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Despite being considered a measure of environmental risk, reported life events are partly heritable. One mechanism that may contribute to this heritability is genetic influences on sensitivity, relating to how individuals process and interpret internal and external signals. The aim of this study was to explore the genetic and environmental overlap between self-reported life events and measures of sensitivity.At age 17, 2,939 individuals from the Twins Early Development Study (TEDS) completed measures of anxiety sensitivity (Children's Anxiety Sensitivity Index), environmental sensitivity (Highly Sensitive Child Scale) and reported their experience of 20 recent life events. Using multivariate Cholesky decomposition models, we investigated the shared genetic and environmental influences on the associations between these measures of sensitivity and the number of reported life events, as well as both negative and positive ratings of life events.The majority of the associations between anxiety sensitivity, environmental sensitivity and reported life events were explained by shared genetic influences (60%-75%), with the remainder explained by nonshared environmental influences (25%-40%). Environmental sensitivity showed comparable genetic correlations with both negative and positive ratings of life events (rDifferences in how individuals process the contextual aspects of the environment or interpret their own physical and emotional response to environmental stimuli may be one mechanism through which genetic liability influences the subjective experience of life events.

Introduction: Computed tomography (CT) scans are associated with increased cost and exposure to radiation when compared to ultrasound (US) in patients presenting with renal colic. Consequently, a Choosing Wisely recommendation from 2014 states that US should be used over CT in uncomplicated presentations of renal colic in patients under the age of 50. The objective of this study was to describe imaging practice patterns in Ontario among patients presenting with renal colic and the relationship between initial imaging modality, subsequent imaging, and burden of care indicators. Methods: This is a population-based study of patients who presented with renal colic in Ontario between 2003 and 2019 using administrative data. Patients were assessed according to the first imaging modality they had during their index visit. Descriptive statistics and the Chi-squared test were used to examine differences between these groups. The primary outcome was the need for subsequent imaging. Secondary outcomes included length of renal colic episode, days to surgery, number of emergency department visits, and number of primary care visits during the renal colic episode. To identify the factors associated with outcomes, both univariate and multivariable logistic regression models were used. Results: A total of 429 060 patients were included in the final analysis. Of those, 50.5% (216 747) had a CT scan as their initial imaging modality, 20% (84 672) had an US, and 3% (13 643) had both a CT and an US on the same day. Subsequent imaging was obtained in 40.7% of those who had a CT scan as the initial imaging, compared to 43% in those who had an US and 43% who had both an US at CT on the same day. Of those who initially had an US, 38% went on to have at least one CT scan during their renal colic episode, including those who had a CT on the same day as the initial US, while 62% were able to avoid a CT scan altogether. In contrast, 17% had a repeat CT after an initial CT at the time of presentation. The overall use of US increased from 15% to 31% during the study period. The length of the renal colic episode was slightly longer in those who had a CT first compared to US in multivariable models (ARR 1.005, 95% confidence interval [CI] 1.000–1.009); however, the time to surgery was less in those who had a CT first (ARR 0.831, 95% CI 0.807–0.856). Fewer emergency department and family physician visits were seen in those who had an initial CT. Conclusions: In patients presenting with renal colic in Ontario, approximately half are having a CT done as the initial imaging modality despite US being the recommended imaging modality in uncomplicated renal colic presentations. While US use remains low, its use doubled during this study period, demonstrating an encouraging trend. Those who have an US done first are often able to avoid subsequent CT scans. Efforts should be made to further promote the use of US in those presenting with renal colic rather than CT when clinically indicated.

BackgroundAnxiety disorders are highly prevalent with an early age of onset. Understanding the aetiology of disorder emergence and recovery is important for establishing preventative measures and optimising treatment. Experimental approaches can serve as a useful model for disorder and recovery relevant processes. One such model is fear conditioning. We conducted a remote fear conditioning paradigm in monozygotic and dizygotic twins to determine the degree and extent of overlap between genetic and environmental influences on fear acquisition and extinction.MethodsIn total, 1937 twins aged 22–25 years, including 538 complete pairs from the Twins Early Development Study took part in a fear conditioning experiment delivered remotely via the Fear Learning and Anxiety Response (FLARe) smartphone app. In the fear acquisition phase, participants were exposed to two neutral shape stimuli, one of which was repeatedly paired with a loud aversive noise, while the other was never paired with anything aversive. In the extinction phase, the shapes were repeatedly presented again, this time without the aversive noise. Outcomes were participant ratings of how much they expected the aversive noise to occur when they saw either shape, throughout each phase.ResultsTwin analyses indicated a significant contribution of genetic effects to the initial acquisition and consolidation of fear, and the extinction of fear (15, 30 and 15%, respectively) with the remainder of variance due to the non-shared environment. Multivariate analyses revealed that the development of fear and fear extinction show moderate genetic overlap (genetic correlations 0.4–0.5).ConclusionsFear acquisition and extinction are heritable, and share some, but not all of the same genetic influences.

