Holmium Laser Enucleation of the Prostate

Introduction: Holmium laser enucleation of the prostate (HoLEP) offers superior voiding outcomes to traditional transurethral resection and less morbidity than open simple prostatectomy. Likewise, HoLEP has been determined to result in excellent outcomes regardless of gland size. We present a step-by-step surgical approach to HoLEP describing both the traditional enucleation technique and a modified “top-down” surgical technique. Materials and Methods: In this video, two techniques are presented that were performed by two (A.E.K., J.E.L.) surgeons at our institution. Results: In the examples of the two enucleation techniques mentioned, outcomes are similar with regard to surgical and functional outcomes. Conclusions: HoLEP as a treatment for BPH with associated lower urinary tract symptoms (LUTS) results in excellent patient outcomes and can be offered to patients regardless of prostate volume

The prevalence and perceptions of bullying in the autistic population: the functionality of social skills training

The current study examined the self-report of bullying experiences and perceptions of high functioning autistic students, as well as the relationship between social functioning and these variables. A sample of 44 children between the ages of 9 and 14 were asked to report their experiences with bullying across educational settings using a revised version of Susan Swearer\u27s The Bully Survey-Student Edition (2001). The students also completed part D of the survey in order to examine their acceptance of bullying behaviors. The social functioning of the children; in particular, their behavioral level and acquisition of particular social skills (conflict resolution, emotional vocabulary), was examined via a teacher completed student-specific survey, as well as daily progress monitoring data. A review of the descriptive data showed a relationship between the students\u27 self-reported prevalences of bullying and their educational setting; in which, students reported less bullying incidences within their current setting as compared to their previous, general educational setting. Using a Pearson-R Correlation, a relationship was not found between the students\u27 mastery of social skills and their perceptions and experiences of bullying. The implications of these results will be discussed for conceptualizing bullying intervention within the autistic population

Best practice in the management of benign prostatic hyperplasia in the patients requiring anticoagulation

In today's aging population, urologists are often treating older patients with multiple comorbidities. Lower urinary tract symptoms from benign prostate hyperplasia (LUTS/BPH) is a common condition that affects men, with increasing prevalence as men age. In a subset of patients, the symptoms are too severe or refractory to medical therapy and, therefore, surgical therapy is required to improve their LUTS. The use of medical therapy often delays the need to intervene surgically in men with LUTS/BPH and with advances in the management of cardiovascular disease, urologists are increasingly encountering more men requiring BPH surgery on chronic anticoagulation therapy. The decision of when to offer surgical intervention and how to manage anticoagulation medication in the perioperative setting is a dilemma with which surgeons are dealing with increasing frequency. The purpose of this review is to clarify the optimal approach to the surgical patient with LUTS/ BPH requiring anticoagulation therapy

Diversidade da educação : avanços e desafios

Orientadora : Márcia Regina FerreiraMonografia (especialização) - Universidade Federal do Paraná, Setor Litoral, Curso de Especialização em Gênero e Diversidade na EscolaInclui referênciasResumo : Entender quais são os avanços percebidos até o momento e o que ainda como profissionais da educação temos para avançar ao tratarmos sobre a diversidade na educação. Considerando que entre nossos pares temos uma grande resistência ao abordarmos esse assunto e que por outro lado temos também muitos profissionais da educação que estão dispostos a evidenciar a importância do respeito ao diferente na escola, colocando em prática todas as qualidades que os sujeitos possuem independentemente de como se apresenta. Ainda, dando a devido importância a receptividade desse sujeito a escola e consequentemente o acesso e a permanência no âmbito escolar. Para tanto realizou-se uma pesquisa no ano de 2015 com a Equipe Pedagógica da Secretaria de Educação de Toledo acerca das temáticas sobre Diversidade. Contudo, os resultados encontrados mostraram a importância de se pensar em novas ações pedagógicas se desejamos que ocorra avanço acerca de novas práticas na educação

Planejamento territorial rural: análise do processo de elaboração de planos diretores em municípios rurais, o caso de Papanduva - Santa Catarina

