The implementation of MALDI-TOF MS for microorganism identification has changed the routine of the microbiology laboratories as we knew it. Most microorganisms can now be reliably identified within ...minutes using this inexpensive, user-friendly methodology. However, its application in the identification of mycobacteria isolates has been hampered by the structure of their cell wall. Improvements in the sample processing method and in the available database have proved key factors for the rapid and reliable identification of non-tuberculous mycobacteria isolates using MALDI-TOF MS.
The main objective is to provide information about the proceedings for the identification of non-tuberculous isolates using MALDI-TOF MS and to review different sample processing methods, available databases, and the interpretation of the results.
Results from relevant studies on the use of the available MALDI-TOF MS instruments, the implementation of innovative sample processing methods, or the implementation of improved databases are discussed.
Insight about the methodology required for reliable identification of non-tuberculous mycobacteria and its implementation in the microbiology laboratory routine is provided.
Microbiology laboratories where MALDI-TOF MS is available can benefit from its capacity to identify most clinically interesting non-tuberculous mycobacteria in a rapid, reliable, and inexpensive manner.
The new generation of gravitational waves detectors require unprecedented levels of isolation from seismic noise. This article reviews the seismic isolation strategy and instrumentation developed for ...the Advanced LIGO observatories. It summarizes over a decade of research on active inertial isolation and shows the performance recently achieved at the Advanced LIGO observatories. The paper emphasizes the scientific and technical challenges of this endeavor and how they have been addressed. An overview of the isolation strategy is given. It combines multiple layers of passive and active inertial isolation to provide suitable rejection of seismic noise at all frequencies. A detailed presentation of the three active platforms that have been developed is given. They are the hydraulic pre-isolator, the single-stage internal isolator and the two-stage internal isolator. The architecture, instrumentation, control scheme and isolation results are presented for each of the three systems. Results show that the seismic isolation sub-system meets Advanced LIGO's stringent requirements and robustly supports the operation of the two detectors.
Objective
Robot‐assisted surgery is a recognised treatment for pelvic‐organ prolapse. Many of the surgical subgroup outcomes for apical prolapse are reported together, leading to a paucity of ...homogenous data.
Design
Prospective observational cohort study (NCT01598467, clinicaltrials.gov) assessing outcomes for homogeneous subgroups of robot‐assisted apical prolapse surgery.
Setting
Two European tertiary referral hospitals.
Population
Consecutive patients undergoing robot‐assisted sacrocolpopexy (RASC) and supracervical hysterectomy with sacrocervicopexy (RSHS).
Methods
Anatomical cure (simplified Pelvic Organ Prolapse Quantification, sPOPQ, stage 1), subjective cure (symptoms of bulge), and quality of life (Pelvic Floor Impact Questionnaire, PFIQ‐7).
Main outcome measures
Primary outcome: anatomical and subjective cure. Secondary outcomes: surgical safety and intraoperative variables.
Results
A total of 305 patients were included (RASC n = 188; RSHS n = 117). Twelve months follow‐up was available for 144 (RASC 76.6%) and 109 (RSHS 93.2%) women. Anatomical success of the apical compartment occurred for 91% (RASC) and in 99% (RSHS) of the women. In all compartments, the success percentages were 67 and 65%, respectively. Most recurrences were in the anterior compartment 15.7% RASC (symptomatic 12.1%); 22.9% RSHS (symptomatic 4.8%). Symptoms of bulge improved from 97.4 to 17.4% (P < 0.0005). PFIQ‐7 scores improved from 76.7 ± 62.3 to 13.5 ± 31.1 (P < 0.0005). The duration of surgery increased significantly for RSHS 183.1 ± 38.2 versus 145.3 ± 29.8 (P < 0.0005). Intraoperative complications and conversion rates were low (RASC, 5.3 and 4.3%; RSHS, 0.0 and 0.0%). Four severe postoperative complications occurred after RASC (2.1%) and one occurred after RSHS (1.6%).
Conclusions
This is the largest reported prospective cohort study on robot‐assisted apical prolapse surgery. Both procedures are safe, with durable results.
Tweetable
European bi‐centre trial concludes that robot‐assisted surgery is a viable approach to managing apical prolapse.
Tweetable
European bi‐centre trial concludes that robot‐assisted surgery is a viable approach to managing apical prolapse.
Summary Purpose Traditional cranioplasty methods focus on pre-operative or intraoperative hand molding. Recently, CT-guided polyether ether ketone (PEEK) plate reconstruction enables precise, ...time-saving reconstruction. This case series aims to show a single institution experience with use of PEEK cranioplasty as an effective, safe, precise, reusable, and time-saving cranioplasty technique in large, complex cranial defects. Methods We performed a 6-year retrospective review of cranioplasty procedures performed at our affiliated hospitals using PEEK implants. A total of nineteen patients underwent twenty-two cranioplasty procedures. Pre-operative, intra-operative, and post-operative data was collected. Results Nineteen patients underwent twenty-two procedures. Time interval from injury to loss of primary cranioplasty averaged 57.7 months (0–336 mo); 4.0 months ( n = 10, range 0–19) in cases of trauma. Time interval from primary cranioplasty loss to PEEK cranioplasty was 11.8 months for infection ( n = 11, range 6–25 mo), 12.2 months for trauma ( n = 5, range 2–27 mo), and 0.3 months for cosmetic or functional reconstructions ( n = 3, range 0–1). Similar surgical techniques were used in all patients. Drains were placed in 11/22 procedures. Varying techniques were used in skin closure, including adjacent tissue transfer (4/22) and free tissue transfer (1/22). The PEEK plate required modification in four procedures. Three patients had reoperation following PEEK plate reconstruction. Conclusion Cranioplasty utilizing CT-guided PEEK plate allows easy inset, anatomic accuracy, mirror image aesthetics, simplification of complex 3D defects, and potential time savings. Additionally, it's easily manipulated in the operating room, and can be easily re-utilized in cases of intraoperative course changes or infection.
