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Electromagnetic interference causes considerable performance degradation on wireless communication systems. The performance degradation is largely affected by the characteristics of the interference. Impulse interference commonly occurs in industrial and automotive environments, where many closely located systems and electronic equipment coexist. In this work, we propose two novel algorithms for adaptive demodulation in impulse noise. The proposed methods compute appropriate log-likelihood ratios based on interference classification and estimation of Middleton’s Class A noise model as well as the symmetric $\alpha$ -Stable (S $\alpha$ S) model. The analytical complexity and intractability of the S $\alpha$ S probability density function (PDF) makes real-time applications unfeasible. Therefore, the proposed algorithms are developed using two different techniques for approximating the S $\alpha$ S PDF. The approximations are achieved through interpolation via i) approximate closed-form expressions of the PDF for a specific parameter set and ii) via numerically pre-calculated look-up tables of the PDF for arbitrary parameter choices. The proposed adaptive techniques are shown to provide a performance gain in terms of bit error rate (BER) of up to 20 dB energy per bit to noise power ratio (Eb/N0), in comparison to traditional, non-adaptive, methods for varying levels of impulse interference. The performance loss of approximating the PDF in comparison to exact calculations amount to less than 8 dB Eb/N0, which is small in relation to the performance gain achieved in comparison to traditional methods. However, the complexity in terms of simulation execution time of the proposed approximate algorithms is reduced by up to a factor 250, compared to methods based on exact computation. The algorithms are validated using regular low density parity check (LDPC) codes, in addition to quasi-cyclic (QC)-LDPC and turbo codes. The proposed adaptive demodulation techniques can be used to improve decoding and demodulation performance in many real-life situations where non-Gaussian interference commonly occurs. [ABSTRACT FROM AUTHOR]

Background. Angioedema (AE) is a common condition which can be complicated by laryngeal edema, having up to 40% mortality. Although sporadic case reports attest to the benefits of fresh frozen plasma (FFP) in treating severe acute bouts of AE, little evidence-based support for this practice is available at present. Study Objectives. To compare the frequency, duration of intubation, and length of intensive care unit (ICU) stay in patients with acute airway AE, with and without the use of FFP. Methods. A retrospective cohort study was conducted, investigating adults admitted to large community hospital ICU with a diagnosis of AE during the years of 2007–2012. Altogether, 128 charts were reviewed for demographics, comorbidities, hospital courses, and outcomes. A total of 20 patients received FFP (108 did not). Results. Demographics and comorbidities did not differ by treatment group. However, nontreated controls did worse in terms of intubation frequency (60% versus 35%; p=0.05) and ICU stay (3.5 days versus 1.5 days; p<0.001). Group outcomes were otherwise similar. Conclusion. In an emergency department setting, the use of FFP should be considered in managing acute airway nonhereditary AE (refractory to steroid, antihistamine, and epinephrine). Larger prospective, better controlled studies are needed to devise appropriate treatment guidelines. [ABSTRACT FROM AUTHOR]

Background: Celiac disease (CD) and eosinophilic esophagitis (EoE) are distinct diseases of the gastrointestinal tract with specific clinico-pathological characteristics. Recent studies have found higher rates of EoE in patients with CD than in the general population. Our aim was to estimate the incidence of EoE among children who were diagnosed with CD over a 42-month period. Methods: The study included patients diagnosed with CD based on endoscopy and histopathological findings between January 2010 and June 2013. Histopathology reports of esophageal biopsies were reviewed to identify all cases of EoE. The patients' presenting symptoms, laboratory evaluations, endoscopic and histopathological findings, treatments, and follow-ups were analysed. Results: Fifty-six patients with CD were identified, of whom six (10.7%) were diagnosed with both CD and EoE. Four of these patients presented with abdominal pain and diarrhea, two presented with failure to thrive, and three presented with food allergies. Endoscopic and histopathological changes typical of EoE were observed in all six patients. During follow-up, two patients showed significant improvement with the gluten-free diet and a proton-pump inhibitor (PPI). Two patients improved with the elimination diet and two patients were treated with topical corticosteroid therapy. Endoscopic appearance was normal in all children on follow-up endoscopy after treatment. Biopsy samples also showed resolution of the histologic features of EoE in all of the children. Conclusion: The incidence of EoE in our cohort of children with CD was 10.7%, which is higher than what has been reported for the general population. In all children undergoing upper gastrointestinal endoscopy for suspected CD, coexistence of EoE should be considered. [ABSTRACT FROM AUTHOR]

