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It is understood that colorectal adenomas progress to colonic adenocarcinoma. Adenoma detection rate (ADR) at endoscopy has been used as a key performance indicator at endoscopy and is inversely associated with diagnosis of interval colorectal cancer. As most endoscopy reporting systems do not routinely incorporate histological assessment, ADR reporting is a cumbersome task. Polyp Detection Rate (PDR) has therefore been adopted as a surrogate marker for ADR. A prospectively maintained database of colonoscopies performed between July 2015 and July 2017 was analysed. This was cross referenced with a histological database. Statistical analysis was performed using IBM SPSS, version 24. Inferential procedures employed included the Pearson’s correlation coefficient (r) and Binomial logistic regression. Of 2964 procedures performed by 8 endoscopists, overall PDR was 27% and ADR was 19%. The PDR, ADR, adenoma to polyp detection rate quotient (APDRQ) and estimated ADR (PDR x APDRQ group average = 0.72) was calculated for each individual. There was a strong positive linear correlation between PDR and ADR,r(8) = 0.734, p = 0.038 and between PDR and estimated ADR, r(8) = 0.998, p 0.001. Adenoma detection rate strongly correlated with estimated ADR, r(8) = 0.720, p = 0.044. With the exclusion of a moderate outlier, these correlations increased in both strength and significance. There was a stronger correlation between PDR and ADR,r(7) = 0.921, p = 0.003 and between ADR and estimated ADR, r(7) = 0.928, p = 0.003.

Infected deep vein thrombophlebitis (i-DVT) in people who inject drugs (PWID) is a clinically challenging but poorly characterised disease. We undertook a retrospective observational study of 70 PWID presenting acutely with i-DVT to improve the clinical and microbiological characterisation of this disease. i-DVT was frequently associated with bacteraemia (59.1% patients with blood cultures obtained), groin abscesses (in 34.3%; of which 54.2% required surgical drainage), and septic pulmonary emboli (38.6%) requiring anticoagulation. Network analysis identified a cluster of patients presenting with respiratory symptoms but lacking typical DVT symptoms, more likely to have septic pulmonary emboli. A microbiologic diagnosis was frequently achieved (70%). Causative pathogens were predominantly gram-positive (S. aureus and streptococci, especially anginosus group), whereas gram-negative pathogens were identified very infrequently (in 6.1% of microbiological diagnoses). This suggests routine empiric therapy against gram-negative bacteria, though commonly administered, is not required. High rates of clinical cure (88.6%) were observed despite the complex nature of infections and independently of the highly variable intravenous and total antimicrobial durations received. There exists a rationale to devise pragmatic approaches to implement novel individualised treatment plans utilising oral antimicrobial therapy for i-DVT. Despite frequent healthcare interactions, opportunities to address HCV treatment and opioid substitution therapy were frequently missed during these acute admissions.

Background Mental illness acts as a barrier to accessing and obtaining effective medical care. It has been shown that out of hours services are an important first stop for emergency care for people experiencing mental health difficulties. However, little is in fact known about the use of out of hours general practice services by people experiencing mental health difficulties. Aim To establish the number and range of consultations that have a primary or related mental health issue attending general practitioner (GP) out of hours and to document adherence to their follow-up care referral. Design and setting Descriptive study in one large out of hours primary care service in the South East of Ireland (Caredoc). Methods An anonymous extraction of retrospective data from 1 year of the out of hours’ electronic database was undertaken. Patients who attended the out of hours with a possible mental health issue and were referred to the psychiatric services or back to their own GP, were tracked via phone follow-up with hospitals and GPs over 6 months to establish if they attended for the recommend follow-up care. Results Over a 1 year period, there were 3844 out of hours presentations with a mental health component. Overall, 9.3% were referred by the out of hours GP for follow-up to a hospital emergency department (ED) or were advised to attend their own GP. A total of 104 patients who were advised to attend their GP or ED following their consultation with the out of hours GP were tracked. Twenty-seven patients were referred back to their GP of which the follow-up call to the GP revealed that 44.5% did not attend. Seventy-seven patients were referred to the hospital services, of whom 37.7% did not attend. Conclusions There are significant challenges at the interface of primary care and secondary mental health services in Ireland. As expounded by the WHO and WONCA, in order to be effective and efficient, care for mental health must be coordinated with services at different levels of care complemented by the broader health system.

Repeat observations underpin our understanding of environmental processes, but financial constraints often limit scientists’ ability to deploy dense networks of conventional commercial instrumentation. Rapid growth in the Internet-Of-Things (IoT) and the maker movement is paving the way for low-cost electronic sensors to transform global environmental monitoring. Accessible and inexpensive sensor construction is also fostering exciting opportunities for citizen science and participatory research. Drawing on 6 years of developmental work with Arduino-based open-source hardware and software, extensive laboratory and field testing, and incorporation of such technology into active research programmes, we outline a series of successes, failures and lessons learned in designing and deploying environmental sensors. Six case studies are presented: a water table depth probe, air and water quality sensors, multi-parameter weather stations, a time-sequencing lake sediment trap, and a sonic anemometer for monitoring sand transport. Schematics, code and purchasing guidance to reproduce our sensors are described in the paper, with detailed build instructions hosted on our King’s College London Geography Environmental Sensors Github repository and the FreeStation project website. We show in each case study that manual design and construction can produce research-grade scientific instrumentation (mean bias error for calibrated sensors –0.04 to 23%) for a fraction of the conventional cost, provided rigorous, sensor-specific calibration and field testing is conducted. In sharing our collective experiences with build-it-yourself environmental monitoring, we intend for this paper to act as a catalyst for physical geographers and the wider environmental science community to begin incorporating low-cost sensor development into their research activities. The capacity to deploy denser sensor networks should ultimately lead to superior environmental monitoring at the local to global scales.

Cancer survivors may experience a wide range of complex health issues as a result of their cancer type and treatment. With increased rates of health care utilisation compared to non-cancer patients, the transition back into the primary care setting post-cancer treatment can be difficult for both GPs and patients to navigate. To identify the current barriers encountered by GPs in Ireland in the area of cancer survivorship, an online survey of GPs was undertaken. A total of 514 completed surveys were analysed, a response rate of 18.2%, which is typical of response rates from GPs in Ireland and internationally. The majority of GPs had never attended a survivorship course, conference or workshop. Only 17.2% and 19.7% of GPs respectively considered that they had enough information on the possible long-term issues from cancer treatments. Further education on cancer survivorship and improved access to services for GPs is necessary in order for the healthcare system in Ireland to be prepared to provide improved cancer survivorship care.

Purpose The purpose of this paper is to report on the evaluation of a one-day mental health wellness workshop which was delivered to male prisoners in an urban prison in the Republic of Ireland. Design/methodology/approach A mixed methods approach was used to evaluate the workshop. This paper presents the findings of the qualitative arm of the evaluation. Qualitative data were collected using semi-structured telephone interviews with ten participants who had completed the programme. Findings The participants were overwhelmingly positive about the wellness workshop and the qualitative interviews articulated the ways that the workshop impacted on their ability to manage their own and other peoples mental health. Originality/value As prisons attempt to limit the negative impact of prison life, implementing recovery orientated approaches such as the wellness workshop can have a positive impact on prisoners’ mental health as well as raising their awareness and improving their attitudes towards mental distress and suicide. The concepts of self-help and peer support, espoused by the workshop offer a real opportunity to equip interested prisoners with skills to support themselves and other prisoners who are in distress.

