Achieving Benchmarks for National Quality Indicators Reduces Recurrence and Progression in Non-muscle-invasive Bladder Cancer.

BACKGROUND: Noncompliance with evidence-based interventions and guidelines contributes to significant and variable recurrence and progression in patients with non-muscle-invasive bladder cancer (NMIBC). The implementation of a quality performance indicator (QPI) programme in Scotland's National Health Service (NHS) aimed to improve cancer outcomes and reduce nationwide variance. OBJECTIVE: To evaluate the effect of hospitals achieving benchmarks for two specific QPIs on time to recurrence and progression in NMIBC. DESIGN, SETTING, AND PARTICIPANTS: QPIs for bladder cancer (BC) were enforced nationally in April 2014. NHS health boards collected prospective data on all new BC patients. Prospectively recorded surveillance data were pooled from 12 collaborating centres. INTERVENTION: QPIs of interest were (1) hospitals achieving detrusor muscle (DM) sampling target at initial transurethral resection of bladder tumour (TURBT) and (2) use of single instillation of mitomycin C after TURBT (SI-MMC). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The primary and secondary endpoints were time to recurrence and progression, respectively. Kaplan-Meier and Cox multivariable regression analyses were performed. KEY FINDINGS AND LIMITATIONS: Between April 1, 2014 and March 31, 2017, we diagnosed 3899 patients with new BC, of which 2688 were NMIBC . With a median follow up of 60.3 mo, hospitals achieving the DM sampling target had a 5.4% lower recurrence rate at 5 yr than hospitals not achieving this target (442/1136 [38.9%] vs 677/1528 [44.3%], 95% confidence interval [CI] = 1.6-9.2, p = 0.005). SI-MMC was associated with a 20.4% lower recurrence rate (634/1791 [35.4%] vs 469/840 [55.8%], 95% CI = 16.4-24.5, p < 0.001). On Cox multivariable regression, meeting the DM target and SI-MMC were associated with significant improvement in recurrence (hazard ratio [HR] 0.81, 95% CI = 0.73-0.91, p = 0.0002 and HR 0.66, 95% CI = 0.59-0.74, p < 0.004, respectively) as well as progression-free survival (HR 0.62, 95% CI = 0.45-0.84, p = 0.002 and HR 0.65, 95% CI = 0.49-0.87, p = 0.004, respectively). We did not have a national multicentre pre-QPI control. CONCLUSIONS: Within a national QPI programme, meeting targets for sampling DM and SI-MMC in the real world were independently associated with delays to recurrence and progression in NMIBC patients. PATIENT SUMMARY: Following the first 3 yr of implementing a novel quality performance indicator programme in Scotland, we evaluated compliance and outcomes in non-muscle-invasive bladder cancer. In 2688 patients followed up for 5 yr, we found that achieving targets for sampling detrusor muscle and the single instillation of mitomycin C during and after transurethral resection of bladder tumour, respectively, were associated with delays in cancer recurrence and progression.

Gritting One's way to success - Grit explains skill in elite youth soccer players beyond (deliberate) practice.

Practice is one of the most important predictors of skill. To become an expert, performers must engage in practice for a prolonged time to develop the psychological characteristics necessary for outstanding performance. Deliberate practice (DP), that is focused repetitive activities with corrective feedback, is particularly beneficial for skill development. The amount of accumulated DP differentiates experts and novices. However, the predictive strength of DP weakens considerably when it comes to differentiating between differently skilled experts, leaving a way clear for other non-practice related factors to exercise their influence. In this paper, we demonstrate using a large sample (388) of elite youth soccer players that one such factor, the personality trait of grit, predicts expertise level both directly and indirectly. Grittier players accumulated more time in coach-led team practice, the activity, which is arguably closest to DP in team sports, which in turn predicted the skill level. Other practice activities, such as self-led training or playing with peers, were not predictive of skill level, neither were they influenced by grit. Grit, however, continued to exert a direct positive influence on the skill level of players even after accounting for the hours of DP accumulated. Overall, a standard deviation of change in the grit score resulted in at least a third of standard deviation improvement in skill. Our findings highlight the need for the inclusion of additional factors in theoretical frameworks in situations where the predictive power of traditional expertise factors, such as practice, is limited.

A scoping review on developmental activities of girls' and women's sports.