Background: Celiac disease (CD) and eosinophilic esophagitis (EoE) are distinct diseases of the gastrointestinal tract with specific clinico-pathological characteristics. Recent studies have found higher rates of EoE in patients with CD than in the general population. Our aim was to estimate the incidence of EoE among children who were diagnosed with CD over a 42-month period. Methods: The study included patients diagnosed with CD based on endoscopy and histopathological findings between January 2010 and June 2013. Histopathology reports of esophageal biopsies were reviewed to identify all cases of EoE. The patients’ presenting symptoms, laboratory evaluations, endoscopic and histopathological findings, treatments, and follow-ups were analysed. Results: Fifty-six patients with CD were identified, of whom six (10.7%) were diagnosed with both CD and EoE. Four of these patients presented with abdominal pain and diarrhea, two presented with failure to thrive, and three presented with food allergies. Endoscopic and histopathological changes typical of EoE were observed in all six patients. During follow-up, two patients showed significant improvement with the gluten-free diet and a proton-pump inhibitor (PPI). Two patients improved with the elimination diet and two patients were treated with topical corticosteroid therapy. Endoscopic appearance was normal in all children on follow-up endoscopy after treatment. Biopsy samples also showed resolution of the histologic features of EoE in all of the children. Conclusion: The incidence of EoE in our cohort of children with CD was 10.7%, which is higher than what has been reported for the general population. In all children undergoing upper gastrointestinal endoscopy for suspected CD, coexistence of EoE should be considered. [ABSTRACT FROM AUTHOR]

BACKGROUND: The ability to critically appraise scholarly journals is an essential skill for surgical residents in their journey to being lifelong learners. Methods to teach evaluation of scholarly articles are scant in the educational literature. METHODS: Residents completed a pre-test on evaluation of surgical literature. Two lectures on methodology and statistics followed. A board-certified surgeon and residents evaluated 7 articles using a scoring form. A post-test followed. Four additional sessions on evaluating surgical articles were held without the rating form. Residents completed a second post-test. RESULTS: Residents showed improved knowledge and skills on evaluating surgical literature on the first and second post-tests when compared with the pretest (P < 0.0005 for both tests). CONCLUSIONS: Surgical residents can be taught to evaluate literature using constructivist Educational theory. There was a significant improvement in knowledge and the skills of literature evaluation, which persisted after the educational aid was removed. [ABSTRACT FROM AUTHOR]

An introduction to this issue of this issue the journal "Quaker Studies" is presented.

A reliable non-destructive evaluation (NDE) approach is required for the inspection of different polyethylene (PE) pipe joints in various material grades and pipe sizes. In February 2010, a European (FP7)-funded project on the development and validation of an automated non-destructive evaluation (NDE) approach for testing welded joints in plastic pipes (TestPEP), involving 13 organisations from seven European countries, was started. Several individual tasks need to be solved before approaching the final solution. The challenging material properties of PE pipes, low speed of sound and high-frequency-dependent attenuation, must be overcome. A flexible scanner with probe and wedge holder incorporated must be adaptable for the variety of pipe joint configurations. Furthermore, a rugged flaw detector instrument will be developed, capable of performing the advanced procedures required for these materials. In this paper, the technical problem, industry needs and the proposed approach to the solution are stated. Initial results show the route for success in the project together with the proposed inspection system and inspection techniques. [ABSTRACT FROM AUTHOR]

In May 1796, Sarah Murray, a 52-year-old widow, left London for a tour of Scotland with the specific aim of writing a guidebook. Presenting herself as competent and capable, Murray used a variety of rhetorical strategies to establish her authority while at the same time retaining her respectability. Not afraid of physically demanding activity, she encouraged her readers to do as she did, persuading them that true “lovers of nature” should be willing to take risks and accept uncomfortable conditions. Much of her advice was aimed directly at women and it is clear that she considered adventurous travel a suitable occupation for upper-class women like herself. This essay discusses Murray's travels and writings within the wider context of eighteenth-century travel writing, focusing on issues of self-representation, women's roles and the destabilizing nature of travel in the late eighteenth century. [ABSTRACT FROM AUTHOR]

In 2003, Grace Jantzen presented the George Richardson Lecture, the annual international lecture in Quaker studies, entitled 'Choose Life! Early Quaker Women and Violence in Modernity', which was published in Quaker Studies. It was part of her ongoing work on the preoccupation of modernity with death and violence. In the lecture she argued that Margaret Fell and most other early Quaker women encouraged a choice of life over a preoccupation with death, while most male Friends (as Quakers are also called) maintained the violent imagery of the Lamb's War, the spiritual warfare that would usher in the kingdom. While both men and women developed what became the Quaker 'peace testimony' (the witness against war and outward violence), the language used by male and female Friends differed in its description of the inward spiritual life and its consequences and mission. Thus. Grace Jantzen argued that these women Friends were choosing a language counter to modernity, while the male apocalyptic was indeed counter-cultural but still within the frame of modernity. In this article, we take Grace Jantzen's basic thesis, that a female 'Choose Life!' imagery may be set against a male 'Lamb's War' metaphor, and apply it to four sets of Quaker data in other geographic and temporal locations, to explore the extent to which the arguments she sets out can usefully illuminate the nature of Quakerism. This four-fold approach highlights the complexity of the history of Quaker discourse, as well as the continually shifting cultural and social contexts in which Quakers necessarily found themselves embedded. It also brings to the fore how useful an analytical tool Grace Jantzen has given us and not only in situations where we come to agree with her conclusions. [ABSTRACT FROM AUTHOR]

