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

Mid-Infrared Photometry and Spectra of Three High Mass Protostellar Candidates at IRAS 18151-1208 and IRAS 20343+4129

We present arcsecond-scale mid-ir photometry (in the 10.5 micron N band and at 24.8 microns), and low resolution spectra in the N band (R~100) of a candidate high mass protostellar object (HMPO) in IRAS 18151-1208 and of two HMPO candidates in IRAS 20343+4129, IRS 1 and IRS 3. In addition we present high resolution mid-ir spectra (R~80000) of the two HMPO candidates in IRAS 20343+4129. These data are fitted with simple models to estimate the masses of gas and dust associated with the mid-ir emitting clumps, the column densities of overlying absorbing dust and gas, the luminosities of the HMPO candidates, and the likely spectral type of the HMPO candidate for which [Ne II] 12.8 micron emission was detected (IRAS 20343+4129 IRS 3). We suggest that IRAS 18151-1208 is a pre-ultracompact HII region HMPO, IRAS 20343+4129 IRS 1 is an embedded young stellar object with the luminosity of a B3 star, and IRAS 20343+4129 IRS 3 is a B2 ZAMS star that has formed an ultracompact HII region and disrupted its natal envelope.Comment: 40 pages, 8 figures, 3 tables. Accepted for publication in Astrophysical Journal (Part 1

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

P-Element Homing Is Facilitated by engrailed Polycomb-Group Response Elements in Drosophila melanogaster

P-element vectors are commonly used to make transgenic Drosophila and generally insert in the genome in a nonselective manner. However, when specific fragments of regulatory DNA from a few Drosophila genes are incorporated into P-transposons, they cause the vectors to be inserted near the gene from which the DNA fragment was derived. This is called P-element homing. We mapped the minimal DNA fragment that could mediate homing to the engrailed/invected region of the genome. A 1.6 kb fragment of engrailed regulatory DNA that contains two Polycomb-group response elements (PREs) was sufficient for homing. We made flies that contain a 1.5kb deletion of engrailed DNA (enΔ1.5) in situ, including the PREs and the majority of the fragment that mediates homing. Remarkably, homing still occurs onto the enΔ1. 5 chromosome. In addition to homing to en, P[en] inserts near Polycomb group target genes at an increased frequency compared to P[EPgy2], a vector used to generate 18,214 insertions for the Drosophila gene disruption project. We suggest that homing is mediated by interactions between multiple proteins bound to the homing fragment and proteins bound to multiple areas of the engrailed/invected chromatin domain. Chromatin structure may also play a role in homing

Dust Emission from Evolved and Unevolved HII Regions in the Large Magellanic Cloud

We present a study of the dust properties of 12 classical and superbubble HII regions in the Large Magellanic Cloud. We use infrared photometry from Spitzer (8, 24, 70, and 160 \mum bands), obtained as part of the Surveying the Agents of a Galaxy's Evolution (SAGE) program, along with archival spectroscopic classifications of the ionizing stars to examine the role of stellar sources on dust heating and processing. Our infrared observations show surprisingly little correlation between the emission properties of the dust and the effective temperatures or bolometric magnitudes of stars in the HII regions, suggesting that the HII region evolutionary timescale is not on the order of the dust processing timescale. We find that the infrared emission of superbubbles and classical HII regions shows little differentiation between the two classes, despite the significant differences in age and morphology. We do detect a correlation of the 24 \mum emission from hot dust with the ratio of 70 to 160 \mum flux. This correlation can be modeled as a trend in the temperature of a minority hot dust component, while a majority of the dust remains significantly cooler.Comment: 15 pages, 5 figures. Accepted to Ap

Keck-I MOSFIRE spectroscopy of compact star-forming galaxies at z≳\gtrsim2: High velocity dispersions in progenitors of compact quiescent galaxies

