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Abstract Objective The objective of this study is to report “real‐world” outcomes of prostatic urethral lift (PUL) in a medically complex US military veteran population while employing liberalized procedural indications. Methods A retrospective review was conducted of patients who underwent PUL at our institution. There were no prostatic size requirements, patients were accepted on anti‐platelet/anticoagulant therapy, no benign prostatic hyperplasia (BPH) medication washout was required, and there was no maximum post‐void residual PVR. Pre‐ and post‐operative International Prostate Symptom Score (IPSS), uroflowmetry, and PVR were recorded. Statistical comparisons were performed using simple t tests. Results From 2013 to 2019, 91 patients underwent PUL. Mean age was 70 (range 55–92) years. The majority of our patients were classified as American Society of Anesthesiologists (ASA) class 3 versus the general population at ASA class 2. Post‐operatively, IPSS decreased by an average of 43% (23 to 13, p

IntroductionEfforts to collect ecological data have intensified over the last decade. This is especially true for freshwater habitats, which are among the most impacted by human activity and yet lagging behind in terms of data availability. Now, to support conservation programmes and management decisions, these data need to be analyzed and interpreted; a process that can be complex and time consuming. The South African Biodiversity Data Pipeline for Wetlands and Waterbirds (BIRDIE) aims to help fast and efficient information uptake, bridging the gap between raw ecological datasets and the information final users need.MethodsBIRDIE is a full data pipeline that takes up raw data, and estimates indicators related to waterbird populations, while keeping track of their associated uncertainty. At present, we focus on the assessment of species abundance and distribution in South Africa using two citizen-science bird monitoring datasets, namely: the African Bird Atlas Project and the Coordinated Waterbird Counts. These data are analyzed with occupancy and state-space models, respectively. In addition, a suite of environmental layers help contextualize waterbird population indicators, and link these to the ecological condition of the supporting wetlands. Both data and estimated indicators are accessible to end users through an online portal and web services.Results and discussionWe have designed a modular system that includes tasks, such as: data cleaning, statistical analysis, diagnostics, and computation of indicators. Envisioned users of BIRDIE include government officials, conservation managers, researchers and the general public, all of whom have been engaged throughout the project. Acknowledging that conservation programmes run at multiple spatial and temporal scales, we have developed a granular framework in which indicators are estimated at small scales, and then these are aggregated to compute similar indicators at broader scales. Thus, the online portal is designed to provide spatial and temporal visualization of the indicators using maps, time series and pre-compiled reports for species, sites and conservation programmes. In the future, we aim to expand the geographical coverage of the pipeline to other African countries, and develop more indicators specific to the ecological structure and function of wetlands.

Vertebral body metastases cause a significant degree of disability in patients with advanced oncological disease. Surgical treatment is an effective treatment however it comes with a long recovery period and significant post-operative pain. When spinal metastases are involved, wound healing is a limiting factor in recommencement of radiotherapy. An endoscopic vertebrectomy allows for safe rhizolysis and subsequent fixation to maintain stability. We present the first case of endoscopic partial vertebrectomy for symptomatic spinal metastases. A fifty-eight-year-old lady presented with spinal metastases secondary to metastatic lung cancer. She underwent a transforaminal endoscopic partial vertebrectomy with rhizolysis of the exiting nerve root and percutaneous pedicle screw fixation of the L3-L5 vertebral bodies. She recovered well post-operatively with complete resolution of the radicular pain and a return to baseline mobility. Endoscopic partial vertebrectomy presents a new approach to treatment of spinal metastases. This allows for a reduction in post-operative length of hospital stay, post-operative pain and an improved rate of wound healing. The reduction in wound healing allows for a faster return to treatment when compared with an open approach. An endoscopic approach is beneficial for treatment of foraminal pathology, allowing for good visualisation of the nerve root to perform optimal rhizolysis.

Previous research has demonstrated that reversing the contrast of the eye region, which includes the eyebrows, affects the N170 ERP. To selectively assess the impact of just the eyes, the present study evaluated the N170 in response to reversing contrast polarity of just the iris and sclera in upright and inverted face stimuli. Contrast reversal of the eyes increased the amplitude of the N170 for upright faces, but not for inverted faces, suggesting that the contrast of eyes is an important contributor to the N170 ERP.

Objective Rheumatoid arthritis (RA) is an autoimmune, inflammatory, systemic condition that requires specific drug treatment to suppress disease activity and prevent joint deformity. To manage the ongoing symptoms of joint pain and fatigue patients are encouraged to engage in self-management activities. People with RA have an increased incidence of serious illness and mortality, with the potential to impact on quality of life. This study explored patients’ experiences of living with RA on physical, psychological and social well-being as well as their ability to employ self-management skills during the coronavirus pandemic.Design Qualitative, longitudinal (baseline, 16 September to 23 November 2020 and after 2–4 months, 11 January to the 17 January 2021), semistructured telephone interviews.Setting A rheumatology service based in a community hospital.Participants 15 adults with RA.Main outcomes Data were analysed using interpretative phenomenological analysis.Results Five themes were identified that related to impact on (1) fear: the dominant emotion, (2) social connections and work practices, (3) physical health, (4) identity and (5) self-management as a coping mechanism. The overriding emotion was one of fear, which remained high throughout both interviews. The negative impact on social well-being increased as the pandemic progressed. Conversely, physical health was not affected at either time point, although participants reported difficulty in interpreting whether physical symptoms were attributable to their RA or COVID-19. Recognition of increased vulnerability led to a reassessment of self-identity; however, respondents reported using previously learnt self-management techniques to cope in the context of the pandemic.Conclusions The main impact was on emotional and social well-being. Levels of fear and vulnerability which affected self-identity remained high throughout the pandemic and the impact on social well-being increased over time. Physical health remained largely unaffected. Self-management skills were used to maintain a sense of well-being.

