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The usage of masks such as the N95 has increased exponentially worldwide. With the ever-increasing global rates of cardiovascular disease, it is vital that preventative measures are adopted to help tackle this crisis. N95 masks have been promoted as health prevention odysseys in the battle against viruses such as COVID-19. A systematic review was conducted on whether the N95 masks could help improve our cardiovascular health. Our data sources included PubMed, Medline and Scopus. Eleven studies met the eligibility criteria to be included in the review. N95 mask usage led to increased reports of dyspnoea, however, no significant effect was seen on blood pressure. N95 masks also showed improvement in aortic parameters. While encouraging results were yielded, further focussed studies on the use of N95 masks and the effect on various cardiovascular parameters would help strengthen the association.

Objective: Robot-assisted radical cystectomy (RARC) is considered the gold-standard for patients who fail Bacillus Calmette–Guérin (BCG) treatment for high-grade non-muscle-invasive bladder cancer. We reviewed our histopathological outcomes to assess whether we are proceeding to cystectomy at an appropriate time. Methods: A retrospective analysis of the RARC database (2015–2020) was performed to identify patients who received intravesical BCG before cystectomy. Data regarding demographics, number of BCG instillations and staging were collected. Histopathological stage at cystectomy was compared between patients who received an induction course of BCG only (group A), and those who had continued maintenance doses (group B). Results: A total of 73 patients (57 males and 16 females) met the final inclusion criteria, with 24 patients in group A and 49 patients in group B. At cystectomy, 19 patients had ⩾T2 disease (group A: 7; group B: 12). There was no significant difference between groups ( p=0.78). Pelvic lymph node dissection was performed in 68 patients, with six patients found to have lymph node metastases. Conclusion: RARC plays a key role in managing BCG failure, considering the number of patients with muscle-invasive disease at final staging. However, prolonged BCG treatment was not associated with more advanced disease in our case series. Thus, persistence with intravesical treatment warrants consideration for selected patients. Level of evidence: Level 4.

Background The comparative effectiveness of robotic-assisted radical cystectomy (RARC) versus open radical cystectomy (ORC) in terms of perioperative outcomes is still a matter of debate affecting payors, physicians, and patients. Objective To evaluate comparative perioperative and longer-term morbidity of RARC versus ORC in a multicenter contemporary retrospective cohort of patients. Design, setting, and participants This retrospective multicenter study included patients with bladder cancer treated with radical cystectomy at 10 academic centers between 2000 and 2017. Outcome measurements and statistical analysis Intraoperative outcomes including blood loss and operative time as well as postoperative outcomes including time to discharge, complication, readmission, reoperation, and mortality rates at 30 and 90 d were assessed. Multiple imputation and inverse probability of treatment weighting (IPTW) were used. IPTW-multivariable-adjusted regression and logistic analyses were performed to evaluate the associations of RARC versus ORC with perioperative outcomes at 30 and 90 d. Results and limitations Overall, 1887 patients (1197 RARC and 690 ORC) were included in the study. After IPTW-adjusted analysis, no differences between the groups in terms of preoperative characteristics were observed. RARC was associated with lower blood loss (p Conclusions While RARC was associated with less blood loss and shorter hospital stay, it also led to longer operation times and more readmissions. There were no differences in 30- and 90-d complications. Because there are no apparent differences in safety between ORC and RARC in expert centers, differences in oncologic and cost-effectiveness outcomes are likely to drive decision making regarding RARC utilization. Patient summary In this study we investigated the differences between RARC and ORC in terms of perioperative outcomes. We found no difference in early and late complications. We concluded that, to date, differences in oncologic and cost-effectiveness outcomes should drive decision making regarding RARC utilization.

