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Objective: SinceMarch 2020, the COVID-19 pandemic has catalyzed rapid integration of telemedicine services into clinical practice. Our primary aim was to assess patient satisfaction with telehealth care in Female Pelvic Medicine and Reconstructive Surgery (FPMRS). Our secondary aim was to assess patient access to technology for telehealth visits. Methods: This was an IRB-approved, single-institution, survey study of a convenience sample of patients presenting for telehealth visits within the Division of FPMRS from July 22, 2020 to January 15, 2021. We invited new and established patients to complete a single survey regarding reason for visit, overall satisfaction, access to technology, previous use of telemedicine, and preference for future visits. We present data as mean ± standard deviation or proportion. Results: Of 227 patients offered the survey, 142 (62.6%) responded;84 (59.2%) completed the survey following a video visit, and 58 (40.9%) completed the survey following a telephone visit. Respondents had a mean age of 51.5 ± 15.4 years, and most were Non-Hispanic White (70.4%) and had at least a Bachelor's degree (64.8%). The most common primary diagnoses were sexual dysfunction (26.1%), overactive bladder (21.8%), and urinary incontinence (14.1%). Most patients in both the video and phone groups were completely satisfied (62.4% and 56.0%, respectively) or moderately satisfied (24.4% and 39.3%, respectively). Patient-reported advantages of telehealth included saving travel time (93.0%), waiting room time (59.2%), parking fees (50.0%), time off work (43.7%), and public transit fees (22.5%). Patients also reported greater overall convenience (60.6%) and feeling that they had more time with the provider (21.8%). Patient-cited disadvantages were concern about the provider's ability to make a diagnosis (69.0%) or see something of concern remotely (64.1%). Only 5.6% of patients expressed concern about difficulty building rapport with a provider virtually. Regarding access to telehealth visits, 8.5% cited a poor internet connection and 7.0% felt that setting up a virtual platform could be challenging. In anticipation of post-COVID FPMRS visits, most respondents (79.6%) preferred a combination of virtual and in-person visits. Only 2.1% indicated a preference for all future visits to be virtual, while 10.6% preferred only inperson visits, and 7.7% did not express a preference. Among respondents who preferred at least some virtual visits, 73.3% preferred video, whereas 25.9% preferred telephone visits. Conclusions: This study demonstrates high patient satisfaction with virtual telehealth visits at our FPMRS Division during the COVID-19 pandemic. Saving travel time and overall convenience were themost highly cited advantages of telehealth by patients. Patients prefer receiving a combination of telehealth and in-person visits post-pandemic. This study underscores an important role for telehealth in future FPMRS practice and should inform future studies to explore which conditions, visit types, and patient characteristics are best served by virtual versus in-person visits.

Objectives Although racial disparities are well documented for common gynecologic surgical procedures, few studies have assessed racial disparities in the surgical treatment of vaginal prolapse. This study aimed to compare the use of obliterative procedures for the treatment of vaginal prolapse across racial and ethnic groups. Study design This is a retrospective cohort study of surgical cases from 2010 to 2018 from the American College of Surgeons National Surgical Quality Improvement Program, a nationally validated database. Cases were identified by Current Procedural Terminology codes. Modified Poisson regression was used to calculate risk ratios and 95% confidence intervals, adjusting for potential confounders selected a priori. Results We identified 45,865 surgical cases, of which 10% involved an obliterative procedure. In the unadjusted model, non-Hispanic Asian and non-Hispanic Black patients were more likely to undergo an obliterative procedure compared with non-Hispanic White patients (risk ratio [95% confidence interval], 2.4 [2.1-2.7] and 1.2 [1.03-1.3], respectively). These relative risks were largely unchanged when controlling for age, body mass index, diabetes, American Society of Anesthesiologists classification, and concurrent hysterectomy. Conclusions Although both obliterative and reconstructive procedures have their respective risks and benefits, the proportion of patients undergoing each procedure differs by race and ethnicity. It is unclear whether such disparities may be attributable to differences in preference or inequity in care.

PURPOSE: We evaluate the cost-effectiveness of prophylactic antibiotic use to prevent catheter-associated urinary tract infections. MATERIALS AND METHODS: A decision tree model was used to assess the cost-effectiveness of prophylactic antibiotics in preventing catheter-associated urinary tract infections for patients with a short-term indwelling urinary catheter. The model accounted for incidence of urinary tract infections with and without the use of prophylactic antibiotics, incidence of antibiotic-resistant urinary tract infections, as well as costs associated with diagnosis and treatment of urinary tract infections and antibiotic-resistant urinary tract infections. Costs were calculated from the healthcare system’s perspective. We conducted one-way sensitivity analyses. RESULTS: The base case analysis showed that the use of prophylactic antibiotics is cost saving in preventing catheter-associated urinary tract infections. The use of prophylactic antibiotics resulted in lower costs and higher quality-adjusted life-years compared to no prophylactic antibiotics. Sensitivity analyses showed that the optimal strategy changes to no prophylactic antibiotics when the incidence of urinary tract infections after prophylactic antibiotics exceeds 22% or the incidence of developing urinary tract infections without prophylactic antibiotics is less than 12%. Varying the costs of prophylactic antibiotics, urinary tract infection treatment, or antibiotic-resistant urinary tract infection treatment within a reasonable range did not change the optimal strategy. CONCLUSIONS: Prophylactic antibiotic use to prevent catheter-associated urinary tract infections is cost effective under most conditions. These results were sensitive to the likelihood of developing catheter-associated urinary tract infections with and without prophylactic antibiotics. Our results are limited to the cost-effectiveness perspective on this clinical practice.

