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Whales are mammals that can dive to depths of > 1000 m without the high water pressure pushing open their mouth or anus. The same is true for the female urethra. The meatus externus and internus are seals that cannot be pushed open by high water pressures. Recent evidence suggests that the female meatus internus is pushed open when the bladder pressure exceeds the urethral pressure. For a relaxed detrusor, this opening is not possible for at least three reasons: the law of elastic collision, Pascal’s law of hydrostatics and the Hagen-Poiseuille law. The three laws do not support that urethral function failure is the predominant cause of stress urinary incontinence (SUI); however, they do support that urethral support failure is. Influential urogynecologists claim the opposite. TVT surgery, according to the integral theory of SUI (IT), has high failure rates because it does not principally prevent the urethra from hanging on a less mobile bladder neck. In the case of a long urethra, the tape is set too distally, and in hypomobile SUI, the use of a tension-free suburethral tape is unwarranted/ineffective, because the proximal urethra is not elevated above its resting position. A successful operation corrects urethral support failure and not urethral function failure.

Introduction and hypothesisThe article discusses three theories of stress urinary incontinence, the urethral hanging theory, Enhörning’s theory, and the integral theory.MethodsThe abdominal pressure transmission theory proposed by Enhörning is often misunderstood. It is regularly interpreted to mean that, in cases of stress urinary incontinence, the bladder neck descends outside the abdominal cavity, and treatment must involve elevating or repositioning the bladder neck.ResultsHowever, this actually contradicts the information provided in Enhörning’s original paper. The urethral hanging theory accepts the core of Enhörning’s theory and the integral theory rejects it. The three theories have different views on closure and opening of the bladder neck and on the pathophysiology of urethral funneling.ConclusionThese differences are described and discussed.

Enhörning’s abdominal pressure transmission theory (ET) is built on Pascal’s law of fluid pressures. A theory that rejects ET also rejects this basic physical law and cannot be considered scientifically sound. The integral theory (IT) of female stress urinary incontinence rejects ET. This issue is discussed from the viewpoint of the urethral hanging theory of female stress urinary incontinence (UHT).

A Correction to this paper has been published: https://doi.org/10.1007/s00192-020-04604-x

Background/Objectives: Food-induced thermogenesis is generally reported to be higher in the morning, although contrasting results exist because of differences in experimental settings related to the preceding fasting, exercise, sleeping and dieting. To definitively answer to this issue, we compared the calorimetric and metabolic responses to identical meals consumed at 0800 hours and at 2000 hours by healthy volunteers, after standardized diet, physical activity, duration of fast and resting. Subjects/Methods: Twenty subjects (age range 20–35 years, body mass index=19–26 kg m − 2 ) were enrolled to a randomized cross-over trial. They randomly received the same standard meal in the morning and, 7 days after, in the evening, or vice versa. A 30-min basal calorimetry was performed; a further 60-min calorimetry was done 120-min after the beginning of the meal. Blood samples were drawn every 30-min for 180-min. General linear models, adjusted for period and carry-over, were used to evaluate the ‘morning effect’, that is, the difference of morning delta (after-meal minus fasting values) minus evening delta (after-meal minus fasting values) of the variables. Results: Fasting resting metabolic rate (RMR) did not change from morning to evening; after-meal RMR values were significantly higher after the morning meal (1916; 95% confidence interval (CI)=1792, 2041 vs 1756; 1648, 1863 kcal; P <0.001). RMR was significantly increased after the morning meal (90.5; 95% CI=40.4, 140.6 kcal; P <0.001), whereas differences in areas-under-the-curve for glucose (−1800; −2564,−1036 mg dl −1 × h, P <0.001), log-insulin (−0.19; −0.30,−0.07  μ U ml −1 × h; P =0.001) and fatty free acid concentrations (−16.1;−30.0,−2.09 mmol l −1 × h; P =0.024) were significantly lower. Delayed and larger increases in glucose and insulin concentrations were found after the evening meals. Conclusions: The same meal consumed in the evening determined a lower RMR, and increased glycemic/insulinemic responses, suggesting circadian variations in the energy expenditure and metabolic pattern of healthy individuals. The timing of meals should probably be considered when nutritional recommendations are given.

The placenta is crucial to fetal well-being and it plays a significant role in the pathogenesis of hypertensive pregnancy disorders. Moreover, a timely diagnosis of placenta previa may save lives. Ultrasound is the primary imaging modality in pregnancy, but high-quality imaging depends on the access to equipment and staff, which is not possible in all settings. Convolutional neural networks may help standardize the acquisition of images for fetal diagnostics. Our aim was to develop a deep learning based model for classification and segmentation of the placenta in ultrasound images. We trained a model based on manual annotations of 7,500 ultrasound images to identify and segment the placenta. The model's performance was compared to annotations made by 25 clinicians (experts, trainees, midwives). The overall image classification accuracy was 81%. The average intersection over union score (IoU) reached 0.78. The model’s accuracy was lower than experts’ and trainees’, but it outperformed all clinicians at delineating the placenta, IoU = 0.75 vs 0.69, 0.66, 0.59. The model was cross validated on 100 2nd trimester images from Barcelona, yielding an accuracy of 76%, IoU 0.68. In conclusion, we developed a model for automatic classification and segmentation of the placenta with consistent performance across different patient populations. It may be used for automated detection of placenta previa and enable future deep learning research in placental dysfunction.

