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Background and Purpose: Endovascular thrombectomy outcomes are impacted by changes in stroke systems of care. During the pandemic, SARS-CoV2 positive status had major implications on hospital arrival and treatment models of non-COVID related hospital admissions. Using the Florida Stroke Registry, we compared the rates of in-hospital death and discharge outcomes of patients treated with endovascular thrombectomy who tested positive for SARS-CoV2 infection during their hospitalization., Materials and Methods: Data from Get with the Guidelines-Stroke hospitals participating in the Florida Stroke Registry during the COVID pandemic from March 2020 to December 2022 were reviewed to identify endovascular thrombectomy patients with coding for SARS-CoV2 testing during their hospital stay. Associations between SARS-CoV2 status and favorable endovascular thrombectomy outcomes of mRS (0-2) at discharge, discharge to home or rehabilitation centre, symptomatic intracerebral hemorrhage, in-hospital mortality, and independent ambulation at discharge were examined using multivariate logistic regression modeling adjusting for demographics, vascular risk factors, and clinical characteristics. Temporal analyses were used to compare outcomes across the study period., Results: A total of 8,184 patients underwent endovascular thrombectomy (median age 71.1 years, female 50%, mean NIHSS 14), of these, 180 (2.2%) were SARS-CoV2 positive. Compared to SARS-CoV2 negative endovascular thrombectomy patients, those who tested positive were younger, more frequently male, but with comparable stroke severity at presentation. In multivariable analysis, adjusting for baseline differences and confounding variables, there was a 33% lower likelihood of being discharged to home/inpatient rehab (OR=0.67, 95% CI=(0.49-0.93)), 65% higher odds of in-hospital death (OR=1.65, 95% CI=(1.06-2.58)), as well as a 85% less chance of having a high mRS (>2) at discharge (OR=0.15, 95% CI=(0.04-0.60)) for patients with positive SARS-CoV2 infection. However, a similar risk of symptomatic intracerebral hemorrhage was present compared to SARS-CoV2 negative patients (OR=0.97, 95% CI=(0.501.88)). Temporal analysis of SARS-CoV2 positive patients showed no significant differences., Conclusions: In this large multicenter stroke registry, despite comparable clinical presentation and in-hospital treatment timelines, SARS-CoV2 positive status negatively impacted thrombectomy outcomes., Abbreviations: AIS = acute ischemic stroke; LVO = large vessel occlusion; EVT = endovascular thrombectomy; FSR = Florida Stroke Registry; sICH = symptomatic intracerebral hemorrhage., Competing Interests: The authors declare no conflicts of interest related to the content of this article., (© 2025 by American Journal of Neuroradiology.)

Environmental offsetting has been developed as a mechanism to facilitate the benefits from economic development while avoiding or minimizing environmental harm. This is achieved by compensating for environmental impacts at one location by generating equivalent environmental improvements elsewhere. However, experience with biodiversity and carbon offsetting indicates it can be difficult to ensure the integrity of offsets. Under recent legislation in the catchments of the Great Barrier Reef (GBR), Australia, it is mandatory for water quality emissions from new or expanded point source development to be offset by reducing pollution elsewhere, frequently through reducing non-point source pollution (NPSP). Therefore, informed by experience with biodiversity and carbon offsetting, we summarised sources of uncertainty in NPSP reduction that would influence water quality offset integrity; estimated the maximum potential demand for water quality offsets from sewage treatment plants, the largest point source emitter of total nitrogen (TN) in the GBR catchments, between 2018 and 2050; and discussed the implications of both on the ability of offsetting to counterbalance the impact of economic development in catchments where nitrogen loads have a large influence on the health of important GBR ecosystems. The catchments surrounding the population centres of Cairns and Mackay had both a potentially high future demand for nitrogen water quality offsets and nitrogen loads with a strong influence on the health of the GBR. Consequently, any low integrity water quality offsets in these catchments could jeopardise progress toward the water quality improvements needed to ensure the continued health of the GBR. Water quality offsetting has numerous strengths as a policy instrument however substantial uncertainties remain related to environmental outcomes. Until further research can reduce these uncertainties, water quality offsets that are implemented near increased point source emissions and have a high certainty of effectiveness may provide a balance between scientific rigour and policy workability., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

The Brisbane River estuary is an anthropogenically-impacted waterway in southeast Queensland, Australia. The estuary is over 80 km long and flows through an urbanised region. It receives over 500 t per year of total nitrogen (N) from direct point-source discharges in addition to sporadic flood loads of N from an agriculturally impacted upper catchment. Comprehensive water quality monitoring data for the estuary have been collected from at least 2001. This monitoring data includes ambient nutrient concentrations in the estuary, nutrient concentration and volume of the catchment inflows, and nutrient concentration and volume of point source discharges. This long-term data from a range of sources was used to determine temporal and spatial variations in concentrations, forms, stores and loads of N along the estuary for the period 2001 to 2022. Results showed that, during low-flow periods, the store of N in the mid-upper estuary (33-81 km upstream) is significantly determined by point-source discharges to this reach, and therefore the store of N can be modelled. Model parameters are the daily point source loads, a point source load decay factor, and a background constant store. In the lower estuary (0-33 km upstream) N store can be accurately determined based on dilution with seawater, with point sources not having significant influence on total N in the reach. Total N from large flood events was found to largely pass through the estuary without detectable removal processes, delivering catchment derived N directly to coastal waters. This work informs potential application of nutrient offsets in the estuary, guiding where and when offset options will be effective to mitigate the water quality impacts of point-source nutrients., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Objective: As the coronavirus disease 2019 (COVID-19) pandemic spread to the United States in 2020, there was an impetus toward postponing or ceasing nonurgent transsphenoidal pituitary surgeries to prevent the spread of the virus. Some centers encouraged transcranial approaches for patients with declining neurologic function. However, no large-scale data exist evaluating the effects that this situation had on national pituitary practice patterns., Methods: Pituitary surgeries in the National Inpatient Sample were identified from 2017 to 2020. Surgeries in 2020 were compared with the 3 years previously to determine any differences in demographics, surgical trends/approaches, and perioperative outcomes., Results: In 2020, there was a decline in overall pituitary surgeries (34.2 vs. 36.3%; odds ratio (OR), 0.88; P < 0.001) yet transsphenoidal approaches represented a higher proportion of interventions (69.0 vs. 64.9%; P < 0.001). Neurosurgical complications were higher (51.9 vs. 47.4%; OR, 1.13; P < 0.001) and patients were less likely to be discharged home (86.4 vs. 88.5%; OR, 0.84; P < 0.001). This finding was especially true in April 2020 during the first peak in COVID-19 cases, when transcranial approaches and odds of mortality/complications were highest., Conclusions: In 2020, transsphenoidal surgery remained the preferred approach for pituitary tumor resection despite initial recommendations against the approach to prevent COVID-19 spread. Pituitary surgeries had a higher risk of periprocedural complications despite accounting for preoperative comorbidities, COVID-19 infection status, and surgical approach, suggesting that an overwhelmed hospital system can negatively influence surgical outcomes in noninfected patients., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Giant falcine meningiomas are surgically complex as they are deep in location, concealed by normal brain parenchyma, in close proximity to various neurovascular structures, and frequently involve the falx bilaterally. Although classically accessed using a bifrontal craniotomy and interhemispheric approach, little data exist on alternative operative corridors for these challenging tumors. We evaluated perioperative and long-term outcomes in patients undergoing transcortical resection of giant bilateral falcine meningiomas., Methods: From 2013 to 2022, fourteen patients with giant bilateral falcine meningiomas treated via a transcortical approach at our institution were identified. Perioperative and long-term outcomes were evaluated to determine predictors of adverse events. Corticectomy depth was also analyzed to determine if it correlated with increased postoperative seizure rates., Results: 57.1% of cases were WHO grade 2 meningiomas. Average tumor volume was 77.8 ± 46.5 cm 3 and near/gross total resection was achieved in 78.6% of patients. No patient developed a venous infarct or had seizures in the 6 months after surgery. Average corticectomy depth was 0.83 ± 0.71 cm and increasing corticectomy depth did not correlate with higher risk of postoperative seizures (P = 0.44). Increasing extent of tumor resection correlated with lower tumor grade (P = 0.011) and only 1 patient required repeat resection during a median follow-period of 24.9 months., Conclusions: The transcortical approach is a safe alternative corridor for accessing giant, falcine meningiomas, and postoperative seizures were not found to correlate with increasing corticectomy depth. Further prospective studies are necessary to determine the best approach to these surgically complex lesions., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Transvenous access is a necessary tool for numerous cerebrovascular pathologies.Transvenous access in the arm offers several benefits compared with transfemoral access, including patient comfort, the avoidance of transfemoral access complications, and the ability to close both radial arterial access and distal arm venous access with a single transradial compression band.1In this video we describe the indications, technical nuances, benefits, and limitations of transvenous access in the arm.neurintsurg;jnis-2023-020996v1/V1F1V1Video 1- Combined venous and arterial access in the arm for treatment of a complex dural arteriovenous fistulaWe present the case of a young patient who presented with pulsatile tinnitus and was found to have a Cognard type IIa dural arteriovenous fistula near the left transverse sigmoid junction.The patient was treated with transvenous embolization via the distal right basilic vein, and a single radial compression band served to close both the arterial and venous access sites., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Impairments in cognition and motivation are core features of psychosis and strong predictors of social and occupational functioning. Accumulating evidence indicates that cognitive deficits in psychosis can be improved by computer-based cognitive training programs; however, barriers include access and adherence to cognitive training exercises. Limited evidence-based methods have been established to enhance motivated behavior. In this study, we tested the effects of web-based targeted cognitive and social cognitive training (TCT) delivered in conjunction with an innovative digital smartphone app called Personalized Real-Time Intervention for Motivational Enhancement (PRIME). The PRIME app provides users with a motivational coach to set personalized goals and secure social networking for peer support., Objective: This study investigated whether deficits in cognition and motivation in people with a psychosis spectrum disorder (N=100) can be successfully addressed with 30 hours of TCT+PRIME as compared with 30 hours of a computer games control condition (CG) plus PRIME (CG+PRIME). Here, we describe our study procedures, the feasibility and acceptability of the intervention, and the results on all primary outcomes., Methods: In this double-blind randomized controlled trial, English-speaking participants completed all cognitive training, PRIME activities, and assessments remotely. Participants completed a diagnostic interview and remote cognitive, clinical, and self-report measures at baseline, posttraining, and at a 6-month follow-up., Results: This study included participants from 27 states across the United States and 8 countries worldwide. The study population was 58% (58/100) female, with a mean age of 33.77 (SD 10.70) years. On average, participants completed more than half of the cognitive training regimen (mean 18.58, SD 12.47 hours of training), and logged into the PRIME app 4.71 (SD 1.58) times per week. The attrition rate of 22% (22/100) was lower than that reported in our previous studies on remote cognitive training. The total sample showed significant gains in global cognition (P=.03) and attention (P<.001). The TCT+PRIME participants showed significantly greater gains in emotion recognition (P<.001) and global cognition at the trend level (P=.09), although this was not statistically significant, relative to the CG+PRIME participants. The total sample also showed significant improvements on multiple indices of motivation (P=.02-0.05), in depression (P=.04), in positive symptoms (P=.04), and in negative symptoms at a trend level (P=.09), although this was not statistically significant. Satisfaction with the PRIME app was rated at 7.74 (SD 2.05) on a scale of 1 to 10, with higher values indicating more satisfaction., Conclusions: These results demonstrate the feasibility and acceptability of remote cognitive training combined with the PRIME app and that this intervention can improve cognition, motivation, and symptoms in individuals with psychosis. TCT+PRIME appeared more effective in improving emotion recognition and global cognition than CG+PRIME. Future analyses will test the relationship between hours of cognitive training completed; PRIME use; and changes in cognition, motivation, symptoms, and functioning., Trial Registration: ClinicalTrials.gov NCT02782442; https://clinicaltrials.gov/study/NCT02782442., (©Melissa Fisher, Kevin Etter, Aimee Murray, Neelu Ghiasi, Kristin LaCross, Ian Ramsay, Ariel Currie, Karrie Fitzpatrick, Bruno Biagianti, Danielle Schlosser, Rachel Loewy, Sophia Vinogradov. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 13.11.2023.)