Objective This study aimed to assess whether the use of visual aids to augment the consent process for pelvic floor surgeries affects patient understanding and satisfaction. Methods We conducted a single-blind, randomized controlled trial. Adults planning robotic sacrocolpopexy or suburethral sling surgeries were eligible. All participants received standard preoperative consent counseling. Participants randomized to the intervention also viewed slides with visual aids that paralleled standard counseling; participants randomized to the control group received only standard counseling. All participants completed surveys after their preoperative visit, the day of surgery, and at their postoperative visit. Each survey contained 12 true-false questions about risks, benefits, and alternatives of surgery, and expectations during recovery. The primary outcome was the percentage of correct true-false questions. We conducted an intention-to-treat analysis. Results We randomized 32 participants undergoing robotic sacrocolpopexy and 32 undergoing suburethral sling surgeries, yielding 16 in the intervention group and 16 in the control group for each procedure. The intervention and control groups for both surgeries were similar in age, body mass index, race, education, and previous surgery for similar symptoms.Among participants undergoing robotic sacrocolpopexies, median knowledge scores at the preoperative visit were similar between the intervention (92% [interquartile range {IQR}, 86%-100%]) and control (86% [IQR, 75%-94%]) groups (P = 0.21). Similar results were seen for participants undergoing suburethral sling procedures in the intervention (83.3% [IQR, 71%-92%]) and control (83% [IQR, 75%-88%]) groups (P = 0.64). Conclusions We found that using visual aids during the consent process for patients undergoing robotic sacrocolpopexy or suburethral sling surgeries did not improve knowledge.

Objective The aim of this study was to evaluate the cost-effectiveness of retrograde voiding trials in the management of postoperative voiding dysfunction. Methods We developed a disease simulation model to assess under which conditions routine retrograde voiding trial is the optimal strategy in terms of cost per quality-adjusted life-year and cost per case of chronic voiding dysfunction avoided. We varied the incidence of voiding dysfunction between 2% and 60%. We discounted future costs and utilities at 3% annually. We conducted 1- and 2-way sensitivity analyses on uncertain model parameters. Results The lifetime analysis showed that when the incidence of postoperative voiding dysfunction exceeded 12.2%, retrograde voiding trials were cost-effective, assuming a willingness-to-pay (WTP) for health of $100,000/quality-adjusted life-year. When the incidence exceeded 31.1%, retrograde voiding trials became the dominant strategy (less costly and more effective). For a simple hysterectomy with voiding dysfunction incidence of approximately 10%, lifetime cost is $230,069/case of chronic voiding dysfunction avoided; for a midurethral sling with voiding dysfunction incidence of approximately 20%, lifetime cost is $60,449/case avoided. Sensitivity analyses showed that WTP for health, the incidence of presentation to the emergency department (ED) for urinary retention and the incidence of chronic urinary retention following treatment in the ED had the greatest impact on the cost-effectiveness results. Conclusions Routine retrograde voiding trials following pelvic surgery can be cost-effective compared with expectant management when the incidence of voiding dysfunction exceeds 12.2%. These results were sensitive to WTP for health, incidence of ED visits for urinary retention, and incidence of chronic urinary retention following ED visits.

The objective was to compare postoperative urinary retention using the Babcock and Kelly clamps for retropubic midurethral sling (RPS) tensioning. This was a retrospective cohort of isolated RPS procedures from December 2010 through April 2016 by five fellowship-trained surgeons at two institutions. Slings were tensioned with a Babcock clamp by grasping a 3-mm midline fold of mesh (RPS-B) or a Kelly clamp as a spacer between the sling and suburethral tissue (RPS-K). Assessment of urinary retention included the primary outcome of postoperative catheterization and several secondary outcomes, including discharge home with a catheter, within 1 year of surgery. Analysis of covariance was used to compute the mean difference in duration of catheterization and log-binomial regression was used to calculate risk ratios (RR) and 95% confidence intervals (CI). We included 240 patients. The RPS-B group had a lower body mass index and was more likely to be menopausal, have had pelvic organ prolapse surgery, and have a lower maximum urethral closure pressure than the RPS-K group. The mean duration of catheterization was similar, as demonstrated by the crude (0.21 days [−0.30–0.71]) and BMI-adjusted (0.07 days [−0.41–0.55]) mean difference in duration of catheterization. The incidence of postoperative OAB symptoms was comparable between the groups (BMI-adjusted RR: 0.95 (0.80–1.1)), and the incidence of revision did not differ (p = 0.7). The Babcock and Kelly clamp tensioning techniques appear comparable, with a low incidence of prolonged postoperative catheterization. Most catheters were removed on the day of the surgery. It is reasonable to tension retropubic midurethral slings with either method.

Our aim was to identify predictors of postoperative voiding trial failure among patients who had a pelvic floor repair without a concurrent incontinence procedure in order to identify low-risk patients in whom postoperative voiding trials may be modified.We conducted a retrospective cohort study of women who underwent pelvic floor repair without concurrent incontinence procedures at two institutions from 1 November 2011 through 13 October 2013 after abstracting demographic and clinical data from medical records. The primary outcome was postoperative retrograde voiding trial failure. We used modified Poisson regression to calculate the risk ratio (RR) and 95 % confidence interval (CI).Of the 371 women who met eligibility criteria, 294 (79.2 %) had complete data on the variables of interest. Forty nine (16.7 %) failed the trial, and those women were less likely to be white (p = 0.04), more likely to have had an anterior colporrhaphy (p = 0.001), and more likely to have had a preoperative postvoid residual (PVR) ≥150 ml (p = 0.001). After adjusting for race, women were more likely to fail their voiding trial if they had a preoperative PVR of ≥150 ml (RR: 1.9; 95 % CI: 1.1-3.2); institution also was associated with voiding trial failure (RR: 3.0; 95 % CI: 1.6-5.4).Among our cohort, postoperative voiding trial failure was associated with a PVR of ≥150 ml and institution at which the surgery was performed.

