Our aim was to determine if the AUA-recommended prophylaxis (vancomycin + gentamicin alone) for primary inflatable penile prosthesis surgery is associated with a higher infection risk than ...nonstandard regimens.
We performed a multicenter, retrospective study of patients undergoing primary inflatable penile prosthesis surgery. Patients were divided into those receiving vancomycin + gentamicin alone and those receiving any other regimen. A Cox proportional-hazards model was constructed adjusted for major predictors. A subgroup analysis to identify the appropriate dosage of gentamicin was also performed.
A total of 4,161 patients underwent primary inflatable penile prosthesis placement (2,411 received vancomycin + gentamicin alone and 1,750 received other regimens). The infection rate was similar between groups, 1% vs 1.2% for standard vs nonstandard prophylaxis. In the multivariable analysis, vancomycin + gentamicin (HR: 2.7, 95% CI: 1.4 to 5.4,
= .004) and diabetes (HR: 1.9, 95% CI: 1.03 to 3.4,
= .04) were significantly associated with a higher risk of infection. Antifungals (HR: 0.08, 95% CI: 0.03 to 0.19,
< .001) were associated with lower risk of infection. There was no statistically significant difference in infection rate between weight-based gentamicin compared to 80 mg gentamicin (HR: 2.9, 95% CI: 0.83 to 10,
= .1).
Vancomycin + gentamicin alone for antibiotic prophylaxis for primary inflatable penile prosthesis surgery is associated with a higher infection risk than nonstandard antibiotic regimens while antifungal use is associated with lower infection risk. A critical review of the recommended antimicrobial prophylactic regimens is needed. Prospective research is needed to further elucidate best practices in inflatable penile prosthesis antimicrobial prophylaxis.
We present simultaneous dual-frequency radio observations of Cygnus X-3 during a phase of low-level activity. We constrain the minimum variability time-scale to be 20 min at 43 GHz and 30 min at 15 ...GHz, implying source sizes of 2–4 au. We detect polarized emission at a level of a few per cent at 43 GHz which varies with the total intensity. The delay of ∼10 min between the peaks of the flares at the two frequencies is seen to decrease with time, and we find that synchrotron self-absorption and free–free absorption by entrained thermal material play a larger role in determining the opacity than absorption in the stellar wind of the companion. A shock-in-jet model gives a good fit to the light curves at all frequencies, demonstrating that this mechanism, which has previously been used to explain the brighter, longer lived giant outbursts in this source, is also applicable to these low-level flaring events. Assembling the data from outbursts spanning over two orders of magnitude in flux density shows evidence for a strong correlation between the peak brightness of an event, and the time-scale and frequency at which this is attained. Brighter flares evolve on longer time-scales and peak at lower frequencies. Analysis of the fitted model parameters suggests that brighter outbursts are due to shocks forming further downstream in the jet, with an increased electron normalization and magnetic field strength both playing a role in setting the strength of the outburst.
ABSTRACT
Using a 16.2-h radio observation by the Australia Telescope Compact Array and archival Chandra data, we found >5σ radio counterparts to four known and three new X-ray sources within the ...half-light radius (rh) of the Galactic globular cluster NGC 6397. The previously suggested millisecond pulsar (MSP) candidate, U18, is a steep-spectrum (Sν ∝ να; $\alpha =-2.0^{+0.4}_{-0.5}$) radio source with a 5.5-GHz flux density of 54.7 ± 4.3 $\mu \mathrm{ Jy}$. We argue that U18 is most likely a ‘hidden’ MSP that is continuously hidden by plasma shocked at the collision between the winds from the pulsar and companion star. The non-detection of radio pulsations so far is probably the result of enhanced scattering in this shocked wind. On the other hand, we observed the 5.5-GHz flux of the known MSP PSR J1740−5340 (U12) to decrease by a factor of >2.8 during epochs of 1.4-GHz eclipse, indicating that the radio flux is absorbed in its shocked wind. If U18 is indeed a pulsar whose pulsations are scattered, we note the contrast with U12’s flux decreases in eclipse, which argues for two different eclipse mechanisms at the same radio frequency. In addition to U12 and U18, we also found radio associations for five other Chandra X-ray sources, four of which are likely background galaxies. The last, U97, which shows strong H α variability, is mysterious; it may be either a quiescent black hole low-mass X-ray binary or something more unusual.
To evaluate predictors of implant length for men undergoing primary IPP placement.
A multicenter, retrospective cohort study was performed for men undergoing primary IPP placement at 16 high-volume ...surgical centers. Patient demographics, comorbidities, operative approach, and implanted cylinder and rear tip extender length were recorded. Associations between potential preoperative and intraoperative predictors of total device length were tested using non-parametric correlation and Kruskal-Wallis tests, followed by multiple regression.
Of 3,951 men undergoing primary IPP placement from July 2016 – July 2021, the median implant length was 20 cm (IQR: 19 – 22). Shorter implant length was associated with increasing age in years (β = -0.01, p=0.009), Asian ethnicity (β = -2.34, p=0.008), history of radical prostatectomy (β = -0.35, p=0.001), and use of an infrapubic surgical approach (β = -1.02, p<0.001). Black or African American ethnicity was associated with the implantation of longer devices (β = 0.35, p<0.001). No significant associations were recorded with BMI, history of intracavernosal injections, diabetes mellitus, tobacco use, radiation therapy, Peyronie’s disease, priapism, or cavernosal dilation technique.
