Robot-assisted artificial urinary sphincter implantation.

PURPOSE OF REVIEW: The aim of the present manuscript was to provide an overview on the current state of robotic artificial urinary sphincter (AUS) implantation in male and female patients. RECENT FINDINGS: Over the past few years, several series have been reported, with promising outcomes for the most part. This has contributed to expand the use of bladder neck AUS, especially in female patients, which was, until then, hampered by its perioperative morbidity. SUMMARY: Robotic AUS has been developed to overcome the technical challenge of bladder neck implantation in female patients and in specific male subgroups, especially self-catheterizing neurological patients. All the series of robotic AUS implantation published in the past few years reported much lower rates of cuff erosion and AUS explantation than the historical open cohorts suggesting that the robotic approach might become the standard for female AUS implantation. This less morbid approach along with technological improvement of the AUS device may contribute to make it a more popular option in the treatment of female stress urinary incontinence due to intrinsic sphincter deficiency. There are much less data available on robotic bladder neck AUS implantation in male patients.

Current Use of the Artificial Urinary Sphincter in Adult Females.

PURPOSE OF REVIEW: The aim of the present report was to review the recent evidences regarding the use of artificial urinary sphincter (AUS) in adult females. RECENT FINDINGS: While the excellent functional outcomes of AUS in female patients with stress urinary incontinence (SUI) due to intrinsic sphincter deficiency (ISD) have been reported for decades, its use has remained confidential in most countries likely due to its challenging implantation and inherent morbidity. Over the past few years, laparoscopic and, more recently, robotic techniques of AUS implantation in female patients have been described with promising perioperative outcomes. As a result, the use of AUS has increased in several countries. The indications are mostly recurrent or persistent SUI after previous anti-incontinence procedures and neurogenic SUI. Owing to its unique potential to restore continence while maintaining low outlet resistance during the voiding phase, AUS may be of special interest in female patients with detrusor underactivity. High level of evidence data from trials which are underway, along with developments in robotic surgery and technological refinements of the device, may well, almost 50 years after its introduction, give to the AUS its momentum as a major contributor in the female SUI armamentarium. While the use of AUS in female patients has been restricted to some countries and a few high-volume centers, it has started spreading again over the past few years, thanks to the rise of minimally invasive approaches which facilitate its implantation, and this is yielding promising outcomes.

Astronaut medical selection during the shuttle era: 1981-2011.

INTRODUCTION: U.S. astronauts undergo extensive job-related screening and medical examinations prior to selection in order to identify candidates optimally suited for careers in spaceflight. Screening medical standards evolved over many years and after extensive spaceflight experience. These standards assess health-related risks for each astronaut candidate, minimizing the potential for medical impact on future mission success. This document discusses the evolution of the Shuttle-era medical selection standards and the most common reasons for medical dis-qualification of applicants. METHODS: Data for astronaut candidate finalists were compiled from medical records and NASA archives from the period of 1978 to 2004 and were retrospectively reviewed for medically disqualifying conditions. RESULTS: During Shuttle selection cycles, a total of 372 applicants were disqualified due to 425 medical concerns. The most common disqualifying conditions included visual, cardiovascular, psychiatric, and behavioral disorders. During this time period, three major expert panel reviews resulted in refinements and alterations to selection standards for future cycles. DISCUSSION: Shuttle-era screening, testing, and specialist evaluations evolved through periodic expert reviews, evidence-based medicine, and astronaut medical care experience. The Shuttle medical program contributed to the development and implementation of NASA and international standards, longitudinal data collection, improved medical care, and occupational surveillance models. The lessons learned from the Shuttle program serve as the basis for medical selection for the ISS, exploration-class missions, and for those expected to participate in commercial spaceflight.

Urologist-perceived barriers and perspectives on the underuse of sacral neuromodulation for overactive bladder in Canada.

