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Creative Arts Educ Ther (2021) 7(1):59–70 DOI: 10.15212/CAET/2021/7/6 Portrait Masks, Appropriated Space, and an Overseas Art Experiential: Nature as Critical Catalyst in the Practice and Training of Art Therapy 肖像面具，挪用空间与海外体验式艺术学习：自然作为艺术治疗实践和培训的关键催化剂 Abstract This article asserts that there are current trends in the practice and training of art therapy that are influenced and inspired by technologies, space, and art. Culture enriches these intertwined constructs demanding that practice and training are duly informed, especially within the contexts in which these are applied. The article is consolidated through a practitioner-based reflective account of the author’s experience of leading a weeklong overseas trip with postgraduate art therapy students from Singapore to Bali, Indonesia. Acknowledging the multilayered processes involved with experiential learning, the focus pivots around one structured and supervised art experiential within an appropriated space in nature. Portrait masks were constructed, worn, and photo-documented within the space. Participant understanding of technologies, space, art, and artmaking were challenged, leading to enriched discourse around these constructs and how best to integrate these emerging trends within their own practice and training, as well as their identities as artist and art therapist with consideration to culture. Keywords: art therapy, technology, portrait masks, space, Southeast Asia. 摘要 本文认为，目前艺术治疗的实践和培训趋向于受到技术、空间和艺术的影响和启发。文化丰富了这些互相交织的概念，特别在应用技术、空间和艺术的情境下，要求以适当的方式让人们了解实践和培训。这篇文章基于实践者反思性的描述，对作者带领艺术治疗研究生从新加坡到印度尼西亚巴厘岛进行为期一周的海外旅行的经验进行整合。认识到体验式学习所涉及的多层次过程，文章的重点围绕着在自然界一个适当的空间里进行的结构化和督导性的艺术体验。参与者制作、佩戴肖像面具，并在空间内进行拍照记录。参与者对技术、空间、艺术和艺术创作的理解受到了挑战，引发了围绕这些概念以及如何最好地在自己的实践和培训中整合这些新兴趋势的丰富讨论，并且以文化为考量论述了作为艺术家和艺术治疗师的身份。 關鍵詞：艺术治疗，科技，肖像面具，空间，东南亚

Lightning superbolts are the most powerful and rare lightning events with intense optical emission, first identified from space. Superbolt events occurred in 2010-2018 could be localized by extracting the high energy tail of the lightning stroke signals measured by the very low frequency ground stations of the World-Wide Lightning Location Network. Here, we report electromagnetic observations of superbolts from space using Van Allen Probes satellite measurements, and ground measurements, and with two events measured both from ground and space. From burst-triggered measurements, we compute electric and magnetic power spectral density for very low frequency waves driven by superbolts, both on Earth and transmitted into space, demonstrating that superbolts transmit 10-1000 times more powerful very low frequency waves into space than typical strokes and revealing that their extreme nature is observed in space. We find several properties of superbolts that notably differ from most lightning flashes; a more symmetric first ground-wave peak due to a longer rise time, larger peak current, weaker decay of electromagnetic power density in space with distance, and a power mostly confined in the very low frequency range. Their signal is absent in space during day times and is received with a long-time delay on the Van Allen Probes. These results have implications for our understanding of lightning and superbolts, for ionosphere-magnetosphere wave transmission, wave propagation in space, and remote sensing of extreme events., Superbolts are powerful, rare lightning events. Here, the authors show simultaneous satellite and ground measurements of a superbolt, and demonstrate different properties of superbolts and lightnings.

The Embodied Art Therapy Process (TEATP) focuses on the co-creation of embodied artistic expressions to promote self-awareness and autonomy for children. A case study describes how TEATP was implem...

Background: Malakoplakia is a rare benign lesion, usually associated with deficient intralysosomal degradation of microorganisms, more commonly, Escherichia coli. Malakoplakia occurs in various organ systems, the most frequently affected site being the urinary bladder. We report a rare case of isolated extensive malakoplakia involving the prostate, diagnosed on transurethral resection performed for radiologically suspected prostatic abscesses. Case Presentation: A 61-year-old African American male presented with symptoms of urinary obstruction for the past 2 months. His medical history was significant for immunosuppression (liver transplantation 3 months prior and diabetes mellitus). He reported four episodes of E. coli-associated urinary tract infection after his liver transplantation. Serum prostate specific antigen was 1.83 ng/cc (normal inferior to 4 ng/cc), and urine culture was positive for E. coli sensitive to ceftriaxone. Pelvic magnetic resonance imaging was suggestive of prostatitis with prostatic abscesses; cystoscopy was unremarkable. The patient was started on intravenous ceftriaxone therapy. A standard bipolar transurethral resection of the prostate was performed, and purulent-like material was encountered in the resected tissue. Histologic examination demonstrated extensive infiltration and replacement of the prostatic tissue by sheets of pink histiocytes with targetoid inclusions consistent with Michaelis–Gutmann bodies, ultimately confirming malakoplakia of the prostate. Conclusion: Prostatic malakoplakia is an unexpected diagnosis in patients suspected of having malignancy or prostatitis. Its exact pathogenesis is unknown, but it involves defective bacterial degradation after phagocytosis. E. coli is often cultured from the patients' urine. Immunosuppression, present in our patient, is a well-known associated factor. Prostatic malakoplakia can radiologically masquerade as prostatic adenocarcinoma, despite the use of cutting-edge imaging technology. With the growing use of multiparametric 3T prostate magnetic resonance imaging to screen for prostate cancer, it is possible that urologists, radiologists, and pathologists will encounter prostatic malakoplakia more frequently in the future.

Art therapy is a dynamic discipline that readily embraces opportunities to further develop and expand practices and applications. This can be observed in art therapy training pedagogy, initiatives,...