Background
Little is known regarding the effect of bariatric surgery on urinary incontinence.
Methods
Between September 2008 and November 2014, 240 female patients underwent bariatric surgery.
...Results
The prevalence of urinary incontinence preoperatively was 45 % (108). Eighty-two (76 %) completed urinary function questionnaires pre-operatively and post-operatively. Fifty-seven (70 %) underwent laparoscopic gastric bypass, twenty-four (29 %) underwent sleeve gastrectomy and one underwent a banding procedure. Thirty-one (38 %) reported leaking on sneezing or coughing—stress urinary incontinence (SUI). Thirteen (16 %) complained of leaking before reaching the toilet—overactive bladder syndrome (OAB). The remaining thirty-eight (46 %) reported mixed symptoms. The mean pre-operative weight and BMI were 133 (18) kg and 50 (SD = 6.2) kg/m
2
respectively. The mean post-operative BMI drop was 16 (SD = 5.2) kg/m
2
. Preoperatively, 61 (75 %) reported moderate to very severe urinary incontinence compared to 30 (37 %) post-operatively (
χ
2
= 3.24.67,
p
= 0.050). Twenty-seven (33 %) patients reported complete resolution of their urinary incontinence. Fifty-one (62 %) patients required incontinence pads on a daily basis pre-operatively, compared to 35 (43 %) post-operatively (
χ
2
= 22.211.6,
p
= 0.00). The mean International Consultation on Incontinence Questionnaire- Urinary Incontinence short form (ICIQ-UI SF) score was 9.3 (SD = 4.4) pre-operatively compared to 4.9 (SD = 5.3) post-operatively (
t
= 7.2,
p
= 0.000). The improvement score post-operatively was 8 (SD = 3). A significant difference in the ICIQ-UI SF was identified between OAB and SUI groups when adjusting for age, number of children, type of delivery and pre-op BMI (
t
= 1.98,
p
= 0.05).
Conclusion
Bariatric surgery results in a clinically significant improvement in urinary incontinence. However, this is not proportional to pre-operative BMI, weight loss, age, parity and mode of delivery.
This article problematises the place of religion within publicly managed Education and Training Board (ETB) schools in the Republic of Ireland. The study draws on interview data from 43 school ...personnel across 18 ETB second‐level schools, as well as eight interviews with ETB Education/Chief Executive Officers. Having established the legal and historical contexts, the place of religion is explored from the perspective of school life and prescribed curriculum. Across the 18 schools, the prescribed curriculum for Religious Education did not take the form of ‘faith formation’. Rather, focus was placed on exploring all world religions. However, this compares with the role of religion within the life of the school; 14 of the 18 participating schools had religious dimensions as part of school life. Half of these schools (n = 7) were Designated Community Colleges, while the remainder were Non‐Designated (n = 7). The religious dimension was always Catholic in nature. Bar a few exceptions, the role of religion within the life of the school remained largely unquestioned by school personnel. The article explores the findings in light of the legislative and historical contexts.
Introduction and hypothesis
The bladder pain syndrome (BPS) is a spectrum of urological symptoms characterised by bladder pain with typical cystoscopic features. Diagnosis and management of this ...syndrome may be difficult. There is no evidence-based management approach for the diagnosis or treatment of BPS. The objective of this study was to critically review and summarise the evidence relating to the diagnosis and treatment of the bladder pain syndrome.
Methods
A review of published data on the diagnosis and treatment of the BPS was performed. Our search was limited to English-language articles, on the “diagnosis”, and “management” or “treatment” of “interstitial cystitis” and the “bladder pain syndrome” in “humans.”
Results
Frequency, urgency and pain on bladder filling are the most common symptoms of BPS. All urodynamic volumes are reduced in patients with BPS. Associated conditions include psychological distress, depression, history of sexual assault, irritable bowel syndrome and fibromyalgia. Cystoscopy remains the test for definitive diagnosis, with visualisation of haemorrhage on cystoreduction. A multidisciplinary treatment approach is essential in the management of this condition. Orally administered amitriptyline is an efficacious medical treatment for BPS. Intravesical hyaluronic acid and local anaesthetic, with/without hydrodistension are among new treatment strategies. Sacral or pudendal neuromodulation is effective, minimally invasive and safe. Surgery is reserved for refractory cases.
Conclusions
There remains a paucity of evidence for the diagnosis and treatment of BPS. We encountered significant heterogeneity in the assessment of symptoms, duration of treatment and follow up of patients in our literature review.
Interferometric gravitational-wave detectors are complex instruments comprised of a Michelson interferometer enhanced by multiple coupled cavities. Active feedback control is required to operate ...these instruments and keep the cavities locked on resonance. The optical response is highly nonlinear until a good operating point is reached. The linear operating range is between and 1% of a fringe for each degree of freedom. The resonance lock has to be achieved in all five degrees of freedom simultaneously, making the acquisition difficult. Furthermore, the cavity linewidth seen by the laser is only Hz, which is four orders of magnitude smaller than the linewidth of the free running laser. The arm length stabilization system is a new technique used for arm cavity locking in Advanced LIGO. Together with a modulation technique utilizing third harmonics to lock the central Michelson interferometer, the Advanced LIGO detector has been successfully locked and brought to an operating point where detecting gravitational-waves becomes feasible.
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