INTRODUCTION: An estimated 18% of Canadians have overactive bladder (OAB), with approximately 24% of those reporting difficulty adhering to pharmacotherapy. To date, there has been no investigation into barriers facing sacral neuromodulation (SNM) as treatment for OAB in Canada. METHODS: Current Canadian Urological Association members were invited to participate in an anonymous survey. Data collected included open-ended and Likert scale responses addressing barriers to referral for SNM. Qualitative analysis used a Theoretical Domains Framework (TDF), while quantitative responses are reported using descriptive statistics. RESULTS: A response rate of 20.4% (n=142) was obtained. Most respondents believed SNM was underused (n=82, 57.7%) compared to only 6.3% (n=9) who believed it was used adequately. The most commonly cited reasons for not offering SNM were lack of availability (n=85, 59.9%), expertise (n=49, 34.5%), and funding (n=26, 18.3%). Participants were neutral regarding confidence to appropriately recommend SNM to patients (median 3, interquartile range [IQR] 2-4) and were not confident to manage patient care and issues related to SNM devices (median 2, IQR 1-3). On thematic analysis using the TDF, the most prevalent barriers to SNM care were related to infrastructure and resources. A lack of trained experts and lack of knowledge related to SNM use were also commonly identified barriers. CONCLUSIONS: In this first study exploring urologist-perceived barriers to SNM referral for medically refractory OAB in Canada, urologists acknowledge that SNM implantation is underused but did not feel confident in recommending SNM appropriately. A lack of trained experts and poor funding were also identified as major barriers to SNM referral.

Syntheses, X-ray crystal structures, and optical, fluorescence, and nonlinear optical characterizations of diphenylphosphino-substituted bithiophenes.

A series of bithiophene derivatives that are either symmetrically disubstituted with two Ph(2)(X)P groups (X = O, S, Se) or monosubstituted with one Ph(2)(X)P group (X = O, S, Se) and an organic functional group (H, CHO, CH(2)OH, CO(2)Me) have been synthesized. The X-ray crystal structures of Ph(2)(Se)P(C(4)H(2)S)(2)P(Se)Ph(2), Ph(2)(O)P(C(4)H(2)S)(2)H, Ph(2)(S)P(C(4)H(2)S)(2)H, and Ph(2)(O)P(C(4)H(2)S)(2)CH(2)OH exhibit very different solid-state structures depending on the type of intermolecular π-π interactions that occur. The compounds have been characterized by electronic absorption and fluorescence studies. Of particular interest is that the quantum yields of Ph(2)(O)P(C(4)H(2)S)(2)H, Ph(2)(O)P(C(4)H(2)S)(2)P(O)Ph(2), Ph(2)(O)P(C(4)H(2)S)(2)CO(2)Me, and Ph(2)(O)P(C(4)H(2)S)(2)CH(2)OH are significantly larger than that of bithiophene (factors of 13, 14, 14, and 22, respectively). This behavior is quite different from that of analogously substituted terthiophenes in which substitution results in only modest increases in the quantum yields over that of terthiophene (factors of 0.94, 2.7, 1.3, and 1.5, respectively). DFT studies of the emission process suggest that modifying the Ph(2)(X)P group affects both the fluorescence and nonradiative rate constants while modifications of the organic substituents primarily affect the nonradiative rate constants. The higher quantum yields of the substituted bithiophenes make them promising for application in organic light-emitting devices (OLED). The optical power limiting (OPL) performances of these Ph(2)(X)P-substituted bithiophenes were evaluated by nonlinear transmission measurements in the violet-blue spectral region (430-480 nm) with picosecond laser pulses. The OPL performances are enhanced by heavier X groups and when by higher solubilities. Saturated chloroform solutions of Ph(2)(O)P(C(4)H(2)S)(2)H and Ph(2)(S)P(C(4)H(2)S)(2)H exhibit significantly stronger nonlinear absorption than any previously reported compounds and are promising candidates for use in broadband optical power limiters.

Conservatism Gets Funded? A Field Experiment on the Role of Negative Information in Novel Project Evaluation.

