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The follow-up of Bosniak IIF (BIIF) renal cysts is associated with significant costs, radiation, and anxiety. Recent studies have suggested a risk of malignancy and upgrading lower than previously reported. We aimed to determine their clinical outcomes and to evaluate the impact of the 2019 Bosniak classification on the diagnosis of such lesions.We identified all radiology reports with the diagnosis of a BIIF cyst at our institution between January 2000 and December 2018. Imaging was reviewed to confirm the diagnosis and determine progression based on the 2005 Bosniak classification. Radiological and clinical characteristics were established, and the 2019 Bosniak criteria were retrospectively applied.Out of 252 cysts reviewed, 55 (22%) were re-classified as BII upon revision using the 2005 Bosniak classification. A total of 181 BIIF cysts were included for final analysis. The median imaging follow-up was 50 months. 4 (2.2%) cysts progressed to BIII or BIV. Five (2.8%) patients underwent surgical interventions, with only 1 malignant pathology being reported. No malignant progression was observed after 36 months. When applied to our cohort, the 2019 Bosniak classification would have led to a 76% decrease in BIIF diagnoses, with no increase in BIII or BIV diagnoses, and identical classification of the confirmed malignant pathology.Upgrading and malignancy rates among BIIF cysts was markedly lower than traditionally reported. No patient had a significant progression beyond 36 months. More than 20% of BIIF cysts were initially overdiagnosed. The 2019 Bosniak classification may help to reduce the overdiagnosis of BIIF lesions requiring follow-up.

Adolescents are more likely than young adults to use electronic nicotine delivery systems (ENDS), yet most of what is known is concluded from young adult ENDS use as young adults are easier to survey. Additionally, while evidence about the prevalence and trends of adolescent ENDS use comes from cross-sectional studies, ecological momentary assessment (EMA) studies provide greater detail about the ways in which adolescents vape and the environments that are favorable to adolescent vaping, providing important guidance for policy, prevention, and intervention.We conducted a 2-week EMA study with 50 adolescents to assess behaviors, contexts, and characteristics of ENDS use. Given longitudinal research showing strong associations between ENDS use and use of other substances, we also examined tobacco cigarettes use, and daily concurrent use with tobacco cigarettes and marijuana.There was little daily variability in motivations, willingness, and intentions, or in product characteristics. ENDS use varied by day and was more frequent on weekends, whereas cigarette use was less likely on weekends. We found daily variability in contexts and the characteristics of situations where adolescents used, which were largely social-normative, including whose device was used, which flavors were used, and where and with whom adolescents used ENDS. Unexpectedly, marijuana accompanied more than a quarter of ENDS use occasions.Socio-ecological context is important for explaining adolescent ENDS use and it is critical to developing adolescent ENDS prevention, intervention, and treatment resources. Prevention messaging may be most relevant and effective on weekends when youth exposure to advertising and peer influences are greatest. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Noninferiority trials are increasingly used in urology. Understanding the methodology and assessment of such trials can be challenging for clinicians. We provide an approach to interpreting the results, validity, and applicability of noninferiority studies in clinical practice.

Contexte : La prise en charge classique de la fibromyalgie est fondée à la fois sur des traitements pharmacologiques et non pharmacologiques. Parmi ces derniers sont compris : la physiothérapie, l’activité physique, la relaxation, les thérapies cognitives et comportementales. L’efficacité de certains de ces traitements manque de preuves. Nous avons donc cherché à évaluer l’efficacité de la relaxation dans la fibromyalgie. Méthode : En nous fondant sur une précédente recherche, cette présente étude était randomisée et en insu de l’observateur. Le groupe expérimental bénéficiait d’un training autogène (TA) supervisé par un professionnel formé en relaxation. Le groupe témoin recevait la relaxation autonome sans supervision. Il y avait six sessions de relaxation durant 30 minutes chacune, et il était conseillé aux patients de réaliser des exercices de relaxation quotidiennement à domicile. Les critères principaux étaient les changements des scores à l’EVA douleur et à la sous-échelle douleur du QIF entre l’inclusion et la fin de l’étude, les critères secondaires concernaient les scores d’anxiété et de dépression de l’HADS (Hospital Anxiety and Depression Scale). Résultats : Quatre-vingts patients atteints de fibromyalgie (71 femmes, 9 hommes) ont été randomisés. Les scores de douleur de l’EVA et du QIF ne différaient pas significativement entre les deux groupes, tout comme les scores d’anxiété et de dépression. Conclusion : Face au constat que le TA seul n’apportait pas de bénéfices par rapport au témoin (relaxation passive), nous devons nous interroger sur la nécessité d’intégrer de la relaxation à d’autres techniques pour apporter un soulagement aux patients.

