Comparative long-term effectiveness between ventral hernia repairs with biosynthetic and synthetic mesh.

BACKGROUND: Debate exists regarding the most appropriate type of mesh to use in ventral hernia repair (VHR). Meshes are broadly categorized as synthetic or biologic, each mesh with individual advantages and disadvantages. More recently developed biosynthetic mesh has characteristics of both mesh types. The current study aims to examine long-term follow-up data and directly compare outcomes-specifically hernia recurrence-of VHR with biosynthetic versus synthetic mesh. METHODS: With IRB approval, consecutive cases of VHR (CPT codes 49,560, 49,561, 49,565, and 49,566 with 49,568) performed between 2013 and 2018 at a single institution were reviewed. Local NSQIP data was utilized for patient demographics, perioperative characteristics, CDC Wound Class, comorbidities, and mesh type. A review of electronic medical records provided additional variables including hernia defect size, postoperative wound events to six months, duration of follow-up, and incidence of hernia recurrence. Longevity of repair was measured using Kaplan-Meier method and adjusted Cox proportional hazards regression. RESULTS: Biosynthetic mesh was used in 101 patients (23%) and synthetic mesh in 338 (77%). On average, patients repaired using biosynthetic mesh were older than those with synthetic mesh (57 vs. 52 years; p = .008). Also, ASA Class ≥ III was more common in biosynthetic mesh cases (70.3% vs. 55.1%; p = .016). Patients repaired with biosynthetic mesh were more likely than patients with synthetic mesh to have had a prior abdominal infection (30.7% vs. 19.8%; p = .029). Using a Kaplan-Meier analysis, there was not a significant difference in hernia recurrence between the two mesh types, with both types having Kaplan Meir 5-year recurrence-free survival rates of about 72%. CONCLUSION: Using Kaplan-Meier analysis, synthetic mesh and biosynthetic mesh result in comparable hernia recurrence rates and surgical site infection rates in abdominal wall reconstruction patients with follow-up to as long as five years.

Cooperative dihydrogen activation at a Na(I)2/Mg(I)2 ensemble.

[{SiNDipp}MgNa]2 ({SiNDipp} = {CH2SiMe2N(Dipp)}2; Dipp = 2,6-i-Pr2C6H3) reacts directly with H2 to provide a heterobimetallic hydride. Although the transformation is complicated by the simultaneous disproportionation of magnesium, computational density functional theory (DFT) studies suggest that this reactivity is initiated by orbitally-constrained and interactions between the frontier MOs of both H2 and the tetrametallic core of [{SiNDipp}MgNa]2.

Evaluating neonicotinoid insecticide uptake by plants used as buffers and cover crops.

Runoff and drainage from fields planted with neonicotinoid-coated seeds often contain insecticides that adversely affect aquatic life and other non-target organisms. Management practices such as in-field cover cropping and edge-of-field buffer strips may reduce insecticide mobility, making it important to understand the ability of different plants used in these interventions to absorb neonicotinoids. In this greenhouse study we evaluated uptake of thiamethoxam, a commonly used neonicotinoid, in six plant species - crimson clover, fescue, oxeye sunflower, Maximillian sunflower, common milkweed, and butterfly milkweed - along with a native forb mixture and a native grass plus native forb mixture. All plants were irrigated with water containing 100 or 500 µg/L of thiamethoxam for 60 days, then plant tissues and soils were analyzed for thiamethoxam and its metabolite clothianidin. Crimson clover accumulated up to 50% of the applied thiamethoxam, which was significantly more than other plants and indicates this species may be a hyper-accumulator that can sequester thiamethoxam. In contrast, milkweed plants had relatively low neonicotinoid uptake (<0.5%), meaning that those species may not pose excessive risk to beneficial insects that feed on them. In all plants, accumulated masses of thiamethoxam and clothianidin were greater in above-ground tissues (leaves and stems) than in below-ground roots, with more accrual in leaves than stems. Plants treated with the higher thiamethoxam concentration retained proportionally more of the insecticides. Because thiamethoxam primarily accumulates in above-ground tissues, management strategies that include biomass removal may reduce the input of such insecticides into the environment.

Influencing Factors of Preference Signaling in the 2022 Urology Residency Match.

OBJECTIVE: To evaluate influencing factors of preference signaling (PS) among urology residency applicants during the 2022 American Urological Association (AUA) Match. METHODS: We emailed an anonymous, deidentified questionnaire survey to applicants to our institution for the 2022 AUA Match. The main question asked to applicants was "What factor(s) went into your decision to send 'Program X' a preference signal?" Certain questions allowed the selection of multiple options, and applicants were further asked to specify these by selecting a single most important option. Descriptive statistical analyses were conducted using IBM SPSS software. RESULTS: Out of 601 registrants to the AUA match, 324 individuals applied to our institution and therefore received a survey; 77 responded for a 24% response rate. A total of 383 PS were sent by the 77 applicants. Overall, 73% and 49% of the total 383 PS had program location and reputation, respectively, selected as an influencing factor. More than 1 influencing factor was considered in 73% of PS selections, with program location (45%) considered the most important factor. In relation to applicant competitiveness, 35% of PS were sent to perceived "target" programs, 31% to "reach" programs, and 8% to "safety" programs. Among respondents who matched, 75% matched at a home, away, or signaled program. CONCLUSION: Program location appears to be the most influential factor in sending a program a PS. Programs were also signaled based on applicant's perception of their own competitiveness. PS appears to have a possible beneficial impact on obtaining interviews and successfully matching.

