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Chang OH, Shepherd JP, Cadish LA, Wallace SL, St Martin B, Sokol ER. Urethral Bulking With Polyacrylamide Hydrogel Compared With Other Treatments for Stress Urinary Incontinence: A Cost-Effectiveness Analysis. Obstet Gynecol 2024; 143:428-430. [PMID: 38207326 DOI: 10.1097/aog.0000000000005503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 11/30/2023] [Indexed: 01/13/2024]
Abstract
Our objective was to perform a cost-effectiveness analysis comparing polyacrylamide hydrogel urethral bulking with other surgical and nonsurgical treatments for stress urinary incontinence (SUI). We created a cost-effectiveness analysis using TreeAge Pro, modeling eight SUI treatments. Treatment with midurethral sling (MUS) had the highest effectiveness (1.86 quality-adjusted life-years [QALYs]), followed by polyacrylamide hydrogel (1.82 QALYs), with a difference (Δ 0.02/year) less than the minimally important difference for utilities of 0.03 annually. When the proportion of polyacrylamide hydrogel urethral bulking procedures performed in the office setting is greater than 58%, polyacrylamide hydrogel is a cost-effective treatment for SUI, along with pessary, pelvic floor physical therapy, and MUS. Although MUS is more effective and, therefore, the preferred SUI treatment, polyacrylamide hydrogel is a reasonable alternative depending on patient preferences and treatment goals.
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Affiliation(s)
- Olivia H Chang
- Division of Female Urology, Voiding Dysfunction and Pelvic Reconstructive Surgery, University of California, Irvine, Irvine, the Department of Obstetrics and Gynecology, Providence Saint John's Health Center, Santa Monica, and Urogynecology and Pelvic Reconstructive Surgery, Stanford University School of Medicine, Stanford, California; the Department of Obstetrics and Gynecology, University of Connecticut Health Center, Farmington, and Urogynecology and Reconstructive Pelvic Surgery, Yale University School of Medicine, New Haven, Connecticut; and the Division of Urogynecology and Pelvic Floor Disorders, Cleveland Clinic Women's Health Institute, Cleveland, Ohio
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Wallace SL, Syan R, Lee K, Sokol ER. Vaginal hysteropexy compared with vaginal hysterectomy with apical suspension for the treatment of pelvic organ prolapse: A 5-year cost-effectiveness Markov model. BJOG 2024; 131:362-371. [PMID: 37667669 DOI: 10.1111/1471-0528.17642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 07/20/2023] [Accepted: 08/10/2023] [Indexed: 09/06/2023]
Abstract
OBJECTIVE Our objective was to perform a 5-year cost-effectiveness analysis of transvaginal hysteropexy (HP) via sacrospinous ligament fixation (SS) or uterosacral ligament suspension (US) versus vaginal hysterectomy (VH) with apical suspension via sacrospinous ligament fixation (SS) or uterosacral ligament suspension (US) for the treatment of uterine prolapse. DESIGN A decision analytic model assessed the cost-effectiveness of the surgical intervention over a 5-year horizon. SETTING This model was constructed using TreeAge® software. POPULATION OR SAMPLE Healthy women undergoing surgery for uterine prolapse were modeled. METHODS A Markov model was constructed to simulate the possible recurrence of prolapse. Recurrence rates, repeat surgery for surgical failures and complication rates were modeled. Base case, sensitivity analyses and probabilistic modeling were performed. MAIN OUTCOME MEASURES The primary outcome was the incremental cost-effectiveness ratio (ICER) of <$100 000 per quality-adjusted life year (QALY). RESULTS Using the available prolapse recurrence rates and repeat surgery rates in the literature, both HP-SS and HP-US are cost-effective at a willingness-to-pay (WTP) threshold of <$100 000 per QALY. The incremental cost-effectiveness ratio (ICER) for HP-US compared to HP-SS is $90 738.14, while VH-US and VH-SS are both dominated strategies. HP-US is the optimal cost-effective strategy but decays exponentially with increasing probability of prolapse recurrence and need for repeat surgery after failed hysteropexy. The cost-effectiveness acceptability curve (CEAC) favors sacrospinous hysteropexy until reaching a WTP threshold between $90 000 and $100 000. CONCLUSION Hysteropexy surgical strategies are cost-effective transvaginal surgical approaches for uterine prolapse. Vaginal hysterectomy with apical suspension becomes more cost-effective with increasing probability of prolapse recurrence and need for repeat surgery after failed hysteropexy. Given the variability of prolapse recurrence rates in the literature, more comparative studies are needed to understand the cost-effectiveness relationship between these different surgical approaches.
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Affiliation(s)
- Shannon L Wallace
- Division of Urogynecology and Pelvic Floor Disorders, Department of Obstetrics and Gynecology, Ob/Gyn & Women's Health Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Raveen Syan
- Division of Female Urology and Urogynecology, Department of Urology, Desai Sethi Medical Institute, University of Miami, Miami, Florida, USA
| | - Kyueun Lee
- Department of Pharmacy, School of Pharmacy, University of Washington, Seattle, Washington, USA
| | - Eric R Sokol
- Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California, USA
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Burton CS, Sokol ER. Pilot Study of a Novel At-Home Posterior Tibial Nerve System for Overactive Bladder Syndrome. Urogynecology (Phila) 2024; 30:107-113. [PMID: 37493289 PMCID: PMC10805982 DOI: 10.1097/spv.0000000000001399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
IMPORTANCE Urgency urinary incontinence and overactive bladder are common conditions. Third-line therapies are often underutilized because of either being too invasive or being burdensome for the patient. OBJECTIVE We aimed to determine the efficacy and acceptability of a noninvasive, home-based posterior tibial nerve treatment system for the treatment of overactive bladder syndrome. STUDY DESIGN In this pilot study, 10 postmenopausal women with urgency urinary incontinence were given the SoleStim System for home-based posterior tibial nerve stimulation. Symptoms at baseline and completion of the 8-week study were determined by 3-day voiding diary and quality-of-life questionnaire (Overactive Bladder Questionnaire) to assess for reduction in incontinence episodes. RESULTS All patients were 100% adherent to the SoleStim System application over the 8-week period and reported statistically significant reductions in the mean number of voids (-16.3%, P = 0.022), urgency episodes (-31.2%, P = 0.02), and urgency urinary incontinence episodes (-31.4%, P = 0.045). Forty percent of participants reported a decrease of ≥50% in their urgency urinary incontinence episodes. SoleStim was scored a value of 1.8 ± 2.0 (mean ± SD) on a 10-point usability scale, indicating that it was highly acceptable from an ease-of-use perspective. No adverse events were reported. CONCLUSIONS The SoleStim System improved key overactive bladder (frequency, urgency, and urgency urinary incontinence episodes) and quality-of-life metrics. The results from this pilot study suggest that the SoleStim System may be a safe, effective, and highly acceptable at-home overactive bladder therapy.
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Affiliation(s)
- Claire S. Burton
- Department of Urology, Stanford University School of Medicine, Stanford, CA
| | - Eric R. Sokol
- Urogynecology and Pelvic Reconstructive Surgery, Stanford University School of Medicine, Stanford, CA
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Chang OH, Shepherd JP, St Martin B, Sokol ER, Wallace S. Surgical correction of the genital hiatus at the time of sacrocolpopexy - a 7-year Markov analysis: a cost-effectiveness analysis. Int Urogynecol J 2023; 34:2969-2975. [PMID: 37650903 DOI: 10.1007/s00192-023-05628-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 07/10/2023] [Indexed: 09/01/2023]
Abstract
INTRODUCTION AND HYPOTHESIS To perform a cost-effectiveness analysis of concurrent posterior repair performed at the time of laparoscopic hysterectomy with sacrocolpopexy over a 7-year time period. We hypothesize it is not cost-effective to perform a posterior colporrhaphy. METHODS We used TreeAge Pro® to construct a decision model with Markov modeling to compare sacrocolpopexy with and without concurrent posterior repair (SCP and SCP+PR) over a time horizon of 7 years. Outcomes included probability and costs associated with prolapse recurrence, prolapse retreatment, and complications including rectal injury, rectovaginal hematoma requiring reoperation, and postoperative dyspareunia. Cost-effectiveness was defined as an incremental cost-effectiveness ratio (ICER) calculated as ∆ costs /∆ effectiveness and the willingness to pay (WTP) was set at $100,000/QALY. RESULTS Our model showed that SCP was the dominant strategy, with lower costs (-$ 2681.06) and higher effectiveness (+0.10) compared to SCP+PR over the 7-year period. In two-way sensitivity analyses, we varied the probability of prolapse recurrence after both strategies. Our conclusions would only change if the probability of recurrence after SCP was at least 29.7% higher than after SCP+PR. When varying the probabilities of dyspareunia for both strategies, SCP+PR only became the dominant strategy if the probability of dyspareunia for SCP+PR was lower than the rate of SCP alone. CONCLUSIONS In this 7-year Markov cost-effectiveness analysis, SCP without concurrent PR was the dominant strategy. SCP+PR costs more with lower effectiveness than SCP alone, due to higher surgical cost of SCP+PR and higher probability of dyspareunia after SCP+PR.
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Affiliation(s)
- Olivia H Chang
- Division of Female Urology, Pelvic Reconstructive Surgery & Voiding Dysfunction, Department of Urology, University of California Irvine, 3800 W. Chapman St, Suite 7200, Orange, CA, 92868, USA.
| | - Jonathan P Shepherd
- Department of Obstetrics and Gynecology, University of Connecticut Health Center, Farmington, CT, USA
| | - Brad St Martin
- Urogynecology and Reconstructive Pelvic Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Eric R Sokol
- Urogynecology and Pelvic Reconstructive Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Shannon Wallace
- Center for Urogynecology and Pelvic Reconstructive Surgery, Women's Health Institute, Cleveland Clinic, Cleveland, OH, USA
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Wisnoski NI, Andrade R, Castorani MCN, Catano CP, Compagnoni A, Lamy T, Lany NK, Marazzi L, Record S, Smith AC, Swan CM, Tonkin JD, Voelker NM, Zarnetske PL, Sokol ER. Diversity-stability relationships across organism groups and ecosystem types become decoupled across spatial scales. Ecology 2023; 104:e4136. [PMID: 37401548 DOI: 10.1002/ecy.4136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 06/09/2023] [Accepted: 06/15/2023] [Indexed: 07/05/2023]
Abstract
The relationship between biodiversity and stability, or its inverse, temporal variability, is multidimensional and complex. Temporal variability in aggregate properties, like total biomass or abundance, is typically lower in communities with higher species diversity (i.e., the diversity-stability relationship [DSR]). At broader spatial extents, regional-scale aggregate variability is also lower with higher regional diversity (in plant systems) and with lower spatial synchrony. However, focusing exclusively on aggregate properties of communities may overlook potentially destabilizing compositional shifts. It is not yet clear how diversity is related to different components of variability across spatial scales, nor whether regional DSRs emerge across a broad range of organisms and ecosystem types. To test these questions, we compiled a large collection of long-term metacommunity data spanning a wide range of taxonomic groups (e.g., birds, fish, plants, invertebrates) and ecosystem types (e.g., deserts, forests, oceans). We applied a newly developed quantitative framework for jointly analyzing aggregate and compositional variability across scales. We quantified DSRs for composition and aggregate variability in local communities and metacommunities. At the local scale, more diverse communities were less variable, but this effect was stronger for aggregate than compositional properties. We found no stabilizing effect of γ-diversity on metacommunity variability, but β-diversity played a strong role in reducing compositional spatial synchrony, which reduced regional variability. Spatial synchrony differed among taxa, suggesting differences in stabilization by spatial processes. However, metacommunity variability was more strongly driven by local variability than by spatial synchrony. Across a broader range of taxa, our results suggest that high γ-diversity does not consistently stabilize aggregate properties at regional scales without sufficient spatial β-diversity to reduce spatial synchrony.
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Affiliation(s)
- Nathan I Wisnoski
- Department of Biological Sciences, Mississippi State University, Mississippi State, Mississippi, USA
- Wyoming Geographic Information Science Center, University of Wyoming, Laramie, Wyoming, USA
- Department of Biology, Indiana University, Bloomington, Indiana, USA
| | - Riley Andrade
- Department of Natural Resources and Environmental Sciences, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
- Department of Wildlife Ecology and Conservation, University of Florida, Gainesville, Florida, USA
| | - Max C N Castorani
- Department of Environmental Sciences, University of Virginia, Charlottesville, Virginia, USA
| | - Christopher P Catano
- Department of Plant Biology, Michigan State University, East Lansing, Michigan, USA
| | - Aldo Compagnoni
- Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
- German Centre for Integrative Biodiversity Research (iDiv) Halle-Jena-Leipzig, Leipzig, Germany
| | - Thomas Lamy
- Marine Science Institute, University of California, Santa Barbara, Santa Barbara, California, USA
- MARBEC, University of Montpellier, CNRS, Ifremer, IRD, Montpellier, France
| | - Nina K Lany
- Northern Research Station, Forest Service, US Department of Agriculture (USDA), Durham, New Hampshire, USA
| | - Luca Marazzi
- Institute of Environment, Florida International University, Miami, Florida, USA
- Thames21, London, UK
| | - Sydne Record
- Department of Biology, Bryn Mawr College, Bryn Mawr, Pennsylvania, USA
- Department of Wildlife, Fisheries, and Conservation Biology, University of Maine, Orono, Maine, USA
| | - Annie C Smith
- Department of Forestry, Michigan State University, East Lansing, Michigan, USA
- Ecology, Evolution, and Behavior Program, Michigan State University, East Lansing, Michigan, USA
- Department of Integrative Biology, Michigan State University, East Lansing, Michigan, USA
- Washington State Department of Natural Resources, Olympia, Washington, USA
| | - Christopher M Swan
- Department of Geography and Environmental Systems, University of Maryland, Baltimore, Maryland, USA
| | - Jonathan D Tonkin
- School of Biological Sciences, University of Canterbury, Christchurch, New Zealand
- Te Pūnaha Matatini Centre of Research Excellence, University of Canterbury, Christchurch, New Zealand
- Bioprotection Aotearoa Centre of Research Excellence, University of Canterbury, Christchurch, New Zealand
| | - Nicole M Voelker
- Department of Geography and Environmental Systems, University of Maryland, Baltimore, Maryland, USA
| | - Phoebe L Zarnetske
- Ecology, Evolution, and Behavior Program, Michigan State University, East Lansing, Michigan, USA
- Department of Integrative Biology, Michigan State University, East Lansing, Michigan, USA
| | - Eric R Sokol
- National Ecological Observatory Network (NEON), Boulder, Colorado, USA
- Institute of Arctic and Alpine Research (INSTAAR), University of Colorado, Boulder, Colorado, USA
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Passy SI, Mruzek JL, Budnick WR, Leboucher T, Jamoneau A, Chase JM, Soininen J, Sokol ER, Tison-Rosebery J, Vilmi A, Wang J, Larson CA. On the shape and origins of the freshwater species-area relationship. Ecology 2023; 104:e3917. [PMID: 36336908 DOI: 10.1002/ecy.3917] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 08/25/2022] [Accepted: 10/06/2022] [Indexed: 11/09/2022]
Abstract
The species-area relationship (SAR) has over a 150-year-long history in ecology, but how its shape and origins vary across scales and organisms remains incompletely understood. This is the first subcontinental freshwater study to examine both these properties of the SAR in a spatially explicit way across major organismal groups (diatoms, insects, and fish) that differ in body size and dispersal capacity. First, to describe the SAR shape, we evaluated the fit of three commonly used models, logarithmic, power, and Michaelis-Menten. Second, we proposed a hierarchical framework to explain the variability in the SAR shape, captured by the parameters of the SAR model. According to this framework, scale and species group were the top predictors of the SAR shape, climatic factors (heterogeneity and median conditions) represented the second predictor level, and metacommunity properties (intraspecific spatial aggregation, γ-diversity, and species abundance distribution) the third predictor level. We calculated the SAR as a sample-based rarefaction curve using 60 streams within landscape windows (scales) in the United States, ranging from 160,000 to 6,760,000 km2 . First, we found that all models provided good fits (R2 ≥ 0.93), but the frequency of the best-fitting model was strongly dependent on organism, scale, and metacommunity properties. The Michaelis-Menten model was most common in fish, at the largest scales, and at the highest levels of intraspecific spatial aggregation. The power model was most frequent in diatoms and insects, at smaller scales, and in metacommunities with the lowest evenness. The logarithmic model fit best exclusively at the smallest scales and in species-poor metacommunities, primarily fish. Second, we tested our framework with the parameters of the most broadly used SAR model, the log-log form of the power model, using a structural equation model. This model supported our framework and revealed that the SAR slope was best predicted by scale- and organism-dependent metacommunity properties, particularly spatial aggregation, whereas the intercept responded most strongly to species group and γ-diversity. Future research should investigate from the perspective of our framework how shifts in metacommunity properties due to climate change may alter the SAR.