Formal thought disorder (FTD) is a key clinical factor in schizophrenia, but the neurobiological underpinnings remain unclear. In particular, relationship between FTD symptom dimensions and patterns of regional brain volume deficiencies in schizophrenia remain to be established in large cohorts. Even less is known about the cellular basis of FTD. Our study addresses these major obstacles based on a large multi-site cohort through the ENIGMA Schizophrenia Working Group (752 individuals with schizophrenia and 1256 controls), to unravel the neuroanatomy of positive, negative and total FTD in schizophrenia and their cellular bases. We used virtual histology tools to relate brain structural changes associated with FTD to cellular distributions in cortical regions. We identified distinct neural networks for positive and negative FTD. Both networks encompassed fronto-occipito-amygdalar brain regions, but negative FTD showed a relative sparing of orbitofrontal cortical thickness, while positive FTD also affected lateral temporal cortices. Virtual histology identified distinct transcriptomic fingerprints associated for both symptom dimensions. Negative FTD was linked to neuronal and astrocyte fingerprints, while positive FTD was also linked to microglial cell types. These findings relate different dimensions of FTD to distinct brain structural changes and their cellular underpinnings, improve our mechanistic understanding of these key psychotic symptoms., Competing Interests: Confiicts of Interest The authors declare that there is no conflict of interest.

Background: Survivors of traumatic brain injury are at increased risk for firearm-related injuries, including suicide., Aims: To determine current practices of Brain Injury Medicine (BIM) physicians and their rehabilitation teams in assessing patients' access to firearms and in providing firearm safety education, and the impact of having received training on this topic on physicians' likelihood of inquiring about patients' access to firearms., Methods: 14-item web-based cross-sectional survey of 86 U.S. physiatrists board-certified in BIM., Results: 81% of respondents indicated they believe BIM physicians should counsel their patients on firearm safety but only 12.9% reported always doing so. Fifteen percent reported always inquiring about their patients' access to firearms. 88.2% indicated having never received formal training on firearm injury prevention counseling. Physicians who received such training had 7.5 times higher odds of reporting at least sometimes inquiring about patients' access to firearms than those who were not trained [95% confidence interval (1.94, 28.64)]. They also had 5.7 times higher odds for reporting being at least moderately comfortable providing patients firearm safety counseling [95% CI: (1.39, 23.22)]., Conclusion: While most BIM specialists who responded to this survey believe they should counsel patients on firearm safety, few always or usually do so. Moreover, most do not routinely inquire about their patients' access to firearms. The provision of firearm injury prevention training to BIM physicians was strongly associated with an increased likelihood they will inquire about their patients' access to guns and with an improved comfort level in providing counseling on this subject matter., Competing Interests: LS holds stock in Doximity. This platform was used to make contact with brain injury specialists for whom we were unable to locate an email address, though ultimately, we received only one survey response via this method. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Ramsay, Miranda-Cantellops, Acosta and Shapiro.)

