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Background While implantation of an inflatable penile prosthesis (IPP) is commonly performed via infrapubic or penoscrotal approaches, the subcoronal (SC) approach for IPP implantation may safely and reliably allow for additional reconstructive procedures through a single incision. Aim The aim of this study is to report outcomes, including complications, of the SC approach and to determine common characteristics of patients undergoing the SC approach. Methods A retrospective chart review from May 11, 2012, to January 31, 2022, was performed at a single, tertiary care institution to identify patients with IPP implantation via the SC approach. Outcomes Postoperative information was reviewed and extracted from all clinic notes available following the date of IPP implantation in the electronic medical record, detailing any complications including wound complications, need for revision or removal, device malfunction, and infections. Results Sixty-six patients had IPP implantation via the SC approach. Median follow-up duration was 29.4 (interquartile range 14.9-50.1) months. One (1.8%) patient had a simple wound complication. Two (3.6%) experienced postoperative infection of the prosthesis, which resulted in explantation of the device. One of these infected prostheses later experienced partial glans necrosis. Revision for mechanical failure or unsatisfactory cosmetic result was performed in 3 (7.3%) IPPs placed via a SC incision. Clinical implications The SC approach for implantation of IPP is safe and feasible with low complication and revision rates. It offers urologists an alternative to the classic infrapubic and penoscrotal approaches, both of which would require a second incision for additional reconstructive procedures required to adequately address deformities associated with severe Peyronie’s disease. Therefore, urologists who treat these specialized populations of men may benefit from having the SC approach in their array of techniques for IPP implantation. Strengths and limitations The limitations of this study include its retrospective nature, risk of selection bias, lack of comparison groups, and sample size. This study reports on early experience with the SC approach performed by a single high-volume reconstructive surgeon, who treats a specialized population of patients requiring complex repair during implantation of an IPP, particularly those with Peyronie’s disease. Conclusion The SC incision for IPP implantation has low rates of complications and remains our approach of choice for IPP implantation in patients with severe Peyronie’s disease, including curvatures >60°, severe indentation with hinge, and grade 3 calcification, which are unlikely to respond adequately to manual modeling alone.

Objectives To evaluate contemporary clinical presentations of priapism, their association with socioeconomic characteristics, and the role of prescribing providers in priapism episodes in a large cohort of patients managed at 3 major academic health systems. Methods We identified all consecutive patients presenting with ischemic priapism to the emergency departments of three major academic health systems (2014 –2019). Demographic characteristics, priapism etiologies, and clinical management were evaluated. Univariable and multivariable analyses were used to assess the contribution of socioeconomic characteristics and the role of prescribing providers in priapism episodes. Results We identified 102 individuals with a total of 181 priapism encounters. Hispanic race, lower income quartile, sickle-cell disease, and illicit drug use were associated with increased risk of recurrent episodes. Of ICI users, 57% received their prescriptions from non-urological medical professionals (NUMPs); the proportion with recurrent episodes was higher for NUMPs compared to urologists (24% vs 0%, P = 0.06) with no demographic differences identified between patients treated by either group. Conclusion Socioeconomic disparities exist among patients presenting with recurrent episodes of priapism, potentially highlighting systemic issues with access to care and patient education. With most patients who developed ischemic priapism from ICI being prescribed these medications by NUMPs, further investigation is required to elucidate the prescribing and counseling patterns of these providers. Increased awareness of disparities and complications may improve patient safety.