We present Keck-I MOSFIRE near-infrared spectroscopy for a sample of 13 compact star-forming galaxies (SFGs) at redshift $2\leq z \leq2.5$ with star formation rates of SFR$\sim$100M$_{\odot}$ y$^{-1}$ and masses of log(M/M$_{\odot}$)$\sim10.8$. Their high integrated gas velocity dispersions of $\sigma_{\rm{int}}$=230$^{+40}_{-30}$ km s$^{-1}$, as measured from emission lines of H$_{\alpha}$ and [OIII], and the resultant M$_{\star}-\sigma_{\rm{int}}$ relation and M$_{\star}$$-$M$_{\rm{dyn}}$ all match well to those of compact quiescent galaxies at $z\sim2$, as measured from stellar absorption lines. Since log(M$_{\star}$/M$_{\rm{dyn}}$)$=-0.06\pm0.2$ dex, these compact SFGs appear to be dynamically relaxed and more evolved, i.e., more depleted in gas and dark matter ($<$13$^{+17}_{-13}$\%) than their non-compact SFG counterparts at the same epoch. Without infusion of external gas, depletion timescales are short, less than $\sim$300 Myr. This discovery adds another link to our new dynamical chain of evidence that compact SFGs at $z\gtrsim2$ are already losing gas to become the immediate progenitors of compact quiescent galaxies by $z\sim2$.Comment: 12 pages, 7 figures, submitted to Ap

Comet 162P/Siding Spring: A Surprisingly Large Nucleus

We present an analysis of thermal emission from comet 162P/Siding Spring (P/2004 TU12) measured during its discovery apparition in 2004 December. The comet showed no dust coma at this time, so we have sampled emission from the comet's nucleus. Observations using the Mid-Infrared Spectrometer and Imager (MIRSI) were performed at NASA's Infrared Telescope Facility, where the peak of the comet's spectral energy distribution was observed between 8 and 25 microns. In combination with the three near-IR spectra presented by Campins et al. (2006, Astron. J. 132, 1346) that show the Wien-law tail of the thermal emission, the data provide powerful constraints on surface properties of the nucleus. We find that the nucleus's effective radius is 6.0+/-0.8 km. This is one of the largest radii known among Jupiter-family comets, which is unusual considering that the comet was discovered only recently. Its geometric albedo is 0.059+/-0.023 in the H band, 0.037+/-0.014 in the R band, and 0.034+/-0.013 in the V band. We also find that the nucleus of 162P has little IR beaming, and this implies that the nucleus has low thermal inertia. Including all near-IR spectra yields a beaming parameter of 1.01+/-0.20. This result is in agreement with others showing that cometary nuclei have low thermal inertia and little IR beaming. If confirmed for many nuclei, the interpretation of radiometry may not be as problematic as feared.Comment: 17 pages, 4 figures, appearing in The Astronomical Journal, September 2006 issu

A contemporaneous infrared flash from a long gamma-ray burst: an echo from the central engine

The explosion that results in a cosmic gamma-ray burst (GRB) is thought to produce emission from two physical processes -- the activity of the central engine gives rise to the high-energy emission of the burst through internal shocking and the subsequent interaction of the flow with the external environment produces long-wavelength afterglow. While afterglow observations continue to refine our understanding of GRB progenitors and relativistic shocks, gamma-ray observations alone have not yielded a clear picture of the origin of the prompt emission nor details of the central engine. Only one concurrent visible-light transient has been found and was associated with emission from an external shock. Here we report the discovery of infrared (IR) emission contemporaneous with a GRB, beginning 7.2 minutes after the onset of GRB 041219a. Our robotic telescope acquired 21 images during the active phase of the burst, yielding the earliest multi-colour observations of any long-wavelength emission associated with a GRB. Analysis of an initial IR pulse suggests an origin consistent with internal shocks. This opens a new possibility to study the central engine of GRBs with ground-based observations at long wavelengths.Comment: Accepted to Nature on March 1, 2005. 9 pages, 4 figures, nature12.cls and nature1.cls files included. This paper is under press embargo until print publicatio