Anorexia nervosa is characterized by anxiety-driven behaviors, such as food avoidance and distressing persistent thoughts about weight gain and body image. The present study used a classical fear conditioning procedure to test the processes of fear acquisition and generalization, extinction, and renewal in patients with anorexia nervosa and healthy controls. An app-based fear conditioning procedure was administered remotely to 64 patients and 60 healthy controls, over two sessions. A human female scream served as the unconditioned stimulus (US) and two neutral shapes were used as either the paired conditioned stimulus (danger cue; CS+) or the unpaired conditioned stimulus (safe cue; CS-). Patients with anorexia nervosa reported greater threat expectancy in response to the danger cue during the extinction and renewal phases and overall higher levels of negative affect throughout the task, compared with controls. Future research is warranted to replicate these findings and highlight the role that anxiety plays in explaining fear conditioning responses in patients with anorexia nervosa. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Introduction: Ambulatory percutaneous nephrolithotomy (PCNL) has been limited to highly selected patients. The objective of our study was to compare complication and stone-free rates after ambulatory PCNL in standard selection criteria vs. extended criteria patients. Methods: We conducted a retrospective review of prospective data on all patients who underwent ambulatory PCNL at one academic center from 2007–2018. Extended criteria patients were defined as one or more of: age >75 years, body mass index (BMI) >30 kg/m2, American Society of Anesthesiologists (ASA) >2, bilateral stones, solitary kidney, transplant kidney, complete staghorn calculi, stone burden >40 mm, multiple tracts, or prior nephrostomy tubes/stents. Primary outcomes were complication rates (Clavien-Dindo classification) and stone-free rates. Results: We identified 118 patients, of which 92 (78%) met extended criteria. Mean BMI was 31 kg/m2 and 45% were ASA 3 or higher. Mean sum maximum stone diameter was 24 mm. Multiple stones were present in 25%, bilateral stones in 7%, and complete staghorn stones in 4% of patients. There was no difference in complication (12% vs. 18%, p=0.56), emergency department visit (12% vs. 18%, p=0.56), or re-admission (4% vs. 5%, p=1) rates between standard and extended criteria patients respectively. Of the complications, 85% were Clavien-Dindo grade 1. Stone-free rates were not different between standard (84%) and extended (83%) criteria patients (p=1). No extended criteria variables were associated with complications in multivariable analysis. Conclusions: Complication and stone-free rates were not different between standard and extended selection criteria patients undergoing ambulatory PCNL. This data indicates that many of the preoperative patient and stone factors that have previously been used as exclusion criteria for ambulatory PCNL are not strictly necessary.

Objectives\ud We aimed to examine differences in fear conditioning between anxious and nonanxious participants in a single large sample.\ud \ud Materials and methods\ud We employed a remote fear conditioning task (FLARe) to collect data from participants from the Twins Early Development Study (n = 1,146; 41% anxious vs. 59% nonanxious). Differences between groups were estimated for their expectancy of an aversive outcome towards a reinforced conditional stimulus (CS+) and an unreinforced conditional stimulus (CS−) during acquisition and extinction phases.\ud \ud Results\ud During acquisition, the anxious group (vs. nonanxious group) showed greater expectancy towards the CS−. During extinction, the anxious group (vs. nonanxious group) showed greater expectancy to both CSs. These comparisons yielded effect size estimates (d = 0.26–0.34) similar to those identified in previous meta‐analyses.\ud \ud Conclusion\ud The current study demonstrates that remote fear conditioning can be used to detect differences between groups of anxious and nonanxious individuals, which appear to be consistent with previous meta‐analyses including in‐person studies.

Inequality is important, both for its own sake and for its political, social, and economic implications. However, measuring inequality is not straightforward, as it requires decisions to be made on the variable, population, and distributional characteristics of interest. These decisions will naturally influence the conclusions that are drawn so they must be closely linked to an underlying purpose, which is ultimately defined by a social welfare function. This paper outlines important considerations when making each of these decisions, before surveying recent advances in measuring inequality and suggesting avenues for future work.

Experimental paradigms measuring key psychological constructs can enhance our understanding of mechanisms underlying human psychological well-being and mental health. Delivering such paradigms remotely affords opportunities to reach larger, more representative samples than is typically possible with in-person research. The efficiency gained from remote delivery makes it easier to test replication of previously established effects in well-powered samples. There are several challenges to the successful development and delivery of remote experimental paradigms, including use of an appropriate delivery platform, identifying feasible outcome measures, and metrics of participant compliance. In this paper, we present FLARe (Fear Learning and Anxiety Response), open-source software in the form of a smartphone app and web portal for the creation and delivery of remote fear conditioning experiments. We describe the particular benefits and challenges associated with the creation of a remote delivery platform for fear conditioning, before presenting in detail the resultant software suite, and one particular instance of deploying this using the FLARe research infrastructure. We provide examples of the application of FLARe to a number of research questions which illustrate the particular benefits of the remote approach to experiment delivery. The FLARe smartphone app and web portal are available for use by other researchers and have been designed to be user friendly and intuitive. We hope that FLARe will be a useful tool for those interested in conducting well-powered fear conditioning studies to inform our understanding of the development and treatment of anxiety disorders.