Unlike in sheep, in which immunization against androstenedione causes mild and reasonably controlled increased ovulation rate, in similar studies cattle showed highly variable responses ranging from increased ovulation rate and fertility through to anovulation/anoestrous or superovulation. As a consequence, interest in manipulation of ovulation rate through this approach has declined and is now focused on immunological manipulation of endogenous inhibin following successful studies in sheep. Studies have concentrated on developing a prototype inhibin-based vaccine to be used for twinning in the Australian beef industry. The prototype vaccine (with recombinant ovine inhibin-alpha.3 fusion protein and Montanide:Marcol adjuvant) has proved to be very potent and control of the degree of ovarian stimulation has not been possible. The proportion of cattle with increased ovulation rate after inhibin immunization is affected by timing of booster vaccination within the ovarian cycle, time after vaccination, vaccine formulation and possibly genotype. Physiological studies show that cattle responding to the inhibin vaccine have increased plasma inhibin binding of native bovine inhibin, high plasma FSH concentrations, greater numbers of large (> or = 8 mm) follicles and fewer small (< 5 mm) follicles during the preovulatory wave of follicular development compared with control or non-responding animals. Significant correlations among the response parameters (i.e. inhibin binding, plasma FSH concentrations, number of large follicles and ovulation rate) have been demonstrated. The results indicate that greater understanding of the various processes of folliculogenesis will be necessary to achieve a controlled increase in ovulation rate in cattle.

BackgroundPeople with enduring mental illness (EMI) have higher morbidity and mortality from chronic diseases than the general population, and this results in a significantly reduced relative life expectancy—accounted for primarily by physical illness. This gap may be partly influenced by the reduced likelihood of access to and uptake of regular physical health screening.AimTo establish Irish service providers’ perspectives regarding the care of the physical health of people with EMI in an effort to inform future service developments aimed at improving the physical health of people with EMI.Design and settingQualitative study of healthcare providers—general practitioners (GPs) and members of the community mental health teams—in Ireland.ParticipantsGPs and mental health service providers.MethodsQualitative semi-structured interviews were conducted with 34 service providers. Thematic analysis was undertaken.ResultsParticipants considered that the physical health of people with EMI is not currently regularly addressed by the patient’s GP or the mental health team. Factors associated with this include patient compliance with attendance, time constraints in consultations to adequately support patient self-management, communication difficulties with the patient and between primary and secondary care, and lack of clarity as to whose responsibility it is to ensure physical health is monitored. In participants’ view, a barrier to improvement is the present funding approach.ConclusionThe evidence from this study has the potential to form the basis for innovation and change in service delivery for people with an EMI in Ireland and internationally, specifically in countries where it is not clear who has the overall responsibility to monitor the physical health of patients with EMI. This role requires time and regular contact, and both the organisation and the funding of the health system need to support it.

Objectives: This study evaluated the impact of a one-day mental health Wellness Workshop on participants’ mental health and attitudes towards mental health. Design: Convergent, longitudinal mixed-methods approach. Setting: The study evaluated Wellness Workshops which took place throughout the Republic of Ireland. Method: Questionnaires measuring hope, mental health self-efficacy, attitudes towards mental health and perceived impact on wellbeing were administered to participants before the workshop ( n = 415), 1 week after ( n = 221) and 3 months after ( n = 110). Semi-structured interviews were carried out with 24 participants to generate a more in-depth understanding of the impact of the workshop. Results: Quantitative findings relating to hope, mental health self-efficacy and attitudes towards mental health did not identify statistically significant changes; however, participants’ perceptions of the effect of the workshop on wellbeing suggested a positive impact which was maintained over time. Qualitative findings, however, suggested that hope and self-efficacy were improved and the simplicity and utility of the wellness strategies disseminated in the workshop, in addition to the warmth and openness of the narrative approach used by the facilitators, were central to the perceived positive impact. Conclusion: This evaluation demonstrates the potential for wellness interventions to have a subjective improvement in wellbeing in members of the general public.

Background Patients with chest pain who have ST elevations on electrocardiogram (ECG) are at high risk for ST-elevation myocardial infarction (STEMI). Recent literature has reported various STEMI equivalents, which may be equally threatening. One STEMI equivalent, previously named the de Winter pattern, describes ECG changes where there are ST-segment depressions in the precordial leads in association with tall, symmetrical, hyperacute T-waves. These changes have been connected with proximal left anterior descending coronary artery occlusion. Case Report We have identified a case of the de Winter ECG pattern immediately after ventricular fibrillation cardiac arrest. A 33-year-old man presented with waxing and waning severe substernal chest pain. The patient was on no prior medications, and had no risk factors for acute coronary syndrome. The initial ECG showed ST depression, which was followed by normalization in a repeat ECG only minutes later. The patient then developed ventricular fibrillation cardiac arrest. After defibrillation, return of spontaneous circulation was achieved and subsequent ECGs demonstrated the de Winter ECG pattern. Why Should an Emergency Physician Be Aware of This? The characteristic ECG changes within the de Winter ECG pattern may be missed or misdiagnosed as nonspecific, reversible ischemia. This can significantly lengthen the transportation to a center equipped with a percutaneous coronary intervention laboratory, and thus the start of reperfusion therapy. It is imperative that all practitioners learn to identify this novel ECG pattern as a STEMI equivalent to ensure appropriate intervention in the cardiac catheterization laboratory.

Purpose RNA transcript analysis is a promising method being used to better identify and understand allograft rejection, but its applicability to analyzing tolerance in heart transplantation has been limited by the lack of tolerant heart samples. Here, we utilized the Nanostring platform for RNA transcript analysis of a unique set of tissue samples from cynomolgus macaques tolerant of cotransplanted heart and kidney allografts. Methods Total RNA was isolated from 144 formalin fixed and paraffin embedded (FFPE) nonhuman primate biopsy and autopsy samples and analyzed for mRNA expression of a custom panel of 216 genes with normalization against housekeeping genes. Differential expression analyses were performed on heart samples from tolerant animals, rejecting animals, animals on immunosuppression and naive animals (native heart). Pathway analysis was performed using Gene Set Enrichment Analysis (GSEA). Results Tolerant heart allografts exhibited a signature with higher expression of cardiac genes, endothelial and angiogenesis related genes, T-cell regulatory genes, and stem cell related genes compared to rejecting organs while rejecting organs exhibited a signature with higher expression of B-cell and immunoglobulin genes, apoptosis related genes, and immune activation. In GSEA analysis, the most enriched pathway in rejecting animals was antigen stimulation through IgG and B-cells. Tolerant heart samples had similar gene expression profiles to immunosuppressed heart samples, both of which were markedly altered compared to naive hearts. Conclusion Nanostring analysis of mRNA expression in tolerant NHP cardiac allografts was performed for first time. RNA profiling could distinguish tolerant allografts from rejecting allografts. Surprisingly, the tolerance profile resembled that observed in allografts from stably immunosuppressed recipients instead of naive hearts, possibly reflecting stable regulatory changes in indirect immunity established during immunosuppression that persist in tolerant animals but not in rejecting animals.