Aims: To describe three cases of early postoperative bowel obstruction after use of barbed suture material during surgery for pelvic organ prolapse (POP). Introduction: The utilization of minimally invasive surgical techniques for the treatment of POP is increasing, with a subsequent increase in the use of barbed, self-anchoring suture material, such as the V-locTM suture, which facilitates intracorporeal suturing. Case report: We present three cases of early postoperative small bowel obstruction related to the use of barbed sutures during minimally invasive surgery for POP, as well as a review of the relevant literature. Conclusion: Surgeons should use barbed suture material judiciously and should have a high index of suspicion for barbedsuture related mechanical obstructions. These obstructions are not likely to resolve with conservative management. Clinical significance: Barbed suture materials allow for ease of laparoscopic suturing but carry a risk of contributing to early bowel obstruction. Laparoscopic surgeons should be aware of this relatively unknown potential complication.

The baseline prevalence of rectocele is not well defined as many women are asymptomatic and do not seek medical help. Gynecologists tend to perform posterior wall repairs more commonly than colorectal surgeons because they also address patients with vaginal symptoms in addition to those with defecatory dysfunction. Overall, surgical correction success rates for rectocele correction are quite high when using a vaginal approach. Vaginal dissection, as opposed to transrectal or transperineal approaches, results in better visualization and access to the endopelvic fascia and levator musculature, allowing for more firm anatomic correction. In addition, the maintenance of rectal mucosal integrity may reduce the risk of postoperative complications such as infection and fistula formation. With the rapidly growing popularity of synthetic and biologic implant kits in the field of pelvic reconstruction, outcomes data reporting is increasing and allowing surgeons to better understand the effect of various surgical techniques on vaginal, sexual, and defecatory symptoms.

Background Urinary voiding dysfunction is reported in many patients with complex regional pain syndrome (CRPS). However, there is a gap in the literature for treating patients with CRPS who develop incontinence symptoms. Case We report a case describing the use of sacral neuromodulation therapy in a patient with urgency urinary and fecal incontinence who had a previously implanted spinal cord stimulator for type 1 CRPS, formerly known as reflex sympathetic dystrophy. Despite initial hesitation and treatment delay, sacral neuromodulation therapy was successful and effective in controlling both fecal and urgency urinary incontinence symptoms for the patient. This intervention continues to provide her with an improved quality of life 10 months after her procedure. Conclusions In this case, there was significant hesitation from the provider and patient to use invasive treatments for incontinence symptoms when the patient's pain symptoms have been well controlled with an existing spinal device. However, in this patient with type 1 CRPS, even in the setting of an existing spinal cord stimulator, sacral neuromodulation therapy was an effective treatment.

To estimate the association between urinary incontinence and glycemic control in women ages 20 to 85 years.We included 7270 women from the 2005 to 2010 National Health and Nutrition Examination Survey, stratified into three groups of glycemic control defined by hemoglobin A1c (HbA1c): (i) those below the diagnostic threshold (HbA1c6.5%), (ii) those with relatively controlled diabetes (HbA1c, 6.5-8.5%), and (iii) those with poorly controlled diabetes (HbA1c8.5%) to allow for a different relationship between glycemic control and urinary incontinence within each group. The primary outcomes were the presence of any, only stress, only urgency, and mixed urinary incontinence. We calculated adjusted risk ratios using Poisson regressions with robust variance estimates.The survey-weighted prevalence was 52.9% for any, 27.2% for only stress, 9.9% for only urgency, and 15.8% for mixed urinary incontinence. Among women with relatively controlled diabetes, each one-unit increase in HbA1c was associated with a 13% (95% confidence interval, 1.03-1.25) increase for any urinary incontinence and a 34% (95% confidence interval, 1.06-1.69) increase in risk for only stress incontinence but was not significantly associated with only urgency and mixed incontinence. Other risk factors included body mass index, hormone replacement therapy, smoking, and physical activity.Worsening glycemic control is associated with an increased risk for stress incontinence for women with relatively controlled diabetes. For those either below the diagnostic threshold or with poorly controlled diabetes, the risk may be driven by other factors. Further prospective investigation of HbA1c as a modifiable risk factor may motivate measures to improve continence in women with diabetes.

Pollution originating from wood combustion characterised the urban atmospheres of the past and led to the formation of thin grey crusts on the surface of the stone of monuments. The grey crusts discovered on the Heads of the Kings of Juda statues, which adorned the facade of Notre Dame in Paris from the 13th century until 1792, constitute a material record of the effects of this ancient air pollution. The height at which the statues stood suggests that the effect was not the result of a point phenomenon, but was caused by a generalised pollution of the Paris atmosphere at the time.

