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Context Staging, restaging, and surveillance of urothelial carcinoma (UC) is challenging due to suboptimal accuracy of standard of care imaging modalities. Prostate-specific membrane antigen (PSMA) imaging may serve to improve characterisation of UC. Objective To appraise available literature regarding cellular, imaging, and prognostic implications of PSMA for UC. Evidence acquisition A systematic review was performed considering all available literature (including conference abstracts) published from 1990 to 2020 and reported according to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines following registration in PROSPERO (CRD42020186744). All relevant texts relating to immunohistochemical analysis and PSMA-based imaging in UC were included and collated. Additionally, FOLH1 (gene encoding PSMA) expression according to The Cancer Genome Atlas (TCGA) database was analysed as well as according to consensus and TCGA molecular classification subtypes and subsequently compared with clinical outcomes. Evidence synthesis PSMA expression across UC tumour tissue was heterogeneous (0–100%) but appeared to decrease with increased grade and stage. The TCGA analysis demonstrated loss of FOLH1 expression with increasing T stage (p = 0.0180) and N stage (p = 0.0269), and reduced FOLH1 expression was associated with worse disease-free survival. PSMA expression in UC neovasculature was variable but mostly increased (44–100%). Eleven reports of PSMA-based imaging for UC were identified, reporting on 18 patients. PSMA positron emission tomography (PET) imaging was positive in 17 out of 18 patients. The included literature review data were limited by mostly low-quality, retrospective studies. Conclusions Tissue PSMA, or FOLH1 expression, may inversely be associated with pathological and survival outcomes in localised UC. PSMA PET imaging may improve detection of metastatic disease and response to systemic therapy due to PSMA expression in neovasculature. Available evidence is limited; thus, larger, prospective studies are required to confirm early results and define populations that benefit most. Patient summary In this systematic review, we assess the potential role of prostate-specific membrane antigen in urothelial cancer. We found that its utility is in expression of blood vessels surrounding metastasis. We conclude that it may be beneficial in detecting metastasis and response to systemic therapies.

Multiparametric magnetic resonance imaging (MRI) is validated for the detection of clinically significant prostate cancer (csPCa), although patients with negative/equivocal MRI undergo biopsy for false negative concerns. In addition,This trial aimed to determine whether the combination of PSMA + MRI was superior to MRI in diagnostic performance for detecting csPCa.A prospective multicentre phase II imaging trial was conducted. A total of 296 men were enrolled with suspected prostate cancer, with no prior biopsy or MRI, recent MRI (6 mo), and planned transperineal biopsy based on clinical risk and MRI. In all, 291 men underwent MRI, pelvic-only PSMA, and systematic ± targeted biopsy.Sensitivity, specificity, and predictive values (negative predictive value [NPV] and positive predictive value) for csPCa were determined for MRI, PSMA, and PSMA + MRI. PSMA + MRI was defined as negative for PSMA negative Prostate Imaging Reporting and Data System (PI-RADS) 2/3 and positive for either MRI PI-RADS 4/5 or PSMA positive PI-RADS 2/3; csPCa was any International Society of Urological Pathology (ISUP) grade group ≥2 malignancy.Of the patients, 56% (n = 162) had csPCa; 67% had PI-RADS 3-5, 73% were PSMA positive, and 81% were combined PSMA + MRI positive. Combined PSMA + MRI improved NPV compared with MRI alone (91% vs 72%, test ratio = 1.27 [1.11-1.39], p 0.001). Sensitivity also improved (97% vs 83%, p 0.001); however, specificity was reduced (40% vs 53%, p = 0.011). Five csPCa cases were missed with PSMA + MRI (four ISUP 2 and one ISUP 3). Of all men, 19% (56/291) were PSMA + MRI negative (38% of PI-RADS 2/3) and could potentially have avoided biopsy, risking delayed csPCa detection in 3.1% men with csPCa (5/162) or 1.7% (5/291) overall.PSMA + MRI improved NPV and sensitivity for csPCa in an MRI triaged population. Further randomised studies will determine whether biopsy can safely be omitted in men with a high clinical suspicion of csPCa but negative combined imaging.The combination of magnetic resonance imaging (MRI) + prostate-specific membrane antigen positron emission tomography reduces false negatives for clinically significant prostate cancer (csPCa) compared with MRI, potentially allowing a reduction in the number of prostate biopsies required to diagnose csPCa.

