Finasteride in the treatment of patients with benign prostatic hyperplasia: a review

Benign prostatic hyperplasia (BPH) is a complex and progressive disease common in aging men. While associated with bothersome lower urinary tract symptoms, it may also result in additional serious complications such as refractory hematuria, acute urinary retention, and BPH-related surgery. Medical therapy has been offered as an approach to halt this progression and perhaps reverse the pathophysiology of BPH. While alpha-blockers provide rapid relief in the form of improved flow rate, their effects may not reduce the overall risk of BPH-related complications. 5α-reductase inhibitors were therefore introduced to affect the underlying disease process by inhibiting the enzyme which converts testosterone to dihydrotesterone, the primary androgen involved in normal and abnormal prostate growth. Through this inhibition, prostate size is decreased, thereby reducing the risk of acute urinary retention and BPH-related surgery while providing symptom control. These effects are most pronounced in men with enlarged prostates (>25 mL) who are at the greatest risk of disease progression. This article reviews the literature for finasteride used in the treatment of BPH and provides evidence for its efficacy, safety and tolerability, applicability for combination therapy, and considerations of its effects on prostate cancer risk

Understanding the patient's perspective on rapid and routine HIV testing in an inner-city urgent care center

The purpose of this study was to explore patient perspectives of rapid and routine HIV-testing in an urgent care center at an urban public hospital. We conducted structured focus groups during a clinical trial comparing routinely offered rapid HIV-testing, routinely offered enzyme immunoassay (EIA) testing, and conventional EIA testing. Participants of the six focus groups were 89% African American, 60% uninsured, and had a low educational status. Four independent coders analyzed the data using iterative content analysis. Rapid testing was preferred to EIA testing because it reduced the need for a return visit and stress of waiting for test results, though there were concerns about accuracy. Participants supported routinely offering testing, but there were concerns about privacy and cost. Fear and stigma were common reasons for refusing testing and not returning for results. Distrust and misconceptions about HIV, particularly regarding the importance of testing, were very common

A "Firework" of H2 Knots in the Planetary Nebula NGC 7293 (the Helix Nebula)

We present a deep and wide field-of-view (4' × 7') image of the planetary nebula (PN) NGC 7293 (the Helix Nebula) in the 2.12 μm H2 v = 1 → 0 S(1) line. The excellent seeing (0farcs4) at the Subaru Telescope, allows the details of cometary knots to be examined. The knots are found at distances of 2farcm2-6farcm4 from the central star (CS). At the inner edge and in the inner ring (up to 4farcm5 from the CS), the knot often show a "tadpole" shape, an elliptical head with a bright crescent inside and a long tail opposite to the CS. In detail, there are variations in the tadpole shapes, such as narrowing tails, widening tails, meandering tails, or multipeaks within a tail. In the outer ring (4farcm5-6farcm4 from the CS), the shapes are more fractured, and the tails do not collimate into a single direction. The transition in knot morphology from the inner edge to the outer ring is clearly seen. The number density of knots governs the H2 surface brightness in the inner ring: H2 exists only within the knots. Possible mechanisms which contribute to the shaping of the knots are discussed, including photoionization and streaming motions. A plausible interpretation of our images is that inner knots are being overrun by a faster wind, but that this has not (yet) reached the outer knots. Based on H2 formation and destruction rates, H2 gas can survive in knots from formation during the late asymptotic giant branch phase throughout the PN phase. These observations provide new constraints on the formation and evolution of knots, and on the physics of molecular gas embedded within ionized gas. Based on data taken with the Subaru Telescope, National Astronomical Observatory of Japan (proposal ID S07B-054).Peer reviewe

Influence of Proportional Number Relationships on Item Accessibility and Students’ Strategies

Extensive evidence points to the need for mathematics instruction to tap into students’ informal understandings in order to conceptually develop formal mathematical ideas (Ahl, Moore, & Dixon, 1992; Freudenthal, 1973, 1991; Treffers, 1987). Contextual problems are a common means of helping students access their informal mathematical ideas (Lamon, 1993; Moore & Carlson, 2012). However, to successfully use context in this manner, we must ensure these problems are accessible to students and have the potential to promote connections to deeper or more formal mathematics (Jackson, Garrison, Wilson, Gibbons, & Shahan, 2013; Stein, Smith, Henningsen, & Silver, 2000). There is thus a need for research to identify what characteristics make contextual tasks accessible to students as a point of entry and useful for educators in analyzing and pressing students’ thinking

