Obesity and dental caries in childhood: trends in prevalence and socioeconomic inequalities-a multicohort population-wide data linkage study.

OBJECTIVES: To quantify levels of coexisting obesity and caries experience in children in Scotland, and any associated socioeconomic inequalities over the years 2011/2012-2017/2018. DESIGN: A multicohort population-wide data linkage study. SETTING: Local authority primary schools in Scotland. PATIENTS: 335 361 primary 1 (approximately 5 years old) schoolchildren in Scotland between 2011/2012 and 2017/2018. MAIN OUTCOME MEASURES: Prevalence and inequalities in coexisting caries and obesity. RESULTS: The prevalence of coexisting obesity and caries experience was 3.4% (n=11 494 of 335 361) and did not change over the 7 years. Children living in the 20% most deprived areas had more than sixfold greater odds of coexisting obesity and caries experience than children from the 20% least deprived areas (adjusted OR=6.63 (95% CI=6.16 to 7.14; p<0.001)). There was a large persistent socioeconomic gradient across the Scottish Index of Multiple Deprivation groups, with the Slope and Relative Indices of Inequality remaining unchanged over the 7 cohort years. CONCLUSIONS: Despite improvements in oral health in children in Scotland, the prevalence of coexisting obesity and caries experience has remained static, with large persistent inequalities. These conditions are likely to signal increased risk of chronic conditions including multimorbidity in adulthood and therefore early identification of children most at risk and timely intervention tackling common risk factors should be developed and evaluated.

International Analgesia and Sedation Weaning and Withdrawal Practices in Critically Ill Adults: The Adult Iatrogenic Withdrawal Study in the ICU.

OBJECTIVES: Iatrogenic withdrawal syndrome (IWS) associated with opioid and sedative use for medical purposes has a reported high prevalence and associated morbidity. This study aimed to determine the prevalence, utilization, and characteristics of opioid and sedative weaning and IWS policies/protocols in the adult ICU population. DESIGN: International, multicenter, observational, point prevalence study. SETTING: Adult ICUs. PATIENTS: All patients aged 18 years and older in the ICU on the date of data collection who received parenteral opioids or sedatives in the previous 24 hours. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: ICUs selected 1 day for data collection between June 1 and September 30, 2021. Patient demographic data, opioid and sedative medication use, and weaning and IWS assessment data were collected for the previous 24 hours. The primary outcome was the proportion of patients weaned from opioids and sedatives using an institutional policy/protocol on the data collection day. There were 2,402 patients in 229 ICUs from 11 countries screened for opioid and sedative use; 1,506 (63%) patients received parenteral opioids, and/or sedatives in the previous 24 hours. There were 90 (39%) ICUs with a weaning policy/protocol which was used in 176 (12%) patients, and 23 (10%) ICUs with an IWS policy/protocol which was used in 9 (0.6%) patients. The weaning policy/protocol for 47 (52%) ICUs did not define when to initiate weaning, and the policy/protocol for 24 (27%) ICUs did not specify the degree of weaning. A weaning policy/protocol was used in 34% (176/521) and IWS policy/protocol in 9% (9/97) of patients admitted to an ICU with such a policy/protocol. Among 485 patients eligible for weaning policy/protocol utilization based on duration of opioid/sedative use initiation criterion within individual ICU policies/protocols 176 (36%) had it used, and among 54 patients on opioids and/or sedatives ≥ 72 hours, 9 (17%) had an IWS policy/protocol used by the data collection day. CONCLUSIONS: This international observational study found that a small proportion of ICUs use policies/protocols for opioid and sedative weaning or IWS, and even when these policies/protocols are in place, they are implemented in a small percentage of patients.

Customized External Cranioplasty for Management of Syndrome of Trephined in Nonsurgical Candidates.