Refereed/Peer-reviewed Background and objective: Radical prostatectomy (RP) is a common and widely used treatment for localized prostate cancer. Sequela following RP may include urinary incontinence and sexual dysfunction, outcomes which are recorded within a bi-national Prostate Cancer Outcomes Registry. The objective was to report population-wide urinary incontinence and sexual function outcomes recorded at 12 months following RP; and to quantify and explore factors associated with variation in outcome. Materials and methods The Prostate Cancer Outcomes Registry of Australia and New Zealand (PCOR-ANZ) was used for this study. Participants were treated with radical prostatectomy between 2016 and 2020. Domain summary scores for urinary incontinence and sexual function from the EPIC-26 instrument were the main outcomes, taken at 12 months following surgery (6–18 months). "Major" urinary and sexual function bother were also assessed. Variation in outcomes was investigated using linear and logistic multivariable regression models adjusted for covariates: age, socioeconomic status, PSA at diagnosis, surgical technique, surgical specimen grade group, margin status, and clinician surgical volume. Results and conclusions: The analytic cohort included 13,083 men with the mean urinary incontinence domain score being 76/100 (SD = 25) with 9.2% reporting major bother. For sexual function, the mean score was 29/100 (SD = 26) with 46% reporting major bother. Of the examined variables, age at surgery and surgical volume category were most predictive of function, with disparities exceeding minimally important differences, though large variation was observed between urologists within volume categories. There is considerable variation in 12-month postprostatectomy functional outcomes. Variation is explained by both patient and clinician factors, though some confounders are unmeasured in this cohort.

Accurate staging of high-risk localised, advanced, and metastatic prostate cancer is becoming increasingly more important in guiding local and systemic treatment. Gallium-68 prostate-specific membrane antigen (PSMA) positron emission tomography (PET) has increasingly been utilised globally to assess the local and metastatic burden of prostate cancer, typically in biochemically recurrent or advanced disease. Following our previous meta-analysis, a high-volume series has been reported highlighting the utility ofTo perform a systematic review and meta-analysis to update reported predictors of positiveWe performed critical reviews of MEDLINE, EMBASE, ScienceDirect, Cochrane Libraries, and Web of Science databases in July 2018 according to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement. Quality assessment was performed using Quality Assessment if Diagnostic Accuracy Studies-2 tool. Meta-analyses of proportions were performed using a random-effect model. Summary sensitivity and specificity values were obtained by fitting bivariate hierarchical regression models.A total of 37 articles including 4790 patients were analysed. For patients with biochemical recurrence, positiveGa-68-PSMA PET improves detection of metastases with biochemical recurrence, particularly at low pre-PET PSA levels of0.2ng/ml (33%) and 0.2-0.5ng/ml (45%). Ga-68-PSMA-PET produces favourable sensitivity and specificity profiles on meta-analysis of pooled data. This analysis highlights different anatomic patterns of metastatic spread according to PSMA PET in the primary and biochemically recurrent settings.Gallium-68 prostate-specific membrane antigen positron emission tomography is now an established imaging technique that has been developed in response to inadequacies in standard of care imaging modalities to improve the detection of metastatic disease in prostate cancer, particularly in the setting of disease recurrence. To date, this imaging modality in the setting of primary staging is controversial, given the paucity of data. In light of the growing body of evidence, we summarised the data to date to provide clinicians with an overview of this imaging modality.

Hematopoietic stem cell transplantation (HSCT) recipients are vulnerable to invasive pneumococcal disease (IPD), with reported IPD rates ranging from 3.81 to 22.5/1000 HSCT. This IPD risk could relate to immunodeficiency, low vaccination uptake, and poor immunogenicity of pneumococcal polysaccharide vaccine (PPV). Literature comparing the clinical effectiveness of pneumococcal conjugate vaccination (PCV) and PPV after HSCT is limited. In this retrospective analysis of HSCT recipients at our center from 2004 to 2015, we evaluated vaccination uptake and compared IPD rates in patients receiving PPV (pre-2010 group) and PCV (post-2010 group). IPD was determined from microbiological results for all HSCT recipients from January 2004 to June 30, 2019. Eight hundred patients had a total of 842 HSCT events, including autologous HSCT (auto-HSCT; n = 562) and allogeneic HSCT (allo-HSCT; n = 280). More than 90% of the HSCT recipients were enrolled, and93% of surviving HSCT recipients completed the vaccination protocol. Fifteen IPD episodes occurred in 13 patients between 2004 and June 30, 2019. Thirteen episodes occurred in the pre-2010 group, even though 9 of 13 (69%) serotyped isolates were covered by PPV. Two episodes occurred in the post-2010 group; neither serotype was covered by PCV. Thus, with PCV introduction, IPD rate was significantly reduced from 38.5/1000 unique HSCTs pre-2010 to 4.0/1000 unique HSCTs post-2010 (P.001). A significant reduction was seen in both auto-HSCTs (from 29.4 to 3.1 /1000 unique auto-HSCTs; P = .011) and allo-HSCTs (from 58.3 to 5.6/1000 unique allo-HSCTs; P = .011). PCV demonstrated superior clinical effectiveness over PPV, highlighting its importance in preventing infectious complications after HSCT. Robust vaccination programs at transplantation centers are needed to optimize vaccination uptake and completion.