In order to explain the weathering mechanisms of marbles and granites used in the monuments of Delos archaeological site (Cyclades–Greece), research has characterized atmospheric particles and defined stones petrophysical properties. In this paper, characteristics of atmospheric particulates are presented from sampling in March and July 1995. Air was filtered through Nuclepore membranes and particles were analysed by X-Ray Fluorescence (XRF), Analytical Scanning Electron Microscopy (ASEM) and Analytical Transmission Electron Microscopy (ATEM). XRF measurements show that Na, Cl and S have the highest concentrations. According to geochemical calculations, it appears that S is constituted in major part by excess S, anthropic in origin. Individual analyses by ASEM allow the classification of particles ⩾1 μm in five categories: marine, terrigenous, mixture of marines and terrigenous and undetermined species, anthropogenic and biogenic. ATEM study concerned S-bearing fine particles (⩽2 μm). Two atmospheric sources able to participate in marbles and granites weathering have been identified: a natural source of marine salts (halite mainly) the production of which depends on wind speed; an anthropic source (high excess sulphur concentrations) which indicates a regional to remote pollution.

Far from the ground moisture zone, marble remains of Delos archaeological site have undergone an extensive weathering through contour scaling and granular disintegration. Comparison of the analytical results from analytical scanning electron microscopy examination of surface samples of weathered marble and air filtration membranes confirms the atmospheric transport of marine salts and their deposition on stone surface. A laboratory experiment emphasizes the role of these atmospheric salts in the weathering process of marbles in coastal environment.

BACKGROUND: Synthetic materials are being used increasingly in reconstructive pelvic surgery. Multifilament polypropylene mesh in particular has been associated with healing abnormalities and other postoperative complications. This article describes an atypical infection presenting as a draining sinus tract to the lower extremity after intravaginal slingplasty. CASE: An otherwise healthy 75-year-old-woman presented with recurrent leg cellulitis 18 months after posterior intravaginal slingplasty for vaginal vault prolapse. A 35-cm fistulous tract draining from the pelvis to the lower thigh was identified. The patient underwent surgical debridement and was treated with 12 weeks of intravenous antibiotics with complete healing and no recurrence of symptoms. CONCLUSION: Complications associated with the multifilament mesh used in the intravaginal slingplasty tunneler device include pain, erosion, localized abscess, and genitourinary fistula.

Experimental conditions characteristic of the urban pollution in many European cities over the last decades were reproduced in a simulation chamber in which samples of limestone were exposed for a period of 12 months, both naked or sprinkled with carbonaceous fly-ash. In agreement with the findings reported in the literature the fly-ash emitted by heavy fuel combustion are highly reactive, undergoing chemical and morphological transformations which give rise to crystals growth, especially gypsum. The development of gypsum crystals was observed overall in close proximity of fly-ash anchoring them to the limestone surface. Samples of the same limestone exposed in the field in a polluted environment for the same period of time led to similar results. The preliminary mechanisms leading to the genesis of sulphated black crusts in polluted environments were thus highlighted. Because of their roughness the embryonic black crusts increase the development of the crust by trapping new particles. This trapping is also facilitated by the wetness of the stone surface leading to the development of hydrated mineral (gypsum) in the water meniscus between fly-ash and stone surface.

The interaction between today’s polluted urban atmosphere and materials leads to the formation of sulphated black crusts containing industrial fly-ash. While many historical documents report the existence of polluted air in towns prior to the modern industrial era, such descriptions have not so far been substantiated by any scientific analysis of samples of older interactions. A new approach is proposed, based on the study of crusts found in Arles and Bologna, which formed in the periods 1180–1636, and 1530–1887, respectively. They are grey, mostly calcitic, and contain wood debris and micrometric siliceous or alumino-silicated spherules. The same tracers were also encountered in the smoke from experimental wood fires. This approach confirms the presence of air polluted by wood combustion in the towns of Southern France and Northern Italy during the Medieval up to pre-industrial age. Such information, near to the source, completes the evidence provided in written documents, as well as the data obtainable, farther from the sources, using core samples of glaciers, lakes and marine sediments.

The methodology of protecting the European stained glass windows against environmental risk (e.g. meteorological factors, air pollution, microorganisms) by means of an external glazing is not new. In spite of many scientific studies carried out in the last 20 years, some questions were still up for discussion. The European VIDRIO (2002–2005) project gave an answer to these questions. The research carried out by the different project partners established a new multidisciplinary approach aimed at evaluating the efficiency of the protective glazing systems and their effects on stained glass windows conservation, and finally at assessing the most appropriate strategy to preserve stained glass windows. Scientific results showed that the so-called isothermal glazing (i.e. ventilation by the air coming from the inside of the building) protected efficiently the ancient stained glass window from environmental attack (i.e. rain, pollutants, condensation, thermal shocks) with very limited secondary effects. The scientific research highlighted that its efficiency was strongly related to the technical design of the protective system. In particular, the ventilation and the size of the interspace had to be carefully considered. The research developed within the VIDRIO project was turned into general recommendations to the owners and practitioners on the best practice for the stained glass windows future conservation.

The Lausanne Atmospheric Simulation Chamber (LASC) has been constructed with the aim of studying the SO2 effects on different materials. It allows the carrying out of numerous measurements on large stone samples simultaneously and on line. The behaviour of two carbonatic stone types (limestone and sandstone), either naked or covered with fly ash or soot particles, exposed at the following conditions, SO2 = 125 ppb (340 μg m−3), NO2 = 50 ppb (98 μg m−3), relative humidity = 79%, temperature = 13°C, has been studied. This experiment has been carried out over a 1 yr period. It has been observed that SO2 deposition velocity decreases with time and in different ways for each of the two stone types, naked or covered with fly ash or soot particles. During the first four months, the deposition velocity is higher on naked stones; later on, it is higher on the stone samples covered with fly ash. Throughout the experiment the SO2 deposition velocity on stone samples covered with soot particles is lower than on naked samples and those covered by fly ash. Finally, the values of SO2 deposition velocity are confirmed by the chemical analysis of sulphur in the samples. Sulphur is present from the stone surface down to about 0.8 mm depth.

