Globally, the number of informal settlement dwellings are increasing rapidly; these areas are often associated with numerous large fires. Unfortunately, until recently, very little research has been ...focused on informal settlement fire issues leaving any attempts to improve their fire safety lacking the evidence base to support effective-decision making. However, over the past 4 years, a limited number of researchers have looked at better understanding these fires through full-scale experimentation and numerical modelling; starting to provide the necessary evidence base and future research directions. It is with this background in mind that this paper seeks to provide a more fundamental understanding of the effect of dwelling separation distance on informal settlement fire spread based on full-scale experiments and analytical equations. In this paper two full-scale experiments were conducted. Both experiments consisted of multiple dwellings, with the main difference between the experiments being the separation distance. Fire spread times, heat release rates, door and window flow velocities, ceiling temperatures and incident heat fluxes were recorded and are reported for both experiments. Theoretical neutral planes are derived and compared to the experimental neutral planes, which show relatively good correlation. The paper continues by calculating the expected incident radiation and time-to-ignition, using the flux-time product method, of the two fire scenarios (i.e., the two experiments) through means of analytical equations, and these findings are compared to the experimental results. Through configuration factors, the paper shows the effect of separation distance, dwelling height and dwelling length on the times-to-ignition, where it is clear that the heat flux received by an adjacent dwelling decrease approximately exponentially as the distance between dwellings increases, and consequently, the time-to-ignition increases exponentially as the separation distance between dwellings increases.
Objective To investigate the role periurethral fibrosis secondary to chronic prostatic inflammation as a potential contributing factor to the etiology of lower urinary tract symptoms (LUTS) in male ...patients. Methods Periurethral prostate tissue from 30 consecutive patients who underwent retropubic radical prostatectomy for prostate cancer was analyzed. We circumferentially performed 16 periurethral core bench biopsies on each radical prostatectomy specimen to evaluate the extent of periurethral inflammatory infiltrate and collagen and elastin amount. The clinical and urodynamic findings and the collagen and elastin periurethral amount in patients with or without inflammation were compared using the Mann-Whitney U test and the Pearson χ2 test. Spearman correlation analysis tested the association between variables. Results Of the 30 patients, 21 (70%) presented with inflammatory infiltration and 9 (30%) had no inflammation. A significant difference was found between the 2 groups in International Prostate Symptom Score (IPSS; P = .03) and in urodymanics findings by Schafer class ( P = .01) and Abrams Griffiths number ( P = .002). The histologic evaluation showed a higher collagen quantity ( P = .04) and lower, albeit not statistically significant, elastin amount ( P = .19) in the inflammation group. A positive association was observed between IPSS with inflammation grading ( r = 0.507; P = .004) and collagen content ( r = 0.649; P <.001), whereas IPSS was correlated negatively with elastin content ( r = −0.565; P = .001). Conclusion Prostate inflammation may induce fibrotic changes in periurethral prostatic tissues, and this may eventually promote urethral stiffness and LUTS. Patients experiencing prostate-related LUTS could benefit from anti-inflammatory therapies, used alone or combined with the currently prescribed regimen.
The one billion people that currently reside in informal settlements are exposed to a high and daily risk of large conflagrations. With the number of informal settlement dwellers expected to increase ...in the years to come, more systematic work is needed to better understand these fires. Over the past 3 years to 4 years, researchers have explicitly started investigating informal settlement fire dynamics, by conducting full-scale experiments and numerical modelling research. It is with this background that this paper seeks to investigate the effects of leakages and ventilation conditions on informal settlement fire dynamics. Three full-scale informal settlement dwelling experiments were conducted in this work. The experiments were kept identical with only a small change to a ventilation or leakage condition from experiment to experiment. During each experiment the heat release rates, heat fluxes, temperature and flow data were recorded and are given in this paper. B-RISK’s (a two-zone model software) predictive capabilities are then benchmarked against the full-scale experiments. B-RISK is then used to conduct a parametric study to further investigate the effects of leakages and ventilation on informal settlement dwelling fire dynamics. It was found that the ventilation conditions can significantly affect the radiation emitted from an informal settlement dwelling, and as a result increase or decrease the probability of fire spread to neighboring dwellings.
