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Background Radiation dose at CT should be as low as possible without compromising diagnostic quality. Objective To assess the potential for maximum dose reduction of pediatric lung dual-source CT with spectral shaping and advanced iterative reconstruction (ADMIRE). Materials and methods We retrospectively analyzed dual-source CT acquisitions in a full-dose group (FD: 100 kV, 64 reference mAs) and in three groups with spectral shaping and differing reference mAs values (Sn: 100 kV, 96/64/32 reference mAs), each group consisting of 16 patients (age mean 11.5 years, standard deviation 4.8 years, median 12.8 years, range 1.3–18 years). Advanced iterative reconstruction of images was performed with different strengths (FD: ADMIRE Level 2; Sn: ADMIRE Levels 2, 3 and 4). We analyzed dose parameters and measured noise. Diagnostic confidence and detectability of lung lesions as well as anatomical structures were assessed using a Likert scale (from 1 [unacceptable] to 4 [fully acceptable]). Results Compared to full dose, effective dose was reduced to 16.7% in the Sn 96 group, 11.1% in Sn64, and 5.5% in Sn32 (PADM4 did not statistically differ from those in FDADM2 (45.7 vs. 38.9 Hounsfield units [HU]; P=0.132), whereas noise was significantly higher in Sn32ADM4 compared to Sn64ADM4 (61.5 HU; P3 was reached in Sn64ADM4 regarding diagnostic confidence (3.2) and detectability of lung lesions (3.3). For detectability of most anatomical structures, no significant differences were found between FDAM2 and Sn64ADM4 (P≥0.05). Conclusion In pediatric lung dual-source CT, spectral shaping together with ADMIRE 4 enable radiation dose reduction to about 10% of a full-dose protocol while maintaining an acceptable diagnostic quality.

Geological records indicate that the hyper-aridity in the Atacama Desert has prevailed since at least the mid-Miocene, with shorter periods of increased humidity punctuating long-term aridity. The 7-m-high accumulation of colluvial sediments at the Salar Grande (21°S/70°W) studied here provides a key palaeoclimate record to understand hillslope dynamics and its relation to humid periods. While 10Be surface exposure ages point to long-term surface stability of the flat upslope surface, a combination of humidity-driven soil creep, overland flow and soil creep related to seismic shaking, caused denudation of the hillslope and accumulation of several metres of colluvium over much shorter timescales during the last 130 ka. A robust chronology for the hillslope sediments has been established by using Infrared Stimulated luminescence (pIR-IR225 protocol) on K-feldspar extracts from nine samples collected within the accumulation. A series of tests has been carried out to confirm the suitability of the method. The estimated ages indicate accelerated sedimentation at 35–80 ka, and 100–130 ka, which are interpreted as periods with more humid climate conditions than present. These findings agree with climate variations in the hyper-arid Atacama indicated by the activity of coastal alluvial fans and river catchments.

Depositional models for clastic sedimentation in large lakes, notably in rift lakes, emphasize on downslope river and gravity-driven processes. Wind-driven waterbodies (WWB), a recently-defined category of lakes, display features created by wave related processes and wind-induced water circulation such as beach ridges or spits along the coasts, as well as sediment drifts, sedimentary shelf progradation and erosional surfaces in deeper, offshore domains. A coupled hydrodynamic, wave and sediment transport three-dimensional Delft3D model was established for Lake Turkana, East Africa, one of the world’s greatest lakes in order to test the WWB validity for fine sediments. Using available data, the model is forced for 1.5 years with river liquid and solid discharge, as well as wind data, in order to simulate cohesive sediment transport and resuspension. The model simulates stratification due to salinity, wave generation and dissipation, and sediment advection and resuspension by waves and currents, with multiple cohesive sediment fractions. Model results were compared with remote sensed imagery and with available in-situ sediment deposition rates, reproducing the general surface suspended sediment patterns, and agreeing with the mass deposition rates data from the literature.By creating scenarios in which certain processes were switched off, the contribution of waves resuspension, wind-induced currents, salinity-induced stratification, and river jet, in resuspending and transporting sediment along the lake could be investigated. With just the wind and/or the river influence, most of the sediment deposition occurs in the first 10 km from the river mouth and at depths from 0 to 10 m. When waves are switched on, significant quantities of sediments can be resuspended by waves, and most of the sediments are deposited in the first 30 km from the river mouth, at depths from 10 to 30 m. This study provides insights on sediment transport in the Lake Turkana, and similarly in great lakes in general, supporting waves as the main agent transporting fine sediments away from river mouths into deeper areas, as opposed to river-plume derived transport.

Organic carbon (OC) in the hyper-arid Atacama Desert soils is known to be extremely low (0.1-0.01%). OC can accumulate on soil colloids (1-1000 nm) and nanoparticles (1-100 nm) due to its high specific surface area. Small-sized colloids may be transferred to deeper depth through the macropores in the soil. However, little is known about the colloidal-OC soil transfer under hyper-arid conditions. In this study, the Water Dispersible Colloids (WDCs, 4) coupled online to an Organic Carbon Detector (OCD). The experimental site is located at 1450 m altitude near Paposo (Antofagasta region, Chile) and receives -1 compared with the content found in crust-related older fan (0.24 mg OC kg-1) or at the edge between the fan sections (0.19 mg OC kg-1). Notably high WDC-OC in the fan near to the few isolated plant remains were also observed. The increase of biological activities and debris near to the plant contributes to more colloidal-OC (26.8 mg kg-1). The relatively flat hard impermeable surface of the crust-related old fan section may induce colloids loss during high-intensity rainfalls, e.g. occurring during past El Niño periods. Furthermore, the relative percentage of WDC-OC as a part of the total was highest in the upper layer (0-1 cm) of the active fan (27-48%) and at the edge (69%), while in the older crust-related sections the highest values were observed in the subsurface (5-10 cm) (19%-29%). Near the plant remains, nano-colloids were dominated in the upper soil accounting for 48% of the WDC-OC, whereas medium colloids were predominant in the older crust-related sections (64%). Dust (colloidal-sized) particles may be deposited at the surface and then are easily trapped near plants. We conclude that WDC-OC depth profiles within the hyper-arid Atacama Desert reflects the differential surface characteristics and the age of the fan surface, i.e., the period of geomorphological inactivity. During the extremely rare rainfall events in the Atacama, both factors will lead to differential infiltration rates, which thus in turn affect the size distribution of colloidal-OC with profile depth.

Over the past decades, substantial progress has been made in tsunami research. Be that as it may, little is still known about tsunami deposits and their related depositional mechanisms in coastal areas in historical and archaeological contexts. In particular, the Phoenician, Greek and Roman trade and military networks along the Mediterranean and Atlantic coasts, with their cities, harbours and additional facilities, are susceptible to serving as archives for extreme wave events. The ruins of the Roman city of Baelo Claudia, located on the Bay of Bolonia Bay (southern Spain), offer a unique environment for studying historical tsunamis in the Gulf of Cadiz. Baelo Claudia suffered at least two earthquakes in Roman times, namely, in the first and fourth centuries CE. The latter, associated with a tsunami, led to the city’s destruction and subsequent decline. Accordingly, three tsunami deposits in Baelo Claudia, dated to ca. 4000 cal BP (2000 BCE), ca. 400 CE and 1755 CE, the last corresponding to the Lisbon tsunami, are described here. The multi-disciplinary research conducted on the sedimentary, archaeological and palaeontological records has revealed event deposits, together with major landscape changes in the environs of the bay after tsunami landfall. Furthermore, the significant archaeoseismic damage detected in recently excavated buildings has been dated to the end of the fourth-century CE. The results presented here serve to supplement the earthquake and tsunami record of coastal Iberia., The authors are grateful to German Science Foundation (DFG grant, RE 1361/28-1) and the MINECO-FEDER Spanish Research Project CGL2015-67169-P (QTECSPAIN-USAL) for their support.