We investigated efficacy and compliance related to percutaneous tibial nerve stimulation in patients treated for overactive bladder at a large, urban safety net hospital.Consecutive patients who underwent percutaneous tibial nerve stimulation at Grady Memorial Hospital from May 2015 through January 2019 were included in our cohort and records were reviewed retrospectively. Primary outcomes of interest included self-reported urinary symptoms and episodes of urinary incontinence. Our secondary outcome of interest was patient compliance, defined as completion of 12 or more treatment sessions. Descriptive analysis and paired t-tests were performed.Of the 50 patients with a mean ± SD age of 59 ± 12 years 80% were black, 52% were male, 34% were uninsured and 54% subscribed to government insurance. Prior treatment included behavioral modification in 100% of cases, anticholinergics in 86% and mirabegron in 4%. Patients completed a mean of 10.7 ± 2.7 of the 12 planned weekly percutaneous tibial nerve stimulation treatments. Of the patients 70% completed all 12 weekly treatments and 77% of those who completed 12 treatments continued to maintenance treatment. After percutaneous tibial nerve stimulation treatment average symptoms improved across all metrics, including mean daytime frequency (from 11.0 to 6.6 episodes per day or -24.5%), nighttime frequency (from 4.8 to 2.5 episodes per night or -47.1%), urgency score (from 3.4 to 1.9 or -42.1%) and incontinence (from 1.6 to 0.4 episodes per day or -79.6%) (each p0.001). A total of 43 patients (86%) reported symptom improvement.Percutaneous tibial nerve stimulation had favorable efficacy and compliance in a traditionally underserved patient population. This should be considered as a feasible modality to manage overactive bladder symptoms in patients in a similar demographic.

Creative Arts Educ Ther (2019) 5(2):117–128 DOI: 10.15212/CAET/2019/5/27 CONFERENCE REVIEW 会议综述报道 British Association of Art Therapists (BAAT) and American Art Therapy Association (AATA) Art Therapy Practice and Research Conference, London, UK, 2019 英国美术治疗师协会（BAAT）和美国美术治疗协会(AATA)联合国际会议 玛格丽特女王大学，英国伦敦，2019年7月 Abstract Six art therapists belonging to the Asian Art Therapy Network give their personal reflections on the International Art Therapy Practice Research Conference, which took place in London, 2019. In common is the importance given to collaboration, cooperation and developing a sense of community. Keywords: International, art therapy, conference, Asia, collaboration, multicultural, research, practice 摘要 出席2019年于伦敦召开的国际美术治疗实践研究会议后，六位属于亚洲美术治疗联盟的美术治疗师进行了个人回顾与思考。不约而同地提出了重视合作，相互协同和发展社区意识的观点和建议。 关键词: 国际性，美术治疗，会议，亚洲，合作，多元文化，研究，实践

The SBND Collaboration acknowledges the generous support of the following organizations: the U.S. Department of Energy, Office of Science, Office of High Energy Physics; the U.S. National Science Foundation; the Science and Technology Facilities Council (STFC), part of United Kingdom Research and Innovation, and The Royal Society of the United Kingdom; the Swiss National Science Foundation; the Spanish Ministerio de Ciencia e Innovación (PID2019-104676GB-C32) and Junta de Andalucía (SOMM17/6104/UGR, P18-FR-4314) FEDER Funds; and the São Paulo Research Foundation (FAPESP) and the National Council of Scientific and Technological Development (CNPq) of Brazil. We acknowledge Los Alamos National Laboratory for LDRD funding. This research used resources of the Argonne Leadership Computing Facility, which is a DOE Office of Science User Facility supported under Contract DEAC02- 06CH11357. SBND is an experiment at the Fermi National Accelerator Laboratory (Fermilab), a U.S. Department of Energy, Office of Science, HEP User Facility. Fermilab is managed by Fermi Research Alliance, LLC (FRA), acting under Contract No. DE-AC02-07CH11359., In liquid argon time projection chambers exposed to neutrino beams and running on or near surface levels, cosmic muons, and other cosmic particles are incident on the detectors while a single neutrino-induced event is being recorded. In practice, this means that data fromsurface liquid argon time projection chambers will be dominated by cosmic particles, both as a source of event triggers and as the majority of the particle count in true neutrino-triggered events. In this work, we demonstrate a novel application of deep learning techniques to remove these background particles by applying deep learning on full detector images from the SBND detector, the near detector in the Fermilab Short-Baseline Neutrino Program. We use this technique to identify, on a pixel-by-pixel level, whether recorded activity originated from cosmic particles or neutrino interactions., U.S. Department of Energy, Office of Science, Office of High Energy Physics, U.S. National Science Foundation, Science and Technology Facilities Council (STFC), The Royal Society of the United Kingdom, Swiss National Science Foundation, Spanish Ministerio de Ciencia e Innovación (PID2019-104676GB-C32), Junta de Andalucía (SOMM17/6104/UGR, P18-FR-4314) FEDER Funds, São Paulo Research Foundation (FAPESP), National Council of Scientific and Technological Development (CNPq) of Brazil, Los Alamos National Laboratory for LDRD, Argonne Leadership Computing Facility, Fermi National Accelerator Laboratory (Fermilab), Fermi Research Alliance, LLC (FRA) DE-AC02-07CH11359

The quench sensitivity of a 6000 series alloy with a high content of dispersoids was studied over a wide range of cooling rate and natural-aging (NA) time. Positron annihilation lifetime spectroscopy, differential scanning calorimetry, and transmission electron microscopy were used to characterize the clustering and precipitation reactions. The alloy showed significant quench sensitivity after short NA (2 and 30 minutes), but the quench sensitivity was lower after long NA (24 hours). The quench sensitivity after the long NA can be accounted for by the solute loss due to the formation of nonhardening β′ precipitates on the dispersoids during cooling from solution treatment. For short NA, however, quenched-in vacancies and modifications to the precipitation sequence also have substantial contributions to the quench sensitivity. The current study provides new insight into the quench sensitivity of 6000 series alloys that contain a high dispersoid density.