The evaluation and selection of novel projects lies at the heart of scientific and technological innovation, and yet there are persistent concerns about bias, such as conservatism. This paper investigates the role that the format of evaluation, specifically information sharing among expert evaluators, plays in generating conservative decisions. We executed two field experiments in two separate grant-funding opportunities at a leading research university, mobilizing 369 evaluators from seven universities to evaluate 97 projects, resulting in 761 proposal-evaluation pairs and more than $250,000 in awards. We exogenously varied the relative valence (positive and negative) of others' scores and measured how exposures to higher and lower scores affect the focal evaluator's propensity to change their initial score. We found causal evidence of a negativity bias, where evaluators lower their scores by more points after seeing scores more critical than their own rather than raise them after seeing more favorable scores. Qualitative coding of the evaluators' justifications for score changes reveals that exposures to lower scores were associated with greater attention to uncovering weaknesses, whereas exposures to neutral or higher scores were associated with increased emphasis on nonevaluation criteria, such as confidence in one's judgment. The greater power of negative information suggests that information sharing among expert evaluators can lead to more conservative allocation decisions that favor protecting against failure rather than maximizing success.

Syntheses, and optical, fluorescence, and nonlinear optical characterization of phosphine-substituted terthiophenes.

Earlier studies of phosphine-substituted terthiophenes have demonstrated that some of these materials exhibit nonlinear absorption at 532 nm. However, this wavelength is significantly removed from the linear absorption maxima of the complexes, suggesting that better nonlinear absorption might be observed at wavelengths closer to the linear absorption maxima. To investigate this possibility, a library of compounds has been prepared either by varying the group attached to the nonbonding pair of electrons on the phosphorus atoms of 5,5''-bis(diphenylphosphino)-2,2':5',2''-terthiophene (PT(3)P), or by introducing additional substituents on the 5''-position of 5-(diphenylphosphino)-2,2':5',2''-terthiophene (PT(3)). All these compounds have been characterized using multinuclear NMR, UV-vis, and fluorescence spectroscopy. The compounds are strongly fluorescent, and both the fluorescence wavelength and the intensity depend upon the thiophene substituents. The nonlinear optical properties have also been evaluated at various wavelengths in the blue region. Each compound exhibits reverse saturable absorption, and the intensity of the reverse saturable absorption at a particular wavelength depends on the chemical structure of the compound.

Permanent Medical Grounding in Royal Canadian Air Force Pilots (20082017).

BACKGROUND: The aim of this retrospective registry study was to review the medical causes of RCAF pilot permanent grounding during the period 20082017 and to compare our findings to the previous study of 19781987 to determine if disease patterns had changed.METHODS: Material was obtained from the RCAF 1 Canadian Air Division Surgeons' medical registry of military pilots. Anonymized data for permanently grounded pilots were classified by medical diagnosis, age, and training status.RESULTS: During the period 20082017, there were a total of 162 pilots permanently grounded, of which 110 were trained and 52 untrained.DISCUSSION: In comparison to the 1991 study, there has been a decrease in permanent groundings due cardiovascular disease, but an increase due to mental health conditions, musculoskeletal issues, and motion sickness.Haworth D, Gray G, Zoltenko R, Bashirzadeh AJ. Permanent medical grounding in Royal Canadian Air Force pilots (20082017). Aerosp Med Hum Perform. 2021; 92(11): 913-918.

Accuracy and safety of partial thickness femtosecond laser radial and arcuate keratotomy incisions in porcine eyes.