Metal additive manufacturing involves manufacturing techniques that add material to produce metallic components, typically layer by layer. The substantial growth in this technology is partly driven by its opportunity for commercial and performance benefits in the aerospace industry. The fundamental opportunities for metal additive manufacturing in aerospace applications include: significant cost and lead-time reductions, novel materials and unique design solutions, mass reduction of components through highly efficient and lightweight designs, and consolidation of multiple components for performance enhancement or risk management, e.g. through internal cooling features in thermally loaded components or by eliminating traditional joining processes. These opportunities are being commercially applied in a range of high-profile aerospace applications including liquid-fuel rocket engines, propellant tanks, satellite components, heat exchangers, turbomachinery, valves, and sustainment of legacy systems. This paper provides a comprehensive review of metal additive manufacturing in the aerospace industry (from industrial/popular as well as technical literature). This provides a current state of the art, while also summarizing the primary application scenarios and the associated commercial and technical benefits of additive manufacturing in these applications. Based on these observations, challenges and potential opportunities are highlighted for metal additive manufacturing for each application scenario.

We investigate the factors (“drivers”) that motivated investment in energy efficiency in commercial real estate office buildings over the 2006–2011 and 2012–2017 period, and looking forward from 2018 in the context of growing concern over carbon emissions around the world. These insights were collected from large Canadian asset managers through interviews conducted in 2017 and 2018. Key findings were that (1) organizations noted an increasing number of factors driving investment decisions over the three periods; (2) cost drivers (payback period and anticipated financial returns) were the top two drivers in 2006–2017; (3) public relations factors became significantly more important looking forward, with brand (reputational impact) as the top-ranked driver and tenant attraction tied for third place; and (4) mitigation against risks such as resilience and anticipated compliance consistently increased in importance. This study contributes to a comprehensive understanding of past, present, and near-future sustainable real estate investment priorities, changing owner behaviors, and the perceived business case for building energy efficiency investments.

The thrust produced by a hybrid rocket motor (HRM) can be controlled by varying the oxidizer flow rate to the combustion chamber. This feature is useful in shaping motor thrust profiles and optimizing a vehicle flight trajectory, but propellant throttling in solid-fuel hybrids is limited to the liquid component only, complicating the control scheme and potentially destabilizing combustion in the motor. While hybrid motor throttling ability remains a subject of considerable interest, there has been little investigation of throttling in motors that use high regression rate, liquefying fuels such as paraffin wax. This article describes the development and implementation of a closed loop thrust control scheme for a laboratory-scale paraffin wax/nitrous oxide HRM using a low-cost ball valve as the controlling hardware element. A model of motor performance is first developed from which proportional-integral-derivative (PID) controller constants are obtained through experimental testing. The control scheme is demonstrated through closed loop hot fire tests of a laboratory-scale motor in which thrust tracks a set-point value with feedback provided through a load cell. Upon reaching the setpoint, the motor remains throttled within ± 2.4% of the maximum thrust of the motor. Constant and ramping thrust profiles are demonstrated.

Tractor-trailer units are the primary horizontal transport medium between the ship and the stacking area in container ports, and their efficient operation has a strong influence on loading and unloading rates. This paper presents a comparative study of the vessel loading and unloading procedure at the Port of Durban for conventional tractor-trailer units versus short multi-trailer systems. A discrete event simulation approach was used to model the terminal’s operations using the two types of vehicles, and to analyse the effect on the terminal’s performance and operating costs. The results of the study showed that the current fleet of tractor-trailer units can be replaced by a fleet of multi-trailer systems capable of carrying four twenty-foot equivalent units (TEUs) each, resulting in equivalent quay crane productivity while reducing the terminal’s operating cost per shift for the horizontal transport subsystem.

To assist educators in developing transformative learning environments, and effectively engaging in difficult dialogues regarding multicultural counseling topics, we conducted a qualitative study to systemically examine the perceptions and reactions of twenty graduate counselor education students enrolled in a multicultural counseling course. In this particular course, students experienced various learning environments all designed to enhance the topic of the day. Students were instructed to journal their thoughts, which became the raw data that was later, analyzed for themes. Students reported a need to be in an environment where there was trust, an ongoing need to reflect on the content, and difficulty discussing their school experiences with friends/family who are not in the helping profession.

Abstract In the past decade, the traditional view of cancers as a homogeneous collection of malignant cells is being replaced by a model of ever increasing complexity suggesting that cancers are complex tissues composed of multiple cell types. This complex model of tumorigenesis has been well supported by a growing body of evidence indicating that most cancers including those derived from blood and solid tissues display a hierarchical organization of tumor cells with phenotypic and functional heterogeneity and at the apex of this hierarchy are cells capable of self‐renewal. These “tumor imitating cells” or “cancer stem cells” drive tumorigenesis and contribute to metastasis, treatment resistance and tumor relapse. Although tumor stem cells themselves may display both genetic and phenotypic heterogeneity, recent studies have demonstrated that cancer stem cells maintain plasticity to transition between mesenchymal‐like (EMT) and epithelial‐like (MET) states, which may be regulated by the tumor microenvironment. These stem cell state transitions may play a fundamental role in tumor progression and treatment resistance. In this review, we discuss the emerging knowledge regarding the plasticity of cancer stem cells with an emphasis on the signaling pathways and noncoding RNAs including microRNAs (miRNA) and long non‐coding RNAs (lncRNAs) in regulation of this plasticity during tumor growth and metastasis. Lastly, we point out the importance of targeting both the EMT and MET states of CSCs in order to eliminate these lethal seeds of cancers.