Background: Streptococcus mutans and Porphyromonas gingivalis are caries and periodontal disease-related bacteria. The mangosteen fruit (Garcinia mangostana L.) peel contains flavonoids, tannins, saponins, and xanthones that have antibacterial properties. Aims: The aim of this study is to analyze mangosteen peel extracts' ability to inhibit S. mutans and P. gingivalis has biofilms growth in vitro. Materials and Methods: Mangosteen peel extract effects on the S. mutans ATCC-3198 and P. gingivalis ATCC-3327 in biofilms growth were evaluated by a crystal violet biofilm assay. Each bacterium was inoculated into a brain–heart infusion broth for 24 h at 37°C anaerobic conditions. A volume of 200 μL (107 colony-forming unit/mL) of bacterial suspension were distributed in microplate wells and incubated for 24 h. Mangosteen peel extracts with different concentrations were added into biofilm wells. Biofilm without treatment was used as negative control. Biofilm mass was calculated by 0.5% crystal violet staining, and optical density was measured at 600 nm using microplate reader. All obtained data were statistically analyzed using one-way analysis of variance test with P < 0.05 set as the level of significance. Results: The results showed that mangosteen peel extract could inhibit the growth of S. mutans and P. gingivalis in biofilms significantly compared to the negative control (P < 0.05). The most effective concentration and incubation time for inhibiting biofilm growth was 100% in 6 h for S. mutans and 100% in 24 h for P. gingivalis. Conclusion: Mangosteen peel extract is effective at inhibiting S. mutans and P. gingivalis biofilms, and this antibiofilm agent can be an alternative therapy in preventing caries and periodontal disease. Future studies are needed to explore this effect.

Creative Arts Educ Ther (2018) 4(2):87–96 DOI: 10.15212/CAET/2018/4/12 East/West Nature of ANZACATA: A Perspective on the Significance of International Connections while Asserting Southeast Asian Relevance and Context in Practice and in Postgraduate Art Therapy Training Abstract The Australian, New Zealand and Asian Creative Arts Therapies Association (ANZACATA) is uniquely positioned, geographically and philosophically, in terms of art therapy practice, training, and the ongoing development of this discipline in the Asia Pacific region. Acknowledgement of, respective for, and an embracing of culture, cultural traditions, and practices that are culturally relevant are some of the fundamentals at the core of this art therapy membership organization. A critical and multipronged relationship has been established among ANZACATA, Singapore, and the MA Art therapy training program at LASALLE College of the Arts, Singapore. This article presents a perspective on the development of art therapy in Southeast Asia with consideration to the significance of East/West influences, relations, and training. The aim is to provide a reflective account of the unique East/West nature and role of ANZACATA and on art therapy in Singapore through my role as program leader of the first and only postgraduate psychodynamic art psychotherapy training in Southeast Asia. This perspective is further informed through substantial experience as a credentialed art therapist bridging Eastern and Western countries, cultures, clinical practices, and professional art(s) therapy organizations. This article was written and articulated through an expatriate’s informed lens of being immersed in the local culture over an extended period. The discourse highlights the significance of international connections while asserting Southeast Asian relevance and context as the discipline of art therapy matures in this region.

This talk will show a statistical analysis of both electric and magnetic field wave amplitudes of very low frequency lightning‐generated whistlers (LGWs) based on the equivalent of 11.5 years of observations made by the Van Allen Probes. We complement this analysis with data from the ground‐based World Wide Lightning Location Network (WWLLN) to explore differences between satellite and ground‐based measurements. We will discuss how LGW mean amplitudes were generally found to be low compared with other whistler mode waves even though there exists extreme events (1 out of 5,000) that can reach 100 pT and contribute strongly to the mean power below L = 2. We will reveal a region of low wave amplitude existing below L=2 thanks to the denser dayside ionosphere, which prevents the intense equatorial lightning VLF waves from propagating through it. Below L = 1.5 at all MLT, LGW amplitudes are found to be weak while the ground‐level lightning activity is maximal. This suggests a difficulty of lightning VLF waves to penetrate / propagate / remain at low L‐shells, certainly due at least to the denser ionosphere during daytime. On the contrary, the mean LGW magnetic power (or RMS) remains nearly constant with respect to L‐shell. We will explain that this is due to strong to extreme LGWs that dominate the wave mean power to the point of compensating the decay of LGW occurrence at low L‐shell. Even though extreme LGW were found to be very powerful, particularly at low L and during night, the mean electric/magnetic power remains low compared with other whistler waves. This implies that LGW resonant effects on electrons are consequently long‐term effects that contribute to “age” trapped inner belt electron populations.

Practice guidelines recommend early consideration for palliative care for patients with advanced malignancies, and there has been limited research regarding the use of palliative care for patients with advanced bladder cancer. Our aim is to describe the rate and determinants of the use of palliative care consultation for patients treated with radical cystectomy at our institution.A retrospective review was performed to identify patients who underwent cystectomy for bladder cancer between September 2014 and June 2019 at our institution. Our primary outcome was receipt of palliative care, defined as receiving a palliative care consult. We tested for associations between factors and our outcome of interest, and then estimated the impact on various determinants of palliative care use by fitting a multivariable logistic regression model.Over the study period, 294 patients underwent radical cystectomy. Of those patients, 29 (9.9%) received palliative care. Mean time from surgery to palliative care consult was 11.4 months. Palliative care consults were initiated by urologists in 32.1% of cases. On multivariable analysis, patients were more likely to receive palliative care if they had pT3+ disease (P0.001), were readmitted after surgery (P = 0.028), or had any major complication after surgery (P = 0.025).Rates of palliative care consults in patients with advanced bladder cancer at our institution are higher than other population-based estimates nationally. The majority of palliative care consults were requested by medical oncologists, highlighting an opportunity for educational initiatives for urologic oncologists to promote earlier consideration of palliative care referrals.