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Affiliation(s)
- Sophia I Passy
- Department of Biology, University of Texas at Arlington, Arlington, Texas, USA
| | - Joseph L Mruzek
- Forestry and Environmental Conservation Department, Clemson University, Clemson, South Carolina, USA
| | - William R Budnick
- Department of Fisheries and Wildlife, Michigan State University, East Lansing, Michigan, USA
| | - Thibault Leboucher
- Laboratory for Continental Environments, National Scientific Research Center, University of Lorraine, Metz, France
| | | | - Jonathan M Chase
- Centre for Integrative Biodiversity Research (iDiv) Halle-Jena-Leipzig, Leipzig, Germany
| | - Janne Soininen
- Department of Geosciences and Geography, University of Helsinki, Helsinki, Finland
| | - Eric R Sokol
- National Ecological Observatory Network (NEON), Battelle, Boulder, Colorado, USA
| | | | - Annika Vilmi
- Freshwater Centre, Finnish Environment Institute, Oulu, Finland
| | - Jianjun Wang
- State Key Laboratory of Lake Science and Environment, Nanjing Institute of Geography and Limnology, Chinese Academy of Sciences, Nanjing, China
| | - Chad A Larson
- Washington State Department of Ecology, Environmental Assessment Program, Lacey, Washington, USA
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7
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Halpern BS, Boettiger C, Dietze MC, Gephart JA, Gonzalez P, Grimm NB, Groffman PM, Gurevitch J, Hobbie SE, Komatsu KJ, Kroeker KJ, Lahr HJ, Lodge DM, Lortie CJ, Lowndes JSS, Micheli F, Possingham HP, Ruckelshaus MH, Scarborough C, Wood CL, Wu GC, Aoyama L, Arroyo EE, Bahlai CA, Beller EE, Blake RE, Bork KS, Branch TA, Brown NEM, Brun J, Bruna EM, Buckley LB, Burnett JL, Castorani MCN, Cheng SH, Cohen SC, Couture JL, Crowder LB, Dee LE, Dias AS, Diaz‐Maroto IJ, Downs MR, Dudney JC, Ellis EC, Emery KA, Eurich JG, Ferriss BE, Fredston A, Furukawa H, Gagné SA, Garlick SR, Garroway CJ, Gaynor KM, González AL, Grames EM, Guy‐Haim T, Hackett E, Hallett LM, Harms TK, Haulsee DE, Haynes KJ, Hazen EL, Jarvis RM, Jones K, Kandlikar GS, Kincaid DW, Knope ML, Koirala A, Kolasa J, Kominoski JS, Koricheva J, Lancaster LT, Lawlor JA, Lowman HE, Muller‐Karger FE, Norman KEA, Nourn N, O'Hara CC, Ou SX, Padilla‐Gamino JL, Pappalardo P, Peek RA, Pelletier D, Plont S, Ponisio LC, Portales‐Reyes C, Provete DB, Raes EJ, Ramirez‐Reyes C, Ramos I, Record S, Richardson AJ, Salguero‐Gómez R, Satterthwaite EV, Schmidt C, Schwartz AJ, See CR, Shea BD, Smith RS, Sokol ER, Solomon CT, Spanbauer T, Stefanoudis PV, Sterner BW, Sudbrack V, Tonkin JD, Townes AR, Valle M, Walter JA, Wheeler KI, Wieder WR, Williams DR, Winter M, Winterova B, Woodall LC, Wymore AS, Youngflesh C. Priorities for synthesis research in ecology and environmental science. Ecosphere 2023. [DOI: 10.1002/ecs2.4342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Affiliation(s)
- Benjamin S. Halpern
- National Center for Ecological Analysis and Synthesis University of California Santa Barbara California USA
- Bren School of Environmental Science and Management University of California Santa Barbara California USA
| | - Carl Boettiger
- Department of Environmental Science, Policy, and Management University of California Berkeley California USA
| | - Michael C. Dietze
- Department of Earth & Environment Boston University Boston Massachusetts USA
| | - Jessica A. Gephart
- Department of Environmental Science American University Washington District of Columbia USA
| | - Patrick Gonzalez
- Department of Environmental Science, Policy, and Management University of California Berkeley California USA
- Institute for Parks, People, and Biodiversity University of California Berkeley California USA
| | - Nancy B. Grimm
- School of Life Sciences Arizona State University Tempe Arizona USA
| | - Peter M. Groffman
- City University of New York Advanced Science Research Center at the Graduate Center New York New York USA
- Cary Institute of Ecosystem Studies Millbrook New York USA
| | - Jessica Gurevitch
- Department of Ecology and Evolution Stony Brook University Stony Brook New York USA
| | - Sarah E. Hobbie
- Department of Ecology, Evolution and Behavior University of Minnesota St. Paul Minnesota USA
| | | | - Kristy J. Kroeker
- Department of Ecology and Evolutionary Biology University of California Santa Cruz Santa Cruz California USA
| | - Heather J. Lahr
- National Center for Ecological Analysis and Synthesis University of California Santa Barbara California USA
| | - David M. Lodge
- Cornell Atkinson Center for Sustainability Cornell University Ithaca New York USA
- Department of Ecology and Evolutionary Biology Cornell University Ithaca New York USA
| | - Christopher J. Lortie
- National Center for Ecological Analysis and Synthesis University of California Santa Barbara California USA
- Department of Biology York University Toronto Ontario Canada
| | - Julie S. S. Lowndes
- National Center for Ecological Analysis and Synthesis University of California Santa Barbara California USA
| | - Fiorenza Micheli
- Hopkins Marine Station, Oceans Department Stanford University Pacific Grove California USA
- Stanford Center for Ocean Solutions Pacific Grove California USA
| | - Hugh P. Possingham
- Centre for Biodiversity and Conservation Science (CBCS) The University of Queensland Brisbane Queensland Australia
| | | | - Courtney Scarborough
- National Center for Ecological Analysis and Synthesis University of California Santa Barbara California USA
| | - Chelsea L. Wood
- School of Aquatic and Fishery Sciences University of Washington Seattle Washington USA
| | - Grace C. Wu
- Environmental Studies University of California Santa Barbara California USA
| | - Lina Aoyama
- Environmental Studies Program and Department of Biology University of Oregon Eugene Oregon USA
| | - Eva E. Arroyo
- Department of Ecology Evolution and Environmental Biology New York New York USA
| | | | - Erin E. Beller
- Real Estate and Workplace Services Sustainability Team Google Inc. Mountain View California USA
| | | | | | - Trevor A. Branch
- School of Aquatic and Fishery Sciences University of Washington Seattle Washington USA
| | - Norah E. M. Brown
- Department of Biology University of Victoria Victoria British Columbia Canada
| | - Julien Brun
- National Center for Ecological Analysis and Synthesis University of California Santa Barbara California USA
| | - Emilio M. Bruna
- Department of Wildlife Ecology & Conservation University of Florida Gainesville Florida USA
| | - Lauren B. Buckley
- Department of Biology University of Washington Seattle Washington USA
| | - Jessica L. Burnett
- Core Science Systems Science Analytics and Synthesis U.S. Geological Survey, 8th and Kipling, Denver Federal Center Lakewood Colorado USA
| | - Max C. N. Castorani
- Department of Environmental Sciences University of Virginia Charlottesville Virginia USA
| | - Samantha H. Cheng
- Center for Biodiversity and Conservation American Museum of Natural History New York New York USA
| | - Sarah C. Cohen
- Estuary and Ocean Science Center, Biology Department San Francisco State University San Francisco California USA
| | | | - Larry B. Crowder
- Hopkins Marine Station, Oceans Department Stanford University Pacific Grove California USA
| | - Laura E. Dee
- Department of Ecology and Evolutionary Biology University of Colorado Boulder Colorado USA
| | - Arildo S. Dias
- Department of Physical Geography (IPG) Goethe‐Universität Frankfurt (Campus Riedberg) Frankfurt am Main Germany
| | | | - Martha R. Downs
- National Center for Ecological Analysis and Synthesis University of California Santa Barbara California USA
| | - Joan C. Dudney
- Department of Plant Sciences UC Davis Davis California USA
| | - Erle C. Ellis
- Geography & Environmental Systems University of Maryland Baltimore Maryland USA
| | - Kyle A. Emery
- Department of Geography UC Los Angeles Los Angeles California USA
| | | | - Bridget E. Ferriss
- Resource Ecology and Fisheries Management Division Alaska Fisheries Science Center, National Marine Fisheries Service, NOAA Seattle Washington USA
| | - Alexa Fredston
- Department of Ocean Sciences University of California Santa Cruz California USA
| | - Hikaru Furukawa
- School of Earth and Space Exploration Arizona State University Tempe Arizona USA
| | - Sara A. Gagné
- Department of Geography and Earth Sciences University of North Carolina at Charlotte Charlotte North Carolina USA
| | | | - Colin J. Garroway
- Department of Biological Sciences University of Manitoba Winnipeg Manitoba Canada
| | - Kaitlyn M. Gaynor
- Departments of Zoology and Botany University of British Columbia Vancouver British Columbia Canada
| | - Angélica L. González
- Department of Biology & Center for Computational and Integrative Biology Rutgers University Camden New Jersey USA
| | - Eliza M. Grames
- Department of Biology University of Nevada, Reno Reno Nevada USA
| | - Tamar Guy‐Haim
- National Institute of Oceanography Israel Oceanographic and Limnological Research (IOLR) Haifa Israel
| | - Ed Hackett
- School of Human Evolution & Social Change Arizona State University Tempe Arizona USA
| | - Lauren M. Hallett
- Environmental Studies Program and Department of Biology University of Oregon Eugene Oregon USA
| | - Tamara K. Harms
- Institute of Arctic Biology and Department of Biology & Wildlife University of Alaska Fairbanks Fairbanks Alaska USA
| | - Danielle E. Haulsee
- Hopkins Marine Station, Oceans Department Stanford University Pacific Grove California USA
| | - Kyle J. Haynes
- Blandy Experimental Farm University of Virginia Boyce Virginia USA
| | - Elliott L. Hazen
- Department of Ecology and Evolutionary Biology University of California Santa Cruz Santa Cruz California USA
| | - Rebecca M. Jarvis
- School of Science Auckland University of Technology Auckland New Zealand
| | | | - Gaurav S. Kandlikar
- Division of Biological Sciences & Division of Plant Sciences University of Missouri Columbia Missouri USA
| | - Dustin W. Kincaid
- Vermont EPSCoR and Gund Institute for Environment University of Vermont Burlington Vermont USA
| | - Matthew L. Knope
- Department of Biology University of Hawai'i at Hilo Hilo Hawaii USA
| | - Anil Koirala
- Warnell School of Forestry and Natural Resources University of Georgia Athens Georgia USA
| | - Jurek Kolasa
- Department of Biology McMaster University Hamilton Ontario Canada
| | - John S. Kominoski
- Institute of Environment Florida International University Miami Florida USA
| | - Julia Koricheva
- Department of Biological Sciences Royal Holloway University of London Surrey UK
| | | | - Jake A. Lawlor
- Department of Biology McGill University Montreal Quebec Canada
| | - Heili E. Lowman
- Department of Natural Resources and Environmental Science University of Nevada, Reno Reno Nevada USA
| | | | - Kari E. A. Norman
- Département de sciences biologiques Université de Montréal Montréal Québec Canada
| | - Nan Nourn
- Department of Fisheries and Wildlife Michigan State University East Lansing Michigan USA
| | - Casey C. O'Hara
- Bren School of Environmental Science and Management University of California Santa Barbara California USA
| | - Suzanne X. Ou
- Department of Biology Stanford University Stanford California USA
| | | | - Paula Pappalardo
- Marine Invasions Laboratory Smithsonian Environmental Research Center Tiburon California USA
| | - Ryan A. Peek
- Center for Watershed Sciences University of California Davis California USA
| | - Dominique Pelletier
- UMR DECOD, HALGO, Département Ressources Biologiques et Environnement Institut Français de Recherche pour l'Exploitation de la Mer Lorient France
| | - Stephen Plont
- Department of Biological Sciences Virginia Polytechnic Institute and State University Blacksburg Virginia USA
| | - Lauren C. Ponisio
- Institute of Ecology and Evolution, Department of Biology University of Oregon Eugene Oregon USA
| | | | - Diogo B. Provete
- Instituto de Biociências Universidade Federal de Mato Grosso do Sul Campo Grande Brazil
| | - Eric J. Raes
- Minderoo Foundation, Flourishing Oceans Nedlands Western Australia Australia
| | | | - Irene Ramos
- Comisión Nacional para el Conocimiento y Uso de la Biodiversidad (CONABIO) Mexico City Mexico
| | - Sydne Record
- Department of Wildlife, Fisheries, and Conservation Biology University of Maine Orono Maine USA
| | - Anthony J. Richardson
- School of Mathematics and Physics University of Queensland St Lucia Queensland Australia
| | | | - Erin V. Satterthwaite
- California Sea Grant Scripps Institution of Oceanography, University of California, San Diego La Jolla California USA
| | - Chloé Schmidt
- Department of Biological Sciences University of Manitoba Winnipeg Manitoba Canada
| | - Aaron J. Schwartz
- Department of Ecology and Evolutionary Biology University of Colorado Boulder Colorado USA
| | - Craig R. See
- Center for Ecosystem Science and Society Northern Arizona University Flagstaff Arizona USA
| | - Brendan D. Shea
- Department of Fish and Wildlife Conservation Virginia Tech Blacksburg Virginia USA
| | - Rachel S. Smith
- Department of Environmental Sciences University of Virginia Charlottesville Virginia USA
| | - Eric R. Sokol
- Battelle, National Ecological Observatory Network (NEON) Boulder Colorado USA
| | | | - Trisha Spanbauer
- Department of Environmental Sciences/Lake Erie Center University of Toledo Toledo Ohio USA
| | | | | | - Vitor Sudbrack
- Department of Ecology and Evolution University of Lausanne Lausanne Switzerland
| | - Jonathan D. Tonkin
- School of Biological Sciences University of Canterbury Christchurch New Zealand
| | - Ashley R. Townes
- School of Aquatic and Fishery Sciences University of Washington Seattle Washington USA
| | - Mireia Valle
- AZTI, Marine Research, Basque Research and Technology Alliance (BRTA) Sukarrieta Spain
| | - Jonathan A. Walter
- Center for Watershed Sciences University of California Davis California USA
| | - Kathryn I. Wheeler
- Department of Earth & Environment Boston University Boston Massachusetts USA
| | - William R. Wieder
- Climate and Global Dynamics Laboratory, Terrestrial Sciences Section National Center for Atmospheric Research Boulder Colorado USA
| | - David R. Williams
- Sustainability Research Institute, School of Earth and Environment University of Leeds Leeds UK
| | - Marten Winter
- German Centre for Integrative Biodiversity Research (iDiv) Halle‐Jena‐Leipzig Leipzig Germany
| | - Barbora Winterova
- Department of Botany and Zoology, Faculty of Science Masaryk University Brno Czech Republic
