Access To Locations Research Articles

Desiccation-rehydration measurements in bryophytes: current status and future insights.

Desiccation-rehydration experiments have been employed over the years to evaluate desiccation tolerance of bryophytes (Bryophyta, Marchantiophyta, and Anthocerotophyta). Researchers have applied a spectrum of protocols to induce desiccation and subsequent rehydration, and a wide variety of techniques have been used to study desiccation-dependent changes in bryophyte molecular, cellular, physiological, and structural traits, resulting in a multifaceted assortment of information that is challenging to synthesize. We analysed 337 desiccation-rehydration studies, providing information for 351 species, to identify the most frequent methods used, analyse the advances in desiccation studies over the years, and characterize the taxonomic representation of the species assessed. We observed certain similarities across methodologies, but the degree of convergence among the experimental protocols was surprisingly low. Out of 52 bryophyte orders, 40% have not been studied, and data are lacking for multiple remote or difficult to access locations. We conclude that for quantitative interspecific comparisons of desiccation tolerance, rigorous standardization of experimental protocols and measurement techniques, and simultaneous use of an array of experimental techniques are required for a mechanistic insight into the different traits modified in response to desiccation. New studies should also aim to fill gaps in taxonomic, ecological, and spatial coverage of bryophytes.

MP41-02 NOVEL ROBOTIC-ASSISTED ELECTROMAGNETIC GUIDANCE FOR PRECISION PERCUTANEOUS ACCESS: A CADAVERIC STUDY OF NOVICES VERSUS AN EXPERT

You have accessJournal of UrologyCME1 May 2022MP41-02 NOVEL ROBOTIC-ASSISTED ELECTROMAGNETIC GUIDANCE FOR PRECISION PERCUTANEOUS ACCESS: A CADAVERIC STUDY OF NOVICES VERSUS AN EXPERT Mitchell Humphreys, Kevin Wymer, Ben Chew, Janet Zhen, Fuad Elkhoury, Sri Sivalingam, Matthew Dunn, and Michael Borofsky Mitchell HumphreysMitchell Humphreys More articles by this author , Kevin WymerKevin Wymer More articles by this author , Ben ChewBen Chew More articles by this author , Janet ZhenJanet Zhen More articles by this author , Fuad ElkhouryFuad Elkhoury More articles by this author , Sri SivalingamSri Sivalingam More articles by this author , Matthew DunnMatthew Dunn More articles by this author , and Michael BorofskyMichael Borofsky More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002607.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: A precise puncture into the exact location in the renal collecting system is an essential skill for successful percutaneous nephrolithotomy (PCNL). The consequences of a suboptimal puncture and tract dilation can result in bleeding or the inability to treat stone burden efficiently or completely. This proficiency is developed over time and can be challenge for novices. The purpose of this study was to determine if a novel technology, robotic-assisted electromagnetic (EM) guidance, can impact the success of percutaneous renal access in a cadaveric model. METHODS: Seven novices (individuals who use IR for access, or gain percutaneous access <24 times/year, or have gained access <30 times after training) used robotic-assisted EM guidance provided by the Monarch® Platform, Urology (Auris Health, Inc., Redwood City, CA) to obtain upper pole, mid kidney, and lower pole access in the supine position vs. the same tasks in a prone position using fluoroscopy in a cadaveric model. Measured variables were time to access, number of needle passes, fluoroscopy time and dosage, and the accuracy of access (location of the puncture). The novices were benchmarked against an expert (>100 lifetime PCNLs including access) to contextualize the influence of the technology. Statistical comparisons were made using paired t-tests. RESULTS: Successful access by the novices and expert was achieved in 100% of cases using robot-assisted EM guidance in supine position, but only in 57% and 100% of cases, respectively, when using fluoroscopy in the prone position (Table 1). Time to access using fluoroscopy was 16.9 min vs 6.9 min (p <0.05) using EM guidance for the novices, compared to <4 min with both methods by the expert. Mean number of needle insertions for the novices was 1.2 vs 3.0 (p <0.05) with EM and fluoroscopy methods, and 1.0 vs 1.7 for the expert, respectively. CONCLUSIONS: Robotic-assisted EM-guidance in the supine position offered a significant advantage to novices. It facilitated quicker and more accurate access to the renal collecting system with fewer attempts. These initial data suggest a potential to democratize the skill of gaining percutaneous access. Additional validation is needed to confirm the value of this tool to the surgeon’s armamentarium. Source of Funding: Johnson & Johnson © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e718 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mitchell Humphreys More articles by this author Kevin Wymer More articles by this author Ben Chew More articles by this author Janet Zhen More articles by this author Fuad Elkhoury More articles by this author Sri Sivalingam More articles by this author Matthew Dunn More articles by this author Michael Borofsky More articles by this author Expand All Advertisement PDF DownloadLoading ...

