"Prevailing perspectives on ancient Jewish life have been shaped largely by the voices of intellectual and social elites, preserved in the writings of Philo and Josephus and the rabbinic texts of the ...Mishnah and Talmud. Commissioned art, architecture, and formal inscriptions displayed on tombs and synagogues equally reflect the sensibilities of their influential patrons. The perspectives and sentiments of nonelite Jews, by contrast, have mostly disappeared from the historical record. Focusing on these forgotten Jews of antiquity, 'Writing on the Wall' takes an unprecedented look at the vernacular inscriptions and drawings they left behind and sheds new light on the richness of their quotidian lives. Just like their neighbors throughout the eastern and southern Mediterranean, Mesopotamia, Arabia, and Egypt, ancient Jews scribbled and drew graffiti everyplace--in and around markets, hippodromes, theaters, pagan temples, open cliffs, sanctuaries, and even inside burial caves and synagogues. Karen Stern reveals what these markings tell us about the men and women who made them, people whose lives, beliefs, and behaviors eluded commemoration in grand literary and architectural works. Making compelling analogies with modern graffiti practices, she documents the overlooked connections between Jews and their neighbors, showing how popular Jewish practices of prayer, mortuary commemoration, commerce, and civic engagement regularly crossed ethnic and religious boundaries."
The Moses technology of the holmium laser has been shown to decrease retropulsion in the ureter and procedural time in kidney stones during laser lithotripsy. Theoretically, these improvements could ...lead to cost savings for the patient.
All patients with total laser energy data recorded who underwent ureteroscopy with laser lithotripsy by a single surgeon at a tertiary care center were included. Total lasing time was calculated from the total laser energy. Sub-analyses were done on stone size and stone composition. The procedure time using Moses technology was projected to be approximately 35% less than procedure time without the Moses technology based on prior in vitro studies. The projected cost savings was then utilized to predict cost-effectiveness of the Moses technology.
Forty patients underwent ureteroscopy with laser lithotripsy. Mean stones size was 10.2 mm and mean lasing time was 3.02 minutes. Linear regression showed a positive association between stone size and laser time, p = 0.01. There was no significant correlation between stone composition or stone Hounsfield units and lasing time. On cost analyses, for stones of all sizes the Moses system has a price differential of an increase in $292.36 when compared to the standard Holmium TracTip system. Specifically for stones larger than 10 mm, the price differential is an increase in $253.16 for the Moses technology.
The decrease in lasing time achieved by the Moses system does not translate into sufficient cost savings to off-set the higher cost of the laser fiber and software.
Post-ureteroscopy stent placement carries significant morbidity which can interfere with daily life. This discomfort unfortunately leads to high utilization of opioid pain medications, which have a ...known risk of addiction. Cannabidiol oil represents an alternative analgesic that has proven anti-inflammatory and antinociceptive effects. The purpose was to evaluate the effect of a Food and Drug Administration-approved cannabidiol oil (Epidiolex) on pain control and opioid usage in the post-ureteroscopy setting.
This was a prospective, randomized, double-blind, placebo-controlled trial at a tertiary care center. Ninety patients undergoing ureteroscopy with stent placement for urinary stone disease were randomized 1:1 to placebo or 20 mg cannabidiol oil daily for 3 days postoperatively. Both groups were prescribed a rescue narcotic, tamsulosin, oxybutynin, and phenazopyridine. Daily pain scores, medication usage, and ureteral stent symptoms using the validated Ureteral Stent Symptom Questionnaire were recorded postoperatively.
Both the placebo and cannabidiol oil groups were not different in pre- and perioperative characteristics. There was no difference in pain scores or opioid usage between groups postoperatively. The level of discomfort with ureteral stents was also not different between groups when comparing physical activity, sleep, urination, and activities of daily life.
This randomized, blinded, placebo-controlled trial showed that cannabidiol oil is safe but ineffective when compared to placebo in reducing post-ureteroscopic stent discomfort or opioid usage. Despite the availability of numerous analgesic agents, stent symptoms continue to be a dissatisfier for most patients, suggesting additional work needs to focus on novel interventions and pain control.
