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Objective To evaluate efficacy of the Elevate Anterior and Apical (EAA) in the repair of pelvic organ prolapse (POP) when performed after previous hysterectomy and with or without uterine preservation during POP surgery. Materials and methods One hundred forty-two women with anterior vaginal prolapse and/or apical descent ≥ stage II were enrolled. The primary outcome was treatment failure defined as > stage II POP-Q during follow-up using the Last observed Failure Carried Forward method. Three sub-groups were analysed: baseline previous hysterectomy (N = 61); concomitant hysterectomy (N = 29), and preserved uterus/no hysterectomy (N = 51). Demographics, primary and secondary outcomes, and extrusion were compared between the groups. A P value less than 0.05 was considered statistically significant. Results Anatomic success shows significant and durable improvement at 24 months. The success for the apical compartment ranged between 93.8% and 100%. Success was slightly lower for the anterior compartment (70.8-89.1%). No statistically significant difference between the 3 subgroups. Age was the only patient characteristic to be found different between the 3 subgroups. In addition, there was no difference in overall intraoperative complications (P = 0.263). Mesh extrusion was found in all groups: 3 of 61 (4.9%) had previous hysterectomy; 4 of 29 (13.8%) had concomitant hysterectomy; and 1 of 51 (2.0%) had uterus preserved (P = 0.094). There appears to be a trend toward higher extrusion when a hysterectomy was performed with the EAA. Conclusions Anatomic success and complications for the EAA do not appear to be significantly impacted when the uterus is removed before or during surgery or preserved. There may be a trend toward increased mesh extrusion when a hysterectomy is performed. However, larger cohort studies are needed to determine if concomitant hysterectomy impact extrusion.

The present recommendations of Australian Rainfall & Runoff (AR&R) for design flood estimation involve the estimation of a flood discharge of given ARI from a storm burst of comparable ARI, with minimal consideration of the impact of lead rainfall on burst response. While losses can be modified to reflect conditions likely at commencement of the design burst, pre-burst flow and storage are much more difficult to estimate and are mostly ignored when applying this procedure. This paper quantifies the likely magnitude of errors arising from omission of lead rainfall from the AR&R procedure. A design flood estimation procedure based on historic storms, rather than storm bursts, is recommended to address uncertainty in the AR&R procedure, and to more realistically simulate historic flooding. An Embedded Design Storm procedure is described meeting this need.

The paper describes experiments on the generation and transport of a low energy (70–120 keV), high intensity (10–30 A/cm2) microsecond duration H+ ion beam (IB) in vacuum and plasma. The IB was generated in a magnetically insulated diode (MID) with an applied radial B field and an active hydrogen-puff ion source. The annular IB, with an initial density of ji∼10–20 A/cm2 at the anode surface, was ballistically focused to a current density in the focal plane of 50–80 A/cm2. The postcathode collimation and transport of the converging IB were provided by the combination of a “concave” toroidal magnetic lens followed by a straight transport solenoid section. With optimized MID parameters and magnetic fields in the lens/solenoid system, the overall efficiency of IB transport at the exit of the solenoid 1 m from the anode was ∼ 50% with an IB current density of 20 A/cm2. Two-dimensional computer simulations of post-MID IB transport supported the optimization of system parameters.

Numerous approaches to the production of intense beams of highly charged heavy ions are compared and contrasted. The competing processes of ionization and electron capture are described and evaluated to explore ways to further improve upon the encouraging recent results from electron-beam (E-MEVVA) and low-impedance Z-discharge (LIZ-MeV) variations on the venerable metal vapor vacuum arc (MEVVA) ion source.

