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Background/Introduction: General practitioners (GPs) referring patients with Erectile Dysfunction (ED) to North Central London (NCL) secondary care urology services must comply with the Erectile Dysfunction Referral Pathway (EDRP). The EDRP requires GPs to provide a detailed patient history, conduct specific blood tests, offer psychological support and attempt certain medical treatments prior to referral.We aim to identify all new patients referred by GPs for ED at two NCL trusts and assess compliance to the EDRP; Royal Free London (RFL) and University College London Hospital (UCLH) foundation trusts. Patients and methods: A retrospective review of the electronic patient care record was undertaken between the dates 11 January 2018 and 31 January 2022. Patients who had been directly referred for ED from primary care were identified, any incomplete records were excluded. Using a non-validated questionnaire, we collected the following data points from referral letters: patient background, date of referral, Peyronie's disease presence, completeness of patient history, treatment(s) attempted. Results: N=445 ED referrals were identified, n=364 were not primary care referrals thus excluded. n=81 patients were direct referrals; n=17 and n=64 patient to RFL and UCLH respectively.Patient history was reported as follows: Peyronies disease (n=72), sexual history (n=47), performance status (n=80), medications (n=40), Performance achieving/maintaining erections or both (n=44), hypertension (n=59), BMI (n=29) and smoking status (n=60).Blood tests reported; testosterone levels (n=26), TFTs (n=26), HbA1c/fasting glucose (n=37), lipid profile (n=37) and urine/electrolytes (n=39).Treatments trialed by GP: sildenafil (n=36), tadalafil (n=17), both sildenafil and tadalafil (n=10), neither sildenafil nor tadalafil or unclear (n=11) and contraindication to PDE5 inhibitor (n=3). Discussion/Conclusion: It is evident GPs do not provide complete patient history, nor exhaust all treatment options, nor organise blood tests prior to referral. We suggest the creation of a proforma and educating GPs on the importance of utilising the proforma to deliver more efficient care.

Résumé : Cet article traite de la question de l’agir des populations et des institutions en période de crise à partir d’un corpus littéraire : Entrez dans la danse de Jean Teulé (2019). Il engage le texte de l’auteur français comme allégorie du temps présent ; temps dominé par la crise sanitaire de la Covid-19. Une lecture allégorique de Entrez dans la danse permet de mettre en lumière, après décryptage, la dimension satirique sous-jacente découlant du propos de l’œuvre : l’origine du mal en période de crise sanitaire n’est pas toujours viral.

The objective of this work is to utilize integrated geomechanics, field vertical seismic profile (VSP) and microseismic data to characterize the complex subsurface stress conditions at the Farnsworth Unit (FWU). The model is based on a five-spot sector model extracted from a primary geomechanical model. The five-spot well injection pattern is characterized by extensive reservoir characterization data, such well logs, extracted cores and borehole geophone data, to facilitate the detailed examination of stress changes and microseismic event occurrences. The study utilizes field vertical seismic volumes acquired from the injection well 13-10A. The seismic volumes successfully provided snapshots of the behavior of the reservoir at distinct times. The use of VSP and microseismic data provided direct and indirect estimates of the dynamic stress changes occurring in the overburden, reservoir and underburden rock formations. In order to illuminate the stress regions and identify rocks that have undergone inelastic failure, microseismic event occurrences were utilized. Microseismic activity has been detected at the FWU; further study of its locations, timing, and magnitude was needed to deduce the nature of the changing stress state. The results of the study revealed that microseismic events were successfully modeled within the Morrow B formation. Moment magnitudes of seismic events were within the same magnitudes for events in the reservoir, suggesting the suitability of the model. The results of the study showed that the computed moment magnitudes for seismic events were insignificant to warrant safety concerns. The study findings showed the usefulness of coupled hydromechanical models in predicting the subsurface stress changes associated with CO2 injection. The knowledge gained from this study will serve as a guideline for industries planning to undertake underground CO2 storage, and characterize the subsurface stress changes.

Magnetization reversal mechanism is found to vary with cellular structures by a comparative study of the magnetization processes of three (Sm, Dy, Gd) (Co, Fe, Cu, Zr)z magnets with different cellular structures. Analysis of domain walls, initial magnetization curves and recoil loops indicates that the morphology of cellular structure has a significant effect on the magnetization process, besides the obvious connection to the difference of domain energy density between cell boundary phase (CBP) and main phase. The magnetization of Sample 2 (with a moderate cell size and uniformly continuous CBPs) behaves as a strong coherence domain-wall pinning effect to the domain wall and lead to a highest coercivity in the magnet. The magnetization of Sample 1 (with thin and discontinuous CBPs) shows an inconsistent pinning effect to the domain wall while that of Sample 3 (with thick and aggregate CBPs) exhibits a two-phase separation magnetization. Both the two cases lead to lower coercivities. A simplified model is given as well to describe the relationships among cellular structure and magnetization behavior.