For those with certain recurrent gynaecological cancers where primary management such as chemo-radiotherapy has failed, or in cases of recurrence following primary surgery, pelvic exenteration (PE) is considered the only curative option. Whilst initially considered a morbid procedure, improved surgical techniques, advancing technology, and nuanced reconstructive options have facilitated more radical resections and improved morbidity and mortality. Open PE remains the gold standard approach, however, minimally invasive techniques for PE may lessen morbidity whilst achieving the same oncological outcomes. The objective of this study was to assess the feasibility and safety of minimally invasive PE with a laparoscopic or robot-assisted approach. We also performed a review of the literature on robot-assisted PE which has not been widely reported for cases of recurrent gynaecological malignancy. Between 2015 and 2021six minimally invasive PE were performed. All patients underwent extensive multi-disciplinary assessment and counselling pre-operatively. Patient characteristics, treatment indication, perioperative data, short-term complications, and histological outcomes were recorded. There were two anterior exenterations, three posterior exenterations and one total exenteration performed. The primary cancer stage varied from stage 1a-3b. Five out of six patients had pre-operative chemo-radiotherapy. The average operative time (including surgical docking) was 600 min. Mean blood loss was 400 mL and the average length of stay was eight days. Enhanced recovery practices were used where possible. There were no intraoperative complications and one major post-operative complicationwhich was breakdown of an inferior gluteal artery perforator flap perineal reconstruction. All patients had negative margins at post-operative histopathology. All patients are alive and recurrence free at follow-up, but long-term outcome data is needed. This initial case series suggest that minimally invasive pelvic exenterationcan feasibly be performed in place of open pelvic exenteration. Furthermore, our findings suggest this may be a safe alternative as we report similar findings to the existing literature, however no firm conclusions can be drawn at such an early stage. Long term follow-up data and a larger cohort study will be needed to establish non-inferiority to open PE.

International audience; We present the first long-term characterization of ionization layers in the lower ionosphere of Mars (below ∼90 km), a region inaccessible to orbital in-situ observations, based on an analysis of radar echo blackouts observed on Mars Express and the Mars Reconnaissance Orbiter from 2006 to 2017. A blackout occurs when the expected surface reflection is partly or totally attenuated for portions of an observation. Enhanced ionization at altitudes of 60-90 km, below the main ionospheric electron density peak, leads to increased absorption of the radar signal, resulting in the blackouts. We find that (a) MARSIS, operating at frequencies between 1.8 and 5 MHz, suffered more blackouts than SHARAD, which has a higher carrier frequency (20 MHz), (b) there is a clear correlation of blackout occurrence with solar cycle, (c) there is no apparent relationship between blackout occurrence and crustal magnetic fields, and (d) blackouts occur during both nightside and dayside observations, although the peak occurrence is deep on the nightside. Analysis of Mars Atmosphere and Volatile EvolutioN Solar Energetic Particle electron counts between 20 and 200 keV demonstrates that these electrons are likely responsible for attenuating the radar signals. We investigate the minimum SEP electron fluxes required to ionize the lower atmosphere and produce measurable attenuation. When both radars experience a blackout, the SEP electron fluxes are at their highest. Based on several case studies, we find that the average SEP spectrum responsible for a blackout is particularly enhanced at its higher energy end, that is, above 70 keV.

INTRODUCTION AND OBJECTIVE:The European Association of Urology recommend post-operative venous thromboembolic prophylaxis for 28 days for patients following radical cystectomy. Currently, subcutane...

OBJECTIVES To report clinical and functional outcomes for patients who have undergone salvage robot-assisted seminal vesicle excision (RA-SVE) for the focal treatment of isolated seminal vesical (SV) recurrence after treatment for prostate cancer by low-dose-rate brachytherapy. PATIENTS AND METHODS Patients with rising prostate-specific antigen (PSA) after low-dose-rate prostate brachytherapy (LDR-PB) underwent multi-parametric magnetic resonance imaging (mp-MRI) of the prostate and 11 C-Choline or 68 Ga-prostate-specific membrane antigen (68 Ga-PSMA) positron emission tomography/computed tomography (PET/CT) scan, followed by targeted transperineal biopsy of the prostate and SVs. Isolated SV recurrence were identified in 17 (0.38%) LDR-PB patients. These 17 patients were offered RA-SVE. RESULTS The median total operative time was 90 min and blood loss 50 mL with no postoperative transfusions required. The median hospital stay was 1 day. No intra- or postoperative complications were documented. Continence status was unaffected, no patient required urinary pads. Postoperative pathology confirmed SV invasion in all specimens. Surgical margins were positive in seven (41%) patients. All patients had at least one positive imaging study, although three (18%) mp-MRI and five (29%) PET/CT assessments were negative. One (6%) pre-SVE biopsy was also negative but with positive imaging. Salvage SVE failure, defined as three consecutive PSA rises or the need for further treatment, occurred in six patients of whom three had a positive margin. Overall failure-free survival rates were 86%, 67%, and 53% at 1, 2, and 3 years after SVE, respectively. CONCLUSIONS Salvage RA-SVE appears to be a safe focal treatment, with very low morbidity, for patients with localised SV recurrence after LDR-PB. It permits deferral of androgen deprivation therapy in selected patients. Bilateral SVE is mandatory. This surgical option should be considered in patients with isolated prostate cancer recurrence to the SV.

