Instituting robotic pediatric urologic surgery in the canadian healthcare system: Evaluating the feasibility and outcomes of robot-assisted pyeloplasty and ureteric reimplantation

Introduction: Robotic pediatric urologic surgery has gained widespread adoption over the last decade. This article describes our experience in instituting the first pediatric urologic robotic surgery program in Canada. We evaluated the feasibility and safety of instituting pediatric robot-assisted urologic surgery and report our early outcomes for robot-assisted pyeloplasty (RAP) and ureteric reimplantation (RUR). Methods: We prospectively evaluated all patients undergoing RAP and RUR by a single surgeon from June 2013 to March 2019. Demographic and clinical data were prospectively collected and included sex, age, and preoperative grade of hydronephrosis or reflux. Descriptive statistics were performed, and comparisons were made using Student’s t-tests where appropriate. Success was defined as resolution or significant improvement of hydronephrosis following RAP and absence of recurrent urinary tract infection (UTI) and/or persistent vesicoureteric reflux (VUR) following RUR. Complications were described using the Clavien-Dindo system. Results: A total of 52 RAPs and 24 RURs were performed with a minimum of six months followup. Forty-five RAP patients met criteria for success, while diagnostic imaging of success in the form of MAG-3 Lasix renograms was documented in the remaining seven for an overall success of 100%. Sixteen RUR patients met criteria for success and seven showed resolution of VUR on imaging following their first UTI, for an overall success rate of 96%. Operative times progressively improved from 204±35 minutes to 121±15 minutes in the RAP group and from 224±52 to 132±39 minutes in the RUR group. In the RAP cohort, one Clavien grade II and four Clavien grade III complications were noted, while three Clavien grade III complications were noted in the RUR cohort. Conclusions: Despite limited case volumes, robotic pediatric urologic surgery can be integrated into the Canadian healthcare system with success rates comparable to reported literature. However, compared to open surgery, RAP and especially RUR warrant further study to ensure lack of significant complications noted in our study

The Impact of Ethnicity and Immigration on Prostate Cancer Mortality in Canada

Despite the prevalence of prostate cancer its pathogenesis remains unclear. Marked differences in mortality rates have been observed between countries, however, it is unclear whether the source of the observed differences is driven by underlying genetics, geographic, or social factors. This thesis investigated the impact of ethnicity and immigration on prostate cancer mortality in Canada using the Canadian Census Health and Environment Cohort. South Asian and East Asian men were seen to be at decreased risk of prostate cancer mortality, while no increased risk was observed in black men. These results affirm studies showing lower risks in Asian men; however, they contradict the previously held notion that black men are at increased risk of aggressive disease. Attempts to study the impact of immigration on prostate cancer mortality were limited by small sample sizes and missing data. Efforts to improve linkages and a longer timespan may allow for future analysis

Erectile dysfunction: a primer for in office management

Introduction: Optimizing erectile dysfunction (ED) remains a clinically significant endeavor as insufficient outcomes from oral, injectable and even surgical approaches to treatment remain less than ideal. In this report, we integrate evolving knowledge and provide an algorithmic approach for the clinician to fine-tune management. Methods: We performed a PubMed and Medline search of Erectile Dysfunction treatment optimization, enhanced patient efficacy for ED, and why men fail ED treatment. All relevant papers for the past two decades were reviewed. Results: Establishing the goals and objectives of the patient and partner while providing detailed instructions for treatment can minimize failures and create an environment that allows treatment optimization. A thorough work-up may identify reversible or contributing causes. We identified several areas where treatment of ED could be optimized. These include; management of associated medical conditions, lifestyle improvements, PDE5 inhibitor prescription strategies, management of hypogonadism and the initiation of intracavernosal injection therapy (ICI). Conclusions: In our view, once a man presents for help to the clinician, use of the simple strategies identified in this review to optimize the tolerability, safety and effectiveness of the selected treatment should result in enhanced patient and partner satisfaction, with improved outcomes

Room-temperature optically detected magnetic resonance of single defects in hexagonal boron nitride