Over the last two decades, minimally invasive surgery (MIS) has emerged as an attractive alternative to traditional open surgical procedures. MIS has been shown to provide excellent surgical outcomes with the added benefit of decreased procedure-related morbidity. Minimal bleeding, reduced blood transfusion rates, shorter hospitalization, and shorter recovery times are all proven advantages for laparoscopic procedures. [1-3] However, many MIS procedures are more technically challenging than the traditional open counterpart, and the learning curve to proficiency is markedly steeper than standard open procedures. Several factors including establishing adequate access, two dimensional vision, decreased depth perception, restricted instrument maneuverability, decreased dexterity and dampened tactile feedback are all unique limitations that make laparoscopic surgery challenging for surgeons trained in traditional open approaches. To the laparoscopically naive surgeon, this translates into a loss of confidence in performing a procedure in which they were previously skilled. Appropriate training and education are therefore essential for a surgeon to develop the necessary skills required in order to comfortably perform a surgery adequately and safely. Unfortunately, resources are limited. Time, monetary and geographical constraints often limit the ubiquitous dissemination of new surgical knowledge, skills and techniques. The inability to provide adequate training opportunities and support for surgeons in the community continues to be the limiting factors determining the success and widespread availability of laparoscopic surgeries. Thankfully, with the ever-increasing push to incorporate technological advances into the medical field, we are now able to overcome these barriers. In this chapter we outline how the recent progress in technology and telecommunication has led to the advent of telemedicine – an ingenious solution to our current problem, which will allow for the widespread availability of MIS and improve patient care.

Introduction This study aims to explore gender-related differences in persistent opioid use following an acute pain episode and evaluate potential explanatory variables. Methods This retrospective population-based study using administrative databases included all opioid-naïve patients in Ontario with renal colic between 2013 and 2017. The primary outcome was to assess any association between persistent opioid use at 3–6 months by gender. Key confounding covariates and explanatory variables examined included both care- and patient-related factors, specifically past evidence of mental health diagnoses. Results The dataset of 64,240 males and 37,656 females demonstrated that 8.7% of males and 9.6% of females had evidence of persistent opioid use 3–6 months after presentation (OR 1.11, 95% CI 1.05, 1.17). Females had a higher incidence of mental health services utilization [44.5% vs 29.6% (p Interpretation After controlling for key covariates, females are at slightly higher risk of demonstrating long term opioid use following an episode of renal colic. Evidence of prior mental health service utilization and acute colic care did not appear to significantly explain these observations.

BackgroundAnxiety disorders are highly prevalent with an early age of onset. Understanding the aetiology of disorder emergence and recovery is important for establishing preventative measures and optimising treatment. Experimental approaches can serve as a useful model for disorder and recovery relevant processes. One such model is fear conditioning. We conducted a remote fear conditioning paradigm in monozygotic and dizygotic twins to determine the degree and extent of overlap between genetic and environmental influences on fear acquisition and extinction.Methods1937 twins aged 22-25 years, including 538 complete pairs from the Twins Early Development Study (TEDS) took part in a fear conditioning experiment delivered remotely via the Fear Learning and Anxiety Response (FLARe) smartphone app.In the fear acquisition phase participants were exposed to two neutral shape stimuli, one of which was repeatedly paired with a loud aversive noise, while the other was never paired with anything aversive. In the extinction phase the shapes were repeatedly presented again, this time without the aversive noise. Outcomes were participant ratings of how much they expected the aversive noise to occur when they saw either shape, throughout each phase.ResultsTwin analyses indicated a significant contribution of genetic effects to the initial acquisition and consolidation of fear, and the extinction of fear (15%, 30% and 15% respectively) with the remainder of variance due to the non-shared environment. Multivariate analyses revealed that the development of fear and fear extinction show moderate genetic overlap (genetic correlations .4-.5).ConclusionsFear acquisition and extinction are heritable, and share some, but not all of the same genetic influences.

We investigate whether the geographic determinants of growth extend to natural amenities. We combine data on spatial and temporal variation in the quality of over 5000 surf breaks globally with data on local economic performance, proxied by night-time lights. We document a strong association between natural amenity quality and local economic development. Economic activity grows faster near good surf breaks; following the discovery of new breaks, or the technology needed to ride them; and during El Niño events that generate high-quality waves. The effects are concentrated in nearby towns and emerging economies, and population changes are consistent with tourism.

Introduction: Crowdfunding is becoming an increasingly used resource for patients to cover costs related to medical care. These costs can be related directly to treatments or indirectly to loss of income or travel-related costs. Little is known as to the extent of which crowdfunding is used for urological disease here in Canada. This study offers a first look at the prevalence of crowdfunding for urological disease and the factors surrounding its use. Methods: In January 2020, we queried the GoFundMe internal search engine for fundraising campaigns regarding urological ailments. Results were categorized according to the major organs of urological disease. Results: Crowdfunding campaigns are very prevalent within several areas of urology. Prostate cancer and chronic kidney disease represent the most frequent reason for campaigns. Fundraising goals and actual funds raised for malignant disease were significantly more than for benign disease. Interestingly, there was a significant portion of crowdfunding campaigns to cover costs for non-conventional treatments and transplant tourism. Conclusion: Crowdfunding use to help cover direct and indirect costs of medical care is becoming increasingly apparent through several facets of medicine. This study shows that this statement holds true when looking at patients with urological disease in Canada. As urologists, we need to be aware of this trend, as it highlights the often-unforeseen financial burdens experienced by our patients.