Nutrient offsetting allows nutrient point source polluters to pay for diffuse source nutrient reductions, or improvements in nutrient load reductions from alternative point sources. These programs have the potential to provide a more cost-effective approach to achieve water quality goals in waterways compared to infrastructure upgrades. However, worldwide adoption of nutrient offset/trading has not been realized. Here, we identified the biophysical-chemical knowledge gaps that can act as barriers to adopting these programs and summarized areas where further research is needed. This includes a) evaluating if any appropriate spatial scale (local-, catchment-, or regional-scale) and time scale (especially for areas with dry/wet cycles) exists to achieve nutrient load management goals, and b) quantifying nutrient characteristic differences and load contributions between point and diffuse sources to determine possible offsets between the two. Where offsets are appropriate, there is also a need to 1) improve monitoring design and reduce modelling uncertainties to better quantify diffuse nutrient loads; 2) quantify and manage uncertainties in catchment interventions to reduce nutrient loads, and design effective long-term monitoring and maintenance to sustain intervention outcomes; 3) prioritize areas within catchments that are key nutrient sources for catchment interventions to achieve the optimal outcomes for nutrient load management and catchment and aquatic ecosystem health; and 4) develop methodologies to determine the environmental equivalency ratio between different nutrient sources in terms of ecosystem effects. This would include identifying the best metric to quantify equivalency ratios, determining discharge patterns for different nutrient sources, and linking this with ecosystem responses across seasons and in the downstream receiving environment. Addressing the identified knowledge gaps will improve the program feasibility assessment process as well as confidence and certainty in the environmental outcomes of nutrient offsetting., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests:Jing Lu reports financial support was provided by Griffith University Australian Rivers Institute. Jing Lu reports a relationship with Griffith University Australian Rivers Institute that includes: employment. No other interests declared., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Intracranial dural arteriovenous fistulas (DAVFs) have been documented to occasionally spontaneously regress. However, the mechanism responsible for this occurrence remains speculative., Methods: We present a case of a Borden II - Cognard IIa+b DAVF involving the superior sagittal sinus (SSS) with bilateral external carotid artery supply that regressed spontaneously. A systematic literature review was conducted to explore the current theories explaining the spontaneous regression of DAVFs according to Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines., Results: A total of 26 studies and 54 cases were included in our results. Of the included cases, 57.14% of cases were Borden I, 16.33% were Borden II, and 26.53% were Borden III. Ruptured status or intracranial hemorrhage was documented in 24.1% of all cases, the majority of which (69.2%) were in cases with aggressive lesions (Borden II or greater). The most commonly involved location was the transverse sinus (38.89% of cases, n = 21), and the SSS was only involved in 12.96% of all cases. 50% of included cases proposed a mechanism responsible for spontaneous regression. The most frequently proposed mechanisms were thrombosis of the involved sinus/chronic inflammatory changes or direct endothelial injury, endoluminal stasis, and thrombogenic effects of contrast medium during angiography. We present the case of a 54-year-old woman with an aggressive ruptured DAVF that likely developed following a pediatric traumatic brain injury that was left untreated before she presented to our institution after significant delay. Her DAVF regressed on repeat angiography before neurovascular intervention without a clear identifying mechanism as proposed by the current literature., Conclusion: Our results suggest that spontaneous regression is not necessarily associated with lower risk DAVFs. The present case offers a unique long-term insight into the natural history of an aggressive ruptured DAVF of the SSS that regressed without intervention. Further research into the natural history of DAVFs will be helpful in deducing key factors leading to spontaneous regression., Competing Interests: There are no conflict of interest., (Copyright: © 2023 Surgical Neurology International.)

The 68 Ga-Collagen Binding Probe #8, 68 Ga-CBP8, is a peptide-based, type I collagen-targeted probe developed for imaging of tissue fibrosis. The aim of this study was to determine the biodistribution, dosimetry, and pharmacokinetics of 68 Ga-CBP8 in healthy human subjects. Methods: Nine healthy volunteers (5 male and 4 female) underwent whole-body 68 Ga-CBP8 PET/MRI using a Biograph mMR scanner. The subjects were imaged continuously for up to 2 h after injection of 68 Ga-CBP8. A subset of subjects underwent an additional imaging session 2-3 h after probe injection. OLINDA/EXM software was used to calculate absorbed organ and effective dose estimates based on up to 17 regions of interest (16 for men) defined on T2-weighted MR images and copied to the PET images, assuming a uniform distribution of probe concentration in each region. Serial blood sampling up to 90 min after probe injection was performed to assess blood clearance and metabolic stability. Results: The mean injected activity (±SD) of 68 Ga-CBP8 was 220 ± 100 MBq (range, 113-434 MBq). No adverse effects related to probe administration were detected. 68 Ga-CBP8 demonstrated an extracellular distribution with predominantly rapid renal clearance. Doses on the urinary bladder were 0.15 versus 0.19 mGy/MBq for men versus women. The highest absorbed doses for the rest of the organs were measured in the kidneys (0.078 vs. 0.088 mGy/MBq) and the liver (0.032 vs. 0.041 mGy/MBq). The mean effective dose was 0.018 ± 0.0026 mSv/MBq using a 1-h voiding model. The 68 Ga-CBP8 signal in the blood demonstrated biexponential pharmacokinetics with an initial distribution half-life of 4.9 min (95% CI, 2.4-9.4 min) and a 72-min elimination half-life (95% CI, 47-130 min). The only metabolite observed had a long blood plasma half-life, suggesting protein-bound 68 Ga. Conclusion: 68 Ga-CBP8 displays favorable in-human characteristics and dosimetry similar to that of other gallium-based probes. 68 Ga-CBP8 could therefore be used for noninvasive collagen imaging across a range of human fibrotic diseases., (© 2023 by the Society of Nuclear Medicine and Molecular Imaging.)

The results of "A Randomized Trial of Unruptured Brain Arteriovenous Malformations" (ARUBA) suggested that observation alone resulted in less morbidity and mortality than intervention for these lesions. These findings generated significant controversy throughout the cerebrovascular community and resulted in several subsequent studies investigating the role of microsurgical resection on ARUBA-eligible patients. Herein, we provide a brief overview of the ARUBA trial, its subsequent criticisms, the resultant publications challenging the findings in ARUBA, and discuss the available data regarding the effect ARUBA has had on arteriovenous malformation (AVM) treatments., Competing Interests: Disclosure The authors have nothing to disclose., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Background: Psychotic-like experiences (PLEs) are considered the subclinical portion of the psychosis continuum. Research suggests that there are resting-state functional connectivity (rsFC) substrates of PLEs, yet it is unclear if the same substrates underlie more severe psychosis. Here, to our knowledge, we report the first study to build a cross-validated rsFC model of PLEs in a large community sample and directly test its ability to explain psychosis in an independent sample of patients with psychosis and their relatives., Methods: Resting-state FC of 855 healthy young adults from the WU-Minn Human Connectome Project (HCP) was used to predict PLEs with elastic net. An rsFC composite score based on the resulting model was correlated with psychotic traits and symptoms in 118 patients with psychosis, 71 nonpsychotic first-degree relatives, and 45 healthy control subjects from the psychosis HCP., Results: In the HCP, the cross-validated model explained 3.3% of variance in PLEs. Predictive connections spread primarily across the default, frontoparietal, cingulo-opercular, and dorsal attention networks. The model partially generalized to a younger, but not older, subsample in the psychosis HCP, explaining two measures of positive/disorganized psychotic traits (the Structured Interview for Schizotypy: β = 0.25, p one-tailed  = .027; the Schizotypy Personality Questionnaire positive factor: β = 0.14, p one-tailed  = .041). However, it did not differentiate patients from relatives and control subjects or explain psychotic symptoms in patients., Conclusions: Some rsFC substrates of PLEs are shared across the psychosis continuum. However, explanatory power was modest, and generalization was partial. It is equally important to understand shared versus distinct rsFC variances across the psychosis continuum., (© 2022 The Authors.)

Background: Healthcare-associated (HCA) SARS-CoV-2 infection is a significant contributor to the spread of the 2020 pandemic. Timely review of HCA cases is essential to identify learning to inform infection prevention and control (IPC) policies and organisational response., Aim: To identify key areas for improvement through rapid investigation of HCA SARS-CoV-2 cases and to implement change., Methods: Cases were identified based on date of first positive SARS-CoV-2 PCR sample in relation to date of hospital admission. Cases were reviewed using a structured gap analysis tool to identify key learning points. These were discussed in weekly multidisciplinary meetings to gain consensus on learning outcomes, level of harm incurred by the patient and required actions. Learning was then promptly fed back to individual teams and the organisation., Findings: Of the 489 SARS-CoV-2 cases admitted between 10 th March and 23 rd June 2020, 114 suspected HCA cases (23.3%) were reviewed; 58/489 (11.8%) were ultimately deemed to be HCA. Five themes were identified: individual patient vulnerability, communication, IPC implementation, policy issues and organisational response. Adaptations to policies based on these reviews were completed within the course of the initial phase of the pandemic., Conclusion: This approach enabled timely learning and implementation of control measures and policy development., Competing Interests: Declaration of conflicting interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2022.)

