Use Of Pads Research Articles

245 ‘Pad culture: the use of continence wear in older people in an Irish University Hospital’

Abstract Background Incontinence in hospital patients can result in a longer length of stay, a greater risk of being discharged to a residential care setting, as well as increased healthcare and personal costs. Older adults may find it difficult to regain continence post discharge contributing to caregiver strain, social isolation and functional decline. There is evidence to suggest that there is an over-reliance on continence aids (wearable absorbent ‘pads’ & urinary catheters) for older adults in hospital. The aim of this study was to assess the prevalence of continence aids among older in-patients in an Irish University Hospital, as part of wider service improvement project. Methods Data was collected on consecutive in-patients 65 years or older on a single day. Medical, surgical, oncology, coronary care and medical assessment unit were included. Current incontinence aid usage and pre-admission continence aid usage was recorded, along with demographics and current mobility status. Results 156 older adults were included. 53.5% were male and the median age was 81. A total of 57.4% (N = 89) of older patients were wearing disposable pads. Of these, 64.5% (N = 58) were not wearing continence pads pre-admission. A total of 23.2% (N = 36) had a urinary catheter inserted. Of these, 91% (N = 33) did not have a urinary catheter pre-admission. 38.3% (N = 61) of those wearing pads could mobilise either independently or with assistance of one. We also found a direct correlation between pad use and length of stay. Conclusion This study highlights the high prevalence of continence aid deployment in the care of older adults admitted to an acute hospital, with conversion to an aid occurring even in those who are able to mobilise independently or with supervision. Continence care and rehabilitation may benefit from inter-disciplinary assessment and management, similar to other complications of ageing and hospitalisation, such as delirium.

222 Incontinence acquired during hospitalisation: targets for improving standards of care

Abstract Background Urinary incontinence is common in older adults, frequently underreported and consequently under-treated. Up to 15% of patients with hospital-acquired incontinence will have persistent incontinence afterwards. We performed an audit in a Level 3 hospital examining documentation of continence, pad use and call bell use in order to identify areas where continence care can be improved. Methods Data were gathered on all inpatient at a single timepoint. Biographical data, admission diagnoses, diagnosis of dementia, delirium and urinary incontinence, use of diuretics and urinary incontinence medications, toileting plans, continence care bundles and mobility status were gathered from medical notes, nursing notes and drug charts. Results The dataset comprised 309 patients. 9% were continent pre-admission and now had incontinence or occasional accidents. 72% of these were admitted >15 days. 17% had a diagnosis of dementia and 48% delirium. 31% were on diuretics. 14% were independently mobile. 44% of patients were wearing pads, one in two of whom were continent or had only occasional accidents. 15% of patients had a continence status documented in the medical admission proforma, 29% had a continence care bundle and 36% a toileting plan recorded. Patients whose continence status was documented at admission were more likely to have a toileting plan and continence care bundle than those without a documented continence status. 20% of patients did not have a call-bell in reach. In the population that required assistance to mobilise, 23% did not have a call-bell, 52% of which were incontinent. Conclusion Long duration of admission, diuretics, delirium and dependent mobility were all risk factors for hospital-acquired incontinence. Pads were used indiscriminately, regardless of continence status. A significant proportion of patients had no access to a call-bell, placing those who could not mobilise independently at risk of incontinence. Our study identifies a number of areas for improvement to promote continence throughout a person’s inpatient stay.

Effectiveness of artificial urinary sphincter to treat stress incontinence after prostatectomy: A meta-analysis and systematic review.

Artificial Urinary Sphincter (AUS) has always been considered the gold standard for surgical treatment of male non-neurogenic Stress Urinary Incontinence (SUI). The purpose of this meta-analysis was to evaluate AUS's effectiveness in treating male SUI, as described in the literature. Two independent reviewers used PubMed, EMBASE, Web of Science, CNKI, WanFang Data, and VIP databases, to find the efficacy of artificial urethral sphincter in treating SUI after male prostate surgery. We excluded studies on female urinary incontinence. The main purpose of this study was to evaluate the clinical efficacy based on the degree of dry rate after AUS AMS 800™: postoperative complete dry was defined as no pad use per day. Postoperative social dry was defined as 0-1 pad per day. The secondary goal was to analyze the use of AUS AMS 800™ to improve SUI and to calculate the degree of influence by analyzing the number of pads and postoperative quality of life. And methodologic quality of the overall body of evidence was evaluated using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) guidelines. The data in this paper are mostly based on prospective or retrospective cohort studies without control groups. Fortunately, most studies have the same criteria to assess effectiveness. The pooled data of 1271 patients from 19 studies (6 prospective cohort studies, 12 retrospective cohort studies, and 1 randomized controlled trial) showed that: the number of pads used (pads/ day) after AUS was significantly reduced by about 4 (P < 0.001) and the quality of life was improved (P < 0.001).In addition, data analysis showed a high degree of heterogeneity between studies. According to the severity of baseline SUI, subgroup analysis was performed on the postoperative dry rate and social dry rate. Although heterogeneity was reduced, I2 is still above 50%, considering that heterogeneity may not be related to the severity of SUI. The random effect model was used for data analysis: the dry rate was about 52% (P < 0.001), and the social dry rate was about 82% (P < 0.001). The evidence level of GRADE of dry rate is very low, the evidence level of social dry rate and Pads use (pads/day) is Moderate, and the evidence level of Quality of life is low. Although the evidence in this paper is based on descriptive studies and limited follow-up, the results show that AUS is effective in treating urinary incontinence and can improve patients' quality of life.