Introduction: Adolescents and young adults are a vulnerable patient population for development of substance use disorder. However, the long-term impact of opioid prescribing in young adult patients with renal colic is not known. Our objective was to describe rates of opioid prescription and identify risk factors for persistent opioid use in patients age 25 years or younger with renal colic from kidney stones. Methods: Using previously validated linked administrative databases, we performed a population-based retrospective cohort study of opioid-naïve patients age 25 years or younger with renal colic between July 1, 2013 and September 30, 2017 in Ontario. All family practitioner, urgent care, and specialist visits in the province were captured. Our primary outcome was persistent opioid use defined as filling a prescription for an opioid between 91 and 180 days after initial visit. Ontario utilizes a narcotic monitoring system, which captures all opioids dispensed in the province. Results: Of the 6962 patients identified, 56% were prescribed an opioid at presentation and 34% of those were dispensed more than 200 oral morphine equivalents. There was persistent opioid use in 313 (8.1%) patients who filled an initial opioid prescription. In adjusted analysis, those prescribed an opioid initially had a significantly higher risk of persistent opioid use (odds ratio [OR] 1.85, 95% confidence interval [CI] 1.50–2.29) and opioid overdose (OR 3.45, 1.08- 11.04). There was a dose-dependent increase in risk of persistent opioid use with escalating initial opioid dose. History of mental illness (OR 1.32, 1.02- 1.71), and need for surgery (OR 1.71, 1.24- 2.34) were also associated with persistent opioid use. Conclusions: Among patients with kidney stones age 25 years or younger, filling an opioid prescription after presentation is associated with an increased risk of persistent opioid use 3-6 months later and a higher risk of serious long-term complications such as opioid overdose.

Introduction: Partial nephrectomy remains the gold standard in the management of small renal masses. However, minimally invasive partial nephrectomy (MIPN) is associated with a steep learning curve, and optimal, standardized techniques for time-efficient hemostasis are poorly described. Given the relative lack of evidence, the goal was to describe a set of actionable guiding principles, through an expert working panel, for urologists to approach hemostasis without compromising warm ischemia or oncological outcomes. Methods: A three-step modified Delphi method was used to achieve expert agreement on the best practices for hemostasis in MIPN. Panelists were recruited from the Canadian Update on Surgical Procedures (CUSP) Urology Group, which represent all provinces, academic and community practices, and fellowship- and non-fellowship-trained surgeons. Thirty-two (round 1) and 46 (round 2) panellists participated in survey questionnaires, and 22 attended the in-person consensus meeting. Results: An initial literature search of 945 articles (230 abstracts) underwent screening and yielded 24 preliminary techniques. Through sequential survey assessment and in-person discussion, a total of 11 strategies were approved. These are temporally distributed prior to tumor resection (five principles), during tumor resection (two principles), and during renorrhaphy (four principles). Conclusions: Given the variability in tumor size, depth, location, and vascularity, coupled with limitations of laparoscopic equipment, achieving consistent hemostasis in MIPN may be challenging. Despite over two decades of MIPN experience, limited evidence exists to guide clinicians. Through a three-step Delphi method and rigorous iterative review with a panel of experts, we ascertained a guiding checklist of principles for newly beginning and practicing urologists to reference.

INTRODUCTION AND OBJECTIVE:Pediatric and young adults are a vulnerable patient population for development of addiction after opioid exposure. The incidence of pediatric urolithiasis has been steadi...

Introduction: Prior studies have identified significant knowledge gaps in acute and chronic pain management among graduating urology residents as of five years ago. Since then, there has been increasing awareness of the impact of excessive opioid prescribing on long-term narcotic use and development of adverse narcotic-related events. However, it is unclear whether the attitudes and experience of graduating urology residents have changed. We set out to evaluate the attitudes and experience of graduating urology residents in prescribing opioid/non-opioid analgesia for acute (AP), chronic non-cancer (CnC), and chronic cancer (CC) pain. Methods: Graduating urology residents were surveyed at a review course in 2018. The survey consisted of open-ended and close-ended five-point Likert scale questions. Descriptive statistics, Mann-Whitney U-test, and Student’s t-test were performed. Results: A total of 32 PGY5 urology residents completed our survey (92% response rate). The vast majority agreed that formal training in managing AP/CnC/CC to be valuable (91/78/81%). Most find their training in CnC/CC management to be inadequate and are unaware of any opioid prescribing guidelines; 66% never counsel patients on how to dispose of excess opioids. In general, 88% are comfortable prescribing opioids, whereas most are very uncomfortable prescribing cannabis or antidepressants (100%/78%). Residents reported the Acute Pain Service as the highest-rated resource for information, and dedicated textbooks the least. Conclusions: This survey demonstrated that experience in pain management remains variable among urology residents. Knowledge gaps remain, particularly in the management of chronic cancer/non-cancer pain.

