Surge-type glaciers in the Tien Shan (Central Asia)

Surge-Type glaciers have been observed in several mountain ranges of the world. Though Karakoram and Pamir are the hot spots for the occurrence of surge-Type glaciers in High Mountain Asia, few surge-Type glaciers also exist in Tien Shan. These have not been studied or reported in detail in the recent literature. We have identified 39 surge-Type glaciers and five tributary surges in Tien Shan either from available literature or by visual interpretation using available images from the period 1960 until 2014. Out of the 39 glaciers, 9 are confirmed as surge-Type, 13 are very probably surge-Type, and the remaining are possibly of surge-Type. Most of the surge-Type glaciers are located in Ak-Shiirak and Central Tien Shan. Compared with the normal glaciers of Tien Shan, the surge-Type glaciers are larger, cover higher ranges of elevations, and have shallower slopes. There is no significant difference in aspect. The largest surge events were observed in Central Tien Shan: North Inylchek Glacier (years 1996/1997) and Samoilowich Glacier (years 1992 until 2006) advanced several kilometers. The surge cycle was around 50 years for both of these glaciers. The advance was less pronounced for all other surge-Type glaciers during the period ca. 1960-2014. Some of the tributary glaciers behaved differently than the main glaciers in the sense that they continuously advanced during the entire period of our study, whereas the main glaciers have remained stable or retreated.Publisher PDFPeer reviewe

clinical recommendations from the european society for sexual medicine exploring partner expectations satisfaction in male and phalloplasty cohorts the impact of penile length girth and implant type reservoir placement and the influence of comorbidities and social circumstances

Abstract Introduction To date, several aspects of inflatable penile prosthesis (IPP) surgical procedure have been poorly studied. Aim The aim of this study was to review the evidence associated with IPP implantation and provide clinical recommendations on behalf of the European Society for Sexual Medicine (ESSM). Overall, 130 peer-reviewed studies and systematic reviews, which were published from 2007−2018 in the English language, were included. Methods MEDLINE and EMBASE were searched for randomized clinical trials, meta-analyses, and open-label prospective and retrospective studies. Main Outcome Measure The panel provided statements exploring patients and partner expectations, satisfaction in male and phalloplasty cohorts, the impact of penile length, girth and implant type, reservoir placement, the influence of comorbidities, and social circumstances. Levels of evidence were provided according to the Oxford 2011 criteria and graded as for the Oxford Centre for Evidence-Based Medicine recommendations. Results In the preoperative setting, it is fundamental to identify and interact with difficult patients with the intention of enhancing the surgeon's ability to establish the surgeon-patient relationship, reduce physical and legal risk, as well as enhancing patient satisfaction. To address this need, the mnemonic Compulsive, Unrealistic, Revision, Surgeon Shopping, Entitled, Denial, and Psychiatric ("CURSED") has been suggested to identify patients who are at high risk of dissatisfaction. The current recommendations suggest improving glycemic control in patients with diabetes. Available evidence suggests evaluating transplant recipients with the criteria of Barry, consisting of stable graft function for >6 months, avoidance of intra-abdominal reservoir placement, and low-dose immunosuppression. HIV status does not represent a contraindication for surgery. Smoking, peripheral vascular disease, and hypertension may be associated with an increased risk of revision surgery. Patients with spinal cord injury may receive IPP. Patients aged ≥70 years, as well as obese patients, can be offered IPP. The IPP implantation can be performed in patients with stable Peyronie's disease. Ectopic high submuscular reservoir placement can be considered as an alternative method. Clinical Implications There is a relevant lack of high-level data and definite conclusions in certain areas remain difficult to draw. Strength & Limitations All studies have been evaluated by a panel of experts providing recommendations for clinical practice. Because of lack of sufficient prospective data, some of the included studies are retrospective and this could be stated as a limitation. Conclusion This ESSM position statement provides recommendations on optimization of patient outcome by patient selection, and individualized peri- and intra-operative management. ESSM encourages centers to collaborate and to create prospective, multicenter registries in order to address this topic of increasing importance. Osmonov D, Christopher AN, Blecher GA, et al. Clinical Recommendations from the European Society for Sexual Medicine Exploring Partner Expectations, Satisfaction in Male and Phalloplasty Cohorts, the Impact of Penile Length, Girth and Implant Type, Reservoir Placement, and the Influence of Comorbidities and Social Circumstances. J Sex Med 2019;XX:XXX–XXX

Masterclass in airways disease: course report.

It is currently a very exciting time in airway disease. With recent pivotal changes in the global directives in the management for both asthma and COPD, new approved treatments and drugs, and innovative approaches in characterising the diseases, the time was right for assembly 5 (airway diseases, asthma and COPD) to undertake a masterclass this year in keeping with the new European Respiratory Society (ERS) continuing professional development initiatives from the Educational Council