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The shovelnose sturgeon (Scaphirhynchus platorynchus) and endangered pallid sturgeon (S. albus) deposit demersal and adhesive eggs in swift currents, near or over coarse substrate. Hydrographic surveys have demonstrated the dynamic nature of spawning habitats and that coarse substrates may episodically be buried (partially or completely) by fine sediments. To evaluate embryo survival of both species in various substrate conditions, laboratory trials were conducted with substrates of clean glass, gravel, medium-coarse sand (MCS), and fine sand-silt (FSS). Embryos in MCS and FSS were tested three ways: unburied, partially buried, and fully buried (1–2-mm depth). Embryos were exposed to trial conditions for 10 days from the day of fertilization (5 days beyond expected hatching). For both species, mean hatch of normally developed free embryos was highest in unburied treatments where embryos were incubated on substrates and not covered with sediments and ranged from 81.0 to 87.1% for shovelnose sturgeon and 55.2–80.0% for pallid sturgeon. Mean hatch of normal free embryos was lowest where incubating embryos were fully buried by MCS or FSS and ranged from 2.4 to 11.6% for shovelnose sturgeon and 4.8–15.2% for pallid sturgeon. We observed free embryos with physical abnormalities in all treatments; however, the occurrence was most variable in treatments fully and partially buried by MCS. Hatch of both species was also delayed in treatments where embryos were incubated fully and partially buried by MCS. Our results may be useful to estimate the relative suitability of spawning substrates in relevant river reaches.

Eucalyptus (Myrtaceae) trees are ubiquitous in riparian–floodplain zones of Australia’s south-eastern river catchments, where natural ecosystems continue to be affected. In the Murray–Darling Basin (MDB), provision of environmental flows to mitigate tree decline is informed by past field studies. However, broadscale empirical field data on tree nutrition and response to external changes remain scarce. This is the first study to gather soil and plant data across a large area of catchment lowlands to generate a low-resolution regional snapshot of tree nutrition and soil chemistry. Leaves and soils were sampled across and adjacent to the MDB; from and beneath mature trees of three key riverine eucalypts, Eucalyptus largiflorens, E. camaldulensis, and E. coolabah. Foliar sodium concentrations ranged from ∼500 mg kg−1 for E. coolabah up to ∼4500 mg kg−1 for E. largiflorens, with highest values at the River Murray sites. The results suggest E. largiflorens is highly salt tolerant by foliage accumulation given all trees sampled were in good condition. Further research into these species is needed to determine toxicity thresholds for elements such as sodium to aid early diagnosis of potential tree stress, which could provide an additional line of evidence for when environmental water is required to mitigate decline.

Pediatric Recurrent Rosai-Dorfman Disease with germline heterozygous SLC29A3 and somatic MAP2K1 mutationsShruthi Suryaprakash, MD1, Amy George, RN2, Scott Langenburg, MD3, and Sureyya Savasan, MD2,41Department of Pediatrics, Children’s hospital of Michigan, Detroit2Division of Hematology/Oncology, Children’s hospital of Michigan, Detroit3Division of Pediatric Surgery, Children’s hospital of Michigan, Detroit4Division of Hematology/Oncology and Blood and Marrow Transplant Program, Department of Pediatrics, Children’s Hospital of Michigan, Barbara Ann Karmanos Cancer Center, Central Michigan University College of Medicine, DetroitCorrespondence: Sureyya Savasan, MD3901 Beaubien Blvd.Division of Hematology/OncologyBlood and Marrow Transplant ProgramChildren’s Hospital of MichiganDetroit, Michigan 48201E-mail: savas1s@cmich.eduPhone: 313-745-5516 Fax: 313-745-5237Text word count: 500Reference count: 16Tables and figures: 1Page number: 7Short running title: Germline and somatic mutations in recurrent Rosai-Dorfman diseaseKey words: recurrent RDD, germline SLC29A3 mutation, somatic MAP2K1 mutation, dysgammaglobulinemia, clonal T-LGL proliferation

Understanding and identifying the risk factors associated with suicide in youth experiencing mental health concerns is paramount to early intervention. 45% of patients are admitted annually for suicidality at BC Children's Hospital. Natural Language Processing (NLP) approaches have been applied with moderate success to psychiatric clinical notes to predict suicidality. Our objective was to explore whether machine-learning-based sentiment analysis could be informative in such a prediction task. We developed a psychiatry-relevant lexicon and identified specific categories of words, such as thought content and thought process that had significantly different polarity between suicidal and non-suicidal cases. In addition, we demonstrated that the individual words with their associated polarity can be used as features in classification models and carry informative content to differentiate between suicidal and non-suicidal cases. In conclusion, our study reveals that there is much value in applying NLP to psychiatric clinical notes and suicidal prediction.

