Approach to endoscopic extraperitoneal radical prostatectomy (EERPE): the impact of previous laparoscopic experience on the learning curve

BACKGROUND: We report our approach regarding the technique of endoscopic extraperitoneal radical prostatectomy (EERPE) and analyze the learning curve of two surgeons after thorough technical training under expert monitoring. The purpose of this study was to investigate the influence of expert monitoring on the surgical outcome and whether previous laparoscopic experience influences the surgeon's learning curve. METHODS: EERPE was performed on 120 consecutive patients by two surgeons with different experience in laparoscopy. An analysis and comparison of their learning curve was made. RESULTS: Median operation time: 200 (110-415) minutes. Complications: no conversion, blood transfusion (1.7%), rectal injury (3.3%). Median catheterisation time: 6 (5-45) days. Histopathological data: 55% pT2, 45% pT3 with a positive surgical margin rate of 6.1% and 46%, respectively. After 12 months, 78% of the patients were continent, 22% used 1 or more pad. Potency rate with or without PDE-5-inhibitors was 66% with bilateral and 31% with unilateral nerve-sparing, respectively. Operation time was the only parameter to differ significantly between the two surgeons. CONCLUSION: EERPE can be learned within a short teaching phase. Previous laparoscopic experience is reflected by shorter operation times, not by lower complication rates or superior early oncological data

Tutorial : Dynamic organic growth modeling with a volatility basis set

Organic aerosols are ubiquitous in the atmosphere and oxygenated organics are a major driver of aerosol growth. The volatility basis set (VBS) as introduced by Donahue et al. (2006, 2011) is often used to simplify the partitioning behavior of the huge variety of atmospheric organics. Recently, the VBS was used to dynamically model aerosol growth from the smallest sizes onwards. This tutorial is intended to equip the reader with the necessary tools to facilitate organic growth modelling based on gas-phase measurements of oxygenated organics using a 2-dimensional VBS. We start with a contextualization of the VBS in partitioning theory and point out the need for dynamic modeling. We provide an overview on the most common methods to estimate the volatility of oxygenated organics and give detailed instruction on how to construct the binned VBS. We then explain the dynamic condensation model including solution and curvature effects. Furthermore, we provide a python package for VBS growth calculations and show with two examples from ambient and chamber measurements how growth rates can be calculated. Last, we summarize the limitation of this approach and outline necessary future developments.Peer reviewe

TEACHING MARKETING AND MANAGEMENT TO AN EXTENSION AUDIENCE IN AN INTER-DISCIPLINARY SETTING

This paper discusses how economists utilize an inter-disciplinary workshop to teach marketing and management concepts to beef cattle producers and beef industry advisors. Range and animal scientists along with economists teach concepts in the classroom and then demonstrate these concepts with hands-on field activities in an 8-day Ranch Practicum, spread over an 8-month period.Teaching/Communication/Extension/Profession,

A DMA-train for precision measurement of sub-10 nm aerosol dynamics

Measurements of aerosol dynamics in the sub-10 nm size range are crucially important for quantifying the impact of new particle formation onto the global budget of cloud condensation nuclei. Here we present the development and characterization of a differential mobility analyzer train (DMA-train), operating six DMAs in parallel for high-time-resolution particle-size-distribution measurements below 10 nm. The DMAs are operated at six different but fixed voltages and hence sizes, together with six state-of-the-art condensation particle counters (CPCs). Two Airmodus A10 particle size magnifiers (PSM) are used for channels below 2.5 nm while sizes above 2.5 nm are detected by TSI 3776 butanol-based or TSI 3788 water-based CPCs. We report the transfer functions and characteristics of six identical Grimm S-DMAs as well as the calibration of a butanol-based TSI model 3776 CPC, a water-based TSI model 3788 CPC and an Airmodus A10 PSM. We find cutoff diameters similar to those reported in the literature. The performance of the DMA-train is tested with a rapidly changing aerosol of a tungsten oxide particle generator during warmup. Additionally we report a measurement of new particle formation taken during a nucleation event in the CLOUD chamber experiment at CERN. We find that the DMA-train is able to bridge the gap between currently well-established measurement techniques in the cluster–particle transition regime, providing high time resolution and accurate size information of neutral and charged particles even at atmospheric particle concentrations