Introduction: Without universal access to point-of-care SARS-CoV-2 testing, many hospitals rely on clinical judgement alone for identifying cases of COVID-19 early., Methods: Cambridge University Hospitals NHS Foundation Trust introduced a 'traffic light' clinical judgement aid to the COVID-19 admissions unit in mid-March 2020. Ability to accurately predict COVID-19 was audited retrospectively across different stages of the epidemic., Results: One SARS-CoV-2 PCR positive patient (1/41, 2%) was misallocated to a 'green' (non-COVID-19) area during the first period of observation, and no patients (0/32, 0%) were mislabelled 'green' during the second period. 33 of 62 (53%) labelled 'red' (high risk) tested SARS-CoV-2 PCR positive during the first period, while 5 of 22 (23%) 'red' patients were PCR positive in the second., Conclusion: COVID-19 clinical risk stratification on initial assessment effectively identifies non-COVID-19 patients. However, diagnosing COVID-19 is challenging and risk of overcalling COVID-19 should be recognised, especially when background prevalence is low., (© Royal College of Physicians 2021. All rights reserved.)

Background: We previously demonstrated that the high heterogeneity of response to computerized Auditory Training (AT) in psychosis can be ascribed to individual differences in sensory processing efficiency and neural plasticity. In particular, we showed that Auditory Processing Speed (APS) serves as a behavioral measure of target engagement, with faster speed predicting greater transfer effects to untrained cognitive domains. Here, we investigate whether the ability of APS to function as a proxy for target engagement is unique to AT, or if it applies to other training interventions, such as Executive Functioning Training (EFT). Additionally, we examine whether changes in APS are durable after these two forms of training., Methods: One hundred and twenty-five participants with Recent Onset Psychosis (ROP) were randomized to AT (n = 66) and EFT (n = 59), respectively. APS was captured at baseline, after treatment, and at 6-month follow-up. Mixed models repeated measures analysis with restricted maximum likelihood was used to examine whether training condition differentiated APS trajectories. Within-group correlational analyses were used to study the relationship between APS and performance improvements in each of the training exercises., Results: The two groups were matched for age, gender, education, and baseline APS. Participants showed high inter-individual variability in APS at each time point. The mixed model showed a significant effect of time (F = 5.99, p = .003) but not a significant group-by-time effect (F = .73, p = .48). This was driven by significant APS improvements AT patients after treatment (d = .75) that were maintained after 6 months (d = .63). Conversely, in EFT patients, APS improvements did not reach statistical significance after treatment (p = .33) or after 6 months (p = .24). In AT patients, baseline APS (but not APS change) highly predicted peak performance for each training exercise (all r' s >.42)., Conclusions: Participant-specific speed in processing basic auditory stimuli greatly varies in ROP, and strongly influences the magnitude of response to auditory but not executive functioning training. Importantly, enhanced auditory processing efficiency persists 6 months after AT, suggesting the durability of neuroplasticity processes induced by this form of training. Future studies should aim to identify markers of target engagement and durability for cognitive training interventions that target sensory modalities beyond the auditory domain., (Copyright © 2020 Biagianti, Fisher, Loewy, Brandrett, Ordorica, LaCross, Schermitzler, McDonald, Ramsay and Vinogradov.)

Objective: Cytomegalovirus (CMV) is an opportunistic herpesvirus, and reactivation of infection is possible in immunocompromised patients. Historically, the risk for haematology patients is restricted to those treated with an allogeneic transplant or T-cell depleting agents. Bortezomib is a highly efficacious proteasome inhibitor widely used to treat multiple myeloma and light chain (AL) amyloidosis patients. The objective of this small prospective study was to quantify the risk of CMV reactivation associated with bortezomib treatment., Methods: Fifty-seven consecutive multiple myeloma or AL amyloidosis patients commencing bortezomib-based therapy were included. Viral copy numbers were established at baseline and then at fortnightly intervals during treatment. Pre-emptive anti-viral treatment was initiated in patients with a viral load >7500 copies/mL., Results: Reactivation of CMV was detected in 39% (n = 12/31) of seropositive bortezomib treated patients compared with 0% of CMV seronegative patients. Detectable DNAemia developed during the first two cycles of treatment in 83% (n = 10/12) patients. Anti-viral treatment was initiated in 42% (n = 5/12), but no cases of active CMV disease were seen., Conclusion: This study suggests that there is a substantial risk of CMV reactivation in CMV-seropositive plasma cell dyscrasia patients treated with bortezomib., (© 2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: Deficits in cognition, social cognition, and motivation are significant predictors of poor functional outcomes in schizophrenia. Evidence of durable benefit following social cognitive training is limited. We previously reported the effects of 70 h of targeted cognitive training supplemented with social cognitive exercises (TCT + SCT) verses targeted cognitive training alone (TCT). Here, we report the effects six months after training., Methods: 111 participants with schizophrenia spectrum disorders were randomly assigned to TCT + SCT or TCT-only. Six months after training, thirty-four subjects (18 TCT + SCT, 16 TCT-only) were assessed on cognition, social cognition, reward processing, symptoms, and functioning. Intent to treat analyses was used to test the durability of gains, and the association of gains with improvements in functioning and reward processing were tested., Results: Both groups showed durable improvements in multiple cognitive domains, symptoms, and functional capacity. Gains in global cognition were significantly associated with gains in functional capacity. In the TCT + SCT group, participants showed durable improvements in prosody identification and reward processing, relative to the TCT-only group. Gains in reward processing in the TCT + SCT group were significantly associated with improvements in social functioning., Conclusions: Both TCT + SCT and TCT-only result in durable improvements in cognition, symptoms, and functional capacity six months post-intervention. Supplementing TCT with social cognitive training offers greater and enduring benefits in prosody identification and reward processing. These results suggest that novel cognitive training approaches that integrate social cognitive exercises may lead to greater improvements in reward processing and functioning in individuals with schizophrenia., Competing Interests: Bruno Biagianti MD, PhD is Senior Scientist at Posit Science, a company that produces cognitive training and assessment software. Drs. Vinogradov, Fisher, and Nahum have scientific collaborations with scientists at Posit Science, and do not hold any financial interests in the company. Dr. Vinogradov serves on Scientific Advisory Boards for the following organizations: Mindstrong, Inc., Alkermes, Inc., and Psyberguide., (© 2019 The Authors.)

Background: The National Health Service in England advises hospitals collect data on hospital-onset diarrhoea (HOD). Contemporaneous data on HOD are lacking., Aim: To investigate prevalence, aetiology and management of HOD on medical, surgical and elderly-care wards., Methods: A cross-sectional study in a volunteer sample of UK hospitals, which collected data on one winter and one summer day in 2016. Patients admitted ≥72 h were screened for HOD (definition: ≥2 episodes of Bristol Stool Type 5-7 the day before the study, with diarrhoea onset >48 h after admission). Data on HOD aetiology and management were collected prospectively., Findings: Data were collected on 141 wards in 32 hospitals (16 acute, 16 teaching). Point-prevalence of HOD was 4.5% (230/5142 patients; 95% confidence interval (CI) 3.9-5.0%). Teaching hospital HOD prevalence (5.9%, 95% CI 5.1-6.9%) was twice that of acute hospitals (2.8%, 95% CI 2.1-3.5%; odds ratio 2.2, 95% CI 1.7-3.0). At least one potential cause was identified in 222/230 patients (97%): 107 (47%) had a relevant underlying condition, 125 (54%) were taking antimicrobials, and 195 (85%) other medication known to cause diarrhoea. Nine of 75 tested patients were Clostridium difficile toxin positive (4%). Eighty (35%) patients had a documented medical assessment of diarrhoea. Documentation of HOD in medical notes correlated with testing for C. difficile (78% of those tested vs 38% not tested, P<0.001). One-hundred and forty-four (63%) patients were not isolated following diarrhoea onset., Conclusion: HOD is a prevalent symptom affecting thousands of patients across the UK health system each day. Most patients had multiple potential causes of HOD, mainly iatrogenic, but only a third had medical assessment. Most were not tested for C. difficile and were not isolated., (Copyright © 2019 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.)