Mass spectra are an important signature by which compounds can be identified. We recently formulated a mathematical approach for incorporating measurement variability when comparing sets of high-resolution mass spectra. Leveraging replicate mass spectra, we construct high-dimensional consensus mass spectra-representing each of the compared analytes-and compute the similarity between these data structures. In this paper, we present this approach and discuss its applications and limitations when trying to discriminate methamphetamine and phentermine using in-source collision induced dissociation mass spectra collected with direct analysis in real time mass spectrometry.

Introduction: Safety research in the U.S. motor carrier context remains important, as the trucking industry employs approximately 1.7 million large truck drivers. Drivers face many competing pressures in this unique high risk, high regulation, and low direct supervision context. They represent the cornerstone of safe carrier operations. Methods: Using a multi-theoretical approach, this study investigates how drivers' perceptions of carrier safety climate influence their safety-related attitudes and intentions. Results: Responses from nearly 1500 over the road drivers provide evidence that safety climate directly influences drivers' attitudes toward safety, safety norms, and driver risk avoidance, and indirectly influences drivers' intentions to commit unsafe acts. These findings replicate previous findings and also extend the nomological network of theory in this context, adding driver risk avoidance as a central factor to the driver safety theoretical framework. Additionally, carrier managers are encouraged to reflect on the study's evidence and pursue a better understanding of their drivers' risk perceptions and tolerance, while minimizing avoidable risk through prudent safety and operational policies, procedures, and processes. Future research in this area is highly encouraged.

Safety is of critical importance in many industries. One of the more dangerous environments in industry, and the military, is air freight handling, where the fatal injury rate has consistently been higher than the national average. Nonetheless, peer-reviewed safety research that is focused on air freight handling is practically non-existent. Therefore, research that helps academicians and managers better understand safety climate and its potential influence on employee attitudes and behaviors is vitally important. To address these concerns, we develop and validate an air freight handling-specific safety climate scale capable of capturing employees’ safety climate perceptions at the organization and group levels. We also found that, in general, measurement scale dimensions in this context are like those in other high-risk, transportation-related contexts, and that the nomological network may be converging on a cross-context set of safety climate dimensions. The resultant scale can be used to investigate safety climate’s relationship with various employee attitudes, safety and operational behaviors in this high-risk environment.

Objective Evaluating Health Information Technologies (HITs) can be challenging, but studies are necessary so that the most beneficial interventions can be identified. Our objective was to systematically review the available recommendations for improving the methods used in HIT evaluations. Methods HIT evaluation frameworks were identified from database (MEDLINE, EMBASE, CINAHL) and grey literature searches. Outcome measures included framework recommendations and characteristics. Recommendations were coded and organised using thematic analysis methods. A scoring instrument was used to measure framework quality. Results The search identified 23 frameworks and 272 recommendations. These were organised into five evaluation domains and 42 themes. The themes included recommendations for improving the evaluation of technical aspects of HITs (e.g. describing aspects of HIT functionality) and suggestions for improving the evaluation of complex factors that may influence the overall effects of HITs (e.g. careful reporting of whether the HIT became integrated into existing working patterns). The frameworks were not generally developed in association with healthcare professionals, or with input from patients. The frameworks tended not to have been developed using systematic methods designed to reduce the risk of bias. Discussion HIT evaluations are important but they are challenging to conduct and appraise. This review was conducted using systematic methods enabling the organisation of framework recommendations into key themes. These findings may help investigators to successfully plan, conduct and appraise HIT evaluations. The quality appraisal demonstrated that HIT evaluation research may be improved by using more systematic methods and the involvement of participants from a range of differing backgrounds.