| | - Lucy C. Woodall
- School of Aquatic and Fishery Sciences University of Washington Seattle Washington USA
| | - Adam S. Wymore
- Department of Natural Resources and the Environment University of New Hampshire Durham New Hampshire USA
| | - Casey Youngflesh
- Ecology, Evolution, and Behavior Program Michigan State University East Lansing Michigan USA
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8
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SanClements MD, Record S, Rose KC, Donnelly A, Chong SS, Duffy K, Hallmark A, Heffernan JB, Liu J, Mitchell JJ, Moore DJP, Naithani K, O'Reilly CM, Sokol ER, Stack Whitney K, Weintraub‐Leff SR, Yang D. People, infrastructure, and data: A pathway to an inclusive and diverse ecological network of networks. Ecosphere 2022. [DOI: 10.1002/ecs2.4262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
| | - Sydne Record
- Department of Wildlife, Fisheries, and Conservation Biology University of Maine Orono Maine USA
| | - Kevin C. Rose
- Department of Biological Sciences Rensselaer Polytechnic Institute Troy New York USA
| | - Alison Donnelly
- Department of Geography University of Wisconsin‐Milwaukee Milwaukee Wisconsin USA
| | - Steven S. Chong
- University of California Berkeley Library University of California Berkeley California USA
| | - Katharyn Duffy
- School of Informatics, Computing and Cyber Systems Northern Arizona University Flagstaff Arizona USA
| | - Alesia Hallmark
- National Ecological Observatory Network Battelle Boulder Colorado USA
| | - James B. Heffernan
- Nicholas School of the Environment Duke University Durham North Carolina USA
| | - Jianguo Liu
- Center for Systems Integration and Sustainability, Department of Fisheries and Wildlife Michigan State University East Lansing Michigan USA
| | | | - David J. P. Moore
- School of Natural Resources and the Environment University of Arizona Tucson Arizona USA
| | - Kusum Naithani
- Department of Biological Sciences University of Arkansas Fayetteville Arkansas USA
| | - Catherine M. O'Reilly
- Department of Geography, Geology, and the Environment Illinois State University Normal Illinois USA
| | - Eric R. Sokol
- National Ecological Observatory Network Battelle Boulder Colorado USA
| | - Kaitlin Stack Whitney
- Science, Technology & Society Department Rochester Institute of Technology Rochester New York USA
| | | | - Di Yang
- Wyoming Geographic Information Science Center University of Wyoming Laramie Wyoming USA
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9
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Liang M, Baiser B, Hallett LM, Hautier Y, Jiang L, Loreau M, Record S, Sokol ER, Zarnetske PL, Wang S. Consistent stabilizing effects of plant diversity across spatial scales and climatic gradients. Nat Ecol Evol 2022; 6:1669-1675. [PMID: 36123533 DOI: 10.1038/s41559-022-01868-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 08/01/2022] [Indexed: 11/09/2022]
Abstract
Biodiversity has widely been documented to enhance local community stability but whether such stabilizing effects of biodiversity extend to broader scales remains elusive. Here, we investigated the relationships between biodiversity and community stability in natural plant communities from quadrat (1 m2) to plot (400 m2) and regional (5-214 km2) scales and across broad climatic conditions, using an extensive plant community dataset from the National Ecological Observatory Network. We found that plant diversity provided consistent stabilizing effects on total community abundance across three nested spatial scales and climatic gradients. The strength of the stabilizing effects of biodiversity increased modestly with spatial scale and decreased as precipitation seasonality increased. Our findings illustrate the generality of diversity-stability theory across scales and climatic gradients, which provides a robust framework for understanding ecosystem responses to biodiversity and climate changes.
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Affiliation(s)
- Maowei Liang
- Institute of Ecology, College of Urban and Environmental Science and Key Laboratory for Earth Surface Processes of the Ministry of Education, Peking University, Beijing, P. R. China
| | - Benjamin Baiser
- Department of Wildlife Ecology and Conservation, University of Florida, Gainesville, FL, USA
| | - Lauren M Hallett
- Department of Biology and Environmental Studies Program, University of Oregon, Eugene, OR, USA
| | - Yann Hautier
- Ecology and Biodiversity Group, Department of Biology, Utrecht University, Utrecht, the Netherlands
| | - Lin Jiang
- School of Biological Sciences, Georgia Institute of Technology, Atlanta, GA, USA
| | - Michel Loreau
- Theoretical and Experimental Ecology Station, CNRS, Moulis, France
| | - Sydne Record
- Department of Wildlife, Fisheries, and Conservation Biology, University of Maine, Orono, ME, USA
| | - Eric R Sokol
- National Ecological Observatory Network (NEON), Battelle, Boulder, CO, USA.,Institute of Arctic and Alpine Research (INSTAAR), University of Colorado Boulder, Boulder, CO, USA
| | - Phoebe L Zarnetske
- Department of Integrative Biology, Michigan State University, East Lansing, MI, USA.,Ecology, Evolution, and Behavior Program, Michigan State University, East Lansing, MI, USA
| | - Shaopeng Wang
- Institute of Ecology, College of Urban and Environmental Science and Key Laboratory for Earth Surface Processes of the Ministry of Education, Peking University, Beijing, P. R. China.
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10
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Li D, Record S, Sokol ER, Bitters ME, Chen MY, Chung YA, Helmus MR, Jaimes R, Jansen L, Jarzyna MA, Just MG, LaMontagne JM, Melbourne BA, Moss W, Norman KEA, Parker SM, Robinson N, Seyednasrollah B, Smith C, Spaulding S, Surasinghe TD, Thomsen SK, Zarnetske PL. Standardized
NEON
organismal data for biodiversity research. Ecosphere 2022. [DOI: 10.1002/ecs2.4141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Affiliation(s)
- Daijiang Li
- Department of Biological Sciences Louisiana State University Baton Rouge Louisiana USA
- Center for Computation and Technology Louisiana State University Baton Rouge Louisiana USA
| | - Sydne Record
- Department of Biology Bryn Mawr College Bryn Mawr Pennsylvania USA
- Department of Wildlife, Fisheries, and Conservation Biology University of Maine Orono Maine USA
| | - Eric R. Sokol
- National Ecological Observatory Network (NEON), Battelle Boulder Colorado USA
- Institute of Arctic and Alpine Research (INSTAAR) University of Colorado Boulder Boulder Colorado USA
| | - Matthew E. Bitters
- Department of Ecology and Evolutionary Biology University of Colorado Boulder Boulder Colorado USA
| | - Melissa Y. Chen
- Department of Ecology and Evolutionary Biology University of Colorado Boulder Boulder Colorado USA
| | - Y. Anny Chung
- Departments of Plant Biology and Plant Pathology University of Georgia Athens Georgia USA
| | - Matthew R. Helmus
- Integrative Ecology Lab, Center for Biodiversity, Department of Biology Temple University Philadelphia Pennsylvania USA
| | | | - Lara Jansen
- Department of Environmental Science and Management Portland State University Portland Oregon USA
| | - Marta A. Jarzyna
- Department of Evolution, Ecology and Organismal Biology The Ohio State University Columbus Ohio USA
- Translational Data Analytics Institute The Ohio State University Columbus Ohio USA
| | - Michael G. Just
- Ecological Processes Branch U.S. Army ERDC CERL Champaign Illinois USA
| | | | - Brett A. Melbourne
- Department of Ecology and Evolutionary Biology University of Colorado Boulder Boulder Colorado USA
| | - Wynne Moss
- Department of Ecology and Evolutionary Biology University of Colorado Boulder Boulder Colorado USA
| | - Kari E. A. Norman
- Department of Environmental Science, Policy, and Management University of California Berkeley Berkeley California USA
| | - Stephanie M. Parker
- National Ecological Observatory Network (NEON), Battelle Boulder Colorado USA
| | - Natalie Robinson
- National Ecological Observatory Network (NEON), Battelle Boulder Colorado USA
| | - Bijan Seyednasrollah
- School of Informatics, Computing and Cyber Systems Northern Arizona University Flagstaff Arizona USA
| | - Colin Smith
- Environmental Data Initiative University of Wisconsin‐Madison Madison Wisconsin USA
| | - Sarah Spaulding
- Institute of Arctic and Alpine Research (INSTAAR) University of Colorado Boulder Boulder Colorado USA
| | - Thilina D. Surasinghe
- Department of Biological Sciences Bridgewater State University Bridgewater Massachusetts USA
| | - Sarah K. Thomsen
- Department of Integrative Biology Oregon State University Corvallis Oregon USA
| | - Phoebe L. Zarnetske
- Department of Integrative Biology Michigan State University East Lansing Michigan USA
- Ecology, Evolution, and Behavior Program Michigan State University East Lansing Michigan USA
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11
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Jarzyna MA, Norman KEA, LaMontagne JM, Helmus MR, Li D, Parker SM, Perez Rocha M, Record S, Sokol ER, Zarnetske PL, Surasinghe TD. Community stability is related to animal diversity change. Ecosphere 2022. [DOI: 10.1002/ecs2.3970] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Affiliation(s)
- Marta A. Jarzyna
- Department of Evolution, Ecology and Organismal Biology The Ohio State University Columbus Ohio USA
- Translational Data Analytics Institute The Ohio State University Columbus Ohio USA
| | - Kari E. A. Norman
- Department of Environmental Science, Policy, and Management University of California Berkeley Berkeley California USA
| | | | - Matthew R. Helmus
- Department of Biology Temple University Philadelphia Pennsylvania USA
| | - Daijiang Li
- Department of Biological Sciences Louisiana State University Baton Rouge Louisiana USA
- Center for Computation and Technology Louisiana State University Baton Rouge Louisiana USA
| | | | | | - Sydne Record
- Department of Biology Bryn Mawr College Bryn Mawr Pennsylvania USA
| | - Eric R. Sokol
- Battelle National Ecological Observatory Network Boulder Colorado USA
- Institute of Arctic and Alpine Research University of Colorado Boulder Boulder Colorado USA
| | - Phoebe L. Zarnetske
- Department of Integrative Biology Michigan State University East Lansing Michigan USA
- Ecology, Evolution, and Behavior Program Michigan State University East Lansing Michigan USA
| | - Thilina D. Surasinghe
- Department of Biological Sciences Bridgewater State University Bridgewater Massachusetts USA
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12
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Nagy RC, Balch JK, Bissell EK, Cattau ME, Glenn NF, Halpern BS, Ilangakoon N, Johnson B, Joseph MB, Marconi S, O’Riordan C, Sanovia J, Swetnam TL, Travis WR, Wasser LA, Woolner E, Zarnetske P, Abdulrahim M, Adler J, Barnes G, Bartowitz KJ, Blake RE, Bombaci SP, Brun J, Buchanan JD, Chadwick KD, Chapman MS, Chong SS, Chung YA, Corman JR, Couret J, Crispo E, Doak TG, Donnelly A, Duffy KA, Dunning KH, Duran SM, Edmonds JW, Fairbanks DE, Felton AJ, Florian CR, Gann D, Gebhardt M, Gill NS, Gram WK, Guo JS, Harvey BJ, Hayes KR, Helmus MR, Hensley RT, Hondula KL, Huang T, Hundertmark WJ, Iglesias V, Jacinthe P, Jansen LS, Jarzyna MA, Johnson TM, Jones KD, Jones MA, Just MG, Kaddoura YO, Kagawa‐Vivani AK, Kaushik A, Keller AB, King KBS, Kitzes J, Koontz MJ, Kouba PV, Kwan W, LaMontagne JM, LaRue EA, Li D, Li B, Lin Y, Liptzin D, Long WA, Mahood AL, Malloy SS, Malone SL, McGlinchy JM, Meier CL, Melbourne BA, Mietkiewicz N, Morisette JT, Moustapha M, Muscarella C, Musinsky J, Muthukrishnan R, Naithani K, Neely M, Norman K, Parker SM, Perez Rocha M, Petri L, Ramey CA, Record S, Rossi MW, SanClements M, Scholl VM, Schweiger AK, Seyednasrollah B, Sihi D, Smith KR, Sokol ER, Spaulding SA, Spiers AI, St. Denis LA, Staccone AP, Stack Whitney K, Stanitski DM, Stricker E, Surasinghe TD, Thomsen SK, Vasek PM, Xiaolu L, Yang D, Yu R, Yule KM, Zhu K. Harnessing the NEON data revolution to advance open environmental science with a diverse and data‐capable community. Ecosphere 2021. [DOI: 10.1002/ecs2.3833] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- R. Chelsea Nagy
- Earth Lab, CIRES University of Colorado Boulder Boulder Colorado USA
| | - Jennifer K. Balch
- Earth Lab, CIRES University of Colorado Boulder Boulder Colorado USA
- Department of Geography University of Colorado Boulder Boulder Colorado USA
| | - Erin K. Bissell
- Biology Department Metropolitan State University of Denver Denver Colorado USA
| | - Megan E. Cattau
- Human‐Environment Systems Boise State University Boise Idaho USA
| | - Nancy F. Glenn
- Human‐Environment Systems Boise State University Boise Idaho USA
- University of New South Wales Sydney Sydney New South Wales Australia
| | - Benjamin S. Halpern
- National Center for Ecological Analysis and Synthesis (NCEAS) Santa Barbara California USA
- University of California Santa Barbara Santa Barbara California USA
| | - Nayani Ilangakoon
- Earth Lab, CIRES University of Colorado Boulder Boulder Colorado USA
| | - Brian Johnson
- Earth Lab, CIRES University of Colorado Boulder Boulder Colorado USA
| | - Maxwell B. Joseph
- Earth Lab, CIRES University of Colorado Boulder Boulder Colorado USA
| | - Sergio Marconi
- School of Natural Resources & Environment University of Florida Gainesville Florida USA
| | | | - James Sanovia
- Department of Math, Science, and Technology Oglala Lakota College Kyle South Dakota USA
| | | | - William R. Travis
- Earth Lab, CIRES University of Colorado Boulder Boulder Colorado USA
- Department of Geography University of Colorado Boulder Boulder Colorado USA
| | - Leah A. Wasser
- Earth Lab, CIRES University of Colorado Boulder Boulder Colorado USA
- Department of Geography University of Colorado Boulder Boulder Colorado USA
| | - Elizabeth Woolner
- Earth Lab, CIRES University of Colorado Boulder Boulder Colorado USA
| | - Phoebe Zarnetske
- Department of Integrative Biology Michigan State University East Lansing Michigan USA
| | - Mujahid Abdulrahim
- Department of Civil and Mechanical Engineering University of Missouri Kansas City Kansas City Missouri USA
| | - John Adler
- Department of Geography University of Colorado Boulder Boulder Colorado USA
- CIRES University of Colorado Boulder Boulder Colorado USA
| | - Grenville Barnes