Purpose To evaluate the biodistribution, metabolism, and pharmacokinetics of a new type I collagen-targeted magnetic resonance (MR) probe, CM-101, and to assess its ability to help quantify liver fibrosis in animal models. Materials and Methods Biodistribution, pharmacokinetics, and stability of CM-101 in rats were measured with mass spectrometry. Bile duct-ligated (BDL) and sham-treated rats were imaged 19 days after the procedure by using a 1.5-T clinical MR imaging unit. Mice were treated with carbon tetrachloride (CCl 4 ) or with vehicle two times a week for 10 weeks and were imaged with a 7.0-T preclinical MR imaging unit at baseline and 1 week after the last CCl 4 treatment. Animals were imaged before and after injection of 10 µmol/kg CM-101. Change in contrast-to-noise ratio (ΔCNR) between liver and muscle tissue after CM-101 injection was used to quantify liver fibrosis. Liver tissue was analyzed for Sirius Red staining and hydroxyproline content. The institutional subcommittee for research animal care approved all in vivo procedures. Results CM-101 demonstrated rapid blood clearance (half-life = 6.8 minutes ± 2.4) and predominately renal elimination in rats. Biodistribution showed low tissue gadolinium levels at 24 hours (<3.9% injected dose [ID]/g ± 0.6) and 10-fold lower levels at 14 days (<0.33% ID/g ± 12) after CM-101 injection with negligible accumulation in bone (0.07% ID/g ± 0.02 and 0.010% ID/g ± 0.004 at 1 and 14 days, respectively). ΔCNR was significantly (P < .001) higher in BDL rats (13.6 ± 3.2) than in sham-treated rats (5.7 ± 4.2) and in the CCl 4 -treated mice (18.3 ± 6.5) compared with baseline values (5.2 ± 1.0). Conclusion CM-101 demonstrated fast blood clearance and whole-body elimination, negligible accumulation of gadolinium in bone or tissue, and robust detection of fibrosis in rat BDL and mouse CCl 4 models of liver fibrosis. © RSNA, 2017 Online supplemental material is available for this article.

Recurrence occurs in approximately 25% of all cases of Clostridium difficile infection (CDI) and poses a unique clinical challenge. Traditionally, treatment options of CDI have been limited to regimes of established antibiotics (eg, pulsed/tapered vancomycin) but faecal transplantation is emerging as a useful alternative. In recent years, promising new strategies have emerged for effective prevention of recurrent CDI (rCDI) including new antimicrobials (eg, fidaxomicin) and monoclonal antibodies (eg, bezlotoxumab). Despite promising progress in this area, obstacles remain for making the best use of these resources due to uncertainty over patient selection. This commentary describes the current epidemiology of rCDI, its clinical impact and risk factors, some of the measures used for treating and preventing rCDI, and some of the emerging treatment options. It then describes some of the obstacles that need to be overcome., Competing Interests: Declaration of conflicting interests:The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Purpose To compare intravascular contrast enhancement produced by the manganese-based magnetic resonance (MR) imaging contrast agent manganese-N-picolyl-N,N',N'-trans-1,2-cyclohexenediaminetriacetate (Mn-PyC3A) to gadopentetate dimeglumine (Gd-DTPA) and to evaluate the excretion, pharmacokinetics, and metabolism of Mn-PyC3A. Materials and Methods Contrast material-enhanced MR angiography was performed in baboons (Papio anubis; n = 4) by using Mn-PyC3A and Gd-DTPA. Dynamic imaging was performed for 60 minutes following Mn-PyC3A injection to monitor distribution and elimination. Serial blood sampling was performed to quantify manganese and gadolinium plasma clearance by using inductively coupled plasma mass spectrometry and to characterize Mn-PyC3A metabolism by using high-performance liquid chromatography. Intravascular contrast enhancement in the abdominal aorta and brachiocephalic artery was quantified by measuring contrast-to-noise ratios (CNRs) versus muscle at 9 seconds following Mn-PyC3A or Gd-DTPA injection. Plasma pharmacokinetics were modeled with a biexponential function, and data were compared with a paired t test. Results Aorta versus muscle CNR (mean ± standard deviation) with Mn-PyC3A and Gd-DTPA was 476 ± 77 and 538 ± 120, respectively (P = .11). Brachiocephalic artery versus muscle CNR was 524 ± 55 versus 518 ± 140, respectively (P = .95). Mn-PyC3A was eliminated via renal and hepatobiliary excretion with similar pharmacokinetics to Gd-DTPA (area under the curve between 0 and 30 minutes, 20.2 ± 3.1 and 17.0 ± 2.4, respectively; P = .23). High-performance liquid chromatography revealed no evidence of Mn-PyC3A biotransformation. Conclusion Mn-PyC3A enables contrast-enhanced MR angiography with comparable contrast enhancement to gadolinium-based agents and may overcome concerns regarding gadolinium-associated toxicity and retention. © RSNA, 2017 Online supplemental material is available for this article.

We introduce a new biochemically responsive Mn-based MRI contrast agent that provides a 9-fold change in relaxivity via switching between the Mn 3+ and Mn 2+ oxidation states. Interchange between oxidation states is promoted by a "Janus" ligand that isomerizes between binding modes that favor Mn 3+ or Mn 2+ . It is the only ligand that supports stable complexes of Mn 3+ and Mn 2+ in biological milieu. Rapid interconversion between oxidation states is mediated by peroxidase activity (oxidation) and l-cysteine (reduction). This Janus system provides a new paradigm for the design of biochemically responsive MRI contrast agents.

Background: Therapeutic immunoglobulins are used as replacement or immunomodulatory therapy, but can transmit clinically important molecules. We investigated hepatitis B virus (HBV) antibodies and galactomannan enzyme immunoassay (GM-EIA) positivity. Detection of HBV core antibody may prompt antiviral prophylaxis when commencing therapy such as rituximab; a positive GM-EIA result prompts investigation or treatment for invasive fungal disease., Methods: We performed a cross-sectional analysis of HBV serology in 80 patients established (>6 months) on immunoglobulin therapy; prospective analysis of HBV serology in 16 patients commencing intravenous immunoglobulin (IVIG); and pre- and post-infusion analysis of GM-EIA in 37 patients receiving IVIG., Results: Pre-IVIG, 9 of 80 patients tested positive for HBV surface antibody and 1 of 80 tested equivocal for HBV core antibody. On IVIG, 79 of 79 tested positive for surface antibody, 37 of 80 tested positive for core antibody, and 10 of 80 tested equivocal for core antibody. There were significant differences by product, but among patients receiving products that appear to transmit core antibody, negative results correlated with lower surface antibody titers and longer time since infusion, suggesting a simple concentration effect. There was a progressive increase with each infusion in the percentage of patients testing positive for HBV core antibody among patients newly commencing IVIG. Some patients "seroreverted" to negative during therapy. Certain IVIG products tested positive for GM-EIA and there were rises in index values in corresponding patient samples from pre- to post-infusion. Overall, 5 of 37 patient samples pre-infusion and 15 of 37 samples post-infusion tested positive for GM-EIA., Conclusions: HBV antibodies and GM-EIA positivity are common in patients receiving IVIG and confound diagnostic results., (© The Author 2016. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail journals.permissions@oup.com.)

Background: The classic Hoffman and Rigler (H&R) sign, originally described in 1965, suggests that left ventricular (LV) dilatation is present if the left ventricle extends more than 18 mm posterior to the inferior vena cava at a level 2 cm above their crossing on a lateral chest radiograph. This sign is still widely used by radiologists but has not been well evaluated against modern methods of noninvasive assessment. This study investigated the sensitivity and specificity of the H&R sign in a modern population., Methods: A sample of 145 patients with LV dilatation based on current echocardiographic criteria was matched for age and sex with 145 patients without LV dilatation. Patients were required to have undergone a lateral chest radiograph in the 3 months before or after undergoing echocardiography; the H&R sign and the cardiothoracic index were assessed on the radiograph independently by 2 blinded physicians., Results: Using the threshold value of 18 mm, sensitivity, specificity, and positive and negative likelihood ratios of the H&R sign were 54.9%, 59.2%, 1.34, and 0.76, respectively (area under the curve [AUC], 0.58). In comparison, the cardiothoracic index provided better prediction of LV dilatation (sensitivity, 87.9%; specificity, 47.5%; AUC, 0.72)., Conclusions: The H&R sign is a poor marker of LV enlargement when compared with echocardiography and should not be used as a radiologic index of LV enlargement., (Copyright © 2016 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.)

