Using their heads - A novel, collaborative approach between industry and scientists to monitor a commercial mullet fishery as a result of COVID-19 restrictions.

The COVID-19 global pandemic-related restrictions during 2020 severely impacted the Australian seafood industry, including essential scientific monitoring to support stock assessment and to demonstrate sustainability. Here we detail a novel, collaborative monitoring program between scientists and the seafood industry to generate length and age compositions that were representative of one of the largest, most valuable, and controversial fisheries along eastern Australia, the pre-spawning ocean run fishery for Sea Mullet Mugil cephalus that is predominantly a roe fishery. The standard approach to monitoring this fishery has been to base trained scientific staff at the major processing facility for M. cephalus, where they access whole fish from entire catches to generate representative length and age compositions during the peak season, April to May. Covid-19 restrictions prevented this approach for 2020 in eastern Australia. In recognition that in addition to the high-value roe, all components of the female fish are utilized (heads and guts for bait, bodies for human consumption), a multi-stage, spatially stratified sampling design was investigated. Female heads were retained from randomly selected catches from each of the three major fishing zones and transported to the New South Wales Department of Primary Industries fish laboratory based in Sydney. Head lengths (HLs) were measured and converted to Fork Lengths (FLs) using a HL to FL relationship. The resulting fish length compositions from each catch were subsequently combined based on: (i) relative catch size of females within an ocean zone, and; (ii) the relative reported landings of females in each ocean fishing zone. Otoliths were randomly collected from heads sampled from each ocean zone and used to estimate age. The resulting ocean zone to age matrix was combined with the relative reported landings of female fish in each ocean fishing zone to generate a total female age composition for the fishery. The estimated age composition of females were typical in being mainly between ages 3 and 6, with a strong presence of 4-year olds. This stronger cohort was present as 3-year olds in 2018/19 and 5-year olds in 2020/21, thus providing confidence that our sampling was representative of the fishery. The study reinforces the positive outcomes that can be generated through co-management between scientists and the seafood industry.

The sensitivity of simulated streamflow to individual hydrologic processes across North America.

Streamflow sensitivity to different hydrologic processes varies in both space and time. This sensitivity is traditionally evaluated for the parameters specific to a given hydrologic model simulating streamflow. In this study, we apply a novel analysis over more than 3000 basins across North America considering a blended hydrologic model structure, which includes not only parametric, but also structural uncertainties. This enables seamless quantification of model process sensitivities and parameter sensitivities across a continuous set of models. It also leads to high-level conclusions about the importance of water cycle components on streamflow predictions, such as quickflow being the most sensitive process for streamflow simulations across the North American continent. The results of the 3000 basins are used to derive an approximation of sensitivities based on physiographic and climatologic data without the need to perform expensive sensitivity analyses. Detailed spatio-temporal inputs and results are shared through an interactive website.

Great Lakes Runoff Intercomparison Project Phase 3: Lake Erie (GRIP-E).

Hydrologic model intercomparison studies help to evaluate the agility of models to simulate variables such as streamflow, evaporation, and soil moisture. This study is the third in a sequence of the Great Lakes Runoff Intercomparison Projects. The densely populated Lake Erie watershed studied here is an important international lake that has experienced recent flooding and shoreline erosion alongside excessive nutrient loads that have contributed to lake eutrophication. Understanding the sources and pathways of flows is critical to solve the complex issues facing this watershed. Seventeen hydrologic and land-surface models of different complexity are set up over this domain using the same meteorological forcings, and their simulated streamflows at 46 calibration and seven independent validation stations are compared. Results show that: (1) the good performance of Machine Learning models during calibration decreases significantly in validation due to the limited amount of training data; (2) models calibrated at individual stations perform equally well in validation; and (3) most distributed models calibrated over the entire domain have problems in simulating urban areas but outperform the other models in validation.

"The Back-up Vasectomy Reversal." Simultaneous Sperm Retrieval and Vasectomy Reversal in the Couple With Advanced Maternal Age: A Cost-Effectiveness Analysis.