A sensitive fluorescence resonance energy transfer method was developed for the direct measurement of the dissociation constants of stromelysin inhibitors. The method is applied to the thiadiazole class of stromelysin inhibitors and it takes advantage of the fact that, upon binding to the active site of enzyme, the thiadiazole ring, with its absorbance centered at 320 nm, is able to quench the fluorescence of the tryptophan residues surrounding the catalytic site. The changes in fluorescence are proportional to the occupancy of the active site: Analysis of the fluorescence versus inhibitor concentration data yields dissociation constants that are in agreement with the corresponding competitive inhibitory constants measured by a catalytic rate assay. The affinity of nonthiadiazole inhibitors of stromelysin—such as hydroxamic acids and others—can be determined from the concentration-dependent displacement of a thiadiazole of known affinity. Using this displacement method, we determined the affinities of a number of structurally diverse inhibitors toward stromelysin. Since the three tryptophan residues located in the vicinity of the active site of stromelysin are conserved in gelatinase and collagenase, the method should also be applicable to inhibitors of other matrix metalloproteinases.

The flood hydrograph model WBNM calculates flood runoff from rainfall hyetographs. It divides the catchment into subcatchments, thus allowing hydrographs to be calculated at various points within the catchment, and spatial variability of rainfall and rainfall losses to be modelled. It separates overland flow routing from channel routing, thus allowing changes to either or both of these processes, for example in urbanising catchments. The computer program for WBNM contains many useful features for flood studies, including built in design storms, runoff from impervious and pervious catchment surfaces, flood routing through storage reservoirs, built in culvert and weir hydraulics, and diversion of surcharging flows. The program is menu driven and designed to satisfy quality assurance requirements. Full graphics displays are included.

132 Background: In response to the FDA safety communication we banned the use of intracorporeal morcellation effective April 22nd 2014. Clinicians expressed frustration and a concern that an increase in the abdominal hysterectomy rate or percentage, wound complications, and length of stay would occur. Our PDCA (plan, do, check, and act) safety process reviewed these quality and safety metrics one year later. Methods: This is a retrospective evaluation of a prospective institutional decision. Data evaluated in a patient anonymous fashion using Crimson and Optum quality reporting software. Results: In 2013 the power morcellator was used in 157 cases. In the twelve months following the ban, the wound complication rate, SSI's, and LOS all decreased, and vaginal hysterectomy rate increased. Conclusions: An institutional ban of intracorporeal and power morcellation resulted in a decrease in the overall number of hysterectomies, including abdominal hysterectomy. Laparoscopic supracervical hysterectomy was replaced by vaginal hysterectomy and an associated decrease in complications and length of stay. [Table: see text]

The objective of this study was to assess the safety and efficacy of the Elevate Apical and Posterior single-incision mesh system (SIMS) with IntePro Lite for pelvic organ prolapse repair. This prospective multicenter study included 139 women with a parts per thousand yen stage II posterior vaginal prolapse and/or apical descent who underwent placement of type I polypropylene mesh through a single transvaginal incision with no external needle passes. Primary endpoint was the percent of patients with posterior and/or apical stage a parts per thousand currency sign I ("cure") at follow-up. Secondary endpoints included, but were not limited to, rate of mesh extrusion and disease-specific quality of life outcomes. At 12 months, objective posterior wall and apical cure rates were 92.5 and 89.2 %, respectively, with an extrusion rate of 6.5 %. The SIMS appears to be effective and safe in treating patients with posterior vaginal and/or apical prolapse. The risks and benefits of transvaginal synthetic mesh insertion should be considered

The low inductance Z-discharge metal vapor (LIZ-MeV) ion source, which uses a magnetized Z-pinch, is a pseudo-spark device capable of producing intense currents (several kA) of highly chargedgold or other ions. Typical operations produce an extracted charge-state distribution with a range in gold ion charge state from 4 to 19. Time-of-flight (TOF) spectra (excluding contributions from impurities) indicate that charge states at least as high as Au +12 were generated. Various TOF spectra are presented here to support this conclusion. Although the results are preliminary, LIZ-MeV shows great potential. Existing heavy-ion sources can produce either high beam currents, but low charge states (e.g., the metal-vapor vacuum arc) or high charge states, but low beam currents (e.g., the electron beamion source). For ion beam injection our goal has been to develop an ion source that produces both high charge states and high beam currents. The existing LIZ-MeV has sufficiently large electron impact energies and electron current densities, but performance is limited by charge exchange with ambient gas and short confinement times. Plans are underway to add another Z-pinch stage to both lengthen confinement times and to minimize charge-state reducing processes. Such an enhanced LIZ-MeV should eventually produce even larger currents of more highly ionized heavy metal ions for accelerator applications.