OBJECTIVE To determine the prevalence of intra-patient inter-metastatic heterogeneity based on positron emission tomography (PET)/computed tomography (CT) in patients with metastatic castration-resistant prostate cancer (mCRPC) and to determine the prevalence of neuroendocrine disease in these patients and their eligibility for radioligand therapies (RLTs). PATIENTS AND METHODS This multicentre observational prospective clinical study will include 100 patients with mCRPC from five Canadian academic centres. Patients with radiological or biochemical progression and harbouring at least three metastases by conventional imaging will be accrued. Intra-patient inter-metastatic heterogeneity will be determined with triple-tracer imaging using fluorine-18 fluorodeoxyglucose (18 F-FDG), gallium-68-(68 Ga)-prostate-specific membrane antigen (PSMA)-617 and 68 Ga-DOTATATE, which are a glucose analogue, a PSMA receptor ligand and a somatostatin receptor ligand, respectively. The 68 Ga-PSMA-617 and 18 F-FDG PET/CT scans will be performed first. If at least one PSMA-negative/FDG-positive lesion is observed, an additional PET/CT scan with 68 Ga-DOTATATE will be performed. The tracer uptake of individual lesions will be assessed for each PET tracer and patients with lesions presenting discordant uptake profiles will be considered as having inter-metastatic heterogeneous disease and may be offered a biopsy. EXPECTED RESULTS The proposed triple-tracer approach will allow whole-body mCRPC characterisation, investigating the inter-metastatic heterogeneity in order to better understand the phenotypic plasticity of prostate cancer, including the neuroendocrine transdifferentiation that occurs during mCRPC progression. Based on 68 Ga-PSMA-617 or 68 Ga-DOTATATE PET positivity, the potential eligibility of patients for PSMA and DOTATATE-based RLT will be assessed. Non-invasive whole-body determination of mCRPC heterogeneity and transdifferentiation is highly innovative and might establish the basis for new therapeutic strategies. Comparison of molecular imaging findings with biopsies will also link metastasis biology to radiomic features. CONCLUSION This study will add novel, biologically relevant dimensions to molecular imaging: the non-invasive detection of inter-metastatic heterogeneity and transdifferentiation to neuroendocrine prostate cancer by using a multi-tracer PET/CT strategy to further personalise the care of patients with mCRPC.

Clinical guidelines for guiding clinical decision-making must be trustworthy, especially when there is controversy or a shifting paradigm. In urology, the management of small renal masses is one area in which there is currently a paradigm shift towards active surveillance. A number of international guidelines address this paradigm shift to some extent, with varying degrees of rigor. To be trustworthy, guidelines should be developed by panels that include content experts – the traditional panel members – as well as methodologists with expertise in evidence interpretation, front-line clinicians who take care of the patients who constitute the target audience, and patient partners. At a minimum, panels should integrate four key concepts: (1) guidelines provide a systematic summary of evidence used to support answerable questions, including assessment of the quality of the evidence; (2) there is a clear and transparent link between the evidence and recommendations; (3) recommendations incorporate patient values and preferences; and (4) conflicts of interest are managed optimally. In this article we address several issues in four international guidelines, with an emphasis on guideline methods and implications for guidance statements. The strengths and limitations of available recommendations are reviewed and summarized with suggestions for improving the next iterations of guidelines on the management of small renal masses. Patient summary Good clinical decision-making relies on trustworthy guidelines. We assessed four international guidelines on the management of small kidney tumors that illustrate some of the key issues in developing a trustworthy guideline. Patient values and preferences are under-represented in most clinical guidelines.