Displacement continues to increase at a global scale and is increasingly happening in complex, multicrisis settings, leading to more complex and deeper humanitarian needs. Humanitarian needs are therefore increasingly outgrowing the available humanitarian funding. Thus, responding to vulnerabilities before disaster strikes is crucial but anticipatory action is contingent on the ability to accurately forecast what will happen in the future. Forecasting and contingency planning are not new in the humanitarian sector, where scenario-building continues to be an exercise conducted in most humanitarian operations to strategically plan for coming events. However, the accuracy of these exercises remains limited. To address this challenge and work with the objective of providing the humanitarian sector with more accurate forecasts to enhance the protection of vulnerable groups, the Danish Refugee Council has already developed several machine learning models. The Anticipatory Humanitarian Action for Displacement uses machine learning to forecast displacement in subdistricts in the Liptako-Gourma region in Sahel, covering Burkina Faso, Mali, and Niger. The model is mainly built on data related to conflict, food insecurity, vegetation health, and the prevalence of underweight to forecast displacement. In this article, we will detail how the model works, the accuracy and limitations of the model, and how we are translating the forecasts into action by using them for anticipatory action in South Sudan and Burkina Faso, including concrete examples of activities that can be implemented ahead of displacement in the place of origin, along routes and in place of destination.

Courts are increasingly invoking copyright law's \"scenes a faire\" doctrine, which precludes infringement liability for copying typical or standard elements in a copyrighted work. But judges and commentators only cursorily discuss why certain elements constitute scenes a faire. Alternatively, they characterize the doctrine as merely an extension of other copyrightability doctrines. The result is doctrinal inconsistency in how scenes a faire applies and theoretical disagreement about why the doctrine exists.

The purpose of this study was to investigate the relationship between the time to positivity (TTP) of blood cultures and outcome in patients with bloodstream infections (BSIs). Between January 1st, 2011 and December 31st, 2013, the blood cultures of inpatients with BSI or catheter-related BSI were collected at Peking University Third Hospital. The TTP of different isolates was analyzed, and the relationship between the TTP of isolates and outcome of patients with Enterobacter BSI was retrospectively analyzed. We analyzed the TTP of 886 isolates. Escherichia coli has the shortest (11.97 ± 10.06 h) and Candida has the longest first TTP (61.62 ± 42.77 h). 68.01 % of isolates reached positivity within 24 h and 88.33 % within 48 h. Over 90 % of E. coli isolates reached positivity within 24 h. Over 50 % of Candida isolates reached positivity within 48 h. The TTP differed significantly between cultures that were single or double positive for coagulase-negative staphylococci isolates, Enterobacteriaceae, and Pseudomonas aeruginosa , and between aerobic and anaerobic cultures of E. coli ( p  < 0.05). However, the TTP did not differ significantly between coagulase-negative staphylococci (double positivity) and Staphylococcus aureus . The best TTP threshold for prediction of mortality from Enterobacter species BSI was 16.3 h [area under the curve (AUC) 0.730, 95 % confidence interval (CI) 0.557, 0.864, sensitivity 100 %, specificity 44.4 %]. The TTP of clinical isolates may represent a valuable marker of the clinical significance of BSIs. Laboratories and clinics should consider using the TTP to predict the prognosis of patients with BSI by bacteria, including Enterobacter and other species.

Background Intraarticular distal humeral fractures of AO/OTA type 13 C2 and C3 pose a surgical challenge despite the evolution of surgical implants and techniques. Open reduction and internal fixation (ORIF) is often preferred as the first choice of treatment, but the results vary and are sometimes disappointing. Total elbow arthroplasty (TEA) has been widely used for fractures that are not amenable to ORIF in elderly patients, but the mechanical complications remain a challenge, especially in active patients. Elbow hemiarthroplasty (EHA) provides a modern alternative that might avoid the mechanical complications and weight bearing restrictions related to the linked articulation in semi-constrained TEA. No studies have compared the results of EHA to that of ORIF, but case series have reported promising results. Methods/design This is a study protocol describing an investigator-initiated, non-blinded randomized controlled trial comparing the outcome of EHA with ORIF for AO/OTA type 13 C2 and C3 fractures of the distal humerus in patients who are 50 years or older. Forty-four patients with AO/OTA type 13 C2 and C3 fractures of distal humerus will be randomized to either EHA or ORIF. The Oxford Elbow Score (OES) will be used as primary outcome. Mayo Elbow Performance Score (MEPS), pain severity score (VAS), range of motion, and patient satisfaction will be used as secondary outcomes. Reoperations, complications, and the length of sick leave will be recorded. The patients will be examined after the operation and at 3 months and 1, 2, 5, and 10 years. Discussion The main objective of this study is to investigate the best treatment option for AO/OTA type 13 C2 and C3 fractures of distal humerus in patients aged 50 years or above. We hypothesize that EHA results in fewer complications and superior functional outcome compared with ORIF and that the mechanical complications related to the linked articulation of TEA can be avoided. Trial registration ClinicalTrials.gov , PRS, NCT04163172 . Registered November 13, 2019. https://clinicaltrials.gov/ct2/results?cond=&term=evori&cntry=&state=&city=&dist= (Table 2). The protocol has been approved by The Scientific Ethics Committee of the Capital Region of Denmark (Jr. no.: H − 19,035,590 ). The processing of personal data has been approved by the Danish Data Protection Agency (Jr. no. P-2019-246). Inclusion started on February 1, 2020.