Wear-friction properties of friction pairs in disc-pad brakes

This paper reports data on the dynamic coefficient of friction and wear of materials of different types of friction pads and brake discs obtained from experimental research during braking under bench conditions. It was established that on the basis of the chemical composition of the materials of the friction pads with codes, in the temperature range of 100–450 °C with a step of 50 °C, the ratio of the maximum to the minimum wear of the disc varies from 6.0 to 10.0. The value of the disc wear ratio at 800 and 1000 brakings, respectively, in the temperature range of 100–250 °C and 100–450 °C was 7.6 and 14.0. This indicates that for pad materials of type A, B, C, and D under the second thermal regime, the linear wear of the working surfaces of the discs is greater than under the first thermal regime. And for the pad materials of type E and F, the wear of the discs was the same. This indicates that the use of traditional pads is characterized by a higher thermal tension of the disc brake friction pair; the absolute temperature values are in the unfavorable zone of 400–700 °C. That, in turn, could lead to both phase changes and thermal fatigue aging of materials and, as a result, to the deterioration of their tribological and thermophysical characteristics in operation. Thus, the implementation of the method of selecting pad components could improve the performance of disc brake devices of cars

Early prediction of ventricular fibrillation using electrocardiographic characteristics in prehospital suspected ST-segment elevation myocardial infarction: a case-control study.

Our objective was to determine characteristics of electrocardiograms (ECG) that predict ventricular fibrillation (VF) among prehospital patients with suspected ST-segment elevation myocardial infarction (STEMI) in Québec. We performed a matched case-control study of prehospital adult suspected with STEMI. Patients in case group (STEMI/VF+) were matched with controls (STEMI/VF-) for age and sex and then compared for ECG characteristics, including ST-segment elevations (STE) and depressions (STD), duration of interval complexes, general characteristics, and several calculated variables. Logistic regression was used to measure the association between ECG characteristics and VF development. Overall, 310 prehospital patients with suspected STEMI were included in the analysis (case group, n = 155; control group, n = 155). We confirmed that the presence of TW-pattern complex (OR 7.0, 95% CI 1.55-31.58), premature ventricular contraction (PVC) (OR 5.5, 95% CI 2.04-14.82), and STE in V2-V6 (OR 3.8, 95% CI 1.21-11.74) were electrocardiographic predictors of VF. We also observed that STD in V3-V5 (OR 6.5, 95% CI 1.42-29.39), atrial fibrillation (AF) ≥ 100 beats per minute (bpm) (OR 6.3, 95% CI 1.80-21.90), the combination of STE in V4 and V5, and STD in II, III and aVF (OR 4.8, 95% CI 1.01-22.35), and the presence of STD in ≥ 6 leads (OR 4.2, 95% CI 1.33-13.13) were also associated with VF development. Finally, simultaneous association of 2 (OR 2.3, 95% CI 1.13-4.06) and 3 (OR 11.6, 95% CI 3.22-41.66) predictors showed significant association with VF. In addition to some already known predictors, we have identified several ECG findings associated with the development of VF in patients with suspected STEMI. Early identification of patients with STEMI at increased risk of VF should help EMS providers anticipate adverse events and encourage use of defibrillation pads.

Intraoperative control of air leak using a sutureless free pericardial fat pad covering method in lung cancer resection.

Here, we introduce a new method for intraoperative control of air leak using a free pericardial fat pad covering to lung damage with sutureless fixation. We covered the damaged lung tissue with a free pericardial fat pad with a polyglycol acid sheet and fibrin glue fixation. This method provides a good air leak controlling effect with the use of a free pericardial fat pad and relatively short operative time with sutureless fixation.

Recognition of emotion and pain by owners benefits the welfare of donkeys in a challenging working environment.

