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Available soil moisture is thought to be the limiting factor for most ecosystem processes in the cold polar desert of the McMurdo Dry Valleys (MDVs) of Antarctica. Previous studies have shown that microfauna throughout the MDVs are capable of biological activity when sufficient soil moisture is available (~2–10% gravimetric water content), but few studies have attempted to quantify the distribution, abundance, and frequency of soil moisture on scales beyond that of traditional field work or local field investigations. In this study, we present our work to quantify the soil moisture content of soils throughout the Fryxell basin using multispectral satellite remote sensing techniques. Our efforts demonstrate that ecologically relevant abundances of liquid water are common across the landscape throughout the austral summer. On average, the Fryxell basin of Taylor Valley is modeled as containing 1.5 ± 0.5% gravimetric water content (GWC) across its non-fluvial landscape with ~23% of the landscape experiencing an average GWC > 2% throughout the study period, which is the observed limit of soil nematode activity. These results indicate that liquid water in the soils of the MDVs may be more abundant than previously thought, and that the distribution and availability of liquid water is dependent on both soil properties and the distribution of water sources. These results can also help to identify ecological hotspots in the harsh polar Antarctic environment and serve as a baseline for detecting future changes in the soil hydrological regime.

The species-area relationship (SAR) has over a 150-year long history in ecology, but how its shape and origins vary across scales and organisms is still not fully understood. This is the first subcontinental freshwater study to examine both properties of the SAR in a spatially explicit way across major organismal groups (diatoms, insects, and fish), differing in body size and dispersal capacity. First, to describe the SAR shape, we evaluated the fit of three commonly used models, logarithmic, power, and Michaelis-Menten. Second, we proposed a hierarchical framework to explain the variability in the SAR shape, captured by the parameters of the SAR model. According to this framework, scale and species group were the top predictors of the SAR shape, climatic factors (heterogeneity and median conditions) represented the second predictor level, and metacommunity properties (intraspecific spatial aggregation, γ-diversity, and species abundance distribution), the third predictor level. We calculated the SAR as a sample-based rarefaction curve using 60 streams within landscape windows (scales) in the US, ranging from 160,000 to 6,760,000 km

Biological invasion and environmental change pose major threats to ecosystems. While long‐term ecological change is commonly evaluated through sediment cores in lakes, it is generally not feasible for smaller ponds, and spatial resolution is limited. Here, we analyze pond diatom communities collected during Shackleton's Nimrod expedition at Cape Royds, Antarctica, to compare with the same waterbodies a century later. We find historical samples to be almost identical to modern counterparts, and provide no evidence of exotic introductions despite increasing human activity. However, a shift occurred in the pond nearest Shackleton's hut, Pony Lake, which was dominated by Luticola muticopsis a century ago, and was replaced by Craspedostauros laevissimus. Both are endemic species previously and currently present at Cape Royds, and we hypothesize that a shift in conductivity accompanying changing precipitation patterns may be responsible. Collectively, these results provide important data for assessing human and climate impacts among Antarctic lacustrine habitats.

We use correlative field studies and high-resolution multispectral remote sensing data from the WorldView-2 instrument to estimate the abundance of photosynthetically active biomass (photoautotroph...

\ₑprint: https://onlinelibrary.wiley.com/doi/pdf/10.1111/oik.08517; International audience; There is increasing interest in measuring ecological stability to understand how communities and ecosystems respond to broad-scale global changes. One of the most common approaches is to quantify the variation through time in community or ecosystem aggregate attributes (e.g. total biomass), referred to as aggregate variability. It is now widely recognized that aggregate variability represents only one aspect of communities and ecosystems, and compositional variability, the changes in the relative frequency of species in an assemblage, is equally important. Recent contributions have also begun to explore ecological stability at regional spatial scales, where interconnected local communities form metacommunities, a key concept in managing complex landscapes. However, the conceptual frameworks and measures of ecological stability in space have only focused on aggregate variability, leaving a conceptual gap. Here, we address this gap with a novel framework for quantifying the aggregate and compositional variability of communities and ecosystems through space and time. We demonstrate that the compositional variability of a metacommunity depends on the degree of spatial synchrony in compositional trajectories among local communities. We then provide a conceptual framework in which compositional variability of 1) the metacommunity through time and 2) among local communities combine into four archetype scenarios: spatial stasis (low/low), spatial synchrony (high/low), spatial asynchrony (high/high) and spatial compensation (low/high). We illustrate this framework based on numerical examples and a case study of a macroalgal metacommunity in which low spatial synchrony reduced variability in aggregate biomass at the metacommunity scale, while masking high spatial synchrony in compositional trajectories among local communities. Finally, we discuss the role of dispersal, environmental heterogeneity, species interactions and suggest future avenues. We believe this framework will be helpful for considering both aspects of variability simultaneously, which is important to better understand ecological stability in natural and complex landscapes in response to environmental changes.

This clinical consensus statement on vaginal energy-based devices (EBDs) reflects an update by content experts from the American Urogynecologic Society's EBD writing group. In 2019, the American Urogynecologic Society's EBD writing group used a modified Delphi process to assess statements that were evaluated for consensus after a structured literature search. A total of 40 statements were assessed and divided into 5 categories: (1) patient criteria, (2) health care provider criteria, (3) efficacy, (4) safety, and (5) treatment considerations. Of the 40 statements that were assessed, 28 reached consensus and the remaining 12 did not. Lack of evidence was among the main reasons that vulvovaginal EBD treatment statements did not reach consensus. In March 2022, these statements were reassessed using the interim literature.