Emissions from Ethanol-Gasoline Blends: A Single Particle Perspective

Due to its agricultural origin and function as a fuel oxygenate, ethanol is being promoted as an alternative biomass-based fuel for use in spark ignition engines, with mandates for its use at state and regional levels. While it has been established that the addition of ethanol to a fuel reduces the particulate mass concentration in the exhaust, little attention has been paid to changes in the physicochemical properties of the emitted particles. In this work, a dynamometer-mounted GM Quad-4 spark ignition engine run without aftertreatment at 1,500 RPM and 100% load was used with four different fuel blends, containing 0, 20, 40 and 85 percent ethanol in gasoline. This allowed the effects of the fuel composition to be isolated from other effects. Instrumentation employed included two Aerosol Time-of-Flight Mass Spectrometers covering different size ranges for analysis of single particle composition, an Aethalometer for black carbon, a Scanning Mobility Particle Sizer for particle size distributions, a Photoelectric Aerosol Sensor for particle-bound polycyclic aromatic hydrocarbon (PAH) species and gravimetric filter measurements for particulate mass concentrations. It was found that, under the conditions investigated here, additional ethanol content in the fuel changes the particle size distribution, especially in the accumulation mode, and decreases the black carbon and total particulate mass concentrations. The molecular weight distribution of the PAHs was found to decrease with added ethanol. However, PAHs produced from higher ethanol-content fuels are associated with NO2 − (m/z—46) in the single-particle mass spectra, indicating the presence of nitro-PAHs. Compounds associated with the gasoline (e.g., sulfur-containing species) are diminished due to dilution as ethanol is added to the fuel relative to those associated with the lubricating oil (e.g., calcium, zinc, phosphate) in the single particle spectra. These changes have potential implications for the health effect impacts of particulate emissions from biofuel blends

On the relation between apparent ion and total particle growth rates in the boreal forest and related chamber experiments

The understanding of new particle formation and growth processes is critical for evaluating the role of aerosols in climate change. One of the knowledge gaps is the ion-particle interaction during the early growth process, especially in the sub-3 nm range, where direct observations are sparse. While molecular interactions would imply faster growth rates of ions compared to neutral particles, this phenomenon is not widely observed in the atmosphere. Here, we show field measurements in the boreal forest indicating a smaller apparent growth rate of the ion population compared to the total particles. We use aerosol dynamics simulations to demonstrate that this effect can be caused by the changing importance of ion-induced nucleation mechanisms during the day. We further compare these results with chamber experiments under similar conditions, where we demonstrate that this effect critically depends on the abundance of condensable vapors and the related strength of ion-induced nucleation. Our results imply that atmospheric ion growth rate measurements below 3 nm need to be evaluated very carefully as they do not represent condensational growth alone but are influenced by ion-particle population interactions.Peer reviewe

Laparoendoscopic single-site and natural orifice transluminal endoscopic surgery in urology: a critical analysis of the literature

CONTEXT: Natural orifice transluminal endoscopic surgery (NOTES) and laparoendoscopic single-site surgery (LESS) have been developed to benefit patients by enabling surgeons to perform scarless surgery. OBJECTIVE: To summarize and critically analyze the available evidence on the current status and future perspectives of LESS and NOTES in urology. EVIDENCE ACQUISITION: A comprehensive electronic literature search was conducted in June 2010 using the Medline database to identify all publications relating to NOTES and LESS in urology. EVIDENCE SYNTHESIS: In urology, NOTES has been completed experimentally via transgastric, transvaginal, transcolonic, and transvesical routes. Initial clinical experience has shown that NOTES urologic surgery using currently available instruments is indeed possible. Nevertheless, because of the immaturity of the instrumentation, early cases have demanded high technical virtuosity. LESS can safely and effectively be performed in a variety of urologic settings. As clinical experience increases, expanding indications are expected to be documented and the efficacy of the procedure to improve. So far, the quality of evidence of all available studies remains low, mostly being small case series or case-control studies from selected centers. Thus, the only objective benefit of LESS remains the improved cosmetic outcome. Prospective, randomized studies are largely awaited to determine which LESS procedures will be established and which are unlikely to stand the test of time. Technology advances hold promise to minimize the challenging technical nature of scarless surgery. In this respect, robotics is likely to drive a major paradigm shift in the development of LESS and NOTES. CONCLUSIONS: NOTES is still an investigational approach in urology. LESS has proven to be immediately applicable in the clinical field, being safe and feasible in the hands of experienced laparoscopic surgeons. Development of instrumentation and application of robotic technology are expected to define the actual role of these techniques in minimally invasive urologic surgery