Drone Forensics and Machine Learning: Sustaining the Investigation Process

Drones have been increasingly adopted to address several critical challenges faced by humanity to provide support and convenience . The technological advances in the broader domains of artificial intelligence and the Internet of Things (IoT) as well as the affordability of off-the-shelf devices, have facilitated modern-day drone use. Drones are readily available for deployment in hard to access locations for delivery of critical medical supplies, for surveillance, for weather data collection and for home delivery of purchased goods. Whilst drones are increasingly beneficial to civilians, they have also been used to carry out crimes. We present a survey of artificial intelligence techniques that exist in the literature in the context of processing drone data to reveal criminal activity. Our contribution also comprises the proposal of a novel model to adopt the concepts of machine learning for classification of drone data as part of a digital forensic investigation. Our main conclusions include that properly trained machine-learning models hold promise to enable an accurate assessment of drone data obtained from drones confiscated from a crime scene. Our research work opens the door for academics and industry practitioners to adopt machine learning to enable the use of drone data in forensic investigations.

E-COMMERCE AND ECONOMIC GROWTH IN INDONESIA: ANALYSIS OF PANEL DATA REGRESSION

Digital economy has a major contribution to Indonesia's Gross Domestic Product (GDP). Digital economy sector that has the highest growth is e-commerce. The development of e-commerce and rapid improvements in internet infrastructure are expected to encourage public consumption, so as to increase GDP growth. The purpose of the research examines the general overview of economic growth and several e-commerce indicators in Indonesia and analyzes the effect of several e-commerce indicators on economic growth in Indonesia from 2016 to 2018. Economic growth and several e-commerce indicators in Indonesia have a positive trend. DKI Jakarta has some of the highest e-commerce indicators compared to other provinces, while East Nusa Tenggara has the biggest number of additional points internet access locations from 2016 to 2018. The results of panel data regression analysis show that the variable computer users, e-commerce users, internet access, and expenditure on information technology communication have a positive and significant effect on economic growth in Indonesia and the e-commerce indicators that have the greatest influence is computer users. Thus, the results of this study indicate the importance of utilizing the role of e-commerce in promoting economic growth in Indonesia. Keywords: economic growth; e-commerce; panel

Comparison of the Right and Left Distal Radial Access for Coronary Procedures

Distal radial coronary access is effective. This study examined if the access location affects vascular access and procedure success. A prospective database was created to compare rDRA and lDRA using propensity score matching. “Access time, coronary procedure success, radial spasm, ionising radiation exposure, and patient comfort were observed. The rDRA and lDRA compared 182 of 385 procedures. Approach success was comparable (97.6%vs.97.6%, p=1.0), access time (sec) was shorter (39 (25-60)vs.50 (29-90); p=0.0026), and procedural success was 100% vs. 100% (p=1.000). Radial spasm was not statistically significant (2.2%vs.6.62%, p=0.150). There were no significant differences between the groups in dose-area product (32 (20-57.1) Gy.m2 vs. 32.5 (19.4-46.3) Gy.m2; p=0.487) or fluoroscopy time (min; 4.4 (2.6-9)vs.4.3 (2.5-7.5); p=0.215.”No study population had vascular access concerns. Those undergoing coronary procedures spent about same time in the catheterization laboratory after switching to the rDRA as they did with the lDRA, but the rDRA required less time to get access to the heart.