We provide a scoping review of research on athlete development in girls' and women's sports. Our emphasis is on pathways to expertise in the context of deliberate practice theory and associated models, such as the Developmental Model of Sport Participation (DMSP). Despite rationale for sex and gender differences in sport development, there are relatively few studies where the developmental pathways of female elite athletes have been evaluated. We sought to map the scope of the literature on this population over the last 30 years, focusing on measures of practice types and amounts. Following an extensive search of the literature, 32 studies were identified that included all female participants or presented sex/gender disaggregated data. Retrospective methods were commonly used to quantify practice, play and specialization. National-level athletes were the most represented, although there was considerable heterogeneity in sport and expertise-level, making general or comparative judgements challenging. We identified some groups that had accumulated high volumes of practice at a young age, particularly in soccer and gymnastics. Across sports and studies, early majority hours of engagement in the primary sport was the norm. Athletes deviated from predictions in the specialization pathway detailed in the DMSP, by continuing to participate in other sports throughout childhood and adolescence. In addition to highlighting the relative paucity of data pertaining to athlete development pathways in female athletes, we show that the data from these groups deviate from predictions detailed in current models of athlete development.

Hypercalcaemia and acute kidney injury: A rare presentation of seminoma.

Hypercalcaemia is common in patients with malignancy, but is rare in seminoma with only eight cases reported in the literature. We present an unusual case of a 36-year-old man who presented with hypercalcaemia and stage 3 acute kidney injury. He presented initially with headache and malaise, and was found to have markedly deranged blood tests. He underwent a renal biopsy before imaging confirmed an unexpected large abdominal mass, which was confirmed histologically to be a seminoma. He was referred to a tertiary oncology centre, and underwent emergency chemotherapy and radical resection with no evidence of recurrence to this date and with return to normocalcaemia.

Short-term forecasting of the coronavirus pandemic.

We have been publishing real-time forecasts of confirmed cases and deaths from coronavirus disease 2019 (COVID-19) since mid-March 2020 (published at www.doornik.com/COVID-19). These forecasts are short-term statistical extrapolations of past and current data. They assume that the underlying trend is informative regarding short-term developments but without requiring other assumptions about how the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus is spreading, or whether preventative policies are effective. Thus, they are complementary to the forecasts obtained from epidemiological models. The forecasts are based on extracting trends from windows of data using machine learning and then computing the forecasts by applying some constraints to the flexible extracted trend. These methods have been applied previously to various other time series data and they performed well. They have also proved effective in the COVID-19 setting where they provided better forecasts than some epidemiological models in the earlier stages of the pandemic.

Modeling and forecasting the COVID-19 pandemic time-series data.

Objective: We analyze the number of recorded cases and deaths of COVID-19 in many parts of the world, with the aim to understand the complexities of the data, and produce regular forecasts. Methods: The SARS-CoV-2 virus that causes COVID-19 has affected societies in all corners of the globe but with vastly differing experiences across countries. Health-care and economic systems vary significantly across countries, as do policy responses, including testing, intermittent lockdowns, quarantine, contact tracing, mask wearing, and social distancing. Despite these challenges, the reported data can be used in many ways to help inform policy. We describe how to decompose the reported time series of confirmed cases and deaths into a trend, seasonal, and irregular component using machine learning methods. Results: This decomposition enables statistical computation of measures of the mortality ratio and reproduction number for any country, and we conduct a counterfactual exercise assuming that the United States had a summer outcome in 2020 similar to that of the European Union. The decomposition is also used to produce forecasts of cases and deaths, and we undertake a forecast comparison which highlights the importance of seasonality in the data and the difficulties of forecasting too far into the future. Conclusion: Our adaptive data-based methods and purely statistical forecasts provide a useful complement to the output from epidemiological models.

Enhanced Quality and Effectiveness of Transurethral Resection of Bladder Tumour in Non-muscle-invasive Bladder Cancer: A Multicentre Real-world Experience from Scotland's Quality Performance Indicators Programme.