Background Erdafitinib, a pan-fibroblast growth factor receptor (FGFR) tyrosine kinase inhibitor, was shown to be clinically active and tolerable in patients with advanced urothelial carcinoma and prespecified FGFR alterations in the primary analysis of the BLC2001 study at median 11 months of follow-up. We aimed to assess the long-term efficacy and safety of the selected regimen of erdafitinib determined in the initial part of the study. Methods The open-label, non-comparator, phase 2, BLC2001 study was done at 126 medical centres in 14 countries across Asia, Europe, and North America. Eligible patients were aged 18 years or older with locally advanced and unresectable or metastatic urothelial carcinoma, at least one prespecified FGFR alteration, an Eastern Cooperative Oncology Group performance status of 0–2, and progressive disease after receiving at least one systemic chemotherapy or within 12 months of neoadjuvant or adjuvant chemotherapy or were ineligible for cisplatin. The selected regimen determined in the initial part of the study was continuous once daily 8 mg/day oral erdafitinib in 28-day cycles, with provision for pharmacodynamically guided uptitration to 9 mg/day (8 mg/day UpT). The primary endpoint was investigator-assessed confirmed objective response rate according to Response Evaluation Criteria In Solid Tumors version 1.1. Efficacy and safety were analysed in all treated patients who received at least one dose of erdafitinib. This is the final analysis of this study. This study is registered with ClinicalTrials.gov, NCT02365597. Findings Between May 25, 2015, and Aug 9, 2018, 2328 patients were screened, of whom 212 were enrolled and 101 were treated with the selected erdafitinib 8 mg/day UpT regimen. The data cutoff date for this analysis was Aug 9, 2019. Median efficacy follow-up was 24·0 months (IQR 22·7–26·6). The investigator-assessed objective response rate for patients treated with the selected erdafitinib regimen was 40 (40%; 95% CI 30–49) of 101 patients. The safety profile remained similar to that in the primary analysis, with no new safety signals reported with longer follow-up. Grade 3–4 treatment-emergent adverse events of any causality occurred in 72 (71%) of 101 patients. The most common grade 3–4 treatment-emergent adverse events of any cause were stomatitis (in 14 [14%] of 101 patients) and hyponatraemia (in 11 [11%]). There were no treatment-related deaths. Interpretation With longer follow-up, treatment with the selected regimen of erdafitinib showed consistent activity and a manageable safety profile in patients with locally advanced or metastatic urothelial carcinoma and prespecified FGFR alterations.

Background In German hospitals, severe shortage of physicians can currently be partially compensated by hiring foreign physicians. Results on job satisfaction (JS) and physician burnout (PBO) in this important occupational group are currently not available. Methods The cross-sectional “Assessment of their urological work environment by foreign clinicians in Germany (EUTAKD)” study was conducted in 2020 using a 101-item questionnaire among physicians working in German urological departments who were born in a country outside Germany and having non-German citizenship. This study compared JS and the occurrence of PBO between Arab (group A, n = 57) and non-Arab (group B, n = 39) participants. Results Significant group differences with advantages for group B were analyzed in overall JS and also in other JS items. High scores in the PBO dimensions, that is, “emotional exhaustion” and “depersonalization,” were shown by 27.9 and 51.5% of the study participants, respectively, although there were no group differences found (p = 0.972 and 0.237, respectively). Conclusion Prospective longitudinal studies of appropriate intervention measures aimed at increasing JS and decreasing PBO are needed.

To evaluate patients’ radiation exposure undergoing CT-guided joint injection in preparation of MR-arthrography. We developed a novel ultra-low-dose protocol utilizing tin-filtration, performed it in 60 patients and compared the radiation exposure (DLP) and success rate to conventional protocol (26 cases) and low-dose protocol (37 cases). We evaluated 123 patients’ radiation exposure undergoing CT-guided joint injection from 16 January–21 March. A total of 55 patients received CT-guided joint injections with various other examination protocols and were excluded from further investigation. In total, 56 patients received shoulder injection and 67 received hip injection with consecutive MR arthrography. The ultra-low-dose protocol was performed in 60 patients, the low-dose protocol in 37 patients and the conventional protocol in 26 patients. We compared the dose of the interventional scans for each protocol (DLP) and then evaluated success rate with MR-arthrography images as gold standard of intraarticular or extracapsular contrast injection. There were significant differences when comparing the DLP of the ultra-low-dose protocol (DLP 1.1 ± 0.39; p < 0.01) to the low dose protocol (DLP 5.3 ± 3.24; p < 0.01) as well as against the conventional protocol (DLP 22.9 ± 8.66; p < 0.01). The ultra-low-dose protocol exposed the patients to an average effective dose of 0.016 millisievert and resulted in a successful joint injection in all 60 patients. The low dose protocol as well as the conventional protocol were also successful in all patients. The presented ultra-low-dose CT-guided joint injection protocol for the preparation of MR-arthrography demonstrated to reduce patients’ radiation dose in a way that it was less than the equivalent of the natural radiation exposure in Germany over 3 days—and thereby, negligible to the patient.

OBJECTIVES The purpose of this study was to evaluate the minimum diagnostic radiation dose level for the detection of high-resolution (HR) lung structures, pulmonary nodules (PNs), and infectious diseases (IDs). MATERIALS AND METHODS A preclinical chest computed tomography (CT) trial was performed with a human cadaver without known lung disease with incremental radiation dose using tin filter-based spectral shaping protocols. A subset of protocols for full diagnostic evaluation of HR, PN, and ID structures was translated to clinical routine. Also, a minimum diagnostic radiation dose protocol was defined (MIN). These protocols were prospectively applied over 5 months in the clinical routine under consideration of the individual clinical indication. We compared radiation dose parameters, objective and subjective image quality (IQ). RESULTS The HR protocol was performed in 38 patients (43%), PN in 21 patients (24%), ID in 20 patients (23%), and MIN in 9 patients (10%). Radiation dose differed significantly among HR, PN, and ID (5.4, 1.2, and 0.6 mGy, respectively; P < 0.001). Differences between ID and MIN (0.2 mGy) were not significant (P = 0.262). Dose-normalized contrast-to-noise ratio was comparable among all groups (P = 0.087). Overall IQ was perfect for the HR protocol (median, 5.0) and decreased for PN (4.5), ID-CT (4.3), and MIN-CT (2.5). The delineation of disease-specific findings was high in all dedicated protocols (HR, 5.0; PN, 5.0; ID, 4.5). The MIN protocol had borderline IQ for PN and ID lesions but was insufficient for HR structures. The dose reductions were 78% (PN), 89% (ID), and 97% (MIN) compared with the HR protocols. CONCLUSIONS Personalized chest CT tailored to the clinical indications leads to substantial dose reduction without reducing interpretability. More than 50% of patients can benefit from such individual adaptation in a clinical routine setting. Personalized radiation dose adjustments with validated diagnostic IQ are especially preferable for evaluating ID and PN lesions.

BACKGROUND AND PURPOSE: The high diagnostic value of DWI for cholesteatoma diagnostics is undisputed. This study compares the diagnostic value of readout-segmented echo-planar DWI and single-shot TSE DWI for cholesteatoma diagnostics. MATERIALS AND METHODS: Thirty patients with newly suspected cholesteatoma were examined with a dedicated protocol, including readout-segmented echo-planar DWI and single-shot TSE DWI at 1.5T. Acquisition parameters of both diffusion-weighted sequences were as follows: b=1000 s/mm,(2) axial and coronal section orientations, and section thickness of 3 mm. Image quality was evaluated by 2 readers on a 5-point Likert scale with respect to lesion conspicuity, the presence of susceptibility artifacts mimicking cholesteatomas, and overall subjective image quality. Sensitivity and specificity were calculated using histology results as the gold standard. RESULTS: Twenty-five cases of histologically confirmed cholesteatomas were included in the study group. Lesion conspicuity was higher and fewer artifacts were found when using TSE DWI (both P

Zusammenfassung Hintergrund Gemäß einer aktuellen Metaanalyse zeigt in Europa jeder zweite Patient mit einem Peniskarzinom (PeK) eine Assoziation mit dem Humanen Papillomavirus (HPV). Es liegen keine Daten darüber vor, inwieweit UrologInnen die Häufigkeit dieser viralen Karzinogenese kennen. Methoden Es wurde ein 14-Items umfassender deutschsprachiger Survey erstellt und in Q3/2018 einmalig an UrologInnen von 45 Kliniken in Deutschland (n = 34), Österreich (n = 8), der Schweiz (n = 2) und Italien/Südtirol (n = 1) verschickt. Insgesamt waren nach vorher definiertem Qualitätsstandard 557 Fragebögen auswertbar (mediane Rücklaufquote 85,7 %). In dem Survey wurde u. a. nach der Häufigkeit HPV-assoziierter PeK in Europa gefragt und 4 Antwortmöglichkeiten vorgegeben: (A)-„ 50 – 75 %“, (D)-„kein Wissen über die Häufigkeit des Zusammenhangs“. Es wurde in der Auswertung eine Toleranz von 50 % akzeptiert, sodass B und C (25 – 75 %) als korrekte Antworten gewertet wurden. Mittels eines Bootstrap-korrigierten multivariaten logistischen Regressionsmodells wurden Kriterien identifiziert, die unabhängig eine richtige Antwort der Befragten vorhersagten. Ergebnisse Die Kategorien A – D wurden von 19,2 % (n = 107), 48,8 % (n = 272), 12,9 % (n = 72) bzw. 19 % (n = 106) als Antwort gewählt, sodass der Endpunkt von 61,8 % (n = 344) der UrologInnen erreicht wurde (B + C). Die selbstständige Durchführung der Chemotherapie durch die Urologische Klinik (OR 1,55; p[Bootstrap] = 0,036) und die Anzahl der urologischen Klinikbetten (OR 1,02; p[Bootstrap] = 0,025) waren die einzigen Studienkriterien, die signifikant das richtige Ergebnis prädizierten. Der Status einer Universitätsklinik (p = 0,143), eine leitende Position der UrologInnen (p = 0,375) bzw. die jährliche Anzahl behandelter PeK-Patienten (p = 0,571) blieben hingegen ohne signifikanten Einfluss auf den Endpunkt. Schlussfolgerung Unsere Studienergebnisse zeigen, dass sich deutschsprachige Klinik-UrologInnen der Häufigkeit einer gegenwärtigen HPV-Assoziation des PeK nur unzureichend bewusst sind.

