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The patient is a 74-year-old female who presented with bothersome Stage III pelvic organ prolapse. She desired definitive surgical management for her prolapse and opted for total vaginal hysterectomy, uterosacral ligament suspension and anterior/posterior vaginal repairs. She had urodynamic testing before surgery that showed no stress urinary incontinence, no detrusor overactivity, and normal bladder capacity. The surgery was uncomplicated. She was discharged home the same day as surgery and her postoperative recovery was unremarkable.

Background/Aims In 2014, the Royal College of Surgeons expressed concern that a postcode lottery was determining the commissioning of procedures of limited clinical value. The research was carried out to assess whether there is variation in the clinical commissioning of hallux valgus surgery in England. Methods The commissioning policies for clinical commissioning groups were identified. Data were analysed to assess both adherence to the British Orthopaedic Association guidelines for surgery and the minimum criteria that a patient must fulfil for surgery. Results Variation was recorded in commissioning policies and in the number of criteria a patient must fulfil to be offered surgery. Conclusions There is currently no standardised national commissioning policy for hallux valgus surgery. Referral guidelines have been produced by leading national bodies but their implementation is varied. This can lead to variation in referral patterns in England for patients requiring hallux valgus surgery.

The patient is a 38-year-old female who presented with fecal incontinence, constipation, and stress urinary incontinence. She was found to have stage II posterior vaginal wall prolapse. She desired definitive surgical management of her prolapse and opted for posterior vaginal repair. Although stress urinary incontinence was demonstrated on urodynamic testing, the decision was made not to proceed with concurrent mid-urethral sling given her history of pelvic floor dyssynergia and intermittent urinary retention. The surgery was uncomplicated, and she was discharged on the day of surgery. Her recovery was unremarkable.

Several Legionella species can cause legionellosis, which results in influenza-like illness (Pontiac fever) or pneumonia (Legionnaires’ disease) (1,2). L. pneumophila, which is mainly transmitted from aerosolized water, has been the principal Legionella species reported from Canada (3). Unlike L. pneumophila, L. longbeachae is highly adapted to the soil environment and primarily transmitted from potting soils and compost (2). During summer 2015, a regional public health authority in Quebec, Canada, received reports of 2 cases of pneumonia attributable to L. longbeachae infection. These cases occurred 1 month apart in persons who shared the same workplace. We conducted epidemiologic and environmental investigations to identify the source of infection and propose appropriate control measures.

Survey data of the general population, counselors, and counselor educators indicate that spiritual and religious issues are therapeutically relevant, ethically appropriate, and potentially significant topics for counseling and counselor education in secular settings. In this article, the authors propose that a balanced, thoughtful inclusion of these topics in Council for Accreditation of Counseling and Related Educational Programs (CACREP) core curriculum areas is a reasonable and sound approach to preparing counselors to work ethically and effectively with these issues in secular counseling settings. Methods and examples for achieving this inclusion are presented for each of the CACREP core curriculum areas.

Health care professionals are increasingly called upon to work collaboratively. This commentary discusses our experience at the Summer Institute on Interdisciplinary Health Research, which aimed to increase the capacity of future Canadian researchers to work with health professionals from other disciplines. We discuss, in particular, our small group experience--the challenges we faced, and how we were able to resolve the internal conflicts that occurred. We also discuss the conditions necessary to engage in interdisciplinary work and offer suggestions to improve future initiatives to build interdisciplinary research capacity.

This is an account of the methods used by a teacher/researcher to elicit response to a postal questionnaire, undertaken as the preliminary stage of a retrospective follow-up study of outcomes for a specific population of children perceived to have speech and language difficulties. The response rate was raised from 25.7% from the first mail drop to an overall rate of 67%, by persevering through seven initiatives. Discussion includes the approaches adopted and the emergent issues from the nature of the response as well as from the resultant data.

Health care professionals are increasingly called upon to work collaboratively. This commentary discusses our experience at the Summer Institute on Interdisciplinary Health Research, which aimed to increase the capacity of future Canadian researchers to work with health professionals from other disciplines. We discuss, in particular, our small group experience--the challenges we faced, and how we were able to resolve the internal conflicts that occurred. We also discuss the conditions necessary to engage in interdisciplinary work and offer suggestions to improve future initiatives to build interdisciplinary research capacity.

Starch hydrolysis products, or dextrins, are widely used throughout the food industry for their functional properties. Dextrins are saccharide polymers linked primarily by alpha-(1 --> 4) D-glucose units and are prepared by partial hydrolysis of starch. Hydrolysis can be accomplished by the use of acid, enzymes, or by a combination of both. The hydrolysis products are typically characterized by the "dextrose equivalent" (DE), which refers to the total reducing power of all sugars present relative to glucose. While the DE gives the supplier and buyer a rough guide to the bulk properties of the material, the physiochemical properties of dextrins are dependent on the overall oligosaccharide profile. High-performance anion-exchange chromatography (HPAEC) with pulsed amperometric detection and size-exclusion chromatography (SEC) with multi-angle light-scattering and refractive index detection were used to characterize dextrins from commercial sources. HPAEC was used to acquire the oligosaccharide profile, and SEC to obtain an overall molar mass distribution. These methods in combination extended our understanding of the relationship between oligosaccharide profile, DE, and the hydrolysis process. Data from the two techniques enabled a method for estimating the DE that gave results in reasonable agreement with the accepted titration method.

These results are from sodium exposure test cell experiments with advanced AMTEC electrodes performed at Texas AM the minority of the results are for ceramic electrodes. Initial results for iridium and titanate electrodes have been good, but degrade with time.

Texas A&M University has begun an investigation of materials and fabrication methods which will improve AMTEC electrode performance. The study currently involves gathering data on materials which meet the basic requirements of operating in an AMTEC cell, and sorting out candidates possessing characteristics conducive to efficient AMTEC operation. An initial assessment has shown Iridium as a promising metal electrode candidate. Sodium-containing double-oxides, with melting temperatures above AMTEC operating temperatures, including NaNbO3 and Na2Ti3O7, have been identified as possible electrode dopants, to enhance the sodium conductivity of an electrode. Photo-deposition and Evaporative-deposition will be investigated further as electrode fabrication techniques.

Texas A&M University, in conjunction with Advanced Modular Power Systems, is performing a series of material studies on key components of an alkali metal thermal to electric conversion (AMTEC) cell for the NASA outer planets power system program. These studies involve SEM, x-ray mapping, EDS, and WDS analysis of AMTEC components from unexposed (as built) samples, from sodium exposure tests, and from operating cells, specifically PX-4C and PX-5B run at the Air Force Research Lab’s Phillips Research Site. Findings are still prelimary, but indicate that recrystallization regions seen in the oven samples are an artifact of excess sodium and oxygen levels in those tests, more potassium is present than expected, and that diffusion bonding between the current collector and electrode takes place.

The psychosocial impact on the patient having a hysterectomy is of prime concern to the nurse. This impact can dramatically influence the entire course of the surgery. Postoperatively, the physical care needed by the patient can over-shadow the psychosocial implications of the surgery: This must not happen. The psychosocial needs of the patient are an integral part of the care plan for the hysterectomy patient. By incorporating these needs into the plan of care, the nurse will meet the total needs of the patient and help her return to life-force equilibrium.