The relationship between biodiversity and stability, or its inverse, temporal variability, is multidimensional and complex. Temporal variability in aggregate properties, like total biomass or abundance, is typically lower in communities with higher species diversity (i.e., the diversity-stability relationship or DSR). Recent work has shown that, at broader spatial extents, regional-scale aggregate variability is also lower with higher regional diversity (in plant systems) and with lower spatial synchrony. However, it is not yet clear whether regional DSRs hold across a broad range of organisms and ecosystem types. Furthermore, focusing exclusively on aggregate properties of communities may overlook potentially destabilizing compositional shifts. To test these questions, we compiled a large collection of long-term spatial metacommunity data spanning a wide range of taxonomic groups (e.g., birds, fish, plants, invertebrates) and ecosystem types (e.g., deserts, forests, oceans). We applied a newly developed quantitative framework for jointly analyzing aggregate and compositional variability across scales. We quantified DSRs for composition and total abundance in local communities and metacommunities. At the local scale, compositional DSRs suggested that higher local (α) diversity was associated with lower variability in animal populations but higher variability in plant populations, while aggregate DSRs supported the classic stabilizing effects of diversity. Spatial synchrony differed among taxa (birds had the lowest, plants the highest), suggesting differences in stabilization by spatial processes. Spatial synchrony declined with higher diversity among sites (β) for both compositional and aggregate properties. However, at the regional (γ) scale, we found no aggregate DSR, but a positive compositional DSR. Across a broader range of taxa, our results suggest that high γ-diversity does not consistently stabilize aggregate properties at regional scales without sufficient spatial β-diversity to reduce spatial synchrony.Open research statementAll data sets are accessible via the Environmental Data Initiative, and a specific data package of the data sets used in this analysis will be made publicly available (doi: pending). Citations to original sources are included in Appendix S1. Code to reproduce the analyses is found in a Zenodo archive (doi: pending) of the GitHub repository for this project (https://github.com/sokole/ltermetacommunities/tree/master/Manuscripts/MS3).

Data on long-term mesh hysteropexy outcomes are limited. This study provides 7-year data from the original VAULT (Vaginal and Laparoscopic Mesh Hysteropexy for Uterovaginal Prolapse Trial) study.The aim of this study was to compare long-term outcomes and success for laparoscopic sacral hysteropexy (LSHP) and vaginal mesh hysteropexy (VMHP).This multicenter, prospective parallel cohort was an extension to the initial VAULT study. Subjects were contacted, and informed consent was obtained. We collected baseline demographics and the latest Pelvic Organ Prolapse-Quantification examination data from chart review and conducted telephone interviews to update demographic information and collect Pelvic Floor Distress Inventory Short-Form, Patient Global Impression of Improvement, prolapse reoperation/pessary use, and complications. Surgical success was defined as no bulge symptoms, satisfaction score of "very much better" or "much better," and no reoperation/pessary use.Five of 8 original sites enrolled 53 subjects (LSHP n = 34 and VMHP n = 19). The LSHP group was younger (67 vs 74, P0.01), but there were no differences in parity, body mass index, menopause, race, insurance, tobacco use, or Charlson Comorbidity Index. The median subjective follow-up was 7.3 ± 0.9 years. Composite success was 82% LSHP versus 74% VMHP. Pelvic Floor Distress Inventory Short-Form composite scores were similar at baseline and improved for both groups (P0.01) with lower bother observed in the LSHP group (20.8 vs 43.8, P = 0.01). There were no differences in complications.Over 7 years after surgery, LSHP and VMHP have high success, low retreatment, and low complication rates that did not differ between groups. Although there is a trend toward better anatomic support in the LSHP group, these findings were not significant and we are underpowered to detect a difference.

Our primary objectives were to compare < 30-day postoperative complications and RP recurrence rates after RP-only surgery and combined surgery. Our secondary objectives were to determine preoperative predictors of < 30-day complications and RP recurrence. A prospective IRB-approved cohort study was performed at a single tertiary care center from 2017 to 2020. Female patients with symptomatic RP underwent either RP-only surgery or combined surgery based on the discretion of the colorectal and FPMRS surgeons. Primary outcome measures were < 30-day complications separated into Clavien-Dindo (CD) classes and rectal prolapse on physical examination. Seventy women had RP-only surgery and 45 had combined surgery with a mean follow-up time of 208 days. Sixty-eight percent underwent abdominal RP repair, and 32% underwent perineal RP repair. Twenty percent had one or more complications, 14% in the RP-only group and 29% in the combined surgery group (p = 0.06). On multivariate analysis, combined surgery patients had a 30% increased risk of complications compared to RP-only surgery patients (RR = 1.3). Most of these complications were minor (14/17, 82.4%) and categorized as CD I or II, including urinary retention and UTI. Twelve percent of this cohort had RP recurrence, 11% in the RP-only group and 13% in the combined surgery group (p = 0.76). Preoperative risk factors for RP recurrence included a primary complaint of rectal bleeding (RR 5.5) and reporting stools consistent with Bristol Stool Scale of 1 (RR 2.1). Patients undergoing combined RP + POP surgery had a higher risk of complications and equivalent RP recurrence rates compared to patients undergoing RP-only surgery.