Ideologically motivated mass shootings: a crime script analysis of far-right, far-left, and jihadist-inspired attacks in the United States

ABSTRACT This study uses a crime script analysis to examine far-right, far-left, and jihadist-inspired ideologically motivated mass shooters (IMMS) in the US (1970-2019). This work provides a comparison of incident rates and shooter backgrounds, as well as the preparation, execution, and conclusion of attacks. When comparing the three IMMS types, findings indicate far-right incidents were most common, far-left shooters were largely Black Nationalists, and jihadist-inspired shooters had more success in life (college graduates, employed, married, parents). During initial preparation, IMMS often leaked violent intentions and had facilitating conditions including criminal, domestic violence, and military histories. Jihadist-inspired shooters had more planning, and far-left shooters often accessed guns illegally. During attack execution, IMMS incidents often occurred in the South and involved open-space and/or unrestricted access locations. Jihadist-inspired shooters targeted government locations more often, while far-left incidents often occurred outside with law enforcement on the scene. During attack conclusion, IMMS incidents often ended quickly and involved gunfire with police. Jihadist-inspired shooters had a higher rate of victim casualties, and far-left shooters had a higher rate of police casualties. Far-right shooters had a higher number of victim and police casualties overall. A discussion of findings contextualises IMMS threats and explores strategies for countering the phenomenon.

Retracted: Lifetime maximization energy‐aware routing protocol for route optimization to improve quality of service in wireless sensor networks

AbstractWireless sensor networks (WSNs) are part of the short‐term networks, including sensitivity, computation, and Wi‐Fi connectivity capability. Many routing, range management, and log transfer protocols are specifically designed for WSN. The previous method showed less efficiency in routing management. The proposed lifetime maximization energy‐aware routing protocol (LTMEARP) protocol is known for its high routing efficiency, giving a higher lifetime and throughput performance. The requirement for a routing system approach is advanced with Internet service provider's protocols by recalculating the routing table after the link stage's substitution worldwide, leading to responses and connection failures by sharing important data after traffic. LTMEARP routing protocol has assured high availability routing performances during traffic conditions. LTMEARP support sends homogeneous and expanded nodes. Analyze a new approach to routing‐based selection algorithms for homogeneous node WSNs. The number of connections is limited and must be adjusted using separate paths and header packets to meet the user's network access location. The results show that the LTMEARP has achieved quality without introducing excessive network access program overhead, which deals with the study of communication and the benefits and problems with the performance of each routing technology.

Distribution network reconfiguration with distributed generation based on parallel slime mould algorithm

This paper proposes a solution for the distribution network reconfiguration (DNR) problem with distributed generation (DG) based on the parallel slime mould algorithm (PSMA). Firstly, we construct the four optimization objectives of active power loss, voltage stability index, load balance degree, and switching operation times are integrated by the analytic hierarchy process (AHP) and the DNR problem models with different DG types. Next, we propose PSMA based on the grouping communication strategy and inertia weight; we verify the performance of PSMA by testing a CEC2014 test suite. Finally, we apply the PSMA for the six types of DG of the IEEE-33 bus distribution network as the case study; the outcomes are compared with the other four algorithms. Experimental results show that the PSMA can solve the DNR problem with DG more accurately and quickly than the other three algorithms. At the same time, the results show that the type and access location of DG will affect the DNR problem in different degrees.

Investigating the biochemical effects of heat stress and sample quenching approach on the metabolic profiling of abalone (Haliotis iris).

Ocean temperatures have been consistently increasing due to climate change, and the frequency of heatwave events on shellfish quality is a growing concern worldwide. Typically, shellfish growing areas are in remote or difficult to access locations which makes in-field sampling and sample preservation of shellfish heat stress difficult. As such, there is a need to investigate in-field sampling approaches that facilitate the study of heat stress in shellfish. This study aims to apply a gas chromatography-mass spectrometry (GC-MS) based metabolomics approach to examine molecular mechanisms of heat stress responses in shellfish using abalone as a model, and compare the effects of different quenching protocols on abalone metabolic profiles. Twenty adult Haliotis iris abalone were exposed to two temperatures (14°C and 24°C) for 24h. Then, haemolymph and muscle tissues of each animal were sampled and quenched with 4 different protocols (liquid nitrogen, dry ice, cold methanol solution and normal ice) which were analyzed via GC-MS for central carbon metabolites. The effects of different quenching protocols were only observed in muscle tissues in which the cold methanol solution and normal ice caused some changes in the observed metabolic profiles, compared to dry ice and liquid nitrogen. Abalone muscle tissues were less affected by thermal stress than haemolymph. There were 10 and 46 compounds significantly influenced by thermal stress in muscle and haemolymph, respectively. The changes of these metabolite signatures indicate oxidative damage, disturbance of amino acid and fatty acid metabolism, and a shift from aerobic metabolism to anaerobic pathways. The study provided insights into the heat response of abalone, which could be useful for understanding the effects of marine heatwaves and summer mortality events on abalone. Dry ice appeared to be a suitable protocol, and safer in-field alternative to liquid nitrogen, for quenching of abalone tissues.