Video Objective This first segment of the video will describe the process involved in preparing an autologous graft derived from platelet rich plasma. The latter segment of video will demonstrate the surgical technique involved in the incorporation of autologous graft into a standard native tissue repair. We will then review our prospective cohort data with up to 18 months follow up. Setting Pelvic organ prolapse is a condition with a lifetime surgical risk of 10-20%. Native tissue repair alone is associated with a failure rate often quoted as around 30-50%. With the withdrawal of vaginal mesh and xenograft products from the market by the TGA and other regulatory bodies due to complications, Gynecologists are faced with managing complex pelvic organ prolapse cases with less tools in their armamentarium. Platelet rich plasma and autologous tissue grafts have been successfully used in plastic and reconstructive surgery, orthopedics and dentistry. We describe an innovative technique to biologically augment a native tissue vaginal repair. Interventions Patient blood is taken at the commencement of the procedure in the operating theatre and centrifuged to produce platelet rich plasma and fibrinogen. This is then mixed with calcium gluconate in a pre-defined ratio prior to further processing in a centrifuge. This creates a 3-4cm autologous biological graft which is able to be sutured to the vesicocervical or pararectal fascia to biologically augment a native tissue repair. Results There have been 30 cases of PRP membrane augmented vaginal repairs. Baseline characteristics was compared to follow-up. Results of the study and video of the autologous membrane will be presented at the conference. Conclusion This video demonstrates the preparation of the autologous graft which is being evaluated as a technique to be easily incorporated into standard practice to augment a vaginal native tissue repair and reduce the risk of recurrence.

Video Objective The purpose of the video is to describe the surgical technique involved in performing laparoscopic mesh sacrohysteropexy. A brief review of the outcomes from a 10 year retrospective single centre cohort study will be discussed. Setting Laparoscopic mesh sacrohysteropexy is a uterine conserving surgical technique for the management of apical vaginal prolapse. Interventions Laparoscopic mesh sacrohysteropexy involves fixing non-absorbable mesh from the posterior cervix to the sacral promontory. This is then covered with peritoneum from the para-rectal space. Conclusion A ten year retrospective cohort study has demonstrated success in 86% of patients with no further vaginal surgery required during the follow up period. This technique is useful for women wishing uterine preservation or for women who would be unable to tolerate a longer procedure such as a laparoscopic hysterectomy and sacrocolpopexy.

Male Antechinus stuartii (Marsupialia: Dasyuridae) undergo significant endocrinological changes during their life history. The endocrine changes are associated with complete male mortality. The accessory reproductive tract of males is important for seminal plasma production, and changes associated with the reproductive cycle were not described in detail by earlier studies. The present study sought to describe some of the seasonal changes in structure of the male accessory reproductive tract in relation to the known hormonal changes. The epididymis, prostate, and bulbourethral glands are relatively undifferentiated in February and May, a time when plasma concentrations of testosterone are known to be low. By July, considerable hypertrophy and differentiation of the accessory reproductive tract are observed. This is most obvious in the bulbourethral glands, which change from being indistinguishable from one another in February and May to being three large morphologically and histologically distinct glands in July. The hypertrophy and secretory activity continue into August, the breeding season. These findings correlate with the hormonal profiles found in other studies of A. stuartii. J Morphol 231:261-275, 1997. © 1997 Wiley-Liss, Inc.

OBJECTIVE To compare current practice in the management of female pelvic organ prolapse in Australia and New Zealand with that in 2007, and assess the impact on practice of the withdrawal of Prolift® and Prosima® mesh kits in 2015. MATERIALS AND METHODS In early 2015, two invitations to participate in a survey, including a link to Surveymonkey, were emailed to 2506 Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) trainees and fellows. The online survey closely resembled a printed survey that was posted to RANZCOG trainees and fellows in 2007 and had additional questions relating to the impact of withdrawal of Prolift® and Prosima® products. RESULTS Four-hundred-and-three doctors participated, giving a response rate of 16%. Native tissue repair was the procedure of choice for primary and recurrent prolapse of the anterior and posterior vaginal wall. An implant was used to treat 45% of anterior recurrences and 25% of posterior recurrences. Vaginal hysterectomy and repair were the procedures of choice for uterovaginal prolapse. Sacrospinous hysteropexy was the uterine preservation procedure of choice, preferred by 41%. For post-hysterectomy vault prolapse, sacrospinous colpopexy and vaginal repair was preferred by 65% of respondents. Between 2007 and 2015, there was a substantial decrease in respondents' usage of implants across all indications except for midurethral slings and sacrocolpo/hysteropexy. Forty-two percent of respondents changed their practice as a result of Prolift® and Prosima® being withdrawn. CONCLUSION There is a trend toward increasing use of various native tissue prolapse repair procedures and midurethral slings, and less utilisation of transvaginal mesh for prolapse.

Historically, it was common practice to dispose of landfill waste in low-lying estuarine and coastal areas where land had limited value due to flood risk. Such ‘historic landfills’ are frequently unlined with no leachate management and inadequate records of the waste they contain. Globally, there are 100,000s such landfills, for example, in England there are >1200 historic landfills in low-lying coastal areas with many in close proximity to designated environmental sites or in/near areas influencing bathing water quality; yet, there is a very limited understanding of the environmental risk posed. Hence, coastal managers are more likely to select conservative management policies, for example, hold-the-line, when alternative more sustainable policies, for example, managed realignment, may be preferred. Some historic coastal landfills have already started to erode and release waste, and with the anticipated effects of climate change, erosion events are likely to become more frequent. Strategies to mitigate the risk of contaminant release from historic landfills such as excavation and relocation or incineration of waste would be prohibitively expensive for many countries. Therefore, it will be necessary to identify which sites pose the greatest pollution risk in order that resources can be prioritized, and to develop alternative management strategies based on site specific risk. Before such management strategies can be achieved there remain many unknowns to be addressed including the extent of legacy pollution in coastal sediments, impacts of saline flooding on contaminant release and the nature, behavior and environmental impact of solid waste release in the coastal zone. WIREs Water 2018, 5:e1264. doi: 10.1002/wat2.1264 For further resources related to this article, please visit the WIREs website.

Background There is little information on the effectiveness of laparoscopic techniques for native tissue repair of cystocoele. Aim To assess the long-term outcome of laparoscopic cystocoele repair. Methods Two hundred and twenty-three women with symptomatic pelvic organ prolapse underwent laparoscopic paravaginal repair and treatment of associated conditions. Women were assessed pre-operatively and postoperatively at 6 weeks, 6 months, 12 months and then annually or biannually with pelvic organ prolapse quantification (POPQ) and subjective assessment at each visit. Results Median follow-up was 5.2 years (range: 1–12 years) with 140 women (63%) followed for at least 5 years. During follow-up, 79% of women developed prolapse of at least POPQ stage 2 in one or more compartments and 58% became symptomatic again. Overall, 48% underwent further prolapse surgery, but only 24% of women had an anterior prolapse beyond the hymen. Thirty per cent eventually had a further cystocoele repair. Conclusion Long-term follow-up of laparoscopic cystocoele repair shows that cystocoeles are difficult to repair successfully.