Over the past several years, a multitude of factors have converged to make the financing and delivery of personal assistant services (PAS) two of the most critical issues in American disability policy making. This article chronicles the development of assistive services and examines some of the more noteworthy strategies designed to improve PAS policy making. The argument is made that PAS should be a mandatory benefit provided through Medicaid. This approach, although imperfect, holds the greatest potential for improving the PAS delivery system. Incorporating PAS as a Medicaid benefit offers advantages over the current system, including the opportunity for ongoing need and satisfaction assessment among program beneficiaries, the development of a platform for strengthening the personal assistant workforce, and the ability to generate evidenced-based recommendations for improved service outcomes and cost-effectiveness. [ABSTRACT FROM AUTHOR]

Purpose. To compare outcomes for persons who were enrolled in an agency-directed personal assistance services (PAS) programme and then changed to a consumer-directed PAS programme. Method. A convenience sample was used for this longitudinal study. In-home interviews were conducted by a trained data collector from April 2000 to December 2001. Results. Participants reported more satisfaction and safety with personal assistance, and fewer unmet needs after receiving consumer-directed services than after receiving agency-directed services. Other variables related to outcomes included race and ethnicity, employment, functional status, unmet needs, and the level of confidence in obtaining help if assistance is unavailable. Participants (74%) also reported high rates of unmet needs in the past month. Conclusions. Consumer-directed PAS enhances outcomes for many persons with disabilities. Self-reported outcomes are affected by many factors that could be addressed in PAS program development. [ABSTRACT FROM AUTHOR]

Objective: Persons with osteoarthritis and rheumatoid arthritis frequently require access to a broad range of healthcare services. The purpose of the current study was to examine the healthcare access experiences of these two populations. Design: Mail surveys were completed by 409 adults with self-reported osteoarthritis or rheumatoid arthritis who were recruited through a variety of recruitment strategies such as advertisements placed in arthritis publications, internet sources, and physician referrals. Results: Participants self-reported not obtaining needed health care at high rates for several service domains, including mental health services (42%) and rehabilitation therapies (39%). The most frequent reasons for not obtaining services included lack of service coverage by the health plan and high costs. Type of arthritis was predictive of the ability to obtain primary doctor services. Conclusions: The United States healthcare system continues to focus on treating acute disorders and has yet to adapt to the growing prevalence of chronic illness and disability. Changes will be needed in both healthcare financing and delivery structures to promote access to specialized services such as mental health services and rehabilitation therapies for persons with osteoarthritis and rheumatoid arthritis. [ABSTRACT FROM AUTHOR]

Focuses on conditions under which a prisoner in the U.S., who has been convicted and sentenced, can apply for his release using the certificate of appealability. Suggestion that an intermediate approach permitting vacatur of facially invalid certificate of appealability is most consistent with the U.S. Supreme Court precedent; Information on the framework of habeas corpus proceedings and the historical approaches to appealability of habeas decisions; Investigation of the intermediate approaches permitting vacatur under particular circumstances.

The photocatalytic oxidation (PCO) of trace amounts of propane (500 ppm) on nanocrystalline anatase TiO2 has been investigated in situ as a function of temperature (T = 318−473 K), humidity (CH2O = 0−4%), and time by means of mass spectrometry and diffuse reflectance Fourier transform infrared spectroscopy (DRIFT). Propane adsorbs associatively on TiO2 at 318 K in dry air, while at 473 K small amounts of thermal dissociation products appear on the surface. In agreement with previous studies, propane is found primarily to be converted to acetone by reactions with photogenerated oxygen radicals. Various successive reaction paths exist, where the branching depends on the temperature and hydroxylation state of the surface. Under dry conditions at 318 K, acetone oxidation is initially kinetically hindered, while, above 400 K, acetone readily decomposes. The thermally assisted reaction channel leads to detrimental bonding of surface species and inhibition of the catalytic activity. It is manifested by a coloration of the sample and suggested to be coupled to surface reduction. Under humidified conditions, there is an optimum of the PCO in CH2O and T space, which is estimated to correspond to an equilibrium coverage of one monolayer of H2O (or bilayer). The latter reaction condition also corresponds to sustained high propane conversion and is characterized by rapid establishment of steady state rates. The optimum PCO is discussed in terms of a balance between (i) sustaining enough of a photoactive water monolayer to avoid detrimental bonding of surface species, (ii) allowing reactants to adsorb and access bulk TiO2 photoexcitations, and at the same time (iii) maximizing the thermally assisted decomposition of intermediates. [ABSTRACT FROM AUTHOR]