- Department of Forest, Fisheries and Geomatics Sciences University of Florida Gainesville Florida USA
| | - Kristina J. Bartowitz
- Department of Forest, Rangeland, and Fire Sciences University of Idaho Moscow Idaho USA
| | - Rachael E. Blake
- National Socio‐Environmental Synthesis Center University of Maryland Annapolis Maryland USA
| | - Sara P. Bombaci
- Department of Fish, Wildlife, and Conservation Biology Colorado State University Fort Collins Colorado USA
| | - Julien Brun
- National Center for Ecological Analysis and Synthesis (NCEAS) Santa Barbara California USA
- University of California Santa Barbara Santa Barbara California USA
| | - Jacob D. Buchanan
- Department of Biological Sciences Bowling Green State University Bowling Green Ohio USA
| | - K. Dana Chadwick
- Department of Geological Sciences University of Texas Austin Austin Texas USA
- Department of Integrative Biology University of Texas Austin Austin Texas USA
| | - Melissa S. Chapman
- Department of Environmental Science, Policy, and Management University of California Berkeley Berkeley California USA
| | - Steven S. Chong
- National Center for Ecological Analysis and Synthesis (NCEAS) Santa Barbara California USA
- University of California Santa Barbara Santa Barbara California USA
- University of California Berkeley Library University of California Berkeley Berkeley California USA
| | - Y. Anny Chung
- Departments of Plant Biology and Plant Pathology University of Georgia Athens Georgia USA
| | - Jessica R. Corman
- School of Natural Resources University of Nebraska Lincoln Lincoln Nebraska USA
| | - Jannelle Couret
- Department of Biological Sciences University of Rhode Island Kingston Rhode Island USA
| | - Erika Crispo
- Department of Biology Pace University New York City New York USA
| | - Thomas G. Doak
- Department of Biology Indiana University Bloomington Indiana USA
| | - Alison Donnelly
- Department of Geography University of Wisconsin‐Milwaukee Milwaukee Wisconsin USA
| | - Katharyn A. Duffy
- School of Informatics, Computing & Cyber Systems Northern Arizona University Flagstaff Arizona USA
| | - Kelly H. Dunning
- School of Forestry and Wildlife Auburn University Auburn Alabama USA
| | - Sandra M. Duran
- Department of Ecology and Evolutionary Biology University of Arizona Tucson Arizona USA
| | - Jennifer W. Edmonds
- Department of Physical and Life Sciences Nevada State College Henderson Nevada USA
| | - Dawson E. Fairbanks
- Department of Environmental Science University of Arizona Tucson Arizona USA
| | - Andrew J. Felton
- Department of Wildland Resources Utah State University Logan Utah USA
| | | | - Daniel Gann
- Department of Biological Sciences Florida International University Miami Florida USA
| | - Martha Gebhardt
- School of Natural Resources and the Environment University of Arizona Tucson Arizona USA
| | - Nathan S. Gill
- Department of Natural Resources Management Texas Tech University Lubbock Texas USA
| | - Wendy K. Gram
- University Corporation for Atmospheric Research Boulder Colorado USA
| | - Jessica S. Guo
- College of Agriculture and Life Sciences University of Arizona Tucson Arizona USA
| | - Brian J. Harvey
- School of Environmental and Forest Sciences University of Washington Seattle Washington USA
| | - Katherine R. Hayes
- Department of Integrative and Systems Biology University of Colorado Denver Denver Colorado USA
| | - Matthew R. Helmus
- Department of Biology Temple University Philadelphia Pennsylvania USA
| | - Robert T. Hensley
- Battelle National Ecological Observatory Network Boulder Colorado USA
| | - Kelly L. Hondula
- National Socio‐Environmental Synthesis Center University of Maryland Annapolis Maryland USA
| | - Tao Huang
- Human‐Environment Systems Boise State University Boise Idaho USA
- Cary Institute of Ecosystem Services Millbrook New York USA
| | | | - Virginia Iglesias
- Earth Lab, CIRES University of Colorado Boulder Boulder Colorado USA
| | - Pierre‐Andre Jacinthe
- Department of Earth Sciences Indiana University Purdue University Indianapolis Indiana USA
| | - Lara S. Jansen
- Department of Environmental Science & Management Portland State University Portland Oregon USA
| | - Marta A. Jarzyna
- Department of Evolution, Ecology, and Organismal Biology The Ohio State University Columbus Ohio USA
- Translational Data Analytics Institute The Ohio State University Columbus Ohio USA
| | | | | | | | | | - Youssef O. Kaddoura
- Department of Forest, Fisheries and Geomatics Sciences University of Florida Gainesville Florida USA
| | | | - Aleya Kaushik
- National Oceanic and Atmospheric Administration Boulder Colorado USA
| | - Adrienne B. Keller
- Department of Ecology, Evolution, and Behavior University of Minnesota Twin Cities St. Paul Minnesota USA
| | - Katelyn B. S. King
- Department of Fisheries and Wildlife Michigan State University East Lansing Michigan USA
| | - Justin Kitzes
- Department of Biological Sciences University of Pittsburgh Pittsburgh Pennsylvania USA
| | - Michael J. Koontz
- Earth Lab, CIRES University of Colorado Boulder Boulder Colorado USA
| | - Paige V. Kouba
- Department of Plant Sciences University of California Davis Davis California USA
| | - Wai‐Yin Kwan
- CALeDNA University of California Los Angeles Los Angeles California USA
| | | | - Elizabeth A. LaRue
- Department of Forestry and Natural Resources Purdue University West Lafayette Indiana USA
| | - Daijiang Li
- Department of Biological Sciences Louisiana State University Baton Rouge Louisiana USA
- Center for Computation & Technology Louisiana State University Baton Rouge Louisiana USA
| | - Bonan Li
- Department of Biological & Ecological Engineering Oregon State University Corvallis Oregon USA
| | - Yang Lin
- Soil and Water Sciences Department University of Florida Gainesville Florida USA
| | | | - William Alex Long
- Science and Technology Innovation Program Woodrow Wilson International Center for Scholars Washington D.C. USA
| | - Adam L. Mahood
- Department of Geography University of Colorado Boulder Boulder Colorado USA
| | - Samuel S. Malloy
- Battelle Center for Science, Engineering and Public Policy in the John Glenn College of Public Affairs Ohio State University Columbus Ohio USA
| | - Sparkle L. Malone
- Department of Biological Sciences Florida International University Miami Florida USA
| | | | - Courtney L. Meier
- Battelle National Ecological Observatory Network Boulder Colorado USA
| | - Brett A. Melbourne
- Department of Ecology and Evolutionary Biology University of Colorado Boulder Boulder Colorado USA
| | | | - Jeffery T. Morisette
- U.S. Department of Agriculture Forest Service Rocky Mountain Research Station Fort Collins Colorado USA
| | - Moussa Moustapha
- Department of Biological Science University of Ngaoundere Ngaoundere Adamawa Cameroon
| | - Chance Muscarella
- Department of Environmental Science University of Arizona Tucson Arizona USA
| | - John Musinsky
- Battelle National Ecological Observatory Network Boulder Colorado USA
| | | | - Kusum Naithani
- Department of Biological Sciences University of Arkansas‐Fayetteville Fayetteville Arkansas USA
| | - Merrie Neely
- GEO AquaWatch Clearwater Florida USA
- Global Science and Technology, Inc Greenbelt Maryland USA
| | - Kari Norman
- Department of Environmental Science, Policy, and Management University of California Berkeley Berkeley California USA
| | | | | | - Laís Petri
- School for Environment and Sustainability University of Michigan East Lansing Michigan USA
| | - Colette A. Ramey
- Biology Department Metropolitan State University of Denver Denver Colorado USA
| | - Sydne Record
- Department of Biology Bryn Mawr College Bryn Mawr Pennsylvania USA
| | - Matthew W. Rossi
- Earth Lab, CIRES University of Colorado Boulder Boulder Colorado USA
| | | | - Victoria M. Scholl
- Earth Lab, CIRES University of Colorado Boulder Boulder Colorado USA
- Department of Geography University of Colorado Boulder Boulder Colorado USA
| | - Anna K. Schweiger
- Remote Sensing Laboratories Department of Geography University of Zurich Zurich Switzerland
| | - Bijan Seyednasrollah
- School of Informatics, Computing & Cyber Systems Northern Arizona University Flagstaff Arizona USA
| | - Debjani Sihi
- Department of Environmental Sciences Emory University Atlanta Georgia USA
| | - Kathleen R. Smith
- Biology Department Metropolitan State University of Denver Denver Colorado USA
| | - Eric R. Sokol
- Battelle National Ecological Observatory Network Boulder Colorado USA
- INSTAAR University of Colorado Boulder Boulder Colorado USA
| | | | - Anna I. Spiers
- Earth Lab, CIRES University of Colorado Boulder Boulder Colorado USA
- Department of Ecology and Evolutionary Biology University of Colorado Boulder Boulder Colorado USA
| | - Lise A. St. Denis
- Earth Lab, CIRES University of Colorado Boulder Boulder Colorado USA
| | - Anika P. Staccone
- Department of Ecology, Evolution, & Environmental Biology Columbia University New York New York USA
| | - Kaitlin Stack Whitney
- Department of Science, Technology, and Society Rochester Institute of Technology Henrietta New York USA
| | | | - Eva Stricker
- Department of Biology University of New Mexico Albuquerque New Mexico USA
| | - Thilina D. Surasinghe
- Department of Biological Sciences Bridgewater State University Bridgewater Massachusetts USA
| | - Sarah K. Thomsen
- Department of Integrative Biology Oregon State University Corvallis Oregon USA
| | - Patrisse M. Vasek
- Department of Math, Science, and Technology Oglala Lakota College Kyle South Dakota USA
| | - Li Xiaolu
- Department of Earth and Atmospheric Sciences Cornell University Ithaca New York USA
| | - Di Yang
- Wyoming GIS Center University of Wyoming Laramie Wyoming USA
| | - Rong Yu
- Department of Geography University of Wisconsin‐Milwaukee Milwaukee Wisconsin USA
| | - Kelsey M. Yule
- Biodiversity Knowledge Integration Center Arizona State University Tempe Arizona USA
| | - Kai Zhu
- Department of Environmental Studies University of California, Santa Cruz Santa Cruz California USA
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13
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Lamy T, Wisnoski NI, Andrade R, Castorani MCN, Compagnoni A, Lany N, Marazzi L, Record S, Swan CM, Tonkin JD, Voelker N, Wang S, Zarnetske PL, Sokol ER. The dual nature of metacommunity variability. OIKOS 2021. [DOI: 10.1111/oik.08517] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Thomas Lamy
- Marine Science Inst., Univ. of California Santa Barbara CA USA
- MARBEC, Univ. of Montpellier, CNRS, Ifremer, IRD Sète France
| | - Nathan I. Wisnoski
- Dept of Biology, Indiana Univ. Bloomington IN USA
- WyGISC, Univ. of Wyoming Laramie WY USA
| | - Riley Andrade
- Dept of Wildlife Ecology and Conservation, Univ. of Florida Gainesville FL USA
- Dept of Natural Resources and Environmental Sciences, Univ. of Illinois at Urbana – Champaign Urbana IL USA
| | | | - Aldo Compagnoni
- Martin Luther Univ. Halle‐Wittenberg Halle (Saale) Germany
- German Centre for Integrative Biodiversity Research (iDiv) Halle‐Jena‐Leipzig Leipzig Germany
| | - Nina Lany
- Dept of Forestry, Michigan State Univ. East Lansing MI USA
- Ecology, Evolution and Behavior Program, Michigan State Univ. East Lansing MI USA
| | - Luca Marazzi
- Inst. of Environment, Florida International Univ. Miami FL USA
| | - Sydne Record
- Dept of Biology, Bryn Mawr College Bryn Mawr PA USA
| | - Christopher M. Swan
- Dept of Geography and Environmental Systems, Univ. of Maryland, Baltimore County Baltimore MD USA
| | - Jonathan D. Tonkin
- Dept of Integrative Biology, Oregon State Univ. OR USA
- School of Biological Sciences, Univ. of Canterbury Christchurch New Zealand
| | - Nicole Voelker
- Dept of Geography and Environmental Systems, Univ. of Maryland, Baltimore County Baltimore MD USA
| | - Shaopeng Wang
- Key Laboratory for Earth Surface Processes of the Ministry of Education, Inst. of Ecology, College of Urban and Environmental Sciences, Peking Univ. Beijing China
| | - Phoebe L. Zarnetske
- Ecology, Evolution and Behavior Program, Michigan State Univ. East Lansing MI USA
- Dept of Integrative Biology, Michigan State Univ. East Lansing MI USA
| | - Eric R. Sokol
- Inst. of Arctic and Alpine Research (INSTAAR), Univ. of Colorado Boulder Boulder CO USA
- Battelle, National Ecological Observatory Network (NEON) Boulder CO USA
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Wallace SL, Enemchukwu EA, Mishra K, Neshatian L, Chen B, Rogo-Gupta L, Sokol ER, Gurland BH. Postoperative complications and recurrence rates after rectal prolapse surgery versus combined rectal prolapse and pelvic organ prolapse surgery. Int Urogynecol J 2021; 32:2401-2411. [PMID: 33864476 DOI: 10.1007/s00192-021-04778-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 03/24/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Our primary objectives were to compare < 30-day postoperative complications and RP recurrence rates after RP-only surgery and combined surgery. Our secondary objectives were to determine preoperative predictors of < 30-day complications and RP recurrence. METHODS A prospective IRB-approved cohort study was performed at a single tertiary care center from 2017 to 2020. Female patients with symptomatic RP underwent either RP-only surgery or combined surgery based on the discretion of the colorectal and FPMRS surgeons. Primary outcome measures were < 30-day complications separated into Clavien-Dindo (CD) classes and rectal prolapse on physical examination. RESULTS Seventy women had RP-only surgery and 45 had combined surgery with a mean follow-up time of 208 days. Sixty-eight percent underwent abdominal RP repair, and 32% underwent perineal RP repair. Twenty percent had one or more complications, 14% in the RP-only group and 29% in the combined surgery group (p = 0.06). On multivariate analysis, combined surgery patients had a 30% increased risk of complications compared to RP-only surgery patients (RR = 1.3). Most of these complications were minor (14/17, 82.4%) and categorized as CD I or II, including urinary retention and UTI. Twelve percent of this cohort had RP recurrence, 11% in the RP-only group and 13% in the combined surgery group (p = 0.76). Preoperative risk factors for RP recurrence included a primary complaint of rectal bleeding (RR 5.5) and reporting stools consistent with Bristol Stool Scale of 1 (RR 2.1). CONCLUSION Patients undergoing combined RP + POP surgery had a higher risk of complications and equivalent RP recurrence rates compared to patients undergoing RP-only surgery.