Internal Hemorrhoids: A Source of Massive Obscure Lower Gastrointestinal Bleeding in Cirrhosis.

Anorectal bleeding is the second most common site of lower gastrointestinal bleeding. Colonoscopy remains the gold standard test to localize sources of lower gastrointestinal bleeding, but it can miss left-sided colon pathologies such as diverticula, rectal varices, and internal hemorrhoids. We report an unusual case of a male cirrhotic patient with massive hemorrhoidal bleeding which went undiagnosed despite multiple imaging and endoscopic evaluations. He underwent urgent sigmoidoscopy that identified grade III internal hemorrhoids and sclerotherapy which resolved the hematochezia. Decompensated cirrhosis complicates patient candidacy for surgical hemorrhoidectomy, but sclerotherapy is a viable option even for high-risk patients. Urgent sigmoidoscopy during active bleeding should be considered if hemorrhoidal bleeding is suspected but inconclusive by colonoscopy.

Soil organic matter can delay-but not eliminate-leaching of neonicotinoid insecticides.

Soil organic matter (SOM) retains and attenuates many contaminants; however, its interactions with neonicotinoid insecticides under field conditions remain poorly understood. The goal of this study was to determine if SOM influences the persistence or leaching of two neonicotinoid insecticides: thiamethoxam (TMX) and its transformation-product clothianidin (CLO). Thiamethoxam-coated soybean [Glycine max (L.) Merr.] was planted into a clay soil containing different soil organic carbon (SOC) concentrations. Leachate and soil samples were collected for 10 wk after planting and were analyzed for insecticide concentrations using liquid chromatography-tandem mass spectrometry. Single and multiple linear regressions were performed between SOC, leaching volumes, and measured insecticide concentrations, focusing on rainfall events near the beginning, middle, and end of the study. Correlations were also tested between SOC and cumulative mass of leached insecticides. Neither SOC nor per-event leachate volumes explained variability in TMX leaching or residual CLO concentrations in soils; however, by the conclusion of the study residual thiamethoxam concentrations in soil were negatively correlated with cumulative volume of leached water. Initially, the concentration and total mass of leached CLO were significantly and negatively correlated with SOC content; however, this effect faded with time. Leachate dynamics also affected CLO transport, with positive correlations between leachate volume and CLO concentration during the latter events. This analysis demonstrates that SOM can reduce peak loading of neonicotinoids but may not alter cumulative leaching over the entire growing season.

Life after lockdown: The experiences of older adults in a contactless digital world.

Introduction: The digital response to the Coronavirus (COVID-19) pandemic and its effects on the lives of older adults has been well-documented, but less is known about how they experienced the post-lockdown re-emergence into a relatively contactless digital society. Methods: We report the findings from a qualitative survey (n = 93) and subsequent interviews (n = 9) with older adults aged 50+, where they describe their struggles with some of the newly implemented digital interactions. These struggles cover a range of settings but include using contactless payments, QR codes and apps to facilitate transactions in cafes, bars, and restaurants. Results: A thematic analysis of our data revealed the intrinsic (e.g. digital literacy) and extrinsic (e.g. malfunctioning technology) factors that limited social inclusion for these participants, and that sometimes even led to moments of public humiliation. Discussion: Our findings shed light on some of the motivational factors that underpin the age-related digital divide, whilst also highlighting the role of self-directed agism in limiting motivations to learn new digital routines.

Corrigendum: Technological Change in the Retirement Transition and the Implications for Cybersecurity Vulnerability in Older Adults.

[This corrects the article on p. 623 in vol. 11, PMID: 32425841.].

Technological Change in the Retirement Transition and the Implications for Cybersecurity Vulnerability in Older Adults.

Retirement is a major life transition, which leads to substantial changes across almost all aspects of day-to-day life. Although this transition has previously been seen as the normative marker for entry into older adulthood, its influence on later life has remained relatively unstudied in terms of technology use and cybersecurity behaviours. This is problematic as older adults are at particular risk of becoming victims of cyber-crime. This study aimed to investigate which factors associated with the retirement transition were likely to increase vulnerability to cyber-attack in a sample of 12 United Kingdom based older adults, all of whom had retired within the past 5 years. Semi-structured, one to one interviews were conducted and subsequently analysed using thematic analysis. Six themes were identified referring to areas of loss in: social interaction, finances, day-to-day routine, feelings of competence, sense of purpose, and technology support structures. We discuss the implications of these losses for building cyber-resilience in retirees, with suggestions for future research.

Infanticide and partial cannibalism in free-ranging Coquerel's sifaka (Propithecus coquereli).

Infanticide has been observed across many primate taxa, but the extent of its occurrence is not fully understood due to difficulty in observation and uneven reporting. Several hypotheses have been proposed to explain why infanticide occurs in primates and whether it benefits some individuals within a social group. Here we report on a case of infanticide, followed by partial consumption of the infant, in a population of Coquerel's sifaka (Propithecus coquereli) at Mariarano, Northwest Madagascar. We witnessed an adult male sifaka kill and consume part of an infant, a member of his own social group, as well as the mother's reaction to the infanticide. Following the infanticide, the mother of the deceased infant left the social group after repeated agonistic encounters with the other group members. We evaluate how this event relates to the predictions of four common hypotheses. Further research on Coquerel's sifaka is needed to determine the frequency of infanticide in this species, and in lemurs more generally, because infanticide is currently poorly understood in this taxon.