The James Webb Space Telescope (JWST) is the successor to the Hubble Space Telescope. JWST will be an infrared-optimized telescope, with an approximately 6.5 m diameter primary mirror, that is located at the Sun-Earth L2 Lagrange point. Three of JWST’s four science instruments use Teledyne HgCdTe HAWAII-2RG (H2RG) near infrared detector arrays. During 2010, the JWST Project noticed that a few of its 5 μm cutoff H2RG detectors were degrading during room temperature storage, and NASA chartered a “Detector Degradation Failure Review Board” (DD-FRB) to investigate. The DD-FRB determined that the root cause was a design flaw that allowed indium to interdiffuse with the gold contacts and migrate into the HgCdTe detector layer. Fortunately, Teledyne already had an improved design that eliminated this degradation mechanism. During early 2012, the improved H2RG design was qualified for flight and JWST began making additional H2RGs. In this article, we present the two public DD-FRB “Executive Summaries” that: (1) determined the root cause of the detector degradation and (2) defined tests to determine whether the existing detectors are qualified for flight. We supplement these with a brief introduction to H2RG detector arrays, some recent measurements showing that the performance of the improved design meets JWST requirements, and a discussion of how the JWST Project is using cryogenic storage to retard the degradation rate of the existing flight spare H2RGs.

Purpose: The leaves of Perilla frutescens var. acuta (PFA) are generally reported to have antioxidant, anti-allergic, anti-inflammatory, and antitumor effects and commonly used as a traditional medicine in East Asia. This study aimed to investigate the protective effect and antioxidant activity of PFA on busulfan-induced testicular dysfunction, histological damage, oxidative stress (OS), sperm quality, and hormone levels using a mouse model. Materials and Methods: C57BL/6 male mice were divided into four groups: control, busulfan-only treated, and varying concentrations of PFA (100 and 200 mg/kg) with busulfan. In the busulfan group, 40 mg/kg of busulfan was intraperitoneally injected to induce azoospermia. Mice were orally administered PFA for 35 consecutive days after busulfan administration. Samples were collected and assessed for testis/body weight, testicular histopathology, sperm quality, serum hormone levels, and OS to evaluate the effects of PFA treatment on spermatogenesis dysfunction induced by busulfan. Results: The busulfan-induced testicular dysfunction model showed reduced testis weight, adverse histological changes, significantly decreased sex hormones and sperm quality, and attenuated OS. These results indicate that PFA treatment significantly increased testis weight, testis/body weight, epididymal sperm count, motility, and testosterone level compared with busulfan alone. PFA treatment also attenuated the busulfan-induced histological changes. Furthermore, compared with mice treated with busulfan alone, PFA supplementation upregulated the testicular mRNA expression of the antioxidant enzymes superoxide dismutase 1 (Sod1) and glutathione peroxidase 1 (Gpx1), with a decrease in malondialdehyde (MDA) production and an increase in SOD and GPx activities. Conclusions: This study shows that PFA exerts a protective effect against testicular damage by attenuating OS induced by busulfan. Our results suggest that PFA is a potentially relevant drug used to decrease the side effects induced by busulfan on testicular function and sperm during cancer chemotherapy. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to provide the basic data needed to estimate future urologist supply and demand by applying various statistical models related to healthcare utilization. Materials and Methods: Data from multiple sources, including the Yearbook of Health and Welfare Statistics, Korean Hospital Association, Korean Medical Association, and the Korean Urological Association, were used for supply estimation. Demand estimation incorporated data on both clinical and non-clinical urologists, along with future population estimates. In-and-out moves and demographic methods were employed for supply estimation, while the Bureau of Health Professions model was utilized for demand estimation. Supply estimation assumptions included fixed resident quotas, age-specific death rates, migration rates, and retirement age considerations. Demand estimation assumptions included combining clinical and nonclinical urologist demands, adjusting population size for age-related healthcare usage variations. Urologist productivity was determined by adjusting productivity levels to 100%, 90%, and 80% of the base year based on actual clinical practice volumes. Results: Estimations of both demand and supply consistently indicate an oversupply of urologists until 2025, followed by an expected shortage by 2035 owing to increased deaths and retirements attributed to the aging urologist population. This shortage becomes more pronounced when employing more reliable models, such as logit or ARIMA (autoregressive integrated moving average), underscoring the growing need for urologists in the future. Conclusions: All estimation models estimated an oversupply of urologists until 2025, transitioning to a deficit due to reduced supply thereafter. However, considering potential unaccounted factors, greater effort is needed for accurate predictions and corresponding measures. [ABSTRACT FROM AUTHOR]