Resume Les 2 et 3 juin 2021, une panne telephonique nationale affecte le fonctionnement des numeros d’urgence. L’analyse de l’activite des CRRA15 des huit SAMU d’Ile-de-France a montre (par rapport aux periodes de reference) une baisse du nombre d’appels au SAMU centre 15 et une diminution des dossiers de regulation medicale pendant la panne, suivie d’une augmentation 2 heures plus tard. Parallelement, il n’a pas ete observe de variation du nombre de sorties des SMUR, ni du nombre de patients accueillis dans les services d’urgences hospitaliers. Le faible impact observe peut etre explique par la nature partielle de la panne, mais aussi par la mise en place rapide par l’ARSIF et l’AP-HP d’une information destinee au public et d’une solution de contournement de la panne.

IntroductionSchools in the United States are hierarchical institutions that actively (re)produce the power relations of the wider social world, including those associated with heteronormativity. Structural stigma, informed by heteronormativity and perpetuated through schools, contributes to the production of academic and health disparities among youth who are lesbian, gay, bisexual, transgender, queer, or of other gender and sexual identities (LGBTQ+). We draw upon 5 years of qualitative data from a cluster randomized controlled trial conducted in New Mexico that used implementation science frameworks to promote the uptake and sustainment of evidence-informed practices (EIPs) to examine how power operates to hinder or promote the ability of school staff to change school environments, disrupt structural stigma, and increase safety and support for LGBTQ+ youth.MethodsData sources included annual individual and small group qualitative interviews with school professionals (e.g., administrators, school nurses, teachers, and other staff), several of whom took part in Implementation Resource Teams (IRTs) charged with applying the EIPs. Other data sources included bi-weekly periodic reflections with implementation coaches and technical assistance experts. Data were recorded, transcribed, and analyzed using deductive and inductive coding techniques.ResultsThe IRTs experienced variable success in implementing EIPs. Their efforts were influenced by: (1) constraining school characteristics, including staff turnover and resource scarcity; (2) community-based opposition to change and concerns about community backlash; (3) the presence or absence of supportive school leadership; and (4) variations in school, district, and state policies affecting LGBTQ+ students and attitudes about their importance. Findings illustrate how diverse power structures operated in and across outer and inner contexts to bound, shift, amplify, and otherwise shape how new practices were received and implemented.ConclusionFindings indicate that the efforts of IRTs were often a form of resistant power that operated within and against school hierarchies to leverage epistemic, discursive, and material power toward implementation. To improve health equity, implementation scientists must attend to the multiple real and perceived power structures that shape implementation environments and influence organizational readiness and individual motivation. Implementers must also work to leverage resistant power to counter the institutional structures and social norms that perpetuate inequities, like heteronormativity and structural stigma.

Innovation consists of making collaborative efforts in term of relationship with other organization and institutions to attain competitive advantage by means of innovative services and products, as well as different relationships with their shareholders and stakeholders. Logistics services includes warehousing, freight, transportation, product return and repairs, inventory management, packaging, order entry/order processing. All these can be managed internally. But the challenges of coping with manufacturing and handling logistics which is not the core of the organization business model result to the outsourcing for logistics service providers, such as third-party logistics service providers. This paper aimed at investigating the moderating effect of innovation on logistics practices, particularly, warehousing, transport and packaging services, of 3PLs service provider in Malaysia manufacturing sector. Quantitative method of research was adopted, and questionnaire was distributed electronically. It was analysed using SPSS and the result indicated that innovation of green logistics moderates the relationship between inventory management and operational performance, packaging and service performance but does not moderate relationship between transportation and service performance.