Measuring the impact and reach of informal educational videos on YouTube: The case of Scientific Animations Without Borders

Given the popularity, reach, and variable accessibility of online platforms as channels for informal education by higher-education institutions (HEIs), it becomes practically and theoretically important to better understand the factors that affect the impact and reach of any such Internet-delivered ICT informal learning. Accordingly, this study analysed viewer data from one informal, science animation educational channel on currently the most-watched online platform, YouTube, to measure characteristics affecting the videos’ impact and reach. Results from the study identified the most watched videos on the channel—including survival gardening using drip irrigation, charcoal water filtration, and tuberculosis prevention—and characteristic demand, time, location, and volume of video access. While the basic findings reaffirm prior research measuring statistically significant correlations between user-activity and YouTube engagement metrics (including watch-time, view counts, likes, and subscribers), they also demonstrate the and ability to make such content broadly applicable across demographics and globally. Offering some measure of insights for boosting HEI participation in informal educational science animation and ICT learning practices using platforms like YouTube—especially around the topics of water, agriculture, food security, and improved health outcomes—the findings also point to where improved methods for reaching the intended recipients of informal education online are needed to best leverage the potential of such platforms.

Laser interstitial thermal therapy for brain metastases.

Laser interstitial thermal therapy (LITT) is a minimally invasive treatment for intracranial lesions entailing thermal ablation via a stereotactically placed laser probe. In metastatic disease, it has shown the most promise in the treatment of radiographically progressive lesions after initial stereotactic radiosurgery, whether due to recurrent metastatic disease or radiation necrosis. LITT has been demonstrated to provide clinical benefit in both cases, as discussed in the review below. With its minimal surgical footprint and short recovery period, LITT is further advantaged for patients who are otherwise high-risk surgical candidates or with lesions in difficult to access locations. Exploration of the current data on its use in metastatic disease will allow for a better understanding of the indications, benefits, and future directions of LITT for these patients.

RANCANG BANGUN PROTOTYPE PADA APLIKASI E-COMMERCE BERBASIS WAP

Entering the era of globalization, the use of information technology in all areas of daily life cannot be avoided. There are at least two technologies that have developed rapidly in the last few years for the lives of millions of people, namely the internet and cell phones. By combining these two technologies, technology is created that makes it possible to access information that does not depend on the information source and location of access, namely WAP.&#x0D; Along with the development of the combination of the two technologies, several business owners began to use it. One of them is the Podomoro Notebook Store, which is located at SCC Plaza Simpang Lima, Fl. V No. 62 Semarang which is engaged in selling notebooks is trying to use it. There are several things that might encourage this application to be used, including in terms of notebook sales. The absence of an application regarding ordering goods online is also an obstacle for the shop.&#x0D; The solution to solving the problem of this case is to create a wap-based information system for ordering goods. With the wap-based information system, it is hoped that it will help a little in terms of sales and this system can help to order goods online.