Background: Streptococcus mutans and Porphyromonas gingivalis are caries and periodontal disease-related bacteria. The mangosteen fruit (Garcinia mangostana L.) peel contains flavonoids, tannins, saponins, and xanthones that have antibacterial properties. Aims: The aim of this study is to analyze mangosteen peel extracts’ ability to inhibit S. mutans and P. gingivalis has biofilms growth in vitro. Materials and Methods: Mangosteen peel extract effects on the S. mutans ATCC-3198 and P. gingivalis ATCC-3327 in biofilms growth were evaluated by a crystal violet biofilm assay. Each bacterium was inoculated into a brain–heart infusion broth for 24 h at 37°C anaerobic conditions. A volume of 200 μL (107 colony-forming unit/mL) of bacterial suspension were distributed in microplate wells and incubated for 24 h. Mangosteen peel extracts with different concentrations were added into biofilm wells. Biofilm without treatment was used as negative control. Biofilm mass was calculated by 0.5% crystal violet staining, and optical density was measured at 600 nm using microplate reader. All obtained data were statistically analyzed using one-way analysis of variance test with P < 0.05 set as the level of significance. Results: The results showed that mangosteen peel extract could inhibit the growth of S. mutans and P. gingivalis in biofilms significantly compared to the negative control (P < 0.05). The most effective concentration and incubation time for inhibiting biofilm growth was 100% in 6 h for S. mutans and 100% in 24 h for P. gingivalis. Conclusion: Mangosteen peel extract is effective at inhibiting S. mutans and P. gingivalis biofilms, and this antibiofilm agent can be an alternative therapy in preventing caries and periodontal disease. Future studies are needed to explore this effect.

Background Water irrigant is discouraged in ureteroscopy due to risks demonstrated in more invasive endoscopic procedures. However, water is not well studied in ureteroscopy and may provide better visualization than standard saline. Objective To determine whether water irrigant increases the risk of hyponatremia compared with saline and provides better visualization in ureteroscopy. Design, setting, and participants A randomized, prospective, double-blinded trial was conducted. In 2017, eligible adult ureteroscopy patients at a university hospital were recruited for the study. Intervention Participants randomized to water or saline irrigant in ureteroscopy. Outcome measurements and statistical analysis Serum sodium and osmolality, body temperature, subjective surgeon visualization, and objective turbidity clarity were analyzed. Chi-square or Fisher’s exact tests for categorical variables and analysis of variance test for continuous variables were performed. Results and limitations A total of 121 individuals (mean age 57 ± 15 yr) underwent ureteroscopy (mean time 35 ± 18 min) with a mean irrigation volume of 839 ± 608 ml. For the 101 (83%) patients who had nephrolithiasis, the mean number of stones was 2 ± 1 and the mean stone burden was 13 ± 7 mm. There were no significant differences in demographic, clinical, and intraoperative variables between water and saline groups, except for a higher body mass index in the saline group (p = 0.01). There was no significant difference between groups in the incidence of hyponatremia, hypo-osmolality, or hypothermia. The median surgeon visualization score was significantly higher using water (p Conclusions Water irrigant does not increase the incidence of hyponatremia in uncomplicated ureteroscopy and provides clearer visualization than saline. Patient summary We compared safety and clarity of water and saline irrigation, which aid surgeon visualization, in ureteroscopy, which can treat kidney stones. We found that water irrigant does not reduce blood sodium levels significantly compared with saline in ureteroscopy and provides better visualization.

Objective To evaluate the relationship between dynamic changes in the modified Glasgow Prognostic Scale (mGPS) and postnephrectomy survival among localized clear cell renal cell carcinoma (ccRCC) patients. Methods We retrospectively identified patients who underwent nephrectomy for localized ccRCC with preoperative mGPS = 0 from 2005 to 2018. The primary exposure of interest was ΔmGPS between 2 points – 60 days prior to surgery and 1 year after surgery. We assessed the relationship between ΔmGPS and survival outcomes. Kaplan-Meier curves were generated to determine survival estimates and Cox proportional hazards models were fit to estimate hazard ratios (HRs). Multivariable models were constructed using both ΔmGPS and clinical variables known to be associated with differences in survival. Results We identified 313 patients for our analytic cohort with a median follow-up time of 20.2 months. Thirty-seven (11.9%) patients died and 39 (12.54%) showed recurrence during follow-up. Two hundred sixty-three (84.6%) patients had unchanged mGPS before and after surgery, while 48 (15.4%) patients showed an increase in postoperative mGPS from preoperative mGPS. Compared to patients with unchanged mGPS, patients with a higher postoperative mGPS had an increased risk of death (HR = 3.05 [1.39-6.68], P = .005) and recurrence (HR = 2.98 [1.34-6.64], P = .008). Conclusion Patients with an increase in mGPS following nephrectomy for ccRCC were more likely to die and experience cancer recurrence. Assessing dynamic changes in this cheap, validated, and reproducible test may be useful in identifying patients at higher risk for more aggressive disease or for counseling patients regarding risk of cancer recurrence.

Impulsive phenomena in the Earth's atmosphere produce acoustic and gravity waves which perturb the ionosphere. Such perturbations are often measured using total electron content fluctuations (TEC), derived from ground-based Global Positioning System data. Using TEC data from the Japanese GEONET ground network after the Tōhoku earthquake on 11 March 2011, we demonstrate capabilities of a new framework of methodologies for analyzing ionospheric perturbations. The framework consists of several new techniques: calculating velocity along a single direction to reduce error due to anisotropic propagation, producing normalized bidirectional band-pass spectra that preserve relative timing between various frequencies and allowing a more systematic determination of broadband pulses, and utilizing a wavelet-based technique that considers instantaneous wave phase changes, rather than best fit time differences, to evaluate wave characteristics (speed, direction, and wavelength) within spectral ranges of interest. Using these techniques together decreases subjectivity and reduces errors in attributing fluctuations to given sources. In validating this framework using the Tōhoku case, we consistently identify three kinds of waves: a broad-band pulse (speed: >2000 m/s, max range: >1400 km) arriving in the ionosphere 10–15 min after the quake, acoustic waves following the pulse (period: 3–5 min, speed: 700–1000 m/s, max range: 1400 km) propagating away from the epicenter, consistent with theory and demonstrated in previous studies. This framework also can be applied to other impulsive events in the atmosphere that are more difficult to detect and attribute to sources.