PURPOSE: To compare a consumer-directed personal assistance services (PAS) programme with an agency-directed PAS programme. METHOD: A convenience sample was used for this cross-sectional study with one data collection point. Outcomes were compared for consumer-directed and agency-directed PAS. Hierarchical regressions were also used to determine the predictors of outcomes across PAS programmes. In-home interviews were conducted by a trained data collector from April 2000 to December 2001. RESULTS: Participants in the consumer-directed programme reported more choices over PAS and satisfaction with PAS. Self-reported outcomes were primarily predicted by the following variables: service arrangement, type of provider, importance of directing PAS, health status, number of personal assistants used in past 12 months, sufficient PAS hours received, and social support. CONCLUSIONS: Consumer-directed PAS enhances outcomes for many persons with disabilities. Self-reported outcomes are affected by many factors that could be addressed in PAS programme development. [ABSTRACT FROM AUTHOR]

Personal assistant services (PAS) are designed to support persons with disabilities in their routine performance of activities of daily living (ADLs) and to provide individuals with disability the opportunity to go to school, volunteer, obtain active employment, and participate in social and recreational activities. PAS are primary and essential to the realization of societal inclusion and personal freedom among persons with severe, disabling conditions. This paper reviews the personal assistance literature for persons with spinal cord injury and other disabilities. Evidence-based recommendations are made for PAS policy initiatives and future directions in PAS research. [ABSTRACT FROM AUTHOR]

Discusses the role of infected-cell protein 0 (ICP0) in the strategy of conquest of the host cell by herpes simplex virus 1. Characterization of proteins contained in virions purified from cells; Identification of putative viral proteins accumulating in infected cells; Interaction of ICP0 with cellular proteins.

Herpes simplex virus type 1 (HSV-1) infected cell protein 0 (ICP0) is a multifunctional protein that functions as a promiscuous transactivator and promotes the degradation of multiple cellular proteins. In vitro studies indicated that it encodes two physically separated functional E3 ubiquitin ligase domains. One, designated herpesvirus ubiquitin ligase 1 (HUL-1), maps to a region encoded by exon 3 and is contained between residues 543 and 680. Deletion of amino acids 621 to 625 abolishes this activity. The second, designated HUL-2, maps to the RING finger domain present in ICP0 encoded by exon 2. Earlier studies have shown that ICP0 stabilizes cyclins D1 and D3, and several lines of investigation led to the hypothesis that this function of ICP0 is the consequence of degradation of the E2 enzyme cdc34, known to be involved in the proteasome-dependent degradation of D-type cyclins. Consistent with this hypothesis, we have previously shown that cdc34 physically interacts with ICP0 at or near aspartate 199 and at amino acids 621 to 625 and that the former site is required for effective ubiquitylation and degradation of cdc34. Furthermore, the ICP0 HUL-1 domain promotes the polyubiquitination of cdc34 in vitro. If the mechanism by which D-type cyclins are salvaged in wild-typeinfected cells is dependent on polyubiquitination and consequent destruction of cdc34, than the mutant virus R6701, which was constructed for these studies and lacks ICP0 residues 621 to 625, should destabilize the D cyclins and preclude the degradation of cdc34. We report that ICP0 residues 621 to 625 are essential for degradation of cdc34 in infected cells and for the ICP0-mediated stabilization of D-type cyclins, that a mutation that specifically disrupted the ring finger domain of the HUL-2 site had no effect on the degradation of cdc34 in infected cells, and that deletion of ICP0 residues 621 to 625 decreased the replicative capacity of the virus in growth-arrested but not in dividing cells and resulted in diminished pathogenicity on intracerebral inoculation of mice. We conclude that the ICP0 HUL-1 domain acts in infected cells to degrade cdc34 and that this function requires the interaction of cdc34 with sequences in exons 2 and 3 but does not involve the HUL-2 RING finger E3 domain. [ABSTRACT FROM AUTHOR]