Although a number of studies have pointed out the remarkable slowness of Earth surface processes in the Atacama Desert, process mechanisms under such extremely limited water availability are poorly understood, and process rates remain unknown. This paper revisits the discussion on the formation of the prominent Atacama-specific hillslope zebra (stone) stripes, previously interpreted to result from palaeo-overland flow (Owen et al., 2013). Compared to this study, our data document different stripe characteristics with regard to stripe form and orientation as well as sorting- and bedding-patterns of stripe-confining surface gravel units. We found a remarkable form-concordance between zebra stripes and deposits from experiments on segregation-induced granular fingering. Hence, we propose a combination of seismic shaking and instantaneous dry granular free surface flows as the key mechanism for zebra stripe formation. Our findings underline the potential significance of seismicity in shaping Atacama landscapes, which bear important analogies to extra-terrestrial surfaces.

Based on data retrieved from a comprehensive multicenter database, we externally validated a published postoperative nomogram for the prediction of disease-specific survival (DSS) in patients with papillary renal cell carcinoma (papRCC). A multicenter database containing data of 2325 patients with surgically treated papRCC was used as validation cohort. After exclusion of patients with missing data and patients included in the development cohort, 1372 patients were included in the final analysis. DSS-probabilities according to the nomogram were calculated and compared to actual DSS-probabilities. Subsequently, calibration plots and decision curve analyses were applied. The median follow-up was 38 months (IQR 11.8–80.7). Median DSS was not reached. The c-index of the nomogram was 0.71 (95% CI 0.60–0.83). A sensitivity analysis including only patients operated after 1998 delivered a c-index of 0.84 (95% CI 0.77–0.92). Calibration plots showed slight underestimation of nomogram-predicted DSS in probability ranges below 90%: median nomogram-predicted 5-year DSS in the range below 90% was 55% (IQR 20–80), but the median actual 5-year DSS in the same group was 58% (95% CI 52–65). Decision-curve analysis showed a positive net-benefit for probability ranges between a DSS probability of 5% and 85%. The nomogram performance was satisfactory for almost all DSS probabilities; hence it can be recommended for application in clinical routine and for counseling of patients with papRCC.

In the southernmost part of the Colchian plain (Georgia), the Supsa and Rioni rivers represent important catchments for reconstructing Holocene landscape changes. Using granulometric methods, geochemical analyses and radiocarbon dating, we demonstrate that significant palaeoenvironmental changes have taken place in the surroundings of the Supsa fan since at least 4000 BCE. The initial foothill fan accumulation was prolonged by delta plain progradation. Due to continued fluvial sediment supply, mainly from the Rioni, the lagoon silted up and extended peat bogs formed east of the beach ridge complex. The Supsa fan first prograded northwards (since the third millennium BCE) and later shifted westwards, eventually following an avulsion of the Rioni. While Supsa deposits remain limited to the area of the fan and the modern estuary, the alluvial fines of the Rioni dominate the surrounding areas. The relative sea-level (RSL) index points of the region suggest a gradual RSL rise from ∼-9 m between 4000 and 3500 BCE to −3/−2 m below the modern sea level in the second half of the first millennium BCE, the period during which Greek colonization and Colchian settlements are attested by archaeological remains.

Background Liver dynamic computed tomography (CT) is an established method for pre- and post-interventional evaluation of hepatocellular carcinoma. To date only the liver parenchyma and perfusion information of dynamic CT has been evaluated widely. Purpose To evaluate the vascular information contained in dynamic CT datasets. Material and Methods Dynamic CT performed one day after transarterial chemoembolization (60 mL of contrast medium, 6 mL/s, 40 s scan duration) were retrospectively evaluated. Conventional slice and angiographic maximum-intensity-projection reconstructions were calculated on a multi-modality post-processing platform. Datasets were evaluated for viable tumor, anatomy of the vasculature, and potential tumor-feeding vessels. The results were compared to digital subtraction angiography images. Results In total, 94 treated hepatocellular carcinoma nodules were evaluated (62 dynamic CT scans, 46 patients [34 men; mean age = 69 years]). Forty-six partially viable tumors were diagnosed after transarterial chemoembolization. In all of these, tumor-feeding vessels were found in dynamic CT. Seventeen suspected extra-hepatic tumor feeders were reported, of which 14 had not been found during previous transarterial chemoembolization. Conclusion Dynamic CT is useful in post-interventional imaging of hepatocellular carcinoma after transarterial chemoembolization due to its ability to detect residual viable tumor parts and to show previously unknown intra- and extra-hepatic tumor-feeding vessels.

Objectives To assess the incidence of acute adverse events (AAEs) in gadolinium-enhanced cardiac magnetic resonance (CMR) imaging. Methods Gadolinium-based contrast agent (GBCA)–enhanced CMR data from the multinational, multicenter European Society of Cardiovascular Radiology MRCT Registry was included. AAE severity was classified according to the American College of Radiology Manual on Contrast Media (mild, moderate, severe). Multivariable generalized linear mixed effect models were used to assess the likelihood of AAEs in various GBCA, adjusting for pharmacological stressor, main indications (i.e., suspected or known coronary artery disease or myocarditis), age, sex, and submitting center as a random effect. Results In the study population of 72,839 GBCA-enhanced CMRs, a total of 260 AAEs were reported (0.36%), with a minority of severe AAEs (n = 24, 0.033%). Allergic-like AAEs were less likely than physiologic AAEs (29% versus 71%). Patients without pharmacological stress imaging had a lower AAE rate (0.22%) compared to stress imaging (0.75%), with the highest AAE rates for regadenoson (2.95%). AAE rates also varied by GBCA subtype (overall p

Fur den ambulant tatigen Urologen konnte die Therapieempfehlung aus der Klinik im Kampf gegen Rezidiv und Progression des nicht muskelinvasiven Harnblasenkarzinoms eine wichtige Hilfestellung sein. Unsere Daten zur Einschatzung der eigenen Empfehlungen und deren tatsachlichem Wert zeigen: Hier ist noch Luft nach oben.

Background High rates of multiresistant pathogens require detailed knowledge about rational utilization of antibiotics. Many physicians consider themselves uncertain about the interpretation of microbiological diagnostics. We examined whether self-confidence, self-rated knowledge, and objective knowledge regarding the use of antibiotics are associated with gender. Methods For this survey study, in 2017, anaesthesiologists and residents of 16 anaesthetic departments in Germany were asked to complete the Multiinstitutional Reconnaissance of practice with Multiresistant bacteria (MR2) survey. It consists of 55 items evaluating self-confidence regarding the practical use of antibiotics (n = 6), self-rated theoretical knowledge (n = 16), and objective knowledge (n = 5). Their answers to these items in relation to their gender were analysed using Chi-square, Kruskal-Wallis-H-Tests, and unadjusted as well as adjusted logistic regression models. Results Six hundred eighty-four (response rate: 53.9 %) questionnaires were returned and were available for analysis. Female doctors (35.5 %) felt less self-confident (P < 0.001). Self-rated knowledge differed in overall mean (P = 0.014) and the unadjusted (odds ratio [OR]: 0.55; P = 0.013) but not in the adjusted logistic regression (OR: 0.84; P = 0.525). Objective knowledge differed after pooling questions (61.2% correct answers vs 65.4%, P = 0.01) but not with respect to single items and the adjusted logistic regression (OR: 0.83, P = 0.356). Conclusion Less self-confidence and a lower self-rated knowledge were found in female anaesthetists; this is consistent to the gender phenomena observed by other researchers. Nevertheless, between the 2 groups objective knowledge did not differ significantly in any item.