Fly ash produced by coal combustion using two types of desulphurization process were studied: a conventional pulverized coal boiler equipped with lime injection (PCL ash), and a circulating fluidized bed combustion boiler with limestone injection (CFBC ash). The ashes were characterized completely: granulometry, morphology, mineralogy, chemical composition and behaviour to water contact. Both PCL ash and CFBC ash present similar features: fine granulometry, presence of anhydrite phase and sulphate content. However, PCL ash also shows lots of spherical particles, unlike CFBC ash, and a much higher lime content, due to the lower desulphurization rate in PC boilers. Unlike CFBC ash, most of the trace elements in PCL ash show an inverse concentration-particle size dependence. Leachates obtained from both samples are rich in soluble salts [CaSO4 and Ca(OH) 2] and arsenic and selenium are prevented from solubilizing by high lime content. In wetted PCL ash, the formation of ettringite crystals stabilizes calcium and sulphate ions. Simultaneously, arsenate, selenate and chromate anions are trapped in the crystal. CFBC ash does not really harden because the lime content is too low. However, the leached selenium concentration is cut down in wetted CFBC ash samples. © 1996 ISWA

We aimed to determine if the use of permanent suture for the apical fixation during traditional anterior colporrhaphy results in improved outcomes compared to delayed absorbable suture. A retrospective case-control study was performed in patients who underwent traditional non-grafted anterior colporrhaphy with reattachment of the anterior endopelvic fascia to the apex/cervix comparing permanent (group 1) or absorbable suture (group 2). Patients were matched based on age, body mass index, and presenting stage of prolapse. The primary outcome assessed was anterior wall vaginal prolapse recurrence defined as Pelvic Organ Prolapse Quantification (POP-Q) points Aa or Ba ≥ −1 cm. Secondary outcome measures included overall prolapse stage, subjective reporting of satisfaction, and any healing abnormalities or complications resulting from suture type. A total of 230 patients were reviewed (80 in group 1 and 150 in group 2) and median follow-up was 52 (24–174) weeks. A statistically significant improvement in anterior wall anatomy was seen in group 1 compared to group 2 [(Aa −2.70 ± 0.6 cm vs −2.5 ± 0.75 cm, p = 0.02) and Ba (−2.68 ± 0.65 cm vs −2.51 ± 0.73 cm, p = 0.03), respectively]. Comparing prolapse stage, there were no observed differences between the groups. Exposure of the permanent suture occurred in 12 patients (15 %) and 5 (6.5 %) required suture trimming to treat the exposure. Reattachment of endopelvic fascia to the apex at the time of anterior colporrhaphy results in low recurrence rates. Use of permanent suture for apical fixation is associated with improved anatomic correction at the expense of increased suture exposures.

This study aims to evaluate clinical outcomes of concomitant suburethral sling with LeFort colpocleisis including its effect on postoperative voiding.We performed a retrospective review of all LeFort colpocleisis procedures from our institution. We reviewed demographics, symptoms of stress urinary incontinence, incontinent events/day, pads usage/day, urodynamic parameters, and presence of voiding dysfunction.Two hundred ten patients underwent colpocleisis during the study period. Mean age was 82.2 ± 4.9 and median follow-up was 22 weeks (2-169). Preoperatively, 73 (35%) complained of stress urinary incontinence (SUI) symptoms, and an additional 105 (50%) were diagnosed with occult SUI. One hundred sixty-one (77%) patients underwent concurrent suburethral sling. Overall, sling placement resulted in a 92.5% subjective stress continent rate. Fifty-six patients presented with voiding dysfunction (VD). Postoperatively, VD resolved in 91%. De novo VD occurred in two patients (1.9%) and one (0.6%) required sling revision.Sling placement at time of colpocleisis is associated with high continence rates with minimal risk of postoperative voiding dysfunction.

In the frame of the European project, entitled MULTI-ASSESS, specimens of structural metals, glass, stone and concrete materials were exposed to air pollution at a station, which was installed for this purpose on a building, located in the centre of Athens. The main purpose of this project was to determine the corrosion and soiling effects of air pollution on materials. A set of the specimens was exposed in a position that was sheltered from rain and partly from wind, and another set was exposed in unsheltered positions on the roof of the above said building. In addition, other specimens were exposed at different heights on the same building, in order to investigate for the first time the corrosion and soiling effects on various materials as a function of height. For the determination of these effects, chemical analysis of the specimens was performed and basic parameters as the weight change, the layer thickness and the optical properties were calculated. Finally, the results obtained are discussed and their plausible interpretation is attempted.

The objective of this study was to compare the results of the Pelvic Organ Prolapse Quantification (POP-Q) examination by visual estimation to measurement.Women with pelvic organ prolapse underwent both "eyeball"/estimated and measured POP-Q examinations by two trained examiners in a randomized order. POP-Q points and stage were analyzed using the paired t test, chi-square, Pearson's correlation, and kappa statistics.Fifty subjects had a mean age of 60, mean BMI 27.8, and median parity of 2. The POP-Q stages by the measured technique were 18% (9/50) stage 1, 38% (19/50) stage 2, 44% (22/50) stage 3, and 0% (0/50) stage 4. The POP-Q stages based on estimation and measurement were highly associated (p0.05). Individual points did not differ significantly between the techniques and did not differ significantly between examiners (all p0.05).Among examiners who routinely perform POP-Q examinations, there is no significant difference between "eyeball"/estimated and measured POP-Q values and stage.