Earlier reports have shown that the d120 mutant of herpes simplex virus 1 lacking both copies of the gene encoding the infected cells protein No. 4 (ICP4) induces apoptosis in a variety of cell lines. The programmed cell death induced by this mutant is blocked by overexpression of Bcl-2 or by transduction of infected cells with the gene encoding the viral US3 protein kinase. HEp-2 cells infected with the d120 mutant express predominantly α proteins. Studies on these proteins revealed the accumulation of a Mr 37,500 protein that reacted with antibody directed against the carboxyl-terminal domain of ICP22. We report that the Mr 37,500 protein is a product of the proteolytic cleavage of ICP22 by a caspase activated by the d120 mutant. Thus the accumulation of the Mr 37,500 protein was blocked in cells transduced with the US3 protein kinase, in cells overexpressing Bcl-2, or in infected cells treated with the general caspase inhibitor zVAD-fmk. Exposure of ICP22 made in wild-type virus-infected cells to caspase 3 yielded two polypeptides, of which one could not be differentiated from the Mr 37,500 protein with respect to electrophoretic mobility. We conclude that the cellular apoptotic response targets at least one viral protein for destruction. [Copyright &y& Elsevier]

Examines the critical determinants for herpes virus Ub ligase-1 (HUL-1) exon 3 (E3) activity. Physiological effects of infected cell protein 0 (ICP0); Sufficiency of ICP0 residues 54-–680 for HUL-1 E3 activity; Information on in vitro ubiquitylation reactions.

Investigates a cell protein infected (ICP) with herpes simplex virus type 1. Recruitment of ubiquitin (Ub) to ubiquitylation pathways; Promotion of Ub-protein ligation; Role of the ICP in the stabilization of cyclin D1.

Explores the interaction of proteasomes with the infected cell protein O (ICPO) of herpes simplex virus 1. Enhancement of gene expression by transactivator ICPO; Interaction of ICPO with ubiquitin-conjugating enzyme; Pathway of ubiquitin-proteasomal degradation; Display of in vitro E3 ubiquitin ligase activity.

Objective: Bladder injury is one of the complications of cesarean section (CS). It is reported that the overall incidence of bladder injury is 0.22-0.44% of CS. It is, however, unclear what factors influence this rate. The aim of this study was to determine if there is a difference in bladder injury rate between scheduled and emergency CS, as well as in primary and repeat CS at a large metropolitan hospital that serves a population at high risk for obstetric complications. In addition, the use of urology consultation following bladder injury and whether demographic factors and labor characteristics affect the rate of bladder injury were investigated. Material and Methods: A total of 8,488 records were reviewed (4,292 primary CS and 4,196 repeat CS) from January 1, 2013 to December 31, 2020. The incidence of bladder injury was calculated and the rate of intraoperative urology/urogynecology consultation was recorded. Then the association between bladder injury and intraoperative urology/urogynecology consultation and between bladder injury and maternal age, body mass index (BMI), and gestational age were compared. Results: There was a significant increase in risk of bladder injury in repeat CS versus primary CS (p=0.01). There was also a significant increase in risk of bladder injury in emergency CS versus scheduled CS (p=0.04). Intraoperative urogynecology/urology consultations were significantly higher in the bladder injury versus no bladder injury groups (p<0.0001). Both emergency CS and repeat CS are predictors of bladder injury with odd ratios of 5.7 and 7.4, respectively. Conclusion: These results add to the existing evidence that bladder injury is a rare complication in CS that may occur more often in women undergoing repeat or emergency CS than primary or scheduled CS. Given that the risk increases with repeat or emergency CS, patients should be made aware of such risks and surgeons should make careful intraoperative considerations with close postoperative follow-ups. [ABSTRACT FROM AUTHOR]

Reports on the incidence of total hip replacements performed in Iceland between 1982 and 1996. Annual rates of total hip replacements due to primary osteoarthrosis; Indication that the incidence of total hip replacements is at least 50 percent higher in Iceland than in Sweden.

Presents information on a study which focused on the Health Care Options Plus (HCO+), a Medicaid-funded program for people with disabilities. Impact of HCO+ on professional psychology and health care delivery models for people with disabilities; Dependence of the efficiency of Medicaid dollars for nondisabled populations on managed care; Role of psychologists in aiding consumer decision making.

Presents views on child development and socialization in the wake of peace education. Peace education and assumptions about child development; Child as creator of a better world; Child and the group; Peace education for life.