Since early-stage decisions have the largest impact on climate related emissions, if modelling is to help deliver zero carbon designs, tools are needed that can be used by those involved at this stage. By contrast, tools that require a detailed description of the building or a specialist have less usefulness at this point in the design cycle. So, just how simple can models be (mathematically and interface-wise), to give meaningful answers to decisions such as the shape of the building and the glazing ratio? The ideal tool would be pedagogical and leave the user with knowledge that they could apply even earlier to the next project. In this work we present ZEBRA, a highly simplified, quick-to-use, model for scoping zero-carbon buildings. The model only requires approximately 33 inputs, no training, considers embodied emissions and renewables and leaves the user upskilled on zero carbon design. The predictions from 5 very low energy buildings placed into 559 climates obtained by this new model are compared to the leading model for high-performing buildings. The average difference was 0.9 kWh·m−2·a−1 (SD = 0.6). The mean time taken to model a building by someone not previously exposed to ZEBRA was 35 min (SD = 8), and 17 min (SD = 3) on second use. Therefore, ZEBRA is highly accurate when compared to the best-in-class tool and can be used quickly by the uninitiated. Hence ZEBRA has the potential to be highly useful as a first-pass tool whilst simultaneously rapidly upskilling the industry.

This paper reviews recent hydrological risk assessment, communication and early warning systems and proposes a framework to reformulate the classic view of Early Warning and Monitoring Systems towards a participatory one. The new framework is developed for flood risks (from multiple flood hazards), using examples from selected Nordic and other European countries. The study shows a potential for public participation in all stages of the Disaster Risk Reduction (DRR) cycle, with enhanced risk communication and awareness. Web-based access to hydrological data and nationwide modelling results can support adaptive and integrated management and learning about the flood risks on catchment scale. This can help identify cost-efficient solutions with synergy to other policy goals. The study shows how social media and digitalisation initiatives in the Nordic countries can support web-based access to historical data, real-time forecasts, and climate projections. Furthermore, the web-based access to data and model results can provide a coherent and integrated platform for stakeholder interaction and co-production for planning and decision-making that integrate hazard and risk knowledge. This can increase societal resilience and flood risk assessment across community and sector boundaries with proper analysis of risk areas, trade-off in costs and benefits of different solutions, and optimisation of climate change adaptation at the catchment scale.

Fast-dissolving oral films (FDFs) provide an alternative approach to increase consumer acceptance by advantage of rapid dissolution and administration without water. Usually, FDFs require taste-masking agents. However, inclusion of these excipients could make developing the formulation a challenging task. Hence, this work employed fused-deposition modeling three-dimensional printing to produce single-layered FDFs (SLFDFs), or multilayered FDFs (MLFDFs) films, with taste-masking layers being separated from drug layer. Filaments were prepared containing polyethylene oxide (PEO) with ibuprofen or paracetamol as model drugs at 60°C. Also, filaments were produced containing polyvinyl alcohol and paracetamol at 130°C. Furthermore, a filament was prepared containing PEO and strawberry powder for taste-masking layer. FDFs were printed at temperatures of 165°C (PEO) or 190°C (polyvinyl alcohol) with plain or mesh designs. High-performance liquid chromatography and mass spectroscopy analysis indicated active ingredient stability during film preparation process. SLFDFs had thicknesses as small as 197 ± 21 μm, and MLFDFs had thicknesses starting from 298 ± 15 μm. Depending on the formulation and design, mesh SLFDFs presented disintegration time as short as 42 ± 7 s, and this was 48 ± 5 s for mesh MLFDFs. SLFDFs showed drug content uniformity in the range of 106.0%-112.4%. In conclusion, this study provides proof-of-concept for the manufacturing of FDFs by using 3D printing.

In-situ or operando quantitative analysis is very important for Li-O 2 batteries, in order to properly, accurately and comprehensively evaluate electrocatalysts and characterize Li-O 2 electrochemistry in real-time. Synchrotron XRD can provide much higher X-ray intensity and time resolution than traditional in-house diffractometers, and therefore can contribute to quantitative analysis for Li-O 2 batteries. Here, operando synchrotron XRD is further developed to quantitatively study Li-O 2 batteries with nano-catalysts, Ru/MnO 2 . The time-resolved oxygen evolution reaction (OER) kinetics for Li-O 2 cells with Ru/MNT was systematically investigated using operando synchrotron radiation powder X-ray diffraction (SR-PXD). Li 2 O 2 decomposition in the electrodes with Ru/MNT catalysts during galvanostatic and potentiostatic charge processes followed pseudo -zero-order kinetics and showed ideal Coulombic efficiency (close to 100%). Furthermore, it was found that the OER kinetics for a cell with 2 wt% Ru/MNT charged at a constant potential of 4.3 V was even faster than that for a cell with the same amount of pure Ru nanoparticles, which have been considered as a highly active catalyst for Li-O 2 batteries. These results indicated that Ru/MNT with a special nanostructure represented a very efficient electrocatalyst for promoting the OER in Li-O 2 batteries. We also demonstrate that synchrotron radiation XRD can “highlight” a way to quantitative analysis for Li-O 2 batteries.