Building on one decade of theory and methodology maturation, we investigate the coherent and incoherent components of the response of the Martian surface to nadir-looking orbital radar. We apply a reflectometry technique known as radar statistical reconnaissance to Mars Reconnaissance Orbiter Shallow Radar data over a test region with a large dynamic range in echo strength. This technique provides a set of statistical parameters describing the heterogeneity of the surface and near-surface structure, presumably at a scale of ∼15 m. We discuss the physical meanings of these parameters related to surface and near-surface properties. Most (but not all) investigated terrains have a dominantly coherent surface return, a characteristic that is not necessarily indicative of a smooth surface. The observed behavior of the coherent and incoherent power components of the echo matches signal growth with increasing surface roughness. This finding allows us to identify smooth and level terrains that we use as a reference to approximate the surface height and slope variations of other regions. Nearly systematic mismatches between the SHARAD and MOLA-pulse-width roughness illustrate the complementarity of these data sets from their respective sensitivity range, and advocate for the use of self-affine radar backscattering models to account for roughness variations at different scales. Our methodology provides a wealth of surface properties assessment based on radar scattering with quasi-global coverage, without a dependence on other data, and at a decametric horizontal scale relevant to subregional geology investigation and landing site reconnaissance.

Bifacial photovoltaic (PV) modules can absorb light from both front and rear sides of the module, resulting in an additional gain of ~ 10-15% in output. The additional gain depends on the amount of reflected light (albedo) reaching the rear side. This is highly depended on the local site layout, ground cover, distance between modules and the ground, distance between modules in a row and the distance between the rows. There is lot of uncertainty in energy forecast due to the variabilities of albedo due to all these factors. These uncertainties are a hindrance in adoption of bifacial modules in the industry and hence have attracted lot of research interest recently. Measurement of soiling loss in bifacial modules is another area that is very important and suffers from uncertainties in the albedo at a site. The problem is compounded due to a slight spectral mismatch between the front and rear side, and anticipated differences in the rate of soiling on two sides. In this paper we report on experiments using two identical half cut cell bifacial PV modules in Logan, UT for about 6 months during June-December 2020. The short circuit current of the two modules has been measured along with the supporting measurements of incident and reflected light intensity underneath each module. A method is proposed to separate the contributions to module output from front and rear sides. The soiling loss on both sides can also be calculated separately, using this method. The soiling loss is dominated by soiling on the front side as expected. The soiling loss on the rear side is minimal and may be affected by the spatial variations in the albedo across the two modules under comparison.

Past and future trends in the frequency of high-danger fire weather conditions have been analysed for the UK. An analysis of satellite-derived burned area data from the last 18 years has identified the seasonal cycle with a peak in spring and a secondary peak in summer, a high level of interannual variability, and a lack of a significant trend despite some large events occurring in the last few years. These results were confirmed with a longer series of fire weather indices back to 1979. The Initial Spread Index (ISI) has been used for spring, as this reflects the moisture of fine fuel surface vegetation, whereas conditions conducive to summer wildfires are hot, dry weather reflected in the moisture of deeper organic layers which is encompassed in the Fire Weather Index (FWI). Future projections are assessed using an ensemble of regional climate models from the UK Climate Projections, combining variables to derive the fire weather indices. The results show a large increase in hazardous fire weather conditions in summer. At 2 ∘C global warming relative to 1850–1900, the frequency of days with “very high” fire danger is projected to double compared to the recent historical period. This frequency increases by a factor of 5 at 4 ∘C of global warming. Smaller increases are projected for spring, with a 150 % increase for England at 2 ∘C of global warming and a doubling at 4 ∘C. A particularly large projected increase for late summer and early autumn suggests a possible extension of the wildfire season, depending on fuel availability. These results suggest that wildfire can be considered an “emergent risk” for the UK, as past events have not had widespread major impacts, but this could change in future, with adaptation actions being required to manage the future risk. The large increase in risk between the 2 and 4 ∘C levels of global warming highlights the importance of global efforts to keep warming below 2 ∘C.