The objective was to perform a cost-effectiveness analysis of posterior repair performed at the time of sacrocolpopexy (SCP).We used TreeAge Pro to construct a decision model comparing laparoscopic hysterectomy with SCP with and without concurrent posterior repair (SCP and SCP + PR). Using a time horizon of 1 year, we modeled prolapse recurrence, prolapse retreatment, and complications, including rectal injury, rectovaginal hematoma requiring surgical take-back, and postoperative dyspareunia. Costs included index surgery, surgical retreatment, and complications. We modeled effectiveness as quality-adjusted life years (QALYs). Cost-effectiveness was defined using the incremental cost-effectiveness ratio and willingness to pay of $100,000/QALY. Sensitivity analyses were performed.Sacrocolpopexy was the dominant strategy with a cost of $65,714 and an effectiveness of 0.84. It was cost-effective at willingness to pay threshold less than $100,000/QALY. The SCP + PR costs more ($75,063) with lower effectiveness (0.83). The effectiveness of the 2 strategies was similar, differing only by 0.01 QALY, which is less than the minimally important difference for utilities. Tornado plots showed CEA results were most influenced by the cost of SCP, cost of SCP + PR, and probability of dyspareunia after SCP. In 1-way sensitivity analyses, the model outcome would change only if the cost of SCP was increased by 12.8% or if the cost of SCP + PR decreased by 14.5%. For dyspareunia, our model would only change if the probability of dyspareunia after SCP alone was 75.9% (base case, 18.6%), whereas the probability of dyspareunia after SCP + PR was 26.8%.In this cost-effectiveness analysis, SCP without concurrent PR was the dominant strategy.

Objectives Energy-based devices have gained momentum as minimally invasive procedures to treat both medical and cosmetic pelvic floor disorders including genitourinary syndrome of menopause, vaginal laxity, stress urinary incontinence, dyspareunia, and vulvar disorders such as lichen diseases and vestibulitis. However, the FDA recently issued a statement cautioning patients and providers that the safety and efficacy of energy-based devices for the treatment of vaginal symptoms has not been well established. Additionally, the FDA sent letters to the manufactures of energy-based devices with notifications that they could be violating the marketing standards of the FDA. The existing data on side effects is insufficient and limited to observational studies. We sought to characterize the safety events of vaginal energy-based devices by analysis of surveillance data from the FDA Manufacturer and User Facility Device Experience (MAUDE) database and specifically look at those events that occurred prior to the July 30, 2018 warning. Methods The MAUDE database was queried between September 30, 2013 and October 31, 2019 for all vaginal energy-based devices. The incidence of safety events was reported for these devices and the most common complaints were described and characterized. Event reporting was analyzed before and after July 30, 2018. Results Forty-two unique and relevant medical device reports (MDRs) were retrieved. The Mona Lisa Touch had the highest number of MDRs (40.5%) followed by ThermiVa (16.7%) and Viveve (14.2%). Each medical device report was associated with a single patient experience and within the 42 medical device reports, there were 85 complaints. A majority of the MDR complaints (52.9%) were also indications for energy-based devices procedures, which include vaginal pain, dyspareunia, lichen sclerosis, and urinary frequency. Two-thirds of the complaints (68.2%) were related to pain, but serious adverse events such as third-degree burns (3.5%) were rare. Most of the reportable events occurred before July 30, 2018 (83.3%), but most were reported after July 30, 2018 (78.6%). Conclusions MAUDE-reported data suggests that the majority of patient complaints after vaginal energy-based device treatment include vaginal pain, bladder pain, and urinary symptoms. This study suggests that the majority of complaints are not severe, and some may be related to progression of the disease. The few severe adverse events reported in the MAUDE database may have contributed to the FDA warning regarding energy-based devices. Recall bias after the FDA warning, as well as the potential for litigation, may have prompted an increase in adverse event reporting after July 30, 2018. : Video Summary:http://links.lww.com/MENO/A650.

Cyanobacterial mat communities are the main drivers of primary productivity in the McMurdo Dry Valleys, Antarctica. These microbial communities form laminar mats on desert pavement surfaces adjacent to glacial meltwater streams, ponds, and lakes. The low-density nature of these communities and their patchy distribution make assessments of distribution, biomass, and productivity challenging. We used satellite imagery coupled with in situ surveying, imaging, and sampling to systematically estimate microbial mat biomass in selected wetland regions in Taylor Valley, Antarctica. On January 19th, 2018, the WorldView-2 multispectral satellite acquired an image of our study areas, where we surveyed and sampled seven 100 m2 plots of microbial mats for percent ground cover, ash-free dry mass (AFDM), and pigment content (chlorophyll-a, carotenoids, and scytonemin). Multispectral analyses revealed spectral signatures consistent with photosynthetic activity (relatively strong reflection at near-infrared wavelengths and relatively strong absorption at visible wavelengths), with average normalized difference vegetation index (NDVI) values of 0.09 to 0.28. Strong correlations of microbial mat ground cover (R2 = 0.84), biomass (R2 = 0.74), chlorophyll-a content (R2 = 0.65), and scytonemin content (R2 = 0.98) with logit transformed NDVI values demonstrate that satellite imagery can detect both the presence of microbial mats and their key biological properties. Using the NDVI—biomass correlation we developed, we estimate carbon (C) stocks of 21,715 kg (14.7 g C m−2) in the Canada Glacier Antarctic Specially Protected Area, with an upper and lower limit of 74,871 and 6312 kg of C, respectively.