Background Adolescents who dual use ENDS with tobacco cigarettes are more likely to have an increased risk of developing dependence. Yet, little is understood about the factors driving dual use among adolescents. The current study sought to reveal the day-to-day contextual and community factors associated with adolescents’ use of electronic nicotine delivery systems (ENDS), and how these factors predict dual use with tobacco cigarettes. Methods We collected ecological momentary assessments (EMA) from a sample of 50 adolescent past two-week vapers (ages 14–17 years old) over 14 days. Daily EMA data were collected on ENDS and tobacco cigarette use, as well as a range of contextual (i.e., motivations to vape, location of vaping, who with when vaping) and community factors (i.e., exposure to peers vaping, to adults vaping, to ENDS advertising, to ENDS warning messages). Our primary analyses were multilevel regressions, accounting for daily observations nested within individuals (N = 700 observations). Results Participants used ENDS exclusively on 44% of days and dual used ENDS and tobacco cigarettes on 8% of the days. Dual use days (versus exclusive ENDS use days) were associated with vaping because tobacco use was prohibited (OR = 34.65, p

The interaction that exists between two wythes of concrete, inner and outer, goes a long way to establish the structural behavior of the whole components and particularly, lightweight foamed concrete sandwich panel. Precast concrete sandwich panel (PCSP) has become a household name since it has been utilized in the construction of structural shell in some building types. This research investigated the load deflection of six different lightweight foamed concrete panels. The six panels were produced using a foamed concrete mix of the same density and the mechanical properties of the mix were tested. Each panel consists of two withes (facings) made of lightweight foamed concrete and polystyrene was used as the core and the insulation layer. Mild steel wire mesh of 6mm sizes was used as reinforcement in three of the panels while 9mm diameter high yield steel was used in the remaining three panels. The reinforcement in both facing was tied together using shear and bend to an angle of 450.End crushing of the panels was avoided using concrete capping. An axial load test was conducted, the load deflection, mode of failure and crack patterns of the panels was observed. The result also revealed that panels with concrete capping deflect along with their Wythe in the same directions and small deflection was recorded in panels with concrete capping. Cracking modes in panels reinforced with 6mm mild steel were controlled by material failure while those in panels with 9mm high yield steel, cracks was only observed at the lower part of the capping.

Traditionally, intervention was recommended for angiomyolipomas (AMLs)4 cm due to the risk of catastrophic hemorrhage.To delineate the natural history of AMLs, including growth rates and need for intervention.A retrospective review was performed of an AML series from 2002 to 2013, which have been followed prospectively until 2018. We defined lesion size by maximum axial diameter and categorized lesion size at baseline.A total of 458 patients with 593 AMLs, with a median follow-up of 65.2 mo, were identified. At diagnosis, 534 (90.1%) lesions were ≤4 cm. Forty-three interventions were required for 34 (5.7%) AMLs: 30 were treated with embolization, seven surgery, two with radiofrequency ablation (RFA), three with mammalian target of rapamycin (mTOR) inhibitors, and one with nivolumab when epithelioid AML was confirmed. The median size at intervention was 4.9 cm (range 1.1-29 cm).Most (94%) of the lesions grew slowly (growth rate of0.25 cm/yr) during the period of observation. The number of AMLs4 cm needed to treat (NNT) prophylactically to prevent one emergent bleed would have been 136 or that to prevent one blood transfusion would have been 205. The NNT (4 cm) prophylactically to prevent one elective intervention would have been 82. On multivariate analysis, there were significant differences in intervention rates based on tuberous sclerosis complex, size at presentation, and clinical presentation.This large single-institution updated series of renal AMLs demonstrates that early intervention is not required, regardless of the traditional 4 cm cut-off. The vast majority of AMLs are indolent lesions that are predominantly asymptomatic and slow growing. Follow-up should be no more frequent than annually.The majority of angiomyolipomas (AMLs) are indolent, slow-growing lesions that do not require intervention, regardless of size at presentation. We suggest that surveillance is a safe initial approach for patients presenting with AMLs.