Several exposure campaigns of silica–soda–lime window glass have been performed in 30 European sites and 1 in Canada in order to understand, quantify and model the phenomenon of soiling. In this purpose samples were exposed sheltered from the rain. Parallel to exposure, several meteorological parameters and pollution concentrations have been monitored. This paper shows first results on the establishment of a dose–response function for glass soiling. Statistical analyses show that PM10 is not the only parameter, but also SO2 and NO2 atmospheric concentrations seem to be responsible for the optical impairment of glass surfaces, expressed as haze.

As part of the MULTI-ASSESS and VIDRIO EC projects, the soiling of modern glass is characterised in various European urban atmospheres. Our original methodology relies on crossed chemical measurements of the deposit (evaluation of the ion, elemental and organic carbon contents, and subsequent “mass closure”) and exhaustive measurements of glass optical properties (light reflectance, transmittance and absorption). Samples were exposed sheltered from rain in Athens, Krakow, London, Montelibretti (Italy), Prague and Troyes (France), during increasing exposure durations, up to more than two years. Although a slowing down of the deposition rate is observed for some species at some sites, no obvious saturation phenomenon seems to occur for the particle deposition. The chemical composition of the deposit is shown to reflect the atmospheric environment of the exposure site. Some post-deposit evolutions, such as the disappearance of ammonium and possibly of particulate organic matter, are found to occur. For thin deposits, the glass optical properties (e.g. light absorption and diffuse transmittance) are found to evolve quasi-linearly with species concentrations (EC and ions, respectively). However, for conditions creating heavier deposits such as long time exposures in rather polluted environments, a saturation phenomenon is observed. Using a simple model, light absorption, which is primarily due to EC particles, is shown to reach the saturation level (S) for A≈16% and the concentration for which the semi-saturation level is reached (C1/2) is found to be about 15 μgC of EC/cm2. For diffuse transmittance, due to scattering species, these parameters are found to be about 30% and 65 μg of ions/cm2, respectively. These values may be considered as representative of the soiling in Europe.

Modern silica-soda-lime float glass samples were exposed to background pollution conditions in Paris, sheltered from rain, during 1, 2, 6, 12 and 24 months. Analytical scanning electron microscopy pointed to the importance of soot particles and soluble salts as fine and coarse deposited particles. Four pertinent soiling parameters were measured: total mass of deposited particles (by weighing), mass of total carbon (by thermo-coulometry), mass of water soluble ions (by ion chromatography on glass surface rinsing water) and haze (by spectrophotometry). Model fitting to experimental data showed a continuous increase of soiling in time, following a variable slope sigmoid (Hill equation) for all the four soiling parameters. This similar evolution allowed defining one general model for soiling.

Fine particulate matter present in urban areas seems to be incriminated in respiratory disorders. The aim of this study was to relate physicochemical characteristics of PM2.5 (particulate matter collected with a 50% efficiency for particles with an aerodynamic diameter of 2.5 microm) to their biological activities toward a bronchial epithelial cell line 16-HBE. Two seasonal sampling campaigns of particles were realized, respectively, in a kerbside and an urban background station in Paris. Sampled-PM2.5 mainly consist of particles with a size below 1 microm and are mainly composed of soot as assessed by analytical scanning electron microscopy. The different PM2.5 samples contrasted in their PAH content, which was the highest in the kerbside station in winter, as well as in their metal content. Kerbside station samples were characterized by the highest Fe and Cu content, which appears correlated to their hydroxyl radical generating properties measured by electron paramagnetic resonance. Particles were compared by their capacity to induce cytotoxicity, intracellular ROS production, and proinflammatory cytokine release (GM-CSF and TNF-alpha). At a concentration of 10 microg/cm2, all samples induced peroxide production and cytokine release to the similar extent in the absence of cytotoxicity. In conclusion, whereas the PM2.5 samples differ by their PAH and metal composition, they induce the same biological responses likely either due to components bioavailability and/ or interactions between PM components.

Publisher Summary Pollution linked to the combustion of wood is characteristic of the atmosphere of the cities in the past. It led to the development of thin grey crusts on the surface of the stones of monuments. The grey crusts were discovered on the Heads of Kings of Juda Statues, present on the western facade of Notre-Dame in Paris from the 13 th Century to 1792. These thin grey crusts are the material witnesses of the effects of the ancient air pollution, prevalent during the French revolution and the period immediately before it. This chapter focuses on the research conducted on the character and evolution of urban air pollution in the past; and the comparison of results with those derived from studies on the modern industrial black crusts. Several analytical techniques were used to highlight the main physicochemical and mineralogical characteristics of the grey crusts: colorimetric technique, X-ray diffraction, and photon microscopy. Many of the characteristics of the ancient grey crusts of the Heads of Kings of Juda directly contrast with those of the modern day black crusts: color, texture, thickness, and chemicomineralogical nature of the crusts and of the prismatic or spherical particles embedded in the matrix. Diffractometric analysis of the modem black crusts highlights the presence of the same minerals as those found in the ancient crusts of the Heads, but in different proportions greater amounts of gypsum than calcite, followed by quartz and weddellite. A further major difference between the ancient grey crusts and the modern black crusts lies in the kind of particles contained in the gypsum-calcite cement. While the grey crusts only contain the residues of incomplete wood combustion, the modern crusts embed microspheres, which turn out to be fly-ash released into the atmosphere by the combustion of coal or heavy fuel.