This paper demonstrates how to use pressure data from offset wells to assess fracture growth and evolution through each stage by quantifying the impacts of nearby parent well depletion, completion design, and formation. Production data is analyzed to understand the correlation between fracture geometries, well interactions, and well performance. The dataset in this project includes three child wells and one parent well, landed within two targets of the Wolfcamp B reservoir in the Midland Basin. The following workflow helped the operator understand the completion design effectiveness and its impact to production:Parent well pressure analysis during completionIsolated stage offset pressure analysis during completionOne-month initial production analysis followed by one month shut-inPressure interference test: sequentially bringing wells back onlineProduction data comparison before and after shut-in period An integrated analysis of surface pressure data acquired from parent and offset child wells during completions provides an understanding of how hydraulic dimensions of each fracture stage are affected by fluid volume, proppant amount, frac stage order of operations, and nearby parent well depletion. Production data from all wells was analyzed to determine the impact of depletion on child well performance and to investigate the effects of varying completion designs. A pressure interference test based on Chow Pressure Group was also performed to further examine the connectivity between wells, both inter- and intra-zone. Surface pressure data recorded from isolated stages in the offset child wells during completions was used to resolve geometries and growth rates of the stimulated fractures. Asymmetric fracture growth, which preferentially propagates toward the depleted rock volume around the parent well, was identified at the heel of the child well closest to the parent. Fracture geometries of various child well stage groups were analyzed to determine the effectiveness of different completion designs and the impact of in situ formation properties. Analysis of parent well surface pressure data indicates that changing the completion design effectively reduced the magnitude of Fracture Driven Interactions (FDIs) between child and parent wells. Child well production was negatively impacted in the wells where the fracture boundary overlapped with the parent well depleted volume in the same formation zone. This study combines pressure and production analyses to better understand inter- and intra-zone interference between wells. The demonstrated workflow offers a very cost-effective approach to studying well interference. Observing and understanding the factors that drive fracture growth behavior enables better decision-making during completion design planning, mitigation of parent-child communication, and enhancement of offset well production.

Objective To evaluate urology patient satisfaction with telephone consultations during the COVID-19 pandemic. Methods All patients who received a telephone appointment in a 1-month period were invited to complete a questionnaire. An adaption of the Telehealth Satisfaction Scale (TeSS) was used. Patient responses were compared based on type of clinic, age and gender. Results 119 questionnaires were completed. The majority of responses to the adapted TeSS (Q1–7) were graded as ‘Excellent’, ranging from 79 (66%) to 112 (94%). ‘Agree’ responses ranged from 92 (77%) to 117 (98%) for questions (Q8–12), indicating high satisfaction. Patients consulted in post radical prostatectomy and PSA surveillance clinics gave a significantly greater number of ‘Excellent’ or ‘Agree’ responses. Older age was associated with a significantly greater number of ‘Agree’ responses to one item only. Responses were not affected by gender. Conclusion Our study demonstrates high overall satisfaction with the use of telephone consultations among urology patients. For some patients, telephone consultations are more suitable and may be utilised more frequently in the future. However, it is clear that in selected cases face-to-face consultations are required for safe, comprehensive clinical assessment.