There are no study results on the private and professional satisfaction and the burnout risk of urologists with a migrant background at German hospitals to date. Non-medical reading has been described to have an influence on lower burnout rates among physicians of different specialties.A SurveyMonkey questionnaire with 101 items on criteria characterising the study participant, questions on private and professional satisfaction and the complete Maslach Burnout Inventory was opened to urologists with a migrant background at German clinics between August and October 2020. The impact of non-medical reading on professional satisfaction and burnout was comparatively assessed (group A: ≤1 book/12 months versus group B: ≥2 books/12 months).Eighty-one study participants were included. They were almost equally distributed into groups A (49.4%) and B (50.6%). In several items on personal and professional satisfaction, there was a significantly higher satisfaction in group B. In the burnout dimensions of emotional exhaustion (EE), depersonalisation (DP) and personal accomplishment (PA), a high risk of burnout was present in 27.9%, 35.3% and 73.5% of the study participants. A group comparison revealed significant advantages for Group B in the PA dimension in both the sum score (Reading non-medical books was associated with higher professional satisfaction and a lower burnout risk among urologists with a migrant background at German hospitals.Es liegen aktuell keine Studienergebnisse zur privaten und beruflichen Zufriedenheit sowie zum Burnout-Risiko von Urologe*innen mit Migrationshintergrund an deutschen Kliniken vor. Der Einfluss des Lesens nicht-medizinischer Bücher auf geringere Burnout-Raten bei Ärzte*innen verschiedener Fachrichtungen wurde beschrieben.Ein Survey-Monkey mit 101 Items zu charakterisierenden Kriterien des Studienteilnehmers, Fragen zur privaten und beruflichen Zufriedenheit und dem vollständigen Maslach-Burnout-Inventary wurde zwischen August und Oktober 2020 für Urologe*innen mit Migrationshintergrund an deutschen Kliniken geöffnet. Der Einfluss des Lesens nicht-medizinischer Bücher auf berufliche Zufriedenheit und Burnout wurde vergleichend untersucht (Gruppe A: ≤1 Buch/12 Monate versus Gruppe B: ≥2 Bücher/12 Monate).81 Studienteilnehmer konnten eingeschlossen werden, die nahezu paritätisch in den Gruppen A (49,4%) und B (50,6%) verteilt waren. In mehreren Items der privaten und beruflichen Zufriedenheit bestand eine signifikant höhere Zufriedenheit in der Gruppe B. In den Burnout-Dimensionen emotionale Erschöpfung (EE), Depersonalisation (DP) und Verringerung der persönlichen Leistungsfähigkeit (VL) lag bei 27,9%, 35,3% bzw. 73,5% der Studienteilnehmer ein hohes Burnout-Risiko vor. Im Gruppenvergleich bestanden in der VL-Dimension signifikante Vorteile für die Gruppe B sowohl im Summenscore (Das Lesen nicht-medizinischer Bücher war bei Urologe*innen mit Migrationshintergrund an deutschen Kliniken mit höherer beruflicher Zufriedenheit und geringerem Burnout-Risiko assoziiert.

Zusammenfassung Hintergrund Es liegen aktuell keine Studienergebnisse zur privaten und beruflichen Zufriedenheit sowie zum Burnout-Risiko von Urologe*innen mit Migrationshintergrund an deutschen Kliniken vor. Der Einfluss des Lesens nicht-medizinischer Bücher auf geringere Burnout-Raten bei Ärzte*innen verschiedener Fachrichtungen wurde beschrieben. Material und Methoden Ein Survey-Monkey mit 101 Items zu charakterisierenden Kriterien des Studienteilnehmers, Fragen zur privaten und beruflichen Zufriedenheit und dem vollständigen Maslach-Burnout-Inventary wurde zwischen August und Oktober 2020 für Urologe*innen mit Migrationshintergrund an deutschen Kliniken geöffnet. Der Einfluss des Lesens nicht-medizinischer Bücher auf berufliche Zufriedenheit und Burnout wurde vergleichend untersucht (Gruppe A: ≤1 Buch/12 Monate versus Gruppe B: ≥2 Bücher/12 Monate). Ergebnisse 81 Studienteilnehmer konnten eingeschlossen werden, die nahezu paritätisch in den Gruppen A (49,4%) und B (50,6%) verteilt waren. In mehreren Items der privaten und beruflichen Zufriedenheit bestand eine signifikant höhere Zufriedenheit in der Gruppe B. In den Burnout-Dimensionen emotionale Erschöpfung (EE), Depersonalisation (DP) und Verringerung der persönlichen Leistungsfähigkeit (VL) lag bei 27,9%, 35,3% bzw. 73,5% der Studienteilnehmer ein hohes Burnout-Risiko vor. Im Gruppenvergleich bestanden in der VL-Dimension signifikante Vorteile für die Gruppe B sowohl im Summenscore (p=,001) als auch im kategorialen Vergleich (p=,002). Studienteilnehmer der Gruppe B wiesen im Vergleich zur Gruppe A ebenfalls einen signifikant geringeren Summenscore der DP-Dimension auf (p=,047). Es bestanden unabhängige Zusammenhänge zwischen der Gruppenvariable mit einem kombinierten Score aus EE und DP einerseits (OR 0,316; p=,031) und mit der VL-Dimension andererseits (OR 0,170; p=,024). Schlussfolgerungen Das Lesen nicht-medizinischer Bücher war bei Urologe*innen mit Migrationshintergrund an deutschen Kliniken mit höherer beruflicher Zufriedenheit und geringerem Burnout-Risiko assoziiert.

Objectives To evaluate an image-navigated isotropic high-resolution 3D late gadolinium enhancement (LGE) prototype sequence with compressed sensing and Dixon water-fat separation in a clinical routine setting. Material and methods Forty consecutive patients scheduled for cardiac MRI were enrolled prospectively and examined with 1.5 T MRI. Overall subjective image quality, LGE pattern and extent, diagnostic confidence for detection of LGE, and scan time were evaluated and compared to standard 2D LGE imaging. Robustness of Dixon fat suppression was evaluated for 3D Dixon LGE imaging. For statistical analysis, the non-parametric Wilcoxon rank sum test was performed. Results LGE was rated as ischemic in 9 patients and non-ischemic in 11 patients while it was absent in 20 patients. Image quality and diagnostic confidence were comparable between both techniques (p = 0.67 and p = 0.66, respectively). LGE extent with respect to segmental or transmural myocardial enhancement was identical between 2D and 3D (water-only and in-phase). LGE size was comparable (3D 8.4 ± 7.2 g, 2D 8.7 ± 7.3 g, p = 0.19). Good or excellent fat suppression was achieved in 93% of the 3D LGE datasets. In 6 patients with pericarditis, the 3D sequence with Dixon fat suppression allowed for a better detection of pericardial LGE. Scan duration was significantly longer for 3D imaging (2D median 9:32 min vs. 3D median 10:46 min, p = 0.001). Conclusion The 3D LGE sequence provides comparable LGE detection compared to 2D imaging and seems to be superior in evaluating the extent of pericardial involvement in patients suspected with pericarditis due to the robust Dixon fat suppression. Key Points • Three-dimensional LGE imaging provides high-resolution detection of myocardial scarring. • Robust Dixon water-fat separation aids in the assessment of pericardial disease. • The 2D image navigator technique enables 100% respiratory scan efficacy and permits predictable scan times.

Background: Studies exist that identify factors associated with higher professional satisfaction among clinicians. However, there are no reliable findings for clinicians with a migration background as to whether there is a correlation between particular dimensions of professional satisfaction and the desire to leave their current specialty or country of employment. For the first time, these data were collected within a questionnaire-based study from urological clinicians with a migration background (UCMBs) working in Germany. Material and Methods: A SurveyMonkey® with 101 items relating to characterizing features of the study participants and questions about job satisfaction (n = 39) was opened for UCMBs between August and October 2020. The influence of different dimensions of job satisfaction on the desire to quit the urological specialty/leave Germany was analyzed (group A: neither want to leave urology nor Germany; group B: can at least imagine leaving the urological profession and/or Germany). Results: Eighty-one UCMBs were distributed almost equally in groups A (50.6%) and B (49.4%). Occupational satisfaction was higher in several respects in group A. Three dimensions that differed significantly with regard to occupational satisfaction were used to create an aggregate score ranging from 3 to 15 points as follows: (1) relationship to superiors (p = 0.014), (2) career opportunities in the clinic (p < 0.001), and (3) opportunities for the further development of surgical skills (p = 0.006). For each point value of this aggregate score, the UCMB’s desire to quit urology or leave Germany (or at least uncertainty about this question) decreased by a relative value of 34.6% (odds ratio: 0.654, 95% confidence interval: 0.496–0.861, p = 0.002). Conclusions: Various dimensions of job satisfaction have been identified, the improvement of which could contribute to the long-term retention of UCMBs at German urological clinics.

