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BACKGROUND: The COVID-19 pandemic drastically reduced opportunities for surgical skill sharing between high-income and low to middle-income countries. Augmented reality (AR) technology allows mentors in one country to virtually train a mentee in another country during surgical cases without international travel. We hypothesize that AR technology is an effective live surgical training and mentorship modality. METHODS: Three senior urologic surgeons in the US and UK worked with four urologic surgeon trainees across the continent of Africa using AR systems. Trainers and trainees individually completed post-operative questionnaires evaluating their experience. RESULTS: Trainees rated the quality of virtual training as equivalent to in-person training in 83% of cases (N = 5 of 6 responses). Trainers reported the technologys visual quality as acceptable in 67% of cases (N = 12 of 18 responses). The audiovisual capabilities of the technology had a high impact in the majority of the cases. CONCLUSION: AR technology can effectively facilitate surgical training when in-person training is limited or unavailable.

Heart failure (HF) is a leading cause of death and disability in older adults. Despite decades of high-quality evidence to support their use, guideline-directed medical therapies (GDMTs) that reduce death and disease burden in HF have been suboptimally implemented. Approaches to closing care gaps have focused largely on strategies proven to be ineffective, whilst effective interventions shown to improve GDMT uptake have not been instituted. This review synthesizes implementation interventions that increase the uptake of GDMT, discusses barriers and facilitators of implementation, summarizes conceptual frameworks in implementation science that could improve knowledge uptake, and offers suggestions for trial design that could better facilitate end-of-trial implementation. We propose an evidence-to-care conceptual model that could foster the simultaneous generation of evidence and long-term implementation. By adopting principles of implementation science, policymakers, researchers, and clinicians can help reduce the burden of HF on patients and health care systems worldwide.

INTRODUCTION: Mitigation behaviors are key to preventing SARS-CoV-2 transmission. We identified the behaviors associated with secondary transmission from confirmed SARS-CoV-2 primary cases to household contacts and described the characteristics associated with reporting these behaviors. METHODS: Households with confirmed SARS-CoV-2 infections were recruited in California and Colorado from January to April 2021. Self-reported behaviors and demographics were collected through interviews. We investigated behaviors associated with transmission and individual and household characteristics associated with behaviors using univariable and multivariable logistic regression with generalized estimating equations to account for household clustering. RESULTS: Among household contacts of primary cases, 43.3% (133 of 307) became infected with SARS-CoV-2. When an adjusted analysis was conducted, household contacts who slept in the same bedroom with the primary case (AOR=2.19; 95% CI=1.25, 3.84) and ate food prepared by the primary case (AOR=1.98; 95% CI=1.02, 3.87) had increased odds of SARS-CoV-2 infection. Household contacts in homes ≤2,000 square feet had increased odds of sleeping in the same bedroom as the primary case compared with those in homes >2,000 square feet (AOR=3.97; 95% CI=1.73, 9.10). Parents, siblings, and other relationships (extended family, friends, or roommates) of the primary case had decreased odds of eating food prepared by the primary case compared with partners. CONCLUSIONS: Sleeping in the same bedroom as the primary case and eating food prepared by the primary case were associated with secondary transmission. Household dimension and relationship to the primary case were associated with these behaviors. Our findings encourage innovative means to promote adherence to mitigation measures that reduce household transmission.

