In young girls, vaginal foreign bodies (FB) often present with symptoms of vaginal spotting or malodorous discharge (1-4). These symptoms usually resolve without sequelae once the object is removed. ...However, significant sequelae can occur when these FB remain in place for prolonged periods of time. In these cases, diagnostic delays may have to do with an inefficient workup.
A healthy 8-year-old female was referred to us for six weeks of serosanginous vaginal discharge. Initial genitourinary exam, urinalysis, urine and vaginal cultures were negative. Subsequently, a transabdominal ultrasound (TAUS) was completed to rule out FB and two 2-3mm punctate non-shadowing echogenic foci were identified in the vagina. An unsuccessful attempt was made to flush these FB out of the vagina with saline. Therefore, an in-office vaginoscopy was performed utilizing an Endosee® Advance (CooperSurgical, Trumbull, CT). The device was inserted into the vaginal canal and vaginal occlusion was performed by pinching the vulva, allowing for distention. Two hair collections were noted. One hair mass was guided out with a targeted fluid flush. The other required active grasping and removal with biopsy forceps. The patient tolerated the procedure without great discomfort.
While TAUS supported the diagnosis in this case, the most common vaginal FB, small toys and toilet paper, are often missed by TAUS (5-6). As a result, TAUS appears to be a poor screening test for vaginal FB. We reviewed 17 case reports of vaginal FB published from 1953-2022 and found that out of 5 cases where TAUS was performed, 4 produced a false negative result leading to delay in treatment and significant sequelae. Thus, we urge caution in over-reliance on TAUS as a screening test for vaginal FB and support office vaginoscopy regardless of the results of an initial TAUS. Vaginoscopy under anesthesia has been the definitive diagnostic and therapeutic approach to vaginal FB but presumes a high index of suspicion. It is not typically used as a screening test since it requires operating room (OR) scheduling, staffing, and patient sedation, which are associated with increased costs. Office vaginoscopy could reduce time to diagnosis, allowing for triaging of patients for the OR or ruling out FB with high sensitivity, without the need for sedation. Anecdotally, providers are using this tool to increase diagnostic efficiency; however, there are no studies affirming its benefits in this population to date. We recommend future studies compare sensitivity, efficacy, and safety of office vaginoscopy in the pediatric population to the typical work-up of patients with symptoms concerning for vaginal FB.
In current enterprise environments, information is becoming more readily accessible across a wide range of interconnected systems. However, trustworthiness of documents and actors is not explicitly ...measured, leaving actors unaware of how latest security events may have impacted the trustworthiness of the information being used and the actors involved. This leads to situations where information producers give documents to consumers they should not trust and consumers use information from non-reputable documents or producers. The concepts and technologies developed as part of the Behavior-Based Access Control (BBAC) effort strive to overcome these limitations by means of performing accurate calculations of trustworthiness of actors, e.g., behavior and usage patterns, as well as documents, e.g., provenance and workflow data dependencies. BBAC analyses a wide range of observables for mal-behavior, including network connections, HTTP requests, English text exchanges through emails or chat messages, and edit sequences to documents. The current prototype service strategically combines big data batch processing to train classifiers and real-time stream processing to classifier observed behaviors at multiple layers. To scale up to enterprise regimes, BBAC combines clustering analysis with statistical classification in a way that maintains an adjustable number of classifiers.
The formation of isoprene nitrates (IsN) can lead to significant secondary organic aerosol (SOA) production and they can act as reservoirs of atmospheric nitrogen oxides. In this work, we estimate ...the rate of production of IsN from the reactions of isoprene with OH and NO
radicals during the summertime in Beijing. While OH dominates the loss of isoprene during the day, NO
plays an increasingly important role in the production of IsN from the early afternoon onwards. Unusually low NO concentrations during the afternoon resulted in NO
mixing ratios of ca. 2 pptv at approximately 15:00, which we estimate to account for around a third of the total IsN production in the gas phase. Heterogeneous uptake of IsN produces nitrooxyorganosulfates (NOS). Two mono-nitrated NOS were correlated with particulate sulfate concentrations and appear to be formed from sequential NO
and OH oxidation. Di- and tri-nitrated isoprene-related NOS, formed from multiple NO
oxidation steps, peaked during the night. This work highlights that NO
chemistry can play a key role in driving biogenic-anthropogenic interactive chemistry in Beijing with respect to the formation of IsN during both the day and night.
Reablement – or restorative care – is a central feature of many western governments’ approaches to supporting and enabling older people to stay in their own homes and minimise demand for social care. ...Existing evidence supports this approach although further research is required to strengthen the certainty of conclusions being drawn. In countries where reablement has been rolled out nationally, an additional research priority – to develop an evidence base on models of delivery – is emerging. This paper reports a prospective cohort study of individuals referred to three English social care reablement services, each representing a different model of service delivery. Outcomes included healthcare‐ and social care–related quality of life, functioning, mental health and resource use (service costs, informal carer time, out‐of‐pocket costs). In contrast with the majority of other studies, self‐report measures were the predominant source of outcomes and resource use data. Furthermore, no previous evaluation has used a global measure of mental health. Outcomes data were collected on entry to the service, discharge and 6 months post discharge. A number of challenges were encountered during the study and insufficient individuals were recruited in two research sites to allow a comparison of service models. Findings from descriptive analyses of outcomes align with previous studies and positive changes were observed across all outcome domains. Improvements observed at discharge were, for most, retained at 6 months follow‐up. Patterns of change in functional ability point to the importance of assessing functioning in terms of basic and extended activities of daily living. Findings from the economic evaluation highlight the importance of collecting data on informal carer time and also demonstrate the viability of collecting resource use data direct from service users. The study demonstrates challenges, and value, of including self‐report outcome and resource use measures in evaluations of reablement.