Introduction: Lymphocele (LC) formation is a common complication which may cause severe symptoms after robot-assisted radical prostatovesiculectomy (RARP) with concomitant pelvic lymph node dissection (PLND). Compared to open radical prostatectomy, the amount of data on potential risk factors for LC formation is still limited. The aim of the present study was to identify risk factors for symptomatic LC formation (sLC) after RARP with PLND. Methods: We used the data of a prospective multicentre series of 232 RARP patients which were treated between March 2017 and December 2017. The primary endpoint was the presence of sLC within 90 days. Asymptomatic LC (aLC) formation was also recorded. We evaluated clinical, perioperative, and histopathological criteria and compared their distribution in patients with and without post-operative sLC. Uni- and multivariable logistic regression analyses (MVAs) were performed to identify potential predictors for LC formation. Regarding the influence of patients’ BMI, 2 models were calculated: BMI continuously (model 1) and BMI dichotomized with cut-off 30 kg/m2 (WHO definition, model 2). Results: Post-operative sLC was present in 21 patients (9.1%), while aLC was detected in 49 patients (21.1%) 90 days after RARP with PLND. Patients with sLC showed higher median baseline PSA levels (9.8 vs. 8.1 ng/mL), higher prevalence of obesity (BMI >30; 42.9 vs. 19.9%), and longer median console time (180 vs. 165 min) compared to patients without sLC. On MVA higher BMI {model 1: OR 1.145 (confidence interval [CI] 1.025–1.278); model 2: OR 2.761 (1.045–7.296)}, longer console time (model 1: OR 1.013 [1.005–1.021]; model 2: OR 1.013 [1.005–1.020]) and an ISUP grade ≥3 (model 1: OR 3.247 [1.182–8.917]; model 2: OR 2.791 [1.050–7.423]) were identified as independent predictors for sLC development. Conclusion: Patients with aggressive tumours and higher BMI should be informed about a potentially increased risk for sLC formation. In case of a long console time, a close and regular follow-up should be considered to check for LC development.

The chronostratigraphy of coastal sedimentary records such as washover fans or beach-ridge sequences may be used to reconstruct storm chronologies on centennial to millennial time scales. However, modern analogues are crucial for interpretations of depositional processes and for reducing uncertainty in evaluating the typically complex chronostratigraphic architecture of these landforms. Such a modern analogue was provided by category 3 tropical cyclone (TC) Olwyn in 2015, which caused a significant storm surge in the Gulf of Exmouth, Western Australia, and which activated large washover fans located in the southwestern part of the Gulf. Pre- and post-TC Olwyn geomorphological surveys and high-resolution drone-derived topographical data of one of these washover fans document a detailed history of erosion and deposition during the event. The modern analogue deposits provided an excellent opportunity to evaluate the use of luminescence-based proxies (luminescence inventories) including quartz single-grain age distributions and associated remnant ages, as well as quartz and feldspar luminescence signal comparisons for tracing event-related sediment source environments and understanding transport processes (May et al., 2020). Sediments deposited during Olwyn show a systematic relationship between luminescence characteristics and washover fan position. Seaward and central washover sections are indicated by well-bleached deposits due to the beach as the dominant source and/or long transport distances across the fan. Lateral washover deposits, in contrast, are characterised by rather local source areas and short transport distances, resulting in higher remnant ages of 70-140 a. This data shows that the combination of sediment source environments and sediment transport length across the fan represents the main control in resetting the luminescence signal and enabling reliable depositional ages to be calculated. It documents the benefit of investigating luminescence inventories when establishing chronologies from complex sedimentary records, thereby demanding a careful consideration of local processes and source areas when interpreting sedimentary TC records.May, S. M., Callow, J. N., Brill, D., Hoffmeister, D., & May, J.-H. (2020). Revealing sediment transport pathways and geomorphic change in washover fans by combining drone-derived digital elevation models and single grain luminescence data. Journal of Geophysical Research: Earth Surface, 125, e2020JF005792. https://doi.org/10.1029/2020JF005792

The aim of this study was to evaluate the performance of a tablet-based, digitized structured self-assessment (DSSA) of patient anamnesis (PA) prior to computed tomography (CT). Of the 317 patients consecutively referred for CT, the majority (n = 294) was able to complete the tablet-based questionnaire, which consisted of 67 items covering social anamnesis, lifestyle factors (e.g., tobacco abuse), medical history (e.g., kidney diseases), current symptoms, and the usability of the system. Patients were able to mark unclear questions for a subsequent discussion with the radiologist. Critical issues for the CT examination were structured and automatically highlighted as “red flags” (RFs) in order to improve patient interaction. RFs and marked questions were highly prevalent (69.5% and 26%). Missing creatinine values (33.3%), kidney diseases (14.4%), thyroid diseases (10.6%), metformin (5.5%), claustrophobia (4.1%), allergic reactions to contrast agents (2.4%), and pathological TSH values (2.0%) were highlighted most frequently as RFs. Patient feedback regarding the comprehensibility of the questionnaire and the tablet usability was mainly positive (90.9%; 86.2%). With advanced age, however, patients provided more negative feedback for both (p = 0.007; p = 0.039). The time effort was less than 20 min for 85.1% of patients, and faster patients were significantly younger (p = 0.046). Overall, the DSSA of PA prior to CT shows a high success rate and is well accepted by most patients. RFs and marked questions were common and helped to focus patients’ interactions and reporting towards decisive aspects.

Low-dose dual-source computed tomography (DSCT) protocols for the evaluation of lung diseases in children and adolescents are of importance since this age group is particularly prone to radiation damage. The aim of this study was to evaluate image quality of low-dose DSCT of the lung and to assess the potential of radiation dose reduction compared to digital radiographs (DR). Three groups, each consisting of 19 patients, were examined with different DSCT protocols using tin prefiltration (Sn96/64/32 ref. mAs at 100 kV). Different strengths of iterative reconstruction were applied (ADMIRE 2/3/4). DSCT groups were compared to 19 matched patients examined with posterior–anterior DR. Diagnostic confidence, detectability of anatomical structures and small lung lesions were evaluated on a 4-point Likert scale (LS 1 = unacceptable, 4 = fully acceptable, a value ≥ 3 was considered acceptable). Effective dose (ED) was 31-/21-/9-fold higher in Sn96/Sn64/Sn32 compared to DR. Diagnostic confidence was sufficient in Sn96/Sn64 (LS 3.4/3.2), reduced in Sn32 (LS 2.7) and the worst in DR (LS 2.4). In DSCT, detectability of small anatomical structures was always superior to DR (p &lt, 0.05). Mean lesion size ranged from 5.1–7 mm, detectability was acceptable in all DSCT groups (LS 3.0–3.4) and superior to DR (LS 1.9, p &lt, 0.05). Substantial dose lowering in DSCT of the pediatric lung enables acceptable detectability of small lung lesions with a radiation dose being about 10-fold higher compared to DR.

Chronostratigraphic investigations on coastal sedimentary records such as washover fans or beach‐ridge sequences may be used to reconstruct storm chronologies on centennial to millennial time scales. However, modern analogs are pivotal in interpreting depositional processes and reducing uncertainty in evaluating the complex chronostratigraphic architecture of these landforms. Such a modern analog was provided by category 3 tropical cyclone (TC) Olwyn in 2015, which caused a significant storm surge in the Exmouth Gulf (Western Australia). Pre‐ and post‐TC Olwyn geomorphological surveys and high‐resolution drone‐derived topographical data of a large washover fan document a detailed history of erosion and deposition during the event. The modern analog deposits provided an excellent opportunity to evaluate the use of luminescence‐based proxies (luminescence inventories) for tracing event‐related sediment source environments and understanding transport processes. Sediments deposited during Olwyn show a systematic relationship between luminescence characteristics and washover fan position. Seaward and central washover sections are indicated by well‐bleached deposits due to the beach as the dominant source and/or long transport distances. Lateral washover deposits are characterized by rather local source areas and short transport distances, resulting in higher remnant ages of 70–140 a. Our data show that the combination of sediment source environments and sediment transport length across the fan represents the main control in resetting the luminescence signal and enabling reliable depositional ages to be calculated. It documents the benefit of investigating luminescence inventories when establishing chronologies from complex sedimentary records, thereby demanding a careful consideration of local processes and source areas when interpreting sedimentary TC records., Key Points: We investigated deposits of tropical cyclone Olwyn by combining drone‐derived digital elevation models and single grain luminescence data. High‐resolution pre‐ and post‐TC Olwyn DEMs helped to quantify the complex pattern of erosion and deposition in a large washover fan. The single grain luminescence data revealed differences in sediment source areas and transport distances of the washover deposits., Deutsche Forschungsgemeinschaft (DFG) http://dx.doi.org/10.13039/501100001659