We investigate the role of business dynamism in the transmission of monetary policy by exploit- ing the variation in firm demographics across U.S. states. Using local projections, we find that a larger fraction of young firms significantly mutes the effects of monetary policy on the labor market and personal income over the medium term. The firm entry rate and the employment share of young firms are key factors underpinning these results, which are robust to a battery of robustness tests. We develop a heterogeneous-firm model with age-dependent financial frictions that rationalizes the empirical evidence.

Objectives To model renal function 2 years following radical nephrectomy with quantitative analyses using clinical, histopathologic, and renal composite cortical volumes (CCV). Methods This retrospective study involved an assessment of the nonneoplastic kidney tissue by three blinded nephropathologists using modified Banff 1997 criteria for renal allograft pathology. Volumetric image acquisition was obtained by three independent radiologists using preoperative imaging. A 2-year estimated glomerular filtration (eGFR) calculator was created. Results Among the 126 patients, median age was 60 years; median CCV, 398.1 cm3; preoperative eGFR, 77 mL/min/1.73 m2; and 2-year postoperative eGFR, 54 mL/min/1.73 m2. Of the subjects, 64% had hypertension, 26% diabetes, and 37% were smokers. Increasing age, glomerulopathy/sclerosis, tubulointerstitial scarring, and arteriosclerosis were statistically significantly and adversely associated with eGFR. Conversely, increasing CCV was associated with a higher eGFR. Conclusions Quantitative analysis of the nephrectomized kidney in conjunction with patient age can accurately predict renal function at 2 years.

Introduction: We sought to determine whether protocol biopsies could be used to guide treatment and improve outcomes in simultaneous pancreas-kidney (SPK) patients.Methods: Between 2004 and 2013, protocol biopsies were performed on SPK patients at 3–6 months and one year post-transplant. Maintenance immunosuppression consisted of a calcineurin inhibitor, anti-proliferative agent, and corticosteroid. Corticosteroid was withdrawn in negative early biopsies, maintained in subclinical/ borderline biopsies, and increased if Banff IB or greater rejection was identified. Endpoints included presence of interstitial fibrosis and tubular atrophy on biopsy at one year (IF/TA), rejection episodes, and renal and pancreas function at five years’ followup.Results: Forty-one SPK transplant patients were reviewed and a total of 75 protocol biopsies were identified. On early biopsy, 51% had negative biopsies, 44% had borderline rejection, and 5% had subclinical rejection. Renal and pancreas function were not significantly different at one, two, and five years post-transplant between negative vs. borderline early biopsy patients. No difference in the degree of IF/TA was found between these two groups.Conclusions: To our knowledge, this is the first study to evaluate protocol biopsies as an investigative tool prior to steroid withdrawal in SPK patients. Our study suggests that there are no detrimental functional or histological effects at five years post-transplant, despite weaning steroids in the negative biopsy group.

Introduction: Participation in scholarly activity is an important tenet of residency training and is firmly entrenched in Canada since the introduction of CanMEDS roles by the Royal College of Physicians and Surgeons. As Canadian residency programs transition to competency- based training, it will remain important to understand how to best implement and encourage scholarly pursuits among resident trainees. The objective of this study was to understand the experiences, attitudes, and barriers that surgical residents face when pursuing research during their training.Methods: An anonymous, cross-sectional, self-report questionnaire was administered to chief residents of all English-speaking urology programs in Canada in 2015. Questions were open- and close-ended, including an agreement score based on a five-point Likert scale. Questions addressed residents’ involvement in and attitudes towards research, as well as their perceptions of the utility of research involvement during training. The residents were also asked about the support they received and potential areas to improve the attainment of this competency. Descriptive and correlative statistics were used to analyze the responses.Results: There was a 100% overall response rate to the questionnaire. This study revealed that Canadian urology residents have a high rate of participation in scholarly work, with the vast majority (94%) publishing at least one manuscript with a mean of four papers. Despite this, there appeared to be significant variation in the respondent’s experiences, including protected time for research. Furthermore, many residents appeared unconvinced of the importance of research involvement, with only 51% agreement that participation was important to their overall training. As well, a significant number of residents reported largely external, rather than internal, motivations for research participation, such as attaining a preferred fellowship (66% agreement). While the majority of respondents felt (66% agreement) that the scholar role was important in residency training, it would appear that significant barriers, including time and mentorship, limited the effectiveness of research participation to gain those competencies.Conclusions: The results of this self-report survey outline the significant differences in attitudes and experience towards mandatory research as a component of scholarship in Canadian urology training programs. As postgraduate medical education evolves, particularly with the uptake of competency-based medical education, programs and residents will need to address the motives and barriers to better foster academic pursuits during urology training.