We report a case of severe hemorrhagic cystitis complicating high-dose cyclophosphamide (CY), total body irradiation and allogeneic hematopoietic stem cell transplantation (HSCT). Supportive care with i.v. hydration, platelet transfusions, continuous bladder irrigation and aluminum irrigation of the bladder was ineffective and the patient developed multiple complications from hemorrhagic cystitis. His condition became critical with persistent bleeding, pulmonary edema and acute renal failure. These problems resolved following successful simple cystectomy and ileal conduit. The patient did not develop any acute or chronic complications following surgery. He is alive with a good quality of life and in third remission after receiving salvage chemotherapy 14 months after his transplantation. Bone Marrow Transplantation (2000) 26, 899–901. [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: The objective was to investigate the relationship between mesh exposure and persistent stress urinary incontinence (SUI) post-midurethral sling (MUS) surgery. Methods: Extensive data collection including patient demographics, obstetric history, existing medical conditions, previous surgeries, and surgical outcomes, encompassing both perioperative and postoperative complications. Results: Out of 456 patients who underwent the MUS procedure within the specified period, the persistence of SUI was noted in 6.4% of cases. Mesh exposure was observed in 8.8% of these cases. Notably, 25% of patients with mesh exposure suffered from persistent SUI, in stark contrast to 4.6% of those without mesh exposure (p < 0.0001). Further, multivariate analysis indicated that patients with mesh exposure had an approximately 6.5-fold increased likelihood (95% CI: 2.71—15.44) of experiencing persistent SUI compared with those without mesh exposure. Conclusions: Mesh exposure is a significant independent risk factor for persistent SUI post-MUS surgery. Patients with mesh exposure are about 6.5 times more prone to persistent SUI than those without. Although mesh exposure is typically managed with expectant measures, vaginal estrogen or mesh excision, current evidence does not support surgical revision of MUS affected by mesh exposure or additional incontinence procedures during mesh excision. [ABSTRACT FROM AUTHOR]

Deals with drama education in Sweden. Information on the drama education in the 1930s; Details on headmistress Ester Boman who ran a boarding school for 10-18-year-old girls; Subjects taught at the boarding school; Importance of theater and drama according to Boman.

Postoperative pain within 24 hours after surgery is 41% lower when robotic-assisted sacrocolpopexy is performed at 12 mm Hg insufflation compared with 15 mm Hg. OBJECTIVE: To evaluate whether decreasing insufflation pressure reduces postoperative pain and opioid use in women undergoing robotic-assisted sacrocolpopexy. METHODS: In a single-blinded randomized trial, women with pelvic organ prolapse underwent robotic-assisted sacrocolpopexy at either 12 mm Hg (experimental) or 15 mm Hg (standard) insufflation pressure. The primary outcome was pain rating on a visual analog scale (VAS) on postoperative day 1 within 24 hours of surgery. Secondary outcomes included VAS pain rating at outpatient follow-up, inpatient and outpatient use of opioids, operative time, and estimated blood loss. A margin of 15 mm was considered clinically different on the VAS, and at 80% power, a sample size of at least 64 participants was needed to show significance. RESULTS: From April 27, 2021, to May 17, 2022, 80 women were enrolled, with 41 in the experimental group and 39 in the standard group. All participants underwent surgery as planned and attended a 2-week postoperative follow-up. Participants in the experimental group had less pain on postoperative day 1 with median VAS of 17.0 mm (interquartile range 26.0) compared with 29.0 mm (interquartile range 32.0, P =.007) in the standard group. No differences were noted in the secondary outcomes of operative time, estimated blood loss, or length of stay. Participants in the experimental group were noted to use fewer opioids while an inpatient (P =.04) and outpatient (P =.02). In multivariable analyses, lower insufflation pressure and increasing age were negatively associated with postoperative VAS scores. CONCLUSION: Lowering insufflation pressure (12 mm Hg) during robotic-assisted sacrocolpopexy safely reduced postoperative pain and opioid use compared with standard pressure (15 mm Hg). CLINICAL TRIAL REGISTRATION: ClinialTrials.gov, NCT 04858438. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Stress urinary incontinence (SUI) affects between 4% and 35% of adult women. Midurethral slings (MUSs) are the gold standard for the treatment of SUI. Mesh exposure has been reported in 4.7–16.4% of patients who undergo MUS. It is unclear whether mesh exposure portends an increased risk of persistent SUI. The purpose of this study was to determine whether mesh exposure is associated with MUS failure/persistent SUI. METHODS: This was a retrospective cohort study from December 1, 2015 to January 1, 2022, of all patients who had a MUS procedure at a large community hospital. The primary outcome was persistent SUI at the 12-week postoperative appointment after MUS in patients with and without mesh exposure. RESULTS: A total of 456 patients underwent MUS procedure. The incidence of persistent SUI and mesh exposure was 6.4% and 8.8%, respectively. Twenty-five percent of patients with mesh exposure experienced persistent SUI, compared with 4.6% of patients without mesh exposure (P <.0001). In univariable analysis, mesh exposure and postmenopausal status were associated with persistent SUI while asthma was associated with mesh exposure. In logistic regression, persistent SUI was 6.5 times higher in patients with MUS mesh exposure compared to those without mesh exposure (adjusted odds ratio 6.46, 95% CI 2.71–15.44). CONCLUSION: Mesh exposure is an independent risk factor for persistent SUI. Patients with mesh exposure are approximately seven times more likely to experience persistent SUI compared to patients without mesh exposure. Currently, there is insufficient evidence to recommend surgical revision of MUSs complicated by mesh exposure, and further studies are warranted. [ABSTRACT FROM AUTHOR]