To report on the first short-term oncologic outcomes of percutaneous irreversible electroporation for small renal masses. Patients with cT1a renal masses treated with irreversible electroporation from April 2013 through December 2016 were reviewed. Small, low complexity tumors were generally selected for irreversible electroporation using the NanoKnife® System (Angiodynamics, Latham, NY, USA). Surveillance imaging was performed post-operatively, and survival analysis was completed using the Kaplan–Meier method. A total of 42 tumors in 41 patients underwent irreversible electroporation. Mean tumor size was 2.0 cm with a median R.E.N.A.L nephrometry score of 5. Twenty-nine patients (71%) were discharged the same day of the procedure and no major (Clavien grade II or higher) intraoperative or post-operative complications occurred. Initial treatment success rate was 93%; our three failures (7%) underwent salvage radiofrequency ablation. With a mean follow-up of 22 months, 2-year local recurrence-free survival was 83% for patients with biopsy confirmed renal cell carcinoma, 87% with biopsy confirmed or a history of renal cell carcinoma, and 92% for the intent-to-treat cohort. Although with low morbidity, in comparison to extirpation and conventional thermal ablation technologies, irreversible electroporation has suboptimal short-term local disease control results in this series of small, low complexity tumors. Larger series and longer follow-up will determine the durability of this modality.

Early urinary control is a major goal for patients undergoing robot-assisted radical prostatectomy (RARP). We report our technique of posterior urethral suspension (PUS) performed at the time of urethrovesical anastomosis.We prospectively followed men with localized prostate cancer undergoing RARP by a single surgeon from August 2012 to October 2015. Patients before April 2014 underwent only bladder neck preservation (controls), while patients after April 2014 also underwent PUS. Patients were given a modified Expanded Prostate Cancer Index Composite questionnaire, along with questions depicting objective measures of urinary control (type of pad, number of pads, wetness of pad). Time points queried were preoperatively and postoperatively at weeks 1, 2, 4, and 12. Our primary outcome was pad-free survival.Questionnaire response rate was 52% (56/107) for controls and 43% (36/83) for PUS. There were no differences in baseline demographics, preoperative urinary control, intraoperative variables, or postoperative complications between groups. There were few subjective improvements in urinary control for PUS compared with controls. More notable, PUS patients had significantly improved objective measures of urinary control, including less protective incontinence products at 1 and 2 weeks after catheter removal (p 0.03). They also wore fewer pads and had less leakage on each pad that lasted from week 1 to week 4 after catheter removal (p 0.01). PUS patients had pad-free rates of 37%, 47%, 54%, and 60% compared with controls 15%, 18%, 24%, and 36%, at weeks 1, 2, 4, and 12 after catheter removal (p = 0.07).PUS may improve objective measures of early urinary control compared with controls. With no increase in operative time and no change in complication rates, further work in a randomized setting would provide additional weight to our findings.

Quench sensitivity in Al–Mg–Si alloys has been largely attributed to the solute loss at the heterogeneous nucleation sites, primarily dispersoids, during slow cooling after extrusion. As such, the number density of dispersoids, the solute type and concentration are considered to be the key variables for the quench sensitivity. In this study, quench sensitivity and the influence of natural ageing in a lean Al–Mg–Si alloy, AA6060, which contains few dispersoids, have been investigated by hardness measurement, thermal analysis, transmission electron microscopy (TEM) and positron annihilation lifetime spectroscopy (PALS). It is shown that the quench sensitivity in this alloy is associated with the degree of supersaturation of vacancies after cooling. Due to vacancy annihilation and clustering during natural ageing, the quench sensitivity is more pronounced after a short natural ageing time (30 min) compared to a longer natural ageing time (24 h). Therefore, prolonged natural ageing not only leads to an increase in hardness, but can also have a positive effect on the quench sensitivity of lean Al–Mg–Si alloys.

We present refinements of a method of ionospheric D-region sounding that makes opportunistic use of powerful (109–1011 W) broadband lightning radio emissions in the low-frequency (LF; 30–300 kHz) band. Such emissions are from "Narrow Bipolar Event" (NBE) lightning, and they are characterized by a narrow (10-μs), simple emission waveform. These pulses can be used to perform time-delay reflectometry (or "sounding") of the D-region underside, at an effective LF radiated power exceeding by orders-of-magnitude that from man-made sounders. We use this opportunistic sounder to retrieve instantaneous LF ionospheric-reflection height whenever a suitable lightning radio pulse from a located NBE is recorded. We show how to correct for three sources of "regular" variability, namely solar zenith angle, radio-propagation range, and radio-propagation azimuth. The residual median magnitude of the noise in reflection height, after applying the regression corrections for the three regular variabilities, is on the order of 1 km. This noise level allows us to retrieve the D-region-reflector-height variation with solar X-ray flux density for intensity levels at and above an M-1 flare. The instantaneous time response is limited by the occurrence rate of NBEs, and the noise level in the height determination is typically in the range ±1 km.

Nighttime eating is often associated with a negative impact on weight management and cardiometabolic health. However, data from recent acute metabolic studies have implicated a benefit of ingesting a bedtime snack for weight management. The present study compared the impact of ingesting a milk snack containing either 10 (BS10) or 30 g (BS30) protein with a non-energetic placebo (BS0) 30 min before bedtime on next morning metabolism, appetite and energy intake in mildly overweight males (age: 24·3 (sem 0·8) years; BMI: 27·4 (sem 1·1) kg/m2). Next morning measurements of RMR, appetite and energy intake were measured using indirect calorimetry, visual analogue scales and an ad libitum breakfast, respectively. Bedtime milk ingestion did not alter next morning RMR (BS0: 7822 (sem 276) kJ/d, BS10: 7482 (sem 262) kJ/d, BS30: 7851 (sem 261) kJ/d, P=0·19) or substrate utilisation as measured by RER (P=0·64). Bedtime milk ingestion reduced hunger (P=0·01) and increased fullness (P=0·04) during the evening immediately after snack ingestion, but elicited no effect the next morning. Next morning breakfast (BS0: 2187 (sem 365) kJ, BS10: 2070 (sem 336) kJ, BS30: 2582 (sem 384) kJ, P=0·21) and 24 h post-trial (P=0·95) energy intake was similar between conditions. To conclude, in mildly overweight adults, compared with a non-energetic placebo, a bedtime milk snack containing 10 or 30 g of protein does not confer changes in next morning whole-body metabolism and appetite that may favour weight management.