The length of an implanted penile prosthesis was found to be associated with preoperative and intraoperative factors including history of radical prostatectomy and operative approach. The knowledge of these associations may assist in the preoperative counseling of patients receiving IPP and help create accurate postoperative expectations.
To assess the difference in outcomes between single dilation (SingD) and sequential dilation (SeqD) in primary penile implantation, hypothesizing that patients who undergo SeqD had higher rates of ...noninfectious complications.
We performed a multicenter, retrospective study of men undergoing primary inflatable penile prosthesis placement. Intraoperative complications and postoperative noninfectious outcomes were assessed between the two groups. Multivariable analysis was performed to identify predictors of complications.
A total of 3293 patients met inclusion criteria. After matching, there were 379 patients who underwent SingD and 379 patients who underwent SeqD. There was no significant difference in intraoperative complications between patients who underwent SingD vs SeqD, nor was there any difference in cylinder length (20 cm with interquartile range IQR 18-21 cm vs 20 cm with IQR 18-20 cm respectively, P = .4). On multivariable analysis, SeqD (OR 5.23 with IQR 2.74-10, P < .001) and older age (OR 1.04 with IQR 1.01-1.06, P = .007) were predictive of postoperative noninfectious complications. There was no significant difference in intraoperative complications between patients who underwent SingD vs SeqD, nor was there any difference in cylinder length. SeqD and older age were predictive of postoperative noninfectious complications.
During inflatable penile prosthesis placement in the uncomplicated patient without fibrosis, SingD is a safe technique to utilize during implantation that will minimize postoperative adverse events, and promote device longevity without loss of cylinder length.
Abstract
We report the discovery of 1RXH J082623.6−505741, a 10.4 hr orbital period compact binary. Modeling extensive optical photometry and spectroscopy reveals a ∼0.4
M
⊙
K-type secondary ...transferring mass through a low-state accretion disk to a nonmagnetic ∼0.8
M
⊙
white dwarf. The secondary is overluminous for its mass and dominates the optical spectra at all epochs and must be evolved to fill its Roche Lobe at this orbital period. The X-ray luminosity
L
X
∼ 1–2 × 10
32
erg s
−1
derived from both new XMM-Newton and archival observations, although high compared to most CVs, still only requires a modest accretion rate onto the white dwarf of
M
̇
∼ 3 × 10
−11
to 3 × 10
−10
M
⊙
yr
−1
, lower than expected for a cataclysmic variable with an evolved secondary. No dwarf nova outbursts have yet been observed from the system, consistent with the low derived mass-transfer rate. Several other cataclysmic variables with similar orbital periods also show unexpectedly low mass-transfer rates, even though selection effects disfavor the discovery of binaries with these properties. This suggests the abundance and evolutionary state of long-period, low mass-transfer rate cataclysmic variables are worthy of additional attention.
Abstract Black hole (BH) X-ray binaries (XRBs) are ideal targets to study the connection between accretion inflow and jet outflow. Here we present quasi-simultaneous, multiwavelength observations of ...the Galactic BH system MAXI J1820+070, throughout its 2018–2019 outburst. Our data set includes coverage from the radio through X-ray bands from 17 different instruments/telescopes, and encompasses 19 epochs over a 7 month period, resulting in one of the most well-sampled multiwavelength data sets of a BH XRB outburst to date. With our data, we compile and model the broadband spectra of this source using a phenomenological model that includes emission from the jet, a companion star, and an accretion flow. This modeling allows us to track the evolution of the spectral break in the jet spectrum, a key observable that samples the jet launching region. We find that the spectral break location changes over at least ≈3 orders of magnitude in electromagnetic frequency over this period. Using these spectral break measurements, we link the full cycle of jet behavior, including the rising, quenching, and reignition, to the changing accretion flow properties as the source evolves through its different accretion states. Our analysis shows consistent jet behavior with other sources in similar phases of their outbursts, reinforcing the idea that jet quenching and recovery may be a global feature of BH XRB systems in outburst. Our results also provide valuable evidence supporting a close connection between the geometry of the inner accretion flow and the base of the jet.
Abstract Objective To address challenges in large-scale electronic health record (EHR) data exchange, we sought to develop, deploy, and test an open source, cloud-hosted app “listener” that accesses ...standardized data across the SMART/HL7 Bulk FHIR Access application programming interface (API). Methods We advance a model for scalable, federated, data sharing and learning. Cumulus software is designed to address key technology and policy desiderata including local utility, control, and administrative simplicity as well as privacy preservation during robust data sharing, and artificial intelligence (AI) for processing unstructured text. Results Cumulus relies on containerized, cloud-hosted software, installed within a healthcare organization’s security envelope. Cumulus accesses EHR data via the Bulk FHIR interface and streamlines automated processing and sharing. The modular design enables use of the latest AI and natural language processing tools and supports provider autonomy and administrative simplicity. In an initial test, Cumulus was deployed across 5 healthcare systems each partnered with public health. Cumulus output is patient counts which were aggregated into a table stratifying variables of interest to enable population health studies. All code is available open source. A policy stipulating that only aggregate data leave the institution greatly facilitated data sharing agreements. Discussion and Conclusion Cumulus addresses barriers to data sharing based on (1) federally required support for standard APIs, (2) increasing use of cloud computing, and (3) advances in AI. There is potential for scalability to support learning across myriad network configurations and use cases.
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