Training to qualify as a manual ultrasonic inspector takes a long time and costs a considerable amount of money. We developed a virtual training environment using an innovative dead-reckoning optical sensor that yields translational position which offers additional information to operators and examiners alike. The training environment contains a library of test scenarios, shows surface coverage, measures the time of inspection, indicates detected defects and provides a performance score. Our test-bed trial results using a pool of Ultrasonic Test (UT) qualified and unqualified participants on two virtual training blocks that contain 2 flaws each reveal 100% detection and an accuracy of 5 mm in locating defects in more than 50% of the measured defect locations. [ABSTRACT FROM AUTHOR]

Dual‐ion batteries that use anions and cations as charge carriers represent a promising energy‐storage technology. However, an uncharted area is to explore transition metals as electrodes to host carbonate in conversion reactions. Here we report the reversible conversion reaction from copper to Cu2CO3(OH)2, where the copper electrode comprising K2CO3 and KOH solid is self‐sufficient with anion‐charge carriers. This electrode dissociates and associates K+ ions during battery charge and discharge. The copper active mass and the anion‐bearing cathode exhibit a reversible capacity of 664 mAh g−1 and 299 mAh g−1, respectively, and relatively stable cycling in a saturated mixture electrolyte of K2CO3 and KOH. The results open an avenue to use carbonate as a charge carrier for batteries to serve for the consumption and storage of CO2. [ABSTRACT FROM AUTHOR]

Dual‐ion batteries that use anions and cations as charge carriers represent a promising energy‐storage technology. However, an uncharted area is to explore transition metals as electrodes to host carbonate in conversion reactions. Here we report the reversible conversion reaction from copper to Cu2CO3(OH)2, where the copper electrode comprising K2CO3 and KOH solid is self‐sufficient with anion‐charge carriers. This electrode dissociates and associates K+ ions during battery charge and discharge. The copper active mass and the anion‐bearing cathode exhibit a reversible capacity of 664 mAh g−1 and 299 mAh g−1, respectively, and relatively stable cycling in a saturated mixture electrolyte of K2CO3 and KOH. The results open an avenue to use carbonate as a charge carrier for batteries to serve for the consumption and storage of CO2. [ABSTRACT FROM AUTHOR]

Background: Eosinophilic esophagitis (EoE) is defined by infiltration of eosinophils in the esophageal mucosa (>20 eosinophils/hpf). The epidemiology and seasonal variation have not been well studied in children and adolescents. Methods: Review of all esophageal biopsies performed from January 2001 to December 2006 on patients younger than 21 year of age, focusing on demographics, onset and duration of presenting symptoms, history of allergies and endoscopic findings. Results: A total of 753 upper endoscopies were performed, 44 of which showed histologic evidence of EoE (5.8 %). Fifty percent of all EoE endoscopies were grossly normal. Onset of symptoms was 23 % in the spring, 29 % in the summer, 23 % in the fall and 25 % in the winter. More cases (36 %) were diagnosed in the fall. Time between onset of symptoms and diagnosis was 115 ± 145 days (mean ± SD). The most common presenting symptoms were vomiting (61 %), dysphagia (39 %), abdominal pain (34 %), feeding disorders (14 %), heartburn (14 %), food impaction (7 %), vague chest pain (5 %) and diarrhea (5 %). Children presenting with vomiting and feeding disorders were younger ( p < 0.02), whereas children presenting with heartburn and dysphagia were older ( p < 0.02). Conclusions: The incidence of EoE did not increase between 2001 and 2006. Onset of symptoms did not vary by season, indicating that allergens triggering EoE are present all year around. Vomiting and feeding disorders are seen in young children, while dysphagia and heartburn are seen in older children. As endoscopic findings were normal in 50 % of cases, an esophageal biopsy should be performed in all patients with suspected EoE. [ABSTRACT FROM AUTHOR]