In southern Iberia, the surroundings of the Strait of Gibraltar are known as a crossroad for population movements, cultural exchanges, and trade from Late Prehistory to modern times. However, questions remain about the impact of this historical development on the environment. The settlement of La Silla del Papa, an important hillfort in southern Andalusia (Cádiz), was occupied during the entire Iron Age, replaced by the coastal town Baelo Claudia during Roman times, and re‐occupied during Early Medieval times. As such, La Silla del Papa and its territory represent an ideal location for long‐term studies on human‐environment interactions. Within the framework of the interdisciplinary project “Archeostraits,” geoarchaeological investigations in the surroundings of La Silla del Papa aimed at constraining ecological conditions and human‐environment interactions during the mid‐ and late Holocene and during major human occupation phases. Our results document an early mid‐Holocene marine embayment in the lower floodplain of the Río del Cachón, rapidly turning into a coastal lagoon and later into freshwater‐dominated wetlands. After approximately 2100 BP (c. 150 BC), fluvial and alluvial deposition i600ing a high anthropogenic impact on the local landscape during Roman or post‐Roman times. Palynological results reveal fluctuating agricultural and pastoral activities and distinct periods of landscape opening during the Neolithic and Iron Age., Deutsche Forschungsgemeinschaft http://dx.doi.org/10.13039/501100001659, Agence Nationale de la Recherche http://dx.doi.org/10.13039/501100001665

BACKGROUND: The use of organ sparing strategies to treat penile cancer (PC) is currently supported by evidence that has indicated the safety, efficacy and benefit of this surgery. However, radical penectomy still represents up to 15–20% of primary tumor treatments in PC patients. The aim of the study was to evaluate efficacy in terms of overall survival (OS) and disease-free survival (DFS) of radical penectomy in PC patients. METHODS: Data from a retrospective multicenter study (PEnile Cancer ADherence study, PECAD Study) on PC patients treated at 13 European and American urological centers (Hospital “Sant’Andrea”, Sapienza University, Roma, Italy; “G.D’Annunzio” University, Chieti and ASL 2 Abruzzo, Hospital “S. Pio da Pietrelcina”, Vasto, Italy; Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL, USA; Hospital of Budapest, Hungary; Department of Emergency and Organ Transplantation, Urology and Andrology Unit II, University of Bari, Italy; Hospital “Spedali Civili”, Brescia, Italy; Istituto Europeo di Oncologia, University of Milan, Milan, Italy; University of Modena & Reggio Emilia, Modena, Italy; Hospital Universitario La Paz, Madrid, Spain; Ceara Cancer Institute, Fortaleza, Brazil; Virginia Commonwealth University, Richmond, VA, USA; Aristotle University of Thessaloniki, Thessaloniki, Greece; Maria Skłodowska-Curie Memorial Cancer Center, Warsaw, Poland) between 2010 and 2016 were used. Medical records of patients who specifically underwent radical penectomy were reviewed to identify main clinical and pathological variables. Kaplan-Meier method was used to estimate 1- and 5-year OS and DFS. RESULTS: Of the entire cohort of 425 patients, 72 patients (16.9%) treated with radical penectomy were extracted and were considered for the analysis. The median age was 64.5 (IQR, 57.5–73.2) years. Of all, 41 (56.9%) patients had pT3/pT4 and 31 (43.1%) pT1/pT2. Moreover, 36 (50.0%) were classified as pN1–3 and 5 (6.9%) M1. Furthermore, 61 (84.7%) had a high grade (G2–G3) with 6 (8.3%) positive surgical margins. The 1- and 5-year OS rates were respectively 73.3% and 59.9%, while the 1- and 5-year DFS rates were respectively 67.3% and 35.1%. CONCLUSIONS: PC is an aggressive cancer particularly in more advanced stage. Overall, more than a third of patients do not survive at 5 years and more than 60% report a disease recurrence, despite the use of a radical treatment.

Background: Robot-assisted radical prostatectomy (RARP) including pelvic lymph node dissection (PLND) is the current state of the art in surgical therapy of localized prostate cancer with intermediate or high risk. PLND in particular is associated with morbidity inherent to this method; the rate of symptomatic lymphoceles (sLCs), for example, ranges up to 10%. Objective: Various intraoperative modifications have been developed with the aim of reducing the sLC rate. Based on current studies, a peritoneal interposition flap (PIF) appears to be one of the most effective methods for this purpose. Under the criteria of a systematic review, 5 retrospective studies have been identified until now, 4 of which showed a positive effect of PIF on the sLC rate. Results and Limitations: A total of 1,308 patients were included in the aggregated analysis of these 5 studies. The amount of sLCs was 1.3% (8/604) and 5.7% (40/704) in the PIF and standard groups, respectively (p < 0.001). The resulting odds ratio (OR) was 0.23 (95% confidence interval [CI]: 0.05–0.99), taking in­to account a noteworthy heterogeneity of the 5 studies (Q = 9.47, p = 0.05; I2 = 58%). In addition, a prospective randomized and blinded study (Pianoforte trial) with corresponding sLC rates of 8.3% (9/108) versus 9.7% (12/124) (p = 0.820) exists. In this study, the OR was 0.85 (95% CI: 0.34–2.10, p = 0.722). Conclusion: Despite positive results from retrospective studies with indirect evidence, the role of the PIF in the reduction of sLC in RARP could not be conclusively assessed yet. The results of the first prospective randomized study do not show a positive effect of PIF, declaring a research gap for further studies with direct evidence.

This paper deals with the long-term bonding and tensile strengths of textile reinforced mortar (TRM) exposed to harsh environments. The objective of this study was to investigate the long-term bonding and tensile strengths of carbon TRM by an accelerated aging method. Moisture, high temperature, and freezing&ndash, thaw cycles were considered to simulate harsh environmental conditions. Grid-type textiles were surface coated to improve the bond strength with the mortar matrix. A total of 130 TRM specimens for the bonding test were fabricated and conditioned for a prolonged time up to 180 days at varying moisture conditions and temperatures. The long-term bonding strength of TRM was evaluated by a series of bonding tests. On the other hand, a total of 96 TRM specimens were fabricated and conditioned at freezing&ndash, thaw conditions and elevated temperature. The long-term tensile strength of TRM was evaluated by a series of direct tensile tests. The results of the bonding test indicated that TRM was significantly degraded by moisture. On the other hand, the influence of the freezing&ndash, thaw conditions and high temperature on the tensile strength of the TRM was insignificant.

Introduction Penile cancer (PeCa) is an orphan disease in European countries. The current guidelines are predominantly based on retrospective studies with a low level of evidence. In our study, we aimed to identify predictors for guideline-conform treatment and hypothesize that reference centers for PeCa and physicians' experience promote guideline compliance and therefore correct local tumor therapy. Methods This study is part of the European PROspective Penile Cancer Study (E-PROPS), an international collaboration group evaluating therapeutic management for PeCa in Central Europe. For this module, a 14-item-survey was developed and sent to 681 urologists in 45 European centers. Three questions focused on therapeutic decisions for PeCa in clinical stage Tis, Ta-T1a, and T1b. Four questions addressed potential personal confounders. Survey results were analyzed by bootstrap-adjusted stepwise multivariate linear regression analysis to identify predictors for EAU guideline-conform local treatment of PeCa. Results For local therapy of cTis 80.4% recommended guideline-conform treatment, for cTa-cT1a 87.3% and for cT1b 59.1%. In total, 42.4% chose a correct approach in all tumor stages. The number of PeCa patients treated at the hospital, a higher level of training of the physicians, resource-based answering and the option of penile-sparing surgery offered at the hospital matched with giving guideline-conform recommendations and thus accurate local tumor treatment. Conclusion Patients with PeCa are best treated by experienced physicians, in centers with a high number of cases, which also offer a wide range of local tumor therapy. This could be offered in reference centers.