This paper examines spatial effects on hybrid-electric vehicle (HEV) adoption. This is in contrast to most existing analyses, which concentrate on analyzing socioeconomic factors and demographics. This paper uses a general spatial model to estimate the strength of ‘neighbor effects’ on HEV adoption—namely that each consumer’s HEV-adoption decision can be influenced by the HEV-adoption decisions of geographic neighbors. We use detailed census tract-level demographic data from the 2010 United States Census and the 2012 American Community Survey and vehicle registration data collected by the Ohio Bureau of Motor Vehicles. We find that HEV adoption exhibits significant spatial effects. We further conduct a time-series analysis and show that historical HEV adoption has a spatial effect on future adoption. These results suggest that HEVs may appear in more dense clusters than models that do not consider spatial effects predict.

This paper presents a large wound cell for in operando neutron diffraction (ND) from which high quality diffraction patterns are collected every 15 min while maintaining conventional electrochemical performance. Under in operando data collection conditions the oxygen atomic displacement parameters (ADPs) and cell parameters were extracted for Li 0.18 Sr 0.66 Ti 0.5 Nb 0.5 O 3 . Analysis of diffraction data collected under in situ conditions revealed that the lithium is located on the (0.5 0.5 0) site, corresponding to the 3 c Wyckoff position in the cubic perovskite unit cell, after the cell is discharged to 1 V. When the cell is discharged under potentiostatic conditions the quantity of lithium on this site increases, indicating a potential position where lithium becomes pinned in the thermodynamically stable phase. During this potentiostatic step the oxygen ADPs reduce significantly. On discharge, however, the oxygen ADPs were observed to increase gradually as more lithium is inserted into the structure. Finally, the rate of unit cell expansion changed by ∼44% once the lithium content approached ∼0.17 Li per formula unit. A link between lithium content and degree of mobility, disorder of the oxygen positions and changing rate of unit cell expansion at various stages during lithium insertion and extraction is thus presented.

Buildings contribute a significant portion of global greenhouse gas emissions and have the potential for large-scale impact reductions. Reducing the whole-life impacts of buildings is critical for creating a net-zero carbon built environment. For this to be achieved, the whole-life carbon impacts of design decisions must be considered during the building design process. A systematic review of academic literature was conducted to assess how life cycle assessment (LCA) is incorporated at various stages of the building design process, and what improvements are needed to support net-zero carbon design. The review compiled 274 papers that were published up to the end of 2019, of which 108 were subject to detailed review following screening. The review found that LCA is generally used late in the design process, when it is too late to greatly influence the design. Incorporating LCA with either building information modelling or life cycle costing is seen to have the same challenges as undertaking a traditional LCA. Parametric methods show promise for design development, but tools and algorithms require further verification and regionalisation to be implemented throughout industry. The use of benchmarks, target values and other pre-populated information can be used to incorporate life-cycle thinking without the need to undertake a detailed LCA. The review has demonstrated that LCA continues to face barriers, in both methods and practice, preventing its ability to guide early-stage design decisions and have a large impact on the environmental performance of buildings.

Background Atorvastatin and metformin are known energy restricting mimetic agents that act synergistically to produce molecular and metabolic changes in advanced prostate cancer (PCa). This trial seeks to determine whether these drugs favourably alter selected parameters in men with clinically-localized, aggressive PCa. Methods/design This prospective phase II randomized, controlled window trial is recruiting men with clinically significant PCa, confirmed by biopsy following multiparametric MRI and intending to undergo radical prostatectomy. Ethical approval was granted by the Royal Brisbane and Women's Hospital Human and The University of Queensland Medical Research Ethics Committees. Participants are being randomized into four groups: metformin with placebo; atorvastatin with placebo; metformin with atorvastatin; or placebo alone. Capsules are consumed for 8 weeks, a duration selected as the most appropriate period in which histological and biochemical changes may be observed while allowing prompt treatment with curative intent of clinically significant PCa. At recruitment and prior to RP, participants provide blood, urine and seminal fluid. A subset of participants will undergo 7Tesla magnetic resonance spectroscopy to compare metabolites in-vivo with those in seminal fluid and biopsied tissue. The primary end point is biochemical evolution, defined using biomarkers (serum prostate specific antigen; PCA3 and citrate in seminal fluid and prostatic tissue). Standard pathological assessment will be undertaken. Discussion This study is designed to assess the potential synergistic action of metformin and atorvastatin on PCa tumour biology. The results may determine simple methods of tumour modulation to reduce disease progression.