Background/aims: To examine potential geographic differences among individuals with traumatic brain injury (TBI) and spinal cord injury (SCI) in demographics, rehabilitation services/costs, and outcomes at one year follow-up. Methods: 152 participants with TBI from the Missouri Model Brain Injury System and 149 participants with SCI from the Missouri Model Spinal Cord Injury System were enrolled at initial acute or rehabilitation hospitalization and followed for one year. Measures included demographics, rehabilitative services/costs, functional independence measure, residency at discharge, and substance use. Findings: Few differences in demographics or rehabilitation services were found when comparing rural and urban groups, and there were no differences in one year outcomes measured. Conclusions: The results suggest that, contrary to expectations, individuals with severe disabilities in rural areas do not necessarily experience worse outcomes than those in urban areas, indicating potential improvements in access to services in rural areas. [ABSTRACT FROM AUTHOR]

Background/aims: To examine potential geographic differences among individuals with traumatic brain injury (TBI) and spinal cord injury (SCI) in demographics, rehabilitation services/costs, and outcomes at one year follow-up. Methods: 152 participants with TBI from the Missouri Model Brain Injury System and 149 participants with SCI from the Missouri Model Spinal Cord Injury System were enrolled at initial acute or rehabilitation hospitalization and followed for one year. Measures included demographics, rehabilitative services/costs, functional independence measure, residency at discharge, and substance use. Findings: Few differences in demographics or rehabilitation services were found when comparing rural and urban groups, and there were no differences in one year outcomes measured. Conclusions: The results suggest that, contrary to expectations, individuals with severe disabilities in rural areas do not necessarily experience worse outcomes than those in urban areas, indicating potential improvements in access to services in rural areas. [ABSTRACT FROM AUTHOR]

Purpose. This study evaluated a personal assistance services (PAS) training programme that aimed to improve the consumer and personal assistant relationship and increase consumer and personal assistant knowledge on health and wellness issues. Method. A total of 87 consumers and 53 personal assistants were enrolled in this longitudinal intervention study. Consumers and personal assistants in the intervention group participated in a six-hour in-person PAS training programme. Results. Consumers and personal assistants who participated in the training had increased knowledge at both three and six months post-training compared to consumers and personal assistants who were in the non-treatment group. There were no differences in consumer/personal assistant relationship variables. Conclusions. Future studies should examine the impact of PAS training programmes on health behaviours needed to decrease secondary conditions. [ABSTRACT FROM AUTHOR]

Objective: To apply the World Health Organization model of functioning to a study of perceived choice over life activities and barriers to engaging in life activities among persons with spinal cord injury. Participants and Setting: This large community-dwelling sample included 255 participants from 2 urban sites and 1 rural site. Measure: Items from the Participation of People With Mobility Limitations Survey were used. Results: Approximately half of the participants reported little or no perceived choice with employment, and the majority reported low levels of satisfaction with choice with employment. Access to employment was limited by physical barriers (48%) and transportation (46%). Physical impairment, pain, and fatigue were also barriers. Conclusions: Improvements of workplace and transportation accessibility, increased vocational supports, and interventions to decrease pain and fatigue are needed to ensure participation for persons with spinal cord injury. [ABSTRACT FROM AUTHOR]

This paper connects findings from the field of placebo studies with research into patients' interactions with their clinician's visit notes, housed in their electronic health records. We propose specific hypotheses about how features of clinicians' written notes might trigger mechanisms of placebo and nocebo effects to elicit positive or adverse health effects among patients. Bridging placebo studies with (a) survey data assaying patient and clinician experiences with portals and (b) randomized controlled trials provides preliminary support for our hypotheses. We conclude with actionable proposals for testing our understanding of the health effects of access to visit notes. [ABSTRACT FROM AUTHOR]

Background: Patient empowerment is an important concept and a movement toward person-centered care of patients with chronic conditions. Nevertheless, to date, most research on empowered patients or informal caregivers has been conducted from a narrow clinical perspective. Such research has mainly focused on how health care professionals can empower patients to increase self-care or compliance with treatment. Research on empowered patient and informal caregiver needs and self-empowering activities is scarce. Objective: We aimed to explore empowering behaviors from a patient and informal caregiver perspective in the context of self-management and to understand how health care can support such behaviors better. Methods: We used an exploratory, qualitative study design. A total of 15 semistructured interviews and 6 focus group interviews were conducted with 48 patients and informal caregivers. We analyzed the interviews using thematic analysis and used a directed content analysis to analyze the focus group interviews. Results: A total of 14 patterns of empowering behaviors were identified that were characterized by several exploratory and influencing activities performed by the participants. The participants expressed a desire to be more active in their care than what is expected and supported by health care professionals. The participants also desired better support for activities imposed on them by health care professionals. Conclusions: To enable a transformation of the health care system to better support self-empowering behaviors, there is a need to develop self-management approaches from a patient and informal caregiver perspective. [ABSTRACT FROM AUTHOR]