Introduction: The aim of the study was to assess 12 month changes in upper limb function in patients affected by spinal muscular atrophy type 2 and 3. Methods: Longitudinal 12 month data was ...collected in 114 patients, 60 type 2 and 54 type 3, using the Revised Upper Limb Module. Results: The 12 month changes ranged between ‐7 and 9 (mean: ‐0.41; SD: 2.93). The mean changes were not significantly different between the three spinal muscular atrophy groups (‐0.45 in type 2, ‐0.23 in non‐ambulant type 3 and ‐0.34 in ambulant type 3, p = 0.96) and the relationship between 12 month change and age classes was not significantly different among the three types of SMA patients. Discussion: Our results confirm that the Module explores a wide range of functional abilities and can be used in ambulant and non‐ambulant patients of different ages in conjunction with other functional scales. Muscle Nerve 59:426–430, 2019
Objective
To evaluate response to surgical management of sliding hiatal hernia (SHH) and gastroesophageal reflux (GER) in dogs using standardized clinical scoring, videofluoroscopic swallow studies, ...and impedance planimetry.
Study design
Prospective clinical trial.
Animals
A total of 17 client‐owned dogs.
Methods
Dogs were included if they had clinical signs and videofluoroscopic evidence of SHH and/or GER. Owners were asked to complete a standardized canine dysphagia assessment tool (CDAT) preoperatively and postoperatively. Conscious videofluoroscopic swallowing studies and impedance planimetry (IP) were used to evaluate esophageal function and lower esophageal sphincter location and geometry preoperatively and in a subsection of dogs postoperatively.
Results
Preoperatively, 13/17 dogs included in the study had a history of regurgitation, and 4/17 had radiographic evidence of aspiration pneumonia. Postprandial regurgitation improved in 8/10 dogs with preoperative regurgitation, and for which completed preoperative and postoperative CDAT questionnaires were available (P < .01). The hiatal hernia severity score improved postoperatively (P = .046) in dogs with preoperative and postoperative videofluoroscopic swallowing studies (n = 12). However, hernia frequency score (P = .2) and IP parameters did not differ significantly between time points.
Conclusion
Clinical signs of SHH generally improved with surgery but did not consistently resolve. Videofluoroscopic studies provide evidence that GER and SHH can persist postoperatively in some patients. Based on IP findings, clinical improvement may be attributed to a mechanism independent of lower esophageal sphincter attenuation.
Novel cold‐hardy berries and small fruits represent an opportunity for growers in the Intermountain West, USA, as the harsh environment is not suited for other common berries and small fruits. This ...study analyzed the fresh market and value‐added potential of haskap berries (Lonicera caerulea), saskatoon berries (Amelenchier alnifolia), and dwarf sour cherry (DSC) fruit (Prunus x kerrasis) by instrumental and consumer studies. Fresh and 2‐week stored haskap (cv. Aurora), saskatoon (Lee 3), and DSC (Romeo) were measured for fruit weight, flesh firmness, bulk titratable acidity, pH, and soluble solid content. Participants (n = 115) in at‐home sensory tests scored these fruits for overall liking (OL, 9‐point hedonic scale), purchase intent (PI, 5‐point scale), and willingness‐to‐pay (WTP, 5‐point scale). Ten participants further shared insight on these fruits in focus groups. Instrumental testing found a significant decrease in flesh firmness for 2‐week stored haskap, but the consumers’ OL was still comparable to fresh haskap. The fresh and 2‐week stored haskap received significantly higher OL, PI, and WTP scores (7.7 ± 1.0, 3.8 ± 1.0, and $3.7 ± 1.0; 7.7 ± 1.2, 3.8 ± 1.1, and $3.7 ± 1.0, respectively) compared to saskatoon (6.1 ± 1.8, 2.8 ± 1.1, and $3.0 ± 0.9, respectively) and DSC (5.6 ± 2.2, 2.5 ± 1.2, and $3.1 ± 1.0, respectively) (α = 0.05). The focus groups indicated that participants want to support local produce. The participants expressed interest in fresh unprocessed haskap berries, but preferred saskatoon and DSC in different value‐added formats. Hence, this study concluded that there is an untapped fresh‐market potential for haskap berries and there are value‐added opportunities to extend the sale season and improve the palatability of saskatoon and DSC.
Practical Application
This research has examined consumer perception of three species of novel small fruits by determining fresh‐market potential and linking this to the opportunity for value‐added product development. For haskap berries, the study not only indicated fresh market potential, but for the cultivar Aurora, consumer liking was not meaningfully altered by 2 weeks of cold storage. These results are meaningful because they will assist growers in the Intermountain West with market planning, including the possibility of formulating products that utilize these novel crops. This study provides growers the opportunity to diversify their income stream by utilizing local produce.
Highlights • The paper reports for the first time patterns of progression in type 2 and 3 SMA. • Different trajectories can be identified in ambulant and non-ambulant patients. • Age appears to be an ...important factor in determining trajectories of progression.
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