[spa] Son numerosos los municipios de Catalunya y Balears que disponían de colecciones de retratos de conciudadanos ilustres en el periodo de la Restauración. Se plantea aquí que pueden ser considerados como «lugares de memoria» y que actuaban como soportes de identidades territoriales (mayormente locales y regionales) e instrumentos de legitimación del rol preponderante de determinadas elites sociales en la colectividad. El estudio pretende ofrecer un marco interpretativo que permita comprender el fenómeno en su complejidad y aborda numerosos conjuntos icónicos a partir de una perspectiva comparada que atiende la mayor parte de las facetas fundamentales del objeto de estudio. La investigación invita a prestar mayor atención a los «espacios locales» y al rol de las ciudades en la producción de imaginarios autoreferenciales, proceso que es simultáneo a la proliferación de todo tipo de usos del pasado puestos al servicio de la construcción de las culturas regionales y nacionales. Los resultados del estudio apuntan a las galerías de ciudadanos ilustres en cuestión como instancias de consagración del rol referente que los intelectuales y profesionales cualificados pretendían despeñar en la colectividad, en un contexto de creciente presión democratizadora. Así mismo, indican que, a la vez que estos lieux de mémoire eran un mecanismo de dominio simbólico de la colectividad, actuaban como un dispositivo orientado a construir la reputación positiva de la población (y sus élites), con el fin de agenciar sus instituciones y poderes en el marco más amplio de la política provincial, regional y nacional. En definitiva, el artículo demuestra la voluntad y la capacidad que tuvieron las ciudades (incluso núcleos de tamaño modesto) de fomentar sus propias autoimágenes, e identifica los responsables y móviles de su producción., [eng] During the Restoration period, many municipalities in Catalonia and the Balearic Islands kept collections of illustrious citizens' portraits. This article posits that those collections can be considered sites of memory. They served to reinforce territorial identities (mainly local and regional ones) and to legitimate the dominant role of certain social elites in the community. This study aims to provide an interpretive framework that allows the phenomenon of illustrious citizens' galleries to be understood in its full complexity. A number of such collections are analysed, using a comparative perspective that addresses most of the fundamental aspects of the object of study. The research presented here invites further discussion of «local places» and the role cities played in the production of self-referential imaginaries, a process that was simultaneous with the proliferation of various uses of the past to further the construction of regional and national cultures. The results of this study suggest that illustrious citizens' galleries were institutions that served to consecrate the guiding role that intellectuals and members of the liberal professions aimed to play in the community at a time of rising democratizing pressure. Moreover, they show that these lieux de mémoire were a means of symbolic domination of the community, as well as a device to help the city (and its elites) build a positive reputation, with the aim of asserting the agency of local institutions, authorities, and leaders within the broader framework of provincial, regional, and national politics. In short, this article is intended to verify that cities (even modestly sized ones) had both the desire and the capability to promote their own self-image. Additionally, both the agents responsible and the reasons for the production of these self-images are identified.

With the rise of software-as-a-service and microservice architectures, RESTful APIs are now ubiquitous in mobile and web applications. A service can have tens or hundreds of API methods, making it a challenge for programmers to find the right combination of methods to solve their task. We present APIphany, a component-based synthesizer for programs that compose calls to RESTful APIs. The main innovation behind APIphany is the use of precise semantic types, both to specify user intent and to direct the search. APIphany contributes three novel mechanisms to overcome challenges in adapting component-based synthesis to the REST domain: (1) a type inference algorithm for augmenting REST specifications with semantic types; (2) an efficient synthesis technique for "wrangling" semi-structured data, which is commonly required in working with RESTful APIs; and (3) a new form of simulated execution to avoid executing APIs calls during synthesis. We evaluate APIphany on three real-world APIs and 32 tasks extracted from GitHub repositories and StackOverflow. In our experiments, APIphany found correct solutions to 29 tasks, with 23 of them reported among top ten synthesis results.

Citizen science (CS) is the practice where amateurs without formal scientific training collect data to contribute to the scientific observations available to scientists and decision makers (Bonney, et al., 2009). Citizen science is increasingly utilized for environmental protection and conservation as well as related purposes such as education, access to nature, access to justice, inclusion, civics and equality or other ‘social goods’ (Mor Barak, 2020; Makuch & Aczel, 2020). Several eco-citizen science projects are developing in China (Chen, et al., 2020; Hsu, Yeo & Weinfurter, 2020), though little research has evaluated their effectiveness in facilitating environmental protection or advancing social goods. This paper aims to identify the role and potential benefits of environmental citizen science in China to promote environmental and social objectives within the context of what has been called “authoritarian environmentalism” (Beeson, 2018). Through semi-structured interviews and a review of the (limited) available literature, we identify three key areas in which citizen science could potentially benefit environmental protection and promote social good in China: (1) fostering education to inform society and encourage environmental advocacy; (2) facilitating effective environmental governance through monitoring and litigation; and (3) improving data collection for biodiversity and conservation research.