OBJECTIVE To compare outcomes of anterior colporrhaphy alone to that reinforced with bovine pericardium graft. METHODS Women with anterior vaginal wall prolapse were enrolled in a randomized fashion in this grafted compared with nongrafted repair study. Outcome measures included pelvic organ prolapse quantification data, quality-of-life assessment, healing abnormalities, and complications. RESULTS Ninety-four patients were enrolled. Seventy-two (77%) provided 1-year data, and 59 (63%) supplied 2-year data. Demographics and stage of prolapse were similar between groups at baseline. Postoperative complications consisted basically of low urinary tract infection and were low in both groups (10 in bovine pericardium graft and 16 in anterior colporrhaphy alone). One year after surgery, successful anterior vaginal wall support was obtained in 85.7% of the bovine pericardium graft group and 78.4% of anterior colporrhaphy-alone group (P=.544). For the cohort that comprised 2-year analyses, the success rate was 76.5% for the bovine pericardium graft group and 63% for anterior colporrhaphy-alone group (P=.509). Postoperative Urogenital Distress Inventory-6 and Pelvic Organ Prolapse-Urinary Incontinence Sexual Function Questionnaire-12 scores were uniformly improved over baseline in both groups. CONCLUSION The use of bovine pericardium graft for anterior vaginal prolapse does not have higher complication rates or healing difficulties. At 1- and 2-year follow-up, anterior colporrhaphy with bovine pericardium reinforcement did not show a statistically significant improvement over colporrhaphy alone. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, www.clinicaltrials.gov, NCT00860912 LEVEL OF EVIDENCE I.

A two-fold (C2) symmetric inhibitor of the protease of human immunodeficiency virus type-1 (HIV-1) has been designed on the basis of the three-dimensional symmetry of the enzyme active site. The symmetric molecule inhibited both protease activity and acute HIV-1 infection in vitro, was at least 10,000-fold more potent against HIV-1 protease than against related enzymes, and appeared to be stable to degradative enzymes. The 2.8 angstrom crystal structure of the inhibitor-enzyme complex demonstrated that the inhibitor binds to the enzyme in a highly symmetric fashion.

Research has demonstrated a close relationship between verbal short-term (STM) and working memory (WM) and receptive language in children (Baddeley, Gathercole, & Papagno, 1998; Ellis & Sinclair, 1996). Few studies have examined the relationship between memory and language production, and these studies focus on STM only. Though correlations have been found between verbal STM and production, the nature of the correlations are unclear. The current study examined the possibility that receptive language mediates the relationship between memory and language production. Children between 3;0 and 5;11 were administered tests assessing receptive vocabulary, receptive grammar, expressive vocabulary, verbal STM, and verbal WM. Additionally, transcripts from free-play sessions were used to assess grammar production. A regression based analytic approach revealed STM and WM mediate the relationship between receptive language and productive language. The existence of these mediated relationships are discussed in relation to the role of working memory in the speech output buffer.

