Documentation of specific mesh implant at the time of midurethral sling surgery in women with stress incontinence

Objective: We aimed to assess documentation completeness of the operative record for mesh implanted at the time of midurethral sling surgery and to identify modifiable predictors of documentation completeness. Methods: A retrospective cross-sectional study of women with stress incontinence who underwent midurethral sling placement between January 2009 and December 2011 was conducted. Data from the dictated operative note and nursing operative record were extracted to determine if the specific mesh implanted during surgery was documented. The primary outcome was the rate of documentation of mesh implanted in the physician's dictated operative note and in the nursing record. Logistic regression was used to determine if any characteristics were associated with the rate of documentation while accounting for correlation of patients from the same dictating surgeon. Results: There were 816 surgeries involving the implantation of a midurethral sling during the study period. All surgeries were performed at 6 Indiana University hospitals. Fifty-two surgeons of varying specialties and levels of training dictated the operative notes. A urogynecologist dictated 71% of the operative notes. The rate of documentation completeness for mesh implanted in the physician's note was 10%. The rate of documentation completeness for mesh implanted in the nursing operative record was 92%. Documentation of mesh implanted in the physician's note was not significantly associated with the level of training, specialty, or year of surgery. Conclusions: Documentation completeness for specific mesh implant in the physician's note is low, independent of specialty and level of training. Nursing documentation practices are more rigorous. Postmarket surveillance, currently mandated by the Food and Drug Administration, may not be feasible if only the physician's note is available or if nursing practices are inconsistent. Development of documentation guidelines for physicians would improve the feasibility of surveillance

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

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

Multiple-University Extension Program Addresses Postdisaster Oil Spill Needs Through Private Funding Partnership

In response to the Deepwater Horizon Oil Spill, the Gulf of Mexico Research Initiative (GoMRI) was formed to answer oil spill–related scientific questions. However, peer-reviewed scientific discoveries were not reaching people whose livelihoods depended on a healthy Gulf of Mexico. GoMRI and the four Gulf of Mexico Sea Grant programs partnered to develop a regional Extension program with a team of multidisciplinary specialists and a regional manager embedded within the Sea Grant programs. The team answered oil spill science questions from target audiences. The program leaders also identified the value of adding a regional Extension communicator to enhance their Extension products

Fin-Tail Coordination during Escape and Predatory Behavior in Larval Zebrafish

Larval zebrafish innately perform a suite of behaviors that are tightly linked to their evolutionary past, notably escape from threatening stimuli and pursuit and capture of prey. These behaviors have been carefully examined in the past, but mostly with regard to the movements of the trunk and tail of the larvae. Here, we employ kinematics analyses to describe the movements of the pectoral fins during escape and predatory behavior. In accord with previous studies, we find roles for the pectoral fins in slow swimming and immediately after striking prey. We find novel roles for the pectoral fins in long-latency, but not in short-latency C-bends. We also observe fin movements that occur during orienting J-turns and S-starts that drive high-velocity predatory strikes. Finally, we find that the use of pectoral fins following a predatory strike is scaled to the velocity of the strike, supporting a role for the fins in braking. The implications of these results for central control of coordinated movements are discussed, and we hope that these results will provide baselines for future analyses of cross-body coordination using mutants, morphants, and transgenic approaches

Psychosocial factors that influence men's help-seeking for cancer symptoms: A systematic synthesis of mixed methods research

Objective Effectiveness of cancer control partly depends upon early identification and treatment. Men appear to be more likely to delay help-seeking for symptoms, resulting in later diagnosis. This review aims to provide a mixed research synthesis of the psychosocial barriers to and facilitators of help-seeking for cancer symptoms among men. Methods Systematic methods were followed, including a predefined research question and search strategy. Searches retrieved 7131 international records from online databases: MEDLINE (n = 3011), PubMed (n = 471), SCOPUS (n = 896), Informit (n = 131), PsychINFO (n = 347), and Web of Science (n = 2275). Forty studies were eligible for inclusion in the review (25 qualitative studies, 11 quantitative studies, and 4 mixed-method studies). Results There was strong observational evidence for several psychosocial barriers to men's help-seeking behaviour: low cancer knowledge and inaccurate symptom interpretation, embarrassment and fear, and conformity to masculine gender role norms. The strongest facilitating factor associated with men's help-seeking behaviour was encouragement and support of spouses and family members. The majority of research was qualitative and used small samples, making generalisations to the wider population difficult. Conclusions Men's help-seeking for cancer symptoms is influenced by several psychosocial factors, which, in part, may be gender-specific. Health promotion initiatives to improve help-seeking behaviour among men should aim to increase cancer knowledge, reduce embarrassment and fear, address social norms deterring timely help-seeking, and acknowledge informal help-seeking with spouses and family members. Increasing the theoretical grounding of research could aid cohesion across the research area and the design of effective health promotion interventions