111 Background: Advancement of treatment pathways in the management of metastatic prostate cancer (mPC) has identified newer systemic agents associated with survival advantage over androgen deprivation therapy (ADT) alone. Despite FDA approvals and guideline recommendations outlining standard of care (SOC) intensification of (ADT) with such additional systemic therapies such as docetaxel or novel hormonal therapies (NHT), these treatments are not being utilized uniformly by all practitioners. Our objective is to assess the utilization of such advanced therapies in patients with mPC and study differences in prescribing patterns. Methods: Between 2017 to present, we retrospectively identified all consecutive men with prostate cancer in a single health system. Electronic health record ICD code inquiries were used to identify patients. The population was further restricted utilizing diagnosis codes to include only those with metastatic prostate cancer and to exclude patients with second primary cancers. All treatment modalities and demographic information were analyzed to assess for prescribing patterns. Results: In total, 5,761 men had a diagnosis of prostate cancer. Exclusion criteria applied stepwise removed those with age

INTRODUCTION AND OBJECTIVE:Renal cell carcinoma (RCC) tumors vary widely with respect to oncologic risk and are composed of heterogenous histological subtypes that can affect treatment decisions an...

OBJECTIVE. The purpose of this study was to conduct a meta-analysis to assess the safety and efficacy of empiric embolization compared with targeted embolization in the treatment of acute upper gastrointestinal bleeding (UGIB). MATERIALS AND METHODS. We searched the PubMed and Cochrane Library databases for studies performed without language restrictions from January 2000 to November 2019. Only clinical studies with a sample size of five or more were included. Clinical success, rebleeding and complication rates, survival rates, bleeding cause, embolic materials, and vessels embolized were recorded. Empiric embolization and targeted embolization (i.e., embolization performed based on angiographic evidence of ongoing bleeding) were compared when possible. Meta-analysis was performed. RESULTS. Among 13 included studies (12 retrospective and 1 prospective), a total of 357 of 725 patients (49.2%) underwent empiric embolization for UGIB. The clinical success rate of empiric embolization was 74.7% (95% CI, 63.1-86.3%) among the 13 studies, and the survival rate was 80.9% (95% CI, 73.8-88.0%) for 10 studies. On the basis of comparative studies, no statistically significant difference was observed between empiric and targeted embolization in terms of rebleeding rate in 111 studies (36.5% vs 29.6%; odds ratio [OR], 1.13; 95% CI, 0.77-1.65; p = .53), mortality in eight studies (23.3% vs 18.0%; OR, 1.44; 95% CI, 0.89-2.33; p = .14), and need for surgery to control rebleeding in four studies (17.8% vs 13.4%; OR, 1.34; 95% CI, 0.58-3.07; p = .49). The pooled embolization-specific complications were 1.9% (empiric) and 2.4% (targeted). CONCLUSION. According to all available published evidence, empiric embolization assessed with endoscopic or preprocedural imaging findings (or both) appears to be as effective as targeted embolization in preventing rebleeding and mortality in patients with angiographically negative acute UGIB. Because of its favorable safety profile, empiric embolization should be considered for patients in this clinical scenario.

Background: Delayed proximal ureteral stricture (DPUS) after nephron-sparing treatment (partial nephrectomy [PN] and image-guided percutaneous ablation) of renal masses is a rare complication that occurs because of an unrecognized injury to the proximal ureter and/or its associated vascular supply. We present a multi-institutional series of patients who developed DPUS after nephron-sparing treatment and review relevant tumor characteristics, timing of DPUS presentation, presenting symptoms, and outcome of stricture management. Case Presentation: Between 2000 and 2019, nine patients (five PN and four ablation) were found to have DPUS diagnosed at an average of 9 (6–119) months after PN and 5.5 (1–6) after ablation. Average tumor size was 4.5 (2.9–7.3) cm and 3.6 (3–4.1) cm for those treated with PN and ablation, respectively. Nephrometry score was 8.3 (6–11) and 6.5 (5–8), respectively. For resected tumors, all were located in the lower pole, but uniformity was not found as far as medial vs lateral (3 vs 2), anterior vs posterior (2 vs 2, 1 N/A), and right vs left (3 vs 2). For ablated tumors, all four tumors were right sided, anterior, medial, and lower pole. Initial signs and symptoms include sepsis (2), flank pain (5), and asymptomatic hydronephrosis (2). Concomitant urinoma (2) and retroperitoneal abscess (1) was found on imaging. Initial management included ureteral stenting (5) and percutaneous nephrostomy tube (4). Three underwent nephrectomy. Two had spontaneous resolution of DPUS after a course of ureteral stenting. Conclusion: Potential risk factors associated with DPUS after nephron-sparing treatment, including medial and lower pole tumors, and particularly right-sided anterior masses for ablation and higher complexity nephrometry score for PN. Recognition of delayed symptoms and imaging abnormalities in the surveillance period should cue clinical suspicion to DPUS.

