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Summary Biogas production is a biotechnological process realized by complex bacterial, archaeal and likely fungal communities. Their composition was assessed in nine full‐scale biogas plants with distinctly differing feedstock input and process parameters. This study investigated the actually active microbial community members by using a comprehensive sequencing approach based on ribosomal 16S and 28S rRNA fragments. The prevailing taxonomical units of each respective community were subsequently linked to process parameters. Ribosomal rRNA of bacteria, archaea and fungi, respectively, showed different compositions with respect to process parameters and supplied feedstocks: (i) bacterial communities were affected by the key factors temperature and ammonium concentration; (ii) composition of archaea was mainly related to process temperature; and (iii) relative abundance of fungi was linked to feedstocks supplied to the digesters. Anaerobic digesters with a high methane yield showed remarkably similar bacterial communities regarding identified taxonomic families. Although archaeal communities differed strongly on genus level from each other, the respective digesters still showed high methane yields. Functional redundancy of the archaeal communities may explain this effect. 28S rRNA sequences of fungi in all nine full‐scale anaerobic digesters were primarily classified as facultative anaerobic Ascomycota and Basidiomycota. Since the presence of ribosomal 28S rRNA indicates that fungi may be active in the biogas digesters, further research should be carried out to examine to which extent they are important players in anaerobic digestion processes. In our study we investigated active bacterial, archaeal and fungal communities (based on 16S and 28S RNA gene transcripts) in nine full‐scale anaerobic digesters. Ribosomal rRNA of bacteria, archaea and fungi, respectively, showed different compositions with respect to process parameters and supplied feedstocks: (i) bacterial communities were affected by the key factors temperature and ammonium concentration; (ii) composition of archaea was mainly related to process temperature; and (iii) relative abundance of fungi was linked to feedstocks supplied to the digesters.

Summary Numerous observations indicate a high flexibility of microbial communities in different biogas reactors during anaerobic digestion. Here, we describe the functional redundancy and structural changes of involved microbial communities in four lab‐scale continuously stirred tank reactors (CSTRs, 39°C, 12 L volume) supplied with different mixtures of maize silage (MS) and sugar beet silage (SBS) over 80 days. Continuously stirred tank reactors were fed with mixtures of MS and SBS in volatile solid ratios of 1:0 (Continuous Fermenter (CF) 1), 6:1 (CF2), 3:1 (CF3), 1:3 (CF4) with equal organic loading rates (OLR 1.25 kgVS m−3 d−1) and showed similar biogas production rates in all reactors. The compositions of bacterial and archaeal communities were analysed by 454 amplicon sequencing approach based on 16S rRNA genes. Both bacterial and archaeal communities shifted with increasing amounts of SBS. Especially pronounced were changes in the archaeal composition towards Methanosarcina with increasing proportion of SBS, while Methanosaeta declined simultaneously. Compositional shifts within the microbial communities did not influence the respective biogas production rates indicating that these communities adapted to environmental conditions induced by different feedstock mixtures. The diverse microbial communities optimized their metabolism in a way that ensured efficient biogas production. In this study, we describe the functional redundancy and structural changes of involved microbial communities in four lab‐scale continuously‐stirred tank reactors (CSTRs, 39 °C, 12 L volume) supplied with different mixtures of maize silage (MS) and sugar beet silage (SBS) over 80 days. Especially pronounced were changes in the archaeal composition towards Methanosarcina with increasing proportion of SBS, while Methanosaeta declined simultaneously.Compositional shifts within the microbial communities did not influence the respective biogas production rates indicating that these communities adapted to environmental conditions induced by different feedstock mixtures.

Introduction and hypothesisCystocele recurrence remains a major challenge. Anterior colporrhaphy (AC) offers variable success rates that are mostly poorer than native-tissue repairs in other compartments. We compared outcomes after the use of Uphold™ transvaginal mesh kit and AC.MethodsA retrospective external audit including patients after Uphold™ mesh implantation (2010–2016) analysed against previously published data obtained in identical fashion after AC at the same hospital (2002–2005). Patients underwent an interview, clinical examination and 4D-translabial ultrasound. Offline analysis was performed blinded against all other data.ResultsOf 264 patients after mesh and 242 patients after AC, we saw 82 (31%) and 83 (34%), after a median interval of 3.9 years (range 0.4–7.3). Mean age was 64 years (34–86), mean body mass index was 27.7 kg/m2 (15–56) and median vaginal parity 3 deliveries (1–9). AC and mesh groups significantly differed with regard to median follow-up interval (4.3 vs 3.2 years), mean age (61.3 ± 12 vs 67.2 ± 7.5 years), vaginal parity (3 vs 2), past instrumental delivery (20 out of 83 vs 36 out of 82) and concurrent hysterectomy, other prolapse repair or midurethral sling (35 out of 83 vs 1 out of 82, 58 out of 83 vs 76 out of 82 and 12 out of 83 vs 29 out of 82 respectively). The mesh group had 9 cases of dyspareunia, 4 of chronic pelvic pain and 4 vaginal mesh exposures. Univariate comparison between groups for satisfaction and sonographic cystocele favoured mesh. However, point Ba, symptoms of prolapse and reoperation for prolapse were not significantly different. Associations were confirmed on multivariate analysis.ConclusionsThis analysis of two audit projects suggests that the transvaginal Uphold™ mesh kit may confer some advantages over AC for cystocele repair.