Working donkeys (Equus asinus) support human living standards globally. However, there is little information on the effect of human perceptions of emotion and pain on the welfare of working donkeys. We interviewed donkey owners (n=332) in Pakistan to determine the relationship between human perspectives on donkey sentience: emotions and the ability to feel pain, and the routine working practices that could impact donkey welfare. The majority of donkey owners used padding under the saddle (n=211; 63.6%; 95% CI (58.3%-68.9%)) and provided access to food (n=213; 64.2%; 95% CI (58.9%-69.3%)) and water (n=195; 58.7%; 95% CI (53.4%-64.1%)) during the working day. Owners reported that at some point in their donkey's life, 65.3% (95% CI (60.2%-70.5%)) had load-associated injuries, of which 27.7% (n=92; 95% CI (22.8%-32.5%)) were wounds, 20.5% (n=68; 95% CI (16.1%-24.8%)) were lameness and 7.2% (n=24; 95% CI 4.4%-10.0%) were back pain. In total, 81.3% (95% CI 77.1%-85.5%; n=270) of owners believed that their donkeys felt pain, and 70.2% (95% CI (65.2%-75.1%; n=233) of owners believed that their donkeys had emotions. Multiple correspondence analysis (MCA) was used to understand the relationship between owners' recognition of emotions and pain in donkeys and their working practices. The MCA factor map revealed two clusters, named positive and negative clusters. The positive cluster included owner's recognition of donkey pain and emotions, the availability of food and water, use of padding under the saddle, absence of injuries along with the willingness to follow loading guidelines. The negative cluster represented practices that did not benefit donkey welfare, such as using saddles without padding and a lack of food and water during work. The presence of injuries, owners not recognizing that donkeys feel pain and emotion along with an unwillingness to follow loading guidelines were also found in the negative cluster. We show that the owners who recognized sentience in their donkeys were more likely to use practices that are good for donkey welfare. The ability of owners to identify sentience in donkeys, along with their willingness to follow welfare guidelines, are important factors in improving the lives of working donkeys.

Robot-assisted versus three-dimensional laparoscopic radical prostatectomy: 12-month outcomes of a randomised controlled trial.

To compare functional and oncological outcomes of robot-assisted laparoscopic prostatectomy (RALP) to three-dimensional laparoscopic radical prostatectomy (3D-LRP) at 12 months after surgery. Prospective randomised single-centre study of 145 consecutive men referred to radical prostatectomy in a tertiary referral centre in Finland. Patients were randomised 1:1 to the RALP (N = 75) and 3D-LRP (N = 70) groups. The primary outcome was urinary continence evaluated with the Expanded Prostate Cancer Index Composite 26-item version (EPIC-26) incontinence domain score at 12 months after surgery. Secondary outcomes included the use of protective pads at 12 months after surgery, EPIC-26 domain scores of irritative/obstructive, bowel, sexual and hormonal symptoms, positive surgical margin (PSM) rate, and biochemical recurrence (BCR). Complication frequency within the 3-month period after surgery was evaluated according to Clavien-Dindo classification. Statistical significance between groups was analysed using Mann-Whitney, chi-square and Fisher's exact tests. The trial was terminated after interim analysis based on no statistically significant difference in EPIC-26 urinary incontinence domain scores. Altogether 145 patients of the target accrual of 280 patients were recruited. Postoperative continence at 12 months after surgery according to the EPIC-26 incontinence domain was 79.25 in both groups (P = 0.4). Between group difference was -5.8 (95% confidence interval -15.2 to 3.6). There was no statistically significant difference in the rates of PSM or BCR between the two surgical modality groups. We were unable to demonstrate a difference between the RALP and 3D-LRP groups for functional and oncological outcomes at 12 months after surgery.

Menstrual Hygiene Practices in Indian Tribal Females: A Systematic Review and Meta-Analysis.