Aerodigestive adverse effects (AD-AE) during intravenous pentamidine (IV-P) infusion for Pneumocystis jiroveci pneumonia prophylaxis are uncommon in retrospective chart review studies. We conducted a survey in patients on IV-P, which included 31 specific questions. Twenty-five patients were included in the analysis; AD-AE were observed in 22 (88%) with recurrence of symptoms in 88% participants with subsequent infusions. Five leading symptoms were congestion (48%), lip tingling (32%), nausea (28%), tongue tingling (24%), vomiting, and throat swelling (17%); multiple symptoms were reported in 72% of the patients. In conclusion, AD-AE of IV-P infusion are common, self-limited, and tend to be recurrent.

Remote underwater video (RUV) cameras are commonly used in marine environments to sample fish, but to date have infrequently been used in freshwater environments. We tested the utility of a range of underwater video camera deployments (floating/benthic and fixed/moving) for surveying fish assemblages within tropical wetland habitats of Kakadu National Park, Australia. RUV cameras in both fixed and moving configurations were able to detect a range of fish species in various habitat types, with shy and/or flighty species readily detected. Cameras also performed well in a variety of conditions, although dense macrophytes posed a challenge for all video deployment types. RUV camera survey data compared favourably to two traditional fish survey techniques (visual census and pop netting). However, fixed camera deployments more closely resembled data collected via traditional techniques; whereas moving RUV deployments were consistently lower than any other method. We find that RUV cameras are a valuable monitoring and sampling technique for assessing freshwater fish assemblages in tropical wetlands, and are especially useful where remoteness, difficult access, variable water quality, complex habitats and interactions between humans and dangerous aquatic life can limit the use of other traditional fish sampling techniques.

Syncytial variant of nodular sclerosis (SV-NS) classical Hodgkin lymphoma (cHL) with its histologic features and clinical presentation is uncommon in adults and extremely rare in children. Here, we report a female teenager presenting with long-standing B symptoms, prominent soft tissue and bone involvement mimicking sarcoma and significant nodal disease who is diagnosed with advanced SV-NS cHL. Rare Reed-Sternberg-like cells displaying neutrophil and erythrocyte emperipolesis were seen on bone marrow aspiration slides. Despite initial complete response to chemotherapy and radiotherapy, the patient experienced early relapse suggestive of high-risk biology. This variant may constitute a unique entity.

When we consider questions of alphabetic, cultural, and visual literacy in colonial Mesoamerica, an analysis of the way in which the producers of the Book of Chilam Balam of Kaua appropriated European astronomical texts and images from medieval reportorios demonstrates much about how Mayan scribes and illustrators understood European astrology and the importance that the Maya placed on both visual representations and Spanish textuality. These excerpts served a didactic purpose of teaching European conceptions of astrology and astronomy to a Mayan audience via a deliberate textual and visual translation process.

To compare recurrent prolapse after vaginal uterosacral ligament suspension in normal-weight compared with overweight or obese women.We performed a retrospective cohort study of the risk of recurrent prolapse after uterosacral ligament suspension in normal-weight compared with overweight or obese women at our institution from December 1, 1996, through June 30, 2011. Women with fewer than 6 months of follow-up and those with a prior vault suspension were excluded. Our primary outcome was a composite measure defined as anterior, posterior, or apical prolapse recurrence extending beyond the hymen or repeat treatment for prolapse with surgery or a pessary in women undergoing uterosacral ligament suspension and other vaginal repairs.We included 219 participants (81 [37%] normal-weight and 138 [63%] overweight or obese women). There was no difference in median follow-up (14 months; interquartile range 8.5-26.5 months] in the normal-weight compared with 13 months [interquartile range 9.0-29.0 months] in the overweight or obese women, P=.98). Prolapse recurred in 22.2% (n=18) of the normal-weight group and 26.1% (n=36) of the overweight or obese group (P=.52). Surgery for recurrent prolapse was performed in 16.0% (n=13) of the normal-weight women and in 14.5% (n=20) of the overweight or obese women (P=.76). The most common site of recurrence was the anterior compartment (17.4% [n=38]) compared with the apical compartment (8.7% [n=19]) or posterior compartment (6.8% [n=15]) with no significant difference between cohorts.After uterosacral ligament suspension, overweight or obese women have similar prolapse recurrence compared with normal-weight women. Anterior prolapse is the most common site of recurrence after uterosacral ligament suspension.

