Abstract
Compact binary mergers involving at least one neutron star are promising sites for the synthesis of the
r
-process elements found in stars and planets. However, mergers can take place at ...significant offsets from their host galaxies, with many occurring several kpc from star-forming regions. It is thus important to understand the physical mechanisms involved in transporting enriched material from merger sites in the galactic halo to the star-forming disk. We investigate these processes, starting from an explosive injection event and its interaction with the halo medium. We show that the total outflow mass in compact binary mergers is too low for the material to travel to the disk in a ballistic fashion. Instead, the enriched ejecta is swept into a shell, which decelerates over ≲10 pc scales and becomes corrugated by the Rayleigh–Taylor instability. The corrugated shell is denser than the ambient medium and breaks into clouds that sink toward the disk. These sinking clouds lose thermal energy through radiative cooling, and are also ablated by shearing instabilities. We present a dynamical heuristic that models these effects to predict the delay times for delivery to the disk. However, we find that turbulent mass ablation is extremely efficient and leads to the total fragmentation of sinking
r
-process clouds over ≲10 pc scales. We thus predict that enriched material from halo injection events quickly assimilates into the gas medium of the halo and that enriched mass flow to the disk could only be accomplished through turbulent diffusion or large-scale inflowing mass currents.
Compact binary mergers involving at least one neutron star are promising sites for the synthesis of \(\textit{r}\)-process elements found in stars and planets. However, mergers can take place at ...significant offsets from their host galaxies, with many occurring several kpc from star-forming regions. It is thus important to understand the physical mechanisms involved in transporting enriched material from merger sites in the galactic halo to the star-forming disk. We investigate these processes, starting from an explosive injection event and its interaction with the halo medium. We show that the total outflow mass in compact binary mergers is too low for the material to travel to the disk in a ballistic fashion. Instead, the enriched ejecta is swept into a shell, which decelerates over \(\lesssim 10\) pc scales and becomes corrugated by the Rayleigh-Taylor instability. The corrugated shell is denser than the ambient medium, and breaks into clouds which sink toward the disk. These sinking clouds lose thermal energy through radiative cooling, and are also ablated by shearing instabilities. We present a dynamical heuristic that models these effects to predict the delay times for delivery to the disk. However, we find that turbulent mass ablation is extremely efficient, and leads to the total fragmentation of sinking \(\textit{r}\)-process clouds over \(10-100\) pc scales. We thus predict that enriched material from halo injection events quickly assimilates into the gas medium of the halo, and that enriched mass flow to the disk could only be accomplished through turbulent diffusion or large-scale inflowing mass currents.
To understand the effect of bicycle saddle shape and size on the pressure transmitted to the perineum, as prolonged perineal pressure and microtrauma amongst avid cyclists may increase the risk for ...complications following lower genitourinary surgery.
We tested five seats (Bontrager, Waterloo, WI) with varying levels of padding and morphology (comfort, fitness, fitness gel, race, and performance) for two different riders. The seats were installed on a Peloton stationary exercise bike (New York City, NY). Force measurements were performed using a 9833E-50 Large F-Socket Sensor (Tekscan, South Boston, MA). We measured total and perineal forces in three conditions at the same resistance: (a) at rest (not pedaling); (b) at 8mph; (c) at 15mph.
Significant differences across the bicycle seats were observed with fitness gel seats providing the lowest perineal pressure. In all measurements, perineal forces were significantly lower at 15mph compared to 8mph (P < .001). When a rider used an oversized seat, less force was exerted compared to the appropriate size at both 8mph (P < .001) and 15mph (P < .001) speeds. Conversely, an undersized seat significantly increased perineal pressures at both 8mph (P = .018) and 15mph (P = .007).
Larger seats constructed of more impressionable materials absorb a greater total force and act to distribute the subject’s weight thereby delivering less force to the perineum. More perineal pressure is delivered at lower speeds and at rest likely due to the cyclist lifting off the seat during times of strenuous activity.
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Available for:
GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
5.
Editorial Comment Amend, Gregory M.; Breyer, Benjamin N.
The Journal of urology,
10/2021, Volume:
206, Issue:
4
Journal Article
Abstract
Peyronie’s disease (PD) is a fibrotic disorder of the tunica albuginea that may result in penile deformity, pain, a palpable plaque, and erectile dysfunction. In order to understand the ...psycho-sexual impacts of PD on patients and their partners, we selected three online forums containing the largest number of threads on PD. Threads focusing on the psycho-sexual impacts posted from January 1, 2011 to January 1, 2021 were compiled, and thematic analysis was performed on Dedoose. There were 277 unique posters, including 225 patients and 52 partners. Eighty-four categories and five themes were developed including information and social support, physical symptoms, psycho-sexual symptoms, treatment and effect, and impacts on partners and relationship. Emotional distress including depressed mood (
n
= 75, 33.3%) and feelings of isolation (
n
= 41, 18.2%) was prevalent. Partners developed sexual dysfunction including sexual dissatisfaction (
n
= 11, 21.2%) and dyspareunia (
n
= 4, 7.7%). Relationships experienced disruption (
n
= 14, 5.1%) or termination (
n
= 10, 3.6%). Posters received psychological treatment including psychotherapy (
n
= 20, 8.9%) and antidepressants (
n
= 17, 7.6%). Of these, 12 reported improvement and 11 stated no improvement. On these forums, psychological burden affecting individuals with PD and their partners is reported. Few seek help from a psychologist or therapist, and psychological distress may persist even after successful PD treatment. Further research is needed to identify strategies for effective psychological management.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
To assess provider and practice characteristics that drive opioid prescription behavior using the American Urological Association census data.