Urological senior physicians in Germany are a heterogeneous group with various clinical priorities and career objectives. To date, there are no reliable data concerning the impact of the time span for which senior physicians have been holding their position on professional, personal and position-linked aspects.The objective of this study was a comparative analysis of perspectives, private and professional settings, specific job-related activities and individual professional goals of urological senior physicians in Germany based on their experience in this position assessed as number of years (dichotomised at 8 years as senior physician). As part of a cross-sectional study, a 55-item web-based questionnaire was designed, which was sent via a link to members of a mailing list of the German Society of Urology. The survey was available for urological senior physicians between February and April 2019. Group differences were evaluated using multivariate regression models.107 of 192 evaluable questionnaires were completed by senior physicians holding this position for less than 8 years ( 8y senior physicians), 85 were completed by senior physicians holding this position for at least 8 years (≥ 8y senior physicians). 8y senior physicians worked significantly more often at university hospitals (42.1 % vs. 18.8 %, p = 0.002). Overall, 82.4 % of ≥ 8y senior physicians assessed themselves autonomously safe in performing open surgery, compared to 39.3 % among 8y senior physicians (p 0.001). No significant differences concerning the self-assessment were found for endourological procedures (94.1 % vs. 87.9 %) and for the overall lower-rated self-assessment concerning laparoscopy (29.4 % vs. 20.6 %) and robotic surgery (14.1 % vs. 10.3 %). Despite the high management responsibility associated with their position, only about one third of participants (34.8 %) had received specific postgraduate education preparing them for managing and executive tasks.This study shows significant differences among senior physicians regarding surgical skills depending on the time span they hold their position. Moreover, there is considerable dissatisfaction regarding the development of leadership skills and the preparation for managing tasks. In order to ensure availability of senior staff members for the field of urology in the future, it is important to consider their professional needs and to overcome existing shortcomings by education programs within well-orchestrated human resources development strategies.Urologische OberärztInnen in Deutschland stellen eine heterogene Berufsgruppe mit verschiedenen klinischen Schwerpunkten und Karriereabsichten dar. Bisher gibt es keine gesicherten Kenntnisse darüber, welchen Einfluss die Anzahl der Berufsjahre in dieser Position auf die aktuelle Berufsausübung und Zufriedenheit hat.Ziel der vorliegenden Studie war die vergleichende Analyse der berufsbezogenen Sichtweisen, des privaten und beruflichen Umfelds, der konkreten Tätigkeiten und der fachlichen Zielvorstellungen urologischer OberärztInnen in Deutschland anhand der Anzahl der Berufsjahre in dieser Position (Dichotomisierung bei 8 Jahren Oberarzttätigkeit). Im Rahmen einer Querschnittsstudie wurde ein 55 Items umfassender, webbasierter Fragebogen entwickelt, der als Link über den E-Mail-Verteiler der Deutschen Gesellschaft für Urologie versendet wurde und zwischen Februar und April 2019 für urologische OberärztInnen geöffnet war. Unterschiede zwischen beiden Gruppen wurden mittels multivariater Regressionsmodelle geprüft.192 Studienfragebögen urologischer OberärztInnen waren auswertbar, von denen 107 (55,7 %) und 85 (44,3 %) eine Oberarzttätigkeit 8 Jahre ( 8J-OÄ) bzw. ≥ 8 Jahre (≥ 8J-OÄ) aufwiesen. In der Gruppe 8J-OÄ arbeiteten signifikant mehr Teilnehmer an Universitätskliniken (42,1 % vs. 18,8 %, p = 0,002). Insgesamt gaben 82,4 % der Teilnehmer in der Gruppe ≥ 8J-OÄ an, die offen operative Chirurgie eigenständig sicher durchzuführen, während dies in der Gruppe 8J-OÄ nur von 39,3 % so eingeschätzt wurde (p 0,001). Keine signifikanten Unterschiede bez. des eigenen Kompetenzniveaus fanden sich bei endourologischen Verfahren (94,1 % vs. 87,9 %) sowie bez. der insgesamt eher niedrig eingeschätzten eigenen Kompetenz in der Laparoskopie (29,4 % vs. 20,6 %) und der robotischen Chirurgie (14,1 % vs. 10,3 %). Trotz der hohen organisatorischen Verantwortung als urologische OberärztInnen hat nur ungefähr ein Drittel der Teilnehmer (34,8 %) eine Weiterbildungsmaßnahme zur Vorbereitung auf Leitungs- und Führungsaufgaben erhalten.Die vorliegende Studie zeigt deutliche Unterschiede bez. der operativen Fertigkeiten in Abhängigkeit von der Dauer der bisherigen OA-Tätigkeit. Außerdem wird eine erhebliche Unzufriedenheit mit der Förderung von Führungsqualitäten und der Vorbereitung auf Führungsaufgaben deutlich. Um qualifiziertes Personal langfristig als urologische OberärztInnen an den Kliniken im Fach Urologie zu binden, erscheint es notwendig, die Bedürfnisse der Berufsgruppe zu berücksichtigen und Defizite durch strategische Förderungen zu beheben.

Wave-transported boulders represent important records of storm and tsunami impact over geological timescales. Their use for hazard assessment requires chronological information that in many cases cannot be achieved by established dating approaches. To fill this gap, this study investigated, for the first time, the potential of optically stimulated luminescence rock surface exposure dating (OSL-RSED) for estimating transport ages of wave-emplaced coastal boulders. The approach was applied to calcarenite clasts at the Rabat coast, Morocco. Calibration of the OSL-RSED model was based on samples with rock surfaces exposed to sunlight for ~ 2 years, and OSL exposure ages were evaluated against age control deduced from satellite images. Our results show that the dating precision is limited for all boulders due to the local source rock lithology which has low amounts of quartz and feldspar. The dating accuracy may be affected by erosion rates on boulder surfaces of 0.06–0.2 mm/year. Nevertheless, we propose a robust relative chronology for boulders that are not affected by significant post-depositional erosion and that share surface angles of inclination with the calibration samples. The relative chronology indicates that (i) most boulders were moved by storm waves; (ii) these storms lifted boulders with masses of up to ~ 40 t; and (iii) the role of storms for the formation of boulder deposits along the Rabat coast is much more significant than previously assumed. Although OSL-RSED cannot provide reliable absolute exposure ages for the coastal boulders in this study, the approach has large potential for boulder deposits composed of rocks with larger amounts of quartz or feldspar, older formation histories and less susceptibility to erosion.

The obstructive sleep apnoea syndrome (OSAS) is a disorder with a high prevalence and is associated with an elevated cardiovascular risk and increased morbidity and mortality. For longitudinal studies and functional analysis cardiac MRI is regarded as the gold standard. Aim of this study was to evaluate the long-term effect of continuous positive airway pressure (CPAP) therapy on cardiac functional parameters with cardiac Magnetic Resonance Imaging (cMRI). 54 patients with OSAS (mean apnea hypopnea index-AHI: 31) were prospectively enrolled in this study and cMRI was performed before and after 7 months of CPAP therapy. Data were acquired on a 1.5 T MRI and right and left ventricular cardiac function were analysed. CPAP treatment was considered compliant when used ≥ 4 h per night. 24-h blood pressure was measured at baseline and follow up. 33 patients could be assigned to the compliance group. Left ventricular stroke volume (LV SV) and right ventricular ejection fraction (RV EF) improved significantly with CPAP therapy (LV SV from 93 ± 19 to 99 ± 20 ml, p = 0.02; RV EF from 50 ± 6 to 52 ± 6%, p = 0.04). All other cardiac parameters did not change significantly while mean systolic and diastolic blood pressure improved significantly (p

The COVID-19 pandemic represents a challenge for rheumatologists: how activity of rheumatological diseases or disease-modifying therapies may affect the outcome of SARS-CoV-2 infection is only beginning to be understood. Gianfrancesco et al provided important insights in this regard by evaluating the hospitalisation rate of 600 patients with rheumatological diseases from 40 different countries.1 They found that glucocorticoid treatment in doses equivalent with prednisolone 10 mg/day or higher was associated with an increased hospitalisation rate. Here, we describe the case of a 50-year-old man who was diagnosed with Lofgren syndrome in January 2019 presenting with cough, bilateral ankle joint swelling and mediastinal lymphadenopathy. ACE (37.3 U/L, normal range

Objectives Conventional perfusion-weighted MRI sequences often provide poor spatial or temporal resolution. We aimed to overcome this problem in head and neck protocols using a golden-angle radial sparse parallel (GRASP) sequence. Methods We prospectively included 58 patients for examination on a 3.0-T MRI using a study protocol. GRASP (A) was applied to a volumetric interpolated breath-hold examination (VIBE) with 135 reconstructed pictures and high temporal (2.5 s) and spatial resolution (0.94 × 0.94 × 3.00 mm). Additional sequences of matching temporal resolution (B: 2.5 s, 1.88 × 1.88 × 3.00 mm), with a compromise between temporal and spatial resolution (C: 7.0 s, 1.30 × 1.30 × 3.00 mm) and with matching spatial resolution (D: 145 s, 0.94 × 0.94 × 3.00 mm), were subsequently without GRASP. Instant inline-image reconstructions (E) provided one additional series of averaged contrast information throughout the entire acquisition duration of A. Overall diagnostic image quality, edge sharpness and contrast of soft tissues, vessels and lesions were subjectively rated using 5-point Likert scales. Objective image quality was measured as contrast-to-noise ratio in D and E. Results Overall, the anatomic and pathologic image quality was substantially better with the GRASP sequence for the temporally (A/B/C, all p p p = 0.291). Image artefacts were also less likely to occur with GRASP. Differences in motion, aliasing and truncation were mainly significant, but pulsation and fat suppression were comparable. In addition, the contrast-to-noise ratio of E was significantly better than that of D (pD-E Conclusions High temporal and spatial resolution can be obtained synchronously using a GRASP-VIBE technique for perfusion evaluation in head and neck MRI. Key Points • Golden-angle radial sparse parallel (GRASP) sampling allows for temporally resolved dynamic acquisitions with a very high image quality. • Very low-contrast structures in the head and neck region can benefit from using the GRASP sequence. • Inline-image reconstruction of dynamic and static series from one single acquisition can replace the conventional combination of two acquisitions, thereby saving examination time.