Introduction: In recent years, the method of vascular control during laparoscopic donor nephrectomy (LDN) has come under scrutiny due to catastrophic consequences of a device failure. This study sought to examine the surgical preferences of Canadian donor surgeons with regards to vascular control and their perception on the safety of these modalities. We also surveyed the experience with device malfunction and their subsequent management during LDN.Methods: An online survey was sent out to donor surgeons registered with the Canadian Society of Transplantation. Surveys were anonymous and voluntary. Descriptive statistics were used to analyze the collected responses. Recollection of the sequelae and outcomes from device malfunction were also queried.Results: Twenty-eight of 37 surgeons (76% response rate) responded to the survey. At least one surgeon from every institution in Canada performing LDN responded to the survey. Laparoscopic stapler is the most commonly used device for securing the renal artery (61%) and renal vein (67%). Overall, surgeons felt the stapler was the safest method of securing the renal artery. Stapler misfire and clip slippage were reported by eight (28.5%) and 1 2 (43%) surgeons, respectively. Most cases were salvageable: laparoscopically (30%), open conversion (30%), and by hand port (5%). Slippage of a plastic locking clip resulted in one emergent laparotomy on POD#1 and one stapler misfire was converted to open resulting in donor death.Conclusions: Although rare, hemorrhagic complications can occur from device malfunction resulting in poor outcomes for healthy volunteers undergoing LDN. Surgeons need to remain vigilant when selecting the appropriate modality for vascular control.

This paper uses a panel-VAR approach to estimate both the dynamic and structural macroeconomic response of resource-rich, low-income countries to global commodity price shocks. I use a block recursive ordering, as well as a simple Choleski decomposition, to identify structural commodity price shocks for a set of developing countries. The block recursive identification strategy assumes only that global macroeconomic conditions do not respond to individual low-income country conditions contemporaneously. The results suggest that a one standard deviation increase in commodity prices raises per capita income in developing countries by 0.26% and government spending and investment by 4.4% and 12.4%. The effects are larger for less developed countries, economies with fixed exchange rate regimes and those that are more depended on commodity exports. Commodity price shocks also result in significant transformation of these economies, with the share of value-added in manufacturing contracting by 0.17–0.22 percentage points. Whilst these effects may appear small, they represent the effect of exogenous commodity price shocks that are not due to changes in aggregate demand or global financial conditions. This suggests that commodity price movements alone may be less important in explaining the volatility of low-income country growth than other explanations. Taken together, these results present a more nuanced picture of the ‘resource curse’ in poor countries. Whilst per capital income levels are positively affected by resource booms, the potential for de-industrialisation does exist. The channel through which this link operates appears to be the real exchange rate, with resource booms leading to appreciation pressures. To illustrate the relevance of these results, I investigate the impact of the recent oil price collapse on the Nigerian economy.

Background A primary obstacle to providing renal transplantation is limited access to donated kidneys. The living-donor pool for renal allografts was greatly expanded through implementation of a kidney paired donation program. Whereas some programs ship donor kidneys to the site of renal transplantation, others send the donor to the site of transplantation. Performing the nephrectomy and transplantation at the same location may optimize functional renal outcomes, but preferred surgical approaches may differ between surgical teams performing the donor workup and donor surgery. Our objective was to identify incongruence between the surgery planned by the team that performed the donor's workup, and the surgery that took place at the site of donation. Methods A retrospective chart review was performed between the site of preoperative surgical planning, and the site of surgery for kidney donors in the Canadian kidney paired donation program. Results Fifty-one donors were preoperatively prepared in any of six Canadian provinces, and then underwent surgery in a different province. The surgical procedure performed for 31% of the patients' nephrectomies differed from the procedure suggested by the surgical team who conducted the preoperative workup. Half of these differences were between left laparoscopic and left laparoscopic hand-assisted, but the remainder included more substantial changes of sides and/or laparoscopic versus open procedures. Conclusion Optimal patient care is challenged in a kidney paired donation program that uses the “traveling donor” approach due to differing surgical techniques selected by the surgeon at the site of donor workup and the surgeon at the site of donation.

Background and objectives Fear conditioning paradigms use various measures to assess learned fear, including autonomic arousal responses like skin conductance, and self-reports of both associative (US-expectancies) and evaluative (affective ratings) learning. The present study uses a dimensional approach to examine associations among fear indices directly. Methods Seventy-three participants completed a differential fear conditioning experiment, during which a neutral stimulus (CS+) was paired with an electric shock (US), while another stimulus (CS-) was never paired with the shock (partially instructed fear acquisition). Ten minutes later, both stimuli were presented without any shocks (fear extinction). Skin conductance responses and US-expectancy ratings were recorded during each phase, while self-reported negative affect was assessed for each CS at the end of extinction. Results Results showed a positive association among US-expectancy ratings and skin conductance responses during acquisition and early extinction. US-expectancy ratings during overall extinction were positively associated with post-extinction negative affect. Limitations The lack of affective ratings post-acquisition may have obscured associations between associative and evaluative learning indices. Conclusions Results provide evidence for the expected correspondence among different indices of associative fear learning. Findings emphasize the need for incorporating both associative and evaluative learning measures in fear conditioning paradigms., Highlights • Fear conditioning studies use physiological and self-report measures to assess fear. • We examined the association among these indices using a dimensional approach. • Autonomic arousal was associated with US-expectancy ratings. • US-expectancy ratings during extinction predicted post-extinction negative affect. • Results support the need for both associative and evaluative indices of learned fear.