Association of preoperative vein mapping with hemodialysis access characteristics and outcomes in the Vascular Quality Initiative

BackgroundPreoperative vein mapping before arteriovenous fistula (AVF) or arteriovenous graft (AVG) placement has been debated as a possible method of improving hemodialysis access outcomes for patients. However, high-quality national studies that have addressed this relationship are lacking. Thus, we assessed the association of preoperative vein mapping with hemodialysis access configuration and outcomes. MethodsIn the present cohort study, we analyzed all patients who had undergone AVF or AVG placement with data captured in the Vascular Quality Initiative hemodialysis access dataset from August 2011 to September 2019. The patients were stratified by whether they had undergone preoperative vein mapping. The primary (configuration) outcomes were access type (AVF vs AVG) and location (upper arm vs forearm). The secondary (longitudinal) outcomes were the successful initiation of hemodialysis, maintenance of secondary patency, and the need for reintervention 1 year after the index operation. ResultsOverall, 85.6% of the 46,010 included patients had undergone preoperative vein mapping. Of the 46,010 patients, 76.1% and 23.9% had undergone AVF and AVG creation, respectively. AVF creation (77.6% vs 67.3%) and forearm location (54.6% vs 47.3%) were more frequent for the patients who had undergone preoperative vein mapping than for those who had not (P < .001). After adjusting for baseline differences between the groups, preoperative vein mapping was associated with increased odds of receiving an AVF vs AVG (adjusted odds ratio, 1.64; 95% confidence interval [CI], 1.55-1.75) and forearm vs upper arm access (adjusted odds ratio, 1.22; 95% CI, 1.16-1.30). The incidence of the loss of secondary patency was lower for patients with preoperative vein mapping (P < .001), and persisted after risk adjustment (adjusted hazard ratio, 0.81; 95% CI, 0.75-0.88). ConclusionsPreoperative vein mapping was associated with favorable hemodialysis access configurations and outcomes in real-world practice. These data suggest that the use of preoperative vein mapping could improve the likelihood of favorable outcomes for patients requiring hemodialysis access.

Evaluating the efficacy of bimanual compression of abdomen-flank to control postoperative bleeding after percutaneous nephrolithotomy: A randomized clinical trial.

To investigate the influence of bimanual compression of abdomen-flank to control bleeding after completion of percutaneous nephrolithotomy (PCNL) including tubeless PCNL. This study is a parallel-group randomized clinical trial with 1:1:1 randomization. Ninety patients who were candidates for PCNL during July to October 2019 were enrolled. After completion of PCNL operation, patients were randomized into three groups to receive bimanual abdomen-flank compression for 0, 3, and 7 min by the operating surgeon with the opening of sealed envelopes (groups 0, 3, and 7 min afterwards). Preoperative, 24, and 48 h postoperative hemoglobin (Hb) and electrolytes were collected. The primary endpoint of interest was the comparison of 48-h blood loss across study groups. Secondary endpoints included the percent drop in 24- and 48-h Hb, transfusion rates, and operation complications. This trial is registered at www.irct.ir with the following number: IRCT20190618043925N1 on 18 July 2019. There was no statistically significant difference in study groups regarding stone mass, stone location, access location, and patients' age (all p > 0.05). The medians (IQR) of 48-h blood loss were 490 mL (105-916), 338 mL (160-933), and 413 mL (71-650) in groups of 0, 3, and 7 min. The percent drop in 24-h postoperative Hb relative to preoperative Hb were 11.5 ± 8.6% versus 9.2 ± 7.3% versus 9.3 ± 6.8% (p = 0.44) and relative values for the percent drop in 48-h Hb relative to preoperative Hb were 8.6 ± 8.7% versus 9.5 ± 9.9% versus 7.2 ± 9.6% (p = 0.63) in groups of 0, 3, and 7 min respectively. Transfusion was needed in four patients in group 0 min, five patients in group 3 min, and three patients in group 7 min. The results of this study reveal that postoperative bimanual compression of abdomen-flank has no statistically significant influence on the control of bleeding after PCNL operations.

Analysis and Suppression of Voltage Violation and Fluctuation with Distributed Photovoltaic Integration