BACKGROUND: Craniectomies represent a lifesaving neurosurgical procedure for many severe neurological conditions, such as traumatic brain injury. Syndrome of trephined (SoT) is an important complication of decompressive craniectomy, and cranial reconstruction is the definitive treatment. However, many patients cannot undergo surgical intervention because of neurological status, healing of the primary surgical wound, or the presence of concurrent infection, which may prevent cranioplasty. OBJECTIVE: To offer a customized external cranioplasty option for managing skull deformities for patients who could not undergo surgical intervention for definitive cranioplasty. METHODS: We describe the design and clinical application of an external cranioplasty for a patient with a medical history of intractable epilepsy, for which she underwent multiple right cerebral resections with a large resultant skull defect and SoT. RESULTS: The patient had resolution of symptoms and restoration of a symmetrical skull contour with no complication at 17 months. CONCLUSION: Customized external cranioplasty can improve symptoms associated with SoT for patients who cannot undergo a definitive cranioplasty. In addition, inset monitoring options, such as electroencephalography or telemetric intracranial pressure sensors, could be incorporated in the future for comprehensive monitoring of the patient's neurological condition.

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.

Child oral health and preventive dental service access among children with intellectual disabilities, autism and other educational additional support needs: A population-based record linkage cohort study.

OBJECTIVE: Inequalities in child oral health are a global challenge and the intersection of socioeconomic factors with educational additional support needs (ASN), including children with intellectual disabilities or autism, have thus far received limited attention in relatively small clinical studies. We aimed to address this evidence gap by investigating oral health and access to preventive dental services among children with ASN compared to the general child population. METHODS: Cohort study linking data from six Scotland-wide health and education databases compared: dental caries experience and tooth extraction via general anaesthetic; receipt of school-based dental inspection; access to primary care and hospital dental services; and access to the Childsmile national oral health improvement programme between children with a range of ASN (intellectual disabilities, autism, social and other) and their peers for the school years 2016/17-2018/19 (n = 166 781). RESULTS: Children with any ASN had higher rates of caries experience than those with no ASN, however, after adjustment for socioeconomic deprivation, sex, year, and school type only those with a social or other ASN remained at increased risk. Rates of tooth extraction under general anaesthesia in hospital were higher among children with intellectual disabilities (aRR = 1.67;95% CI = [1.16-2.37]). School-based dental inspection access improved for children with intellectual disability and/or autism from 2016/17 onwards, although higher rates of child refusal on the day were observed in these groups (no ASN refusal: 5.4%; intellectual disability: 35.8%; autism: 40.3%). Children with any ASN were less likely to attend primary dental-care regularly, and in those who attended, children with intellectual disability or autism were less likely than their peers to receive prevention (fluoride varnish, oral-hygiene instruction, or dietary advice). Childsmile nursery-supervised toothbrushing programme access among children with any ASN was similar to children with no ASN and children with intellectual disability (aRR = 1.27;95% CI = [1.12-1.45]) or autism (aRR = 1.32;95% CI = [1.19-1.45]) were more likely to receive support from Childsmile dental health support worker. CONCLUSIONS: We have identified inequalities in oral health and dental care for children with different ASN in Scotland with both a greater burden of disease among some groups and higher complexity of care; compounded by reduced and variable access to preventive dental services. Further efforts are needed to develop and improve preventive care pathways for children with ASN and integrate oral health to wider healthcare systems for these children to mitigate against oral health inequalities.

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.

Subsurface Manure Injection Reduces Surface Transport of Antibiotic Resistance Genes but May Create Antibiotic Resistance Hotspots in Soils.

Compared to surface application, manure subsurface injection reduces surface runoff of nutrients, antibiotic resistant microorganisms, and emerging contaminants. Less is known regarding the impact of both manure application methods on surface transport of antibiotic resistance genes (ARGs) in manure-amended fields. We applied liquid dairy manure to field plots by surface application and subsurface injection and simulated rainfall on the first or seventh day following application. The ARG richness, relative abundance (normalized to 16s rRNA), and ARG profiles in soil and surface runoff were monitored using shotgun metagenomic sequencing. Within 1 day of manure application, compared to unamended soils, soils treated with manure had 32.5-70.5% greater ARG richness and higher relative abundances of sulfonamide (6.5-129%) and tetracycline (752-3766%) resistance genes (p ≤ 0.05). On day 7, soil ARG profiles in the surface-applied plots were similar to, whereas subsurface injection profiles were different from, that of the unamended soils. Forty-six days after manure application, the soil ARG profiles in manure injection slits were 37% more diverse than that of the unamended plots. The abundance of manure-associated ARGs were lower in surface runoff from manure subsurface injected plots and carried a lower resistome risk score in comparison to surface-applied plots. This study demonstrated, for the first time, that although manure subsurface injection reduces ARGs in the runoff, it can create potential long-term hotspots for elevated ARGs within injection slits.