We report a case of testicular torsion in an adolescent with polyorchidism, specifically quadorchidism. Sonographic and intraoperative images are provided to describe the presentation and management of this case, while the challenges and pitfalls with this clinical scenario are discussed.

On August 16, 2014, an intense seismic swarm started below the eastern part of Barðarbunga caldera in the north-western part of Vatnajokull ice cap, Iceland, marking the onset of a major rifting event. The intense seismicity, corroborated by a complicated deformation pattern, migrated away from the Barðarbunga caldera for >45 km, until a small effusive eruption started in Holuhraun, outside of the ice cap, on August 29 which lasted a few hours. On August 31 a second, more intense, eruption started. It lasted 180 days and is the largest effusive eruption in Iceland since the Laki event in 1783–1784. A lava field covered about 84 km2 in the middle of the highlands with a bulk volume of ~1.44 km3. Although the potential danger of ice melting and subsequent flooding coupled with tephra fallout was the main concern at the beginning of the crisis, the main associated hazard turned out to be an abundant and constant release of volcanic gases that polluted the country threatening human health and the environment for several months. Very little (or almost no) ash was produced. The impact of the Holuhraun eruption outside of Iceland was minor if compared with what happened in 2010 when Eyjafjallajokull erupted. However, on three occasions the dense gas cloud released by the fissure eruption reached some European countries where unusually high SO2 concentrations were measured at ground level. Managing and living with such a prolonged effusive event was a major effort for the Icelandic scientific community and civil protection authorities and it significantly affected the local population in the northern and eastern parts of the country. This paper retraces the main events that accompanied the volcanic crisis at Barðarbunga and focuses on the scientific and operative response provided throughout its duration. Particular attention is given to the direct links between the observed phenomena, monitoring effort, hazard assessment and concrete actions taken by the authorities in charge of risk and mitigation assessment. The different roles of the involved institutions are clarified, and the wide and collaborative response on a national basis is explained. A major finding of this post-event analysis is that a strong internal collaboration between the scientific community and operative institutions is the basic element for proper crisis management. Iceland has established protocols that, while imperfect, ensured a well-coordinated response to the Holuhraun eruption and the preceding unrest, and will continue to provide a prompt and effective response for future events. Important realizations, including the need for a proper ground-based alert level system, have been raised and they will be a matter for further development.

Context Treatment for lower urinary tract symptoms resulting from benign prostatic hyperplasia (BPH) is varied, and significant side effects, particularly concerning sexual function, affect uptake. The prostatic urethral lift (PUL) procedure is a recent addition to the armamentarium for BPH treatment, with independent reports suggesting improvement of symptoms, sexual function, and urinary flow. Objective We undertook a systematic review and meta-analysis of reported symptomatic, functional, and sexual outcomes following the PUL procedure. Evidence acquisition We performed a critical review of Medline, Embase, ScienceDirect, Cochrane Library, and Web of Science databases in May 2014 according to the Preferred Reporting Items for Systematic Review and Meta-Analysis statement. Quality assessment was performed using a modification of the Methodological Index for Non-Randomized Studies tool. All retrospective, prospective, and controlled trials were included for analysis. Symptom scores, sexual health scores, and functional outcomes were pooled and meta-analysed using quality and random-effects models. Evidence synthesis Ten articles comprising six independent patient cohorts were included for analysis. Pooled estimates from between 452 and 680 patients suggested overall improvement following PUL, including symptoms (large gain; standardised mean gain range of 1.3–1.6, International Prostate Symptom Score difference of −7.2 to −8.7 points), maximum flow rate (3.8–4.0ml/s), and quality of life (2.2–2.4 points). Sexual function was preserved with a small improvement estimated at 12 mo (standardised mean gain range of 0.3–0.4). Pooled estimates were mostly heterogeneous across study groups. Conclusions PUL is a well-tolerated, minimally invasive therapy for BPH that provides favourable symptom, sexual health, and functional outcomes during follow-up to 12 mo. Longer follow-up and larger randomised studies are required to further confirm these preliminary results. Patient summary We reviewed the early results of an innovative procedure directed towards the management of prostate enlargement. The results revealed a well-tolerated procedure that produces improvement in urinary symptoms and function while preserving sexual function.