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Affiliation(s)
- Shannon L Wallace
- Women's Health Institute, Division of Urogynecology and Pelvic Floor Disorders, Cleveland Clinic Foundation, 9500 Euclid Avenue, Mailcode A81, Cleveland, OH, 44195, USA.
| | - Ekene A Enemchukwu
- Department of Urology, Division of Female Urology, Stanford University School of Medicine, Stanford, CA, USA
| | - Kavita Mishra
- Women's Health Institute, Division of Urogynecology and Pelvic Floor Disorders, Cleveland Clinic Foundation, 9500 Euclid Avenue, Mailcode A81, Cleveland, OH, 44195, USA
| | - Leila Neshatian
- Department of Gastroenterology, Stanford University School of Medicine, Stanford, CA, USA
| | - Bertha Chen
- Department of Obstetrics and Gynecology, Division of Urogynecology and Pelvic Reconstructive Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Lisa Rogo-Gupta
- Department of Obstetrics and Gynecology, Division of Urogynecology and Pelvic Reconstructive Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Eric R Sokol
- Department of Obstetrics and Gynecology, Division of Urogynecology and Pelvic Reconstructive Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Brooke H Gurland
- Department of Surgery, Division of Colorectal Surgery, Stanford University School of Medicine, Stanford, CA, USA
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Record S, Voelker NM, Zarnetske PL, Wisnoski NI, Tonkin JD, Swan C, Marazzi L, Lany N, Lamy T, Compagnoni A, Castorani MCN, Andrade R, Sokol ER. Novel Insights to Be Gained From Applying Metacommunity Theory to Long-Term, Spatially Replicated Biodiversity Data. Front Ecol Evol 2021. [DOI: 10.3389/fevo.2020.612794] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Global loss of biodiversity and its associated ecosystem services is occurring at an alarming rate and is predicted to accelerate in the future. Metacommunity theory provides a framework to investigate multi-scale processes that drive change in biodiversity across space and time. Short-term ecological studies across space have progressed our understanding of biodiversity through a metacommunity lens, however, such snapshots in time have been limited in their ability to explain which processes, at which scales, generate observed spatial patterns. Temporal dynamics of metacommunities have been understudied, and large gaps in theory and empirical data have hindered progress in our understanding of underlying metacommunity processes that give rise to biodiversity patterns. Fortunately, we are at an important point in the history of ecology, where long-term studies with cross-scale spatial replication provide a means to gain a deeper understanding of the multiscale processes driving biodiversity patterns in time and space to inform metacommunity theory. The maturation of coordinated research and observation networks, such as the United States Long Term Ecological Research (LTER) program, provides an opportunity to advance explanation and prediction of biodiversity change with observational and experimental data at spatial and temporal scales greater than any single research group could accomplish. Synthesis of LTER network community datasets illustrates that long-term studies with spatial replication present an under-utilized resource for advancing spatio-temporal metacommunity research. We identify challenges towards synthesizing these data and present recommendations for addressing these challenges. We conclude with insights about how future monitoring efforts by coordinated research and observation networks could further the development of metacommunity theory and its applications aimed at improving conservation efforts.
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Brosche T, Kuhn A, Lobodasch K, Sokol ER. Seven-year efficacy and safety outcomes of Bulkamid for the treatment of stress urinary incontinence. Neurourol Urodyn 2021; 40:502-508. [PMID: 33410544 PMCID: PMC7839440 DOI: 10.1002/nau.24589] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 10/31/2020] [Accepted: 11/18/2020] [Indexed: 01/14/2023]
Abstract
AIMS Bulking agents are a minimally invasive treatment option for women with stress urinary incontinence (SUI) or stress-predominant mixed urinary incontinence (MUI). The aim of this study was to evaluate long-term efficacy and safety following treatment with Bulkamid as a primary procedure for SUI or stress-predominant MUI. METHODS This was an Institutional Review Board-approved single-center retrospective study of female patients with SUI or stress-predominant MUI who had undergone injection with Bulkamid since 2005 and had completed 7 years of follow up. The primary endpoint was patient satisfaction measured on a four-point scale as cured, improved, unchanged, or worse. Secondary outcomes included the number of incontinence pads used, International Consultation on Incontinence Questionnaire-Short Form (ICIQ-UI SF) scores, Visual Analog Scale Quality of Life (VAS QoL), reinjection rates, and perioperative and postoperative complications. RESULTS A total of 1,200 patients were treated with Bulkamid since 2005 and of these, 388 (32.3%) had completed 7 years of follow-up. A total of 67.1% of the patients reported feeling cured or improved if Bulkamid was a primary procedure, 11.1% reported no change, and 2.3% reported worsening of incontinence. A total of 19.5% of patients received a subsequent other incontinence procedure. The ICIQ-UI SF was reduced by 8.6 points. VAS QoL improved by a mean of 4.3 points. Postoperative complications were transient. Prolonged bladder emptying time was reported in 15.3% of patients and urinary tract infection in 3.5%. CONCLUSIONS Bulkamid injections are an effective and safe first-line treatment option for women with SUI or stress-predominant MUI providing durable outcomes at 7 years.
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Affiliation(s)
- Torsten Brosche
- Gyneacology ‐ Pelvic Floor Center, Women's HospitalDRK‐Hospital Chemnitz‐RabensteinChemnitzGermany
| | - Annette Kuhn
- Inselspital Bern, Women's HospitalSwitzerland and University of BernBernSwitzerland
| | - Kurt Lobodasch
- Gyneacology ‐ Pelvic Floor Center, Women's HospitalDRK‐Hospital Chemnitz‐RabensteinChemnitzGermany
| | - Eric R. Sokol
- Section of Urogynecology and Pelvic Reconstructive SurgeryStanford University School of MedicineStanfordCaliforniaUSA
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Wallace SL, St Martin B, Lee K, Sokol ER. A cost-effectiveness analysis of vaginal carbon dioxide laser therapy compared with standard medical therapies for genitourinary syndrome of menopause-associated dyspareunia. Am J Obstet Gynecol 2020; 223:890.e1-890.e12. [PMID: 32562659 DOI: 10.1016/j.ajog.2020.06.032] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 06/02/2020] [Accepted: 06/10/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Topical vaginal estrogen therapy is considered the gold standard treatment for genitourinary syndrome of menopause-associated dyspareunia, but early investigations of energy-based devices show promise for patients with contraindications or those who are refractory to vaginal estrogen cream therapy. Although evaluating safety, efficacy, and long-term outcomes for novel technologies is critically important when new technologies become available to treat unmet healthcare needs, evaluation of the costs of these new technologies compared with existing therapies is also critically important but often understudied. OBJECTIVE We sought to perform a cost-effectiveness analysis of 3 therapies for genitourinary syndrome of menopause, including vaginal estrogen therapy, oral ospemifene therapy, and vaginal CO2 laser therapy and determine if vaginal laser therapy is a cost-effective treatment strategy for dyspareunia associated with genitourinary syndrome of menopause. STUDY DESIGN An institutional review board-exempt cost-effectiveness analysis was performed by constructing a decision tree using decision analysis software (TreeAge Pro; TreeAge Software, Inc, Williamstown, MA) using integrated empirical data from the published literature. Tornado plots and 1-way and 2-way sensitivity analyses were performed to assess how changes in the model's input parameters altered the overall outcome of the cost-effectiveness analysis model. RESULTS All 3 treatment methods were found to be cost-effective below the willingness-to-pay threshold of $50,000.00 per quality-adjusted life year for moderate dyspareunia. The incremental cost-effectiveness ratio for vaginal CO2 laser therapy was $16,372.01 and the incremental cost-effectiveness ratio for ospemifene therapy was $5711.14. Although all 3 treatment strategies were on the efficient frontier, vaginal CO2 laser therapy was the optimal treatment strategy with the highest effectiveness. In a 1-way sensitivity analysis of treatment adherence, vaginal CO2 laser therapy was no longer cost-effective when the adherence fell below 38.8%. Vaginal estrogen cream and ospemifene therapies remained cost-effective treatment strategies at all ranges of adherence. When varying the adherence to 100% for all strategies, oral ospemifene therapy was "dominated" by both vaginal CO2 laser therapy and vaginal estrogen cream therapy. In a 2-way sensitivity analysis of vaginal CO2 laser therapy adherence and vaginal CO2 laser therapy cost, vaginal CO2 laser therapy still remained the optimal treatment strategy at 200% of its current cost ($5554.00) when the adherence was >55%. When the cost fell to 20% of its current cost ($555.40), it was the optimal treatment strategy at all adherence values above 29%. CONCLUSION This study showed that vaginal fractional CO2 laser therapy is a cost-effective treatment strategy for dyspareunia associated with GSM, as are both vaginal estrogen and oral ospemifene therapies. In our model, vaginal CO2 laser therapy is the optimal cost-effective treatment strategy, and insurance coverage should be considered for this treatment option if it is proven to be safe and effective in FDA trials.
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Affiliation(s)
- Shannon L Wallace
- Division of Urogynecology, Department of Obstetrics and Gynecology, Stanford University Hospital, Palo Alto, CA.
| | - Brad St Martin
- Division of Urogynecology, Department of Obstetrics and Gynecology, Stanford University Hospital, Palo Alto, CA
| | - Kyueun Lee
- Department of Health Research and Policy, Stanford University, Palo Alto, CA
| | - Eric R Sokol
- Division of Urogynecology, Department of Obstetrics and Gynecology, Stanford University Hospital, Palo Alto, CA
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Zemmer SA, Detwiler JT, Sokol ER, Da Silva Neto JG, Wyderko J, Potts K, Gajewski ZJ, Sarment LV, Benfield EF, Belden LK. Spatial scale and structure of complex life cycle trematode parasite communities in streams. PLoS One 2020; 15:e0241973. [PMID: 33232346 PMCID: PMC7685432 DOI: 10.1371/journal.pone.0241973] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 10/23/2020] [Indexed: 11/19/2022] Open
Abstract
By considering the role of site-level factors and dispersal, metacommunity concepts have advanced our understanding of the processes that structure ecological communities. In dendritic systems, like streams and rivers, these processes may be impacted by network connectivity and unidirectional current. Streams and rivers are central to the dispersal of many pathogens, including parasites with complex, multi-host life cycles. Patterns in parasite distribution and diversity are often driven by host dispersal. We conducted two studies at different spatial scales (within and across stream networks) to investigate the importance of local and regional processes that structure trematode (parasitic flatworms) communities in streams. First, we examined trematode communities in first-intermediate host snails (Elimia proxima) in a survey of Appalachian headwater streams within the Upper New River Basin to assess regional turnover in community structure. We analyzed trematode communities based on both morphotype (visual identification) and haplotype (molecular identification), as cryptic diversity in larval trematodes could mask important community-level variation. Second, we examined communities at multiple sites (headwaters and main stem) within a stream network to assess potential roles of network position and downstream drift. Across stream networks, we found a broad scale spatial pattern in morphotype- and haplotype-defined communities due to regional turnover in the dominant parasite type. This pattern was correlated with elevation, but not with any other environmental factors. Additionally, we found evidence of multiple species within morphotypes, and greater genetic diversity in parasites with hosts limited to in-stream dispersal. Within network parasite prevalence, for at least some parasite taxa, was related to several site-level factors (elevation, snail density and stream depth), and total prevalence decreased from headwaters to main stem. Variation in the distribution and diversity of parasites at the regional scale may reflect differences in the abilities of hosts to disperse across the landscape. Within a stream network, species-environment relationships may counter the effects of downstream dispersal on community structure.