Our primary objective was to determine rectal prolapse (RP) and pelvic organ prolapse (POP) reoperation rates and postoperative < 30-day complications after combined RP and POP surgery at a single institution. This was an IRB-approved retrospective cohort study of all female patients who received combined RP and POP surgery at a single tertiary care center from 2008 to 2019. Recurrence was defined as the need for subsequent repeat RP or POP surgery at any point after the index surgery. Surgical complications were separated into Clavien-Dindo classes. Sixty-three patients were identified, and 18.3% (12/63) had < 30-day complications (55% Clavien-Dindo grade 1; 27% Clavien-Dindo grade 2; 18% Clavien-Dindo grade 4). Of patients undergoing combined abdominal RP and POP repair, no postoperative < 30-day complications were noted in the MIS group compared to 37.5% of those patients in the laparotomy group (p

There is a growing interest in combined pelvic organ prolapse and rectal prolapse surgery for concomitant pelvic floor prolapse despite a paucity of data regarding complications and clinical outcomes of combined repair.The primary objective of this study was to compare the30-day postoperative complication rate in women undergoing combined POP + RP surgery with that of women undergoing pelvic organ prolapse-only surgery. The secondary objectives were to describe the30-day postoperative complications, compare the pelvic organ prolapse recurrence between the 2 groups, and determine the preoperative predictors of30-day postoperative complications and predictors of pelvic organ prolapse recurrence.This was a multicenter, retrospective cohort study at 5 academic hospitals. Patients undergoing combined pelvic organ prolapse and rectal prolapse surgery were matched by age, pelvic organ prolapse stage by leading compartment, and pelvic organ prolapse procedure compared with those undergoing pelvic organ prolapse-only surgery from March 2003 to March 2020. The primary outcome measure was30-day complications separated into Clavien-Dindo classes. The secondary outcome measures were (1) subsequent pelvic organ prolapse surgeries and (2) pelvic organ prolapse recurrence, defined as patients who complained of vaginal bulge symptoms postoperatively.Overall, 204 women underwent combined surgery for pelvic organ prolapse and rectal prolapse, and 204 women underwent surgery for pelvic organ prolapse only. The average age (59.3±1.0 vs 59.0±1.0) and mean parity (2.3±1.5 vs 2.6±1.8) were similar in each group. Of note, 109 (26.7%) patients had at least one30-day postoperative complication. The proportion of patients who had a complication in the combined surgery group and pelvic organ prolapse-only surgery group was similar (27.5% vs 26.0%; P=.82). The Clavien-Dindo scores were similar between the groups (grade I, 10.3% vs 9.3%; grade II, 11.8% vs 12.3%; grade III, 3.9% vs 4.4%; grade IV, 1.0% vs 0%; grade V, 0.5% vs 0%). Patients undergoing combined surgery were less likely to develop postoperative urinary tract infections and urinary retention but were more likely to be treated for wound infections and pelvic abscesses than patients undergoing pelvic organ prolapse-only surgery. After adjusting for combined surgery vs pelvic organ prolapse-only surgery and parity, patients who had anti-incontinence procedures (adjusted odds ratio, 1.85; 95% confidence interval, 1.16-2.94; P=.02) and perineorrhaphies (adjusted odds ratio, 1.68; 95% confidence interval, 1.05-2.70; P=.02) were more likely to have30-day postoperative complications. Of note, 12 patients in the combined surgery group and 15 patients in the pelvic organ prolapse-only surgery group had subsequent pelvic organ prolapse repairs (5.9% vs 7.4%; P=.26). In the combined surgery group, 10 patients (4.9%) underwent 1 repair, and 2 patients (1.0%) underwent 2 repairs. All patients who had recurrent pelvic organ prolapse surgery in the pelvic organ prolapse-only surgery group had 1 subsequent pelvic organ prolapse repair. Of note, 21 patients in the combined surgery group and 28 patients in the pelvic organ prolapse-only surgery group reported recurrent pelvic organ prolapse (10.3% vs 13.7%; P=.26). On multivariable analysis adjusted for number of previous pelvic organ prolapse repairs, combined surgery vs pelvic organ prolapse-only surgery, and perineorrhaphy at the time of surgery, patients were more likely to have a subsequent pelvic organ prolapse surgery if they had had ≥2 previous pelvic organ prolapse repairs (adjusted odds ratio, 6.06; 95% confidence interval, 2.10-17.5; P=.01). The average follow-up times were 307.2±31.5 days for the combined surgery cohort and 487.7±49.9 days for the pelvic organ prolapse-only surgery cohort. Survival curves indicated that the median time to recurrence was not statistically significant (log-rank, P=.265) between the combined surgery group (4.2±0.4 years) and the pelvic organ prolapse-only surgery group (5.6±0.4 years).In this retrospective cohort study, patients undergoing combined pelvic organ prolapse and rectal prolapse surgery had a similar risk of30-day postoperative complications compared with patients undergoing pelvic organ prolapse-only surgery. Furthermore, patients who underwent combined surgery had a similar risk of recurrent pelvic organ prolapse and subsequent pelvic organ prolapse surgery compared with patients who underwent pelvic organ prolapse-only surgery.

INTRODUCTION AND OBJECTIVE:Women with persistent or recurrent SUI following prior surgical intervention have an unmet medical need with symptoms which substantially impact daily functioning and qua...

INTRODUCTION AND OBJECTIVE:This multicenter Phase 3 study (NCT01893138) evaluated efficacy and safety of AMDC-USR compared to PBO for SUI treatment.METHODS:297 adult women with average 14.4 ± 11.4 ...