Background Lymphocele is the most common complication arising after pelvic lymph node dissection (PLND) in the setting of robot-assisted radical prostatectomy (RARP). The only data available until now on the utility of a peritoneal flap to prevent lymphocele were retrospectively acquired. Methods A randomized, controlled, multi-center trial with blinded assessment of endpoints was carried out on 232 patients with prostate cancer who underwent RARP with PLND. The patients in the intervention group were given a peritoneal flap; in the control group, surgery was performed without this modification. The two joint primary endpoints were the rates of symptomatic lymphocele during the same hospitalization as the operative procedure (iT1) and within 90 days of surgery (iT2). The secondary endpoints were lymphocele volume, the need for treatment of lymphocele, complications requiring an intervention, and the degree of postoperative stress incontinence. German Clinical Trials Register number: DRKS00011115. Results The data were evaluated in an intention-to-treat analysis, which, in this trial, was identical to an as-treated analysis. 108 patients (46.6%) were allotted to the intervention group. There were no statistically significant intergroup differences with respect to any clinical or histopathological criteria. A median of 16 lymph nodes were removed (interquartile range, 11-21). A symptomatic lymphocele arose in 1.3% (iT1) and 9.1% (iT2) of the patients, without any statistically significant difference between the two trial groups (p = 0.599 and p = 0.820, respectively). Nor did the groups differ significantly with respect to lymphocele volume (p = 0.670 on hospital discharge [T1], p = 0.650 90 days after surgery [T2]) or the type and frequency of need for subsequent surgical intervention (p = 0.535; iT2). 81.5% of all patients (n = 189) had no complications at all in the first three months after surgery. Nor were there any intergroup differences at 90 days with respect to the degree of stress urinary incontinence (p = 0.306) or complications (p = 0.486). Conclusion A peritoneal flap after RARP was not found to influence the rate of postoperative lymphocele, whether asymptomatic or requiring treatment.

Recent analysis of spatio-temporal variations of Sentinel-1 InSAR coherences for the entire Atacama Desert have revealed that about 70% of the area show hardly any detectable surface change in an ENSO-affected time series between 2015 and 2018. This validates that geomorphic processes in the central Atacama are of remarkable slowness or even stagnant, as also suggested by the age of surfaces and landforms, i.e. the age of the landscape in general. Most of these surfaces in the central desert are characterized by rather smooth morphologies, which is a result of thick atmospherically derived salt and dust deposits masking the desert surface, supported by the presence of gypsum crusts and/or Biological Soil Crusts (BSCs). In contrast, geomorphic activity on recent time scales is typically linked to episodic Andean discharge or severe precipitation events, which can cause overland flow or flash flood activity even in the hyperarid core of the Atacama as recently shown by the 2015 rainfall event. Likewise, fog-related atmospheric moisture is assumed to provoke salt-driven shrink-swell processes, and episodic activity by slumping and/or seismicity may successively alter landforms in the central desert over longer time scales as well.Based on Sentinel-1 InSAR coherence data, this contribution presents the spatial pattern of morphodynamic activity in the central Atacama Desert, which is paired with further independent variables achieved by remote sensing such as soil surface indices and geomorphometric parameters (e.g., using TanDEM-X WorldDEMTM, DLR science grant), ultimately characterising the different types of desert surfaces. The satellite-based regional morphodynamic pattern is compared to on-site field evidence collected between 2016 and 2019, which suggests (limited) geomorphic activity rather than stability on late Pleistocene time scales at a variety of locations. Among these locations are flood-affected channel systems and alluvial fans, but also patterned ground structures, zebra stripes, slump- or creep-related slope deposits, or BSC-covered surfaces, which are assumed to support aeolian deposition. Except for the flooding activity, field sites with inferred late Pleistocene to Holocene activity seem to be located in the fog-affected zones of the Coastal Cordillera. Our study shows that the combination of field and remote sensing data may contribute to a better understanding of past and present – particularly rainfall-independent – geomorphic processes in the hyperarid Atacama.

The hyperarid parts of the Atacama Desert, N Chile, are among the driest places on Earth, and a number of studies have emphasized the remarkable slowness of Earth surface processes since the late Tertiary. Despite episodic overland flow or flash flood activity, salt-driven shrink-swell processes, dust deposition, and seismic shaking have significantly contributed to the formation of the characteristic landscape. The enigmatic and Atacama-specific zebra stripes are contour-parallel, thin lateral bands of rather angular gravels on hillslopes, characterized by grain sorting, a lateral succession of 1-3 m-wide frontal lobes, and specific wavelengths, occurring generally in areas with lowest rainfall and low to no fog occurrence. While previous investigations suggest that zebra stripes represent fossil evidence of overland flow, a recent study challenged their water-related evolution and emphasized the role of seismicity in their formation, and in shaping the Atacama landscape in general. Similar landforms may also be found on Mars, although related processes may be different to those on Earth.We use UAV-derived orthophotos and digital elevation models, geomorphological surveys and sediment sampling, as well as OSL rock surface dating and cosmogenic nuclide (21Ne, 10Be) analysis of surface clasts to provide new insights into zebra stripe activity and stability in the Atacama Desert. Our investigations show that zebra stripes are found in numerous areas in the hyperarid core of the Atacama, implying a wider distribution of zebra-striped hillslopes than previously suggested. Inter-site comparison illustrates considerable differences between individual zebra stripe sites, and geomorphological characteristics suggest that zebra stripes may be active or inactive forms, depending on their location. Active forms are indicated by well-developed frontal lobes, reduced dust contents, and clearly developed downslope sorting trends with a high percentage of freely floating clasts, whereas inactivity seems to be indicated by poorly visible frontal lobes, high dust contents, poor sorting trends and a high proportion of clasts embedded into the underlying vesicular soil horizon. At the same time, preliminary chronological data based on OSL rock surface dating suggests that active stripes contain clasts with active bleaching fronts at top and bottom sides, pointing to late Pleistocene to Holocene activity and clast overturning. Inactivity, in contrast, is indicated by similar IR50 and pIR225 bleaching curves (equilibrium of bleaching and dosing) in upper clast surfaces and the lack of a bleaching front at the bottom side, pointing to long exposures without clast overturning. Combined with cosmogenic nuclide concentrations, our results allow for inter-site comparisons and a better understanding of (relative) stripe chronologies and activity-stability patterns. Alongside further investigations on the significance of fog, wind, rain and seismicity, future work will aim at constraining time scales on which active/young and inactive/old forms have developed. If these forms are seismicity-related, our study contributes important information on the paleoseismic evolution of the central Atacama.

Wave transported boulders represent important records of storm and tsunami impact over geological timescales. Their use for hazard assessment requires chronological information that in many cases cannot be achieved by established dating approaches such as radiocarbon and U-Th dating. To fill this gap, we investigated the potential of optically stimulated luminescence rock surface exposure dating for estimating transport ages of coastal boulders. The approach was applied to wave-emplaced calcarenite clasts at the Rabat coast, Morocco. Calibration of the OSL surface exposure model was based on samples with rock surfaces exposed for ~2 years, and OSL exposure ages were evaluated against age control deduced from satellite images. The dating precision is very limited for all boulders due to the local source rock lithology, which contains low amounts of quartz and feldspar and was formed after MIS 5 (OSL signals are not in field saturation). Nevertheless, we propose a robust relative chronology for boulders that are not affected by significant post-depositional erosion and that share surface angle of inclination with the calibration samples. The relative chronology indicates that most boulders were moved by storm waves; these storms lifted boulders with masses of up to ~40 t; indicating that the role of storms for the formation of boulder deposits along the Rabat coast is much more significant than assumed previously. While OSL rock surface exposure dating cannot provide reliable absolute exposure ages for the coastal boulders from Rabat, the approach has great potential for boulder deposits composed of rocks with larger amounts of quartz or feldspar, older formation histories and lower susceptibility for erosion.

Increasing population and economic pressures along the world's coastlines have made, and are continuing to make coastal communities more vulnerable to hazards. The hazard management of tsunamis and other extreme waves (storm waves, seiches, infragravity waves) is based on the assessment of the frequency-magnitude relationship of these events, which uses instrumental, historical and, critically for the evaluation of long-term recurrence patterns, geological evidence. The identification of tsunami deposits in coastal sedimentary environments is challenging and has systematically evolved as a subdiscipline of sedimentology only over the last. 30 years (i.e., paleotsunami research). Nevertheless, a wide range of field sampling methods, proxy analyses, and dating approaches have been successfully applied to identify tsunami deposition in different sedimentary environments and infer tsunami impacts in the past. This compendium summarizes the state of the art in paleotsunami research in an effort to provide detailed methodological insights and aims at guiding workflows and site-specific research designs.