Introduction: Mental illness can act as barrier to accessing and obtaining effective medical care, and is associated with increased medical morbidity1. People with serious mental illness have higher morbidity and mortality from chronic diseases than the general population, and this results in a significantly reduced life expectancy2-3. The vast majority of the gap in life expectancy between those with mental illness and the general population is accounted for by physical illness4-5. There is also evidence that people with mental illness are further disadvantaged as they are less likely than the general population to be offered, or to access, regular health screening and are also less likely to undergo a range of procedures compared to those with no mental illness4,6. There is evidence to suggest that the physical health needs of people with serious mental illness are often “unrecognised, unnoticed or poorly managed”7. The literature presents a strong argument for primary health/general practice and mental health services to work together to provide holistic care in order to reduce the significant physical health inequality experienced by people with a severe mental illness. It also argues that an integrated approach to the provision of primary health care services for this population group will yield economic benefits through appropriate use of, and improved access to, health services (including hospital services) and will increase the take up of preventative measures. Achieving this outcome will require local area service coordination and shared accountability between specialist mental health, general practice and primary care services. The overall aim of this research project is to develop and assess a standard protocol to aid the health professional in the monitoring and treatment of the physical health of patients who have a severe mental health illness presenting in general practice. Methods: This project is using a mixed methods approach. The aspect presented here involves qualitative semi-structured interviews with service providers (general practitioners (GPs) and general practice staff, psychiatrists and members of the community mental health teams) and patients. The purpose of these is to ascertain the barriers and facilitators experienced by service providers and persons with a diagnosed mental illness accessing and engaging in health services related to the care of their physical health. Results: Preliminary results indicate that the physical health of people with a severe mental illness is not currently addressed regularly by the primary care team or the patient’s GP or the mental health team. Factors associated with this includes patient attendance and adherence and time constraints in consultations. A barrier to GPs having a role in this in an integrated model is the present funding approach, which does not adequately ‘incentivise’ such activities. Discussion/Conclusions: Improving physical health for this patient group takes considerable time, needs to be introduced step by step and requires sustained effort. The evidence from this work will provide meaningful information to the service providers and planners to guide future service development and to form the basis for innovation and change in practice and service delivery for people with a severe mental health illness.

Metals are concerning pollutants in estuaries, where contamination can undergo significant remobilisation driven by physico-chemical forcing. Environmental concentrations of metals in estuarine sediments are often higher than natural backgrounds, but show no contiguity to potential sources. Thus, better understanding the metal mobility in estuaries is essential to improve identification of pollution sources and their accountability for environmental effects. This study aims to identify the key biogeochemical drivers of metal mobilisation on contaminated estuarine sediments through (1) evaluation of the potential mobilisation under controlled conditions, and (2) investigation of the relevance of metal mobilisation for in situ pollution levels in an area with multiple contaminant sources. Sediments from a saltmarsh adjacent to a coastal landfill, a marina, and a shipyard on the Thames Estuary (Essex, UK) were exposed in the laboratory (24 h, N = 96, 20 °C) to water under various salinity, pH, and redox potential. Major cations, Fe(II), and trace metal concentrations were analysed in the leachate and sediment. Salinity, pH and redox had a significant effect on metal mobilisation (p < 0.001), e.g. under certain conditions Fe(II) leaching was increased ~ 1000-fold. Measurements in situ of surface and subsurface sediment cores revealed that landfill proximity poorly explained metal spatial distribution. However, physicochemical parameters explained up to 97% of geochemically normalized metal concentrations in sediments. Organic matter and pH were dominant factors for most of the metal concentrations at the sediment surface. At subsurface, major cations (Ca, Na, Mg and K) were determinant predictors of metal concentrations. Applying the empirical model obtained in the laboratory to geochemical conditions of the studied saltmarsh it was possible to demonstrate that Fe mobilisation regulates the fate of this (and other) metal in that area. Thus, present results highlight the importance of metal mobility to control sediment pollution and estuarine fate of metals.

Prior to modern environmental regulation landfills in low-lying coastal environments were frequently constructed without leachate control, relying on natural attenuation within inter-tidal sediments to dilute and disperse contaminants reducing environmental impact. With sea level rise and coastal erosion these sites may now pose a pollution risk, yet have received little investigation. This work examines the extent of metal contamination in saltmarsh sediments surrounding a historic landfill in the UK. Patterns of sediment metal data suggest typical anthropogenic pollution chronologies for saltmarsh sediments in industrialised nations. However, many metals were also enriched at depth in close proximity to the landfill boundary and are indicative of a historical leachate plume. Though this total metal load is low, e.g., c. 1200 and 1650 kg Pb and Zn respectively, with > 1000 historic landfills on flood risk or eroding coastlines in the UK this could represent a significant, yet under-investigated, source of diffuse pollution.

Background Lichen sclerosus (LS) is an inflammatory dermatosis with autoimmune pathogenesis. Although relatively common, its true incidence is unknown and likely underestimated. LS is usually anogenital, but in around 10% of patients, it can present as extragenital lesions. Continuous administration of topical corticosteroids is the mainstay of medical treatment. Other treatments are available but are only occasionally prescribed along with or instead of topical steroids. Injection of platelet-rich plasma (PRP) into affected areas has been reported to result in the regeneration of normal skin. In this study, we aimed to evaluate the safety, symptom resolution, and objective improvement in patients with autoimmune condition like genital LS after treatment with PRP. Methods Over a 2-year period at FBW Gynaecology Plus, we had a total of 28 patients with confirmed LS on biopsy, unresponsive to topical steroid treatment. After acquiring informed consent, patients' own blood was centrifuged on site and injected under local anesthesia to the external genitalia. Results Almost all of our patients showed clinical improvement in the size of their lesions, and in 8 cases, lesions totally disappeared after treatment with PRP. Symptoms disappeared in 15 of the 28 patients after treatment, with no need for further steroid therapy in 23 patients. Thirteen women experienced partial symptom relief. Conclusions Based on our limited findings, we hypothesize that PRP presents a potential alternative to topical steroids for treatment of vulvovaginal autoimmune conditions such as LS. A larger pilot and/or randomized controlled trial study is required to evaluate this finding further.