Objective We developed a peer-led group program for Veterans called Taking Charge of My Life and Health (TCMLH) that emphasizes patient education, goal setting, shared decision making, and whole person care. Our aim was to conduct an evaluation of a facilitator training course to deliver TCMLH in VA sites. Methods Repeated measures ANOVA models were used to examine change over three timepoints (pre-test, post-test, and two-month follow-up) in outcomes of attitudes, knowledge, skills, and self-efficacy related to patient empowerment, skills acquisition, self-care strategies, and curriculum facilitation. Qualitative data analysis of participant feedback was used to identify potential training adaptations and barriers to TCMLH delivery. Results Our sample comprised 70 trainees who completed all three assessments. Participants reported high levels of training satisfaction, quality, and utility, and sustained improvements in knowledge of Whole Health, self-efficacy for group facilitation, and self-efficacy for using Whole Health concepts and tools. Implementation barriers included challenges related to group management and site logistics. Conclusion The facilitator training course improved knowledge and self-efficacy associated with successful peer-led program delivery and identified opportunities to improve the training course and TCMLH dissemination. Practice Implications: Findings provide insights on the design and implementation of training models to support peer-led programs.

Evidence-based approaches promoting patient engagement and chronic illness self-management include peer support, shared decision-making, and education. Designed based on these components, Taking Charge of My Life and Health (TCMLH) is a group-based, ‘Whole Person’ care program promoting mental and physical self-care and patient empowerment. Despite evidence of effectiveness, little is known about implementation for TCMLH and similar programs. In this first-of-its-kind, multi-methods evaluation conducted between 2015–2020, we report on implementation strategies and intervention adaptations with a contextual analysis to describe TCMLH translational efforts in Veterans Health Administration (VHA) facilities across the United States. Quantitative and qualitative data were collected via listening sessions with TCMLH facilitators, open-ended survey responses from facilitators, and quarterly reports from clinical implementation sites. We used the Consolidated Framework for Implementation Research (CFIR) to analyze, interpret, and organize qualitative findings, and descriptive statistics to analyze quantitative data. Most TCMLH programs (58%) were adapted from the original format, including changes to the modality, duration, or frequency of sessions. Findings suggest these adaptations occurred in response to barriers including space, staffing constraints, and participant recruitment. Overall, findings highlight practical insights for improving the implementation of TCMLH, including recommendations for additional adaptations and tailored implementation strategies to promote its reach.

This study examines the relationship between economic growth and energy consumption in Nigeria by using ARDL Bound Test regression analysis. In the investigation process energy consumption, was disaggregated into electricity, coal and petroleum with growth rate of GDP data is used from 1980-2017. The findings show that petroleum and electricity variables are positive and significant to growth while coal is positive but not significant. Overall outcome is that energy consumption has a positive relationship with economic growth. The coal deposit must be put in use to increase energy production and consumption and stimulate other economic activities for growth Keywords: Energy consumption, economic growth, ARDL test.JEL Classifications: Q32, Q044DOI: https://doi.org/10.32479/ijeep.10021

Pathological and oncologic outcomes of delayed radical prostatectomy following prostate cancer active surveillance are not well established. We determined the pathological and oncologic outcomes of favorable risk, Grade Group 1, prostate cancer managed with active surveillance and progressing to radical prostatectomy for clinically significant prostate cancer (Grade Group 2 or greater).Between 1992 and 2015, 170 men with favorable risk prostate cancer underwent delayed radical prostatectomy for clinically significant prostate cancer (ASRP) at the Princess Margaret Cancer Centre. Pathological and oncologic outcomes of the ASRP cohort were compared with a matched cohort treated with up-front radical prostatectomy (405) immediately before surgery. Biochemical recurrence-free survival, overall survival and cancer specific survival were compared. We examined the association between delayed radical prostatectomy and adverse pathology at radical prostatectomy and biochemical recurrence using logistic and Cox regression analyses, respectively.Median time spent on active surveillance before radical prostatectomy was 31.0 months. At radical prostatectomy pT3 (extraprostatic extension, seminal vesicle invasion), positive surgical margin and pN1 rates were comparable between the 2 cohorts. Median followup after radical prostatectomy was 5.6 years. The 5-year biochemical recurrence-free survival rate in the ASRP cohort and up-front radical prostatectomy cohort were 85.8% and 82.4%, respectively (p=0.38). Overall survival and cancer specific survival were comparable between the 2 groups. Delayed radical prostatectomy was not associated with adverse pathological outcomes and biochemical recurrence on regression analyses.Curative intent radical prostatectomy after a period of active surveillance results in excellent pathological and oncologic outcomes at 5 years. A period of active surveillance does not result in inferior outcomes compared to patients with similar risk characteristics undergoing up-front radical prostatectomy.