Fear conditioning models key processes related to the development, maintenance and treatment of anxiety disorders and is associated with group differences in anxiety. However, laboratory administration of tasks is time and cost intensive, precluding assessment in large samplesnecessary for the analysis of individual differences. This study introduces a newly developed smartphone app that delivers a fear conditioning paradigm remotely using a loud human scream as an aversive stimulus. Three groups of participants (total n = 152) took part in three studies involving a differential fear conditioning experiment to assess the reliability and validity of a smartphone administered fear conditioning paradigm. This comprised of fear acquisition, generalisation, extinction, and renewal phases during which online US-expectancy ratings were collected during every trial with evaluative ratings of negative affect at three time points. We show that smartphone app delivery of a fear conditioning paradigm results in a pattern of fear learning comparable to traditional laboratory delivery and is able to detect individual differences in performance that show comparable associations with anxiety to the prior group differences literature., Highlights • A smartphone app reliably delivers a differential fear conditioning paradigm using an aversive human scream. • Within-person associations of fear conditioning between laboratory and app delivery do not differ from those across time. • App-based administration is able to detect individual differences in anxiety related processes. • Fear conditioning data can be collected with minimal financial and time cost.

INTRODUCTION AND OBJECTIVES:Pathological upstaged pT3a for Renal Cell Carcinoma (RCC) may have a wide variance in outcomes. We sought to redefine and reclassify pT3a RCC. We investigated recurrence and survival outcomes in pT3a disease and aimed to better categorize this cohort for improvement on current TMN staging.METHODS:Multicenter retrospective analysis of patients with cT1-3aN0M0 RCC who underwent radical or partial nephrectomy. After comparison of outcomes between pT1, pT2 and pT3a, patients were substratified within the pT3a category based on presenting clinical stage. Survival outcomes in T3a RCC were compared based on initial presenting clinical T stage. Comparison was drawn between pT1, pT2 and the subdivided pT3a group (cT1→pT3a, cT2→pT3a, and cT3a→pT3a). Primary outcome was recurrence free survival (RFS). Secondary outcome was overall survival (OS). Multivariable (MVA) and Kaplan-Meier (KM) analysis were conducted to elucidate risk factors and outcomes.RESULTS:We analyzed 2573 patients (1223 ...

PURPOSE: Partial nephrectomy is the preferred method for managing small renal masses. This procedure has significant advantages over radical nephrectomy. However, partial nephrectomy is under-used due to its difficulty. We propose a navigation system for laparoscopic partial nephrectomy. In this study, we evaluate the usability and accuracy of the navigation system. METHODS: An electromagnetically tracked navigation system for partial nephrectomy was developed. This system tracks the positions of the laparoscopic scissors, ultrasound probe, tumor, and calyces and vasculature. Phantom kidneys were created using mixtures of plastisol and cellulose. To test the system, the navigation display quality was measured through measurement of lag and frames per second displayed. The accuracy of the system was determined through fiducial registration. Finally, a study consisting of ten participants was conducted to assess the usability of the navigation system using the System Usability Survey. RESULTS: The mean System Usability Score of the navigation system was 82.5. The navigation display had an average lag of 243 milliseconds and showed 5 frames per second. The accuracy was measured with fiducial registration and found to have an RMS error of 2.84 mm. CONCLUSION: The results of this study suggest that the partial nephrectomy navigation system developed is both usable and accurate. Future work will include the conversion of the laparoscopic scissor tool tracking to optical. Further studies will be conducted to determine the effectiveness of this technology in tumor resection and avoidance of calyx and vasculature damage. We will additionally explore this system as a training tool.

Fear conditioning models key processes related to the development, maintenance and treatment of anxiety disorders and is associated with group differences in anxiety. However, laboratory administration of tasks is time and cost intensive, precluding assessment in large samples, necessary for analysis of individual differences. This study introduces a newly developed smartphone app that delivers a fear conditioning paradigm remotely. Three groups of participants (total n=152) took part in three studies involving a differential fear conditioning experiment to assess the reliability and validity of a smartphone administered fear conditioning paradigm. This comprised of fear acquisition, generalisation, extinction, and renewal phases. We show that smartphone app delivery of a fear conditioning paradigm results in a pattern of fear learning comparable to traditional laboratory delivery, and is able to detect individual differences in performance that show comparable associations with anxiety to the prior group differences literature.

How do oil price movements affect sovereign spreads in an oil-dependent economy? I develop a stochastic general equilibrium model of an economy exposed to co-moving oil price and output processes, with endogenous sovereign default risk. The model explains a large proportion of business cycle fluctuations in interest-rate spreads in oil-exporting emerging market economies, particularly the countercyclicallity of interest rate spreads and oil prices. Higher risk-aversion, more impatient governments, larger oil shares and a stronger correlation between domestic output and oil price shocks all lead to stronger co-movements between risk premiums and the oil price.