Background: The addition of trastuzumab (H) to pre-operative chemotherapy in H+BC increases the rate of pathological complete remission (pCR). H causes cardiac toxicity, especially when given with anthracyclines (Anth). TCH is a widely used adjuvant regimen with decreased cardiac toxiciy. We reported that TCH produces pCR in 40% of non-randomised pts with H+BC. Lapatinib is an alternative HER2 antagonist, which produces responses following trastuzumab failure, and which has been reported to augment H activity in combination. We studied the non-Anth regimens TCH v TCL v TCHL in pts with H+BC. The primary objective of this study was pCR. Secondary endpoints were toxicity and translational. Methods: Eligibility criteria included: primary BC, HER-2 +, node + disease (histologically or cytologically confirmed) or node-negative with >T1, normal left ventricle ejection fraction, no active/uncontrolled cardiovascular disease, normal organ and marrow function. Treatment consisted of 6 cycles of D (75mg/m2) + C (AUC 6) q3 weekly and H (8 mg/kg on cycle 1 day 1 and 6 mg/kg q3weekly thereafter for one year) ± L (1000mg OD) for up to 1 week before surgery. A sample size of 36 evaluable pts is required to detect an absolute 25% difference in the pCR rate between the hypothesised 65% pCR rate vs the historical-control pCR rate of 40%. Results: Following presentation of NCIC MA31 we decided to suspend accrual on our TCL arm.78 female pts were accrued to TCH/TCHL in 11 ICORG sites between 12/2010- 06/2013. Of 40 patients accrued to TCHL, only 18 pts completed 6 cycles. 17pts came off study early due to toxicity, 3 pts after cycle 3, 2 pts after cycle 2, 12pts after cycle 1. (1 patient was also registered but never started). Of 38 pts accrued to the TCH arm,33 pts completed 6 cycles,2 pts completed 5 cycles and 2 pts w/d after cycle 1. 3 TCHL & 1 TCH pt still remain on Rx. 2 pts have not yet had surgery. 52 SAEs occurred on study, 49 involving hospital admission, & 3 of medical significance. The most frequent SAEs were diarrhoea (10), febrile neutropenia (4), nausea (4), neutropenic sepsis (3), dehydration (2), wound infection (2), vomiting (2) neutropenia (2) decreased haemoglobin (2), GI perforation (1). There was 1 fatality on the TCH arm due to Neutropenic sepsis and typhlitis. One TCHL pt suffered GI perforation at cycle 1. pCR rates were 48% (16/33) for the TCH arm and 44% (7/16) for the TCHL arm. Translational studies are underway. Conclusions: TCH containing treatment produces a high rate of pCR. TCHL will not produce a statistically higher rate of pCR in this sample. The addition of lapatinib to TCH results in substantial GI toxicity. TCHL appears to be less tolerable than other active chemotherapy +H+L regimens such as that used in Neo-ALLTO. ICORG is currently leading an international study of paclitaxel+H +/- L in metastatic BC. Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P4-12-25.

To compare the objective outcome of laparoscopic uterosacral hysteropexy with that of hysterectomy combined with laparoscopic uterosacral colpopexy.Retrospective cohort study, 1999-2010 (Canadian Task Force classification II-2).University hospital in South Australia.Women with uterovaginal prolapse who had undergone laparoscopic uterosacral hysteropexy (n = 104) or laparovaginal hysterectomy with uterosacral colpopexy (n = 160). Apical suspension procedures were subdivided into prophylactic (Pelvic Organ Prolapse Quantification System [POP-Q] stage 1 apical descent, with stage ≥2 prolapse in an adjacent compartment) and therapeutic (POP-Q stage ≥2 apical descent, with or without adjacent compartment prolapse).All patients were assessed via POP-Q scoring preoperatively and postoperatively at 6 weeks, 6 months, annually, and then biannually. Recurrence of bulge symptoms and need for repeat treatment were recorded.Demographic data, preoperative degree of prolapse, and percentages of prophylactic and therapeutic procedures were similar in both groups. With a median follow-up of 2.5 years, objective success rates (POP-Q stage2 in all compartments) for uterosacral hysteropexy were 53% for prophylactic procedures and 41% for therapeutic procedures, and for hysterectomy with uterosacral colpopexy were 66% for prophylactic procedures and 59% for therapeutic procedures. Repeat operation rates overall were 28% for hysteropexy and 21% for hysterectomy with colpopexy. Failures at the apex specifically were 27% for hysteropexy and 11% for hysterectomy with colpopexy (p .02).Hysterectomy with laparoscopic uterosacral colpopexy produced better objective success rates than did laparoscopic uterosacral hysteropexy; however, repeat operation rates were not significantly different.

Meningioma growth has been previously described in patients receiving oestrogen/progestogen therapy. We describe the clinical, radiological, biochemical and pathologic findings in a 45-year-old woman with congenital adrenal hyperplasia secondary to a defect in the 21-hydroxylase enzyme who had chronic poor adherence to glucocorticoid therapy with consequent virilisation. The patient presented with a frontal headache and marked right-sided proptosis. Laboratory findings demonstrated androgen excess with a testosterone of 18.1 nmol/L (0–1.5 nmol) and 17-Hydroxyprogesterone >180 nmol/L (

Study Objective To analyze the objective outcome of laparoscopic supralevator repair in the treatment of rectoenterocele with the Pelvic Organ Prolapse Quantification (POPQ) system. Study Design Retrospective cohort study 1999–2009 (Canadian Taskforce Classification II–2). Setting University hospital in South Australia. Patients A total of 166 women with a median age of 63 years (range 36–89) who underwent laparoscopic supralevator repair for rectoenterocele and treatment of associated conditions over a 10-year period. Interventions All patients were assessed with the POPQ scoring system before surgery and at 6 weeks, 6 months, annually, and biannually after surgery. Measurements and Main Results The median operating time was 151 minutes (range 35–390); median blood loss was 50 mL (range 50–600); and median hospital stay was 4 days (range 1–14). Four women, 2 of whom required laparotomy, had a major complication. Ten women (6%) needed day surgery to treat vaginal granulations or suture exposure. With a median follow-up time of 45 months (interquartile range 16–67) the overall objective success rate was 63% according to National Institute of Health criteria. The median time to failure was 24 months. Of 61 objective failures, 23 required further prolapse surgery, representing a 14% reoperation rate. Conclusion Laparoscopic supralevator repair is a safe and effective procedure for the treatment of rectoenterocele.