India is native to many tribal communities: Bharia (Madhya Pradesh), Bihl (Rajasthan), Santhal (Bihar, Jharkhand), Bodo (Assam, West Bengal), and many more. They reside in isolated geographical regions, which poses challenges in reaching out to them. In addition, they still have firm beliefs and taboos regarding menstruation. Knowledge about menstrual health and hygiene is one of the most important aspects of tribal health. Therefore, it is important to synthesize the results of menstrual hygiene data from the Indian tribal population. We have calculated the pooled prevalence of sanitary pad use, dustbin disposal, and hygienic reuse of menstrual materials. Online databases, namely PubMed, Cochrane Central, CINAHL, Pan African Journals, EBSCO, and Google Scholar, were searched. After the removal of duplicates, a quality check, and screening of cross-references, 19 articles were selected for final review.Statistical analysis was done by Revman 5.4 and STATA 17.0. A p-value of <0.05 was considered statistically significant. PRISMA guidelines were followed. The protocol registration number was CRD42022331376.This is a non-funded article. The pooled prevalence of sanitary pad use in Indian tribal females was 2% (95% CI 1 to 3). The pooled prevalence of dustbin disposal of menstrual material was 1% (95% CI: 0.00 to 0.02). The pooled prevalence of hygienic reuse of menstrual materials was 1%. Sanitary menstrual hygiene practices are very less prevalent in Indian tribal females. Awareness programs and tribal health policies need to be accelerated for the promotion of menstrual hygiene. Also, literature on the use, disposal, and storage of menstrual adsorbents is scarce in Indian tribes. Health research in this area needs to be emphasized.

Adjustable transobturator male system (ATOMS) for stress urinary incontinence: the evidence is mounting.

To evaluate the New Zealand clinical experience with the adjustable transobturator male system (ATOMS), a novel continence device in the management of all degrees of stress urinary incontinence (SUI), focusing on efficacy and safety outcomes. A retrospective review of all ATOMS devices placed between May 2015 and November 2020 was conducted. Severity of SUI was assessed (pad usage) before and after surgery. SUI was defined as mild (1-<3 pads/day), moderate (≥3-5 pads/day) or severe (>5 pads/day). The primary outcome measures considered were the overall success rate (improvement in pad use) and the dry rate (with dry defined as either no or 1 safety pad/day). The number of outpatient adjustments and total filling volumes were also documented in each case. Additionally, we documented incidence and severity of device complications and an analysis of treatment failures. A total of 140 patients were reviewed, with the most common indication for ATOMS placement being SUI after radical prostatectomy (82.8%). Of the patients included, 53 (37.9%) had previous radiotherapy, with 26 (18.6%) patients having had a previous continence procedure performed. No intraoperative complications were noted. The median preoperative pad usage was 4 pads/day. After a median follow-up of 11 months, median postoperative pad usage reduced to 1 pad/day. In our cohort, 116 patients (82.9%) reported an improvement in their pad usage and were considered successful with 107 (76.4%) patients reporting themselves to be dry. Complications within the first 90-days after surgery occurred in 20 (14.3%) of patients. Treatment of SUI with the ATOMS is safe and effective. The option of long-term, minimally invasive adjustment to respond to patient needs is a significant advantage.

Factors Affecting The Success Of Vaginitis Treatment In Pregnant Women ; A Prospective Cohort Study

Introduction&#x0D; Anatomy, physiology, and flora of the female genital system change due to pregnancy-related hormonal, metabolic, endocrinological, and immunological reasons. Dysbiosis increases the risk of spontaneous preterm birth with chronic inflammatory processes by causing infections in the fetoplacental unit by the ascending or hematogenous route. &#x0D; Our study aimed to reveal the bad personal habits and practices predispose to vaginitis, create resistance to treatment, and cause recurrences in pregnant women with vaginitis. &#x0D; &#x0D; Material-Methods&#x0D; Our descriptive study was conducted on a group of patients who applied to the Department of Obstetrics and Gynecology, between December 2021 and April 2022, with the ethics committee's approval. Our study group consists of 178 pregnant women over 18 who are literate, cooperative, and volunteered to answer all the questions in the questionnaire.&#x0D; &#x0D; Results&#x0D; Vaginal douching in 71.9% (128 people) of the participants, not ironing their underwear at all in 67.4% (120 people), cleaning the perineum from back to front in 66.9% (119 people), 61.2% daily pad use in 61.2% (109 people), synthetic laundry use in 41% (73 people), use of genital cleaning products in 16.3% (29 people), hand washing underwear in 7.3% (13 people) and 5.6% (10 people) had frequent sexual intercourse behavior. Regarding genital area cleaning, 11.2% (20 people) of the patients knew about using white vinegar, and 3.4% (6 people) used the acidic mixture. 6.7% (12 people) of the participants knew the use of vaginal probiotics.&#x0D; Conclusion&#x0D; Considering the results of our study, it can be said that wrong practices regarding genital hygiene continue, especially in women from low socio-economic and cultural levels.&#x0D; In this respect, the women need training on genital hygiene as a preventive measure due to the mistakes they make in practice related to genital hygiene and the possibility of experiencing a genital infection in a significant part of them.&#x0D; In conclusion, considering that the most significant deficiency in the occurrence of genital infections in women is the lack of education, it is recommended that all health professionals develop a training plan to prevent genital infections and apply it to women in the regions they work.