Ureteric strictures are the most common urologic complication following renal transplantation. Different management options exist, ranging from temporizing drainage with ureteric stent or percutaneous nephrostomy tube to endoscopic interventions and open surgical repair. Although minimally invasive procedures are typically preferred, they often have a short duration of efficacy and multiple treatments are required. Open surgical repair allows for definitive management with minimal risk to the transplant. We review our experience with complicated ureteral strictures refractory to endoscopic management. We identified 10 renal transplant recipients who developed ureteric strictures that failed multiple endoscopic treatments. All 10 of these strictures were managed by means of pyelovesicostomy with the use of a Boari flap. The median time to ureteric stricture diagnosis was 2.5 months with a median of 4 endoscopic procedures before surgery. Median time from stricture diagnosis to surgical repair was 53 months. Overall success was 100%, with graft function being salvaged in all cases and no stricture recurrence after a mean follow-up of 18 months. We present a case series of complex ureteric strictures after renal transplantation managed by means of pyelovesicostomy with the use of Boari flap after failed endoscopic management. We demonstrate the safety and effectiveness of this approach of to treat complex ureteric strictures.

Objectives To evaluate whether hypothermic machine perfusion (HMP) of transplanted kidneys can improve long-term renal allograft function compared with static cold storage (CS). Methods We evaluated whether graft Doppler ultrasonography resistive indices improved with the use of HMP compared with CS preservation, and examined whether these improvements were predictive of long-term graft function. A total of 30 kidney transplants (15 pairs) were examined. One of the kidney pairs was placed on CS and transplanted first (CS group, n = 15). The other kidney of each pair was placed on HMP and transplanted after the CS group (HMP group, n = 15). Doppler ultrasonography was performed on days 1 and 7 after transplantation and resistive indices were evaluated. The estimated glomerular filtration rate (eGFR) was monitored for 24 months after transplantation. Results Despite longer cold ischaemia times, kidneys maintained with HMP had lower resistive indices (P = 0.005) with correspondingly higher eGFR throughout the follow-up. Subgroup analysis showed that the HMP-induced improvement in postoperative eGFR was greatest in kidneys obtained from donation after cardiac death (DCD), even at 2 years after transplantation (P = 0.008). Conclusions HMP of transplant kidneys appears to improve vascular resistance after transplantation and has a positive impact on long-term allograft function compared with CS in the population of recipients of DCD kidneys.

Introduction: Partial nephrectomy is the gold standard for treatment of small renal masses. Our study compares outcomes for obese (body mass index [BMI] ≥30) and healthy (BMI

SUMMARY Kidney paired donation (KPD) programs are an effort to bridge the disparity between kidney supply and demand. These programs combine several incompatible donor-recipient pairs in a national paired exchange database, thereby increasing the number of compatible matches. But KPD programs face unique challenges, particularly the large distances that often separate donors and recipients. Here we discuss key factors to consider when transitioning from a donor travelling model to a kidney shipment model in the Canadian context.

Ureteric stricture is the most common urologic complication following renal transplantation. Initial treatment should consist of endoscopic management, however patients that fail endoscopic management or strictures that are not amendable to endoscopic management are appropriate candidates for open surgical repair. In this manuscript we describe the steps and surgical technique we use to manage complicated ureteric strictures refractory to endoscopic management at our center. Ureteric re-implant with the use of a Boari flap is a safe, effective and definitive option for repair of ureteric strictures following renal transplantation. This approach provides excellent long term outcomes in terms of renal function preservation and negligible recurrence rates.

Introduction: Renal transplant is the gold standard treatment for end-stage renal disease (ESRD), and the prevalence of both ESRD and renal transplant has been steadily increasing over the past decade. However, involvement of urology in renal transplant has been declining. We examine the current state of urology involvement in renal transplant programs across Canada.Methods: A telephone survey of all surgical transplant centres in Canada was performed. Information regarding the number of transplant surgeons, their individual training background, and their involvement in specific procedures, including open and laparoscopic living donor nephrectomy, deceased donor nephrectomy, and recipient renal transplant were collected.Results: There are 59 Canadian transplant surgeons, including 27 (46%) who completed a urology residency and 32 (54%) with a general surgery background. With regards to procedures performed, 58 (98%) perform recipient renal transplant surgery, 36 (61%) perform laparoscopic donor nephrectomy, and 17 (29%) perform open donor nephrectomy. There was no significant difference in the number of surgeons that perform renal recipient surgery, laparoscopic or open donor nephrectomies, and deceased donor nephrectomies between surgeons of the two different training backgrounds.Conclusions: The role of urology in Canadian renal transplant has declined significantly over the past decade. Given the medical and surgical complexity of renal transplant, along with the growing need for renal transplants, a multidisciplinary team approach is imperative. Strong urology involvement with the transplant team is crucial for optimal care of these complex patients.

We present an unusual complication secondary to indwelling urethral catheter placement. Routine catheter placement by the obstetrics team in a postpartum female leads to retention of the catheter and inability of its removal by both the obstetrics and urology teams. Although a retained urinary catheter is relatively common, inability to remove a catheter secondary to placement inadvertently into a ureter is extremely rare. In this paper we will discuss the options in removing a retained catheter and present our case of a retained catheter secondary to placement within the right proximal ureter.