Encoding semantic relationships between items on word lists (semantic processing) enhances true memories, but also increases memory distortions. Episodic memory impairments in schizophrenia (SZ) are strongly driven by failures to process semantic relations, but the exact nature of these relational semantic processing deficits is not well understood. Here, we used a false memory paradigm to investigate the impact of implicit and explicit semantic processing manipulations on episodic memory in SZ. Thirty SZ and 30 demographically matched healthy controls (HC) studied Deese/Roediger-McDermott (DRM) lists of semantically associated words. Half of the lists had strong implicit semantic associations and the remainder had low strength associations. Similarly, half of the lists were presented under "standard" instructions and the other half under explicit "relational processing" instructions. After study, participants performed recall and old/new recognition tests composed of targets, critical lures, and unrelated lures. HC exhibited higher true memories and better discriminability between true and false memory compared to SZ. High, versus low, associative strength increased false memory rates in both groups. However, explicit "relational processing" instructions positively improved true memory rates only in HC. Finally, true and false memory rates were associated with severity of disorganized and negative symptoms in SZ. These results suggest that reduced processing of semantic relationships during encoding in SZ may stem from an inability to implement explicit relational processing strategies rather than a fundamental deficit in the implicit activation and retrieval of word meanings from patients' semantic lexicon., (Copyright © 2013 Elsevier B.V. All rights reserved.)

Background: There is a lack of information on the long-term outcomes of transobturator tension-free vaginal tape (TO-TVT) in the surgical treatment of female stress urinary incontinence (SUI)., Objectives: To assess the 3-yr outcomes following TO-TVT and to compare the effectiveness of inside-out versus outside-in approaches., Design, Setting, and Participants: A 3-yr follow-up study of the Evaluation of Transobturator Tapes (E-TOT) trial, a randomised controlled trial (RCT) conducted with women undergoing TO-TVT as a sole procedure between April 2005 and April 2007 in a tertiary urogynaecology centre in the United Kingdom., Intervention: Patients (n=341) were randomised to undergo either TVT-O (Ethicon Inc., Somerville, NJ, USA) for the inside-out approach or TOT-Aris (Coloplast Corp., Minneapolis, MN, USA) for the outside-in approach., Outcome Measurements and Statistical Analysis: The primary outcome was patient-reported success rate. Secondary outcomes included further treatment for SUI, improvement in quality of life, late complications, and risk factors for late failures. Categorical variables were compared using the chi-square or Fisher exact test. Within-group comparison was undertaken using Wilcoxon and Mann-Whitney tests. Risk factors for late failures were assessed in a multivariate regression model. All statistical analysis was performed using SPSS v.18.0 (IBM Corp., Armonk, NY, USA)., Results and Limitations: The 3-yr follow-up was completed by 238 of the 341 women (70%). The overall success rate, based on Patient's Global Impression of Improvement response, was 73.1%, with no significant difference between the inside-out and the outside-in TO-TVT (73.18% vs 72.3%; odds ratio: 0.927; 95% confidence interval, 0.552-1.645; p=0.796). Compared with the 1-yr follow-up, there was a significant reduction in the patient-reported success rate (p=0.005); however, no independent risk factors were identified. A clinically significant improvement (≥10 points) was seen in 80% (n=191) of women, with no significant difference between both groups (p=0.113). Twenty-two women (6%) underwent further surgical treatment within 3 yr. The lack of an objective outcome assessment is a potential limitation of this RCT., Conclusions: The E-TOT RCT showed a 73% patient-reported success rate for TO-TVT at 3-yr follow-up, with no significant differences between inside-out and outside-in approaches. There was a significant drop in patient-reported success rates between 1 and 3 yr., (Copyright © 2012 European Association of Urology. Published by Elsevier B.V. All rights reserved.)

Objective: To assess the efficacy of transobturator tapes in the management of women with urodynamic mixed urinary incontinence (UI)., Study Design: A secondary analysis of a prospective randomized study; 83 women with mixed UI on urodynamics and predominant stress UI symptoms were recruited and randomly assigned to undergo "outside-in" or inside-out transobturator tapes. Preoperative assessment included urodynamic assessment and completion of validated symptom severity and quality of life (QoL) questionnaires. The primary outcome was patient-reported success rates at 1-year as assessed by the Patient Global Impression of Improvement (very much/much improved). Secondary outcomes included changes in preoperative urgency/urgency incontinence, changes in QoL scores and comparison between the 2 types of transobturator tapes., Results: Seventy-seven women completed 1-year follow-up (outside-in [n=42] vs inside-out [n=35]). The patient-reported success rate and objective cure rate were 75% and 90%, respectively. At 1-year follow-up; 40 women (52%) and 31 women (57.4%) reported cure in their preoperative urgency and urgency incontinence, respectively. A total of 74% reported≥10 point improvement in QoL scores., Conclusion: In women with urodynamic mixed incontinence and predominant stress UI, transobturator tapes were associated with good patient-reported success rate at 1 year. Urgency/ urgency incontinence are cured in over 50% of women., (Copyright © 2011 Mosby, Inc. All rights reserved.)

Objectives: To assess the efficacy of transobturator tapes in the treatment of women with recurrent urodynamic stress incontinence., Methods: We performed a secondary analysis of a prospective, randomized, single-blinded study. A total of 341 women were recruited (April 2005 and April 2007) and randomly assigned to undergo "inside-out" TVT-O or "outside-in" TOT-ARIS. Of these women, 46 had undergone ≥1 previous continence procedures and were included in the present study. The preoperative assessment included a urodynamic assessment and completion of validated symptom severity and quality-of-life questionnaires. The primary outcome was the patient-reported success rate at 1 year as assessed using the Patient Global Impression of Improvement (very much/much improved). The secondary outcomes included changes in quality of life, sexual function, the objective success rates defined as negative findings on the standard 1-hour pad test, and a comparison between both routes of transobturator tapes. Multivariate analysis was performed to identify the risk factors for failure., Results: All 46 women completed the 1-year follow-up period. The patient-reported success rate and objective cure rate was 69.6% and 76.5%, respectively, with no significant differences between the 2 transobturator routes (P = .104, odds ratio [OR] 2.933, 95% confidence interval [CI] 0.803-10.719; and P = .077, OR 4.524, 95% CI 0.849-24.109, respectively). Of the 46 women, 35 (76.1%) reported >10-point improvement on the total King's Health Questionnaire scores and 71% of sexually active women (n = 22) showed an improvement in the total 12-item Pelvic Organ Prolapse/Incontinence Sexual Function Questionnaire scores. On multivariate analysis, a maximal urethral closure pressure of <30 cm H(2)O was the only independent risk factor for failure (P = .016, OR 9.206, 95% CI 1.511-56.104)., Conclusions: Transobturator tapes have good patient-reported and objective success rates at 1 year of follow-up in women with previous failed incontinence surgery. A low maximal urethral closure pressure was the only independent predictor of failure., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Objectives: To determine significant preoperative risk factors for failure of transobturator tapes., Methods: Secondary analysis of data from the E-TOT (Evaluation of Transobturator Tapes) study. Patient-reported outcomes (n=310) and objective outcomes (n=297) were analyzed using univariate and multivariate analyses., Results: On univariate analysis, body mass index (BMI) >or= 35, maximum urethral closure pressure (MUCP) or=35 (OR 6.37; 95% CI, 1.73-23.44; P=0.005), nocturia (OR 2.18; 95% CI, 1.04-4.58; P=0.039), urgency incontinence (OR 3.35; 95% CI, 1.07-10.51; P=0.039), and previous incontinence surgery (OR 2.33; 95%CI, 1.1-5.48; P=0.048) were independently associated with patient-reported failure. MUCP

Objective: To compare the 'inside-out' versus 'outside-in' routes for transobturator tape insertion for urodynamic stress incontinence, and to identify independent risk factors for failure at 1 year., Design: Prospective single-blinded randomised trial., Setting: Tertiary urogynaecology centre., Population: A cohort of 341 women undergoing transobturator tape procedures between April 2005 and April 2007., Methods: Women were randomised to tension-free vaginal tape-obturator (TVT)-O for the 'inside-out' route (n = 170) and transobturator tape (TOT)-ARIS for the 'outside-in' route (n = 171). Participants completed validated symptom-severity, quality-of-life and sexual-function questionnaires before and after surgery. In addition, they completed the patient global impression of improvement questionnaire (PGI-I) and standard 1-hour pad test postoperatively., Main Outcome Measures: The primary outcome was the patient-reported success rate reported on the PGI-I scale. Secondary outcomes included objective cure rate and improvement in King's Health Questionnaire scores., Results: A total of 341 women were recruited: 171 women to the 'outside-in' (TOT-ARIS) group and 170 to the 'inside-out' (TVT-O) group; 299 completed the 1-year follow up. The patient-reported success rate was 80% with no statistically significant differences between the groups ('outside-in' 77.6% versus 'inside-out' 81.2%; OR 1.25; 95% CI 0.71, 2.20; P = 0.54). The objective cure rate was 91% with no statistically significant difference between the groups ('outside-in' 88% versus 'inside-out' 94%; OR 2.21; 95% CI 0.85, 5.75; P = 0.157). Previous incontinence surgery (OR 1.41; 95% CI 1.18, 1.91; P = 0.029) and preoperative urgency incontinence (OR 1.78; 95% CI 1.21, 3.91, P = 0.048) were significant risk factors for failure of transobturator tape at the 1-year follow up., Conclusions: There are no significant differences in patient reported and objective cure rates between 'inside-out' and 'outside-in' transobturator tapes. Quality of life and sexual function significantly improved following surgery. Both previous incontinence surgery and preoperative urgency incontinence are associated with significantly lower patient-reported cure rates.