Neuronal diversity of the amygdala and the bed nucleus of the stria terminalis

The amygdala complex is a diverse group of more than 13 nuclei, segregated in five major groups: the basolateral (BLA), central (CeA), medial (MeA), cortical (CoA), and basomedial (BMA) amygdala nuclei. These nuclei can be distinguished depending on their cytoarchitectonic properties, connectivity, genetic, and molecular identity, and most importantly, on their functional role in animal behavior. The extended amygdala includes the CeA and the bed nucleus of the stria terminalis (BNST). Both CeA and the BNST share similar cellular organization, including common neuron types, reciprocal connectivity, and many overlapping downstream targets. In this section, we describe the advances of our knowledge on neuronal diversity in the amygdala complex and the BNST, based on recent functional studies, performed at genetic, molecular, physiological, and anatomical levels in rodent models, especially rats and mice. Molecular and connection property can be used separately, or in combinations, to define neuronal populations, leading to a multiplexed neuronal diversity-supporting different functional roles. © 2020 Elsevier B.V

Ecosystem impacts of tamarisk (Tamarix spp.) management in the Arkansas River watershed, Colorado: effects of disturbance and herbicide residues on passive plant community restoration

2013 Spring.Includes bibliographical references.Tamarisk (Tamarix L.) is now one of the most common species of woody plants along waterways in arid and semi-arid areas of the western United States. Tamarisk was intentionally introduced over a century ago for ornamental purposes and erosion control projects, but its expansion since has been influenced by altered hydrologic regimes and global climate change. Approximately sixty years ago the species started to be perceived by federal scientists as noxious and was targeted for control. As the first chapter in this dissertation outlines, management of tamarisk has occurred by many methods, but primarily combinations of herbicides and mechanical tree removal. Successive chapters detail laboratory, greenhouse and field experiments that determined the ecological impacts of currently used tamarisk control strategies, with a particular emphasis on the effects of herbicide residues on plant community restoration patterns following management. First, an in vitro study and high-performance liquid chromatography (HPLC) analysis were used to quantify soil degradation rates for imazapyr and triclopyr from six sites in Colorado. A dose response study was then conducted at two of these sites to determine the relative sensitivity of important restoration plant species to the two herbicides. Exponential decay models estimated imazapyr half-lives (t50) for two soils at 51 and 76 days, and triclopyr half-lives (t50) for all soils averaged 7 days. Glycyrrhiza lepidota was the only species to demonstrate sensitivity to triclopyr. Atriplex canescens, Elymus canadensis and Sporobolus airoides were the most sensitive to typical imazapyr residues. Fecundity in S. airoides and Bouteloua curtipendula were also negatively impacted by the highest rate of both triclopyr (3.92 kg ai ha-1) and imazapyr (0.28 kg ai ha-1). Microbially-mediated degradation of triclopyr was estimated to occur 6.5 times more rapidly than imazapyr. Second, at three field sites in southeastern Colorado a study was conducted that used three dimensional artificial trees and repeated soil sampling to determine whether tamarisk tree canopies retained aerially-applied imazapyr, and if this retention affected soil residues and degradation. Tamarisk mortality was also quantified using repeated stand and individual tree measurements. The average tree canopy captured 75% of aerially-released imazapyr, resulting in significantly lower soil residues beneath the tree canopy. Although initial imazapyr soil residue levels outside the tree canopy were almost four time greater than those inside, soil degradation occurred more than twice as rapidly in outside soils and resulted in lower residue levels. Helicopter imazapyr applications resulted in 98% tamarisk mortality within two years, but the consistency of treatment effectiveness was reduced by non-linear stand boundaries and tall site obstructions. The same factors also increased variability in the actual quantity of herbicide applied to sites, increasing the probability of substantial non-target ecosystem impacts. Last, field plots were established at four sites in southeastern Colorado where tamarisk stands were treated with either an aerial imazapyr application or mechanical biomass removal followed by secondary herbicide (imazapyr and triclopyr) or biological control treatments. In the fourth chapter a study conducted at these sites is detailed in which the tamarisk control and cost effectiveness of the different treatments was quantified over a three year period. Whole plant extraction caused 20% higher tamarisk mortality than aerial imazapyr applications or biomass mulching. Of the secondary treatments evaluated, individual plant treatments (IPTs) of imazapyr caused higher mortality than either triclopyr IPTs or releases of tamarisk leaf beetles (Diorhabda carinulata). Aerial imazapyr applications alone were very cost effective, but when the subsequent removal of tree biomass was accounted for, this strategy was less cost effective than primary mechanical treatments followed by biological control releases. In the final chapter a second study carried out at the same sites is described in which the validity of ecologically based integrated pest management (EBIPM) models for tamarisk management are tested by measuring plant community and ecosystem responses to the different tamarisk control strategies. Plant community dynamics in response to the adjacent treatments were evaluated over three years. Helicopter imazapyr applications severely reduced plant community richness, diversity and abundance and appeared to facilitate invasion by resistant populations of Bassia scoparia. Plant communities did not show a strong response to integrated tamarisk management, which in itself was notable because mechanical tree removal caused soil disturbances that in theory would have promoted secondary invasions of existing ruderal species. Ultimately data suggested that plant community re-vegetation patterns following tamarisk removal were more strongly affected by drought and longer term shifts towards community assemblages dominated by upland plant species. These results provide evidence for the need to integrate state and transition models of ecosystem structure and function into the EBIPM framework in order for this tool to be valuable in managing tamarisk and other woody invaders