PurposeThe challenges in providing urologic care across borders and in resource-constrained settings are poorly understood. We sought to better characterize the impediments to the delivery of urological care in low- and middle-income countries (LMICs) compared to high-income countries (HICs).MethodsA 70 question online survey in RedCap™ was distributed to urologists who had practiced in countries outside of the United States and Europe categorized by World Bank income groups.Results114 urologists from 27 countries completed the survey; 35 (39%) practiced in HICs while 54 (61%) practiced in LMICs. Forty-three percent of urologists received training outside their home country. Most commonly treated conditions were urolithiasis (30%), BPH (15%) and prostate cancer (13%) which did not vary by group. Only 19% of urologists in LMICs reported sufficient urologists in their country. Patients in LMICs were less likely to get urgent drainage for infected obstructing kidney stones or endoscopic treatment for a painful kidney stone or obstructing prostate. Urologists visiting LMICs were more likely to cite deficits in knowledge, inadequate operative facilities and limited access to disposables as the major challenges whereas local LMIC urologists were more likely to cite financial challenges, limited access to diagnostics and support staff as the barriers to care.ConclusionsLMICs lack enough training opportunities and urologists to care for their population. There is disconnect between the needs identified by local and visiting urologists. International collaborations should target broader interventions in LMICs to address local priorities such as diagnostic studies, support staff and financial support.

Objective To quantify the potential impact of engaging religious leaders in promoting safe burial practices during the 2014-2016 Ebola virus disease outbreak in Sierra Leone. Methods We analysed population-based household survey data from 3540 respondents collected around the peak of the outbreak in Sierra Leone, December 2014. Respondents were asked if in the past month they had heard an imam or pastor say that people should not touch or wash a dead body. We used multilevel logistic regression modelling to examine if exposure to religious leaders' messages was associated with protective burial intentions if a family member died at home and other Ebola protective behaviours. Findings Of the respondents, 3148 (89%) had been exposed to faith-based messages from religious leaders on safe Ebola burials and 369 (10%) were unexposed. Exposure to religious leaders' messages was associated with a nearly twofold increase in the intention to accept safe alternatives to traditional burials and the intention to wait [greater than or equal to] 2 days for burial teams (adjusted odds ratio, aOR: 1.69; 95% confidence interval, CI: 1.23-2.31 and aOR: 1.84; 95% CI: 1.38-2.44, respectively). Exposure to messages from religious leaders was also associated with avoidance of traditional burials and of contact with suspected Ebola patients (aOR: 1.46; 95% CI: 1.14-1.89 and aOR: 1.65; 95% CI: 1.27-2.13, respectively). Conclusion Public health messages promoted by religious leaders may have influenced safe burial behaviours during the Ebola outbreak in Sierra Leone. Engagement of religious leaders in risk communication should be prioritized during health emergencies in similar settings. Objectif Quantifier l'impact potentiel de l'implication des autorites religieuses dans la promotion de pratiques funeraires sures durant l'epidemie de maladie a virus Ebola entre 2014 et 2016 en Sierra Leone. Methodes Nous avons analyse les reponses fournies par 3540 menages ayant pris part a des enquetes menees au plus fort de l'epidemie en Sierra Leone, en decembre 2014. Il avait ete demande aux participants si, au cours du mois ecoule, ils avaient entendu un imam, un pretre ou un pasteur dire que les gens ne devaient pas toucher ni laver le corps d'un defunt. Nous avons employe un modele de regression logistique multiniveaux pour determiner si l'exposition aux messages des autorites religieuses entrainait l'adoption de pratiques funeraires preventives en cas de deces d'un proche a domicile, et d'autres comportements de protection contre Ebola en general. Resultats Sur l'ensemble des participants, 3148 (89%) avaient ete exposes a des messages de la part de leurs chefs religieux concernant les pratiques funeraires limitant la propagation d'Ebola, tandis que 369 (10%) n'ont recu aucune information a ce sujet. Ceux exposes aux messages des autorites religieuses ont ete presque deux fois plus nombreux a accepter les alternatives aux enterrements traditionnels et a prevoir d'attendre [greater than or equal to] 2 jours avant de faire appel aux equipes d'inhumation (odds ratio ajuste, ORA: 1,69; intervalle de confiance de 95%, IC: 1,23-2,31 et ORA: 1,84; IC de 95%: 1,38-2,44 respectivement). Lexposition aux messages de la part des chefs religieux a egalement permis d'eviter l'organisation de funerailles traditionnelles et le contact avec des patients susceptibles d'avoir contracte la maladie a virus Ebola (ORA: 1,46; IC de 95%: 1,14-1,89 et ORA: 1,65; IC de 95%: 1,27-2,13 respectivement). Conclusion Le soutien des autorites religieuses aux messages de sante publique pourrait avoir eu une influence positive sur les comportements funeraires durant l'epidemie d'Ebola en Sierra Leone. Il faut privilegier l'implication des instances dirigeantes de chaque confession dans la communication des risques lorsque des urgences sanitaires surviennent dans des environnements similaires. Objetivo Cuantificar el impacto potencial de la implicacion de los lideres religiosos en la promocion de practicas funerarias seguras durante la epidemia del ebola de 2014 a 2016 en Sierra Leona. Metodos Analizamos las respuestas de 3.540 hogares que participaron en las encuestas realizadas en el momento algido de la epidemia en Sierra Leona, en diciembre de 2014. Se pregunto a los participantes si, en el ultimo mes, habian oido a un iman, sacerdote o pastor decir que la gente no debia tocar o lavar el cuerpo de un difunto. Se utilizo un modelo de regresion logistica multinivel para determinar si la exposicion a los mensajes de los lideres religiosos conducia a practicas funerarias preventivas en caso de muerte de un familiar en el hogar, y a otros comportamientos de proteccion contra el ebola en general. Resultados De todos los participantes, 3148 (89%) habian recibido mensajes de sus lideres religiosos sobre las practicas funerarias que limitan la propagacion del ebola, mientras que 369 (10%) no habian recibido ninguna informacion sobre el tema. Las personas expuestas a los mensajes de los lideres religiosos tenian casi el doble de probabilidades de aceptar alternativas a los entierros tradicionales y de planear esperar [greater than or equal to] 2 dias antes de llamar a los servicios funerarios (razon de probabilidades ajustada, aOR: 1,69; intervalo de confianza del 95%, CI: 1,23-2,31 y aOR: 1,84; CI del 95%: 1,38-2,44 respectivamente). La exposicion a los mensajes de los lideres religiosos tambien evito los funerales tradicionales y el contacto con pacientes con riesgo de contraer la enfermedad del ebola (aOR: 1,46; IC del 95%: 1,14-1,89 y aOR: 1,65; IC del 95%: 1,27-2,13 respectivamente). Conclusion El apoyo de los lideres religiosos a traves de los mensajes de salud publica puede haber influido positivamente en el comportamiento funerario durante la epidemia del ebola en Sierra Leona. La implicacion de los lideres religiosos en la comunicacion de riesgos deberia ser prioritaria durante las emergencias sanitarias en entornos similares., Introduction The Ebola virus disease outbreak in West Africa between 2013 and 2016 is the largest in recorded history. (1,2) Sierra Leone was heavily affected by the outbreak with over [...]