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Affiliation(s)
- Sally A. Zemmer
- Biological Sciences, Virginia Polytechnic and State Institute, Blacksburg, Virginia, United States of America
- * E-mail:
| | | | - Eric R. Sokol
- Biological Sciences, Virginia Polytechnic and State Institute, Blacksburg, Virginia, United States of America
| | - Jeronimo G. Da Silva Neto
- Biological Sciences, Virginia Polytechnic and State Institute, Blacksburg, Virginia, United States of America
| | - Jennie Wyderko
- Biological Sciences, Virginia Polytechnic and State Institute, Blacksburg, Virginia, United States of America
| | - Kevin Potts
- Biological Sciences, Virginia Polytechnic and State Institute, Blacksburg, Virginia, United States of America
| | - Zachary J. Gajewski
- Biological Sciences, Virginia Polytechnic and State Institute, Blacksburg, Virginia, United States of America
| | - Lea V. Sarment
- Biological Sciences, Virginia Polytechnic and State Institute, Blacksburg, Virginia, United States of America
| | - E. F. Benfield
- Biological Sciences, Virginia Polytechnic and State Institute, Blacksburg, Virginia, United States of America
| | - Lisa K. Belden
- Biological Sciences, Virginia Polytechnic and State Institute, Blacksburg, Virginia, United States of America
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Sokol ER, Barrett JE, Kohler TJ, McKnight DM, Salvatore MR, Stanish LF. Evaluating Alternative Metacommunity Hypotheses for Diatoms in the McMurdo Dry Valleys Using Simulations and Remote Sensing Data. Front Ecol Evol 2020. [DOI: 10.3389/fevo.2020.521668] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Wallace SL, Syan R, Enemchukwu EA, Mishra K, Sokol ER, Gurland B. Surgical approach, complications, and reoperation rates of combined rectal and pelvic organ prolapse surgery. Int Urogynecol J 2020; 31:2101-2108. [DOI: 10.1007/s00192-020-04394-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 06/09/2020] [Indexed: 11/25/2022]
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21
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Hughey MC, Sokol ER, Walke JB, Becker MH, Belden LK. Ecological Correlates of Large-Scale Turnover in the Dominant Members of Pseudacris crucifer Skin Bacterial Communities. Microb Ecol 2019; 78:832-842. [PMID: 30949751 DOI: 10.1007/s00248-019-01372-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 03/22/2019] [Indexed: 06/09/2023]
Abstract
Animals host a wide diversity of symbiotic microorganisms that contribute important functions to host health, and our knowledge of what drives variation in the composition of these complex communities continues to grow. Microbiome studies at larger spatial scales present opportunities to evaluate the contribution of large-scale factors to variation in the microbiome. We conducted a large-scale field study to assess variation in the bacterial symbiont communities on adult frog skin (Pseudacris crucifer), characterized using 16S rRNA gene amplicon sequencing. We found that skin bacterial communities on frogs were less diverse than, and structurally distinct from, the surrounding habitat. Frog skin was typically dominated by one of two bacterial OTUs: at western sites, a Proteobacteria dominated the community, whereas eastern sites were dominated by an Actinobacteria. Using a metacommunity framework, we then sought to identify factors explaining small- and large-scale variation in community structure-that is, among hosts within a pond, and among ponds spanning the study transect. We focused on the presence of a fungal skin pathogen, Batrachochytrium dendrobatidis (Bd) as one potential driver of variation. We found no direct link between skin bacterial community structure and Bd infection status of individual frog hosts. Differences in pond-level community structure, however, were explained by Bd infection prevalence. Importantly, Bd infection prevalence itself was correlated with numerous other environmental factors; thus, skin bacterial diversity may be influenced by a complex suite of extrinsic factors. Our findings indicate that large-scale factors and processes merit consideration when seeking to understand microbiome diversity.
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Affiliation(s)
- Myra C Hughey
- Biology Department, Vassar College, Poughkeepsie, NY, USA.
- Department of Biological Sciences, Virginia Tech, 4088 Derring Hall, 926 West Campus Drive, Blacksburg, VA, USA.
| | - Eric R Sokol
- Department of Biological Sciences, Virginia Tech, 4088 Derring Hall, 926 West Campus Drive, Blacksburg, VA, USA
- Battelle, National Ecological Observatory Network (NEON), Boulder, CO, USA
- Institute of Arctic and Alpine Research (INSTAAR), University of Colorado Boulder, Boulder, CO, USA
| | - Jenifer B Walke
- Department of Biological Sciences, Virginia Tech, 4088 Derring Hall, 926 West Campus Drive, Blacksburg, VA, USA
- Department of Biology, Eastern Washington University, Cheney, WA, USA
| | - Matthew H Becker
- Department of Biological Sciences, Virginia Tech, 4088 Derring Hall, 926 West Campus Drive, Blacksburg, VA, USA
- Department of Biology and Chemistry, Liberty University, Lynchburg, VA, USA
| | - Lisa K Belden
- Department of Biological Sciences, Virginia Tech, 4088 Derring Hall, 926 West Campus Drive, Blacksburg, VA, USA
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Elmelund M, Sokol ER, Karram MM, Dmochowski R, Klarskov N. Patient Characteristics that May Influence the Effect of Urethral Injection Therapy for Female Stress Urinary Incontinence. J Urol 2019; 202:125-131. [PMID: 30810462 DOI: 10.1097/ju.0000000000000176] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Urethral injection therapy is a well-known treatment of female stress urinary incontinence but to our knowledge the optimal group of recipients has not been established. In this study we examined which patient characteristics are associated with success after urethral injection therapy. MATERIALS AND METHODS This study is a post hoc analysis of a previously published, randomized, 33-center study of the hydrogel bulking agent Bulkamid® vs the collagen gel Contigen®. Regardless of the treatment women were considered cured if there were no stress incontinence episodes in the bladder diary and no stress incontinence symptoms on the ICIQ-UI-SF (International Consultation on Incontinence Questionnaire-Urinary Incontinence-Short Form), improved if there was a 50% or greater reduction in stress incontinence episodes and no effect if there was less than a 50% reduction in stress incontinence episodes 1 year after treatment. RESULTS Of the 345 women who were initially randomized 291 were included in this study. A total of 191 women received hydrogel and 100 received collagen. At 1 year 74 women (25%) were cured, 164 (56%) were improved and 53 (18%) showed no effect. On multivariate logistic regression analysis age 60 years or greater and fewer than 2.5 daily stress incontinence episodes were associated with cure. In this group 90% of women experienced a treatment effect and 38% were cured compared with a 13% cure rate in those younger than 60 years with 2.5 or more daily stress incontinence episodes. CONCLUSIONS Urethral injection therapy was more effective to treat stress urinary incontinence in women 60 years old or older with fewer than 2.5 daily stress incontinence episodes. It had a 90% success rate in these women.
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Affiliation(s)
- Marlene Elmelund
- Department of Obstetrics and Gynecology, Herlev and Gentofte Hospital, University of Copenhagen , Copenhagen , Denmark
| | - Eric R Sokol
- Department of Obstetrics and Gynecology, Stanford University , Stanford , California
| | | | - Roger Dmochowski
- Department of Urology, Vanderbilt University , Nashville , Tennessee
| | - Niels Klarskov
- Department of Obstetrics and Gynecology, Herlev and Gentofte Hospital, University of Copenhagen , Copenhagen , Denmark
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Abstract
Several transvaginal mesh products have been marketed to address vaginal vault prolapse. Although data are limited, prolapse recurrence rates and subjective outcome measures seem to be equivalent for vaginal mesh compared with native tissue apical prolapse repair, and the different vaginal meshes have not proven superior to one another. Given the known unique complications specific to vaginal mesh with equivalent outcomes for the apical vaginal prolapse, it is reasonable to reserve mesh use for specific high-risk cases, such as patients with large apical prolapse recurrence after native tissue repair who are not candidates for sacrocolpopexy.
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Affiliation(s)
- Shannon L Wallace
- Department of Obstetrics and Gynecology, Division of Urogynecology and Pelvic Reconstructive Surgery, Stanford University School of Medicine, 300 Pasteur Drive, Grant S287, Stanford, CA 94305, USA.
| | - Raveen Syan
- Department of Urology, Stanford University School of Medicine, 300 Pasteur Drive, Grant S287, Stanford, CA 94305, USA
| | - Eric R Sokol
- Department of Obstetrics and Gynecology (by Courtesy), Division of Urogynecology and Pelvic Reconstructive Surgery, Stanford University School of Medicine, 300 Pasteur Drive, Room G304a, Stanford, CA 94305, USA; Department of Urology (by Courtesy), Stanford University School of Medicine, 300 Pasteur Drive, Room G304a, Stanford, CA 94305, USA
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Collins SL, Avolio ML, Gries C, Hallett LM, Koerner SE, La Pierre KJ, Rypel AL, Sokol ER, Fey SB, Flynn DFB, Jones SK, Ladwig LM, Ripplinger J, Jones MB. Temporal heterogeneity increases with spatial heterogeneity in ecological communities. Ecology 2018; 99:858-865. [PMID: 29352480 DOI: 10.1002/ecy.2154] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Revised: 12/07/2017] [Accepted: 01/02/2018] [Indexed: 11/12/2022]
Abstract
Heterogeneity is increasingly recognized as a foundational characteristic of ecological systems. Under global change, understanding temporal community heterogeneity is necessary for predicting the stability of ecosystem functions and services. Indeed, spatial heterogeneity is commonly used in alternative stable state theory as a predictor of temporal heterogeneity and therefore an early indicator of regime shifts. To evaluate whether spatial heterogeneity in species composition is predictive of temporal heterogeneity in ecological communities, we analyzed 68 community data sets spanning freshwater and terrestrial systems where measures of species abundance were replicated over space and time. Of the 68 data sets, 55 (81%) had a weak to strongly positive relationship between spatial and temporal heterogeneity, while in the remaining communities the relationship was weak to strongly negative (19%). Based on a mixed model analysis, we found a significant but weak overall positive relationship between spatial and temporal heterogeneity across all data sets combined, and within aquatic and terrestrial data sets separately. In addition, lifespan and successional stage were negatively and positively related to temporal heterogeneity, respectively. We conclude that spatial heterogeneity may be a predictor of temporal heterogeneity in ecological communities, and that this relationship may be a general property of many terrestrial and aquatic communities.
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Affiliation(s)
- Scott L Collins
- Department of Biology, University of New Mexico, Albuquerque, New Mexico, 87131, USA
| | - Meghan L Avolio
- Department of Earth and Planetary Sciences, Johns Hopkins University, Baltimore, Maryland, 21218, USA
| | - Corinna Gries
- Center for Limnology, University of Wisconsin-Madison, Madison, Wisconsin, 53706, USA
| | - Lauren M Hallett
- Environmental Studies Program and Department of Biology, University of Oregon, Eugene, Oregon, 97403, USA
| | - Sally E Koerner
- Department of Biology, University of North Carolina Greensboro, Greensboro, North Carolina, 27402, USA
| | | | - Andrew L Rypel
- Department of Wildlife, Fish and Conservation Biology, University of California, Davis, California, 95616, USA
| | - Eric R Sokol
- National Ecological Observatory Network, Boulder, Colorado, 80301, USA
| | - Samuel B Fey
- Biology Department, Reed College, Portland, Oregon, 97202, USA
| | - Dan F B Flynn
- The Arnold Arboretum of Harvard University, Boston, Massachusetts, 02130, USA
| | - Sydney K Jones
- Department of Biology, University of New Mexico, Albuquerque, New Mexico, 87131, USA
| | - Laura M Ladwig
- Department of Integrative Biology, University of Wisconsin-Madison, Madison, Wisconsin, 53706, USA
| | - Julie Ripplinger
- Department of Botany and Plant Sciences, University of California, Riverside, California, 92521, USA
| | - Matt B Jones
- National Center for Ecological Analysis and Synthesis, 735 State Street, Suite 300, Santa Barbara, California, 93101, USA
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Sokol ER, Brown BL, Barrett JE. A simulation-based approach to understand how metacommunity characteristics influence emergent biodiversity patterns. OIKOS 2016. [DOI: 10.1111/oik.03690] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Eric R. Sokol
- Dept of Biological Sciences; Virginia Tech; Blacksburg VA 24061 USA
- INSTAAR, Univ. of Colorado; Boulder CO USA
| | - Bryan L. Brown
- Dept of Biological Sciences; Virginia Tech; Blacksburg VA 24061 USA
| | - J. E. Barrett
- Dept of Biological Sciences; Virginia Tech; Blacksburg VA 24061 USA
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Abstract
Fecal incontinence, also referred to as accidental bowel leakage, is a debilitating condition that impacts quality of life in a significant number of women. Current treatments for fecal incontinence include behavioral modification, biofeedback, drug therapy, and invasive surgical procedures. However, these treatments have suboptimal efficacy due to patient adherence, variability of presentation across patients, cost, and additional health risks. A vaginal bowel control system (Eclipse™ System) was developed to offer a low-risk, effective, and patient-managed approach to treating accidental bowel leakage. The vaginal bowel control system consists of a vaginal insert and user-controlled, pressure-regulated pump. Once inflated, the balloon of the vaginal insert is directed posteriorly to occlude the rectum, allowing the woman to immediately regain control of bowel function. This article will introduce the design evolution and feasibility studies of the Eclipse System. In addition, this review will discuss the results from a recent clinical trial that demonstrated the safety and efficacy of the vaginal bowel control system in managing fecal incontinence and other symptoms of bowel dysfunction.