Purpose To assess the diagnostic performance and interreader agreement of a standardized diagnostic algorithm in determining the histologic type of small (≤4 cm) renal masses (SRMs) with multiparametric magnetic resonance (MR) imaging. Materials and Methods This single-center retrospective HIPAA-compliant institutional review board-approved study included 103 patients with 109 SRMs resected between December 2011 and July 2015. The requirement for informed consent was waived. Presurgical renal MR images were reviewed by seven radiologists with diverse experience. Eleven MR imaging features were assessed, and a standardized diagnostic algorithm was used to determine the most likely histologic diagnosis, which was compared with histopathology results after surgery. Interreader variability was tested with the Cohen κ statistic. Regression models using MR imaging features were used to predict the histopathologic diagnosis with 5% significance level. Results Clear cell renal cell carcinoma (RCC) and papillary RCC were diagnosed, with sensitivities of 85% (47 of 55) and 80% (20 of 25), respectively, and specificities of 76% (41 of 54) and 94% (79 of 84), respectively. Interreader agreement was moderate to substantial (clear cell RCC, κ = 0.58; papillary RCC, κ = 0.73). Signal intensity (SI) of the lesion on T2-weighted MR images and degree of contrast enhancement (CE) during the corticomedullary phase were independent predictors of clear cell RCC (SI odds ratio [OR]: 3.19; 95% confidence interval [CI]: 1.4, 7.1; P = .003; CE OR, 4.45; 95% CI: 1.8, 10.8; P < .001) and papillary RCC (CE OR, 0.053; 95% CI: 0.02, 0.2; P < .001), and both had substantial interreader agreement (SI, κ = 0.69; CE, κ = 0.71). Poorer performance was observed for chromophobe histology, oncocytomas, and minimal fat angiomyolipomas, (sensitivity range, 14%-67%; specificity range, 97%-99%), with fair to moderate interreader agreement (κ range = 0.23-0.43). Segmental enhancement inversion was an independent predictor of oncocytomas (OR, 16.21; 95% CI: 1.0, 275.4; P = .049), with moderate interreader agreement (κ = 0.49). Conclusion The proposed standardized MR imaging-based diagnostic algorithm had diagnostic accuracy of 81% (88 of 109) and 91% (99 of 109) in the diagnosis of clear cell RCC and papillary RCC, respectively, while achieving moderate to substantial interreader agreement among seven radiologists. © RSNA, 2018 Online supplemental material is available for this article.

Irreversible electroporation (IRE) is a new ablative technology to treat small renal masses. We evaluated differed ablation settings on lesion size and temperature changes in a porcine model.After Institutional Animal Care and Use Committee approval, 36 laparoscopy-guided and 16 open ablations were performed on 13 domestic female pigs. Ablation parameters studied were voltage (1000 V/cm, 1500 V/cm, or 2000 V/cm), probe exposure (1.0 or 1.5 cm), and lesion size over time (survival) (0-, 7-, or 14 day). Temperature changes were monitored during open ablations with differed settings. Gross lesion size was measured, and histologic analysis with hematoxylin and eosin and nicotinamide adenine dinucleotide staining was performed.The 1000 V/cm ablations had no gross or histologic lesions. A factorial analysis of variance demonstrated that day (p = 0.56), exposure (p = 0.33), and voltage (p = 0.06) did not demonstrate statistical significance for affecting lesion size. For 1.0 cm probe exposure, 2000 V/cm did more closely approximate expected lesion size (p = 0.02) compared with 1500 V/cm. While significance was not seen for 1.5 cm probe exposure, 2000 V/cm often exceeded expected lesion volume. Only 1 of 4 temperature sensors, located adjacent to one of the IRE probes, noted a significant increase with increased voltage. However, all maximum temperatures remained less than 70°C.Variation in lesion volume was seen with different ablation settings in this porcine model. Maximal energy and probe exposure settings should be utilized to ensure full coverage of target volume/mass, potentially without concern for thermal injury to renal collecting system or nearby structures.

Current radio frequency ablation series do not distinguish renal cell carcinoma subtypes when reporting oncologic efficacy. Papillary neoplasms may be more amenable to radio frequency ablation than clear cell carcinoma because they are less vascular, which may limit heat energy loss. We report the long-term outcomes of patients treated with radio frequency ablation for small renal masses by renal cell carcinoma subtype.The records of patients undergoing radio frequency ablation for small renal masses (cT1a) at 2 institutions from March 2007 to July 2012 were retrospectively reviewed. Patients were included in analysis if they had biopsy confirmed clear cell or papillary renal cell carcinoma histology. Patients had at least 1 contrast enhanced cross-sectional image following radio frequency ablation. Demographic data between tumor subtypes were compared using the paired t-test. Oncologic outcomes were determined by Kaplan-Meier survival analysis and survivor curves were compared with the log rank test.A total of 229 patients met study inclusion criteria. There were 181 clear cell tumors and 48 papillary tumors. Median followup was 33.2 months. There was no difference between tumor groups based on patient age, tumor size or grade, or months of followup. Five-year disease-free survival was 89.7% for clear cell tumors and 100% for papillary tumors (p = 0.041). There was no significant difference in overall survival (88.4% vs 89.6%, p = 0.764).Radio frequency ablation outcomes seem to be determined in part by renal cell carcinoma subtype with clear cell renal tumors having less favorable outcomes. We hypothesize that this is due to differences in tumor vascularity. Our experience suggests that future tumor ablation studies should consider reporting outcomes based on tumor cell types.