Gender identity, embodiment and liminality in women΄s experience of mastectomy

In addition to a potentially life-threatening illness, women with breast cancer also face several challenges related to the effects of medical treatment on their bodies and their embodied identity. Mastectomy, as a highly invasive treatment, has significant impact on women's lives. This study aims to investigate the experience of mastectomy and the subjective meanings that it holds for women, in relation to their identity and relationships. The research questions were explored through a phenomenological approach in order to better understand the role of the body in this experience, and a gender perspective was adopted in order to critically examine the socio-cultural background that shapes women’s experience. Seventeen women, aged between 26-57, who had undergone mastectomy following a breast cancer diagnosis, participated in the study. The research material was collected through semi-structured interviews and analyzed using phenomenological analysis. The analysis also drew upon a gender perspective, given a focus of the study on the gendered dimension of embodied identity. Findings indicate that a core element of the experience of mastectomy concerns the alteration of embodied identity and a sense of liminality, an unresolved state of being in between the previous normal life and life post-diagnosis. The analysis highlighted the need to expand the concept of liminality in psycho-oncology, to include the ambiguity associated with women’s self-identification as ‘normal women’, in relation to embodied experience and the socio-cultural constructions of the female breast. Interestingly, liminality in relation to gender identity characterizes many women’s experience, despite the use of silicone pads and/or plastic reconstructive surgery to manage the altered body. The findings enrich our theoretical understanding of the experience of mastectomy, broaden the concept of liminality, highlight the gendered dimensions of identity and the role of the socio-cultural context in shaping the experience of mastectomy. Moreover, they point to useful directions for the design and delivery of individualized support to women who have undergone mastectomy.

A statistical characterization model of the microscale contact state of polishing pads

Chemical mechanical polishing (CMP) greatly benefits from the wafer and pad’s microscale contact condition. With so many varying pressures and wafer layouts, it is incredibly difficult to measure all the microscale contact states. Therefore, there is an urgent need to realistically characterize the morphology and contact state of polishing pads. A statistical characterization model of the microscale contact state of polishing pads was developed in this investigation. The microscale contact states under different pressures were measured to make sure that the model was accurate. This proposed model can extract the pad morphology parameters from the microscale contact state to predict the pad surface morphology and, thus, the microscale contact state in arbitrary conditions. This study can provide some recommendations for stability in CMP and the production and use of pads.

Outcomes of holmium laser enucleation of the prostate (HoLEP) for very large-sized benign prostatic hyperplasia (over 150mL): open simple prostatectomy is dead.

Our study aimed to describe the outcomes of transurethral enucleation of the prostate (HoLEP) for large-sized benign prostatic hyperplasia over 150mL (bBPH). We conducted a retrospective, descriptive, and analytical study of patients undergoing HoLEP for bBPH. The primary endpoint was the success of the procedure, defined by a mixed criteria: complete endoscopic enucleation of the prostate, absence of blood transfusion or reoperation for bleeding, post-operative improvement of quality of life (assessed by a ≥ 2 points increase at in the 8th question of the IPSS test) and post-operative continence (no pads use) at 3months. Eighty-one patients were included with a mean age of 73.9 ± 7.3 and a mean measured prostate volume of 183.3 ± 34.5cc. The mean operative time was 57.5 ± 29.7min and the average wet weight of resected tissue removed was 151.8 ± 44.7g. Mean hospitalization stay was 1.3 ± 0.7days with a mean post-operative catheterization period of 1.9 ± 0.9days. The success of the surgery was achieved in 77 patients (95%). Functional improvements were found at 1 and 6months for Qmax, post-void residual, IPSS and QoL-IPSS. The 30-day complication rate was 9.9%. The average PSA level dropped from 14.8 ± 11.6ng/mL at baseline to 0.8 ± 0.5ng/mL at 6months. HoLEP for bBPH is both safe and efficient. Regarding the benefit/risk balance, it should be highlighted as the gold standard for the management of big BPH.

Outcomes and Complication Rates of Cuff Downsizing in the Treatment of Worsening or Persistent Incontinence After Artificial Urinary Sphincter Implantation.