A spectrum of preferential flow alters solute mobility in soils.

Preferential flow reduces water residence times and allows rapid transport of pollutants such as organic contaminants. Thus, preferential flow is considered to reduce the influence of soil matrix-solute interactions during solute transport. While this claim may be true when rainfall directly follows solute application, forcing rapid chemical and physical disequilibrium, it has been perpetuated as a general feature of solute transport-regardless of the magnitude preferential flow. A small number of studies have alternatively shown that preferential transport of strongly sorbing solutes is reduced when solutes have time to diffuse and equilibrate within the soil matrix. Here we expand this inference by allowing solute sorption equilibrium to occur and exploring how physiochemical properties affect solute transport across a vast range of preferential flow. We applied deuterium-labeled rainfall to field plots containing manure spiked with eight common antibiotics with a range of affinity for the soil after 7 days of equilibration with the soil matrix and quantified preferential flow and solute transport using 48 soil pore water samplers spread along a hillslope. Based on > 700 measurements, our data showed that solute transport to lysimeters was similar-regardless of antibiotic affinity for soil-when preferential flow represented less than 15% of the total water flow. When preferential flow exceeded 15%, however, concentrations were higher for compounds with relatively low affinity for soil. We provide evidence that (1) bypassing water flow can select for compounds that are more easily released from the soil matrix, and (2) this phenomenon becomes more evident as the magnitude of preferential flow increases. We argue that considering the natural spectrum preferential flow as an explanatory variable to gauge the influence of soil matrix-solute interactions may improve parsimonious transport models.

Culturable antibiotic-resistant fecal coliform bacteria in soil and surface runoff after liquid dairy manure surface application and subsurface injection.

Land application of manure, while beneficial to soil health and plant growth, can lead to an overabundance of nutrients and introduction of emerging contaminants into agricultural fields. Compared with surface application of manure, subsurface injection has been shown to reduce nutrients and antibiotics in surface runoff. However, less is known about the influence of subsurface injection on the transport and persistence of antibiotic-resistant microorganisms. We simulated rainfall to field plots at two sites (one in Virginia and one in Pennsylvania) 1 or 7 d after liquid dairy manure surface and subsurface application (56 Mg ha-1 ) and monitored the abundance of culturable antibiotic-resistant fecal coliform bacteria (ARFCB) in surface runoff and soils for 45 d. We performed these tests at both sites in spring 2018 and repeated the test at the Virginia site in fall 2019. Manure subsurface injection, compared with surface application, resulted in less ARFCB in surface runoff, and this reduction was greater at Day 1 after application compared with Day 7. The reductions of ARFCB in surface runoff because of manure subsurface injection were 2.5-593 times at the Virginia site in spring 2018 and fall 2019 and 4-5 times at the Pennsylvania site in spring 2018. The ARFCB were only detectable in the 0-to-5-cm soil depth within 14 d of manure surface application but remained detectable in the injection slits of manure subsurface-injected plots even at Day 45. This study demonstrated that subsurface injection can significantly reduce surface runoff of ARFCB from manure-applied fields.

Coupling time-lapse ground penetrating radar surveys and infiltration experiments to characterize two types of non-uniform flow.

Understanding linkages between heterogeneous soil structures and non-uniform flow is fundamental for interpreting infiltration processes and improving hydrological simulations. Here, we utilized ground-penetrating radar (GPR) as a non-invasive technique to investigate those linkages and to complement current traditional methods that are labor-intensive, invasive, and non-repeatable. We combined time-lapse GPR surveys with different types of infiltration experiments to create three-dimensional (3D) diagrams of the wetting dynamics. We carried out the GPR surveys and validated them with in situ observations, independent measurements and field excavations at two experimental sites. Those sites were selected to represent different mechanisms that generate non-uniform flow: (1) preferential water infiltration initiated by tree trunk and root systems; and (2) lateral subsurface flow due to soil layering. Results revealed links between different types of soil heterogeneity and non-uniform flow. The first experimental site provided evidence of root-induced preferential flow paths along coarse roots, emphasizing the important role of coarse roots in facilitating preferential water movement through the subsurface. The second experimental site showed that water infiltrated through the restrictive layer mainly following the plant root system. The presented approach offers a non-invasive, repeatable and accurate way to detect non-uniform flow.