Cohort Learning for Graduate Students at the Dissertation Stage

Doctoral students discuss the power of collaborative cohort learning in transforming the dissertation phase of doctoral study. Innovative components of doctoral cohort learning and dissertation preparation are detailed.https://openriver.winona.edu/educationeddfacultyworks/1015/thumbnail.jp

Cohort Learning For Graduate Students At The Dissertation Stage

Doctoral students discuss the power of collaborative cohort learning in transforming the dissertation phase of doctoral study.  Innovative components of doctoral cohort learning and dissertation preparation are detailed

Exploring the Burden of Inpatient Readmissions After Major Cancer Surgery

Travel distances to care have increased substantially with centralization of complex cancer procedures at high-volume centers. We hypothesize that longer travel distances are associated with higher rates of postoperative readmission and poorer outcomes

Gene-Environment Interaction in the Onset of Eczema in Infancy: Filaggrin Loss-of-Function Mutations Enhanced by Neonatal Cat Exposure

Background Loss-of-function variants in the gene encoding filaggrin (FLG) are major determinants of eczema. We hypothesized that weakening of the physical barrier in FLG-deficient individuals may potentiate the effect of environmental exposures. Therefore, we investigated whether there is an interaction between FLG loss-of-function mutations with environmental exposures (pets and dust mites) in relation to the development of eczema. Methods and Findings We used data obtained in early life in a high-risk birth cohort in Denmark and replicated the findings in an unselected birth cohort in the United Kingdom. Primary outcome was age of onset of eczema; environmental exposures included pet ownership and mite and pet allergen levels. In Copenhagen(n = 379), FLG mutation increased the risk of eczema during the first year of life (hazard ratio [HR] 2.26, 95% confidence interval [CI] 1.27–4.00, p = 0.005), with a further increase in risk related to cat exposure at birth amongst children with FLG mutation (HR 11.11, 95% CI 3.79–32.60, p < 0.0001); dog exposure was moderately protective (HR 0.49, 95% CI 0.24–1.01, p = 0.05), but not related to FLG genotype. In Manchester (n = 503) an independent and significant association of the development of eczema by age 12 mo with FLG genotype was confirmed (HR 1.95, 95% CI 1.13–3.36, p = 0.02). In addition, the risk increased because of the interaction of cat ownership at birth and FLG genotype (HR 3.82, 95% CI 1.35–10.81, p = 0.01), with no significant effect of the interaction with dog ownership (HR 0.59, 95% CI 0.16–2.20, p = 0.43). Mite-allergen had no effects in either cohort. The observed effects were independent of sensitisation. Conclusions We have demonstrated a significant interaction between FLG loss-of-function main mutations (501x and 2282del4) and cat ownership at birth on the development of early-life eczema in two independent birth cohorts. Our data suggest that cat but not dog ownership substantially increases the risk of eczema within the first year of life in children with FLG loss-of-function variants, but not amongst those without. FLG-deficient individuals may need to avoid cats but not dogs in early life

Perceptions of Clinical Research Participation among African American Women

Background: Recruiting minority women into clinical research remains a significant challenge to conducting ethnically representative research. The main objective of this Office on Women's Health, DHHS-funded e-health database evaluation project was to examine African American women 's thoughts and perceptions about the clinical research process and about participation in the University of Michigan Women's Health Registry research database. Methods: Thirty-one African American women were recruited from the community to participate in a total of five 90-minute focus group discussions. All sessions were audiotaped and transcribed verbatim. Thematic content analysis was used to identify relevant themes about participation in clinical research and the Women's Health Registry. Results: Ten common trends were identified. (1) Information about the Women's Health Registry is not reaching the community. (2) Research is perceived as biased to benefit Caucasians. (3) Community involvement by the research team is critical for trust to develop. (4) Research directly relevant to African Americans or their community will encourage participation. (5) Researchers should use existing networks and advertise in appropriate locations. (6) The community needs more information concerning research. (7) Compensation is important. (8) Research that addresses a personal or family medical problem encourages involvement. (9) Minority representation on the research team is a motivator to participation. (10) There is limited time for healthcare-related activities. Conclusions: Successful recruitment strategies for African American women should feature community-based, culturally appropriate approaches. Online research databases for subject recruitment will likely be successful only if implemented within a broader community-oriented program.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/63122/1/jwh.2006.0124.pd