Background The combination of Bev + chemotherapy (CRx) has been shown to produce superior response rates and progression free survival compared to CRx alone, providing a rationale for the study of Bev with AdjCRx for pts with ESBrCa. As Bev can cause hypertension (HTN) and may increase the risk of cardiac failure, there is a rationale for studying a standard non-anthracycline (Anth) AdjCRx with Bev, e.g. TC (docetaxel-cyclophosphamide). We performed a pilot phase II study to evaluate the feasibility and toxicity of TC+Bev in pts with ESBrCa in preparation for participation in a random assignment trial. We have previously reported preliminary toxicity data. Methods: Eligibility criteria included: ESBrCa which was HER-2 normal, node+ or, N- and primary tumour (T) >2 cm and receptor negative, or T >3 cm, normal left ventricle ejection fraction (LVEF), no active/uncontrolled cardiovascular disease, normal organ and marrow function. Treatment consisted of four 3-weekly cycles of docetaxel 75 mg/m2 together with cyclophosphamide 600 mg/m2. Patients commenced Bev 15 mg/kg i.v. on day 1, and then every 3 weeks to a total of 18 cycles of treatments. Pts were monitored clinically, with echocardiograms and with serial estimations of BNP and troponin. Results: A total of 106 female pts were accrued in 9 ICORG sites between 11/2008 and 7/2010. Ages ranged from 25–75 (median 52). On 20/06/2011, 105 pts have completed study Rx, 1 will finish 7/2011. A total of 36 serious adverse events (SAEs) have been reported so far, 33 involving hospital admission, 3 serious for other reasons. In 25 (24%) pts study Rx was discontinued due to: HTN-9, intestinal perforation-2, consent withdrawl-7, infection-2, proteinuria-1, anaphylaxis-1, cancer relapse-1, arthralgia-1, anal fistula-1. The two perforations occurred at cycles 1 and 16 of Bev respectively. Neither pt with perforation had history of prior abdominal surgery. The median number of cycles achieved by the discontinued pts was 9. HTN of any grade occurred in 49 out of 103 (48%) pts who had no HTN at baseline (BL) and 42 of them required Rx. Among pts who experienced HTN on study Rx and completed Bev, 34 (81%) were still on anti-hypertensive 4 weeks after last infusion of Bev. Forty-one (39%) pts had LVEF drop >10% from BL during study Rx. In 8 (7.5%) pts LVEF declined below 50%, 6 are documented to have recovered to normal, 2 had no further LVEF measurements (1 declined, 1 unknown reason). No episodes of CCF were reported. Troponin and BNP levels were normal in all 57 pts with serial measurements. Fourteen pts required treatment for neutropenia-related infection or for abscess/fistula. Conclusions: In this study Bev overall toxicity in ESBC pts was similar to that reported for pts with MBC, and Bev discontinuation due to toxicity was relatively frequent. Although no pt developed CCF 7.5% of decline in LVEF Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P2-18-04.

Lung inflammation contributes to the pathogenesis of bronchopulmonary dysplasia (BPD) and may be accompanied by a systematic inflammatory response. The objective of this study was to investigate the role of systemic inflammation in the development of BPD in a cohort of extremely low gestational age newborns (ELGANs) by examining the relationships between inflammation-associated proteins in neonatal blood samples and pulmonary outcomes. Proteins were measured in blood specimens collected on postnatal days 1–3, 5–8 and 12–15 from 932 ELGANs. Increased risk of BPD was associated with elevated blood concentrations of a variety of pro-inflammatory cytokines, adhesion molecules and proteases. Reduced risk was prominently associated with increased concentrations of one chemokine, RANTES. Elevations of inflammatory proteins associated with BPD risk occurred during the first days following birth, and inflammation intensified thereafter. Therefore, exposures that promote inflammation after the first postnatal days may be more critical in the pathogenesis of BPD. Fetal growth restriction, a known BPD risk factor, was not accompanied by proteins elevations and therefore does not appear to be mediated by systemic inflammation. By contrast, mechanical ventilation altered protein levels and may be associated with systemic inflammation.

BackgroundNeonatal research, particularly neonatal emergency research is a challenging area, notably in relation to obtaining valid prospective informed consent. The aim of this study is to determine parental perceptions of the consent process involved in performing research in newborn care, to explore methods used to obtain consent and their acceptability to parents.MethodsA parental questionnaire was developed that examined attitudes towards research and hypothetical research studies, in which the acceptability of various methods of consent was examined (informed, waived, deferred). These research scenarios were of varying time sensitivity and perceived risk level. The study setting was an Irish maternity hospital.ResultsThere were 600 responses to the questionnaire. In 93% of cases, parents felt that their involvement in the consent process was essential. In emergency situations, 52% felt full prospective informed consent was necessary; however, almost 28% of parents would feel pressure to consent. Most (75%) parents would prefer to be approached to discuss neonatal research studies antenatally, irrespective of study type and 40% of parents felt that neonates involved in research studies received overall better care. Acceptability of deferred consent was greater than waived, and was highest for the more emergency-based scenarios presented.DiscussionParents feel that they should play a central role in research involving their children. There were differences in the acceptability of various consent methods with strongest agreement for informed consent and lowest agreement for waived consent. Parents were more willing to accede to deferred consent in the cardiopulmonary resuscitation scenario study. These findings provide useful insights to consent strategies in future newborn research studies.

The expression and concentration of follistatin and activin change during oestrous cycle suggesting their involvement in the regulation of follicular development. The aim of this study was to determine the level, source and potential role of follistatin in the sheep ovary. Follistatin in ovarian venous blood, measured by radioimmunoassay, remained at its low level from follicular phase (day -1 and 0) to mid-luteal phase (days 11-13) phase but were significantly elevated during the late luteal phase (days 14 and 15) when corpora lutea underwent regression. Western blot analyses of follicular fluid at day 15 of the cycle showed two strong bands at 42 and 45 kDa and weakly stained bands at 39 and 31 kDa. At day 0, these bands became weaker and the 39 kDa band became undetectable. However, there were no differences in follistatin concentrations between ovaries with and without functional corpus luteum (CL) during the whole luteal phase. In addition, although the ovaries of Booroola ewes normally contain more corpora lutea than those of normal merino ewes, follistatin concentrations in both jugular and ovarian venous blood were similar in Booroola and normal merino ewes. It is concluded that the secretion of follistatin from the ovary is not related to the formation of CL or high ovulation rate of Booroola ewes. The elevation in follistatin concentration in follicular fluid and ovarian blood during late luteal phase may indicate a dual role of follistatin in the luteolysis of existing CL and development of new follicle cohort.

The mechanism by which leptin regulate male reproductive development during postnatal periods remain to be determined. Using immunohistochemistry and reverse transcription-polymerase chain reaction (RT-PCR), we established that leptin is expressed in mouse testis with a cell-type and stage-dependent manner during the postnatal period. In testes of 5-day-old mice, leptin expression was mainly restricted to gonocytes, whereas the immunostaining of leptin was confined to spermatogonia in 10-day-old testes. From Day 20 and onwards, stage-specific expression of leptin was evident in spermatocytes at stages VII-XII of the cycle in the seminiferous epithelium. RT-PCR showed that leptin and its receptor isoforms, Ob-Ra, Ob-Rb, and Ob-Re were all expressed in testes from 5- to 60-day-old mice. The mRNA for Ob-Ra and Ob-Re, but not Ob-Rb or leptin were identified in both immature (14-day-old) and adult (60-day-old) isolated Leydig cells. These results suggest that besides its primary actions at the hypothalamic-pituitary level, leptin has direct effects in the proliferation, differentiation of germ cells and the modulation of testicular steroidogenesis, using both autocrine and paracrine mechanisms.