We report on the quantitative hard x-ray phase microscopy obtained with a laboratory source equipped with an x-ray planar waveguide. The waveguide, acting as a small secondary source with increased coherence, allows for phase contrast microscopy to be measured from a phase-only one-dimensional object. We analyzed different strategies and their performances for the case studied of low absorbing one-dimensional sample. It was found that the phase-only approximation for the sample enables the best performance in phase retrieval. Results obtained from experimental data are supported by phase retrieval performed on simulated data allowing an estimation of the performance of the algorithms. The ability to perform quantitative phase contrast microscopy with waveguides is an important advance for this novel x-ray phase contrast method, well suited to compact laboratory setups.

Background Atenolol and metoprolol tartrate are commonly prescribed β-blockers. Atenolol elimination depends on kidney function, whereas metoprolol tartrate does not. We hypothesized that compared to metoprolol tartrate, initiating oral atenolol treatment would be associated with more adverse events in older adults, with the association most pronounced in patients with lower baseline estimated glomerular filtration rates (eGFRs). Study Design Population-based matched retrospective cohort study. Setting & Participants Older adults (mean age, 75 years) in Ontario, Canada, prescribed oral atenolol versus metoprolol tartrate from April 2002 through December 2011. The 2 groups were well matched (n=75,257 in each group), with no difference in 31 measured baseline characteristics. Patients with end-stage renal disease were ineligible, and 4.6% of patients had chronic kidney disease (median eGFR, 38mL/min/1.73m 2 assessed through a database algorithm). Predictors β-Blocker type and eGFR. Outcomes A composite outcome of hospitalization with bradycardia or hypotension and all-cause mortality were assessed in 90-day follow-up. Results Compared to metoprolol tartrate, initiating atenolol treatment was not associated with higher risk of hospitalization with bradycardia or hypotension (incidence, 0.71% vs 0.79%; relative risk, 0.90; 95%CI, 0.80-1.01). Atenolol treatment initiation was associated with lower 90-day risk of mortality than metoprolol tartrate (incidence, 0.97% vs 1.44%; relative risk, 0.68; 95%CI, 0.61-0.74). Lower eGFR did not modify either association ( P for interaction=0.5 and 0.6, respectively). Limitations Heart rate and blood pressure were not available in our data sources, and effects ascertained from observational studies are subject to residual confounding. Conclusions Contrary to our expectation, we found that atenolol versus metoprolol tartrate was associated with lower 90-day risk of mortality in patients regardless of eGFR, with no difference in risk of hospitalization with bradycardia or hypotension.

The ability of clay minerals to adsorb and desorb drugs, including antibacterial molecules, is an attractive and exciting prospect for healthcare applications. The antibacterial ciprofloxacin was adsorbed onto kaolin, montmorillonite K-10, and Laponite® RD then the subsequent antibacterial activity of the composites formed was confirmed. The effects of time, pH, and CIP concentration were investigated. X-ray diffraction (XRD) and Fourier transform infrared (FTIR) spectroscopy were used to confirm the mechanism of ciprofloxacin adsorption onto the clay minerals. Dispersion pH was the most important variable influencing the adsorption of ciprofloxacin onto the clay minerals and the mechanism of adsorption was confirmed as cation exchange. Adsorption isotherms and application of Langmuir and Freundlich models showed that a ciprofloxacin monolayer was formed at different concentrations on each of the clay minerals tested. Kinetic studies showed that maximal CIP adsorption was achieved within the first hour of adsorption. Antibacterial activity of clay–ciprofloxacin composites against the common skin bacteria Staphylococcus epidermidis and Propionibacterium acnes was demonstrated. This work showed that clay–ciprofloxacin composites are potential delivery systems for ciprofloxacin molecules. As a result, this could make them ideal candidates to take forward for healthcare applications, including the development of novel wound dressings.

This paper presents a model to simulate the electricity demand of a single household consisting of multiple individuals. The total consumption is divided into four main categories, namely cold appliances, heating, ventilation, and air conditioning, lighting, and energy consumed by household members’ activities. The first three components are modeled using engineering physically-based models, while the activity patterns of individuals are modeled using a heterogeneous Markov chain. Using data collected by the U.S. Bureau of Labor Statistics, a case study for an average American household is developed. The data are used to conduct an in-sample validation of the modeled activities and a rigorous statistical validation of the predicted electricity demand against metered data is provided. The results show highly realistic patterns that capture annual and diurnal variations, load fluctuations, and diversity between household configuration, location, and size.

The SEI layer formed on metallic Li which has been used as an anode in a Li-O2 battery is studied for the first time. We have used XPS to monitor the surface composition of the lithium electrode an ...