Objective To evaluate changes in Ebola-related knowledge, attitudes and prevention practices during the Sierra Leone outbreak between 2014 and 2015. Methods Four cluster surveys were conducted: two before the outbreak peak (3499 participants) and two after (7104 participants). We assessed the effect of temporal and geographical factors on 16 knowledge, attitude and practice outcomes. Findings Fourteen of 16 knowledge, attitude and prevention practice outcomes improved across all regions from before to after the outbreak peak. The proportion of respondents willing to: (i) welcome Ebola survivors back into the community increased from 60.0% to 89.4% (adjusted odds ratio, aOR: 6.0; 95% confidence interval, CI: 3.9-9.1); and (ii) wait for a burial team following a relative's death increased from 86.0% to 95.9% (aOR: 4.4; 95% CI: 3.2-6.0). The proportion avoiding unsafe traditional burials increased from 27.3% to 48.2% (aOR: 3.1; 95% CI: 2.4-4.2) and the proportion believing spiritual healers can treat Ebola decreased from 15.9% to 5.0% (aOR: 0.2; 95% CI: 0.1-0.3). The likelihood respondents would wait for burial teams increased more in high-transmission (aOR: 6.2; 95% CI: 4.2-9.1) than low- transmission (aOR: 2.3; 95% CI: 1.4-3.8) regions. Self-reported avoidance of physical contact with corpses increased in high but not low-transmission regions, aOR: 1.9 (95% CI: 1.4-2.5) and aOR: 0.8 (95% CI: 0.6-1.2), respectively. Conclusion Ebola knowledge, attitudes and prevention practices improved during the Sierra Leone outbreak, especially in high-transmission regions. Behaviourally-targeted community engagement should be prioritized early during outbreaks. [phrase omitted] [phrase omitted] Objectif Evaluer l'evolution des connaissances, attitudes et techniques de prevention en matiere d'Ebola durant l'epidemie qui a touche la Sierra Leone entre 2014 et 2015. Methodes Quatre enquetes en grappes ont ete menees: deux avant le pic de l'epidemie (3499 participants) et deux apres (7104 participants). Nous avons mesure l'impact des facteurs geographiques et temporels sur 16 resultats lies aux connaissances, aux attitudes et aux techniques de prevention. Resultats Quatorze des seize resultats lies aux connaissances, aux attitudes et aux techniques de prevention ont progresse dans toutes les regions entre la periode avant le pic et celle apres le pic. La proportion de repondants disposes a: (i) accueillir les survivants a Ebola de retour dans leur communaute est passee de 60,0% a 89,4% (odds ratio ajuste, ORA: 6,0; intervalle de confiance de 95%, IC: 3,9-9,1); et (ii) attendre l'equipe d'inhumation apres la mort d'un proche a egalement augmente, passant de 86,0% a 95,9% (ORA: 4,4; IC de 95%: 3,2-6,0). La proportion de repondants ayant abandonne la pratique risquee des funerailles traditionnelles est passee de 27,3% a 48,2% (ORA: 3,1; IC de 95%: 2,4-4,2), tandis que celle convaincue de l'efficacite des guerisseurs spirituels pour traiter Ebola a diminue, passant de 15,9% a 5,0% (ORA: 0,2; IC de 95%: 0,1-03). La probabilite que les repondants attendent les equipes d'inhumation a augmente dans les regions a haut risque de transmission (ORA: 6,2; IC de 95%: 4,2-9,1), plus que dans les regions a faible risque de transmission (ORA: 2,3; IC de 95%: 1,4-3,8). Les repondants declarent avoir davantage evite tout contact physique avec les corps dans les regions a haut risque de transmission, mais pas dans les regions a faible risque de transmission (ORA: 1,9; IC de 95%: 1,4--2,5 et ORA: 0,8; IC de 95%: 0,6-1,2). Conclusion Les connaissances, attitudes et techniques de prevention en matiere d'Ebola ont evolue durant l'epidemie qui a touche la Sierra Leone, surtout dans les regions a haut risque de transmission. Il faut privilegier l'engagement communautaire axe sur le comportement des les premiers stades de l'epidemie. [phrase omitted] Objetivo Evaluar los cambios en los conocimientos, las actitudes y las practicas de prevencion relacionadas con el ebola durante el brote ocurrido en Sierra Leona entre 2014 y 2015. Metodos Se realizaron cuatro encuestas por conglomerados: dos antes del pico del brote (3499 participantes) y dos despues (7104 participantes). Se evaluo el efecto de los factores temporales y geograficos en 16 resultados de conocimientos, actitudes y practicas de prevencion. Resultados 14 de 16 resultados de conocimientos, actitudes y practicas de prevencion mejoraron en todas las regiones desde antes hasta despues del pico del brote. El porcentaje de los encuestados dispuestos a: (i) acoger a los supervivientes del ebola en la comunidad aumento del 60,0 % al 89,4 % (proporcion de probabilidad ajustada, aOR: 6,0; intervalo de confianza del 95 %, IC: 3,9-9,1); y (ii) esperar al servicio funerario tras la muerte de un familiar aumento del 86,0 % al 95,9 % (aOR: 4,4; IC del 95 %: 3,2-6,0). El porcentaje de personas que evitaron los entierros tradicionales inseguros aumento del 27,3 % al 48,2 % (aOR: 3,1; IC del 95 %: 2,4-4,2) y el porcentaje de personas que creen que los sanadores espirituales pueden tratar el ebola disminuyo del 15,9 % al 5,0 % (aOR: 0,2; IC del 95 %: 0,1-03). La probabilidad de que los encuestados esperan a los servicios funerarios aumento mas en las regiones de alta transmision (aOR: 6,2; IC del 95 %: 4,2-9,1) que en las de baja transmision (aOR: 2,3; IC del 95 %: 1,4-3,8). Segun los reportes de los mismos encuestados, se evito mas el contacto fisico con los cadaveres en las regiones de alta pero no de baja transmision, aOR: 1,9 (IC del 95 %: 1,4-2,5) y aOR: 0,8 (IC del 95 %: 0,6-1,2), respectivamente. Conclusion Los conocimientos, las actitudes y las practicas de prevencion del ebola mejoraron durante el brote en Sierra Leona, en especial en las regiones de alta transmision. Se debe dar prioridad a la participacion de la comunidad orientada al comportamiento en las primeras etapas de los brotes., Introduction The 2013-2016 Ebola virus disease outbreak in West Africa mostly affected Guinea, Liberia and Sierra Leone. In Sierra Leone, over 14 000 cases of Ebola and about 4000 deaths [...]