Summary form only given. This paper extends earlier studies, on the transport of intense, wide cross-section neutralized H/sup +/ plasma (PB) and ion beams (IB) with translational energies in the range of /spl sim/0.1 to /spl sim/100 keV, respectively, through various combinations of vacuum, ambient plasma and/or transverse B-fields ranging from 0.1 to 1.6 kG. Particle densities and temperatures for the ambient plasma and PB were of the same order in magnitude (/spl sim/10/sup 13/ cm/sup -3/ and a few eV) while the IB was two orders lower in density and more than one order higher in temperature (/spl sim/10/sup 11/ cm/sup -3/ and hundreds of eV). For the PB, depending on the B-field strength, the ratio of beam width to Larmor radius, d/R, ranged from 1 to 10 and the ratio of beam energy density to B-field pressure, /spl beta/, ranged from 10/sup -2/ to 1. For the IB, these values ranged from 10/sup -1/ to 1 and 10/sup -1/ to 10, respectively. Based on the transport criteria used in, at low B-fields (/spl les/0.4 kG) in vacuum, the PB was mainly diamagnetic, whereas for higher B-fields (/spl ges/0.6 kG), the PB propagated by ExB drift with pronounced peripheral layer loss and beam "braking" due to virtual anode formation. Slowing down of the PB front caused the beam to bunch and consequently the density of the central part of the PB increased by more than one order in magnitude. In the case of the IB, similar peripheral beam loss was not accompanied by beam braking or the enhancement of its central part indicating an ExB mechanism of transport without the formation of a virtual anode. The propagation of the IB in ambient plasma across B-field agrees with the picture of efficient shorting of the polarization E-field with subsequent beam deflection corresponding to a one-particle orbit of an H/sup +/ with respective average beam energy. Differing from this picture, the PB in similar conditions propagated without any noticeable deflection, though bunching and "pealing off" was much less pronounced compared with its propagation in vacuum. A possible cause for this dissimilarity may be insufficient ambient plasma density for the PB and therefore an incomplete shorting of the polarization E-field.

Summary form only given, as follows. Streak measurement of the inverse Brumstrahlun absorption of the laser light in a Z-pinch provides information about the stability and temperature evolution of a high density pinch with high time and spatial resolutions. Our experiment uses the UCI staged pinch with peak parameters: 50 kV, 63 kJ, 1.7 msec rise time, and 2 MA maximum current. A 20 mW He-Ne laser (633 nm, single mode) backlights the plasma and a Hamammatsu 1370 streak-camera records the image. A double cylindrical lens collimator before the plasma increases the probe light intensity which is focused to a 1 mm line in the midplane of the pinch. A 10 mm filter and narrow slit placed at the light focus reduces the influence of plasma self-luminosity, these shots were accompanied by a two frame nitrogen laser shadow pictures, (/spl lambda/=337 nm). These images were separated in time by /spl sim/15 ns, with /spl sim/1 ns exposure.

Recently substantial enhancement of high ion charge states was clearly observed in both the HCEI and ITEP E-MEVVA ion sources. These experimental setups have two different methods of measuring the ion charge state distributions. The results can be considered as a proof of the E-MEVVA principle. These results sparked discussions regarding which physics effects are dominant. Basic physics seems straightforward, an ion charge state in E-MEVVA is determined by the number of collisions with fast electrons versus the number of encounters with neutrals and lower charge state ions during an ion dwell time in the drift channel. However, the fluxes of fast electrons, lower charge state ions, and neutrals encountered by an ion may be a consequence of numerous effects. Factors determining neutral fluxes might be poor vacuum conditions, desorption of adsorbed gas by the electron beam directly or indirectly due to stacking (E-beam reflection) and/or instabilities that cause heating and desorption. Flux and energy of the fast electrons is primarily determined by the electron gun output. But significant contributions from electron beam stacking, instabilities, as well as plasma electron heating, are possible. The various contributions are evaluated to account for past results and to guide future progress.

Objective We sought to assess the efficacy and safety of 2 dosing regimens of a novel, oral tranexamic acid formulation (Lysteda; Ferring Pharmaceuticals Inc, Parsippany, NJ) in women with cyclic heavy menstrual bleeding. Study Design This was a multicenter, double-blind, placebo-controlled, randomized, parallel-group trial for 3 menstrual cycles (n = 304). Women with mean menstrual blood loss (MBL) of ≥80 mL/cycle were randomized to receive either 1.95 g/d or 3.9 g/d of tranexamic acid or placebo for up to 5 days of menstrual bleeding. Primary efficacy endpoints were mean MBL reduction from baseline, mean MBL reductions that were considered "meaningful" by subjects, and mean MBL reductions from baseline >50 mL/cycle. Adverse events (AEs) were also assessed. Results Only the 3.9 g/d group met all 3 primary efficacy endpoints. AEs did not significantly differ among the 3 groups. There were no serious study-related AEs. Conclusion The 3.9-g/d dose met all 3 primary efficacy endpoints, whereas the 1.95 g/d dose met 2 primary efficacy endpoints. Both doses were well tolerated.