among the tree nodes substantially depends on the underlying assumptions of the reconciliation algorithm, e.g. whether or not independent gene gains (gain after loss after gain) are permitted. Biological considerations suggest that, on average, gene loss might be a more likely event than gene gain. Therefore different gain penalties were used and the resulting series of reconstructed gene sets for the last universal common ancestor (LUCA) of the extant life forms were analysed. The number of genes in the reconstructed LUCA gene sets grows as the gain penalty increases. However, qualitative examination of the LUCA versions reconstructed with different gain penalties indicates that, even with a gain penalty of 1 (equal weights assigned to a gain and a loss), the set of 572 genes assigned to LUCA might be nearly sufficient to sustain a functioning organism. Under this gain penalty value, the numbers of horizontal gene transfer and gene loss events are nearly identical. This result holds true for two alternative topologies of the species tree and even under random shuffling of the tree. Therefore, the results seem to be compatible with approximately equal likelihoods of HGT and gene loss in the evolution of prokaryotes. CONCLUSIONS: The notion that gene loss and HGT are major aspects of prokaryotic evolution was supported by quantitative analysis of the mapping of the phyletic patterns of COGs onto a hypothetical species tree. Algorithms were developed for constructing parsimonious evolutionary scenarios, which include gene loss and gain events, for orthologous gene sets, given a species tree. This analysis shows, contrary to expectations, that the number of predicted HGT events that occurred during the evolution of prokaryotes might be approximately the same as the number of gene losses. The approach to the reconstruction of evolutionary scenarios employed here is conservative with regard to the detection of HGT because only patterns of gene presence-absence in sequenced genomes are taken into account. In reality, horizontal transfer might have contributed to the evolution of many other genes also, which makes it a dominant force in prokaryotic evolution

A relational quantum computer using only two-qubit total spin measurement and an initial supply of highly mixed single qubit states

We prove that universal quantum computation is possible using only (i) the physically natural measurement on two qubits which distinguishes the singlet from the triplet subspace, and (ii) qubits prepared in almost any three different (potentially highly mixed) states. In some sense this measurement is a `more universal' dynamical element than a universal 2-qubit unitary gate, since the latter must be supplemented by measurement. Because of the rotational invariance of the measurement used, our scheme is robust to collective decoherence in a manner very different to previous proposals - in effect it is only ever sensitive to the relational properties of the qubits.Comment: TR apologises for yet again finding a coauthor with a ridiculous middle name [12

Abundance Anomalies in NGC6752 - Do AGB Stars Have a Role?

We are in the process of testing a popular theory that the observed abundance anomalies in the Globular Cluster NGC 6752 are due to `internal pollution' from intermediate mass asymptotic giant branch stars. To this end we are using a chemical evolution model incorporating custom-made stellar evolution yields calculated using a detailed stellar evolution code. By tracing the chemical evolution of the intracluster gas, which is polluted by two generations of stars, we are able to test the internal pollution scenario in which the Na- and Al-enhanced ejecta from intermediate mass stars is either accreted onto the surfaces of other stars, or goes toward forming new stars. In this paper we focus mainly on the nucleosynthetic yields of the AGB stars and discuss whether these stars are the source of the observed Na-O anticorrelation. Comparing our preliminary results with observational data suggests that the qualitative theory is not supported by this quantitative study.Comment: To be published in: Nuclear Physics, Section A. 4 pages, 2 figures. Conference: "The Eighth International Symposium on Nuclei in the Cosmos", Canada, July 200