L’évolution actuelle de la demande de soins non programmés porte autant sur une augmentation de volume que sur sa nature. Les missions assurées par les structures d’urgence se sont décentrées vers la prise en charge des complications des pathologies chroniques et des problématiques médicosociales. Une démarche collaborative entre la médecine de ville et l’aide médicale urgente (AMU) a été initiée depuis deux ans dans les Yvelines, entre le Samu 78, l’hôpital de Versailles, le Conseil de l’ordre des médecins 78 et l’Association Plateforme territoriale d’appui 78. Ses objectifs visent, par un travail de coordination multidisciplinaire, à éviter les ruptures de parcours des patients complexes, à favoriser le maintien à domicile et à réorienter les patients vers la ville après un recours à l’hôpital. La crise sanitaire liée au Covid-19 a permis d’accélérer le processus de collaboration ville– AMU avec des objectifs propres à cette crise, notamment grâce à des outils numériques dédiés. Les principaux axes de travail ont été de répondre à l’urgence de la crise sanitaire en organisant une offre de soins sécurisée, d’organiser les parcours des patients fragiles pendant le confinement puis de préparer et d’accompagner le déconfinement grâce à une cellule d’appui et de suivi des cas positifs et de leurs contacts. Les difficultés organisationnelles ou liées à l’acceptabilité de ces nouveaux outils de surveillance et de coordination ont trouvé leurs solutions grâce à un environnement institutionnel favorable et l’implication de leaders intéressés par la conduite de projets innovants. Cette expérience peut préfigurer le futur service d’accès aux soins (SAS).

Objective To determine whether the presence of detrusor overactivity (DO) is associated with the 12-week and 12-month clinical outcomes of selective bladder denervation (SBD) in women with refractory overactive bladder (OAB). Methods Prospective single institutional study of refractory OAB females who underwent a urodynamic study and were categorized according to DO status (DO− vs DO+) prior to receiving SBD. Results Among the 23 patients, 10 were DO− and 13 were DO+. Both groups reported improvement at 12 weeks on the 24-hour pad weight test, in urgency urinary incontinence (UUI) and urgency. At 12 months, both groups still reported improvement in urgency, but only the DO− group reported reduction on the pad weight test and only the DO+ group maintained improvement in the UUI rate. Clinical success (≥50% reduction in UUI) was achieved by all DO− and by 69% of DO+ patients at 12 weeks, and by 60% of DO− and 92% of DO+ patients at 12 months. Treatment benefit (Treatment Benefit Scale ≤2) was reported in 90% of DO− and 85% of DO+ patients at 12 weeks, and in 60% of DO− and 85% of DO+ patients at 12 months. When directly comparing both group outcomes, the only significant difference was the greater reduction of UUI in the DO− group at 12 weeks (−9.0 vs −6.5; P = .045). Conclusion Refractory OAB females appear to be effectively treated by SBD regardless of baseline DO status. DO status does not seem to be associated with the 12-week and 12-month outcomes of SBD.

This study was carried out to determine the effect of dietary supplementation of Dennettia tripetala on some biochemical parameters of rats. Twenty-five rats were used and were divided in to five groups of 5 rats. Group 1 served as control while group 2-5 were fed dietary inclusion of Dennettia tripetala fruits for 28 days. After the feeding trials, the rats were sacrificed and blood was collected for biochemical analyses. The serum concentration triglyceride and glucose were significantly lowered (pDennettia tripetala fruits has hypoglycaemic, antioxidant and hypolipidemic effect. Therefore, it may help in the prevention of coronary heart disease, diabetes mellitus and cancer.