PurposeLittle is known about patterns of local failure following radiation therapy for prostate cancer. We aimed to characterize post-radiation biopsy findings, including the treatment effect and the zonal distribution of recurrent disease after radiation therapy, in men experiencing biochemical recurrence.Materials and methodsWe identified patients who received post-radiation biopsy in the setting of biochemical recurrence following primary radiation for localized disease. Histological post-radiation biopsy results were categorized by the absence of tumor, demonstration of radiation treatment effect, failure (recurrent cancer) or a combination of treatment effect and failure. We described patterns of histological failure and compared them to the diagnostic biopsy findings.ResultsA total of 284 men underwent mapped post-radiation biopsy for biochemical recurrence. Mean age at initial diagnosis was 63 years and median prostate specific antigen was 8.2 ng/ml. Of the men 33%, 32% and 35% were classified at low, intermediate and high risk based on clinical CAPRA (Cancer of the Prostate Risk Assessment) categories. Median time to post-radiation biopsy was 61 months after treatment. Findings were negative in 4% of cases while we noted a treatment effect in 31%, failure in 45% and a combination in 20%. Failure rates were similar across sextants. Of 140 patients with mapped pretreatment and posttreatment biopsies 4% demonstrated cancer in a new location previously identified as negative. Gleason upgrading occurred in 43% of cases with 85% upgraded to 4 + 3 or higher.ConclusionsMen with rising prostate specific antigen after radiotherapy for prostate cancer most often experience recurrence in dominant tumor sites. Whether failure is due to inadequate targeting, dosing or intrinsic radiation resistance remains unknown to our knowledge. Further study is warranted.