OBJECTIVE: To determine the cost-effectiveness of different fertility options in men who have undergone vasectomy in couples with a female of advanced maternal age (AMA). The options include vasectomy reversal (VR), sperm retrieval (SR) with in vitro fertilization (IVF), and the combination of VR and SR with IVF, which is a treatment pathway that has been understudied. MATERIALS AND METHODS: Using TreeAge software, a model-based cost-utility analysis was performed estimating the cost per quality-adjusted life years (QALY) in couples with infertility due to vasectomy and advanced female age over a period of one year. The model stratified for female age (35-37, 38-40, >40) and evaluated four strategies: VR followed by natural conception (NC), SR with IVF, VR and SR followed by failed NC and then IVF, and VR and SR followed by failed IVF and then NC. QALY estimates and outcome probabilities were obtained from the literature and average patient charges were calculated from high-volume centers. RESULTS: The most cost-effective fertility strategy was to undergo VR and try for NC (cost-per-QALY: $7,150 (35-37 y), $7,203 (38-40 y), and $7,367 (>40 y)). The second most cost-effective strategy was the "back-up vasectomy reversal": undergo VR and SR, attempt IVF and switch to NC if IVF fails. CONCLUSION: In couples with a history of vasectomy and female of AMA, it is most cost-effective to undergo a VR. If the couple opts for SR for IVF, it is more cost-effective to undergo a concomitant VR than SR alone.

Erectile dysfunction management after failed phosphodiesterase-5-inhibitor trial: a cost-effectiveness analysis.

BACKGROUND: To evaluate the cost-effectiveness of alternate erectile dysfunction (ED) management options after failed first line phosphodiesterase-5-inhibitors (PDE5-I). METHODS: An empiric, repetitive decision tree analysis model was constructed using literature review and expert clinical judgement. This assessed the expected costs and quality adjusted life years (QALYs) of decision alternatives over a 10-year period. The model incorporated interventions including alternate PDE5-Is, intracorporal injections (ICI) with alprostadil or trimix (alprostadil, phentolamine, and papaverine), and inflatable penile prosthesis placement (IPP) and included respective risks of failure, subsequent interventions, and other complications (including priapism risk). Average model QALY estimates obtained from the literature were as follows: ED =0.56, successful alternate PDE5-I =0.70, successful ICI =0.70, and successful IPP =0.78. Cost data were calculated from a high-volume academic center and published manufacturer data. RESULTS: Over the 10-year period, IPP placement was the most cost-effective management option per preserved QALY (QALY =7.82, cost =$22,009/10 years) as compared to ICI alprostadil (QALY =8.51, cost =$62,890/10 years), ICI trimix (QALY =8.47, cost =$48,617/10 years) and alternate PDE5-I (QALY =7.73, $52,883/10 years). CONCLUSIONS: Using expert opinion and published utility, cost, and complication data in a decision analysis, we demonstrated that IPP placement is the most cost-effective ED intervention following failed initial PDE5-I over a 10-year period as compared to alternate treatment options. Such cost-effectiveness outcomes may be used in ED management counseling.

Efficacy of Pressure Regulating Balloon Exchange in Men With Post Artificial Urinary Sphincter Persistent or Recurrent Stress Urinary Incontinence.

OBJECTIVE: To assess the efficacy of exchanging the pressure regulating balloon (PRB) to 71-80 cm H2O in patients with persistent or recurrent stress urinary incontinence (SUI) following artificial urinary sphincter (AUS) placement. METHODS: Patients with SUI following AUS placement who underwent PRB replacement between 2011 and 2017 in the absence of urethral cuff malfunction, atrophy, stricture, or erosion were reviewed. Primary outcomes included changes in pad per day (PPD), Incontinence Symptom Index score, and Incontinence Quality of Life (I-QOL). Secondary outcomes included rates of device erosion and all-cause explant or revision. Differences were compared between patients with and without erosion, explant, or revision. Kaplan Meier device survival analysis was performed. RESULTS: Twenty two patients (67 ± 9 years, body mass index of 30 ± 5 kg/m2) with a median follow up of 22.4 months (IQR 9.3, 47.3) were included. Incontinence etiology included radical prostatectomy in 60% of patients. After PRB exchange, the average number of PPD decreased from 4.0 ± 3.0 to 1.0 ± 1.6 PPD (P = .01), as did Incontinence Symptom Index scores (21.6 ± 8.5 vs 16.3 ± 8.1, P <.001) and Incontinence Quality of Life (15.2 ± 6.8 vs 7.2 ± 3.4, P = .01). Three patients with prior radiation (14%) experienced cuff erosion. The explantation/revision rate was 45%(10/22) at 33.5(IQR 8.9,48) months. Kaplan-Meier analysis demonstrated 68%(15/22) and 41%(9/22) retained their device for 12 and 24 months, respectively. CONCLUSION: PRB exchange can transiently alleviate persistent or recurrent post-AUS SUI in the absence of mechanical failure or urethral pathology. Caution is warranted in patients with prior radiation as this was a risk factor for urethral erosion. Although many patients may require device revision within 2 years, it can be a temporizing solution that avoids urethral manipulation and periprocedural device deactivation.