To assess the intermediate- and long-term effect of high-grade ureteral injuries from ureteral access sheaths.
Patients undergoing ureteroscopy for upper tract calculi were prospectively enrolled at ...2 sites from 2010 to 2015. A 12/14 French sheath was used and the ureter was inspected with a flexible ureteroscope during withdrawal of the sheath and recorded. The videos were then evaluated by 2 blinded endourologists, and any injuries were graded per the Traxer ureteral injury scale. Only high-grade injuries were included. The primary endpoint was defined as ongoing hydronephrosis without an obstructing stone on follow-up imaging indicating a ureteral stricture. Logistic regression analysis was used to assess the relationship between hydronephrosis, ureteral injury, and other patient variables.
Fifty-six patients were identified with high-grade ureteral injuries. Sixteen patients (28.6%) were female. Median age was 56.4 years (range 14-85). Median follow-up was 35.8 months (range 0-88). Three patients (5.5%) had hydronephrosis on follow-up imaging, only 1 of whom developed a de novo ureteral stricture. On univariate analysis, hydronephrosis was associated with a shorter stent duration (P = .11) and older age (P = .17).
Endoscopically identified high-grade ureteral lesions following ureteral access sheath placement do not lead to clinically significant sequelae on intermediate term follow-up, with a stricture rate comparable to those without visible injuries of 1.8%.
Objectives
To compare the enucleation efficiency of Moses 2.0 with non‐Moses technology in patients undergoing holmium laser enucleation of the prostate (HoLEP).
Patients and Methods
A ...double‐blinded, randomised study of patients undergoing HoLEP at the Mayo Clinic in Arizona, using the Lumenis Pulse™ 120H laser system. Patients were randomised to either right lobe enucleation using Moses 2.0 and left lobe enucleation using non‐Moses, or the opposite. The primary outcome was individual lobe enucleation efficiency. Secondary outcomes included individual lobe laser time, laser energy, individual enucleation and haemostasis laser energies, and fibre burn back. Two independent reviewers watched videos of the procedures and provided a subjective evaluation of the technologies.
Results
A total of 27 patients were included in the study. For the entire cohort, Moses 2.0 had less fibre degradation (3.5 vs 16.8 mm, P < 0.01) compared to non‐Moses. When HoLEP procedures were performed by an expert, Moses 2.0 resulted in shorter enucleation time (21 vs 36.7 min, P = 0.016) and higher enucleation efficiency (1.75 vs 1.05 g/min, P = 0.05) compared to non‐Moses. When HoLEP was performed by trainees, the Moses 2.0 cohort had a shorter haemostasis laser time (4.1 vs 9 min, P = 0.035) compared to the non‐Moses. Fibre degradation was lower with Moses 2.0 compared to non‐Moses for both experts and trainees. Moses 2.0 received a higher score than the standard technology for the incision sharpness, fibre control, tissue separation, tissue damage, haemostasis, visibility, and charring. The overall inter‐observer correlation coefficient was 0.63.
Conclusion
Moses 2.0 has higher enucleation efficiency compared to non‐Moses when used by experts. The subjective evaluation favoured Moses 2.0.
To characterize gender-related differences between the values and salary expectations of US urology residents.
We analyzed 2016-2018 American Urological Association Census data regarding residents’ ...demographics, motivations, and concerns. To explore gendered differences, we queried Census items related to demographics, values, and preparedness for the business of practice. Descriptive statistics and test of hypotheses were used for analysis.
A total of 705 residents responded of whom 196 (28%) were female. More than half of residents (54%) reported educational debt >$150,000. Factors influencing choice of practice setting included lifestyle (87%), compensation (82%), and location (78%) and was not significantly different between males and females. There were also no differences regarding planned practice setting. However, women had significantly lower first year salary expectations; 53% expected to make <$300,000, compared with only 32% of men (P <.001). Finally, significantly more women reported feeling unprepared to handle the business of urology practice, including salary negotiation, (74% vs 53%, P <.001).