Introduction and hypothesisOur primary objective was to describe long-term outcomes after posterior colporrhaphy with and without mesh augmentation.MethodsThis was a retrospective study including 93 patients after posterior colporrhaphy (native tissue in 39 and synthetic mesh augmented in 54). The indication was symptoms of prolapse with clinical posterior vaginal wall prolapse. Mesh augmentation and concomitant prolapse operations were performed at the surgeon’s discretion. Patients underwent interview, clinical examination and 4D pelvic floor ultrasound. Imaging analysis was done with the reviewer blinded against all other data. Generalized linear modeling was used to compare groups with logistic regression for binary and linear regression for continuous outcomes.ResultsPatients were seen on average 5.3 years after surgery and described persistent symptoms of prolapse in 32% and of obstructed defecation in 33%. Clinical recurrence (Bp ≥ −1) was seen in 20%, while sonographic recurrence (rectal ampulla descent to ≥ 15 mm below the symphysis pubis) was noted in 12%. A true rectocele was diagnosed in 33% of patients. No major differences in outcomes were found between those who underwent native tissue and those who had a mesh-augmented repair.ConclusionsMesh augmentation was not superior to native tissue posterior colporrhaphy, and both were only moderately effective in eliminating a true rectocele and symptoms of obstructed defecation 5 years after reconstructive surgery.

Introduction and hypothesisAn increase in vaginal delivery with forceps may increase rates of pelvic floor trauma. This study was designed to predict trauma rates resulting from policies preferencing forceps.MethodsThis is an observational cohort study utilizing data from 660 primiparae enrolled in an RCT in two tertiary obstetric units in Sydney, Australia. Participants were assessed clinically and with 4D translabial ultrasound in the late third trimester and again at 3–6 months postpartum. Incidence of trauma associated with mode of delivery was adjusted to reflect change associated with a conversion of vacuum to forceps delivery. Primary outcome measures were third-/fourth-degree tear, levator avulsion (LA) and external anal sphincter (EAS) trauma diagnosed sonographically.ResultsFive hundred four women were seen at a mean of 5.1 (2.3–24.3) months postpartum. After exclusion of 21 because of missing data, 483 women were analysed: 112 (23%) had a CS, 268 (55%) a normal vaginal delivery (NVD), 69 (14%) a vacuum (VD) and 34 (7%) a forceps (FD). One hundred fifty-two women had EAS trauma and/or LA; 17 sustained both. After VD, 32/69 (46%) women suffered LA and/or EAS trauma; after FD, it was 33/34 (97%). Converting VD to FD was estimated to result in an increase in trauma from 152/483 (31%) to 187/483 (39%). A formula can be generated based on local obstetric and ultrasound data to estimate trauma incidence.ConclusionsA change in obstetric practice resulting in the conversion of primary VD to primary FD would be expected to substantially increase the likelihood of pelvic floor trauma.

Background Large amounts of fibre-rich organic waste material from public green and private gardens have to be treated environmentally friendly; however, this fibre-rich biomass has low biogas yields. This study investigated the presence of fungi in full-scale biogas plants as well as in laboratory reactors and elucidated the importance of fungi for the biogas process. Methods The dominating members of the eukaryotic community were identified by analyzing 18S rRNA gene and internal transcribed spacer 1 (ITS1) region fragments of clone libraries. These identifications were accompanied by diverse microscopic techniques such as fluorescence microscopy and conventional scanning electron microscopy. Results Cells of presumably fungal origin were characterized by intensive fluorescence and were about 1 order of magnitude larger than prokaryotic cells. Molecular techniques enabled to identify fungi from the subphyla Agaricomycotina , Mucoromycotina , Pezizomycotina , Pucciniomycotina and Saccharomycotina and from the class Neocallimastigomycetes . Members of these groups can be important for microbial degradation of complex compounds, due to the ability to penetrate cell walls, and thus open the cells for the influx of bacteria, further enhancing degradation. Conclusions Optimal treatment of biowaste depends on the amount of lignocelluloses. Targeted application of fungi to the biogas process will open wider possibilities for anaerobic treatment of fibre-rich biomass and can result in better biomass utilization as a renewable energy resource. Due to higher temperature optima of fungal cellulolytic enzymes, the thermophilic process is suggested for anaerobic degradation of fibre-rich biomass.

