BACKGROUND: There has been a steady increase in the use of electronic media and instant messaging among healthcare professionals, where it has been almost universally adopted in the workplace. The use of WhatsApp and its perceived benefits in healthcare have been extensively studied; however, there are concerns regarding the potential for ethical breaches in confidentiality through shared electronic patient information.OBJECTIVES: To identify the usage characteristics and incidence of shared patient information with WhatsApp use in a team of medical doctors in an unobserved and unregulated setting.METHODS: We conducted a retrospective cross-sectional content analysis of WhatsApp messages (n=3 340) among a team of 20 doctors in a South African district hospital over 6 months. All messages found within this time period were allocated unique identifiers. The text and image messages were thematically grouped into four categories, i.e. clinical care, resource allocation, social and administrative. Messages that contained patient-identifying information were included in the analysis.RESULTS: Of a total of 3 340 messages sent, 220 (6.6%) contained patient-identifying information. Of these, 109 (3.3%) contained non-anonymised patient information, while in 111 (3.3%) messages, the information was anonymised. The likelihood of sharing patient identifiers was proportionally much higher in shared images (odds ratio (OR) 5.1; 95% confidence interval (CI) 3.2 - 8.2; p<0.0001) compared with text messages, and in messages that related to clinical care (OR 9.3; 95% CI 2.2 - 38.8; p=0.0023) compared with those sent for resource allocation, and social or administrative purposes.CONCLUSIONS: Non-anonymised patient identifiers were found in 3.3% of messages, constituting the potential for breaching patient confidentiality. While WhatsApp groups have significant utility in co-ordinating aspects of clinical care, resource allocation, as well as social and administrative functions, the safe use of WhatsApp should be promoted to ensure that patient confidentiality is maintained.

A large opencast gold mining company in Africa had just completed a feasibility study for an expansion of the operations. A traditional net present value project valuation methodology had been used that showed a very positive net present value (NPV). The project team had conducted a qualitative risk assessment that identified and logged all potential project risks and had subjectively incorporated 'risk' via the discount rate and other assumption contingencies around gold price expectations, operating parameters, etc. Management requested that an independent quantitative risk modelling approach be adopted to obtain a better understanding of the impact of risk on the overall project valuation and confidence level in the final valuation. A detailed project valuation model was configured in the Cyest Carbon Modelling Technology platform, and the stochastic modelling module used to perform the Monte Carlo simulations. Analysis of historical operational performance data relating to actual achievements versus planned and budget determined the historical variability of the underlying parameters as well as variance to budget. This was done at a detailed level for mining rates and costs, processing rate, costs and recovery, and other operational efficiency measures. External market assumptions relating to gold price, exchange rate, and inflation were modelled and the dependency between them modelled using a copula. This case study will demonstrate the approach taken to building and populating the quantitative risk model and the overall results of the Monte Carlo simulation. The final valuation demonstrated that the project had a 44 percent probability of an NPV less than zero i.e. a 44 percent chance of project finance loss.

Introduction: Benign prostatic hyperplasia (BPH) is characterized by lower urinary tract symptoms (LUTS) that may cause ejaculatory disorders, although they could be also a consequence of alpha-blocker treatment. Objectives: To determine the prevalence of ejaculatory dysfunction in patients with HBP undergoing alpha-blocker therapy. Secondary objectives were to evaluate the effect of different drugs on normal ejaculation and the relationship of dysfunction degree to prognostic factors and BPH severity. Materials and methods: Epidemiologic, transversal, uncontrolled and open-label study in 1.177 patients older than 40, who had been diagnosed of BPH/LUTS with more than 6 months of evolution and treated with the same alpha-blocker for at least the last 3 months. Severity of ejaculatory dysfunction was determined by the domain on ejaculation of the Male Sexual Health Questionnaire (MSHQ). Results were stratified by age and BPH severity, determined by the International Prostate Symptoms Score (IPSS). Results: The prevalence of ejaculatory dysfunction has been estimated to be 82.6% in patients with BPH/LUTS treated with alpha-blockers. Although usually mild, the dysfunction is considered as bothersome by a high percentage of those who suffer it. Advanced age is the most influential factor in the severity of both ejaculatory abnormalities and prostate symptoms. Moreover, a solid correlation between these two parameters has been established. Finally, among the analyzed alpha-blockers, alfuzosin has been associated with the best sexual function. Conclussions: More than 80% of patients with BPH suffer ejaculatory abnormalities, which are closely related to the severity of prostate symptoms and increased age. When initiating alpha-blocker treatment, we should consider that alfuzosin is the one with less negative impact on ejaculatory function.

Introducción: La hiperplasia benigna de próstata (HBP) se acompaña de síntomas del tracto urinario inferior (STUI) que pueden causar alteraciones eyaculatorias, aunque éstas podrían ser además consecuencia del tratamiento con alfa-bloqueantes. Objetivos: Determinar la prevalencia de disfunción eyaculatoria en pacientes con HBP tratados con alfa-bloqueantes. Secundariamente, evaluar el efecto del tipo de fármaco y la relación de las alteraciones eyaculatorias con factores pronósticos y la gravedad de la HBP. Material y métodos: Estudio epidemiológico, transversal, no controlado y abierto en 1.177 pacientes =40 años diagnosticados de HBP/STUI con más de 6 meses de evolución, tratados con el mismo alfa-bloqueante durante como mínimo los últimos 3 meses. El grado de disfunción eyaculatoria se determinó mediante el dominio sobre eyaculación del Male Sexual Health Questionnaire (MSHQ). Los resultados se estratificaron según la edad y gravedad de la HBP, establecida mediante el International Prostate Symptoms Score (IPSS). Resultados: Se ha estimado una prevalencia de disfunción eyaculatoria del 82,6% en pacientes con HBP/STUI en tratamiento con alfa-bloqueantes. Aunque generalmente leve, un amplio porcentaje de quienes la sufren la consideran un problema. La edad avanzada es el factor más influyente en la gravedad tanto de las alteraciones eyaculatorias como de los síntomas prostáticos. Entre ambos parámetros se ha establecido una sólida correlación. Finalmente, entre los alfa-bloqueantes evaluados, la alfuzosina se ha asociado a una mejor función sexual. Conclusiones: Más del 80% de pacientes con HBP sufren alteraciones eyaculatorias, estrechamente relacionadas con la severidad de los síntomas prostáticos y la edad del individuo. Al establecer tratamiento con alfa-bloqueantes, deberíamos tener en cuenta que la alfuzosina es el que menos impacto tiene sobre la función eyaculatoria.

A hot rolled Zircaloy-4 alloy, annealed with a final cold rolling, presenting rounded grains, was studied. Hydrogen cathodic charge with a homogenization heat treatment was used to pre-charge the specimens with different hydrogen contents. Hydrogen embrittlement susceptibility analysis was held using J integral and J-R curve results from CT specimens (compact tension specimens) tested at room temperature. As J IC values showed scatter, toughness was evaluated for deltaa = 1mm. Toughness clearly tended to decrease as hydrogen content increased abruptly for low H contents and gradually for high contents. A few specimens with high hydrogen content failed in brittle mode, or presented instability and posterior crack arrest. Fractographic observations showed that, despite the records had presented no signs of brittle fracture, certain specimens showed cleavage-like zones. More cleavage-like area percentage was present the higher the hydrogen content was.