Aims
The aim of our study was to investigate noninvasive predictors for detrusor underactivity (DUA) in male patients with lower urinary tract symptoms (LUTS) and benign prostatic enlargement (BPE).
...Methods
A consecutive series of patients aged 45 years or older with non‐neurogenic LUTS were prospectively enrolled. Patients underwent standard diagnostic assessment including International Prostatic Symptoms Score, uroflowmetry, urodynamic studies (cystometry and pressure‐flow studies), transrectal ultrasound of the prostate, and ultrasound measurements of the bladder wall thickness (BWT). Logistic regression analysis was used to investigate predictors of DUA, defined as a bladder contractility index < 100 mm H2O. A nomogram was developed based on the multivariable logistic regression model.
Results
Overall 448 patients with a mean age of 66 ± 11 years were enrolled. In a multivariable logistic age‐adjusted regression model BWT (odds ratio OR: 0.50 per mm; 95% confidence interval CI, 0.30‐0‐66; P = .001) and Qmax (OR: 0.75 per mL/s; 95% CI, 0.70‐0.81; P = .001) were significant predictors for DUA. The nomogram based on the model presented good discrimination (area under the curve AUC: 0.82), good calibration (Hosmer‐Lemeshow test, P > .05) and a net benefit in the range of probabilities between 10% and 80%.
Conclusions
According to our results, BWT and Qmax can noninvasively predict the presence of DUA in patients with LUTS and BPE. Although our study should be confirmed in a larger prospective cohort, we present the first available nomogram for the prediction of DUA in patients with LUTS.
Cancer stem cells (CSCs) are a small and elusive subpopulation of self-renewing cancer cells with the remarkable ability to initiate, propagate, and spread malignant disease. In the past years, ...several authors have focused on the possible role of CSCs in PCa development and progression. PCa CSCs typically originate from a luminal prostate cell. Three main pathways are involved in the CSC development, including the Wnt, Sonic Hedgehog, and Notch signaling pathways. Studies have observed an important role for epithelial mesenchymal transition in this process as well as for some specific miRNA. These studies led to the development of studies targeting these specific pathways to improve the management of PCa development and progression. CSCs in prostate cancer represent an actual and promising field of research.
Objective To compare the last generation of 3-dimensional imaging (3D) vs standard 2-dimensional imaging (2D) laparoscopy. Materials and Methods A prospective observational study was conducted during ...the 4th Minimally Invasive Urological Surgical Week Course held in Braga (Portugal) in April 2013. The course participants and faculty were asked to perform standardized tasks in the dry laboratory setting and randomly assigned into 2 study groups; one starting with 3D, the other with 2D laparoscopy. The 5 tasks of the European Training in Basic Laparoscopic Urological Skills were performed. Time to complete each task and errors made were recorded and analyzed. An end-of-study questionnaire was filled by the participants. Results Ten laparoscopic experts and 23 laparoscopy-naïve residents were included. Overall, a significantly better performance was obtained using 3D in terms of time (1115 seconds, interquartile range IQR 596-1469 vs 1299 seconds, IQR 620-1723; P = .027) and number of errors (2, IQR 1-3 vs 3, IQR 2-5.5; P = .001). However, the experts were faster only in the “peg transfer” task when using the 3D, whereas naïves improved their performance in 3 of the 5 tasks. A linear correlation between level of experience and performance was found. Three-dimensional imaging was perceived as “easier” by a third of the laparoscopy-naïve participants ( P = .027). Conclusion Three-dimensional imaging seems to facilitate surgical performance of urologic surgeons without laparoscopic background in the dry laboratory setting. The advantage provided by 3D for those with previous laparoscopic experience remains to be demonstrated. Further studies are needed to determine the actual advantage of 3D over standard 2D laparoscopy in the clinical setting.
The purpose of this study was to assess patient frailty as a risk factor for radical cystectomy (RC) complications.
We performed an analysis of prospectively collected data of consecutive patients 80 ...years of age or older who underwent RC and ureterocutaneostomy in 6 primary care European urology centers. Frailty was measured using a simplified frailty index (sFI) with a 5-item score including: (1) diabetes mellitus; (2) functional status; (3) chronic obstructive pulmonary disease; (4) congestive cardiac failure; and (5) hypertension, with a maximum 5-item score meaning high level of frailty. Within 90 days surgical complications were scored according to the Clavien Classification System (CCS). sFI ≥3 was considered as poor frailty status. Clinical and pathological variables were analyzed as predictors of severe complications (CCS ≥3).