Utilizing Playdoh in the Classroom to Construct a 3D Model Depicting Cellular Movements and Tissue Remodeling during Human Gastrulation, Early Organogenesis, and Embryonic Folding.

In classroom studies of mammalian embryology, students must fully grasp the cellular and tissue remodeling needed to initiate gastrulation to ensure comprehension of forthcoming developmental processes such as tissue specification and organogenesis. However, quickly and completely communicating three-dimensional concepts such as gastrulation, neurulation, and embryonic folding through common two-dimensional tools such as PowerPoint is challenging for students because this method lacks the spatial orientation needed to fully understand development. Therefore, professors can utilize active learning approaches with 3D-modeling clay to aid students in visualizing developmental changes. 3D-modeling of the developmental processes focused on cell and tissue movements for the initiation of gastrulation and organogenesis is limited in published literature/videos. Therefore, this activity fills in the modeling gap by focusing on the detachment and movement of the epiblast cell through the primitive streak to generate the three germ layers, neural tube folding, cardiogenesis, and the anatomical position of the early brain and heart to drive embryonic folding. The usage of this hands-on learning tool will assist lecturers in preventing early gaps in knowledge while students first construct the model and allows for correction in misunderstandings by utilizing the complete model in discussions after construction.

Trends in socioeconomic inequalities in underweight and obesity in 5-year-old children, 2011-2018: a population-based, repeated cross-sectional study.

OBJECTIVE: To explore trends in prevalence and socioeconomic inequalities in underweight and obesity in 5-year-old schoolchildren in Scotland between 2011/2012 and 2017/2018. DESIGN: A population-based, repeated cross-sectional study. SETTING: Local authority primary schools in Scotland. PARTICIPANTS: 373 189 5-year-old schoolchildren in Scotland between 2011/2012 and 2017/2018. METHODOLOGY: Trends in prevalence and inequalities in underweight and obesity were examined across seven school years (2011/2012-2017/2018) for 373 189 5-year-old schoolchildren in Scotland. Body mass index SD scores were calculated, and epidemiological cut-offs relative to the UK 1990 references categorised underweight and obesity. Slope/relative indices of inequality (SII/RII) were calculated for underweight and obesity by school year using the area-based Scottish Index of Multiple Deprivation. RESULTS: The prevalence of obesity rose slightly overall during the study period (9.8% in 2011/2012; 10.1% in 2017/2018). However, this masked a widening of inequalities, with children from the most deprived areas experiencing a greater risk of obesity in 2017/2018 than in 2011/2012 (risk ratio=1.14, 95% CI 1.04 to 1.25) compared with an unchanged risk in children from the least deprived areas (risk ratio=0.95, 95% CI 0.82 to 1.11). SII and RII indicate widening inequalities for obesity, with RII rising from 1.95 (95% CI 1.71 to 2.22) in 2011/2012 to 2.22 (95% CI 1.93 to 2.56) in 2017/2018. The prevalence of underweight was consistently low (compared with the UK 1990 references) and remained unchanged over the study period (1.2% in 2011/2012; 1.1% in 2017/2018), with no consistent evidence of social patterning over time. CONCLUSIONS: Inequalities in obesity in schoolchildren in Scotland are large and have widened from 2011, despite only a slight rise in overall prevalence. In contrast there has been little change in underweight prevalence or inequalities during the study period. Extra resources for policy implementation and measures which do not widen inequalities and focus on reaching the most deprived children are required to tackle the high prevalence and growing inequalities in childhood obesity in Scotland.

K in an Urban World: New Contexts for Hydraulic Conductivity.

Hydraulic conductivity (K) is a key hydrologic parameter widely recognized to be difficult to estimate and constrain, with little consistent assessment in disturbed, urbanized soils. To estimate K, it is either measured, or simulated by pedotransfer functions, which relate K to easily measured soil properties. We measured K in urbanized soils by double-ring infiltrometer (K dring), near-saturated tension infiltrometry (K minidisk), and constant head borehole permeametry (K borehole), along with other soil properties across the major soil orders in 12 United States cities. We compared measured K with that predicted from the pedotransfer function, ROSETTA. We found that regardless of soil texture, K dring was consistently larger than K minidisk; with the latter having slightly less sample variance. K borehole was dependent upon specific subsurface conditions, and contrary to common expectations, did not always decrease with depth. Based on either soil textural class, or percent textural separates (sand, silt clay), ROSETTA did not accurately predict measured K for surface nor subsurface soils. We go on to discuss how K varies in urban landscapes, the role of measurement methods and artifacts in the perception of this metric, and implications for hydrologic modeling. Overall, we aim to inspire consistency and coherence when addressing K-related challenges in sustainable urban water management.