Publisher Summary Carbonaceous fly-ash, particularly those emitted by heavy fuel oil combustion, has a strong physicochemical reactivity. They contain many sulfured chemical species, in particular sulfates along with metals such as vanadium, iron, and nickel. This chapter describes the role of carbonaceous fly-ash in the nucleation of gypsum crystals and in the development of incipient sulfated black crust on carbonate surface. This study is conducted by comparing simulation chamber data with those obtained in the field. Embryonic black crust forming over 12 months through interaction between carbonaceous fly-ash and samples of Jaumont limestone in the controlled atmosphere of a simulation chamber are compared with those forming in the field on the same carbonate stone, over the same time period in a real polluted atmosphere. The Jaumont limestone samples were placed inside the LASC, either naked or sprinkled with fly-ash. Similarly, Jaumont field samples were collected and examined with ASEM. The chapter discusses the results from both samples and compares them to draw conclusions. On the basis of simulation chamber and field data obtained over 12 months, the study of the morphology, mineralogy, and chemical composition of the deposits and associated neocrystallizations indicates that they represent the first stage of black crust development. The fly-ash appears to play a crucial role in the formation of black crusts because they facilitate the precipitation of gypsum, which constitutes the predominant mineral in the black crusts.

Περιγράφονται οι κυριότερες φθορές στα μνημεία από μάρμαρο και γρανίτη της Δήλου και αναλύονται οι φυσικοχημικοί μηχανισμοί της ανάπτυξης τους, λαμβάνοντας υπόψη τις περιβαλλοντικές διαδικασίες που καθορίζουν τη δημιουργία τους. Εντοπίζονται δύο κύριοι συντελεστές φθοράς : τα θαλάσσια άλατα και η ατμοσφαιρική ρύπανση. Ενεχόμενα σε κύκλους διάλυσης-κρυσταλλοποίησης, τα θαλάσσια άλατα δημιουργούν απολεπίσεις, αποσαθρώσεις και κρατήρες. Οι κύκλοι αυτοί προκύπτουν από την εξάτμιση των διαλυμάτων που εκλύονται από το έδαφος μέσω της τριχοειδούς ανύψωσης και από τη διαλύτωση των αλάτων που επικάθηνται στους λίθους μέσω των αιωρουμένων σταγονιδίων. Η ατμοσφαιρική ρύπανση επιτείνει τις διαδικασίες διάλυσης και τη δημιουργία καστανών επικαθισμάτων., The principal forms of weathering found on the marble and granite remains on Delos are described and the physico-chemical mechanisms of their development are explained by the environmental processes which gave rise to their formation. Two main factors were revealed: marine salts and atmospheric pollution. Cycles of dissolution and crystallisation of these salts lead to exfoliation, disaggregation and pitting. They are caused by the evaporation of solutions migrating from the soil through capilliary action and the solvation of the salts deposited on the stones by sea spray. Atmospheric pollution increases the processes of dissolution and formation of brown crusts., Les principales altérations rencontrées sur les vestiges en marbre et en granite de Délos sont décrites et les mécanismes physico-chimiques de leur développement sont expliqués en tenant compte des processus environnementaux qui conditionnent leur formation. Deux facteurs principaux d'altération ont ainsi été mis en évidence : les sels marins et la pollution atmosphérique. Impliqués dans les cycles de dissolution-cristallisation, ces sels forment des desquamations, des désagrégations et des cratères. Ces cycles résultent de l'évaporation des solutions migrant depuis le sol par capillarité et de la solvatation des sels déposés sur les pierres par les embruns. La pollution atmosphérique accentue les processus de dissolution et la formation d'encroûtements bruns., Chabas Anne, Jeannette Daniel, Lefèvre Roger. Altération du marbre et du granite de Délos: rôle de l'environnement atmosphérique marin naturel et pollué. In: Bulletin de correspondance hellénique. Volume 122, livraison 2, 1998. pp. 487-500.

Summary The limestones (“tuffeau”) of the ”Cloitre du Grand Moutiers” and the “Salle Capitulaire” in the Fontevraud Abbey (Loire Valley, France) contain two types of mineral microspherules : - in the non-altered substrate stone : microspherules (10 μm in diameter), only siliceous in composition and probably biogenic in origin. - in the altered black crust : alumino-silicate or metallic microspherules (1-5 μm in diameter) associated with gypsum crystals. A study by means of Analytical Scanning Electron Microscopy has been performed on the microspherules both in non-altered and altered stone. The chemical composition of the microspherules associated with gypsum is the same as that of industrial fly-ash emitted by coal-burning power plants. Their presence in the altered crusts of carbonatic rocks is in agreement with a previous study. Their role in the formation of the sulphate crust is probably of major importance. The origin of fly-ash has been studied by back trajectories of air masses during the sampling period.

Glassy microspherules collected from the plume of Etna volcano show a surprising compositional variability with SiO 2 from 48 to 90 wt%, despite a very homogeneous basaltic source magma (SiO 2 = 48%). This same variability is also observed in individual microspherules from their inner to outer parts. The most plausible hypothesis concerning these compositional variabilities is the interaction of the microspherules with the volcanic gases inside the crater prior to their atmospheric dispersal. In order to study this compositional variability we experimentally exposed basaltic glass to volcanic gases at Etna. The resulting glass composition documents a fundamental alteration mechanism, involving an apparent leaching process that can rapidly form nearly pure silica. Because microspherules erupted directly into the air from lava fountains remain unaltered, the duration of microspherules within a gas plume can explain the chemical variability of glass alteration. A major implication for the origin of glassy atmospheric particulates is that chemical compositions cannot be used as a reliable indicator of their source (e.g., meteoric, volcanic, anthropogenic).