This study investigated the functional outcomes and complication rates of cuff downsizing for the treatment of recurrent or persistent stress urinary incontinence (SUI) in men after the implantation of an artificial urinary sphincter (AUS). Data from our institutional AUS database spanning the period from 2009 to 2020 were retrospectively analyzed. The number of pads per day was determined, a standardized quality of life (QoL) questionnaire and the International Consultation on Incontinence Questionnaire (ICIQ) were administered, and postoperative complications according to the Clavien-Dindo classification were analyzed. Out of 477 patients who received AUS implantation during the study period, 25 (5.2%) underwent cuff downsizing (median age, 77 years; interquartile range [IQR], 74-81 years; median follow-up, 4.4 years; IQR, 3-6.9 years). Before downsizing, SUI was very severe (ICIQ score 19-21) or severe (ICQ score 13-18) in 80% of patients, moderate (ICIQ score 6-12) in 12%, and slight (ICIQ score 1-5) in 8%. After downsizing, 52% showed an improvement of >5 out of 21 points. However, 28% still had very severe or severe SUI, 48% had moderate SUI, and 20% had slight SUI. One patient no longer had SUI. In 52% of patients, the use of pads per day was reduced by ≥50%. QoL improved by >2 out of 6 points in 56% of patients. Complications (infections/urethral erosions) requiring device explantation occurred in 36% of patients, with a median time to event of 14.5 months. Although cuff downsizing carries a risk of AUS explantation, it can be a valuable treatment option for selected patients with persistent or recurrent SUI after AUS implantation. Over half of patients experienced improvements in symptoms, satisfaction, ICIQ scores, and pad use. It is important to inform patients about the potential risks and benefits of AUS to manage their expectations and assess individual risks.

Comparison of In-person FPMRS-directed Pelvic Floor Therapy Program Versus Unsupervised Pelvic Floor Exercises Following Prostatectomy

To compare comprehensive continence outcomes in patients receiving pelvic floor muscle training (PFMT) vs standard unsupervised home pelvic floor exercise therapy (UPFE). As part of the UVA prostatectomy functional outcomes program, participating patients complete a 12-month PFMT program under FPMRS specialist supervision. We performed a retrospective review of prospectively collected longitudinal outcomes in patients receiving PFMT vs UPFE through 12-month follow-up. Primary study outcome was ICIQ-MLUTS SUI domain score (SDS). Secondary outcomes included daily pad use (PPD), SUI Cure (SDS=0), and quality of life score (IIQ-7). Multilevel mixed effects linear regression was used to model SDS over time. Analysis included 40 men. No difference in patient characteristics was seen in comparison of PFMT vs UPFE cohorts (P=NS, all comparisons). Mean predicted SDS was significantly better in the PFMT vs UPFE cohorts at 6-month (0.81±0.21 vs 1.75±0.34, respectively) (P=.014) and 12-month (0.72±0.17 vs 1.67±0.30, respectively) (P=.004) time points. At 12-month follow-up, 11 (55%) vs 4 (20%) patients reported absence of SUI in PFMT vs UPFE cohorts, respectively. Predicted probabilities of SUI cure in PFMT vs UPFE cohorts at 12months were 0.52±0.14 vs 0.23±0.13, respectively (P=.14). At 12-month follow-up, the mean predicted PPD and IIQ score was 0.19±0.10 vs 0.79±0.33 and 2.86±0.86 vs 2.55±1.07 in PFMT vs UPFE cohorts, respectively (P=NS). In-person, FMPRS-directed PFMT is associated with improved SUI domain scores following robotic-assisted laparoscopic prostatectomy, a finding durable through 12-month follow-up.

A landing pad system for multicopy gene integration in Issatchenkia orientalis

The robust nature of the non-conventional yeast Issatchenkia orientalis allows it to grow under highly acidic conditions and therefore, has gained increasing interest in producing organic acids using a variety of carbon sources. Recently, the development of a genetic toolbox for I. orientalis, including an episomal plasmid, characterization of multiple promoters and terminators, and CRISPR-Cas9 tools, has eased the metabolic engineering efforts in I. orientalis. However, multiplex engineering is still hampered by the lack of efficient multicopy integration tools. To facilitate the construction of large, complex metabolic pathways by multiplex CRISPR-Cas9-mediated genome editing, we developed a bioinformatics pipeline to identify and prioritize genome-wide intergenic loci and characterized 47 gRNAs located in 21 intergenic regions. These loci are screened for guide RNA cutting efficiency, integration efficiency of a gene cassette, the resulting cellular fitness, and GFP expression level. We further developed a landing pad system using components from these well-characterized loci, which can aid in the integration of multiple genes using single guide RNA and multiple repair templates of the user’s choice. We have demonstrated the use of the landing pad for simultaneous integrations of 2, 3, 4, or 5 genes to the target loci with efficiencies greater than 80%. As a proof of concept, we showed how the production of 5-aminolevulinic acid can be improved by integrating five copies of genes at multiple sites in one step. We have further demonstrated the efficiency of this tool by constructing a metabolic pathway for succinic acid production by integrating five gene expression cassettes using a single guide RNA along with five different repair templates, leading to the production of 9 g/L of succinic acid in batch fermentations. This study demonstrates the effectiveness of a single gRNA-mediated CRISPR platform to build complex metabolic pathways in a non-conventional yeast. This landing pad system will be a valuable tool for the metabolic engineering of I. orientalis.