Purpose: Local anesthetic agents such as bupivacaine and lidocaine are commonly used after surgery for pain control. The aim of this prospective study was to evaluate the safety of a mixture of bupivacaine and lidocaine in children who underwent urologic inguinal and scrotal surgery. Materials and Methods: Fifty-five patients who underwent pediatric urologic outpatient surgeries, were prospectively enrolled in this study. The patients were divided into three groups according to age (group I: under 2 years, group II: between 3−4 years, and group III: 5 years and above). Patients were further sub-divided into unilateral and bilateral groups. All patients were injected with a mixture of 0.5% bupivacaine and 2% lidocaine (2:1 volume ratio) at the surgical site, just before the surgery ended. Hemodynamic and electrocardiographic parameters were measured before local anesthesia, 30 minutes after administration of local anesthesia, and 60 minutes after administration. Results: The patients' mean age was 40.5±39.9 months. All patients had normal hemodynamic and electrocardiographic parameters before local anesthesia, after 30 minutes, and after 60 minutes. Also, results of all intervals were within normal values, when analyzed by age and laterality. No mixture related adverse events (nausea, vomiting, pruritus, sedation, respiratory depression) or those related to electrocardiographic parameters (arrhythmias and asystole) were reported in any patients. Conclusions: A mixture of bupivacaine and lidocaine can be safely used in children undergoing urologic inguinal and scrotal surgery. An appropriate dose has no clinically significant hemodynamic or cardiac changes and adverse effects.

Purpose: Pediatric obesity is increasing in many countries as socioeconomic status improves and the consumption of high calorie food increases. Thus, effect of obesity on genital development is an important topic. This study aimed to determine relationships of body mass index (BMI) with penile parameters and testicular volume in pediatric patients without penile or testicular abnormalities. Materials and Methods: Data from 1,499 male pediatric patients from our center were analyzed. Patients with penile or testicular abnormalities were excluded. Their age ranged from 2 to 18 years. These patients were divided into two groups based on their BMI: normal BMI (5th-85th percentile) and high BMI (=85th percentile). Factors used in analysis included age, anthropometric indicators, baseline penile length (BPL), stretched penile length (SPL), penile circumference (PC), and mean testicular volume. These same parameters were analyzed for different age groups. Results: Pediatric patients with normal BMI showed longer BPL and SPL than patients with high BMI (p<0.05). However, PC and mean testicular volumes showed no significant difference between the two groups. BPL was significantly longer in the normal BMI group starting at ten years of age. SPL was significantly longer in the normal BMI group starting at eleven years of age. Conclusions: Our study confirms that having a higher BMI during childhood has a negative effect on penile length. However, there was no significant relationship between BMI and PC or testicular volume. [ABSTRACT FROM AUTHOR]

Purpose: The ability to concentrate urine becomes an important index in determining nocturnal enuresis (NE) treatment. The aim of our study was to investigate first-morning urine osmolality (Uosm) changes at the end of treatment compared to before treatment in children with NE. Methods: A total of 71 children with NE were divided into two groups according to the level of first-morning Uosm before treatment: high group (=800 mOsm/kg) and low group (<800 mOsm/kg). Baseline parameters were obtained from uroflowmetry, frequency volume charts for at least 2 days, and a questionnaire for lower urinary tract symptoms. All patients were basically treated with standard urotherapy and medication. The first-morning Uosm was measured twice, before treatment and at the end of treatment. Results: The response rate was higher in the low group after 3 months of treatment than in the high group (P=0.041). However, there was no difference between the two groups at the end of the treatment. In the high group, the first-morning Uosm at the end of treatment did not show a significant change compared to before treatment. In contrast, the first-morning Uosm increased in the low group at the end of treatment (P<0.001). However, it was still lower than that of the high group (P=0.007). Conclusions: The ability to concentrate nocturnal urine improved at the end of treatment compared to before treatment in the low Uosm NE children. In addition, NE improved faster in the low Uosm group before treatment than in the high group. [ABSTRACT FROM AUTHOR]

This paper proposes new concepts for the point-to-point rocket cargo transportation system (RCTS). The RCTS is a transportation system that can deliver cargo anywhere on Earth in an hour using reusable launch vehicle technologies. As a fundamental study of global transportation on Earth, we especially address the mission profiles for short-range transportation within hundreds of kilometers using small rocket engines, which are intended for logistics transportation within neighboring countries or domestic transportation in a country. Two mission profiles of the RCTS are introduced, and the flight phases of each concept are explained in detail. The trajectory optimization problem of the RCTS is formulated based on the mission profiles, incorporating the flight constraints, boundary conditions, and an objective function that aims to maximize the payload ratio. The explicit-guidance is employed during the landing burn phase to enhance the convergence of the optimization problem by expanding the feasible region. The coevolutionary augmented Lagrangian method, one of the evolutionary algorithms, is utilized to obtain the solution for the trajectory optimization problem. The optimal trajectory and state variables are presented through numerical simulations. Additionally, parametric studies are performed to determine the payload mass trend of the RCTS. The trajectory optimization results are summarized to provide an analysis and comparison of the proposed mission profiles. [ABSTRACT FROM AUTHOR]