Acute colonic pseudo-obstruction (Ogilvie's syndrome) is a rare complication of surgery. Delayed recognition and treatment can lead to severe complications. Herein we describe two cases of Ogilvie's syndrome in patients following pelvic reconstructive surgery. Recognition of signs and symptoms of this rare postoperative complication is important for surgeons of the female pelvis to identify to avoid potentially serious sequela.

Inadequate bowel preparation is a known factor associated with increased failure rates of afternoon colonoscopy and lower adenoma detection rates. The aim of our study was to compare the efficacy of bowel cleansing achieved by administering 1-gallon (4 l) polyethylene glycol (PEG) preparation to patients in the morning of an afternoon colonoscopy with that of the traditional evening regimen.A prospective endoscopist-blinded study was conducted, in which patients undergoing afternoon colonoscopy were randomized to receive either 1 gallon of PEG the evening before the procedure or the morning of the colonoscopy. Bowel cleansing efficacy was scored by a blinded endoscopist using the Ottawa scale and each participant filled out a satisfaction survey. Mean scores for each bowel segment, composite mean scores, and rates of "good prep" interpreted from the Ottawa scale were compared between the two groups.A total of 136 patients (mean age 51.8 years, 52.2% men) evenly distributed between the two groups formed the study sample. Patients in the morning group had significantly lower Ottawa scale scores and were more likely to have a good preparation for each bowel segment and overall when compared with the evening group (P0.01). Moreover, patients in the morning group were over 50% less likely to lose sleep or have bloating compared with the evening group (P0.05). There was no difference in the study groups on overall polyp detection rate, adenomatous polyps, or number of patients with adenomas.This study shows that the bowel cleansing efficacy of morning-only 1-gallon PEG is superior and better tolerated compared with consumption of 1-gallon PEG in the evening before the day of an afternoon colonoscopy. Thus, administering 1-gallon PEG solution in the morning of an afternoon colonoscopy is a feasible option that can improve the quality of an afternoon colonoscopy.

Key ecological processes must be present and maintained in ecosystems to ensure the success of ecological restoration and conservation programs. The present paper identifies and defines key ecological processes operating at various spatial scales within aquatic ecosystems of the Magela Creek catchment, within Kakadu National Park, and prioritises those that may be vulnerable to potential mine-derived stressors. This assessment was required to ensure that current and future environmental monitoring programs are in place to safeguard the protection of these processes, particularly in the context of rehabilitation of Ranger uranium mine. Ecological processes within riparian habitats and biotic interactions across all habitats were at a higher risk of exposure to potential stressors. Generally, the selected assessment endpoints used for the operational phase of the mine are sufficient to measure and assess ecological processes. However, biological endpoints require additional suitable early detection indicators because marked lags exist in their response, which will be more important during the rehabilitation phase of the mine because of the longer timeframes to be assessed. The lags would otherwise allow potential impacts to underpinning processes to pass undetected. Risk identification allows monitoring programs to move beyond simple measurement variables to full evaluation of underlying ecological processes, which maintain both structure and function in ecosystems.

OBJECTIVE The impact of obesity on the recurrence rates of stress urinary incontinence (SUI) after urethrolysis/sling revision was analyzed. STUDY DESIGN A retrospective analysis was conducted of patients who underwent urethrolysis or sling revision from January 2004 to November 2010. RESULTS Data from 74 patients were included. The mean body mass index (BMI) was 29.8 kg/m (SD, 6.3) and 37/74 (50%) women were obese (BMI ≥ 30 kg/m) with a mean length of follow-up of 27 weeks (range, 6-132 weeks). The following urethrolysis/sling revision surgical techniques were varied: partial transvaginal urethrolysis, complete transvaginal urethrolysis, abdominal urethrolysis, sling transection, and transvaginal sling stretching.Of the 74 cases, 25 (33.8%) had recurrent SUI after urethrolysis or sling revision. The BMI did not differ between those who did and did not have a recurrence (t test P = 0.68); 25/49 (51%) women who did not have a recurrence were obese and 12/25 (48%) women with recurrence were obese. CONCLUSIONS Obesity was not associated with increased rates of SUI recurrence after urethrolysis/sling revision.