Objective The aim of the study was to compare 6-month efficacy and safety for treatment of vaginal dryness/genitourinary syndrome of menopause in women undergoing fractionated CO2 vaginal laser therapy to women using estrogen vaginal cream. Methods This multicenter, randomized trial compared fractionated CO2 laser to estrogen cream at 6 institutions. We included menopausal women with significant vaginal atrophy symptoms and we excluded women with prolapse below stage 2, recent pelvic surgery, prior mesh surgery, active genital infection, history of estrogen sensitive malignancy, and other autoimmune conditions. The primary outcome was the visual analog scale vaginal dryness score. Secondary outcomes included evaluation of vaginal atrophy, quality of life symptoms, assessment of sexual function, and urinary symptoms. Adverse events (AEs) and patient global impression of improvement (PGI-I) and satisfaction were also assessed. Results Sixty-nine women were enrolled in this trial before enrollment was closed due to the Federal Drug Administration requiring the sponsor to obtain and maintain an Investigational Device Exemption. Of the 69 participants enrolled, 62 completed the 6-month protocol; 30 women were randomized to the laser and 32 to estrogen cream from June 2016 to September 2017. Demographics did not differ between groups except the laser group was less parous (0 [range 0-4] vs 2 [0-6], P = 0.04). On patient global impression, 85.8% of laser participants rated their improvement as "better or much better" and 78.5% reported being either "satisfied or very satisfied" compared to 70% and 73.3% in the estrogen group; this was not statistically different between groups. On linear regression, mean difference in female sexual function index scores was no longer statistically significant; and, vaginal maturation index scores remained higher in the estrogen group (adj P value 0.02); although, baseline and 6-month follow-up vaginal maturation index data were only available for 34 participants (16 laser, 18 estrogen). Conclusions At 6 months, fractionated CO2 vaginal laser and vaginal estrogen treatment resulted in similar improvement in genitourinary syndrome of menopause symptoms as well as urinary and sexual function. Overall, 70% to 80% of participants were satisfied or very satisfied with either treatment and there were no serious adverse events. : Video Summary:http://links.lww.com/MENO/A470.

Urethral injection therapy is a well-known treatment of female stress urinary incontinence but to our knowledge the optimal group of recipients has not been established. In this study we examined which patient characteristics are associated with success after urethral injection therapy.This study is a post hoc analysis of a previously published, randomized, 33-center study of the hydrogel bulking agent Bulkamid® vs the collagen gel Contigen®. Regardless of the treatment women were considered cured if there were no stress incontinence episodes in the bladder diary and no stress incontinence symptoms on the ICIQ-UI-SF (International Consultation on Incontinence Questionnaire-Urinary Incontinence-Short Form), improved if there was a 50% or greater reduction in stress incontinence episodes and no effect if there was less than a 50% reduction in stress incontinence episodes 1 year after treatment.Of the 345 women who were initially randomized 291 were included in this study. A total of 191 women received hydrogel and 100 received collagen. At 1 year 74 women (25%) were cured, 164 (56%) were improved and 53 (18%) showed no effect. On multivariate logistic regression analysis age 60 years or greater and fewer than 2.5 daily stress incontinence episodes were associated with cure. In this group 90% of women experienced a treatment effect and 38% were cured compared with a 13% cure rate in those younger than 60 years with 2.5 or more daily stress incontinence episodes.Urethral injection therapy was more effective to treat stress urinary incontinence in women 60 years old or older with fewer than 2.5 daily stress incontinence episodes. It had a 90% success rate in these women.

Animals host a wide diversity of symbiotic microorganisms that contribute important functions to host health, and our knowledge of what drives variation in the composition of these complex communities continues to grow. Microbiome studies at larger spatial scales present opportunities to evaluate the contribution of large-scale factors to variation in the microbiome. We conducted a large-scale field study to assess variation in the bacterial symbiont communities on adult frog skin (Pseudacris crucifer), characterized using 16S rRNA gene amplicon sequencing. We found that skin bacterial communities on frogs were less diverse than, and structurally distinct from, the surrounding habitat. Frog skin was typically dominated by one of two bacterial OTUs: at western sites, a Proteobacteria dominated the community, whereas eastern sites were dominated by an Actinobacteria. Using a metacommunity framework, we then sought to identify factors explaining small- and large-scale variation in community structure-that is, among hosts within a pond, and among ponds spanning the study transect. We focused on the presence of a fungal skin pathogen, Batrachochytrium dendrobatidis (Bd) as one potential driver of variation. We found no direct link between skin bacterial community structure and Bd infection status of individual frog hosts. Differences in pond-level community structure, however, were explained by Bd infection prevalence. Importantly, Bd infection prevalence itself was correlated with numerous other environmental factors; thus, skin bacterial diversity may be influenced by a complex suite of extrinsic factors. Our findings indicate that large-scale factors and processes merit consideration when seeking to understand microbiome diversity.

Several transvaginal mesh products have been marketed to address vaginal vault prolapse. Although data are limited, prolapse recurrence rates and subjective outcome measures seem to be equivalent for vaginal mesh compared with native tissue apical prolapse repair, and the different vaginal meshes have not proven superior to one another. Given the known unique complications specific to vaginal mesh with equivalent outcomes for the apical vaginal prolapse, it is reasonable to reserve mesh use for specific high-risk cases, such as patients with large apical prolapse recurrence after native tissue repair who are not candidates for sacrocolpopexy.