Optically addressable spins in materials are important platforms for quantum technologies, such as repeaters and sensors. Identification of such systems in two-dimensional (2d) layered materials offers advantages over their bulk counterparts, as their reduced dimensionality enables more feasible on-chip integration into devices. Here, we report optically detected magnetic resonance (ODMR) from previously identified carbon-related defects in 2d hexagonal boron nitride (hBN). We show that single-defect ODMR contrast can be as strong as 6% and displays a magnetic-field dependence with both positive or negative sign per defect. This bipolarity can shed light into low contrast reported recently for ensemble ODMR measurements for these defects. Further, the ODMR lineshape comprises a doublet resonance, suggesting either low zero-field splitting or hyperfine coupling. Our results offer a promising route towards realising a room-temperature spin-photon quantum interface in hexagonal boron nitride

Alkalinizing Agents: A Review of Prescription, Over-the-Counter, and Medical Food Supplements.

Introduction Kidney stones affect 1 in every 11 people in the United States each year. There is a significant high recurrence rate without a stone prevention protocol. Alkali citrate is beneficial in decreasing stone recurrence, but due to the cost and gastrointestinal side effects there is a low adherence rate. This study aims to serve as a review of some of the most commonly used alkalizing over‐ the‐ counter supplements that are advertised to prevent and treat kidney stones. Methods Data was gathered by a comprehensive online literature search and company inquiries for kidney stone prevention supplements. An additional informal poll of the authors selected supplements that are most commonly taken by their patients. A total of eight supplements were evaluated for cost, alkali equivalent provided, dosing and regulatory information. Results Eight of the most commonly used supplements were reviewed with a focus on alkalizing agents. Information reviewed revealed dosing recommendations resulting in decreased citrate alkali equivalents per day compared to prescription‐strength potassium citrate. Cost, peer‐reviewed study results and regulatory data were reviewed, tabulated and analyzed. Cost per alkali equivalent was substantially decreased for each supplement compared to the prescribed drug. All supplements were found to be readily available online. Conclusion Over‐ the‐ counter alkalizing agents are available to patients and may be an appropriate alternative to cost prohibitive potassium citrate when treating urolithiasis patients. Additional testing will be necessary in the future to determine the efficacy of these supplements in the treatment and prevention of urinary stone disease

Development, implementation, and evaluation of a competency-based didactic and simulation-focused boot camp for incoming urology residents: Report of the first three years

Introduction: The Royal College of Physicians and Surgeons of Canada’s Competence by Design (CBD) initiative presents curricula challenges to ensure residents gain proficiency while progressing through training. To prepare first-year urology residents (R1s), we developed, implemented, and evaluated a didactic and simulation-focused boot camp to implement the CBD curriculum. We report our experiences and findings of the first three years. Methods: Urology residents from two Canadian universities participated in the two-day boot camp at the beginning of residency. Eleven didactic and six simulation sessions allowed for instruction and deliberate practice with feedback. Pre-and post-course multiple-choice questionnaires (MCQs) and an objective structured clinical exam (OSCE) evaluated knowledge and skills uptake. For initial program evaluation, three R2s served as historical controls in year 1. Results: Nineteen residents completed boot camp. The mean age was 26.4 (±2.8) and 13 were male. Participants markedly improved on the pre- and post-MCQs (year 1: 62% and 91%; year 2: 55% and 89%; year 3: 58% and 86%, respectively). Participants scored marginally higher than the controls on four of the six OSCE stations. OSCE scores remained \u3e88% over the three cohorts. All participants reported higher confidence levels post-boot camp and felt it was excellent preparation for residency. Conclusions: During its first three years, our urology boot camp has demonstrated high feasibility and utility. Knowledge and technical skills uptake were established via MCQ and OSCE results, with participants’ scores near or above those of R2 controls. This boot camp will remain in our CBD curriculum and can provide a framework for other urology residency programs