EPIC-26 urinary incontinence score results and pad use 12 months after radical prostatectomy for localized or (locally) advanced prostate cancer: Results of a cohort of 14,920 patients from 118 certified centers in Germany, Switzerland, and Austria.

e17102 Background: Besides erectile dysfunction, urinary incontinence is the most common functional impairment after radical prostatectomy (RP) for localized and (locally) advanced prostate cancer (PCa). Clinical guidelines recommend informing patients about incontinence and other functional impairment of the different therapy options. Yet, real-world data on incontinence following RP is sparse in most countries, impeding the information of patients. This work aims to present data on urinary incontinence after RP from routine care in Germany, Switzerland and Austria using the EPIC-26 urinary incontinence score and the single item on pad use. Methods: We analyzed data from the prospective cohort study PCO (Prostate Cancer Outcomes Study), partly funded by the Movember Foundation. The data presented was based on patients treated with RP for localized and (locally) advanced PCa in one of 118 Certified Prostate Cancer Centers between 2016 and 2021. The Berlin Medical Association's ethics board and local ethics boards approved the study. Each patient gave informed written consent. Patients included in the analytic sample had to complete a baseline questionnaire (EPIC-26) before (T0) and a follow-up questionnaire 12 months after RP (T1). Questionnaire data were linked to clinical data and analyzed descriptively: We report changes in the urinary incontinence score between T0 and T1 and the proportion of patients using pads ("pad use") stratified by age and risk group according to the German clinical guideline (based on the d’Amico risk groups). Results: 14,920 patients from 118 centers were included in the analysis. The median age was 66 (interquartile range 61-70). The average urinary incontinence score (value range: 0 - worst possible to 100 - best possible) was 93 points at T0 and 73 points 12 months later. 97% of the patients did not use pads at T0, compared to 57% using at least one pad per day at T1. Among patients who did not use pads at T0, 42% used at least one pad a day 12 months later, and 12% used two or more pads per day. The proportion of patients using pads differs meaningfully according to age and risk group and across centers. Conclusions: The data presented gives insight into real-world functional outcomes after RP. These results may help inform providers and patients when discussing treatment options in an easy-to-understand way. Availability of comparable data from other countries is limited, with Australian registry data suggesting slightly better outcomes at 12 months. Results are limited to Prostate Cancer Centers certified according to the requirements of the German Cancer Society. They are thus a selection of units with at least 50 RPs per year and many other quality standards met.