AIMS Bulking agents are a minimally invasive treatment option for women with stress urinary incontinence (SUI) or stress-predominant mixed urinary incontinence (MUI). The aim of this study was to evaluate long-term efficacy and safety following treatment with Bulkamid as a primary procedure for SUI or stress-predominant MUI. METHODS This was an Institutional Review Board-approved single-center retrospective study of female patients with SUI or stress-predominant MUI who had undergone injection with Bulkamid since 2005 and had completed 7 years of follow up. The primary endpoint was patient satisfaction measured on a four-point scale as cured, improved, unchanged, or worse. Secondary outcomes included the number of incontinence pads used, International Consultation on Incontinence Questionnaire-Short Form (ICIQ-UI SF) scores, Visual Analog Scale Quality of Life (VAS QoL), reinjection rates, and perioperative and postoperative complications. RESULTS A total of 1,200 patients were treated with Bulkamid since 2005 and of these, 388 (32.3%) had completed 7 years of follow-up. A total of 67.1% of the patients reported feeling cured or improved if Bulkamid was a primary procedure, 11.1% reported no change, and 2.3% reported worsening of incontinence. A total of 19.5% of patients received a subsequent other incontinence procedure. The ICIQ-UI SF was reduced by 8.6 points. VAS QoL improved by a mean of 4.3 points. Postoperative complications were transient. Prolonged bladder emptying time was reported in 15.3% of patients and urinary tract infection in 3.5%. CONCLUSIONS Bulkamid injections are an effective and safe first-line treatment option for women with SUI or stress-predominant MUI providing durable outcomes at 7 years.

Our primary objectives were to compare30-day postoperative complications and RP recurrence rates after RP-only surgery and combined surgery. Our secondary objectives were to determine preoperative predictors of30-day complications and RP recurrence.A prospective IRB-approved cohort study was performed at a single tertiary care center from 2017 to 2020. Female patients with symptomatic RP underwent either RP-only surgery or combined surgery based on the discretion of the colorectal and FPMRS surgeons. Primary outcome measures were 30-day complications separated into Clavien-Dindo (CD) classes and rectal prolapse on physical examination.Seventy women had RP-only surgery and 45 had combined surgery with a mean follow-up time of 208 days. Sixty-eight percent underwent abdominal RP repair, and 32% underwent perineal RP repair. Twenty percent had one or more complications, 14% in the RP-only group and 29% in the combined surgery group (p = 0.06). On multivariate analysis, combined surgery patients had a 30% increased risk of complications compared to RP-only surgery patients (RR = 1.3). Most of these complications were minor (14/17, 82.4%) and categorized as CD I or II, including urinary retention and UTI. Twelve percent of this cohort had RP recurrence, 11% in the RP-only group and 13% in the combined surgery group (p = 0.76). Preoperative risk factors for RP recurrence included a primary complaint of rectal bleeding (RR 5.5) and reporting stools consistent with Bristol Stool Scale of 1 (RR 2.1).Patients undergoing combined RP + POP surgery had a higher risk of complications and equivalent RP recurrence rates compared to patients undergoing RP-only surgery.

By considering the role of site-level factors and dispersal, metacommunity concepts have advanced our understanding of the processes that structure ecological communities. In dendritic systems, like streams and rivers, these processes may be impacted by network connectivity and unidirectional current. Streams and rivers are central to the dispersal of many pathogens, including parasites with complex, multi-host life cycles. Patterns in parasite distribution and diversity are often driven by host dispersal. We conducted two studies at different spatial scales (within and across stream networks) to investigate the importance of local and regional processes that structure trematode (parasitic flatworms) communities in streams. First, we examined trematode communities in first-intermediate host snails (Elimia proxima) in a survey of Appalachian headwater streams within the Upper New River Basin to assess regional turnover in community structure. We analyzed trematode communities based on both morphotype (visual identification) and haplotype (molecular identification), as cryptic diversity in larval trematodes could mask important community-level variation. Second, we examined communities at multiple sites (headwaters and main stem) within a stream network to assess potential roles of network position and downstream drift. Across stream networks, we found a broad scale spatial pattern in morphotype- and haplotype-defined communities due to regional turnover in the dominant parasite type. This pattern was correlated with elevation, but not with any other environmental factors. Additionally, we found evidence of multiple species within morphotypes, and greater genetic diversity in parasites with hosts limited to in-stream dispersal. Within network parasite prevalence, for at least some parasite taxa, was related to several site-level factors (elevation, snail density and stream depth), and total prevalence decreased from headwaters to main stem. Variation in the distribution and diversity of parasites at the regional scale may reflect differences in the abilities of hosts to disperse across the landscape. Within a stream network, species-environment relationships may counter the effects of downstream dispersal on community structure.