BACKGROUND: To evaluate the accuracy and safety of micro radial and arcuate keratotomy incisions constructed by a femtosecond laser system with a curved contact patient interface in porcine eyes. METHODS: Partial thickness micro radial and arcuate keratotomy incisions were constructed in porcine eyes with a femtosecond laser system and evaluated for precision of depth, quality, and consistency. Optical coherence tomography was used to determine the accuracy and precision of incision depth. Corneal endothelial safety was assessed by a fluorescent live/dead cell viability assay to demonstrate laser-induced endothelial cell loss. Quality was evaluated by ease of opening and examination of interfaces. RESULTS: In two micro radial incision groups, intended incision depths of 50% and 80% resulted in mean achieved depths of 50.01% and 77.69%, respectively. In three arcuate incision groups, intended incision depths of 80%, 600 µm or 100 µm residual uncut bed thickness resulted in mean achieved depths of 80.16%, 603.03 µm and residual bed of 115 µm, respectively. No loss of endothelial cell density occurred when the residual corneal bed was maintained at a minimum of 85-116 µm. The incisions were easy to open, and interfaces were smooth. CONCLUSIONS: A femtosecond laser system with curved contact interface created precise and reproducible micro radial and arcuate keratotomy incisions. Accuracy and precision of the incision depth and preservation of endothelial cell density demonstrated the effectiveness and safety of the system.

Correlation between aflatoxin contamination and various USDA grade categories of shelled almonds.

The California almond industry is interested in determining if there is a correlation between aflatoxin contamination and almonds classified into various U.S. Department of Agriculture (USDA) grades. A 12 000 g sample was taken from each of 50 lots of shelled almonds. The almonds in each sample were then partitioned into five USDA grades: high quality (HQ), insect damage (ID), mold damage (MOD), mechanical damage (MED), and other defects (OD). Across all 50 samples, kernels in the HQ grade accounted for 83.7% of the kernel mass and 3.2% of the aflatoxin mass. Conversely, kernels in the remaining four damage grades (ID, MOD, MED, and OD) accounted for 16.3% of the kernel mass and 96.8% of the aflatoxin mass. ID kernels had the highest risk for aflatoxin contamination. Almonds in the ID grade accounted for 76.3% of the total aflatoxin mass and 7.2% of the kernel mass. Regression equations were developed to predict the aflatoxin concentration in each 12 000 g sample by measuring the aflatoxin mass in one or more of the four damage grades. Regression equations demonstrated that aflatoxin mass only in the insect damaged kernels was also an effective way to predict the aflatoxin concentration in each 12 000 g sample.

Clinical risk management approach for long-duration space missions.

INTRODUCTION: In the process of crewmember evaluation and certification for long-duration orbital missions, the International Space Station (ISS) Multilateral Space Medicine Board (MSMB) encounters a surprisingly wide spectrum of clinical problems. Some of these conditions are identified within the ISS Medical Standards as requiring special consideration, or as falling outside the consensus Medical Standards promulgated for the ISS program. METHODS: To assess the suitability for long-duration missions on ISS for individuals with medical problems that fall outside of standards or are otherwise of significant concern, the MSMB has developed a risk matrix approach to assess the risks to the individual, the mission, and the program. The goal of this risk assessment is to provide a more objective, evidence- and risk-based approach for aeromedical disposition. Using a 4 x 4 risk matrix, the probability of an event is plotted against the potential impact. Event probability is derived from a detailed review of clinical and aerospace literature, and based on the best available evidence. The event impact (consequences) is assessed and assigned within the matrix. RESULTS: The result has been a refinement of MSMB case assessment based on evidence-based data incorporated into a risk stratification process. This has encouraged an objective assessment of risk and, in some cases, has resulted in recertification of crewmembers with medical conditions which hitherto would likely have been disqualifying. CONCLUSIONS: This paper describes a risk matrix approach developed for MSMB disposition decisions. Such an approach promotes objective, evidence-based decision-making and is broadly applicable within the aerospace medicine community.

The history of sacral neuromodulation in Canada.

Sacral neuromodulation (SNM) has been used for the past 30 years, with significant improvements in the implantation technique and technology over the last several years. Canadian centers were involved with this technique from the very beginning by participating in several multicenter clinical trials and engaging in basic and clinical research. Presently, six Canadian centers continue to have SNM implantation programs.

Use of ionically tagged glycosyl donors in the synthesis of oligosaccharide libraries.