One hundred seventeen patients were enrolled. Most patients reported an sFI score of 2 and 3, respectively, 31/117 (26.5%) and 45/117 patients (38.5%). CCS ≥3 occurred in 17/117 patients (14.5%). Patients with sFI ≥3 were significantly older than patients with sFI <3 (median age, 85 years interquartile range (IQR), 82-86 versus 82 years IQR, 80-84; P = .001). Most CCS ≥3 scores occurred in patients with sFI ≥3: 13 (11.1%) versus 4 (3.4%; P = .02). No significative differences were detected in terms of length of hospital stay, pathological stage, and postoperative bowel canalization when related to sFI. sFI ≥3 was an independent risk factor of CCS ≥3 in univariate and multivariate analysis (respectively, odds ratio OR, 3.81 95% confidence interval (CI), 1.16-12.5; P = .02 and OR, 3.1 95% CI, 0.7-13.7; P = .01). Body mass index, age, American Society of Anesthesiologists score ≥3, and pathological stage were not related to CCS ≥3.
RC appears feasible in elderly patients with an sFI <3. In cases of sFI ≥3, this choice should be carefully valued, discussed, and possibly avoided because of a higher risk of complications.
We used the Frailty index as a risk factor for radical cystectomy (RC) complications. We performed an analysis of data of consecutive patients 80 years of age or older who had undergone RC and ureterocutaneostomy (UCS) in 6 European centers. No differences were detected in terms of length of hospital stay, pathological stage, or postoperative bowel canalization as related to the Frailty index. RC and UCS seem to be a feasible option in frail elderly patients.
The aim of our study was to compare the performance of residents vs. consultants in transrectal fusion prostate biopsies (FUS-PBs), as well as patient-reported comfort. Between January 2021 and ...October 2022, a consecutive series of patients undergoing FUS-PBs were randomized into two groups: (A) FUS-PBs performed by a consultant; (B) FUS-PBs performed by trained residents (>50 procedures). All patients underwent FUS-PBs with 12 systematic cores and 3/6 target cores. The detection rate and number of positive cores in the target lesion were compared between groups, and the patient's discomfort after the procedure was evaluated using the VAS scale. Overall, 140 patients with a median age of 72 years were enrolled. Overall, 69/140 (49.3%) presented prostate cancer and 53/69 (76.8%) presented a clinically significant cancer (Grade Group ≥ 2). Consultants presented a detection rate of 37/70 (52.9%) and residents a detection rate of 32/70 (45.7%) (
> 0.2); the mean number of positive cores in the index lesion was similar in both groups (1.5 vs. 1.1;
> 0.10). In terms of the patients' experiences, the procedure was well tolerated, with a median VAS score of 2 in both groups, with no statistically significant differences. Residents showed satisfactory outcomes in terms of detection rate, procedural time, and patient comfort when performing prostate biopsies. Residents, after adequate training, can safely perform prostate biopsies.
Informal settlements (ISs) are a high-risk environment in which fires are often seen. In 2019 alone, 5544 IS fires were reported in South Africa. One of the main problems, when investigating an IS ...fire, is determining the fire cause. In the last 15 years, approximately 40% of the fire causes were classified as ‘undetermined’ in South Africa. Furthermore, the cases where the fire causes have been determined, do not provide the necessary information to comprehend why the fire started. This paper seeks to gain better insight with respect to fire causes by analysing the fire risk perception of IS inhabitants. To this end, a survey that was conducted in 2017, consisting of data from 2178 IS households, that were affected by a large-scale fire, was analysed. The survey consisted of questions relating to the fire risk perception with regards to the settlement in general, to the inhabitants’ own household, and about measures that could reduce fire risk. The analysis suggests that (a) the survey’s risk target had a strong influence on risk perception, (b) the inhabitants’ fire risk perception of their settlement is similar to that of firefighters in previous research, (c) the risk mitigation demands are more focused on decreasing the consequences of the fire than on the occurrence of a fire event, (d) the national fire statistics are not capturing the causes of real fire incidents, and (e) improvements to the documentation process after a fire event could provide critical information for the implementation of prevention measures.
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