A possible volcanic origin has been suggested for the micrometre-sized spherules that have been discovered in polar snows or ice-cores1–5, and in the stratosphere6,7. However, although such particles, especially when black and magnetic, have been identified among the tephra deposits of some volcanoes3,8–12, their volcanic emission has never been directly observed. Here we describe micro-spherules intercepted in the plume of Mount Etna, Sicily, during moderate recurring volcanic activity. Their study, using analytical transmission and scanning electron microscopy (ATEM and ASEM) demonstrates the simultaneous presence in the plume of glassy silicate microspherules of various chemical compositions (47–98% SiO2).

Aluminum localization in bone from hemodialyzed patients: Relationship to matrix mineralization. It has been suggested that in uremic bone, aluminum interferes with normal mineralization. Aluminum content and aluminum localization were studied in iliac crest biopsies of two groups of patients on regular hemodialysis; one group had histologic osteomalacia, and little or no bone resorption (group 1); the other, osteitis fibrosa and no mineralization defect (group 2). Group 1 patients had significantly higher plasma aluminum concentrations than those of group 2. No difference was found in bone aluminum content, which was above normal in both groups. In the bone samples of the osteomalacic subjects, aluminum was mainly localized at the limit between osteoid and calcified tissue, the site where the bone mineral is normally first deposited. Osteomalacia could not be related to hypocalcemia or to phosphate depletion. Active vitamin D derivatives (25-hydroxychole-calciferol and 1α-hydroxycholecalciferol) failed to prevent or to improve the bone disease. In the bone samples of group 2 subjects, aluminum could not be localized by the methods used, except in the two cases with greatly elevated bone aluminum, where it was mainly localized on cement lines. In group 2 subjects, immunoreactive parathyroid hormone plasma concentrations, osteoclast surface, and marrov/ fibrosis were significantly higher than they were in group 1 subjects. It is concluded that in bone from uremic patients on regular dialysis, aluminum can induce a particular form of osteomalacia, resistant to the vitamin D active derivatives. The bone disease is only observed in the absence of severe secondary hyperparathyroidism. This suggests that parathyroid hormone may be involved in the development of the aluminum-induced mineralization defect. Localisation de l'aluminium dans le tissu osseux de malades en hemodialyse periodique: Relation avec la mineralisation de la matrice. L'hypothese que l'aluminium influence la mineralisation dans le tissu osseux de malades uremiques a ete recemment avancee. Dans ce travail la teneur en aluminium et la localisation de l'aluminium ont ete etudiees dans les biopsies osseuses de deux groupes de malades hemodialyses. Un groupe avait des signes histologiques d'osteomalacie, la resorption etant absente ou peu prononcee (groupe 1), l'autre des lesions plus ou moins importantes d'osteite fibreuse, sans troubles de la mineralisation (groupe 2). L'aluminemie des malades du groupe 1 etait significative-ment superieure a celle des malades du groupe 2; aucune difference n'existait dans la teneur en aluminium de l'os, qui dans les deux groupes etait superieure a la normale. Dans le tissu osseux des malades osteomalaciques l'aluminium etait principalement concentre a la limite entre tissu mineralise et tissu osteoide, a l'endroit ou normalement la matrice organique se mineralise. Les lesions n'etaient pas dues a une carence en calcium ou a une depletion en phosphore. Les derives actifs de la vitamine D (25-hydroxycholecalciferol et 1α-hydroxycholecalciferol) n'ont pas ameliore Fosteomalacie ou empeche son apparition. Dans le tissu osseux des malades du groupe 2 l'aluminium n'a pu etre localise, sauf chez deux malades dont la concentration osseuse en aluminium etait tres elevee. Chez ces deux malades l'aluminium etait principalement situe le long des lignes cementantes. La concentration plasmatique de l'hormone parathyroidienne immunoreactive, la surface osteoclastique et la fibrose medullaire des malades du groupe 2 etaient significativement superieures a celles des malades du groupe 1. En conclusion, chez des malades hemodialyses, l'aluminium peut entrainer une forme particuliere d'osteomalacie qui resiste aux derives actifs de la vitamine D. Cette osteomalacic ne s'observe qu'en l'absence d'hyper-parathyroidie secondaire importante; l'hormone parathyroidienne pourrait donc jouer un role dans le developement de Fosteomalacie par intoxication a l'aluminium.

Mineralogical characterisation of insoluble microparticles entrapped in ice layers successively deposited on the Antarctic continent is a useful tool for paleoclimate reconstruction. Indeed, it is likely to provide information on the distribution of potential source areas and of climatic conditions prevailing over different time periods. A first study, covering the last 30 kyr and including the end of the last glacial age, has shown that, over central East Antarctica, continental input was soil derived and originated probably from South America. In this work, the time period covered is l60 kyrs which includes a complete climate cycle. Clay species and particle size considerations suggest that local sources and Australia have been of minor importance for the studied area over the last 160 kyr. They support the hypothesis of colder and drier conditions prevailing over the source areas during glacial extrema. Lastly the predominance of illite, feldspar and quartz in association with presumably weathered volcanic products is consistent with a continental input originating from South America for the East Antarctic area, but is not in complete agreement with the results of general circulation models.

An occurrence of inoceramids enclosed within a complex of rudistid limestones of middle Senonian age (upper Cretaceous) in the Lycian Taurus (Antalya province, Turkey) is described. A description of a new species is given: Inoceramus antalyaensis and two associated varieties in this locality.

Systematic descriptions, revision of Chondrodonta, new subgenera