Acoustic waves with periods of 2–4 min and gravity waves with periods of 6–16 min have been detected at ionospheric heights (250–350 km) using GPS total electron content measurements. The area disturbed by these waves and the wave amplitudes have been associated with underlying thunderstorm activity. A statistical study comparing Next Generation Weather Radar thunderstorm measurements with ionospheric acoustic and gravity waves in the midlatitude U.S. Great Plains region was performed for the time period of May–July 2005. An increase of ionospheric acoustic wave disturbed area and amplitude is primarily associated with large thunderstorms (mesoscale convective systems). Ionospheric gravity wave disturbed area and amplitude scale with thunderstorm activity, with even small storms (i.e., individual storm cells) producing an increase of gravity waves.

Three-dimensional (3D) printing applications have increased over the past decade. Our objective was to test rapid prototyping of a 3D printed surgical clip for intraoperative use.Our prototype was modeled after the 10 mm WeckInitial 3D printed clips were not functional as they split at the hinge upon closure of the clip jaws. Design changes were made to add Objet TangoBlackPlus FLX980 at the hinge to improve flexibility. Additional modifications were made to allow for clips to be compatible with the Hem-o-lok endoscopic clip applier. A total of 50 clips were tested. Fracture rate for the printed clips using a clip applier was 54% (n = 27), whereas none of the commercial Hem-o-lok clips broke upon closure. Of the 23 printed clips that closed, mean leak was at 20.7 κPa (range 4.8-42.7). In contrast, none of the commercial clips leaked, and fill continued until Penrose rupture at mean 46.2 κPa (44.8-47.6).This pilot study demonstrates feasibility of 3D printing functional surgical clips. However, the performance of our first generation clips is poor compared with commercial grade product. Refinement in printers and materials available may allow for customization of such printed surgical instruments that could be economically competitive to purchasing and stocking product.

Irreversible electroporation (IRE) is a non-thermal minimally invasive technique that is used to treat small renal masses (SRMs). Prior work has demonstrated greater narcotic requirements after radiofrequency ablation (RFA) for tumors that are closer to body-wall musculature. We hypothesized that pain after IRE is not dependent on tumor location due to the athermal mechanistic action.A retrospective review of 50 consecutive percutaneous IRE and RFA cases was performed from 2013 to 2014. Eight patients were excluded from analysis due to incomplete anesthesia record and/or multiple ablations per session, leaving 21 patients in each group. Data collected included patient age, sex, body mass index, nephrometry score, shortest distance to the closest body-wall muscle, perioperative narcotic use, and patient-reported pain score. Pearson correlation test and multivariable linear regression were used to identify predictors of postoperative pain, with significance set at p = 0.05.There was no difference in the mean distance from tumor edge to the nearest body-wall muscle between IRE and RFA (2.6 cm vs 2.4 cm, p = 0.729, respectively). Total mean perioperative narcotic usage was 20.4 mg after IRE and 26.7 mg after RFA (p = 0.096). Mean postoperative pain score (scale 0-10) was slightly higher after RFA (4.3) compared with IRE (2.4), but this was not statistically significant (p = 0.088). Pearson correlation test identified tumor proximity to be significiantly associated with both pain score (p = 0.011) and postoperative narcotic use (p = 0.049) after RFA but not after IRE. On multivariable analysis, only tumor proximity to the body wall was significantly correlated to pain score (-1.4, p = 0.041) after RFA but was not found to be a factor for pain after IRE.Patients whose tumors lie close to their body-wall musculature do not have greater narcotic requirements or higher pain scores in the perioperative period after IRE. Percutaneous IRE may be preferred over RFA for SRMs that are close to the body wall to minimize pain.

PurposeThe detection of small renal masses is increasing with the use of cross-sectional imaging, although many incidental lesions have negligible metastatic potential. Among malignant masses clear cell renal cell carcinoma is the most prevalent and aggressive subtype. A method to identify such histology would aid in risk stratification. Our goal was to evaluate a likelihood scale for multiparametric magnetic resonance imaging in the diagnosis of clear cell histology.Materials and methodsWe retrospectively reviewed the records of patients with cT1a masses who underwent magnetic resonance imaging and partial or radical nephrectomy from December 2011 to July 2015. Seven radiologists with different levels of experience who were blinded to final pathology findings independently reviewed studies based on a predefined algorithm. They applied a clear cell likelihood score, including 1-definitely not, 2-probably not, 3-equivocal, 4-probably and 5-definitely. Binary classification was used to determine the accuracy of clear cell vs all other histologies. Interobserver agreement was calculated with the weighted κ statistic.ResultsA total of 110 patients with 121 masses were identified. Mean tumor size was 2.4 cm and 50% of the lesions were clear cell. Defining clear cell as scores of 4or greater demonstrated 78% sensitivity and 80% specificity while scores of 3 or greater showed 95% sensitivity and 58% specificity. Interobserver agreement was moderate to good with a mean κ of 0.53.ConclusionsA clear cell likelihood score used with magnetic resonance imaging can reasonably identify clear cell histology in small renal masses and may decrease the number of diagnostic renal mass biopsies. Standardization of imaging protocols and reporting criteria is needed to improve interobserver reliability.