Closed Analytic Elements with Flexible Geometry.

A simple and fast treatment of hydrogeologic features with irregularly shaped boundaries in two-dimensional analytic element groundwater flow models is presented. The star domain shapes of the features are restricted to closed shapes represented as smooth and continuous single-valued functions of distance from a focus point, rˆθ . The element can be used to treat a variety of boundary and continuity conditions, including those of irregularly shaped lakes or heterogeneities in hydraulic conductivity. The new element is demonstrated via some simple illustrative test cases and shown to be efficient, accurate, and much simpler to implement than existing solutions for irregular shapes.

Proton-pump inhibitor use does not affect semen quality in subfertile men.

Proton-pump inhibitors (PPIs) are among the most widely used drugs worldwide. PPI use has recently been linked to adverse changes in semen quality in healthy men; however, the effects of PPI use on semen parameters remain largely unknown specifically in cases with male factor infertility. We examined whether PPI use was associated with detrimental effects on semen parameters in a large population of subfertile men. We retrospectively reviewed data from 12 257 subfertile men who had visited our fertility clinic from 2003 to 2013. Patients who reported using any PPIs for >3 months before semen sample collection were included; 7698 subfertile men taking no medication served as controls. Data were gathered on patient age, medication use, and conventional semen parameters; patients taking any known spermatotoxic medication were excluded. Linear mixed-effect regression models were used to test the effect of PPI use on semen parameters adjusting for age. A total of 248 patients (258 samples) used PPIs for at least 3 months before semen collection. In regression models, PPI use (either as the only medication or when used in combination with other nonspermatotoxic medications) was not associated with statistically significant changes in semen parameters. To our knowledge, this is the largest study to compare PPI use with semen parameters in subfertile men. Using PPIs was not associated with detrimental effects on semen quality in this retrospective study.

Amniotic therapeutic biomaterials in urology: current and future applications.

To examine the rationale and applications of amniotic tissue augmentation in urological surgery. Published literature in English-language was reviewed for basic science and clinical use of amniotic or amnion-chorionic tissue in genitourinary tissues. Basic science and animal studies support the likely benefit of clinical applications of amnion-derived tissues in a variety of urologic interventions. The broad number of properties found in amniotic membrane, coupled with its immunologically privileged status presents a number of future applications in the urological surgical realm. These applications are in their clinical infancy and suggest that further studies are warranted to investigate the use of these products in a systematic fashion.

Impacts of Abstinence Time on Semen Parameters in a Large Population-based Cohort of Subfertile Men.

OBJECTIVE: To assess the effects of abstinence time on semen parameters in normozoospermic and oligozoospermic men using a large cohort of subfertile men. MATERIALS AND METHODS: From 2002 to 2013, we retrospectively reviewed data from 15,623 patients seen at our fertility clinic. Data on patient age and semen parameters were extracted along with abstinence time. Abstinence time was categorized into 4 groups (≤2 days; >2 and ≤5 days; >5 and ≤7 days; and >7 days). Semen samples were further categorized as normozoospermic or oligozoospermic based on concentration. Age-adjusted linear mixed effect regression models were used to test the effect of abstinence categories on semen parameters. RESULTS: Data from 11,782 encounters (10,095 patients) were used for the final analysis after excluding patients <18 years old, azoospermic samples, and those missing all semen parameters. Mean age was 32.4 (standard deviation: 6.5) and median abstinence time was 4.0 days. There were 9840 normozoospermic and 1939 oligozoospermic samples. In normozoospermic men, longer abstinence was associated with increases in ejaculate volume, concentration, total sperm count, and total motile sperm count. However, in oligozoospermic men, longer abstinence time was not associated with improvements in semen parameters except ejaculate volume. CONCLUSION: The effects of abstinence are different on semen parameters in normozoospermic and oligozoospermic patients. Longer abstinence does not improve most semen parameters in oligozoospermic samples. The World Health Organization recommendations for 2-7 days of abstinence may not be beneficial for subfertile patients when timing is a factor.