In recent years, the violation and fluctuation of system voltage has occurred with greater frequency with the integration of high-penetration distributed photovoltaic generation. In this paper, the voltage violation and fluctuation in a high-penetration distributed photovoltaic integrated system is analyzed, and then a corresponding suppression strategy is proposed. Firstly, based on solar cell and photovoltaic control system models, the influence factors of photovoltaic output are analyzed. Secondly, the voltage violation and fluctuation caused by photovoltaic integration is analyzed, and the quadratic parabola relationship between bus voltage fluctuation and photovoltaic power variation is constructed. Next, according to the virtual synchronous generator characteristic of distributed photovoltaics, a double-hierarchical suppression strategy is proposed to make full use of reactive power regulation capability, which can maintain the symmetry of power supply while meeting standard requirements. The proposed strategy can conveniently realize quick response and support the photovoltaic extensive access. Moreover, with the employment of the proposal, the system voltage violation and fluctuation can be suppressed effectively. Finally, considering the photovoltaic access location, capacity, and partial shading, the effectiveness of the proposed strategy is verified in IEEE 33-bus distribution system with field measured data. After distributed photovoltaic accesses the system, more than 60% of buses appear to have undergone bus voltage violation. With the proposed method, more than 20% of the voltage deviation and more than 6% of the voltage fluctuation are effectively suppressed so that the system voltage can be kept below 1.07 p.u. and the voltage fluctuation can be kept within 4%, meeting the requirements of power quality standards.

Топографо-анатомическая характеристика задней большеберцовой артерии и её ветвей в области лодыжечного канала

AIM: To clarify peculiarities of the anatomy and topography of the plantar vessels in the area of the ankle canal, to justify access to the bifurcation of the artery tibialis posterior and ultrasound examination of the plantar arteries. The results of anatomical preparations of 10 amputated lower limbs, and of ultrasound duplex angioscanning (DUS) of 30 healthy volunteers without pathology of the vascular system performed using a linear transducer with frequency of 7–12 MHz, were studied. According to the data of anatomical preparation and ultrasound examination, the bifurcation level of the artery tibialis posterior was 1.7 ± 0.4 cm (min 0.5 cm — max 2 cm) below the level of the posterior edge of the medial ankle and was slightly covered by the musculus abductor hallucis. The average diameter of the artery tibialis posterior above the bifurcation level was 2.56 ± 0.4 mm, of the medial plantar artery 1.4±0.44 mm, and of the lateral plantar artery 1.8 ± 0.5 mm. The lateral plantar artery was 90% larger in diameter than the medial plantar artery. In 7% of cases, the medial plantar artery was larger, and in 3% of cases, the diameters of both arteries were equal. When taking the bifurcation of the posterior tibial artery as the central point, the plantar vessels on the DUS can be traced distally down under the abdomen of the musculus abductor hallucis: the medial vessels lie more anteriorly at 2 o’clock position, and the lateral vessels lie somewhat posteriorly at 1 o’clock. Assessment of blood flow at this level gives an idea of the state of the foot vessels. The level of bifurcation of the artery tibialis posterior is located 1.7 ± 0.4 cm below the posterior edge of the medial malleolus, which makes it possible to identify the location of access to it. The location of the DUS probe from this point at 2 o'clock position corresponds to the projection of the medial plantar artery, at 1 o'clock — to the lateral plantar artery on the right lower limb, on the left lower limb — at 10 and 11 o'clock, respectively.

Physician-Directed Duplex Augments Distal Arteriovenous Fistula Creation

Best practice guidelines for arteriovenous access creation have emphasized selecting distal sites and autogenous tissue before using proximal sites and synthetic shunts. Preoperative vein mapping is a useful tool to evaluate the optimal access location. However, the vein size is often underestimated secondary to patient hydration, room temperature, and basal vascular tone. Infraclavicular brachial plexus blocks (BPBs) are routinely performed for anesthesia but also have known vasodilatory effects. Although many surgeons use both techniques, most do not repeat vein mapping after performance of the BPB to reevaluate the targets after BPB-mediated vasodilation. Therefore, we evaluated whether the role of physician-directed vein mapping after BPBs resulted in more favorable fistula creations. All patients who had undergone primary ipsilateral access creation with physician-directed post-BPB duplex ultrasound from 2017 to 2018 were evaluated. Vein mapping was reviewed for “theoretical access location” using the criterion of >25-mm vessels. Fistula priority was analogous to the current indications, with an order of preference given to wrist radiocephalic, forearm radiocephalic, brachiocephalic, and brachiobasilic, followed by a prosthetic graft. Forty-three patients met the inclusion criteria. Physician-directed vein mapping after initiation of a regional BPB resulted in creation of a more distal access than expected in 62.8% of the patients. In 34.9%, the access site was at the predicted level, with a more proximal graft used in 2.3%. Furthermore, no differences in the maturation rates between the access sites placed distally to the predicted sites compared with those placed at the predicted site (0.65 vs 0.63; P = .38). The overall revision rate for distal fistulas was 22.2%, of which 83.3% were revised to the theoretical location, and 17.7% had required a proximal revision or creation of a graft. Physician-directed ultrasound after BPB is able to identify larger targets for access creation compared with preoperative vein mapping. Of those fistulas created distally, no difference was found in the maturation rates compared with those created at the theoretical location from vein mapping.