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Affiliation(s)
- Eric R Sokol
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, USA
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Lum DA, Sokol ER, Berek JS, Schulkin J, Chen L, McElwain CA, Wright JD. Impact of the 2014 Food and Drug Administration Warnings Against Power Morcellation. J Minim Invasive Gynecol 2016; 23:548-56. [DOI: 10.1016/j.jmig.2016.01.019] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 01/15/2016] [Accepted: 01/21/2016] [Indexed: 01/09/2023]
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Affiliation(s)
- D Lum
- Obstetrics and Gynecology, Stanford University, Stanford, California
| | - J S Berek
- Obstetrics and Gynecology, Stanford University, Stanford, California
| | - F Sheikhi
- Obstetrics and Gynecology, Stanford University, Stanford, California
| | - E R Sokol
- Obstetrics and Gynecology, Stanford University, Stanford, California
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Ohno MS, Richardson ML, Sokol ER. Abdominal sacral colpopexy versus sacrospinous ligament fixation: a cost-effectiveness analysis. Int Urogynecol J 2015; 27:233-7. [PMID: 26282093 DOI: 10.1007/s00192-015-2819-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 07/30/2015] [Indexed: 11/28/2022]
Abstract
INTRODUCTION AND HYPOTHESIS For the surgical correction of apical prolapse the abdominal approach is associated with better outcomes; however, it is more expensive than the transvaginal approach. This cost-effectiveness analysis compares abdominal sacral colpopexy (ASC) with sacrospinous ligament fixation (SSLF) to determine if the improved outcomes of ASC justify the increased expense. METHODS A decision-analytic model was created comparing ASC with SSLF using data-modeling software, TreeAge Pro (2013), which included the following outcomes: post-operative stress urinary incontinence (SUI) with possible mid-urethral sling (MUS) placement, prolapse recurrence with possible re-operation, and post-operative dyspareunia. Cost-effectiveness was defined as an incremental cost-effectiveness ratio (ICER) of less than $50,000 per quality-associated life year (QALY). Base-case, threshold, and one-way sensitivity analyses were performed. RESULTS At the baseline, ASC is more expensive than SSLF ($13,988 vs $11,950), but is more effective (QALY 1.53 vs 1.45) and is cost-effective (ICER $24,574/QALY) at 2 years. ASC was not cost-effective if the following four thresholds were met: the rate of post-operative SUI was above 36 % after ASC or below 28 % after SSLF; the rate of MUS placement for post-operative SUI was above 60 % after ASC or below 13 % after SSLF; the rate of recurrent prolapse was above 15 % after ASC or below 4 % after SSLF; the rate of post-operative dyspareunia was above 59 % after ASC or below 19 % after SSLF. CONCLUSIONS Abdominal sacral colpopexy can be cost-effective compared with sacrospinous ligament fixation; however, as the post-operative outcomes of SSLF improve, SSLF can be considered a cost-effective alternative.
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Affiliation(s)
- Mika S Ohno
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, 300 Pasteur Drive, Rm G332, Stanford, CA, 94305-5317, USA.
| | - Monica L Richardson
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, 300 Pasteur Drive, Rm G332, Stanford, CA, 94305-5317, USA
| | - Eric R Sokol
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, 300 Pasteur Drive, Rm G332, Stanford, CA, 94305-5317, USA
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Hoch JM, Sokol ER, Parker AD, Trexler JC. Migration Strategies Vary in Space, Time, and Among Species in the Small-fish Metacommunity of the Everglades. COPEIA 2015. [DOI: 10.1643/ce-14-040] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Sokol ER, Brown BL, Carey CC, Tornwall BM, Swan CM, Barrett J. Linking management to biodiversity in built ponds using metacommunity simulations. Ecol Modell 2015. [DOI: 10.1016/j.ecolmodel.2014.10.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Richardson ML, Sokol ER. A cost-effectiveness analysis of conservative versus surgical management for the initial treatment of stress urinary incontinence. Am J Obstet Gynecol 2014; 211:565.e1-6. [PMID: 25019485 DOI: 10.1016/j.ajog.2014.07.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Revised: 05/02/2014] [Accepted: 07/03/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVE We sought to determine whether conservative or surgical therapy is more cost effective for the initial treatment of stress urinary incontinence (SUI). STUDY DESIGN We created a decision tree model to compare costs and cost effectiveness of 3 strategies for the initial treatment of SUI: (1) continence pessary, (2) pelvic floor muscle therapy (PFMT), and (3) midurethral sling (MUS). We identified probabilities of SUI after 12 months of use of a pessary, PFMT, or MUS using published data. Parameter estimates included Health Utility Indices of no incontinence (.93) and persistent incontinence (0.7) after treatment. Morbidities associated with MUS included mesh erosion, retention, de novo urge incontinence, and recurrent SUI. Cost data were derived from Medicare in 2012 US dollars. One- and 2-way sensitivity analysis was used to examine the effect of varying rates of pursuing surgery if conservative management failed and rates of SUI cure with pessaries and PFMT. The primary outcome was an incremental cost-effectiveness ratio threshold <$50,000. RESULTS Compared to PFMT, initial treatment of SUI with MUS was the more cost-effective strategy with an incremental cost-effectiveness ratio of $32,132/quality-adjusted life year. Initial treatment with PFMT was also acceptable as long as subjective cure was >35%. In 3-way sensitivity analysis, subjective cure would need to be >40.5% for PFMT and 43.5% for a continence pessary for the MUS scenario to not be the preferred strategy. CONCLUSION At 1 year, MUS is more cost effective than a continence pessary or PFMT for the initial treatment for SUI.
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Affiliation(s)
- Monica L Richardson
- Department of Obstetrics and Gynecology, Division of Urogynecology and Pelvic Reconstructive Surgery, Stanford University School of Medicine, Stanford, CA.
| | - Eric R Sokol
- Department of Obstetrics and Gynecology, Division of Urogynecology and Pelvic Reconstructive Surgery, Stanford University School of Medicine, Stanford, CA
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Sokol ER, Karram MM, Dmochowski R. Efficacy and safety of polyacrylamide hydrogel for the treatment of female stress incontinence: a randomized, prospective, multicenter North American study. J Urol 2014; 192:843-9. [PMID: 24704117 DOI: 10.1016/j.juro.2014.03.109] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2014] [Indexed: 12/15/2022]
Abstract
PURPOSE Bulkamid® is a new polyacrylamide hydrogel bulking agent for stress urinary incontinence that is injected in the urethral submucosa using a specifically designed device. We evaluated the safety and efficacy of Bulkamid vs Contigen® collagen gel for stress urinary incontinence or stress predominant mixed urinary incontinence. MATERIALS AND METHODS This was a single-blind, randomized, prospective, 33-center, 2-arm parallel study of hydrogel vs collagen gel with followup to 1 year. At baseline patients underwent physical examination and bladder testing, and completed quality of life questionnaires and bladder diaries. After randomization patients could receive up to 3 injections at 1-month intervals. Patients were assessed 3, 6, 9 and 12 months after bulking. They completed bladder diaries and quality of life questionnaires, and pad weight was tested. At the last visit Valsalva leak point pressure was measured. Subjective and objective incontinence outcomes and adverse events were compared. RESULTS Of the 345 women 229 were randomized to hydrogel and 116 were randomized to collagen gel. At 12 months a 50% or greater decrease in leakage and incontinence episodes was seen in 53.2% and 55.4% of patients who received hydrogel and collagen gel, respectively. At 12 months 47.2% of patients with hydrogel and 50% with collagen gel reported zero stress incontinence episodes, and 77.1% and 70%, respectively, considered themselves cured or improved. Major adverse events were rare in each group. CONCLUSIONS Bulkamid is not inferior to Contigen. It has a favorable, persistent effect on stress urinary incontinence with a low risk of serious adverse events. Bulkamid is a new, simple, office based bulking system that shows promise as a treatment in women with stress urinary incontinence, particularly since Contigen is no longer commercially available.
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Affiliation(s)
- Eric R Sokol
- Departments of Obstetrics and Gynecology, Stanford University, Stanford, California
| | | | - Roger Dmochowski
- Department of Urology, Vanderbilt University, Nashville, Tennessee.
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Sokol ER, Herbold CW, Lee CK, Cary SC, Barrett JE. Local and regional influences over soil microbial metacommunities in the Transantarctic Mountains. Ecosphere 2013. [DOI: 10.1890/es13-00136.1] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Elliott CS, Rhoads KF, Comiter CV, Chen B, Sokol ER. Improving the accuracy of prolapse and incontinence procedure epidemiology by utilizing both inpatient and outpatient data. Int Urogynecol J 2013; 24:1939-46. [PMID: 23640007 DOI: 10.1007/s00192-013-2113-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Accepted: 04/06/2013] [Indexed: 10/26/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The epidemiologic description of pelvic organ prolapse (POP) and stress urinary incontinence (SUI) procedures is documented in several large studies using national database cohorts. These studies, however, may underestimate the number of procedures performed because they only capture procedures performed in either the inpatient or outpatient settings alone. We present a complete annual description of all inpatient and outpatient surgeries for POP and SUI in California. METHODS We reviewed a record of all inpatient and outpatient POP and SUI surgeries performed in California in 2008 using data from the Office of Statewide Health Planning (OSHPD). RESULTS In 2008, 20,004 and 20,330 women in California underwent POP and SUI procedures, respectively. Of these, 3,134 (15.6%) and 9,016 (44.3%) were performed in an outpatient setting. The age-adjusted rates of POP and SUI were 1.20 and 1.20 per 1,000 US females, respectively. This correlates to 186,000 POP and 186,000 SUI procedures per year nationally. Vaginal apical suspensions were more common in those undergoing surgery as an inpatient (45.1 vs 19.4%). The use of mesh to augment prolapse repairs was similar (22.3% inpatient vs 19.3% outpatient). SUI procedures performed in the outpatient setting were more likely to be performed as stand-alone procedures (82.9 vs 18.8%, respectively). CONCLUSIONS In California, 16% of POP and 44% of SUI procedures were performed in an outpatient surgical setting in 2008. Epidemiologic studies of POP and SUI should account for the fact that a substantial number of repairs are performed in the outpatient setting in order to achieve accuracy.
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Affiliation(s)
- Christopher S Elliott
- Department of Urology, Stanford University School of Medicine, 300 Pasteur Drive S287, Stanford, CA, 94305, USA,
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Richardson ML, Elliott CS, Shaw JG, Comiter CV, Chen B, Sokol ER. To sling or not to sling at time of abdominal sacrocolpopexy: a cost-effectiveness analysis. J Urol 2013; 190:1306-12. [PMID: 23524201 DOI: 10.1016/j.juro.2013.03.046] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2013] [Indexed: 10/27/2022]
Abstract
PURPOSE We compare the cost-effectiveness of 3 strategies for the use of a mid urethral sling to prevent occult stress urinary incontinence in patients undergoing abdominal sacrocolpopexy. MATERIALS AND METHODS Using decision analysis modeling we compared cost-effectiveness during a 1-year postoperative period of 3 treatment approaches including 1) abdominal sacrocolpopexy alone with deferred option for mid urethral sling, 2) abdominal sacrocolpopexy with universal concomitant mid urethral sling and 3) preoperative urodynamic study for selective mid urethral sling. Using published data we modeled probabilities of stress urinary incontinence after abdominal sacrocolpopexy with or without mid urethral sling, the predictive value of urodynamic study to detect occult stress urinary incontinence and the likelihood of complications after mid urethral sling. Costs were derived from Medicare 2010 reimbursement rates. The main outcome modeled was incremental cost-effectiveness ratio per quality adjusted life-years gained. In addition to base case analysis, 1-way sensitivity analyses were performed. RESULTS In our model, universally performing mid urethral sling at abdominal sacrocolpopexy was the most cost-effective approach with an incremental cost per quality adjusted life-year gained of $2,867 compared to abdominal sacrocolpopexy alone. Preoperative urodynamic study was more costly and less effective than universally performing intraoperative mid urethral sling. The cost-effectiveness of abdominal sacrocolpopexy plus mid urethral sling was robust to sensitivity analysis with a cost-effectiveness ratio consistently below $20,000 per quality adjusted life-year. CONCLUSIONS Universal concomitant mid urethral sling is the most cost-effective prophylaxis strategy for occult stress urinary incontinence in women undergoing abdominal sacrocolpopexy. The use of preoperative urodynamic study to guide mid urethral sling placement at abdominal sacrocolpopexy is not cost-effective.
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Elliott CS, Hsieh MH, Sokol ER, Comiter CV, Payne CK, Chen B. Robot-Assisted Versus Open Sacrocolpopexy: A Cost-Minimization Analysis. J Urol 2012; 187:638-43. [DOI: 10.1016/j.juro.2011.09.160] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2011] [Indexed: 11/28/2022]
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Sokol AI, Iglesia CB, Kudish BI, Gutman RE, Shveiky D, Bercik R, Sokol ER. One-year objective and functional outcomes of a randomized clinical trial of vaginal mesh for prolapse. Am J Obstet Gynecol 2012; 206:86.e1-9. [PMID: 21974992 DOI: 10.1016/j.ajog.2011.08.003] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2011] [Revised: 07/06/2011] [Accepted: 08/04/2011] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The purpose of this study was to show 12-month outcomes of a randomized trial that compared vaginal prolapse repair with and without mesh. STUDY DESIGN Women with stage ≥2 prolapse were assigned randomly to vaginal repair with or without mesh. The primary outcome was prolapse stage ≤1 at 12 months. Secondary outcomes included quality of life and complications. RESULTS All 65 evaluable participants were followed for 12 months after trial stoppage for mesh exposures. Thirty-two women had mesh repair; 33 women had traditional repair. At 12 months, both groups had improvement of pelvic organ prolapse-quantification test points to similar recurrence rates. The quality of life improved and did not differ between groups: 96.2% mesh vs 90.9% no-mesh subjects reported a cure of bulge symptoms; 15.6% had mesh exposures, and reoperation rates were higher with mesh. CONCLUSION Objective and subjective improvement is seen after vaginal prolapse repair with or without mesh. However, mesh resulted in a higher reoperation rate and did not improve 1-year cure.
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Affiliation(s)
- Andrew I Sokol
- Section of Female Pelvic Medicine and Reconstructive Surgery, Department of Women and Infants' Services, Washington Hospital Center/Georgetown University School of Medicine, Washington, DC, USA.
