Effect of infundibulopelvic angle on outcomes of ureteroscopy: a systematic review and meta-analysis.

PURPOSE: The infundibulo-pelvic angle (IPA) is reportedly a predictor of successful ureteroscopy for lower pole renal stones, however there is uncertainty at which IPA success is likely. We therefore aimed to perform a meta-analysis and determine at which the angle of likely success and failure. METHODS: We performed a systematic review and meta-analysis as per Cochrane guidelines in accordance to the PRISMA statement. The review was registered with PROSPERO prior to commencement (ID: CRD42022296732). We included studies reporting on outcomes of ureteroscopy for lower pole stones, with IPA. We excluded patients undergoing alternative treatments for lower pole stones, anatomical abnormalities and studies with < 10 patients. We assessed bias with the Newcastle-Ottawa scale. We performed meta-analysis in R, and summarised the findings as per GRADE. RESULTS: Overall, there were 13 studies included, with 10 included for meta-analysis. These studies covered n = 1964 patients (71% stone free). Overall, the stone free patients had a significantly less acute mean IPA (52o ± 9o), compared to the non-stone free patients (39o ± 7o), on meta-analysis (REM MD = -13.0, 95% CI: -18.7 to -7.2, p < 0.001). On examination of forest plots, at IPA < 30o no patients were stone free, whilst > 50o all were stone free. Risk of bias was moderate, and certainty of evidence was 'very low'. CONCLUSION: With a very low certainty of evidence, we demonstrate that at an IPA of < 30o no patient is stone free, whilst > 50o all patients (in this review) are stone free. More evidence is therefore needed.

Access to general obstetrics and gynecology care among Medicaid beneficiaries and the privately insured: a nationwide mystery caller study in the USA.

BACKGROUND: The mean wait time for new patient appointments has been growing across specialties, including obstetrics and gynecology, in recent years. This study aimed to assess the impact of insurance type (Medicaid versus commercial insurance) on new patient appointment wait times in general obstetrics and gynecology practices. METHODS: A cross-sectional study used covert mystery calls to general obstetrician gynecologists. Physicians were selected from the American College of Obstetricians and Gynecologists directory and stratified by districts to ensure nationwide representation. Wait times for new patient appointments were collected and analyzed. RESULTS: Regardless of insurance type, the mean wait time for all obstetrician gynecologists was 29.9 business days. Medicaid patients experienced a marginally longer wait time of 4.8% (Ratio: 1.048). While no statistically significant difference in wait times based on insurance type was observed (P=0.39), the data revealed other impactful factors. Younger physicians and those in university-based practices had longer wait times. The gender of the physician also influenced wait times, with female physicians having a mean wait time of 34.7 days compared to 22.7 days for male physicians (P=0.03). Additionally, geographical variations were noted, with physicians in American College of Obstetricians and Gynecologists District I (Atlantic Provinces, CT, ME, MA, NH, RI, VT) having the longest mean wait times and those in District III (DE, NJ, PA) the shortest. CONCLUSIONS: While the type of insurance did not significantly influence the wait times for general obstetrics and gynecology appointments, physician demographic and geographic factors did.

Teen Girls' Experiences Negotiating the Ubiquitous Dick Pic: Sexual Double Standards and the Normalization of Image Based Sexual Harassment.

A range of important studies have recently explored adult women's experiences of receiving unwanted dick pics (Amundsen, 2020). However, to date there has been limited research that has explored teen girls' experiences of receiving unwanted penis images in depth. To address this gap we draw upon our findings from a qualitative study using focus group interviews and arts based drawing methods to explore social media image sharing practices with 144 young people aged 11-18 in seven secondary schools in England. We argue that being bombarded with unwanted dick pics on social media platforms like Snapchat normalises harassing practices as signs of desirability and popularity for girls, but suggest that being sent unsolicited dick pics from boys at school is more difficult for girls to manage or report than ignoring or blocking random older senders. We also found that due to sexual double standards girls were not able to leverage dick pics for status in the same way boys can use girls' nudes as social currency, since girls faced the possibility of being shamed for being known recipients of dick pics. Finally we explore how some girls challenge abusive elements of toxic masculinity in the drawing sessions and our conclusion argues that unwanted dick pics should always be understood as forms of image based sexual harassment.