Stratified weighted analysis using 1,157 census samples ...was performed to represent 12,660 urologists who practiced in the United States in 2018. We compared urologists according to their opioid prescription patterns to evaluate factors and motivations behind opioid use in the post-operative setting.
Overall, 11,205 (88.5%) urologists prescribe opioids in the post-operative setting. The presence of procedure-specific institutional prescribing guidelines was associated with a greater tendency to prescribe ≤10 pills, and lesser tendency to prescribe 11 to 49 and ≥50 tablets following open abdominal (P = .003), laparoscopic (P < .001), scrotal (P < .001), and endoscopic surgeries (P < .001). The presence of institutional prescribing guidelines was associated with decreasing opioid prescriptions over a three-year period whereas not having guidelines was associated with an unchanged prescription practice over time. Basing current prescriptions on what was given to prior patients was reported by 85% and was more likely to result in an unchanged amount of prescriptions over time (29.2% vs 13.3%, P = .007). Motivations to avoid patient phone calls were reported by 23.8% and were more likely to increase the opioids provided within the next 3 years (3.2% vs 0.1%, P < .001).
Practitioners who endorsed using institutional guidelines prescribed fewer opioids following all types of surgery and were more likely to decrease their prescription behavior over time. This data supports continued efforts to provide urologists with more evidence-based guidance on best practice opioid prescribing in the future.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
The application of evolutionary and ecological principles to cancer prevention and treatment, as well as recognizing cancer as a selection force in nature, has gained impetus over the last 50 years. ...Following the initial theoretical approaches that combined knowledge from interdisciplinary fields, it became clear that using the eco‐evolutionary framework is of key importance to understand cancer. We are now at a pivotal point where accumulating evidence starts to steer the future directions of the discipline and allows us to underpin the key challenges that remain to be addressed. Here, we aim to assess current advancements in the field and to suggest future directions for research. First, we summarize cancer research areas that, so far, have assimilated ecological and evolutionary principles into their approaches and illustrate their key importance. Then, we assembled 33 experts and identified 84 key questions, organized around nine major themes, to pave the foundations for research to come. We highlight the urgent need for broadening the portfolio of research directions to stimulate novel approaches at the interface of oncology and ecological and evolutionary sciences. We conclude that progressive and efficient cross‐disciplinary collaborations that draw on the expertise of the fields of ecology, evolution and cancer are essential in order to efficiently address current and future questions about cancer.
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FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
Pelvic fracture urethral injury (PFUI) occurs in up to 10% of pelvic fractures. There is mixed evidence supporting early endoscopic urethral realignment (EUR) over suprapubic tube (SPT) placement and ...delayed urethroplasty. Some studies show decreased urethral obstruction with EUR, while others show few differences. We hypothesized that EUR would reduce the rate of urethral obstruction after PFUI.
Twenty-six US medical centers contributed patients following either an EUR or SPT protocol from 2015 to 2020. If retrograde cystoscopic catheter placement failed, patients were included and underwent either EUR or SPT placement based on their institution's assigned treatment arm. Endoscopic urethral realignment involved simultaneous antegrade/retrograde cystoscopy to place a catheter across the urethral injury. The primary endpoint was development of urethral obstruction. Fisher's exact test was used to analyze the relationship between PFUI management and development of urethral obstruction.
There were 106 patients with PFUI; 69 (65%) had complete urethral disruption and failure of catheter placement with retrograde cystoscopy. Of the 69 patients, there were 37 (54%) and 32 (46%) in the EUR and SPT arms, respectively. Mean age was 37.0 years (SD, 16.3 years) years, and mean follow-up was 463 days (SD, 280 days) from injury. In the EUR arm, 36 patients (97%) developed urethral obstruction compared with 30 patients (94%) in the SPT arm ( p = 0.471). Urethroplasty was performed in 31 (87%) and 29 patients (91%) in the EUR and SPT arms, respectively ( p = 0.784).
In this prospective multi-institutional study of PFUI, EUR was not associated with a lower rate of urethral obstruction or need for urethroplasty when compared with SPT placement. Given the potential risk of EUR worsening injuries, clinicians should consider SPT placement as initial treatment for PFUI when simple retrograde cystoscopy is not successful in placement of a urethral catheter.
Therapeutic/Care Management; Level III.
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