Serum Biomarkers of Erectile Dysfunction in Diabetes Mellitus: A Systematic Review of Current Literature.

INTRODUCTION: Erectile dysfunction (ED) is a common complication in patients with diabetes mellitus (DM). However, the utility of serum biomarkers as clinical surrogates for the development and/or progression of ED is unknown. AIM: To summarize the current literature for serum biomarkers for ED in DM and emphasize areas for future research. MAIN OUTCOME MEASURES: Human subject data demonstrating the utility of serum markers for the development and progression of ED in patients with DM. METHODS: We performed a systematic PubMed-Medline search in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement using Medical Subject Headings (MeSH) for articles published from January 1, 2000 through December 31, 2016 of serum biomarkers for development or progression of ED in patients with DM using erectile dysfunction [MeSH] AND (biomarkers [MeSH] or inflammation mediators [MeSH] or intercellular signaling peptides and proteins [MeSH] or cell adhesion molecules [MeSH]). A thorough review of these studies was completed. RESULTS: Of the 327 abstracts screened, 12 full-text studies were assessed and 1 study was excluded. Eleven studies assessing serum biomarkers for ED in patients with DM were included in this review. The most studied serum biomarkers for ED in men with DM included endothelial dysfunction markers such as serum E-selectin, endothelial progenitor cells, and endothelial microparticles and specific markers of inflammation such as interleukin-10, ratio of tumor necrosis factor-α to interleukin-10, and reactive oxygen species such as nitric oxide and malondialdehyde. Reliable serum biomarkers will enable earlier diagnosis and objective monitoring of disease progression and responses to treatment in patients with ED. CONCLUSION: Serum biomarkers for ED in men with DM are very limited. Future longitudinal studies with uniform patient characteristics are needed to evaluate the potential clinical use of serum biomarkers in men with DM for the development and progression of ED. Patel DP, Craig JR, Myers JB, et al. Serum Biomarkers of Erectile Dysfunction in Diabetes Mellitus: A Systematic Review of Current Literature. Sex Med Rev 2017:5:339-348.

Obesity, male infertility, and the sperm epigenome.

Obesity is a growing epidemic and a common problem among reproductive-age men that can both cause and exacerbate male-factor infertility by means of endocrine abnormalities, associated comorbidities, and direct effects on the fidelity and throughput of spermatogenesis. Robust epidemiologic, clinical, genetic, epigenetic, and nonhuman animal data support these findings. Recent works in the burgeoning field of epigenetics has demonstrated that paternal obesity can affect offspring metabolic and reproductive phenotypes by means of epigenetic reprogramming of spermatogonial stem cells. Understanding the impact of this reprogramming is critical to a comprehensive view of the impact of obesity on subsequent generations. Furthermore, and perhaps more importantly, conveying the impact of these lifestyle changes on future progeny can serve as a powerful tool for obese men to modify their behavior. Reproductive urologists and endocrinologists must learn to assimilate these new findings to better counsel men about the importance of paternal preconception health, a topic recently being championed by the Centers for Disease Control and Prevention.

High-grade renal injuries are often isolated in sports-related trauma.

INTRODUCTION: Most high-grade renal injuries (American Association for Surgery of Trauma (AAST) grades III-V) result from motor vehicle collisions associated with numerous concomitant injuries. Sports-related blunt renal injury tends to have a different mechanism, a solitary blow to the flank. We hypothesized that high-grade renal injury is often isolated in sports-related renal trauma. MATERIAL AND METHODS: We identified patients with AAST grades III-V blunt renal injuries from four level 1 trauma centres across the United States between 1/2005 and 1/2014. Patients were divided into "Sport" or "Non-sport" related groups. Outcomes included rates of hypotension (systolic blood pressure <90mm Hg), tachycardia (>110bpm), concomitant abdominal injury, and procedural/surgical intervention between sports and non-sports related injury. RESULTS: 320 patients met study criteria. 18% (59) were sports-related injuries with the most common mechanisms being skiing, snowboarding and contact sports (25%, 25%, and 24%, respectively). Median age was 24 years for sports and 30 years for non-sports related renal injuries (p=0.049). Males were more commonly involved in sports related injuries (85% vs. 72%, p=0.011). Median injury severity score was lower for sports related injuries (10 vs. 27, p<0.001). There was no difference in renal abbreviated injury scale scores. Sports related trauma was more likely to be isolated without other significant injury (69% vs. 39% (p<0.001)). Haemodynamic instability was present in 40% and 51% of sports and non-sports renal injuries (p=0.30). Sports injuries had lower transfusion (7% vs. 47%, p<0.001) and lower mortality rates (0% vs. 6%, p=0.004). There was no difference in renal-specific procedural interventions between the two groups (17% sports vs. 18% non-sports, p=0.95). CONCLUSIONS: High-grade sports-related blunt renal trauma is more likely to occur in isolation without other abdominal or thoracic injuries and clinicians must have a high suspicion of renal injury with significant blows to the flank during sports activities.