This study examined the effects of healthcare-associated infectious disease outbreaks on nurses' work in a large acute care hospital in Ontario, Canada.The incidence of healthcare-associated infections has increased. Previous research focuses on epidemiology, healthcare systems, and the economic burden of outbreaks. Few published studies focus on the impact of outbreaks on nurses' work in acute care facilities.Since the severe acute respiratory syndrome epidemic in 2003, combating infectious diseases has become a key issue. Hospitals have implemented measures related to healthcare-associated infections. However, nurses experience challenges in preventing, controlling, and contending with outbreaks.A retrospective exploratory case study approach was used. Data were collected over a 4-month period in 2012. The incidence rates of site-specific HAIs were analysed, and individual interviews were held with 23 bedside nurses and five nurse managers.Five themes emerged from the interviews: comparison of healthcare-associated infections outbreaks; the nature of nurses' work; impact of outbreaks on patient care; innovation and quality control in clinical practice; and increased and expanded IPAC measures. The incidence rates of methicillin-resistant Staphylococcus aureus, Clostridium difficile and vancomycin-resistant enterococci at the study site decreased, but remained above provincial benchmarks. Nurses experienced workload challenges, time pressures and psychological effects stemming from outbreaks and developed various innovations in response. Patient care was also affected.Nurses' work has been impacted by healthcare-associated infectious disease outbreaks. Nursing workloads should be quantified to facilitate the development of guidelines for optimum nurse-patient ratio during outbreaks.A strong evidence-based policy framework is required to address healthcare-associated infectious disease outbreaks. Infection prevention and control guidelines and procedures should be established provincially and nationally. An interdisciplinary approach is essential for the creation of comprehensive and innovative strategies. Nursing research has increased understanding of the implications of infectious diseases in hospitals. Building on the literature, findings from this study can be used to influence policies on the care of patients who have secondary infections. Nurse-driven protocols are important and can lead to the creation of best practice guidelines that can be implemented across settings.

The aim of the present study was to determine the direct cause of the mutation-induced, increased ovulation rate in Booroola Merino (BB) sheep. Granulosa cells were removed from antral follicles before ovulation and post-ovulation from BB (n=5) and WT (n=12) Merino ewes. Direct immunofluorescence measurement of mature cell surface receptors using flow cytometry demonstrated a significant up-regulation of FSH receptor (FSHR), transforming growth factor beta type 1, bone morphogenetic protein receptor (BMPR1B), and LH receptor (LHR) in BB sheep. The increased density of FSHR and LHR provide novel evidence of a mechanism for increasing the number of follicles that are recruited during dominant follicle selection. The compounding increase in receptors with increasing follicle size maintained the multiple follicles and reduced the apoptosis, which contributed to a high ovulation rate in BB sheep. In addition, we report a mutation-independent mechanism of down-regulation to reduce receptor density of the leading dominant follicle in sheep. The suppression of receptor density coincides with the cessation of mitogenic growth and steroidogenic differentiation as part of the luteinization of the follicle. The BB mutation-induced attenuation of BMPR1B signaling led to an increased density of the FSHR and LHR and a concurrent reduction in apoptosis to increase the ovulation rate. The role of BMPs in receptor modulation is implicated in the development of multiple ovulations.

Laser testing assists in identifying the sources of pulse width modulator (PWM) single event effect (SEE) sensitivity and reveals new details of PWM SEE behavior, such as enhanced sensitivity during output switching and delayed onset of latch-up near the single-event latch-up threshold. In combination with analysis to map PWM circuitry in the microchip dies, laser SEE test results provide insights into the mechanisms of the SEE events.

Increasingly, the need to seamlessly link high-level behavioural descriptions of electronic hardware for modelling and simulation purposes to the final application hardware highlights the gap between the high-level behavioural descriptions of the required circuit functionality (considering here digital logic) in commonly used mathematical modelling tools, and the hardware description languages such as VHDL and Verilog-HDL. In this paper, the linking of a MATLAB® model for digital algorithm for implementation on a programmable logic device for design synthesis from the MATLAB® model into VHDL is discussed. This VHDL model is itself synthesised and downloaded to the target Field Programmable Gate Array, for normal operation and also for design debug purposes. To demonstrate this, a circuit architecture mapped from a SIMULINK® model is presented. The rationale is for a seamless interface between the initial algorithm development and the target hardware, enabling the hardware to be debugged and compared to the simulated model from a single interface for use with by a non-expert in the programmable logic and hardware description language use.

Objective: To compare surgical outcomes for laparoscopically-assisted vaginal hysterectomy (LAVH) to total laparoscopic hysterectomy (TLH) and to document the modifications to the technique of laparovaginal hysterectomy which have occurred over the last decade at Flinders Endogynaecology, South Australia, Australia. The method of choice at the start of the decade was LAVH and by the end of the study period it had been superceded by TLH. Sample: Seven hundred and ninety-four consecutive women underwent hysterectomy between January 1992 and December 2001 at Flinders Endogynaecology. This included 424 women who underwent TLH and 370 who underwent LAVH. Methods: Retrospective review of case history notes and manual extraction of data. Main outcome measures: Demographic data including patient age, weight and parity were extracted. Intraoperative complications including ureteric injury, cystotomy, bowel damage or conversion to open procedure were recorded. The rate of non-autologous blood transfusion was recorded and miscellaneous data including length of procedure, estimated blood loss, length of hospitalisation, concomitant procedures carried out and re-admission rates were also recorded. Results: There was a statistically significant reduction in major morbidity in the TLH group when compared to the LAVH group. The lower rate of conversion to laparotomy in the TLH group was statistically significant (3.0 vs 0.9%). A non-significantly higher rate of ureteric injury was observed in the TLH group (0.7 vs 0.3%). Other outcome measures showed a trend toward an improved outcome for TLH but were not statistically significant. This includes a lower rate of bowel injury in the TLH group (0 vs 0.3%), a lower rate of cystotomy in the TLH group (1.4 vs 3.0%) and lower rate in non-autologous blood transfusion in the TLH group (1.2 vs 3.0%). There was a statistically significant reduction in hospital stay from 4.5 days in the LAVH group to 3.4 days in the TLH group. Conclusion: The evolution of laparovaginal hysterectomy from LAVH to TLH over the last 13 years has resulted in improved patient outcomes. Ongoing modification of the technique to ensure ureteric protection must remain a priority.

The circulating concentrations of progesterone, FSH, and follistatin across the estrous cycle and gestation were compared in Australian merino sheep that were homozygous for the Booroola gene, FecB, or were noncarriers. The Booroola phenotype is due to a point mutation in the bone morphogenetic protein receptor 1B. Progesterone concentrations began to rise earlier and were higher in the Booroola ewes than in the noncarriers on most days of the luteal phase but not during the follicular phase of the cycle. Follistatin concentrations remained unchanged across the estrous cycle in both groups of ewes, with no differences between genotypes. FSH concentrations were higher in Booroola ewes than in noncarrier ewes on most days of the estrous cycle, with a significantly higher and broader peak of FSH around the time of estrus. Progesterone concentrations were significantly higher in early and midgestation in Booroola ewes but were lower toward the end of gestation than those in noncarriers. FSH declined in both groups across gestation, with lower concentrations of FSH in Booroola ewes during midgestation. Follistatin remained unchanged across gestation in Booroola ewes and noncarrier ewes with a twin pregnancy but declined across gestation in noncarrier ewes with a singleton pregnancy. These results suggest that follistatin concentration is not regulated by the FecB gene during the estrous cycle and pregnancy but is influenced by the number of fetuses. However, the FecB gene appears to positively affect both progesterone and FSH during the estrous cycle and across pregnancy, which suggests that bone morphogenetic proteins play an important role in the regulation of both hormones.