Introduction and Hypothesis Obstetric anal sphincter injuries (OASI) are a major form of maternal birth trauma. Ultrasound imaging is commonly used to evaluate the condition. We undertook a study to compare the sonographic appearance of the external anal sphincter (EAS) 3 to 6 months and 2 to 3 years after a first birth. Methods A retrospective analysis of data of primiparous women obtained in a prospective perinatal imaging study. Women were invited for postnatal assessment 3 – 6 months and 2 – 3 years after a first delivery. All had completed a standardized questionnaire, and had undergone clinical examination and translabial 4D ultrasound imaging. A “significant” EAS defect was diagnosed if four out of six slices on tomographic ultrasound imaging showed a defect of ≥30° circumference. Results Datasets of 76 women with complete data and no intervening birth were assessed. Their mean age was 30.0 years (range 19.5 – 45.3 years) at the time of antenatal assessment. They were delivered at a mean gestation of 40 weeks (range 37 – 42 weeks), by caesarean section in 19, normal vaginal delivery in 42, vacuum delivery in 14 and forceps delivery in 1. A significant EAS defect on transperineal ultrasound imaging was found in 13 of 57 women (23 %) at an average of 4.7 months and in 12 of 57 (21 %) at a mean 26.4 months after a first vaginal delivery. Conclusions In this cohort of primiparous women after a term singleton delivery, we found only minor improvement in sonographic appearance of the EAS between 4.7 months and 26.4 months on transperineal ultrasound imaging, arguing against any significant degree of structural recovery during this time period.

Background Neurofibromatosis type 1 (NF1) is one of the most common genetic disorders causing learning disabilities by mutations in the neurofibromin gene, an important inhibitor of the RAS pathway. In a mouse model of NF1, a loss of function mutation of the neurofibromin gene resulted in increased gamma aminobutyric acid (GABA)-mediated inhibition which led to decreased synaptic plasticity and deficits in attentional performance. Most importantly, these defictis were normalized by lovastatin. This placebo-controlled, double blind, randomized study aimed to investigate synaptic plasticity and cognition in humans with NF1 and tried to answer the question whether potential deficits may be rescued by lovastatin. Methods In NF1 patients ( n  = 11; 19–44 years) and healthy controls (HC; n  = 11; 19–31 years) paired pulse transcranial magnetic stimulation (TMS) was used to study intracortical inhibition (paired pulse) and synaptic plasticity (paired associative stimulation). On behavioural level the Test of Attentional Performance (TAP) was used. To study the effect of 200 mg lovastatin for 4 days on all these parameters, a placebo-controlled, double blind, randomized trial was performed. Results In patients with NF1, lovastatin revealed significant decrease of intracortical inhibition, significant increase of synaptic plasticity as well as significant increase of phasic alertness. Compared to HC, patients with NF1 exposed increased intracortical inhibition, impaired synaptic plasticity and deficits in phasic alertness. Conclusions This study demonstrates, for the first time, a link between a pathological RAS pathway activity, intracortical inhibition and impaired synaptic plasticity and its rescue by lovastatin in humans. Our findings revealed mechanisms of attention disorders in humans with NF1 and support the idea of a potential clinical benefit of lovastatin as a therapeutic option.

Introduction and hypothesis The purpose of this study is to evaluate whether antepartum use of a birth trainer may reduce levator trauma. Methods Two hundred nulliparous women were examined with four-dimensional translabial ultrasonography at 35–37 weeks of gestation and 3 months postpartum in a randomised controlled pilot study. Women in the intervention group were instructed to use the birth trainer from 37 weeks onwards. Results One hundred forty-six women returned for follow-up 5.6 months (range 2.3–22.1) after childbirth. Seventy-eight of them had had normal vaginal deliveries (53%), 32 vacuum/forceps (22%) and 36 a caesarean section (25%). The risk of avulsion was halved in the intervention group (6% vs 13%, P  = 0.19) on modified intention to treat analysis. A treatment received analysis revealed a nonsignificant 42% and 30% reduction in levator avulsion and microtrauma, respectively ( P  ≥ 0.22). Conclusions This pilot randomised controlled trial showed a nonsignificantly lower incidence of pelvic floor muscle injury in women who used the Epi-No® device from 37 weeks onwards.

This issue of Anthropology in Action is dedicated to the study of welfare -- understood as a social, culturally specific and long-term process of transformation -- from an anthropological perspective. But is a study of 'welfare' still relevant and is it an appropriate concept to study what counts as a 'good life' well-lived? Has comprehensive publicly funded welfare still a role to play, or have collective welfare arrangements and institutions not been replaced by individuals' personal quests for well-being? Adapted from the source document.