We have developed a new procedure based on the random glycosyl reaction of a partially benzoylated glycosyl acceptor with a glycosyl donor containing a 4,6-O-(4-methoxycarbonylbenzylidene) protecting group as a masked/caged ion-tag. Glycosylated products are ionically tagged by saponification of the methyl ester and the use of this anion-tag greatly simplifies the separation of the desired oligosaccharides from unreacted or excess glycosyl acceptors as well as from over-glycosylated oligosaccharides. In addition, the use of partially benzoylated acceptors greatly improves their solubility in dichloromethane increasing the yield of product formation and, also, of altering the distribution of positional isomers in favor of products derived by reaction of the donors at hydroxyl groups which otherwise would be considerably less reactive. Using this new approach in random glycosyl reactions, several oligosaccharide libraries were readily prepared in overall yields of 60-70% and the individual positional isomers present in the libraries were identified using the 'reductive-cleavage' method.

Femtosecond laser-assisted capsulotomy with capsular marks for toric IOL alignment: Comparison of tensile strength with standard femtosecond laser capsulotomy.

PURPOSE: To compare the capsulotomy rim strength with capsular marks (CMs) to the rim strength without CMs in porcine eyes, and to demonstrate the practicality of CMs for intraoperative toric intraocular lens (IOL) alignment. SETTING: LENSAR facility, Orlando, Florida, USA. DESIGN: Laboratory study. METHODS: The biomechanical strength of the capsulotomy with CMs was tested under two different load orientations (orthogonal to or in-line with CMs). Thirty-six porcine eyes were randomly assigned to three treatment cohorts: (1) standard capsulotomy with no CMs, (2) capsulotomy with CMs for in-line tensile testing and (3) capsulotomy with CMs for orthogonal tensile testing. Study parameters were capsulotomy break force and maximum extensibility. The ease of using CMs for toric IOL alignment was also evaluated. RESULTS: There was no significant difference between the mean break force for standard capsulotomy (180.57 mN ± 22 [SD]), capsulotomy with CMs with orthogonal load (178.04 ± 20 mN, P = 1.000), and with in-line load (181.05 ± 15 mN, P = 1.000). Likewise, the mean extensibility at the break point for standard capsulotomy (6.47 ± 0.33 mm) was equivalent to the mean extensibility with CMs with orthogonal load (6.49 ± 0.45 mm, P = 1.000) and with in-line load (6.3 ± 0.47 mm, P = .960). In the implanted eyes, toric IOLs were found to be easily aligned with the CMs. CONCLUSION: The femtosecond laser capsulotomies with CMs were equivalent in tensile strength and extensibility to standard femtosecond laser capsulotomies and showed high potential for effective alignment of toric IOLs.

An introduction to aviation cardiology.

The management of cardiovascular disease (CVD) has evolved significantly in the last 20 years; however, the last major publication to address a consensus on the management of CVD in aircrew was published in 1999, following the second European Society of Cardiology conference of aviation cardiology experts. This article outlines an introduction to aviation cardiology and focuses on the broad aviation medicine considerations that are required to manage aircrew appropriately and optimally (both pilots and non-pilot aviation professionals). This and the other articles in this series are born out of a 3 year collaborative working group between international military aviation cardiologists and aviation medicine specialists, many of whom also work with and advise civil aviation authorities, as part of a North Atlantic Treaty Organization (NATO) led initiative to address the occupational ramifications of CVD in aircrew (HFM-251). This article describes the types of aircrew employed in the civil and military aviation profession in the 21st century; the types of aircraft and aviation environment that must be understood when managing aircrew with CVD; the regulatory bodies involved in aircrew licensing and the risk assessment processes that are used in aviation medicine to determine the suitability of aircrew to fly with medical (and specifically cardiovascular) disease; and the ethical, occupational and clinical tensions that exist when managing patients with CVD who are also professional aircrew.

Assessing aeromedical risk: a three-dimensional risk matrix approach.