Dissertação (mestrado) - Universidade Federal de Santa Catarina, Centro Tecnológico. Programa de Pós-Graduação em Arquitetura e Urbanismo.Este trabalho teve como objetivo principal a análise do processo de elaboração do primeiro Plano Diretor de Papanduva, pequeno município predominantemente agrícola localizado no planalto norte catarinense, no período compreendido entre fevereiro e outubro de 2006. A emergência das discussões sobre a importância do mundo rural e suas relações com o urbano, a falta de referencial teórico e prático sobre o planejamento territorial rural e os poucos exemplos de experiências de elaboração de Planos Diretores em municípios rurais, motivaram estas reflexões. Durante a revisão teórica ficou claro que o conceito de ruralidade ainda está em construção, ainda há muito pré-conceito e desconhecimento em relação a este mundo e seus potenciais. O Brasil urbano precisa se voltar para o campo, tratando-o de igual para igual, direcionando seu desenvolvimento para o interior. Ao longo do trabalho são apresentados: a realidade do município de Papanduva, a metodologia utilizada no Plano Diretor, uma análise dos resultados para verificar se a metodologia esteve adequada à realidade agrícola do município e finalmente as conclusões, entre elas, a de que não existe uma única metodologia de planejamento territorial aplicável aos municípios rurais. O que pode haver é uma concepção a partir da realidade rural, que é muito diversa e heterogênea, fazendo um contraponto à concepção excessivamente urbano do Estatuto da Cidade. This work had as main objective the analysis of the process of elaboration of the first Master plan of Papanduva, small-located rural municipal district in the plateau north Santa Catarina, in the period understood between February and October of 2006. The emergency of the discussions about the importance of the rural world and their relationships with the urban, the lack of theoretical and practical referential on the rural territorial planning and the few examples of experiences of elaboration of Master plans in rural municipal districts, they motivated these reflections. During the revision theoretical, of course this concept is still in construction, there are still a lot of pré-concept and ignorance in relation to this fantastic world and of so many potentials. Urban Brazil needs to return for the field, treating him of equal for equal, addressing his/her development for the municipal districts of the interior. Along the healthy work presented the municipal district of Papanduva, the methodology used in the Master plan, an analysis of the results to verify the methodology was adapted to the agricultural reality of the municipal district and finally the conclusions, among them, the that a single applicable methodology doesn't exist to the rural municipal districts. The one that can have is a conception starting from the rural reality, that it is very several and variable in the whole national territory, making a counterpoint excessively to the conception urban of the Statute of the City

Relatório de Estágio Curricular Obrigatório: Área de Clínica Médica de Pequenos Animais

TCC (graduação) - Universidade Federal de Santa Catarina, Campus Curitibanos, Medicina Veterinária.O estágio curricular obrigatório é uma das várias etapas da graduação do Médico Veterinário, e é de grande importância para a sua capacitação profissional, pois é durante o estágio que o acadêmico consegue desenvolver todos os conhecimentos adquiridos durante a faculdade de maneira prática, e também vivencia a rotina clínica do local onde estagia. O presente trabalho tem como objetivo relatar a estrutura e rotina do local de estágio, bem como atividades realizadas, procedimentos acompanhados e a casuística observada durante o período de 11 de abril de 2022 à 15 de julho de 2022, no Hospital Veterinário Vetplus, localizado na cidade de Joinville – SC

Cost-effectiveness analysis of the management of distal ureteral stones in children

Objective To determine the most cost-effective approach to the management of distal ureteral stones in children given the potential for recurrent renal colic during a trial of passage versus potential stent discomfort and complications of ureteroscopy. Methods We developed a decision tree to project costs and clinical outcomes associated with observation, medical explusive therapy (MET), and ureteroscopy for the management of an index patient with a 4mm distal ureteral stone. We determined which strategy would be least costly and offer the most pain-free days within 30 days of diagnosis. We performed a one-way sensitivity analysis on the probability of successful stone passage with MET. We obtained probabilities from the literature and costs from the 2016 Pediatric Health Information System Database. Results Ureteroscopywas the costliest strategy but maximized the number of pain-free days within 30 days of diagnosis ($5,282/29 pain-free days). MET was less costly than ureteroscopybut also less effective ($615/21.8 pain-free days). Observation cost more than MET and was also less effective ($2,139/15.5 pain-free days). The one-way sensitivity analysis on the probability of successful stone passage with MET demonstrated that ureteroscopyalways has the highest net monetary benefits value and is therefore the recommended strategy given a fixed WTP. Discussion Using a rigorous decision-science approach, we found that ureteroscopy is the recommended strategy in children with small distal ureteral stones. Although it cost more than MET, it resulted in more pain-free days in the first 30 days following diagnosis given the faster resolution of the stone episode

Ökologische Bewertung des Risikos von Charophytenverlusten unter ökotoxikologischem Stress in einem mesotrophen See

In Seen treten ebenso wie in Fließgewässern regelmäßig erhebliche Effekte auf, die es nach Umweltqualitätsnormen (UQN) nicht geben dürfte, auch wenn es im konkreten Fall keinen vernünftigen Zweifel an einem ursächlichen Zusammenhang mit diffusen Einträgen von Xenobiotika gibt (Krambeck 2019, 2020, Liess & vd Ohe 2005). Dass reale Risiken unterschätzt werden, ist darauf zurückzuführen, dass die regulatorisch zu postulierende Standardisierung von UQN und Reproduzierbarkeit von Effekten der Komplexität von Ökosystemen nicht gerecht werden kann. Die Notwendigkeit, diesen Widerspruch aufzulösen, ist imKontext mit Fließgewässern häufig thematisiert worden, das Problem bisher aber nicht gelöst, mit der Folge, dass Ziele wie Artenschutz mit über UQN definiertem Handlungsbedarf verfehlt werden. Es soll gezeigt werden, dass sich auf der Grundlage des geradebei Seen soliden Wissens um ökosystemare Zusammenhänge neue Wege der Erkennung und Interpretation von ökotoxikologischen Störungen eröffnen, sich daraus Möglichkeiten einer pragmatischen, d.h. an Plausibilität orientierten und auf sinnvolle Maßnahmen weisenden Risikobewertung ergeben und dass eine Rückkoppelung an regulatorische Routinen möglich ist