Detecting infiltrated water and preferential flow pathways through time-lapse ground-penetrating radar surveys.

The objective of this paper was to identify the incidence and extent of preferential flow at two experimental areas located in Lyon, France. We used time-lapse ground-penetrating radar (GPR) surveys in conjunction with automatized single-ring infiltration experiments to create three-dimensional (3D) representations of infiltrated water. In total we established three 100 cm × 100 cm GPR grids and used differenced radargrams from pre- and post-infiltration surveys to detect wetting patterns. The analyzed time-lapse GPR surveys revealed the linkage between nonuniform flow and heterogeneous soil structures and plant roots. At the first experimental area, subsurface coarse gravels acted as capillary barriers that concentrated flow into narrow pathways via funneled flow. At the second experimental area, the interpolated 3D patterns closely matched direct observation of dyed patterns, thereby validating the applied protocol. They also highlighted the important role of plant roots in facilitating preferential water movement through the subsurface. The protocol presented in this study represents a valuable tool for improving the hydraulic characterization of highly heterogeneous soils, while also alleviating some of the excessive experimental efforts currently needed to detect preferential flow pathways in the field.

Quantifying cover crop effects on soil health and productivity.

The dataset presented here supports the research paper entitled "A calculator to quantify cover crop effects on soil health and productivity". Soil health (sometimes used synonymously with soil quality) is a concept that describes soil as a living system to sustain plants, animals, and human. Soil physical, chemical, and biological properties, along with their interactions, are required to quantify soil health. The use of cover crops in agricultural rotations may enhance soil health, yet there has been little progress in understanding how external factors such as climate, soil type, and agronomic practices affect soil and cash crop responses. In response, this dataset compiles measurements from 281 studies and provides an analysis of field-measured changes in 38 soil health indicators due to cover crop usage. Environmental and background indicators were also compiled to assess how climatic and management practices affect soil and cash crop responses to cover crops, with specific categories including climate type (tropical, arid, temperate, and continental), soil texture (coarse, medium, and fine), cover crop type (legume, grass, multi-species mixture, and other), and cash crop type (corn, soybean, wheat, vegetable, corn-soybean rotation, corn-soybean-wheat rotation, and other). An unbalanced analysis of variation was used to determine the hierarchy of most to least important factors that affected responsiveness of each soil health indicator. Based on the hierarchy structure, a soil health calculator was then developed to quantify the response of 13 parameters - erosion, runoff, weed suppression, soil aggregate stability, leaching, infiltration, microbial biomass carbon, soil bulk density, soil organic carbon, soil nitrogen, microbial biomass nitrogen, cash crop yield, and saturated hydraulic conductivity - to cover crops. The presented data in the calculator report the mean change in parameter values based on all combinations of climate, soil texture, cover crop type, and cash crop type.

A database for global soil health assessment.

Field studies have been performed for decades to analyze effects of different management practices on agricultural soils and crop yields, but these data have never been combined together in a way that can inform current and future cropland management. Here, we collected, extracted, and integrated a database of soil health measurements conducted in the field from sites across the globe. The database, named SoilHealthDB, currently focuses on four main conservation management methods: cover crops, no-tillage, agro-forestry systems, and organic farming. These studies represent 354 geographic sites (i.e., locations with unique latitudes and longitudes) in 42 countries around the world. The SoilHealthDB includes 42 soil health indicators and 46 background indicators that describe factors such as climate, elevation, and soil type. A primary goal of this effort is to enable the research community to perform comprehensive analyses, e.g., meta-analyses, of soil health changes related to cropland conservation management. The database also provides a common framework for sharing soil health, and the scientific research community is encouraged to contribute their own measurements.

A Novel Ebola Virus VP40 Matrix Protein-Based Screening for Identification of Novel Candidate Medical Countermeasures.