Diatoms are diverse and widespread freshwater Eukaryotes that make excellent microbial subjects for addressing questions in metacommunity ecology. In the McMurdo Dry Valleys of Antarctica, the simple trophic structure of glacier-fed streams provides an ideal outdoor laboratory where well-described diatom assemblages are found within two cyanobacterial mat types, which occupy different habitats and vary in coverage within and among streams. Specifically, black mats ofNostocspp. occur in marginal wetted habitats, and orange mats (Oscillatoriaspp. andPhormidiumspp.) occur in areas of consistent stream flow. Despite their importance as bioindicators for changing environmental conditions, the role of dispersal in structuring dry valley diatom metacommunities remains unclear. Here, we use MCSim, a spatially explicit metacommunity simulation package for R, to test alternative hypotheses about the roles of dispersal and species sorting in maintaining the biodiversity of diatom assemblages residing in black and orange mats. The spatial distribution and patchiness of cyanobacterial mat habitats was characterized by remote imagery of the Lake Fryxell sub-catchment in Taylor Valley. The available species pool for diatom metacommunity simulation scenarios was informed by the Antarctic Freshwater Diatoms Database, maintained by the McMurdo Dry Valleys Long Term Ecological Research program. We used simulation outcomes to test the plausibility of alternative community assembly hypotheses to explain empirically observed patterns of freshwater diatom biodiversity in the long-term record. The most plausible simulation scenarios suggest species sorting by environmental filters, alone, was not sufficient to maintain biodiversity in the Fryxell Basin diatom metacommunity. The most plausible scenarios included either (1) neutral models with different immigration rates for diatoms in orange and black mats or (2) species sorting by a relatively weak environmental filter, such that dispersal dynamics also influenced diatom community assembly, but there was not such a strong disparity in immigration rates between mat types. The results point to the importance of dispersal for understanding current and future biodiversity patterns for diatoms in this ecosystem, and more generally, provide further evidence that metacommunity theory is a useful framework for testing hypotheses about microbial community assembly. United States National Science Foundation OPP (Antarctic Organisms and Ecosystems) awards [1744785, 1744849, 1745053]; NSF OPP award [1637708] This work was funded by United States National Science Foundation OPP (Antarctic Organisms and Ecosystems) awards 1744785, 1744849, and 1745053 and NSF OPP award 1637708 supporting the MCM LTER Project.

This clinical consensus statement on vaginal energy-based devices (EBDs) reflects statements drafted by content experts from the American Urogynecologic Society's EBD writing group. The American Urogynecologic Society's EBD writing group used a modified Delphi process to assess statements that were evaluated for consensus after a structured literature search. A total of 40 statements were assessed and divided into 5 categories: (1) patient criteria, (2) health care provider criteria, (3) efficacy, (4) safety, and (5) treatment considerations. Of the 40 statements that were assessed, 28 reached consensus and the remaining 12 did not. Lack of evidence was among the main reasons that vulvovaginal EBD treatment statements did not reach consensus.

INTRODUCTION AND OBJECTIVE:Hysteropexy (HP) for treatment of uterine/apical prolapse via a vaginal approach is shown to have equivalent medium-term efficacy compared to traditional vaginal hysterec...

Our primary objective was to determine rectal prolapse (RP) and pelvic organ prolapse (POP) reoperation rates and postoperative30-day complications after combined RP and POP surgery at a single institution.This was an IRB-approved retrospective cohort study of all female patients who received combined RP and POP surgery at a single tertiary care center from 2008 to 2019. Recurrence was defined as the need for subsequent repeat RP or POP surgery at any point after the index surgery. Surgical complications were separated into Clavien-Dindo classes.Sixty-three patients were identified, and 18.3% (12/63) had30-day complications (55% Clavien-Dindo grade 1; 27% Clavien-Dindo grade 2; 18% Clavien-Dindo grade 4). Of patients undergoing combined abdominal RP and POP repair, no postoperative30-day complications were noted in the MIS group compared to 37.5% of those patients in the laparotomy group (p 0.01). Overall, in those patients who underwent combined RP and POP surgery, the need for subsequent RP surgery for recurrent RP was 14% and the need for subsequent POP surgery for recurrent POP was 4.8% (p = 0.25).In this cohort of women undergoing combined RP and POP surgery, a higher proportion required subsequent RP surgery compared to those requiring subsequent POP surgery, although this was not statistically significant. Almost one-fifth of patients undergoing combined RP and POP surgery experienced a 30-day surgical complication, regardless of whether the approach was perineal or abdominal. For those patients undergoing abdominal repair,30-day complications were more likely in those patients who had a laparotomy compared to those who had a minimally invasive surgery.

STRUCTURED ABSTRACT: Background Topical vaginal estrogen is considered the gold standard therapy for GSM-associated dyspareunia, but early investigations of energy-based devices show promise for patients with contraindications or who are refractory to vaginal estrogen cream. While evaluating safety, efficacy and long-term outcomes for novel technologies is critically important when new technologies become available to treat unmet healthcare needs, evaluation of the costs of these new technologies compared to existing therapies is also critically important, but often understudied. Objectives We sought to perform a cost-effectiveness analysis of three therapies for GSM including vaginal estrogen, oral ospemifene and vaginal CO2 laser therapy and determine if vaginal laser therapy is a cost-effective treatment for dyspareunia associated with GSM. Study Design An IRB-exempt cost-effectiveness analysis was performed by constructing a decision tree using decision analysis software (TreeAge Pro; TreeAge Software, Inc., Williamstown, MA) using integrated empirical data from the published literature. Tornado plots, one-way and two-way sensitivity analyses were performed to assess how changes in the model’s input parameters altered the overall outcome of the cost-effectiveness model. Results All three treatment methods were found to be cost-effective below the WTP threshold of $50,000 per QALY for moderate dyspareunia. The ICER for vaginal CO2 laser treatment of moderate dyspareunia was $16,372.01 and the ICER for ospemifene was $5,711.14. Although all three treatment strategies were on the efficient frontier, vaginal CO2 laser treatment was the optimal strategy with the highest effectiveness. In a one-way sensitivity analysis of treatment adherence, the vaginal CO2 laser was no longer cost effective when the adherence fell below 38.8%. Vaginal estrogen cream and ospemifene remained cost-effective strategies at all ranges of adherence. When varying the adherence to 100% for all strategies, oral ospemifene was “dominated” by both vaginal fractional CO2 laser therapy and vaginal estrogen cream. In a two-way sensitivity analysis of vaginal CO2 laser adherence and vaginal CO2 laser cost, vaginal CO2 laser therapy still remained the optimal strategy at 200% of its current cost ($5,554.00) if the adherence was greater than 55%. If the cost fell to 20% of its current cost ($555.40), it was the optimal strategy at all adherence values above 29%. Conclusion The present study showed that the vaginal fractional CO2 laser is a cost-effective strategy for the treatment of dyspareunia associated with GSM, as are vaginal estrogen and oral ospemifene. In our model, the vaginal CO2 laser is the optimal cost-effective strategy and consideration should be made to providing insurance coverage for this treatment option.