This paper introduces a new cell design for the construction of lithium ion batteries with conventional electrochemical performance whilst allowing in situ neutron diffraction measurement. A cell comprising of a wound cathode, electrolyte and anode stack has been prepared. The conventional hydrogen-containing components of the cell have been replaced by hydrogen-free equivalents. The electrodes are fabricated using a PTFE binder, the electrolyte consists of deuterated solvents which are supported in a quartz glass fibre separator. Typical battery performance is reported using the hydrogen-free components with a specific capacity of 140 mA h g −1 being observed for LiFePO 4 at a rate of 0.2 C. Neutron diffraction patterns of full cells were recorded with phase change reactions monitored. When aluminium packaging was used a better signal to noise ratio was obtained. The obtained atomic positions and lattice parameters for all cells investigated were found to be consistent with parameters refined from the diffraction pattern of a powder of the pure electrode material. This paper highlights the pertinent points in designing cells for these measurements and addresses some of the problems.

This paper describes a new and economic route for the formation of three dimensional (3D) microstructured battery electrodes using our “in house” developed dip–spin coating technique for depositing layers of active material onto reticulated vitreous carbon (RVC) substrates. These coatings are optimized composite materials containing carbon black and polymer binder to facilitate good electronic and ionic conductivities through the electrode. The application process begins by immersing the substrate in an ink followed by rapid spinning to provide a uniform coating with a well controlled mass loading. The performance of the electrodes was investigated in lithium ion cells as a function of the composition of the inks used and the number of dip–spin coating cycles. Optimization of the ink composition, dip and spin parameters has improved the electrochemical performances of the electrodes to give state of the art footprint area specific capacities (>1000 μA h cm−2) and high rate capabilities (nearly 50% degree of discharge at 25 C) in lithium half cells. This represents the first stage in the development of a full 3D microbattery system. Initial results have also shown the versatility of this approach in depositing other electrode materials by forming uniform layers of both TiO2 and LiMn2O4.

Background Lupus nephritis accounts for ∼1% of patients starting dialysis therapy. Treatment regimens combining cyclophosphamide with steroids preserve kidney function but have significant side effects. Newer immunosuppressive agents may have improved toxicity profiles. Study Design Systematic review and random-effects meta-analysis, searching MEDLINE (1966 to April 2012), EMBASE (1988-2011), and the Cochrane Renal Group Specialised Register. Setting & Population Patients with biopsy-proven proliferative lupus nephritis (classes III, IV, V+III, and V+IV). Selection Criteria Randomized controlled trials. Intervention Immunosuppressive treatment regimens used for induction and maintenance therapy of lupus nephritis. Outcomes Mortality, renal remission and relapse, doubling of creatinine level, proteinuria, incidence of end-stage kidney disease, ovarian failure, alopecia, leukopenia, infections, diarrhea, vomiting, malignancy, and bladder toxicity. Results 45 trials (2,559 participants) of induction therapy and 6 (514 participants) of maintenance therapy were included. In induction regimens comparing mycophenolate mofetil (MMF) with intravenous cyclophosphamide, there was no significant difference in mortality (7 studies, 710 patients; risk ratio [RR], 1.02; 95% CI, 0.52-1.98), incidence of end-stage kidney disease (3 studies, 231 patients; RR, 0.71; 95% CI, 0.27-1.84), complete renal remission (6 studies, 686 patients; RR, 1.39; 95% CI, 0.99-1.95), and renal relapse (1 study, 140 patients; RR, 0.97; 95% CI, 0.39-2.44). MMF-treated patients had significantly lower risks of ovarian failure (2 studies, 498 patients; RR, 0.15; 95% CI, 0.03-0.80) and alopecia (2 studies, 522 patients; RR, 0.22; 95% CI, 0.06-0.86). In maintenance therapy comparing azathioprine with MMF, the risk of renal relapse was significantly higher (3 studies, 371 patients; RR, 1.83; 95% CI, 1.24-2.71). Limitations Heterogeneity in interventions and definitions of remission and lack of long-term outcome reporting. Conclusions MMF is as effective as cyclophosphamide in achieving remission in lupus nephritis, but is safer, with a lower risk of ovarian failure. MMF is more effective than azathioprine in maintenance therapy for preventing relapse, with no difference in clinically important side effects.

This paper specifies and estimates state-level models of short- and long-term electricity demand in the United States. The short-term model predicts hourly load based on weather and calendar inputs. The long-term model estimates interannual demand, and includes population, prices, and gross state product as predictors. These models are combined to incorporate the short- and long-term trends in electricity consumption when generating forecasts of diurnal patterns into the future. Finally, the authors investigate the effects of short-run price elasticities of demand. The short-term model is shown to be within 95% accuracy of actual levels in out-of-sample tests.