BackgroundAfrican American (AA) men suffer a higher prostate cancer (PCa) burden than other groups.ObjectiveWe aim to determine the impact of race on the risk of upgrading, upstaging, and positive surgical margins (PSM) at radical prostatectomy (RP) among men eligible for active surveillance.Design, setting, and participantsWe studied men with low-risk PCa treated with RP at two centers. Low clinical risk was defined by National Comprehensive Cancer Network criteria. Outcome variables were upgrading, upstaging, and PSMs at surgery. Associations between race and the outcomes were evaluated with logistic regression adjusted for age, relationship status, diagnostic prostate-specific antigen level, percentage of positive biopsy cores, surgical approach, year of diagnosis, and clinical site.Results and limitationsOf 9304 men diagnosed with PCa, 4231 were low risk and underwent RP within 1 yr. Men were categorized as AA (n=273; 6.5%), Caucasian (n=3771; 89.1%), or other racial/ethnic group (Other; n=187; 4.4%). AA men had a significantly younger mean age (58.7 yr; standard deviation: ±7.06), and fewer (85%) were married or had a partner. Upgrading (34%) and upstaging (13%) rates did not significantly differ among the groups. The PSM rate was significantly higher in AA men (31%) than in the Caucasian (21%) and Other (20%) groups (p