BACKGROUND: Clinical outcomes from non-muscle-invasive bladder cancer (NMIBC) are partly determined by the quality of initial interventions. To improve and standardise treatment for cancer, Scotland implemented a national Quality Performance Indicator (QPI) programme for bladder cancer (BC). OBJECTIVE: To evaluate compliance with specific quality indicators (QIs) related to transurethral resection of bladder tumour (TURBT) and to understand clinical outcomes from NMIBC following the introduction of the QPI programme. DESIGN, SETTING, AND PARTICIPANTS: Within a robust governance framework, 12 mandatory evidence-based QPIs were implemented nationally in April 2014. We report prospectively collected data for all new BC patients (between April 2014 and March 2017). We include follow-up data for 2689 patients. INTERVENTION: The TURBT-related QPIs were (1) using a bladder diagram, (2) single post-TURBT instillation of mitomycin C (SPI-MMC), (3) detrusor muscle (DM) in the specimen, and (4) early re-TURBT in high-risk NMIBC. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: We measured compliance with these QPIs and (1) recurrence rate at first follow-up cystoscopy (RRFFC), (2) rates of residual cancer, and (3) pT2 cancer at re-TURBT. Associations between QPI compliance, tumour features, and outcomes were assessed with multivariable logistic regression models. RESULTS AND LIMITATIONS: Among 4246 new BC patients, SPI-MMC was used in 67% (2029/3023) NMIBC patients. In 1860 NMIBC patients undergoing TURBT, RRFFC, rate of residual cancer, and rate of pT2 at re-TURBT were 13% (116/888), 33% (212/653), and 2.9% (19/653), respectively. SPI-MMC was associated with lower RRFFC, independent of all variables including hospital volume and surgeon. Presence of DM in the specimen halved the likelihood of residual disease in pT1 cancers. The main limitation is the lack of a pre-QPI introduction cohort for comparison. CONCLUSIONS: The implementation of a QI programme in Scotland appears to facilitate high-quality TURBT, which in a real-world setting is associated with low early recurrence/residual cancer and accurate pathological staging. PATIENT SUMMARY: Following the first 3 yr of implementing a novel Quality Performance Indicator (QPI) programme in Scotland, we assessed compliance and outcomes in non-muscle-invasive bladder cancer. Evaluating over 4000 new bladder cancer patients, we found that the QPI programme was associated with low recurrence and accurate staging following the initial transurethral resection of bladder tumour.

Tracking and Comparing Self-Determined Motivation in Elite Youth Soccer: Influence of Developmental Activities, Age, and Skill.

Purpose: Our aim was to determine if self-determined motivation (SDM) in elite, men's soccer changes over time and differs as a function of age, skill-grouping, and engagement in soccer play and practice. We tested predictions from the Developmental Model of Sport Participation (DMSP) regarding relations between practice and play and SDM among both elite and non-elite samples. Methods: Elite youth soccer players in the United Kingdom (n = 31; from the Under 13/U13 and U15 years age groups) completed practice history and motivation questionnaires at time 1 (T1) and ∼2 years later (T2: now U15 and U17 years). Non-elite players (n = 32; from U15 and U17 years) completed the same questionnaires at T2 only. Results: For the elite groups, global SDM decreased over time for the current U17 group (from U15), but no change was seen for the current U15 group (from U13). Age group differences at T2 mirrored these data, with U17 players showing lower global SDM and higher controlled motivation than U15 elites. The non-elite players did not show age group differences, but elites scored higher for global SDM and autonomous motivation than non-elites. The recent hours accumulated in practice negatively correlated with global SDM in elite and non-elite groups, but play was unrelated to measures of motivation. Conclusion: Differences in SDM as a function of age and skill point toward the dynamic nature of these motivations over time, likely a result of proximity to external rewards related to professional status. Although high volumes of practice are related to lower global SDM in both skill groups, the absence of any relations between SDM and soccer play does not support a key prediction related to the DMSP.

Optimal Development of Youth Athletes Toward Elite Athletic Performance: How to Coach Their Motivation, Plan Exercise Training, and Pace the Race.

Elite athletes have invested many years in training and competition to reach the elite level. One very important factor on the road to elite performance is the decision-making process regarding the regulation of effort over time, termed as pacing behavior. The regulation of effort is vital for optimal athletic performance during a single race and over a longer period of time (e.g., a competitive season) as an inadequate regulation could result in a higher risk of injuries, overtraining, and drop-out. Despite this, there is limited knowledge on how young athletes learn and develop the abilities related to pacing. Pacing behavior of athletes develops from childhood throughout adolescence and is thought to be closely connected to physical maturation, the development of pre-frontal cortical related (meta-) cognitive functions, as well as the gathering of experience with exercise tasks. The motivation of an athlete can critically influence how an athlete paces a single race, but also how they distribute their effort over a longer period of time. Coaches are advised to closely monitor the development of pacing behavior during adolescence (e.g., by gathering split times, and related physiological measurement, during training and competition), as well as the underlying factors including physical maturation (meta-) cognitive development and the motivation of young athletes. Furthermore, pacing behavior development could be aided by providing training in which the task, individual, and environment are manipulated. Hereby, presenting athletes with the opportunity to gain experience in situations which closely resemble the perceptual-motor conditions of upcoming competitions.

Coach ratings of skills and their relations to practice, play and successful transitions from youth-elite to adult-professional status in soccer.