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Sokol ER, Benfield EF, Belden LK, Maurice Valett H. The assembly of ecological communities inferred from taxonomic and functional composition. Am Nat 2011; 177:630-44. [PMID: 21508609 DOI: 10.1086/659625] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Among-site variation in metacommunities (beta diversity) is typically correlated with the distance separating the sites (spatial lag). This distance decay in similarity pattern has been linked to both niche-based and dispersal-based community assembly hypotheses. Here we show that beta diversity patterns in community composition, when supplemented with functional-trait information, can be used to diagnose assembly processes. First, using simulated data, we show how the relationship between distance decay patterns in taxonomic and functional measures of community composition can be used to predict the influence of a given trait on community assembly. We then use the patterns generated by the simulation as a template to show that the sorting of benthic macroinvertebrate metacommunities in headwater streams is likely influenced by different sets of functional traits at regional and local scales. We suggest that functional-trait databases and spatially referenced taxonomic surveys can be used to predict the spatial scales at which different aspects of interspecific functional variation are involved in niche-based community assembly while accounting for the influence of dispersal-based community assembly processes.
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Affiliation(s)
- Eric R Sokol
- Department of Biological Sciences, Virginia Polytechnic Institute and State University, Blacksburg, 24061, USA.
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Man WC, Ho JYP, Wen Y, Sokol ER, Polan ML, Chen B. Is lysyl oxidase-like protein-1, alpha-1 antitrypsin, and neutrophil elastase site specific in pelvic organ prolapse? Int Urogynecol J 2009; 20:1423-9. [PMID: 19763368 DOI: 10.1007/s00192-009-0905-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2008] [Accepted: 04/24/2009] [Indexed: 11/29/2022]
Abstract
INTRODUCTION AND HYPOTHESIS We investigated whether the expression of alpha-1 antitrypsin (ATT), neutrophil elastase (NE), and lysyl oxidase-like protein 1 (LOXL-1) vary within the vagina in subjects with pelvic organ prolapse (POP). METHODS Biopsies were obtained from the anterior and posterior vaginal wall of 22 women with POP (> or =stage 2 by POP-Q). The subjects were grouped by the most prominent defect: cystocele, cystocele plus uterine prolapse, and rectocele. Comparative real-time PCR, Western blotting, and NE enzyme activity assay were performed. RESULTS The ratio of anterior and posterior vaginal wall ATT, NE, and LOXL-1 expression varied between individuals within the same defect group. CONCLUSIONS ATT, NE, and LOXl-1 expression was variable among different biopsy sites in the vagina. No consistent pattern was present when the subjects were grouped by the most prominent defect. We recommend careful consideration of biopsy sites in future studies on POP to enhance reproducibility of data.
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Affiliation(s)
- Weng Chi Man
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, 300 Pasteur Drive, HH-333, Stanford, CA 94305-5317, USA
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Abstract
OBJECTIVE To establish normal ultrasonographic findings for the postpartum uterus after vaginal delivery, and to characterize associated bleeding patterns. METHODS Postpartum women were scanned by transabdominal ultrasound within 48 h after normal vaginal delivery. Uterine length, uterine width, endometrial stripe thickness and endometrial contents were evaluated by a single sonographer. Patients maintained a daily symptom diary for 6 weeks and were interviewed by telephone at 2 weeks. Statistical analysis was performed using chi2, Fisher's exact test, Student's t test and Pearson correlation. RESULTS Mean endometrial stripe thickness was 1.1 +/- 0.6 cm, mean uterine length was 16.1 +/- 1.7 cm and mean uterine width was 8.7 +/- 1.0 cm. Postpartum bleeding requiring more than four protective pads per day for > or =10 days was associated with a thicker endometrial stripe (1.5 +/- 0.7 cm vs. 0.9 +/- 0.4 cm, p = 0.006). However, no patients experienced postpartum bleeding complications requiring intervention. Of the 40 women evaluated, 16 had echogenic material in the uterine cavity (mean size 12.7 +/- 6.9 cm2). The presence of echogenic material was not associated with the amount or duration of bleeding. CONCLUSIONS Frequent postpartum ultrasonographic findings include a thickened endometrial stripe and echogenic material in the uterine cavity. The echogenic material commonly seen in the endometrial cavity of asymptomatic patients was not associated with the development of bleeding complications.
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Affiliation(s)
- E R Sokol
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Chang PL, Sokol ER. Alternative method of suprapubic assistance in operative cystoscopy. Int Urogynecol J 2009; 21:247-9. [DOI: 10.1007/s00192-009-0940-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2009] [Accepted: 06/04/2009] [Indexed: 11/29/2022]
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Sokol ER, Urban R. Novel Repair of Tension-free Midurethral Sling Erosion into the Urethra. J Minim Invasive Gynecol 2008; 15:755-7. [DOI: 10.1016/j.jmig.2008.07.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2008] [Revised: 07/04/2008] [Accepted: 07/12/2008] [Indexed: 10/21/2022]
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Abstract
BACKGROUND Loss of mechanical stability of the urethra and bladder is thought to be important in the development of stress urinary incontinence (SUI). The vaginal wall is the main supporting tissue for pelvic organs and changes in components of supporting tissues are known to be involved in the pathophysiology of SUI. METHODS We evaluated changes in expression of alpha2-macroglobulin (alpha2-M), a protease inhibitor, in vaginal wall tissues from premenopausal women (aged 42-45 years) with SUI (n = 28) compared with menstrual cycle-matched continent women (controls, n = 29). The distribution of alpha2-M in vaginal wall tissues and fibroblasts was analysed by immunohistochemistry and immunofluorescence. Expression levels of alpha2-M mRNA and protein was determined by relative real-time quantitative PCR and enzyme-linked immunosorbent assay, respectively. Protease inhibition was measured to assess bioactivity. RESULTS Vaginal wall tissues do express alpha2-M. Expression of alpha2-M mRNA and protein was significantly higher in tissues from controls compared to women with SUI in both proliferative and secretory phases (P < 0.05). Protease inhibitory activity of alpha2-M was significantly higher in tissues from controls compared to women with SUI in the secretory phase (P < 0.05), but we found no difference in the proliferative phase between groups. alpha2-M protein level was lower in the proliferative phase than the secretory phase in both controls and SUI patients, while for alpha2-M mRNA this was found only in controls. CONCLUSIONS Decreased expression of alpha2-M mRNA and protein and protease inhibitory activity in the vaginal wall tissues of women with SUI may contribute to the development of SUI.
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Affiliation(s)
- Y Wen
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, 300 Pasteur Drive, H333 Stanford, CA 94305, USA.
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Rardin CR, Sung VW, Hampton BS, Clemons JL, Aguilar V, Sokol ER. Long-term follow-up of a transvaginal Burch urethropexy for stress urinary incontinence. Am J Obstet Gynecol 2007; 197:656.e1-5. [PMID: 18060969 DOI: 10.1016/j.ajog.2007.08.060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2007] [Revised: 05/15/2007] [Accepted: 08/27/2007] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The objective of the study was to describe long-term objective and subjective success rates and complications following transvaginal Burch urethropexy for stress urinary incontinence. STUDY DESIGN A case series of 66 women who underwent vaginal Burch urethropexy for urodynamic stress urinary incontinence with urethral hypermobility using a suture carrier device is presented. Concurrent prolapse repairs were performed as indicated. RESULTS Sixty-six women (mean age 49.4 +/- 12.1 years) underwent vaginal Burch urethropexy. Mean follow-up time was 20.9 +/- 18.9 months. Objective failure was observed in 16 patients (24.2%). Subjective failure was reported by 21.2% of patients, with 50% and 28.8% reporting success and improvement, respectively. Six patients (9%) experienced febrile illness, 4 (6%) experienced intraoperative hemorrhage, 1 (1.5%) received transfusion, and 1 (1.5%) experienced pelvic abscess. Twelve patients (18.2%) experienced suture erosion; half required surgical revision or excision. CONCLUSION Vaginal Burch urethropexy is generally well tolerated but is associated with poor long-term success and high suture erosion rates.
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Affiliation(s)
- Charles R Rardin
- Department of Obstetrics and Gynecology, Brown Medical School/Women's and Infants' Hospital, Providence, RI, USA
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Sokol ER, Aguilar VC, Sung VW, Myers DL. Combined trans- and periurethral injections of bulking agents for the treatment of intrinsic sphincter deficiency. Int Urogynecol J 2007; 19:643-7. [PMID: 17965815 DOI: 10.1007/s00192-007-0493-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2007] [Accepted: 10/11/2007] [Indexed: 10/22/2022]
Abstract
The purpose of this study was to compare Contigen combined with Durasphere to Contigen injections alone for the treatment of stress urinary incontinence (SUI) with intrinsic sphincter deficiency (ISD). Subjective and objective incontinence outcomes were compared at 2 weeks and 6 months. We compared rates of urinary retention and future incontinence surgery between groups. Thirty-three women underwent combined injections, and 51 underwent Contigen injections. Two weeks postoperatively, more women in the combined group were cured (72.7 vs. 39.2%, P = 0.003), but this difference diminished at 6 months (33.3 vs. 29.4%, P = 0.70). Retention was more common in the combined group (P = 0.002, odds ratio [OR] = 0.062 [95% confidence interval (CI) = 0.007, 0.52]). Twenty-three women in the Contigen and ten in the combined group underwent subsequent incontinence surgery (P = 0.17, OR = 2.03 [95% CI = 0.80, 5.1]). Combining Contigen and Durasphere injections to treat SUI with ISD does not improve outcomes compared to Contigen injections alone.
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Affiliation(s)
- Eric R Sokol
- Urogynecology and Reconstructive Pelvic Surgery, Stanford University School of Medicine, 300 Pasteur Drive, Room HH333, Stanford, CA 94305, USA.
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Sokol ER, Munro EG. Incarcerated vaginal herniation of the omentum mimicking vaginal prolapse. Am J Obstet Gynecol 2007; 196:e7-8. [PMID: 17346517 DOI: 10.1016/j.ajog.2006.11.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2006] [Revised: 11/21/2006] [Accepted: 11/29/2006] [Indexed: 11/17/2022]
Abstract
We present a 33-year-old woman with a history of radical hysterectomy and pelvic radiation who developed a nonreducible high anterior vaginal wall bulge, postoperative pelvic pain, and dyspareunia. Dynamic MRI revealed herniation of the omentum into the vesico-vaginal space. The incarcerated hernia was repaired transvaginally, and the patient's symptoms improved.
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Affiliation(s)
- Eric R Sokol
- Division of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, USA
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Sung VW, Clark MA, Sokol ER, Rardin CR, Myers DL. Variability of current symptoms in women with pelvic organ prolapse. Int Urogynecol J 2006; 18:787-98. [PMID: 17115232 DOI: 10.1007/s00192-006-0237-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2006] [Accepted: 09/18/2006] [Indexed: 10/23/2022]
Abstract
To describe the variability of current (day-to-day) symptoms of pelvic organ prolapse (POP) and to compare women's overall (comprehensive) and current ratings of prolapse symptoms. This was a prospective observational study of 45 women with symptomatic POP followed-up for 3 months between November 2004 and June 2005. Women had a total of three visits during the study period. We measured current symptoms using daily symptom diaries completed for a total of 4 weeks during the study period. The diaries included 100-mm visual analogue scales anchored at 0 (no symptoms) and 100 (extremely severe symptoms) and patients completed these at three different times each day. At each study visit, patients were examined and completed a 10-item questionnaire, which included questions adapted from the PFDI. This questionnaire compared overall and current symptoms at each study visit. Statistical analyses included descriptive statistics, ANOVA, and Pearson's correlation coefficient. Current symptoms of vaginal bulging varied on a day-to-day basis. Current symptoms varied depending on the time of day with women reporting more severe symptoms in the evenings (P<.01). Women reported experiencing their most severe symptoms at only 13.7% of all study visits. On average, women reported less severe ratings of current symptoms at the time of each visit compared to overall recall ratings (P<.05). Women seeking care for symptomatic POP can have dynamic symptoms and are often not evaluated at the time of their most severe symptoms. This should be considered by clinicians evaluating women for symptoms of POP.
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Affiliation(s)
- Vivian W Sung
- The Division of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology, Brown Medical School, and Women's and Infants' Hospital, Providence, RI 02903, USA.
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Sung VW, Weitzen S, Sokol ER, Rardin CR, Myers DL. Effect of patient age on increasing morbidity and mortality following urogynecologic surgery. Am J Obstet Gynecol 2006; 194:1411-7. [PMID: 16647926 DOI: 10.1016/j.ajog.2006.01.050] [Citation(s) in RCA: 127] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2005] [Revised: 10/28/2005] [Accepted: 01/13/2006] [Indexed: 12/23/2022]
Abstract
OBJECTIVE The purpose of this study was to estimate the effect of age on the risk of in-hospital mortality and morbidity following urogynecologic surgery and to compare risks associated with obliterative versus reconstructive procedures for prolapse in elderly women. STUDY DESIGN We conducted a retrospective cohort study utilizing data from 1998 to 2002 from the Nationwide Inpatient Sample. Multivariable logistic regression was performed to obtain odds ratios estimating the effect of age on risk of death and complications, adjusting for comorbidities and demographic factors. RESULTS There were 264,340 women in our study population. Increasing age was associated with higher mortality risks per 1000 women (< 60 years, 0.1; 60-69 years, 0.5; 70-79 years, 0.9; > or = 80 years, 2.8; P < .01) and higher complication risks per 1000 women (< 60 years, 140; 60-69 years, 130; 70-79 years, 160; > or = 80 years, 200; P < .01). Using multivariable logistic regression, increasing age was associated with an increased risk of death (60-69 years, odds ratio [OR] 3.4 [95% CI 1.7-6.9]; 70-79 years, OR 4.9 [95% CI 2.2-10.9]; > or = 80 years, OR 13.6 [95% CI 5.9-31.4]), compared with women < 60 years. The risk of peri-operative complications was also higher in elderly women 80 years of age and older (OR 1.4 [95% CI 1.3-1.5]) compared with younger women. Elderly women 80 years and over who underwent obliterative procedures had a lower risk of complication compared with those who underwent reconstructive procedures for prolapse (17.0% vs 24.7%, P < .01). CONCLUSION Although the absolute risk of death is low, elderly women have a higher risk of mortality and morbidity following urogynecologic surgery.
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Affiliation(s)
- Vivian W Sung
- Division of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology, Brown Medical School, Providence, RI, USA
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