Semiconductor spin lasers are distinguished from their conventional counterparts by the presence of spin-polarized carriers. The transfer of angular momentum of the spin-polarized carriers to photons provides important opportunities for the operation of lasers. With the injection of spin-polarized carriers, which lead to the circularly polarized light, the polarization of the emitted light can be changed an order of magnitude faster than its intensity. This ultrafast operation of spin lasers relies on a large birefringence, usually viewed as detrimental in spin and conventional lasers. We introduce a transparent description of spin lasers using intensity equations, which elucidate the influence of birefringence on the intensity and polarization modulation of lasers. While intensity modulation is independent of birefringence, for polarization modulation an increase in birefringence directly increases the resonant frequency. Our results for dynamical operation of lasers provide a guide for their spin-dependent response and spintronic applications beyond magnetoresistance., Comment: 11 pages, 9 figures

Aix-en-Provence és una ciutat provençal que es trobà en la circumstància de sortir del període revolucionari encetat el 1789 i d’encarar el debut del segle XIX en unes condicions que en principi podrien considerar-se poc favorables per al manteniment de la seva antiga preponderància relativa. Ens interessa veure la forma en què les elits locals van viure i van reaccionar davant d’aquest procés. L’estudi, de caràcter bibliogràfic, mostra com part d’aquest sector va participar d’una estratègia destinada a assolir l’especialització funcional de la ciutat en l’àmbit de l’ensenyament com a forma de dinamitzar la ciutat i donar-li una importància renovada., Aix-en-Provence is a town in Provence that had to face up to the situation of leaving the revolutionary period started in 1789 behind and it began the new XIXth century in circumstances which, on the face of it, could have been considered quite unfavorable for those holding onto their old, relative preponderance. We are interested in finding out how the local elite underwent and dealt with this process. The study, of a bibliographic nature, shows how a part of this sector participated in a strategy in order to redirect the functional specialisation of the town in the area of education as a way of dynamizing the town and offering it renewed importance.

This panel covered how collateralized loan obligations (CLOs) are similar or different from collateralized debt obligations (CDOs) and other ABS products, the inherent CLO liquidity premium, how value is analyzed across a CLO’s capital structure, how to distinguish between values in the primary (new issue) and secondary CLO markets, whether various CLOs today seem rich or cheap, risks related to differences in CLO documentation across different deals, and how CLO equity compares to other alternative investments.

GOALS To evaluate gastroenterologists' use of esophagogastroduodenoscopy (EGD) for positive fecal occult blood test (FOBT). BACKGROUND Colonoscopy is recommended when an FOBT performed for colorectal cancer screening is positive. Guidelines suggest no further evaluation if anemia and gastrointestinal (GI) symptoms are absent. METHODS Online surveys included 4 vignettes: positive FOBT in average-risk adults 50 years of age or older with/without iron-deficiency anemia and with/without upper GI symptoms. For each scenario, respondents were asked if they would perform colonoscopy only, EGD only, colonoscopy+EGD on same day, or colonoscopy followed by EGD on different day if colonoscopy was negative. RESULTS Surveys were returned by 778 (11%) of 7094 potential responders. In patients without anemia or upper GI symptoms, 65% performed colonoscopy only; 35% added EGD (9% same day, 25% different day). EGD was added in 91% with anemia, 96% with symptoms, and 100% with anemia+symptoms. In patients with positive FOBT alone (no symptoms or anemia), multivariate analysis revealed fear of litigation as the primary factor associated with adding EGD to colonoscopy (odds ratio=4.1; 95% confidence interval, 2.3-7.3). When EGD+colonoscopy were planned for positive FOBT, private practice was associated with performing EGD on a different day (odds ratio=6.3; 95% confidence interval, 2.9-13.5 for private versus academic setting). CONCLUSIONS One third of gastroenterologists perform EGD in addition to colonoscopy for a positive FOBT alone. Fear of litigation is the most important factor in deciding whether to add EGD to colonoscopy. When both procedures are planned, they are more likely to be performed on different days in a private practice setting than in an academic setting.