A Priori Modelling of Fire Test One

Chapter 10 in the book: The Dalmarnock Fire Tests: Experiments and Modelling, Edited by G. Rein, C. Abecassis Empis and R. Carvel, Published by the School of Engineering and Electronics, University of Edinburgh, 2007. ISBN 978-0-9557497-0-4An international round-robin study of fire modelling was conducted prior to the Dalmarnock Fire Tests in order to assess the state-of-the-art of fire modelling in real scenarios. The philosophy behind the Dalmarnock Fire Tests was to provide instrumentation density suitable for comparison to field models and designed the scenario for maximum test reproducibility. Each participating team independently simulated a priori the test using a common detailed description of the compartment geometry, fuel packages, ignition source and ventilation conditions. The aim of the exercise was to forecast the test results as accurately as possible, and not to provide an engineering analysis with adequate conservative assumptions or safety factors. The modelling results and experimental measurements are compared among themselves, allowing for conclusions on the robustness, reliability and accuracy of current modelling practices. The results indicate large scatter and considerable disparity among predicted fires and also differing from the experimental data. The Dalmarnock Fire Test One was benchmarked against a second test to establish the potential experimental variability. The scatter of the simulations is much larger than the experimental error and the experimental variability. The study emphasises on the inherent difficulty of predicting fire dynamics and demonstrates that the main source of scatter is originated in the many degrees of freedom and the uncertainty in the input parameters. The conclusions from the study are made public to encourage debate and exchange of views on the topic of fire modelling

Round-robin study of a priori modelling predictions of the Dalmarnock Fire Test One

Peer-reviewed journal paper published in 2009 about the international modelling exercise conducted in 2006.An international study of fire modelling was conducted prior to the Dalmarnock Fire Test One in order to assess the state-of-the-art of fire simulations using a round-robin approach. This test forms part of the Dalmarnock Fire Tests, a series of experiments conducted in 2006 in a high-rise building. The philosophy behind the tests was to provide measurements in a realistic fire scenario involving multiple fuel packages and non-trivial fire growth, and with an instrumentation density suitable for comparison with computational fluid dynamics models. Each of the seven round-robin teams independently simulated the test scenario a priori using a common detailed description of the compartment geometry, fuel packages, ignition source and ventilation conditions. The aim of the exercise was to forecast the fire development as accurately as possible and compare the results. The aim was not to provide an engineering analysis with conservative assumptions or safety factors. Comparison of the modelling results shows a large scatter and considerable disparity among the predictions, and between predictions and experimental measurements. The scatter of the simulations is much larger than the error and variability expected in the experiments. The study emphasises on the inherent difficulty of modelling fire dynamics in complex fire scenarios like Dalmarnock, and shows that the accuracy to predict fire growth (i.e. evolution of the heat released rate) is, in general, poor

Rapid Redistribution of Synaptic PSD-95 in the Neocortex In Vivo

Most excitatory synapses terminate on dendritic spines. Spines vary in size, and their volumes are proportional to the area of the postsynaptic density (PSD) and synaptic strength. PSD-95 is an abundant multi-domain postsynaptic scaffolding protein that clusters glutamate receptors and organizes the associated signaling complexes. PSD-95 is thought to determine the size and strength of synapses. Although spines and their synapses can persist for months in vivo, PSD-95 and other PSD proteins have shorter half-lives in vitro, on the order of hours. To probe the mechanisms underlying synapse stability, we measured the dynamics of synaptic PSD-95 clusters in vivo. Using two-photon microscopy, we imaged PSD-95 tagged with GFP in layer 2/3 dendrites in the developing (postnatal day 10–21) barrel cortex. A subset of PSD-95 clusters was stable for days. Using two-photon photoactivation of PSD-95 tagged with photoactivatable GFP (paGFP), we measured the time over which PSD-95 molecules were retained in individual spines. Synaptic PSD-95 turned over rapidly (median retention times τ (r) ~ 22–63 min from P10–P21) and exchanged with PSD-95 in neighboring spines by diffusion. PSDs therefore share a dynamic pool of PSD-95. Large PSDs in large spines captured more diffusing PSD-95 and also retained PSD-95 longer than small PSDs. Changes in the sizes of individual PSDs over days were associated with concomitant changes in PSD-95 retention times. Furthermore, retention times increased with developmental age (τ (r) ~ 100 min at postnatal day 70) and decreased dramatically following sensory deprivation. Our data suggest that individual PSDs compete for PSD-95 and that the kinetic interactions between PSD molecules and PSDs are tuned to regulate PSD size