Does Access Location Influence Outcome of Percutaneous Nephrolithotomy in Staghorn Stones?

To assess the effect of lower and middle calyceal accesses on the outcomes of percutaneous nephrolithotomy (PCNL) in staghorn stones. Observational study. Department of Urology, University of Health Sciences, Izmir Bozyaka Training and Research Hospital, Turkey, from April 2012 to January 2019. Patients who underwent PCNL for staghorn stones were retrospectively analysed. The patients were grouped as Group-1 (middle calyceal access) and Group-2 (lower calyceal access). Demographic and stone characteristics (size, density), perioperative and postoperative data, and stone-free rates were compared between these two groups. Postoperative detection of > 4 mm stones was defined as residual stones. There were 249 patients in the study; 108 in middle calyceal access group and 141 in lower calyceal access group. The mean stone burden was 765 (524-1322) and 777 (490-1445) mm2 in group-1 and group-2, respectively (p=0.876). The number of stone-free patients was 50 (46.3%) in middle calyceal access group and 93 (66.0%) in lower calyceal access group. The rate of stone-free status was significantly higher in lower calyceal access group (p=0.002). The overall complication rate was similar between the groups (p=0.132). The binary analysis showed that stone burden, and calyx of entry were predictive factors for success. Although the choice of the calyx to be entered does not affect the complication rate in staghorn stones, the stone-free rate is significantly higher in lower calyceal access. Key Words: Percutaneous nephrolithotomy, Staghorn stones, Clavien scoring system, Calyx, Access.

“One must do, five reductions” qualitative analysis of the diffusion and adoption constraints in Vietnam

ABSTRACT Over the last decades, Vietnam has increased its rice production substantially, which has resulted in environmental degradation and adverse health effects. The present study aimed to document the introduction and diffusion of the sustainable technology package “One Must Do, Five Reductions” (1M5R). Barriers to adoption were investigated with 155 farmers in 17 focus group discussions. Results show that external factors such as the geographical location of farms and access to water seem to be the main barriers. Knowledge provision, demonstration fields, and access to extension services are important to increase the adoption of sustainable rice farming practices.

Associations between breast cancer screening participation and residential area sociodemographic features, geographic accessibility, and features of screening venue location in Greater Sydney, Australia

Breast cancer screening (BCS) participation rates are often suboptimal and vary geographically. Environmental features may influence BCS participation, but few studies have assessed this relationship. This study assessed the associations between BCS participation, residential area sociodemographic characteristics, distance to BCS venue, and venue location attributes. Data for 384,433 women residing in Greater Sydney, Australia, invited to BCS during 2011–2014 were spatially joined to their state suburb (SSC) (n = 800). SSC sociodemographic measures included women's median age, proportion women speaking English at home, full-time employed, and university educated; and proportion dwellings with motor-vehicles. Road network distance was calculated to each BCS venue. BCS venues were coded as co-located with bus-stop, train-station, hospital, general practitioner (GP), and shop. Hot spots were calculated to quantify spatial clustering of BCS participation. Multilevel logistic models were used to estimate the associations between environmental predictors and BCS participation, accounting for SSC-level clustering. BCS participation was 53.9% and spatially clustered. BCS was positively associated with SSC-level median age for women, proportions women speaking English and university educated, and dwellings with motor-vehicles. Distance to venue was inversely associated with BCS. Venue co-location with GP was positively associated and co-location with bus-stop, train-station, and shop, hospital were negatively associated with BCS. Residential sociodemographic features, geographic access, and venue location attributes are associated with BCS participation. These findings implicate the relevance of social and built environmental factors to programmatic aims to raise BCS participation. Additional research on venue location features is required to understand where best to site BCS venues.