Broadband lightning signals are used to probe the D region ionosphere with a temporal resolution of 5 min and a spatial resolution of ~50 × 50 km. Together with a full wave propagation model, this technique allows determination of the reference height, h′, and steepness parameter, β, of an exponential electron density profile sensitive to the range of 106–108 electrons/m3. Daytime and nighttime background electron profiles away from thunderstorms are presented, as well as profiles from three regions nearby and atop thunderstorms. The average daytime profile parameters are found to be h′ = 67.7 km with a standard deviation of 0.9 km and β = 0.7 km−1 with a standard deviation of 0.1 km−1. Average nighttime parameters are h′ = 80.9 km with a standard deviation of 1.3 km and β = 2.8 km−1 with a standard deviation of 0.2 km−1. Nighttime electron profiles nearby and atop thunderstorms show slightly higher values of h′ (82.5–84.2 km) and significantly lower values of β (0.9–1.5 km−1). These findings indicate that there is significant electron depletion above ~80 km near and atop thunderstorms during the nighttime. Detailed analysis also shows substantial profile variations in space and time related to lightning discharges due to localized electron enhancement at high altitudes and reduction at lower altitudes. Nevertheless, the general depletion at higher altitudes appears to be related to the overall electrical behavior of the thunderstorm but not directly to lightning activity.

To examine if poor preoperative split renal function (SRF) and age influence pyeloplasty outcomes in adults with ureteropelvic junction obstruction (UPJO).We retrospectively reviewed our pyeloplasty experience in adults with UPJO from 2004 to 2014. Patients with solitary kidneys or missing renal scans were excluded. Renal scans were performed at 6 weeks, 8 months, and 20-24 months postoperatively. Demographics, operative approaches, and pre and postoperative SRF and diuretic half-times (T1/2) were obtained. Patients were stratified by preoperative SRF (≤ or25%) and age. Cox regression analyses were performed to explore predictors for stability or improvement of SRF.A total of 139 patients met the study criteria: 15 and 124 with preoperative SRF ≤ 25% and25%, respectively. Median follow up was 11 months, 12.9% of patients experienced worsening, 67.6% stability, and 19.4% improvement in SRF at last follow up. Median change in SRF was similar between groups; however, patients with lower preoperative SRF more frequently experienced improvement or worsening of SRF (p = 0.045). Failure rates (need for additional surgery) were comparable (p = 1.000). No significant differences were observed in SRF dynamicity when stratified by age (p = 0.120). On univariate Cox analysis, older age was predictive of stability or improvement in SRF across the entire cohort (HR 1.013, p = 0.016), while preoperative SRF was not (HR 1.007, p = 0.429).Poor SRF (≤ 25%) and age were not associated with worse outcomes after pyeloplasty for UPJO. Our results suggest that older adults with UPJO and patients with poor ipsilateral SRF should not be excluded from pyeloplasty.

Tropospheric thunderstorms have been reported to disturb the lower ionosphere, at altitudes of 65–90 km. The use of lightning signals from a distant mesoscale storm to probe the lower ionosphere above a small tropospheric thunderstorm reveals a reduction in ionospheric electron density in response to lightning discharges in the small storm. Tropospheric thunderstorms have been reported to disturb the lower ionosphere, at altitudes of 65–90 km, by convective atmospheric gravity waves1,2,3,4,5 and by electric field changes produced by lightning discharges6,7,8,9,10,11,12,13,14,15. Theoretical simulations suggest that lightning electric fields enhance electron attachment to O2 and reduce electron density in the lower ionosphere7,8. Owing to the low electron density in the lower ionosphere, active probing of its electron distribution is difficult16,17, and the various perturbative effects are poorly understood. However, it is now possible to probe the lower ionosphere in a spatially and temporally resolved manner by using remotely detected time waveforms of lightning radio signals4,5,18,19. Here we report such observations of the night-time ionosphere above a small thunderstorm. We find that electron density in the lower ionosphere decreased in response to lightning discharges. The extent of the reduction is closely related in time and space to the rate of lightning discharges, supporting the idea that the enhanced electron attachment is responsible for the reduction. We conclude that ionospheric electron density variations corresponding to lightning discharges should be considered in future simulations of the ionosphere and the initiation of sprite discharges.

Altered tissue structure is a feature of many disease states and is usually measured by microscopic methods, limiting analysis to small areas. Means to rapidly and quantitatively measure the structure and organisation of large tissue areas would represent a major advance not just for research but also in the clinic. Here, changes in tissue organisation that result from heterozygosity in Apc, a precancerous situation, are comprehensively measured using microultrasound and three-dimensional high-resolution microscopy. Despite its normal appearance in conventionally examined cross-sections, both approaches revealed a significant increase in the variability of tissue organisation in Apc heterozygous tissue. These changes preceded the formation of aberrant crypt foci or adenoma. Measuring these premalignant changes using microultrasound provides a potential means to detect microscopically abnormal regions in large tissue samples, independent of visual examination or biopsies. Not only does this provide a powerful tool for studying tissue structure in experimental settings, the ability to detect and monitor tissue changes by microultrasound could be developed into a powerful adjunct to screening endoscopy in the clinic.

Objective To assess the efficacy of light-reflectance spectroscopy (LRS) to detect positive surgical margins (PSMs) on ex vivo radical prostatectomy (RP) specimens. Materials and methods A prospective evaluation of ex vivo RP specimens using LRS was performed at a single institution from June 2013 to September 2014. LRS measurements were performed on selected sites on the prostate capsule, marked with ink, and correlated with pathological analysis. Significant features on LRS curves differentiating malignant tissue from benign tissue were determined using a forward sequential selection algorithm. A logistic regression model was built and randomised cross-validation was performed. The sensitivity, specificity, accuracy, negative predictive value (NPV), positive predictive value (PPV), and area under the receiver operating characteristic curve (AUC) for LRS predicting PSM were calculated. Results In all, 50 RP specimens were evaluated using LRS. The LRS sensitivity for Gleason score ≥7 PSMs was 91.3%, specificity 92.8%, accuracy 92.5%, PPV 73.2%, NPV 99.4%, and the AUC was 0.960. The LRS sensitivity for Gleason score ≥6 PSMs was 65.5%, specificity 88.1%, accuracy 83.3%, PPV 66.2%, NPV 90.7%, and the AUC was 0.858. Conclusions LRS can reliably detect PSMs for Gleason score ≥7 prostate cancer in ex vivo RP specimens.