Risk Attitudes in Health: An Exploratory Study

Recent studies on human decision-making under uncertainty have revealed the following typical behavioral principles: (1) the importance of the status quo as a reference point ("target") for assessing outcomes, (2) the prevalence of risk-aversion for gains, i.e. above-target payoffs, but risk-seeking for potential losses, and (3) a tendency to give more weight or "marginal utility" to a small loss than a gain of the same size. We investigate whether and how these aspects carry over from the money to the health context, examining the responses to a questionnaire by 325 patients from three outpatient facilities in Palo Alto, California. The questionnaire consisted of twelve hypothetical choice situations each with the choice between two alternative modes of treatment for a supposed illness. In each case, one of the options promised a certain (favorable or unfavorable) health effect, the other one a probabilistic effect. The majority choices confirm the relevance for the health context of all three above-mentioned principles. Risk-aversion for gains, risk- seeking for losses and the differences in slope of the utility function were all significant and substantial in magnitude. When trying to trace back differences in risk attitudes to demographic or socioeconomic characteristics of the respondents, we find that education is the most important corre1ate:choices of people with more years of schooling exhibit less risk-aversion for gains and less risk-seeking for losses and thus correspond to a more linear relationship between health and utility.

Cellular mechanisms of prostaglandin E2 and vasopressin interactions in the collecting duct

As the final segment of the nephron, the collecting duct is the ultimate regulator of renal salt and water excretion. Balance between intake and renal excretion of salt and water is fine-tuned by the action of several hormones targeted to the collecting duct. Vasopressin is, perhaps, the prototypical example of such a hormone. As total body water decreases and plasma osmolality rises, vasopressin secretion from the posterior pituitary increases [1]. Picomolar concentrations of circulating vasopressin lead to increased water permeability of the apical membrane of the collecting duct cell, resulting in increased water reabsorption and increased total body water [2,3]. There is abundant evidence demonstrating that vasopressin's effect on water reabsorption in the collecting duct is mediated through the classic second messenger, cAMP [3]. V2 selective receptors are linked via a G protein, to stimulation of plasma membrane adenylyl cyclase, resulting in increased cell cyclic AMP levels [4, 5]. The increased cyclic AMP then leads to augmented water permeability of the apical membrane [6, 7].As one might expect with such an important biologic process, other hormones and autocoids provide a counter-regulatory influence to modulate vasopressin mediated increases in osmotic water permeability. There is good evidence that the arachadonic acid metabolite, prostaglandin E2 (PGE2) plays a critical physiologic and pathophysiologic role in inhibiting vasopressin action in the collecting duct [8, 9]. Not only is the collecting duct the major renal site of synthesis for this cyclo-oxygenase product of arachidonic acid but PGE2 production is stimulated by vasopressin itself [10–12]. PGE2 infusion significantly blunts water reabsorption and cycloxygenase inhibition augments vasopressin antidiuresis [9, 13]. Thus, there is good evidence that the autocoid PGE2 plays an important role in regulating vasopressin-stimulated osmotic water flow

Synchronous genitourinary lichen sclerosus signals a distinct urinary microbiome profile in men with urethral stricture disease.

PurposeAlterations in the urinary microbiome have been associated with urological diseases. The microbiome of patients with urethral stricture disease (USD) remains unknown. Our objective is to examine the microbiome of USD with a focus on inflammatory USD caused by lichen sclerosus (LS).MethodsWe collected mid-stream urine samples from men with LS-USD (cases; n = 22) and non-LS USD (controls; n = 76). DNA extraction, PCR amplification of the V4 hypervariable region of the 16S rRNA gene, and sequencing was done on the samples. Operational taxonomic units (OTUs) were defined using a > 97% sequence similarity threshold. Alpha diversity measurements of diversity, including microbiome richness (number of different OTUs) and evenness (distribution of OTUs) were calculated and compared. Microbiome beta diversity (difference between microbial communities) relationships with cases and controls were also assessed.ResultsFifty specimens (13 cases and 37 controls) produced a 16S rRNA amplicon. Mean sample richness was 25.9 vs. 16.8 (p = 0.076) for LS-USD vs. non-LS USD, respectively. LS-USD had a unique profile of bacteria by taxonomic order including Bacillales, Bacteroidales and Pasteurellales enriched urine. The beta variation of observed bacterial communities was best explained by the richness.ConclusionsMen with LS-USD may have a unique microbiologic richness, specifically inclusive of Bacillales, Bacteroidales and Pasteurellales enriched urine compared to those with non-LS USD. Further work will be required to elucidate the clinical relevance of these variations in the urinary microbiome

mRNA-Expression of KRT5 and KRT20 Defines Distinct Prognostic Subgroups of Muscle-Invasive Urothelial Bladder Cancer Correlating with Histological Variants