OBJECTIVE To assess treatment satisfaction and decision regret post robot-assisted radical prostatectomy (RARP) and correlate these with clinical, demographic and quality of life indicators. Our study took place at a high-volume United Kingdom center and patients were assessed at a minimum of 18 months postsurgery. METHODS Patients who underwent RARP between June 2011 and May 2016 were invited to participate through mailed questionnaires. A total of 207 patients formed our cohort. The questionnaires included European Organization for Research and Treatment of Cancer Quality of Life of Cancer patients 30 and PR25 modules, sexual health inventory in men and Likert decisional regret scale. A Decisional Regret Scale score of >15 was used to define an outcome of high decision regret. RESULTS The mean patient age was 63 years and the mean duration of follow up was 36 months. Of the 106 responders, 51 (48%) were fully satisfied with the decision to undergo RARP and 32 (30%) recorded high regret. The mean Decisional Regret Scale score was 11.3. High decision regret associated with the length of time from RARP to questionnaire administration, higher prostate specific quality of life symptom scores and lower sexual and erectile function scores. CONCLUSION Our study represents the first contemporary United Kingdom series assessing decision regret following the management of localised prostate cancer with RARP. Higher regret was seen in one third of patients and was associated with worse disease-specific quality of life, sexual and erectile function measures. To minimize regret, collaborative and detailed discussion should take place pre-operatively when counselling patients about RARP. The potential longevity and impact on quality of life of these side effects should be made clear.

Paramedics have progressed in many developed nations from being primarily a medical transportation service into independent prehospital practitioners, leading to some unique solutions to various issues in public health care policy. Issues such as how to manage increasing Emergency Department (ED) demand have given rise to paramedics establishing specialist roles in non-traditional practice settings (Raven, Tippett, Ferguson, & Smith, 2006).. This is contrasted by the situation in some developing health care systems (according to the WHO), where prehospital care services remain under developed. The more recent contribution to wider public health outcomes made by the emerging paramedic profession needs to be viewed within the context in which it developed. More work needs to be done to describe and understand the contextual nature of the profession, particularly where different roles are performed and training undertaken by prehospital care practitioners. When this context is established, interpreting research conducted in developed systems for use in developing nations may become possible. Furthermore this paper discusses the difficulties in establishing internationally relevant research.

We aim to outline our technique of performing a robotic-assisted bladder diverticulectomy at our institution and report our surgical outcomes. We report the cases of three robotic-assisted bladder diverticulectomies, performed at the Royal Surrey County Hospital during the period of January 2014 to December 2015. Patient was positioned in low dorsal lithotomy position. A 6Fr double-J stent was prophylactically inserted at the start of the procedure. Foley catheter was placed over guide wire into the diverticulum and balloon inflated on the diverticulum neck. We used a transperitoneal extravesical approach to mobilise the distended bladder diverticulum, dissected en bloc and transected at the diverticulum neck in all cases. The bladder was closed in two layers with absorbable sutures. The procedures were uneventful, without post-operative complications and minimal blood loss. The median length of stay was 3 days and all three patients reported a significant improvement in all symptoms with non-significant post-void residuals. Robotic-assisted bladder diverticulectomy is a safe and effective procedure that results in both symptom relief and minimal post-void residuals.

I subscribe to the belief that we actors are craftsmen, and the usual analogy I make, for no particular reason, is to a cabinetmaker. A good cabinetmaker presumably needs to have a set of tools - hammer, level, saw, measuring tape, drill, sander, etc. For an actor, this is technique, the tool belt we carry with us through our lives from which we can pull. It may be a pitch build, or a resonator, or a dialect, or a change of gait, or a set of questions, or even just a good piece of critical thinking. We use these to shape the raw materials we are given - usually a piece of text. Our tools are intangible, but no less necessary.Some see being a craftsperson and an artist as mutually exclusive, but I disagree. I find the framework of craft to be the place where I can shine as an artist - I'm given a set of ground rules, and fellow collaborators with whom I must work, and within those circumstances, I create my art. After all, masons and sculptors, housepainters and impressionists, copywriters and Shakespeare, they all use the same raw materials and tools to create. It is my belief that we actors, as craftspeople, have to determine the artistic value of our work for ourselves. There is artistic possibility in all things, from Hamlet to the latest Chevy Silverado commercial, and the onus is upon me, as a new-minted Master of Fine Arts, to bring that spark to the forefront.