Objectives: To compare the "inside-out (TVT-O)" vs. "outside-in (ARIS)" transobturator tapes in the management of female urodynamic stress incontinence (USI) and to identify independent risk factors of failure of transobturator tapes., Study Design: A prospective, single blinded, randomised trial. Women undergoing transobturator tapes as sole procedure in the period April 2005 and April 2007 were randomised to TVT-O for the inside-out approach and TOT-ARIS for the outside-in approach. The primary outcome measure at 6 months was the absence of USI on urodynamics. Secondary outcomes included; patient-reported success rates, overall patient satisfaction and peri-operative complications., Results: 341 women were recruited: 171 in the outside-in group and 170 in the inside-out. Severe post-operative thigh pain was twice as common in the inside-out group but this was not statistically significant (6.7% vs. 3.5%, p=0.19). 317 women completed the 6 months follow-up; objective cure rates and patient-reported success rates were 85.4 and 80.5%, respectively, with no significant difference between the groups (p=0.28 and p=0.138, respectively). On multivariate analysis: low maximum urethral closure pressure (MUCP) (<30 cm H2O) and previous incontinence surgery were confirmed as independent risk factors for objective failure of transobturator tape with increased odds of failure of 7.06 (2.85-17.48) and 6.22 (2.34-16.52), respectively., Conclusion: This study shows no significant differences in the objective cure rates and patient-reported success rates between the "inside-out (TVT-O)" and "outside-in (ARIS)" transobturator tape procedures in the management of female USI at 6 months follow-up. Previous incontinence surgery and low MUCP were significant risk factors for failure of transobturator tapes., (Copyright 2009 Elsevier Ireland Ltd. All rights reserved.)

The objective of this retrospective longitudinal study was to investigate the incidence and severity of urinary and faecal incontinence in women after either total abdominal hysterectomy or comparable abdominal surgery. Age-matched and postoperative time-matched control groups were drawn from women attending for operation at a Scottish District General Hospital, during the early 1990s (59 women in the hysterectomy group and 33 women in the control group, with a mean preoperative age 40.4 years and 38.1 years, respectively). Within-group and between-group analyses were conducted using t and Fisher's exact tests. Within each group, changes in all urinary and faecal variables during the 10-year period were extremely significant (p < 0003). With the exception of urinary urgency (p = 0.028), there was no statistical difference between the groups.

Forty-seven women participated in a pilot study for a multi-centre randomized controlled trial of the effectiveness of pelvic floor muscle training (PFMT) for women with prolapse. Women with symptomatic stage I or II prolapse [measured by Pelvic Organ Prolapse Quantification (POP-Q)] were randomized to a 16-week physiotherapy intervention (PFMT and lifestyle advice; n = 23) or a control group receiving a lifestyle advice sheet (n = 24). Symptom severity and quality of life were measured via postal questionnaires. Blinded POP-Q was performed at baseline and follow-up. Intervention women had significantly greater improvement than controls in prolapse symptoms (mean score decrease 3.5 versus 0.1, p = 0.021), were significantly more likely to have an improved prolapse stage (45% versus 0%, p = 0.038) and were significantly more likely to say their prolapse was better (63% versus 24%, p = 0.012). The data support the feasibility of a substantive trial of PFMT for prolapse. A multi-centre trial is underway.

Objectives: To assess the complications and short-term outcomes of prolapse repair mesh devices used in the management of female pelvic organ prolapse (POP)., Design: Retrospective cohort study., Setting: Multicentre study involving a tertiary referral urogynaecology unit and two district general hospitals., Population: 329 women who underwent surgical management of prolapse with various prolapse repair mesh devices in the period between January 2005 and December 2006., Methods: Women were identified from theatre records. An independent clinician performed a case notes review during the period March to May 2007., Main Outcome Measures: Complication rates and the short-term cure at 3-month follow-up (defined as

Aim: The objective of this study is to determine whether a simple visual analogue scale; "incontinence bothersome scale (IBS)" can reliably assess the quality of life in women with urinary incontinence., Design: A prospective cohort study in a UK district general hospital., Methods: Two hundreds women with urinary incontinence participated in the study over 1-year period. They completed Kings health questionnaire version 7 (KHQ) and the incontinence bothersome scale (IBS). The results of the IBS were then compared to the total KHQ score and to each domain separately, using the Pearson correlation test. Women in the study were then classified into two main groups according to their urodynamics diagnosis (urodynamic stress incontinence group/detrusor overactivity group) and the total KHQ scores were compared with the IBS scores in each group., Results: The IBS scores had poor correlation with the total KHQ scores (r=0.656) and the difference between both arms was not statistically significant (p=0.084). Further analysis of KHQ domains showed that except for the impact of incontinence domain (r=0.728) all other domains correlated poorly to the IBS. This poor correlation pertained in sub-analysis of women with DO and USI (r=0.65 and 0.48, respectively)., Conclusion: This study has shown that a simple visual scale is not a reliable tool in assessing the QoL in women with urinary incontinence. A formal, validated and reliable QoL questionnaire is still the method of choice for QoL assessment, even if it takes longer to complete.

Urodynamic stress incontinence is a common complaint. There have been over two hundred procedures described for treatment. In 2003, the Royal College of Obstetricians and Gynaecologists in London published a guideline highlighting the evidence for different surgical approaches. These guidelines are intended to guide practice in the United Kingdom, including the two countries that were surveyed. It was our impression however that more sub-urethral tape type procedures were taking place than was recommended. We therefore undertook a postal survey of the consultant gynaecologists in Scotland and Wales, to compare current practice with the evidence base, and also to assess practice from a clinical and manpower perspective. Two hundred and forty consultants were identified in Scotland (161) and Wales (79). About two-thirds of those who saw patients with stress incontinence would always arrange pre-operative physiotherapy, and the majority of consultants would always organise urodynamics preoperatively. There were several different choices of primary procedure, with Tension Free Vaginal Tape (TVT Gynecare- Johnson & Johnson) the most common option. More than half of the respondents in both countries would refer a patient with recurrent stress incontinence to a specialist. TVT was also the most common choice of procedure for recurrent stress incontinence. The procedures that have a grade A recommendation in the RCOG guideline are Burch colposuspension and TVT, and 72% in Scotland and 63% in Wales would perform one of these procedures as first choice. Clinical practice moves on and there are several new sub-urethral tape procedures available on the market. It is important to balance the available evidence base with new developments in order to optimise the management of this common condition.

This study aims to assess the suitability of the transobturator tape (TOT) as a day surgery procedure. A retrospective study of all the patients who underwent TOT as a day surgery procedure, at a tertiary referral centre in the south-west of Scotland, over a 3-year period (August 2002-July 2005). The outcome measures were as follows: complication rates (both intra- and immediate postoperative), voiding dysfunction rates, analgesic requirements and unscheduled in-patient ward admission following the procedure. One hundred and sixty-seven case notes were examined; the mean operating time was 14.7 min (range: 12-28 min, median: 14 min). 97.8% of patients had blood loss <100 ml and the mean blood loss was 54 ml (range: 10-500 ml). None of the patients had major complications such as urethral or bladder injury or anaesthetic complications. 79.6% of patients had satisfactory postoperative voiding pattern achieved within the time frame of the DSU (08:30-17:00 hours). No patient had complete urinary retention. However, 34 patients (20.4%) failed to achieve satisfactory voiding within that time frame and warranted in-patient admission. Three other patients required in-patient admission; the reasons being vaginal bleeding (n=1), postoperative nausea and vomiting (n=1) and postoperative pain (n=1). Therefore, a total of 37 patients required in-patient ward admission, with an admission rate of 22.2%. In conclusion, the transobturator tape procedure is suitable as a day surgery procedure in selected patients. There is minimal peri-operative morbidity, and nearly 80% of patients are discharged home within the scheduled time frame.