Recently, muscle-invasive bladder cancer (MIBC) has been subclassified by gene expression profiling, with a substantial impact on therapy response and patient outcome. We tested whether these complex molecular subtypes of MIBC can be determined by mRNA detection of keratin 5 (KRT5) and keratin 20 (KRT20). Reverse transcriptase quantitative polymerase chain reaction (RT-qPCR) was applied to quantify gene expression of KRT5 and KRT20 using TaqMan (R)-based assays in 122 curatively treated MIBC patients (median age 68.0 years). Furthermore, in silico analysis of the MD Anderson Cancer Center (MDACC) cohort (GSE48277 + GSE47993) was performed. High expression of KRT5 and low expression of KRT20 were associated with significantly improved recurrence-free survival (RFS) and disease-specific survival disease specific survival (DSS: 5-year DSS for KRT5 high: 58%; 5-year DSS for KRT20 high: 29%). KRT5 and KRT20 were associated with rates of lymphovascular invasion and lymphonodal metastasis. The combination of KRT5 and KRT20 allowed identification of patients with a very poor prognosis (KRT20(+)/KRT5(-), 5-year DSS 0%, p < 0.0001). In silico analysis of the independent MDACC cohorts revealed congruent results (5-year DSS for KRT20 low vs. high: 84% vs. 40%, p = 0.042). High KRT20-expressing tumors as well as KRT20(+)/KRT- tumors were significantly enriched with aggressive urothelial carcinoma variants (micropapillary, plasmacytoid, nested)

Lupus cystitis presenting with urinary symptoms.

We present a case of a young woman presenting with irritative lower urinary tract symptoms and microscopic hematuria who was diagnosed with systemic lupus erythematosus (SLE). Abdominal ultrasound revealed bilateral hydronephrosis and a thickened bladder wall. Cystoscopic evaluation revealed severe diffuse inflammation, erythema and hemorrhage at the trigone with punctate extensions to the bladder base. She was treated with prednisone and mycophenolate mofetil with improvements in her symptoms and ultrasound findings. Lupus cystitis is a rare manifestation of SLE

Everything you Want to Know and Never Dared to ask:A Practical Approach to Employing Challenge-Based Learning in Engineering Ethics

Challenge-based learning (CBL) for engineering ethics tasks students with identifying ethical challenges in cooperation with an external partner, e.g., a technology company. As many best-practice parameters of such courses remain unclear, this contribution focuses on a teacher-centric introduction into deploying CBL for engineering ethics. Taking Goodlad's curriculum typology as a point of departure, we discuss practical issues in devising, maintaining and evaluating CBL courses for engineering ethics both in terms of the temporal dimension (before, during and after the course) as well as in terms of the people involved. We will discuss selecting learning objectives, forms of knowledge acquisition, supporting self-organization, and fostering discursive etiquette, as well as cooperative, yet critical attitudes. Additionally, we will delve into strategic matters, e.g., ways to approach potential external partners and maintain fruitful cooperations.</p

Genital Pain and Numbness and Female Sexual Dysfunction in Adult Bicyclists.

IntroductionBicycle seat pressure on the perineum may impair arousal and clitoral erection, likely contributing to genital pain and numbness experienced by female cyclists.AimWe aimed to identify the association between genital pain and numbness experienced by female cyclists and female sexual dysfunction (FSD).MethodsFemale cyclists were recruited to complete an online survey using the Female Sexual Function Index (FSFI), a validated questionnaire to assess FSD. Cyclist demographics, experience, preferred riding style, use of ergonomic cycle modifications, and genital discomfort while riding were also queried. Multivariate logistic regression analysis was used to evaluate risk factors of FSD.Main outcome measuresThe main outcome was FSFI score, which is used to diagnose FSD when the FSFI score is &lt;26.55.ResultsOf the survey respondents, 178 (53.1%) completed the survey and FSFI questionnaire. Mean age was 48.1 years (±0.8 standard error [SE]), and the average riding experience was 17.1 years (±0.9 SE). Overall, 53.9% of female cyclists had FSD, 58.1% reported genital numbness, and 69.1% reported genital pain. After adjusting for age, body mass index, relationship status, smoking history, comorbidities, and average time spent cycling per week, females who reported experiencing genital numbness half the time or more were more likely to have FSD (adjusted odds ratio [aOR], 6.0; 95% CI, 1.5-23.6; P = .01), especially if localized to the clitoris (aOR, 2.5; 95% CI, 1.2-5.5; P = .02). Females that reported genital pain half the time or more while cycling also were more likely to have FSD (aOR, 3.6; 95% CI, 1.2-11.1; P = .02). Cyclists experiencing genital pain within the first hour of their ride were more likely to have FSD (aOR, 12.6; 95% CI, 2.5-63.1; P = .002). Frequency and duration of cycling were not associated with FSD. Analysis of FSFI domains found that the frequency of numbness was correlated with decreased arousal, orgasm, and satisfaction during intercourse, whereas the frequency of pain significantly reduced arousal, orgasm, and genital lubrication.Clinical implicationsFemale cyclists that experience numbness and/or pain have higher odds of reporting FSD.Strengths &amp; limitationsOur study includes a validated questionnaire to assess FSD and queries specific characteristics and symptoms of genital pain and genital numbness; however, the study is limited by its cross-sectional survey design.ConclusionThis study highlights the need for cyclists to address genital pain and numbness experienced while cycling, and future studies are required to determine if alleviating these symptoms can reduce the impact of cycling on female sexual function. Greenberg GR, Khandwala YS, Breyer BN, et al. Genital Pain and Numbness and Female Sexual Dysfunction in Adult Bicyclists. J Sex Med 2019; 16:1381-1389