Early aeromedical risk i was based on aeromedical standards designed to eliminate individuals ii from air operations with any identifiable medical risk, and led to frequent medical disqualification. The concept of considering aeromedical risk as part of the spectrum of risks that could lead to aircraft accidents (including mechanical risks and human factors) was first proposed in the 1980s and led to the development of the 1% rule which defines the maximum acceptable risk for an incapacitating medical event as 1% per year (or 1 in 100 person-years) to align with acceptable overall risk in aviation operations. Risk management has subsequently evolved as a formal discipline, incorporating risk assessment as an integral part of the process. Risk assessment is often visualised as a risk matrix, with the level of risk, urgency or action required defined for each cell, and colour-coded as red, amber or green depending on the overall combination of risk and consequence. This manuscript describes an approach to aeromedical risk management which incorporates risk matrices and how they can be used in aeromedical decision-making, while highlighting some of their shortcomings.

Management of established coronary artery disease in aircrew without myocardial infarction or revascularisation.

This paper is part of a series of expert consensus documents covering all aspects of aviation cardiology. In this manuscript, we focus on the broad aviation medicine considerations that are required to optimally manage aircrew with established coronary artery disease in those without myocardial infarction or revascularisation (both pilots and non-pilot aviation professionals). We present expert consensus opinion and associated recommendations. It is recommended that in aircrew with non-obstructive coronary artery disease or obstructive coronary artery disease not deemed haemodynamically significant, nor meeting the criteria for excessive burden (based on plaque morphology and aggregate stenosis), a return to flying duties may be possible, although with restrictions. It is recommended that aircrew with haemodynamically significant coronary artery disease (defined by a decrease in fractional flow reserve) or a total burden of disease that exceeds an aggregated stenosis of 120% are grounded. With aggressive cardiac risk factor modification and, at a minimum, annual follow-up with routine non-invasive cardiac evaluation, the majority of aircrew with coronary artery disease can safely return to flight duties.

The challenge of asymptomatic coronary artery disease in aircrew; detecting plaque before the accident.

Coronary events remain a major cause of sudden incapacitation, including death, in both the general population and among aviation personnel, and are an ongoing threat to flight safety and operations. The presentation is often unheralded, especially in younger adults, and is often due to rupture of a previously non-obstructive coronary atheromatous plaque. The challenge for aeromedical practitioners is to identify individuals at increased risk for such events. This paper presents the NATO Cardiology Working Group (HFM 251) consensus approach for screening and investigation of aircrew for asymptomatic coronary disease.A three-phased approach to coronary artery disease (CAD) risk assessment is recommended, beginning with initial risk-stratification using a population-appropriate risk calculator and resting ECG. For aircrew identified as being at increased risk, enhanced screening is recommended by means of Coronary Artery Calcium Score alone or combined with a CT coronary angiography investigation. Additional screening may include exercise testing, and vascular ultrasound imaging. Aircrew identified as being at high risk based on enhanced screening require secondary investigations, which may include functional ischaemia, and potentially invasive coronary angiography. Functional stress testing as a stand-alone investigation for significant CAD is not recommended in aircrew. Aircrew identified with coronary disease require further clinical and aeromedical evaluation before being reconsidered for flying status.

Management of established coronary artery disease in aircrew with previous myocardial infarction or revascularisation.

This manuscript focuses on the broad aviation medicine considerations that are required to optimally manage aircrew with established coronary artery disease (CAD) without myocardial infarction (MI) or revascularisation (both pilots and non-pilot aviation professionals). It presents expert consensus opinion and associated recommendations and is part of a series of expert consensus documents covering all aspects of aviation cardiology.Aircrew may present with MI (both ST elevation MI (STEMI) and non-ST elevation MI (NSTEMI)) as the initial presenting symptom of obstructive CAD requiring revascularisation. Management of these individuals should be conducted according to published guidelines, ideally with consultation between the cardiologist, surgeon and aviation medical examiner. Return to restricted flight duties is possible in the majority of aircrew; however, they must have normal cardiac function, acceptable residual disease burden and no residual ischaemia. They must also be treated with aggressive cardiac risk factor modification. Aircrew should be restricted to dual pilot operations in non-high-performance aircraft, with return to flying no sooner than 6 months after the event. At minimum, annual follow-up with routine non-invasive cardiac evaluation is recommended.