Elite soccer players (~15 yr) from professional academies in the UK were rated on technical, tactical, physical and creative skills by coaches at time 1 (T1). Players estimated accumulated hours in soccer practice (coach-led activities) and play (self-led activities) during childhood. Coach-ratings were again collected 2.5 yr later (T2) for players that received a professional contract (~17 yr). Adult-professional status was determined at T3 (~ 20 yr). Skill ratings distinguished across the three "future" groups (academy-only, youth-professional only and adult-professional), for all but creative skill. For players that transitioned to youth-professional, medium sized correlations were noted between childhood practice amounts and technical and creative skill ratings at T1, although practice amounts correlated more strongly with skill ratings at T2. Play amounts were not related to any skills. Within groups of youth elite athletes, domain-specific play in childhood, and to a lesser degree practice, were generally not good discriminators of specific-skills. The effects of sport-specific practice on the development (and discriminability) of skills takes time to emerge. We consider the implications for talent development models and purported links between play and creativity.

Systemic BCG-osis following intravesical BCG instillation for bladder carcinoma.

Intravesical instillation of Bacillus Calmette-Guérin (BCG) has been shown to be an effective form of immunotherapy for bladder cancer. This case report describes a patient who develops systemic BCG-osis following intravesical BCG instillation and demonstrates the importance of being aware of more severe complications associated with BCG immunotherapy.

Getting gritty about practice and success: Motivational characteristics of great performers.

We consider the data reported in the target article with respect to key motivational frameworks and characteristics, including grit and self-determined forms of motivation. Empirical data are reviewed that highlight the relationships between these concepts and practice and success. We highlight the concept of grit as a defining characteristic of the super-elite athletes, in reference to both their continued perseverance in the face of obstacles, as well as the increased motivation seemingly caused by such obstacles or setbacks. We discuss the dynamic nature of motivation with respect to cross-sectional and longitudinal age-related comparisons in athletes. Such research is necessary to better understand the characteristics that are potentially transitory or that are a consequence of success, rather than being causal in nature. In the final section, we provide evidence consistent with a profile of a super-elite athlete that is best defined with respect to coexisting types of motivations that have traditionally been considered both positive and negative with respect to their outcomes. The between group comparisons of highly successful athletes in the target article, is unusual yet important if we are to better understand the psychosocial profiles necessary to succeed, that are unbiased by age, practice, and competition experience.

Carbon dioxide laser treatment of penile intraepithelial neoplasia.

INTRODUCTION & OBJECTIVE: The non-invasive nature of penile intraepithelial neoplasia (PeIN) allows for curative penile sparing therapy and is recommended, in their guidelines, by the European Association of Urology (EAU). Treatment options include topical chemotherapy, immunotherapy, laser treatment, photodynamic therapy and surgical excision. Our primary aim was to evaluate the outcome of carbon dioxide (CO2) laser treatment of penile intraepithelial neoplasia. METHODS: A retrospective review of 47 patients who underwent CO2 laser ablation of PeIN, from May 2008 to June 2015, in our tertiary referral centre was performed. All patients underwent acetic acid mapping and had their lesions ablated with a Lumenis Shaplan CO2 laser device. Patients had regular follow up and further suspicious areas underwent re-biopsy. RESULTS: Forty-seven men had primary PeIN. After laser treatment, 8 men (17%) had a recurrence and the average time to recurrence was 19.4 months. Seven of the eight patients with recurrences, pathologically had further PeIN and one patient developed G1 pT1 disease. These patients underwent further laser treatment, glans resurfacing or local excision. No patients required penectomy. The average length of follow-up was 29 months (rg: 1-76). Penile cancer-specific survival was 100% and overall survival 98%. No patients required re-admission or developed other long-term complications, such as meatal stenosis from their treatment. CONCLUSION: Carbon dioxide laser treatment for penile intra-epithelial neoplasia is effective due to its 100% response rate, low progression rate and lower recurrence rate compared with topical agents. The laser has minimal morbidity with cosmetically acceptable outcomes compared to more invasive resurfacing surgeries.

A field experiment shows that subtle linguistic cues might not affect voter behavior.