BACKGROUND AND PURPOSE Previous studies have suggested an association between stroke and meteorological factors, air pollution and acute respiratory infections as triggering factors. Often, these factors have been evaluated separately. We evaluated the association between all these environmental triggering factors and calls for suspected stroke in a suburb in west Paris from 2004 to 2015. METHODS We used data from the emergency medical dispatching center of all calls for suspected stroke (SAMU 78), climatic parameters (MeteoFrance), pollution (AIRPARIF), and data from influenza epidemic surveillance networks (GROG and Sentinelles). The association between short-term exposure (1-day lag) to environmental triggering factors and stroke occurrence was analyzed using negative-binomial log linear regression model for counting time series. RESULTS Between 2004 and 2015, a total of 11,037 calls for suspected stroke were recorded. In bivariate analysis, there were associations between calls for suspected stroke and temperature (mean, maximum and minimum), humidity and influenza epidemic. In multivariable analysis, only two variables were associated with calls for suspected stroke: humidity [3.93% excess relative risk (ERR) of stroke per 10% increase in humidity; 95% confidence interval (CI), 1.42 to 6.51; P

The chemical element nickel is of particular interest in stellar physics. In the layers in which the Fe-peak elements dominate the mean opacity (the so-called Z-bump), Ni is the second contributor to the Rosseland opacity after iron, according to the Opacity Project data. Reliable nickel cross sections are therefore mandatory for building realistic stellar models, especially for main-sequence pulsators such as $\beta$ Cep and slowly pulsating B stars, whose oscillations are triggered by the $\kappa$-mechanism of the Fe-peak elements. Unfortunately, the Opacity Project data for Ni were extrapolated from those of Fe, and previous studies have shown that they were underestimated in comparison to detailed calculations. We investigate the impact of newly computed monochromatic cross sections on the Rosseland mean opacity of Ni and on the structure of main-sequence massive pulsators. We compare our results with the widely used Opacity Project and OPAL data. Monochromatic cross sections for Ni were obtained with the SCO-RCG code. The Toulouse-Geneva evolution code was used to build the stellar models. With the new data, the Rosseland opacities of Ni are roughly the same as those of the Opacity Project or OPAL at high temperatures ($\log\ T>6$). At lower temperatures, significant departures are observed; the ratios are up to six times higher with SCO-RCG. These discrepancies span a wider temperature range in the comparison with OPAL than in comparison with the Opacity Project. For massive star models, the results of the comparison with a structure computed with Opacity Project data show that the Rosseland mean of the global stellar mixture is only marginally altered in the Z-bump. The maximum opacity is shifted towards slightly more superficial layers. A new maximum appears in the temperature derivative of the mean opacity, and the driving of the pulsations should be affected., Comment: 7 pages, 10 figures, accepted on November 18th 2021

Most patients diagnosed with a small renal mass (SRM) are treated with definitive treatments such as surgery or thermal ablation. Given that some SRMs are benign or have low metastatic potential, active surveillance seeks to reduce the overtreatment and the potential complications. Active surveillance is an alternative that is being increasingly considered. Active surveillance has already been shown to be effective, but there is a current knowledge gap regarding patients' perceptions of active surveillance and factors influencing their decision.To describe patients' perceptions of active surveillance of SRMs and to identify factors influencing those perceptions.This multicenter descriptive qualitative study recruited patients diagnosed with a renal mass from three institutions, using purposeful sampling. Data were collected using focus group discussions, which were recorded and transcribed. A mixed thematic analysis was performed.Six focus group discussions were conducted with a total of 24 participants. Participants perceived active surveillance as an option to avoid definitive treatments and their potential risks. Active surveillance was, however, perceived to be a temporary solution that would affect their chance of survival and their quality of life. Seven factors were documented as influencing patients' perceptions of active surveillance, the most important being their physician's recommendation.Perceptions of patients with SRMs toward active surveillance varies among individuals. The development of more patient-oriented information tools is needed to educate patients, to reduce physician influence on the decision-making process and to ensure that the patients' decision reflects their own values and preferences.