: Introduction: Population‐based biomarker surveys are the gold standard for estimating HIV prevalence but are susceptible to substantial non‐participation (up to 30%). Analytical missing data methods, including inverse‐probability weighting (IPW) and multiple imputation (MI), are biased when data are missing‐not‐at‐random, for example when people living with HIV more frequently decline participation. Heckman‐type selection models can, under certain assumptions, recover unbiased prevalence estimates in such scenarios. Methods: We pooled data from 142,706 participants aged 15–49 years from nationally representative cross‐sectional Population‐based HIV Impact Assessments in seven countries in sub‐Saharan Africa, conducted between 2015 and 2018 in Tanzania, Uganda, Malawi, Zambia, Zimbabwe, Lesotho and Eswatini. We compared sex‐stratified HIV prevalence estimates from unadjusted, IPW, MI and selection models, controlling for household and individual‐level predictors of non‐participation, and assessed the sensitivity of selection models to the copula function specifying the correlation between study participation and HIV status. Results: In total, 84.1% of participants provided a blood sample to determine HIV serostatus (range: 76% in Malawi to 95% in Uganda). HIV prevalence estimates from selection models diverged from IPW and MI models by up to 5% in Lesotho, without substantial precision loss. In Tanzania, the IPW model yielded lower HIV prevalence estimates among males than the best‐fitting copula selection model (3.8% vs. 7.9%). Conclusions: We demonstrate how HIV prevalence estimates from selection models can differ from those obtained under missing‐at‐random assumptions. Further benefits include exploration of plausible relationships between participation and outcome. While selection models require additional assumptions and careful specification, they are an important tool for triangulating prevalence estimates in surveys with substantial missing data due to non‐participation., INTRODUCTION Accurate HIV prevalence estimates are crucial for monitoring HIV disease burden and guiding testing and clinical management. However, population‐based HIV biomarker surveys, the gold standard for estimating HIV prevalence, [...]

Prostate cancer (CaP) is the leading cancer among men of African descent in the USA, Caribbean, and Sub-Saharan Africa (SSA). The estimated number of CaP deaths in SSA during 2008 was more than five times that among African Americans and is expected to double in Africa by 2030. We summarize publicly available CaP data and collected data from the men of African descent and Carcinoma of the Prostate (MADCaP) Consortium and the African Caribbean Cancer Consortium (AC3) to evaluate CaP incidence and mortality in men of African descent worldwide. CaP incidence and mortality are highest in men of African descent in the USA and the Caribbean. Tumor stage and grade were highest in SSA. We report a higher proportion of T1 stage prostate tumors in countries with greater percent gross domestic product spent on health care and physicians per 100,000 persons. We also observed that regions with a higher proportion of advanced tumors reported lower mortality rates. This finding suggests that CaP is underdiagnosed and/or underreported in SSA men. Nonetheless, CaP incidence and mortality represent a significant public health problem in men of African descent around the world.

West Africa detected its first case of Ebola virus disease (EVD) in March 2014 within the forest region of Guinea; shortly thereafter, Liberia and Sierra Leone detected cases of the [...]

The Ebola virus disease (EVD) outbreak in West Africa claimed >11,000 lives with nearly 30,000 cases (l). During the outbreak in Sierra Leone, patients arriving at healthcare facilities were screened [...]