One of the most important recent developments in social psychology is the discovery of minor interventions that have large and enduring effects on behavior. A leading example of this class of results is in the work by Bryan et al. [Bryan CJ, Walton GM, Rogers T, Dweck CS (2011) Proc Natl Acad Sci USA 108(31):12653-12656], which shows that administering a set of survey items worded so that subjects think of themselves as voters (noun treatment) rather than as voting (verb treatment) substantially increases political participation (voter turnout) among subjects. We revisit these experiments by replicating and extending their research design in a large-scale field experiment. In contrast to the 11 to 14% point greater turnout among those exposed to the noun rather than the verb treatment reported in the work by Bryan et al., we find no statistically significant difference in turnout between the noun and verb treatments (the point estimate of the difference is approximately zero). Furthermore, when we benchmark these treatments against a standard get out the vote message, we estimate that both are less effective at increasing turnout than a much shorter basic mobilization message. In our conclusion, we detail how our study differs from the work by Bryan et al. and discuss how our results might be interpreted.

Urinary Retention: Catheter Drainage Bag or Catheter Valve?

The management of patients with intractable urinary incontinence presents as a challenging priority in the ageing population. To preserve the antibacterial mechanisms of the bladder, a urine collection that enables the bladder to fill and empty regularly and completely, should be used. This mimics the action of the healthy bladder. We compared the success rates of two widely used urinary-collection systems (catheter with drainage bag or a catheter valve) at our institution for those patients undergoing a trial of void.

Contemporary practice of testicular prosthesis insertion.

OBJECTIVES: To assess the practice of testicular prosthesis insertion (TPI) related to orchidectomy in one geographical region and to identify the difference in the rates of insertion among different age groups. PATIENTS AND METHODS: Males who underwent orchidectomy between 1989 and 2009 were identified from data collected from Scottish Morbidity Records. Patients were classified into six age groups. The TPI rate and relation to original orchidectomy were analysed according to different age groups. RESULTS: In all, 3364 patients underwent orchidectomy in the 20-year period of the study. The most common indications for orchidectomy were atrophy, undescended testes, torsion, and tumour. In the same period, 530 patients had a TPI, with 59.4% of them (316 patients) having TPI at initial surgery, 17.3% (92) as a second surgical procedure, and 22.8% (122) having the TPI without prior history of orchidectomy. Among patients who underwent TPI, postpubertal males were more likely to have simultaneous insertion at the time of orchidectomy than prepubertal males (83% vs 32%; odds ratio 10.44, 95% confidence interval 5.23-20.82; P < 0.01). CONCLUSION: Younger males are more likely to have TPI at a later date. Paediatric urologists should be mindful of the possibility of concurrent TPI at the time of initial scrotal/groin exploration.

Retroperitoneal lymph node dissection (RPLND) for malignant phenotype Leydig cell tumours of the testis: a 10-year experience.

Retroperitoneal lymph node dissection (RPLND) is a prognostic, palliative, and potentially therapeutic procedure for patients with malignant phenotype Leydig cell tumours of the testis. We reviewed the records of patients diagnosed with malignant phenotype Leydig cell tumours of the testis treated by RPLND. Modified template dissection was performed in all cases with extra-template excision of tumour mass in Stage II disease. Routine clinico-radiological follow-up was performed. Six open RPLNDs (1 re-do procedure) were performed on 5 patients diagnosed with Stage I (n = 3) and Stage II (n = 2) malignant phenotype Leydig cell tumour of the testis. Median age = 63 years (range = 55-72). Median peri-operative blood loss = 1500 ml (range = 500-1500 ml). Median operating time = 6 h (range = 4.5-6.5). Two patients with Stage II disease developed post-operative complications of acute kidney injury (n = 1) and pneumonia (n = 1). Median length of stay was 8 days (range = 6-11). RPLND specimens from patients with Stage I were tumour-free, whilst patients with Stage II disease had evidence of metastatic tumour. At latest follow-up (median = 13 months, range = 7-22), no patient with Stage I disease had radiological evidence of recurrence, however the two patients with Stage II disease had died due to tumour recurrence at 13 months and 36 months. RPLND for malignant phenotype Leydig cell testicular tumours appears to be well tolerated. Despite surgery, overall outcomes for Stage II appear to be poor due to the disease phenotype. Larger prospective multi-centre studies are required to determine the definitive criteria for surgery in Stage I disease.

Development of the lymphoedema genito-urinary cancer questionnaire.

The aim of this study was to develop a patient self-report tool to detect symptoms of genital and lower limb lymphoedema in male survivors of genitourinary cancer. The study incorporated the views of patients and subject specialists (lymphoedema and urology) in the design of a patient questionnaire based on the literature. Views on comprehensiveness, relevance of content, ease of understanding and perceived acceptability to patients were collated. The findings informed the development of the next iteration of the questionnaire. The overall view of participants was that the development and application of such a tool was of great clinical value and the Lymphoedema Genito-Urinary Cancer Questionnaire (LGUCQ) has significant potential for further development as a research tool to inform prevalence of this under-reported condition.