Intralesional injection of mitomycin C at transurethral incision of bladder neck contracture may offer limited benefit: TURNS Study Group.

PURPOSE: Injection of mitomycin C may increase the success of transurethral incision of the bladder neck for the treatment of bladder neck contracture. We evaluated the efficacy of mitomycin C injection across multiple institutions. MATERIALS AND METHODS: Data on all patients who underwent transurethral incision of the bladder neck with mitomycin C from 2009 to 2014 were retrospectively reviewed from 6 centers in the TURNS. Patients with at least 3 months of cystoscopic followup were included in the analysis. RESULTS: A total of 66 patients underwent transurethral incision of the bladder neck with mitomycin C and 55 meeting the study inclusion criteria were analyzed. Mean ± SD patient age was 64 ± 7.6 years. Dilation or prior transurethral incision of the bladder neck failed in 80% (44 of 55) of patients. Overall 58% (32 of 55) of patients achieved resolution of bladder neck contracture after 1 transurethral incision of the bladder neck with mitomycin C at a median followup of 9.2 months (IQR 11.7). There were 23 patients who had recurrence at a median of 3.7 months (IQR 4.2), 15 who underwent repeat transurethral incision of the bladder neck with mitomycin C and 9 of 15 (60%) who were free of another recurrence at a median of 8.6 months (IQR 8.8), for an overall success rate of 75% (41 of 55). Incision with electrocautery (Collins knife) was predictive of success compared with cold knife incision (63% vs 50%, p=0.03). Four patients experienced serious adverse events related to mitomycin C and 3 needed or are planning cystectomy. CONCLUSIONS: The efficacy of intralesional injection of mitomycin C at transurethral incision of the bladder neck was lower than previously reported and was associated with a 7% rate of serious adverse events.

Management of adults with prior failed hypospadias surgery.

Hypospadias is one of the most prevalent anomalies of the male genitalia. Contemporary hypospadias repair is very successful, but patients that have the surgery fail often require multiple surgeries throughout their life. Complications from failed hypospadias repairs have a significant impact on patients both psychologically and physically. Failed hypospadias repair encompasses a spectrum of problems that include hypospadias recurrence with an ectopic meatus, urethral fistula, urethral stricture, and ventral penile curvature. Repairs of hypospadias complications can be challenging due to the poor quality of surrounding tissue from disruption of normal vasculature in the re-operative field associated with the underlying disorder. One of the most challenging issues is dealing with urethral strictures. There have been multiple methods described at repairs of these in both a single stage and multiple staged procedures. Particular attention has been directed towards applications of grafts due to worse outcomes with flaps. Buccal mucosa has emerged as the leading graft material in staged repairs. When counseling patients with failed hypospadias it is important to discuss the expected outcome as repairs directed towards a terminally positioned meatus with a straight phallus may require multiple surgeries due to post-operative complications as well as the necessity of proceeding in a staged approach.

The nested superblock approach for regional-scale analytic element models.

A new approach is presented for improving the computational efficiency of regional-scale ground water models based on the analytic element method (AEM). The algorithm is an extension of the existing "superblock" algorithm, which combines the effects of multiple analytic elements into Laurent series and Taylor series (superblock expansions). With the new "nested superblock" formulation, Laurent series are nested in a hierarchical (quad-tree) data structure with direct mathematical relationships between parent and child superblock coefficients. Nested superblocks significantly accelerate the evaluation of the complex potential and discharge function in models that contain a large number of analytic elements at multiple scales. This evaluation process, the primary computational cost of AEM models, is required to determine the element coefficients, generate contour plots, and trace pathlines. The performance of the nested superblocks is demonstrated with a simplified model based on the Lake Ontario watershed geometry comprising thousands of hydrogeologic features at multiple geographic scales.