Editor’s Note: Special Issue: Gender and Social Change in Myanmar

Editor’s NoteSpecial Issue: Gender and Social Change in Myanmar Jane M. Ferguson The Myanmar military’s 1 February 2021 coup d’etat of the elected government quickly provoked widespread protests, namely the Civil Disobedience Movement and the Spring Revolution. During the earliest days of these manifestations, people of various gender identities were at the forefront of the demands for political change. They made use of numerous creative tactics to fight the military’s political imposition and to bring their grievances to the public sphere. Following the government’s brutal suppression of the nonviolent protests emerged the organization of People’s Defense Forces. In the years since, fighting, repression, and resistance continue. Now, as ever, it is imperative to interrogate how gender—as produced, experienced, and mobilized—operates across cultural fields, and relates to social transformation in Myanmar. Using nuanced, dynamic methodologies, the four research articles in this special issue of The Journal of Burma Studies take up that challenge. They reconsider gender in varied contexts of social activism, everyday practices, identity politics, and religious histories. Gender discourses in Myanmar are reforged through the work of many different agents, from renunciants to punks, to revolutionaries, and to keyboard warriors. Powerful ideologies are confirmed, [End Page 1] reinvented, and modified in complex and often contradictory ways. Superstitious Fabrications? The Revolution’s Secret Weapon Two articles in this special issue foreground a seemingly anomalous protest strategy: using some pieces of cloth to fight an armed-to-the-hilt military. Through their creative use of women’s htamein (sarong-like skirts), protesters have drawn attention to—even weaponized—a specific gender taboo, a taboo which is sometimes considered particular to the region. In their article for this special issue, “Our Htamein, Our Flag, Our Victory: The Role of Young Women in Myanmar’s Spring Revolution,” Marlar, Justine Chambers, and Elena use an intersectional approach to explore how status is interrogated by other types of difference, namely those of gender, age, and class. They argue that during past decade, Myanmar has witnessed important shifts in gender roles, and these present new vistas for solidarity and ways to imagine a more democratic political future. As they argue, the movement’s use of htamein and menstrual pads were part of a public rallying strategy. Through these methods, protesters stand in defiance of the patriarchal and misogynist ideologies of the military. On a related vein, Aye Lei Tun’s article in this issue, “Deconstructing and Reinforcing Gender Norms and Cultural Taboos in Myanmar’s Spring Revolution,” offers experiential accounts from the movement and explores the use of htamein in the Spring Revolution. The article also pivots to analyze how some of the activists’ symbolic attacks mobilized a repertoire that included sexist ideologies as part of their strategies to shame high-status members of the government, as well [End Page 2] as their families and associates. In sum, social transformations are inextricably gendered, and these times of tremendous upheaval demand further questioning. Let’s not skirt the issue raised by both articles: what is special about these items of women’s clothing and absorbent plastic pads in Myanmar, and what makes them so powerful? The general explanation is as follows: mainstream culture in Myanmar, as with that of other societies in the region, treats women’s genitalia and menstrual blood as dirty and polluting. They are therefore considered disgusting, off-limits, and treated with disdain. By contact or even mere association, women’s skirts, nether garments, and menstrual pads carry this taboo as well. In Buddhist temple compounds’ stupa enclosures, posted signs explicitly prohibit women from entering; their bodies are deemed to have the nefarious power to harm sacred relics. Menstrual blood has a contemporary enemy vivant: men. Any contact with a man is perceived to obliterate his hpon, or his special masculine energy. According to anthropologist Melford Spiro (1991), Burmese society locates presence of hpon specifically on a combination of the “sexual anatomy” and a “psycho-spiritual entity”; in short, as argued, the penis is a noble golden flower whereas the vagina is an ignoble polluting organ (Spiro 1991:534). Floral stigma notwithstanding, ideas about hpon and its threats have a profound impact on everyday life...

One treatment with onabotulinumtoxinA relieves symptoms of overactive bladder in patients refractory to one or more oral medications.

Patients with overactive bladder (OAB) often undergo prolonged treatment with one or more oral OAB medications. OnabotulinumtoxinA (onabotA), a type A botulinum toxin, may provide an appropriate alternative to oral treatments in patients intolerant of or refractory to one or more oral OAB medications. The GRACE study demonstrated real-world benefits of onabotA treatment for OAB in patients refractory to oral medications. This exploratory post hoc analysis of data from the GRACE study aims to determine if treatment history impacts benefit from treatment with onabotA. This is a subanalysis of the GRACE study, a prospective observational study (NCT02161159) that enrolled patients with symptomatic OAB inadequately managed by at least one oral OAB medication. Patients had a treatment history of one or more anticholinergics (AC) and/or β-3 adrenoreceptor agonists (β-3) for relief of OAB; results were stratified according to treatment history. Patients in this analysis elected to discontinue oral medications upon treatment with onabotA. Safety was followed for 12 months in all patients that received at least 1 dose of onabotA; efficacy was determined over a 12-week period. Compared to baseline levels, significant reductions in urinary incontinence(UI), urgency, micturition, and nocturia were noted as early as 1week and were sustained at 12 weeks, regardless of the type and number of oral medications taken before treatment with onabotA. At 12 weeks post-onabotA, the mean change from baseline UI episodes/day for those with a treatment history of only one AC was -2.4 (n = 43, p ≤ 0.001); more than one AC, -2.4 (n = 52, p ≤ 0.001); one β-3, -3.3 (n = 12, p < 0.05); at least one AC and at least one β-3, -3.2 (n = 56, p ≤ 0.001). Pad and liner use was significantly decreased at 12 weeks post-onabotA across all treatment history groups. Reductions in diaper pant use varied, with less of a reduction in patients with a treatment history of more than one AC compared to patients with a history of at least one AC and one β-3 (p < 0.05) or those with a history of only one AC (p < 0.05). Overall, a total of 253/288 of patients (88%) reported improvements on the treatment benefit scale 12 weeks after treatment with onabotA, regardless of type and number of prior oral medications. In the population of patients that received at least one dose of onabotA (N = 504), 57 adverse events were reported in 38 patients (7.5%); 9 were serious (1.8%). Urinary retention was reported in 5 patients (1.0%); 1 was severe (0.2%). Symptomatic urinary tract infection was reported in 2 patients (0.4%). In this exploratory post hoc analysis of real-world data from the GRACE study, there were few significant differences in outcomes based on the type and number of prior oral medications. Thus, patients who are refractory to one or more oral OAB medications may benefit from earlier treatment with onabotA.