Two widespread drivers of change in high-elevation lakes are climate warming and atmospheric nitrogen deposition, which may have interactive effects on aquatic ecosystems. Using an outdoor mesocosm experiment at 2900 m above-sea level along the Colorado Front Range, we investigated the individual and combined effects of realistic increases in temperature (ambient versus 2.4 °C increase) and nitrogen concentrations (three levels) on lake plankton and hydrochemistry. Relative to the low temperature treatment, enhanced temperatures decreased the overall density of Daphnia pulicaria by ~ 40% and of gravid females specifically by ~ 20%. Increased nitrogen also reduced Daphnia density, especially in the low-temperature treatments, leading to a significant nitrogen-by-temperature interaction. The calanoid copepod Hesperodiaptomus shoshone, in contrast, was unaffected by experimental manipulations of temperature and nitrogen, and declined in abundance over time regardless of treatment. Chlorophyll-a increased to a maximum in week 4 and was unaffected by the temperature manipulation, suggesting that observed effects on Daphnia were likely direct physiological responses to warming rather than bottom-up effects. Nitrate additions caused transient increases in chlorophyll-a, which converged across treatments by the end of the study as nutrients were assimilated. Nitrogen additions also led to progressive increases in dissolved organic carbon concentrations throughout the experiment. Our results suggest that warming has the potential to reduce zooplankton production, consistent with observed decreases in large-bodied Daphnia density with decreasing elevation in the Colorado Rockies. Future work should evaluate how the observed effects on plankton communities scale-up to natural lakes, particularly the relative importance of species-specific stress responses versus indirect food web effects.

The idea of harmonizing data is not new. Decades of amassing data in databases according to community standards - both locally and globally - have been more successful for some research domains than others. It is particularly difficult to harmonize data across studies where sampling protocols vary greatly and complex environmental conditions need to be understood to apply analytical methods correctly. However, a body of long-term ecological community observations is increasingly becoming publicly available and has been used in important studies. Here, we discuss an approach to preparing harmonized community survey data by an environmental data repository, in collaboration with a national observatory. The workflow framework and repository infrastructure are used to create a decentralized, asynchronous model to reformat data without altering original data through cleaning or aggregation, while retaining metadata about sampling methods and provenance, and enabling programmatic data access. This approach does not create another data ‘silo’ but will allow the repository to contribute subsets of available data to a variety of different analysis-ready data preparation efforts. With certain limitations (e.g., changes to the sampling protocol over time), data updates and downstream processing may be completely automated. In addition to supporting reuse of community observation data by synthesis science, a goal for this harmonization and workflow effort is to contribute these datasets to the Global Biodiversity Information Facility (GBIF) to increase the data's discovery and use.

Background Successful development of a novel medical device requires an early understanding of anatomical feasibility and acceptance by both patient and clinician. In the absence of acceptable artificial anatomical test models, short-term evaluation with controlled observation in a small number of patients can be pursued to demonstrate initial feasibility. The vaginal bowel control (VBC) system, a non-surgical device for faecal incontinence (FI), is difficult to evaluate in artificial models. In-person usage was required to understand the potential for a vaginal insert to provide comfortable, dynamic rectal occlusion. Methods This prospective, open-label study was conducted at a single urogynaecology practice at an academic medical centre with 13 female subjects ≥18 years with self-reported FI. The VBC therapy consists of a vaginal insert and pressure-regulated pump. The vaginal insert includes a balloon that, when inflated, creates an occlusion of the rectum. Subjects’ FI symptoms were collected in a baseline questionnaire. The investigator fitted subjects with multiple sizes of VBC inserts and evaluated the fit, position and degree of rectal occlusion. Subject comfort levels were assessed throughout the fitting process with a verbal response and on a subject questionnaire using a 10-point scale (1=no discomfort, 10=extremely uncomfortable). The insert was returned at the end of the study visit. Results The majority of the rectum was occluded in 77% of patients. Furthermore, comfort scores during insertion (2.1±2.0), inflation (3.3±2.6) and ambulation (2.6±2.0) states indicated minor discomfort with 42% of women indicating no discomfort in any states. No adverse events were reported. Conclusions Pilot evaluation of an early VBC system design and its delivery during a single study visit provided evidence for effectiveness, patient comfort and ease of use of a novel VBC for FI in women. This first-in-woman study confirmed feasibility of VBC and informed continued product development and subsequent clinical research.

Objectives:To assess safety and efficacy of a fractional CO2 laser therapy for the treatment of genitourinary syndrome of menopause (GSM) with follow-up to 1 year posttreatment.Methods:Women presenting with GSM and meeting inclusion criterion were enrolled. Visual Analog Scales were used to