Numerical simulations of wedge impact experiments, undertaken by the Naval Surface Warfare Center, Carderock Division, NSWCCD, and more recently by the United States Naval Academy, USNA, Hydromechanics Laboratory, were performed using the computational fluid dynamics code Numerical Flow Analysis, NFA, to assess its capabilities in simulating the short duration hydrodynamic loading associated with free-surface impact. NSWCCD performed experiments using drop heights of 15.24 cm (6 in) and 25.4 cm (10 in), while the Naval Academy used drop heights of: 7.94, 12.7, 15.88, 25.4, 31.75, 38.1, and 50.8 cm (3.125, 5.0, 6.25, 10.0, 12.5, 15.0, and 20.0 in), measured from the keel of the wedge to the calm water surface. Simulations and comparisons were made at heights of 15.24 cm (6 in) and 25.4 cm (10 in) with the NSWCCD data, and 12.5 inches for the USNA data providing for a detailed examination of NFA’s ability to simulate and predict short duration hydrodynamic impacts.Copyright © 2014 by ASME

To define the role of routine cystoscopy following laparoscopically assisted hysterectomy in the early detection of ureteric injuries. A retrospective observational study based on casenote review. A consecutive series of 436 women who underwent routine video cystoscopy after intrafascial laparoscopically assisted hysterectomy, with or without bilateral salpingo-oophorectomy. In 436 cystoscope evaluations, six cases aroused suspicion of a ureteric injury. Subsequent evaluation confirmed injury in two of these cases. A further two cases were not suspected on cystoscopic grounds but were detected in the early postoperative period. One ureteric injury was associated with endoscopic staples, two with electrosurgery and one with the harmonic scalpel. The staple injury was suspected clinically during the operative procedure; the remainder were not. Routine cystoscopy at intrafascial laparoscopically assisted hysterectomy has not contributed to the early diagnosis and treatment of ureteric injuries sustained with the authors' current technique. Thus cystoscopy ought to be done selectively according to clinical intraoperative concern. The distal pelvic ureter should be routinely inspected for dilatation, via peritoneal windows, at the end of the hysterectomy. Every endogynaecologist should review their data on cystoscopy and ureteric injuries associated with laparoscopically assisted hysterectomy to ascertain whether cystoscopy is justifiable in their practice, and whether surgical techniques need to be modified to enhance ureteric protection.

Objective To review complications of laparoscopic hysterectomy occurring in a citywide population of approximately 1 million people. Design All laparoscopic hysterectomy cases were analysed retrospectively independently of the surgeons involved. Setting All private and public hospitals (n = 19) in metropolitan Adelaide, South Australia. Subjects 1904 patients over the period 1991–98. Interventions The majority of cases involved a combined laparoscopic and vaginal approach with a proportion of total laparoscopic hysterectomies (n = 33). Surgical techniques involved both staples and diathermy. Main outcome measures Rates of major complications such as haemorrhage, haematoma formation, laparotomy and urinary tract injury. Results Significant haemorrhage occurred in 3.7% (n = 70) of cases with a haematoma incidence of 3.2% (n = 60). Laparotomy rates reduced from 5% (1991–93) to 1.7% (1996–98) with an overall incidence of 3.4% (n = 64). Overall urinary tract injury rates remained constant over the survey period, i.e. 3.3% (1991–93) vs. 3.1% (1996–98). However there was a significant reduction in ureteral damage but this was countered by an increasing cystotomy rate. Conclusions Laparotomy rates were comparable to those in published data but reduced significantly over the audit period. The incidence of haematoma formation was significantly greater than that in published data, but reduced over the period 1991–98. Urinary tract damage and haemorrhage exceeded expectations. This audit once again has suggested that the true rate of major complications with laparoscopic hysterectomy is higher than the literature suggests.

Objective To compare outcomes in women undergoing total laparoscopic hysterectomy performed with the assistance of a colpotomizing tube (TLTH), with those in women in whom a laparoscopically assisted hysterectomy (LAH) procedure was performed. Design A retrospective review of consecutive patients. Setting State health service patients were treated at Flinders Medical Centre, Adelaide, South Australia, and private patients were treated by the same surgeons in three private hospitals in metropolitan Adelaide. Subjects A total of 227 women who underwent operation between January 1996 and August 1999. Interventions The women involved in the first two years of this study exclusively underwent an LAH, whilst those in the latter 18 months underwent a TLTH. Main outcome measures These included intraoperative complications, including significant haemorrhage, ureteric, bladder, vascular and bowel injury; postoperative complication rates for vault infection, late bowel and ureteric injury, and miscellaneous febrile morbidity. Also documented were the operating time, nonautologous blood transfusion, operation–discharge interval, and readmission with a complication. Results The women having the TLTH procedure had significantly fewer intraoperative complications (χ2 = 8.07, P = 0.004) in comparison with the LAH group; postoperative complications were not statistically different. The mean operating times and readmission rates with surgical complications were equivalent for the two groups. The hospital stay was shorter by 1.5 days for the women having a TLTH (t = 8.39, P

Seasonal changes in the physiology of Antechinus stuartii result in complete male mortality after mating. The most important endocrine changes in males are large rises in plasma testosterone and cortisol concentrations. Glomerular filtration rate (GFR) in males declines coincident with high plasma testosterone and cortisol. In the present study GFRs were measured in males captured in May (when endogenous plasma testosterone and cortisol levels are low) and given depot injections of either saline, testosterone-only, cortisol-only or testosterone plus cortisol at doses designed to mimic plasma levels during the mating period. GFR decreased significantly with testosterone injection, independent of cortisol treatment. Urinary concentrations of sodium and chloride, and osmolality decreased significantly with cortisol treatment, although the addition of testosterone reversed the effect. Total urinary excretion of electrolytes was similar between groups. Plasma potassium levels significantly increased in testosterone plus cortisol treated males. Plasma sodium levels significantly increased and plasma chloride significantly decreased in all groups treated with cortisol. Water consumption significantly increased in all cortisol-treated males and food consumption significantly increased in all testosterone-treated males. The seasonal renal functional changes observed in A. stuartii were mimicked by testosterone administration.

This article examines the origins of some of the sources of information upon which the Great Powers relied when determining their policies regarding Kurdistan. The nineteenth and early twentieth centuries were an unparalleled period in the European exploration and study of Kurdistan, and the volume of work was to inform European agents both during, and perhaps more crucially, after the First World War. The article examines some of the reasons for European interest in Kurdistan, the nature of research and intelligence gathering in the region, and the significance of the personalities involved. The personalities of writers, as well as their purposes, affected both their own views and also the ways in which those views influenced external policies towards the Kurds. The difficulties inherent in examining ‘British’ policy in the region are also explored, given that British policy was both fluid and multi‐faceted.