Among a nationally representative sample of urology residents, women had significantly lower salary expectations and expressed significantly more discomfort with the business aspects of medicine, including contract negotiation, than their male counterparts. These observational findings may contribute to and potentially perpetuate the urology wage gap.
Objective
We compared the effect of standard office-based consultation (OC) and phone correspondences (PC) on dietary 24-h urinary parameters.
Methods
The medical record of all patients treated ...between January and April 2019 was reviewed. Only patients who had at least two consecutive 24-h urine collections were included. Linear and logistic regressions were used to investigate the difference between the changes in urinary parameters after OC and PC.
Results
Forty-three patients underwent 135 OC and 34 PC. Twenty-one received OC and PC, and 22 had only OC. Gender, age, the distance to stone clinic, the number of previous stone episodes, and baseline urinary parameters were similar between the groups. Patients who had both OC and PC had a longer follow-up time (51.7 vs 18.5 months,
p
< 0.0001) as well as more consults (Median 5.4 vs 2.5,
p
< 0.0001). Six (27%) patients who had only OC, and eight (38%) patients who had both OC and PC, experienced stone recurrence during the study period (
p
= 0.52). Following PC, there was a greater improvement in urine volume in comparison to OC (0.27 l/day vs -0.06 l/day,
p
= 0.034), but there was no difference in the absolute values after the consults between the groups.
Conclusion
In established stone-clinic patients, PC was associated with a better adherence with follow-up. The 24-h urine results were similar between PC and OC. PC may be an effective alternative for urinary stone management.
...Lander uses the archaeological record to read against the grain of the literary one, thereby flouting scholarly conventions that prioritize textual evidence. ...she identifies the rhetorical ...spatial strategies that Nicene Christians ("Catholics") deployed to distance themselves from other sects, whom they variously cast as "Donatists," "Novatianists," and "Jews." ...given the popularity of graffiti in marketplaces and theaters in the Roman East, which constitute forms of religious competition, one wonders whether comparable attention to data from African civic spaces might enhance this regional study (Angelos Chaniotis, "Memory, Commemoration and Identity in an Ancient City: The Case of Aphrodisias," Daedalus 145.2 2016: 88–100). Published excavation reports from the Naro synagogue (Hammam Lif) record discoveries of multiple "Christian" lamps, suggesting some historical Christian presence (or potential displacement, or reuse?) at that site (Karen B. Stern, Inscribing Devotion and Death: Archaeological Evidence for Jewish Populations in North Africa Leiden: Brill, 2007, 245–47).
Kidney stones affect 1 in every 11 people in the United States each year. There is a significant high recurrence rate without a stone prevention protocol. Alkali citrate is beneficial in decreasing ...stone recurrence, but because of the cost and gastrointestinal side effects there is a low adherence rate. This study aims to serve as a review of some of the most commonly used alkalizing over-the-counter supplements that are advertised to prevent and treat kidney stones.
Data were gathered by a comprehensive online literature search and company inquiries for kidney stone prevention supplements. An additional informal poll of the authors selected supplements that are most commonly taken by their patients. A total of eight supplements were evaluated for cost, alkali equivalent provided, dosing, and regulatory information.
Eight of the most commonly used supplements were reviewed with a focus on alkalizing agents. Information reviewed revealed dosing recommendations resulting in decreased citrate alkali equivalents per day compared with prescription-strength potassium citrate. Cost, peer-reviewed study results, and regulatory data were reviewed, tabulated, and analyzed. Cost per alkali equivalent was substantially decreased for each supplement compared with the prescribed drug. All supplements were found to be readily available online.
Over-the-counter alkalizing agents are available to patients and may be an appropriate alternative to cost-prohibitive potassium citrate when treating urolithiasis patients. Additional testing will be necessary in the future to determine the efficacy of these supplements in the treatment and prevention of urinary stone disease.
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