Objectives: The transobturator approach for sub-urethral tension free vaginal tapes had gained wide popularity in surgical treatment of urodynamic stress incontinence over the last few years. This study aims to survey the practice and preferences of urogynaecologists and urologists worldwide as regards the transobturator tapes., Material and Methods: Seven hundred and twenty surgeons worldwide were surveyed via postal/email questionnaire about their views and practice regarding the transobturator tape procedures (TOTs). They were asked about their technique and tape material preference and their reasons for choosing them. They were also asked about every detail of the procedure., Results: Adjusted response rate was 68%. Of the responding surgeons, 97% were well aware of the TOTs and only 44.3% undertake them. While 34.16% of the surgeons thought that TOTs are the way forward in the treatment of USI, 14.84% surgeons disagreed and the majority (51%) are yet to decide. With regards to technique of TOTs, most surgeons (38%) would prefer to use both techniques, while 34% use "In-Out" technique only and 28% use "Out-In" technique only. The vast majority (72%) use polypropylene mesh tapes due to better tissue incorporation and proven safety records. A few surgeons deviate from the originally described TOTs; 13.6% use a catheter guide to deviate the bladder and urethra during the trochar insertion and 31.41% use routine cystoscopy as part of the procedure., Conclusion: Whilst one-third of the responding surgeons think that the transobturator approach for tension free vaginal tapes is the way forward for the management of USI, the majority are awaiting studies with longer-term results. The variation from the originally described TOT procedures seems to be inherited from the TVT procedure.

Objectives: To identify the rate of, and risk factors for, lower urinary tract (LUT) injuries associated with the transobturator tension-free vaginal tape (TOT) procedure., Design: Retrospective cohort study., Setting: Tertiary referral urogynaecology centre., Population: 390 women who underwent transobturator suburethral tapes for management of urodynamic stress incontinence between July 2002 and January 2006., Methods: Early cases were identified from theatre records and a case note review performed. From May 2005 (n = 94), data from an ongoing prospective audit were reviewed. Data for LUT injuries with TOT procedures were examined and routes of insertion were compared using Fischer's exact test., Main Outcome Measures: Rate of LUT injuries associated with the TOT procedures. Assessment of factors increasing risk of LUT injury, and comparison of the 'outside-in' and 'inside-out' techniques., Results: 241 women underwent TOT outside-in technique and 148 of them underwent inside-out technique. Four LUT injuries occurred (1%): two urethral injuries (0.5%) and two bladder injuries (0.5%). All LUT injuries occurred in the outside-in group, although this difference did not reach significance (P = 0.146). Bladder injuries occurred in women who underwent concomitant vaginal surgery, while urethral injuries occurred in women undergoing secondary procedures., Conclusion: LUT injury is an uncommon complication of the TOT procedures, and in our hands only occurred with the outside-in technique. Intraoperative cystoscopy should be considered only in selected cases.

Objective: To compare two transobturator suburethral tapes (Obtape, Mentor-Porges and TVT-O, Gynaecare, Johnson and Johnson) used in the management of urodynamic stress incontinence (USI), for tape erosion (vaginal/urethral) rates, clinical presentation, management and outcome., Patients and Methods: We retrospectively studied women who underwent a transobturator suburethral tension-free vaginal tape (TVT) procedure for managing USI in a tertiary referral centre in the West of Scotland over a 36-month period. In our department, the transobturator approach has been the first-choice approach for TVTs since July 2003. Two types of tapes were mainly used, Obtape and TVT-O, and the choice of tape was primarily decided by the surgeons' preference., Results: In all, 316 women had a transobturator tape procedure, of which 96 were associated with another procedure; 112 women had TVT-O using the 'inside-out' technique and 204 had the 'outside-in' technique. Of the latter, 192 had Obtape, four had Obtryx (Boston Scientific) and eight had Monarc (American Medical Systems Inc.) tapes. Sixteen women developed vaginal tape erosion, and significantly more were in the Obtape group than in the TVT-O group (7.29% vs 1.78%, P = 0.038). The patients' age, body mass index, previous vaginal surgery and concomitant vaginal surgery were not significant risk factors for erosions. The time between surgery and diagnosis of erosion was 1-45 weeks, with only one patient being asymptomatic; all others presented with clinical symptoms such as vaginal bleeding, discharge and dyspareunia. Thirteen patients were continent at presentation and 10 of these remained continent after surgical management. In the TVT-O group the erosions were in the lateral vaginal wall, while in the Obtape group the erosions were in the form of central tape extrusion secondary to defective vaginal wall healing., Conclusion: There were significantly more vaginal tape erosions in the Obtape group than in the TVT-O group. No cases of urethral erosions were identified.

The main objective was to develop a technique to expose spots of invisible set-off of inks and lacquers on the food-contact surface of food-packaging materials. Set-off is the unintentional transfer of components of printing inks from the outer printed surface onto the food-contact surfaces. The target sensitivity was 20 microg cm(-2) and the technique should be capable of examining large areas of printed substrate for no more than 4% coverage by set-off. These requirements equate to an ability to detect a worst-case migration potential of less than 50 microg kg(-1). Other objectives were the industrial requirements that the equipment should be inexpensive, should be easy to use by existing personnel and should preferably be non-destructive with a clear criterion for pass or fail. The approaches investigated included chemical analysis of solvent extracts, Fourier-transform infrared spectroscopy and microbeam analytical techniques, but these were found to be cumbersome and had only limited success. The objectives were achieved using an optical approach to excite and observe luminescence from invisible set-off. In model experiments, resins were applied to different substrates (plastic, paper and cartonboard). For a given resin on a given material, the key to success was to maximize the discrimination between the luminescence from the resin and that from the substrate by selecting the optimal combination of exciting wavelength and viewing goggles with selective wavelength filters. The required level of detection (20 microg cm(-2)) was achieved or exceeded for all ten resins tested on three different plastics. It was also achieved for two different papers and in all but four cases of the resins on three different cartonboards. Quantitation was achieved by the use of a calibration palette prepared using different quantities of resin spotted onto the relevant blank packaging material.

The stoichiometry of reactions that describe protein degradation in anaerobic treatment systems were investigated. A methodology was developed to describe protein degradation to organic acids using a single reaction step. The reactions for individual amino acid fermentation and their mediating organisms were reviewed. The dominant fermentation pathways were selected based on a number of assumptions. Using the amino acid content of a model protein, it was then possible to determine stoichiometric coefficients for each major organic acid product in the overall degradation of the protein. The theoretical coefficients were then compared to those determined from two experimental runs on a continuously-fed, well-mixed, laboratory-scale anaerobic wastewater treatment system. In general, the coefficients compared well thus validating the use of a single reaction step for the overall catabolic reaction of protein degradation to organic acids. Furthermore, even when the protein concentration in feed or the feed flow rate was doubled, the amino acid fermentation pathways were found to occur predominantly by only one pathway. Although the choice of Stickland reactions over uncoupled degradation provided good comparisons, an electron balance showed that only about 40% of the amino acids could have proceeded coupled to other amino acid reactions. Uncoupled degradation of the remaining amino acids must have relied on the uptake of hydrogen produced from these reactions by hydrogen-consuming methane bacteria.

Microorganisms in flowing water were disinfected by UV radiation from two excimer (excited dimer) lamps (emitting at 172 and 222 nm) in combination with two low-pressure mercury lamps (emitting at 254 nm). Synergies were investigated among the three types of radiation in the treatment of water spiked in turn with Escherichia coli, Listeria innocua, Shewanella putrefaciens, and spores of Bacillus subtilis and Bacillus cereus. Synergy was demonstrated between radiations at 222 and 254 nm in the treatment of E. coli, L. innocua, and S. putrefaciens, but little or no synergy was observed in the treatment of B. subtilis and B. cereus. At maximum flow rates (60 liters/min), 5-log reductions in E. coli were achieved at 254 nm, although at 222 nm, less than 1-log reductions were observed. No bacterial kill was observed with 172-nm radiation alone, despite increasing exposure time by reducing flow rates to less than 3 liters/min.