A retrospective cohort of 100 robotic-assisted laparoscopic myomectomy (RM) patients and 48 laparotomic myomectomy (LM) patients at Henry Ford Hospital in Detroit, MI, USA was examined to compare surgical outcomes of RM with LM. Details of age, race, body mass index (BMI), procedure duration, estimated blood loss (EBL), length of stay (LOS), diameter of the largest leiomyoma and number of leiomyomata removed were collected. Procedure duration was significantly longer among RM patients (median: 194 min vs. 127.5 min; Wilcoxon rank sum (WRS) P < 0.001). EBL and LOS were both significantly greater among LM patients (EBL medians 200 vs. 100 ml, WRS P < 0.001; LOS medians 3 vs. 1, WRS P < 0.01). Among the RM patients, 39.4% had a LOS of at least 2 days compared to 89.4% among LM patients. Leiomyomata characteristics did not affect the observed associations. RM could enable widespread use of a minimally invasive approach for leiomyoma treatment.

Study Objective To estimate the impact of body mass index (BMI) on surgical outcomes in patients undergoing robotic myomectomy. Design A retrospective cohort data analysis (Canadian Task Force classification II-2). Setting Community-based teaching hospital. Patients A total of 77 consecutive patients from January 2005 through November 2008 with symptomatic leiomyomata. Intervention Robotic-assisted laparoscopic myomectomy. Measurements and Main Results Body mass index ([BMI] expressed as kg/m 2 ) was abstracted from the medical charts of all patients undergoing robotic myomectomy. Data on estimated blood loss, procedure time, length of hospital stay, diameter of the largest fibroid, and specimen weight were also extracted. Overall patient demographics between the groups were similar. Thirty-two patients (41.6%) were obese or morbidly obese (BMI > 30). The parameters analyzed for associations with the continuous measure of BMI included length of postoperative hospital stay (LOS), estimated blood loss (EBL), and procedure duration. Median (range) procedure time among all patients was (195 minutes, 98-653 minutes), estimated blood loss was (100 mL, 10-700 mL), and length of hospital stay was (1 day, 1-5 days). No associations were determined between BMI and LOS (r = 0.14, p = .22), EBL (r = 0.25, p = .03), or procedure duration (r = 0.16, p = .22) with Spearman correlations. The size of the largest leiomyoma diameter did not affect these associations. Conclusion Preoperative obesity is not a risk factor for poor surgical outcome in patients undergoing robotic myomectomy.

OBJECTIVE Recurrence of pelvic organ prolapse (POP) is a potential complication after mesh removal. We evaluated anatomical and functional outcomes preoperatively and postoperatively in patients undergoing mesh excision. MATERIALS AND METHODS We conducted a retrospective cohort analysis of consecutive patients who underwent mesh excision from years 2005 to 2009. Anatomical outcomes were evaluated using the POP quantification (POP-Q) system. Recurrence of prolapse was defined as stage II or higher-stage prolapse on the POP-Q system, reoperation for prolapse, or postoperative use of a pessary for prolapse reduction. Functional outcomes were assessed using the pelvic floor distress inventory and pelvic floor impact questionnaire scores. RESULTS Data were analyzed from 71 patients who underwent either partial or complete mesh excision. Most (44/70 [63%]) of the patients underwent partial mesh excision, and 26 patients (37%) underwent total mesh removal. Nineteen patients (26.7%) had preoperative prolapse and 27 (38.0%) of the 71 patients underwent concomitant native tissue prolapse repair. Overall change in POP-Q stage in women who underwent partial removal (median, 0 [-1 to 2]) was less advanced than in women with total excision. (median, -1 [-3 to 0]; P = 0.006) at 1 year postoperatively. Four patients prolapsed to the hymen, with all patients having defects in the anterior compartment. No patients required a second surgery, and one patient was treated with a pessary.Total pelvic floor distress inventory and pelvic floor impact questionnaire scores before mesh excision were significantly improved 6 months after mesh removal (P < 0.05). Dyspareunia improved significantly after mesh excision (P = 0.034). CONCLUSION In our patient population, total and partial mesh excision is associated with re-treatment of POP in 1.4% of the patients. Patient functional outcomes significantly improved after mesh removal.