Filoviruses, such as Ebola virus and Marburg virus, are of significant human health concern. From 2013 to 2016, Ebola virus caused 11,323 fatalities in Western Africa. Since 2018, two Ebola virus disease outbreaks in the Democratic Republic of the Congo resulted in 2354 fatalities. Although there is progress in medical countermeasure (MCM) development (in particular, vaccines and antibody-based therapeutics), the need for efficacious small-molecule therapeutics remains unmet. Here we describe a novel high-throughput screening assay to identify inhibitors of Ebola virus VP40 matrix protein association with viral particle assembly sites on the interior of the host cell plasma membrane. Using this assay, we screened nearly 3000 small molecules and identified several molecules with the desired inhibitory properties. In secondary assays, one identified compound, sangivamycin, inhibited not only Ebola viral infectivity but also that of other viruses. This finding indicates that it is possible for this new VP40-based screening method to identify highly potent MCMs against Ebola virus and its relatives.

Comparison of Perioperative Outcomes of Autologous Bladder Neck Fascial Slings Based on Fascial Harvest Site: A Secondary Analysis of the National Surgical Quality Improvement Program Database.

OBJECTIVES: The objective of this study was to compare perioperative outcomes of autologous bladder neck fascial slings (ABNFS) between rectus fascia and fascia lata harvest sites. METHODS: We analyzed women undergoing ABNFS in the 2006 to 2015 American College of Surgeons National Surgical Quality Improvement Program database, separating rectus fascia and fascia lata harvest sites by Current Procedural Terminology codes. We compared the 2 harvest sites for perioperative outcomes within 30 days including adverse events, readmission, and reoperation as well as operative time and length of hospital stay. The primary outcome was a composite of postoperative adverse events, readmission, and reoperation. A multivariable logistic regression model was used incorporating race, smoking status, surgical specialty, anesthesia class, concurrent procedures, body mass index, operating time, and length of hospital stay. RESULTS: A total of 161 women in the database underwent ABNFS: 126 (78.3%) rectus fascia and 35 (21.7%) fascia lata harvest. Patients undergoing rectus fascial harvest were more likely to be white (140 [90.5%] rectus vs 26 [74.3%] fascia lata, P=0.02) and more likely to have ABNFS by a urologist (117 [93%] rectus vs 23 [66%] fascia lata, P < 0.01). There were no significant differences in operative time, length of stay, rate of reoperation, nonserious or serious adverse events, or readmission between the 2 harvest site groups. The 2 harvest sites had similar composite morbidity (adjusted odds ratio of 0.88 for rectus fascia; 95% confidence interval, 0.21-3.75; P=0.87). CONCLUSIONS: Rectus fascia and fascia lata harvest for ABNFS have similar perioperative outcomes.

Predictors of Postdischarge Surgical Recovery Following Laparoscopic Sacrocolpopexy: A Prospective Cohort Study.

OBJECTIVES: Our aim was to identify sociodemographic/clinical, surgical, and psychosocial predictors of postdischarge surgical recovery after laparoscopic sacrocolpopexy. METHODS: Study participants (N = 171) with at least stage 2 pelvic organ prolapse completed a preoperative survey measuring hypothesized sociodemographic/clinical, surgical, and psychosocial recovery predictors followed by a postoperative survey at 4 time points (days 7, 14, 42, and 90) that included the Postdischarge Surgical Recovery 13 scale. One multivariate linear regression model was constructed for each time point to regress Postdischarge Surgical Recovery 13 scores on an a priori set of hypothesized predictors. All variables that had P < 0.1 were considered significant predictors of recovery because of the exploratory nature of this study and focus on model building rather than model testing. RESULTS: Predictors of recovery at 1 or more time points included the following: sociodemographic/clinical predictors: older age, higher body mass index, fewer comorbidities, and greater preoperative pain predicted greater recovery; surgical predictors: fewer perioperative complications and greater change in the leading edge of prolapse after surgery predicted greater recovery; psychosocial predictors: less endorsement of doctor's locus of control, greater endorsement of other's locus of control, and less sick role investment predicted greater recovery. CONCLUSIONS: Identified sociodemographic/clinical, surgical, and psychosocial predictors should provide physicians with evidence-based guidance on recovery times for patients and family members. This knowledge is critical for informing future research to determine if these predictors are modifiable by changes to our narrative during the preoperative consultation visit. These efforts may reduce the postdischarge surgical recovery for patients with pelvic organ prolapse after laparoscopic sacrocolpopexy, accepting the unique demands on each individual's time.