El Cercle Literari de Vic va congregar durant bona part de la segona meitat del segle XIX el més granat de la societat vigatana. Espai de sociabilitat intel·lectual, va actuar també com a plataforma d’intervenció d’una elit d’ascendència local. L’article presenta el context i els estímuls en funció dels quals es constituí l’entitat, el perfil dels seus socis i les activitats dutes a terme., The Literary Cercle of Vic brought together the best of the society from Vic during most of the second half of the XIX century. A place of intellectual sociability, which also operated as a platform for intervention of a local elite in ascendancy. The article introduces the context and the incentives which gave form to the entity, the profile of their members and the activities which they developed.

Our previous work demonstrated that prenatal morphine exposure twice daily during gestational days 11-18 differentially alters male and female sexual behavior. One possible explanation may be that prenatal morphine exposure alters the sexual behavior via alterations of mu-opioid receptors in brain regions involved in reproductive function and behavior, including the ventromedial nucleus of the hypothalamus (VMH), arcuate nucleus (ARC), and medial preoptic area (mPOA). In experiment 1, mu-opioid receptor density was analyzed in three groups of adult male rats: gonadally intact, gonadectomized (GNX), and GNX and testosterone 17beta-propionate-treated (TP). In experiment 2, mu-opioid receptor density was analyzed in four groups of adult female rats: ovariectomized (OVX), OVX and estradiol benzoate-treated (EB), OVX and progesterone-treated (P), and OVX and EB- and P-treated (EB+P). Experiment 1 demonstrated that prenatal morphine exposure lowered the mu-opioid receptor density in the mPOA of adult, gonadally intact and in TP males, while this difference was not apparent in GNX male rats. Experiment 2 demonstrated that prenatal morphine exposure increased mu-opioid receptor density in OVX females, while decreasing it in EB females in the VMH. When compared to our previous sexual behavior data, the present results demonstrate that at least some changes in sexual behavior of adult male and female rats prenatally exposed to morphine may be related to alterations in mu-opioid receptors in brain regions controlling sexual behavior.

El presente artículo se propone destacar el peso que tuvieron la historia y la reivindicación de las tradiciones jurídico-institucionales catalanas en la formación de las culturas políticas de la Cataluña del siglo XIX. A lo largo del texto se muestra cómo diferentes intelectuales catalanes leyeron el pasado constitucional del Principado a lo largo de este siglo. El marco interpretativo en la base del presente artículo son aquellas reflexiones de autores clásicos en la historia de los derechos que han permitido estudiar las constituciones desde una perspectiva más amplia que la meramente normativa. El hecho de considerar las constituciones como productos culturales, expresión de modelos políticos teóricos, pero también de actitudes, ideas y valores, los cuales son producidos e interpretados por los ciudadanos, nos conduce a preguntamos sobre la existencia y los rasgos característicos de la cultura constitucional catalana contemporánea, cuestión que ha merecido hasta el momento una atención más bien marginal. Cet article se propose de souligner le poids qu’eurent l’histoire et la revendication des traditions juridico-institutionnelles dans la formation des cultures politiques de la Catalogne du XIXe siècle. On montre quelle fut la lecture que divers intellectuels catalans, tout au long du siècle, firent du passé constitutionnel de la Principauté. Le cadre interprétatif sur lequel se fonde le présent article sont les réflexions des auteurs classiques sur l’histoire des droits qui ont permis d’étudier les constitutions d’un point de vue plus ample que la simple approche normative. Le fait de considérer les constitutions comme des produits culturels, l’expression de modèles politiques théoriques, mais aussi d’attitudes, d’idées et de valeurs, produites et interprétées par les citoyens, nous conduit à nous interroger sur l’existence et les caractéristiques de la culture constitutionnelle catalane contemporaine, une question n'avait suscité jusqu'à présent qu'une attention limitée. This paper examines the relative importance of the history and defense of Catalan legal and institutional traditions in the formation of political cultures in Catalonia in the nineteenth century. The text shows how various Catalan intellectuals interpreted the constitutional past of the Principality over the course of that century. The interpretative framework for the paper draws fundamentally on the thinking of classic scholars in the history of rights, who have paved the way for the study of constitutions from a viewpoint broader than the merely normative. By regarding constitutions as cultural products that express models of political theory, but also reflect the attitudes, ideas and values produced and interpreted by the people, we are led to pose questions about the existence and characteristic traits of contemporary Catalan constitutional culture, which has thus far received rather marginal attention.