Impact of combination therapy 5-alpha reductase inhibitors (5-ARI) plus alpha-blockers (AB) on erectile dysfunction and decrease of libido in patients with LUTS/BPH: a systematic review with meta-analysis

Lower urinary tract symptoms (LUTS) secondary to benign prostatic obstruction (BPO) represent one of the most common clinical complaints in adult men. Several drugs used for LUTS/BPO may strongly affect sexual function and bother. The aim of this systematic review and meta-analysis was to evaluate the impact of combination therapy with alpha-blockers (AB), 5-alpha reductase inhibitors (5-ARI) on the risk of erectile dysfunction(ED) and libido alterations (LA) from randomized clinical trial (RCT). Based on the inclusion and exclusion criteria, five RCTs involving 6131 patients were included in the analysis. According to the analysis, the overall prevalence of ED and LA were significantly greater in the combination treatment group than in the AB group (7.93% versus 4.66%; OR 1.81; p?p?=?0.003, respectively). The combination therapy increased the risk of ED compared to monotherapy with 5-ARI (7.93% versus 6.47%; OR 1.25; p?=?0.04) but not the risk of LA (3.51% versus 3.37; OR 1.03; p?=?0.84). In our systematic meta-analysis, we demonstrated that combination therapy with ABs and 5-ARIs was associated with significantly higher risk of ED and LA compared with single monotherapy. Combination therapy showed similar risk of LA compared with 5-ARI monotherapy.     

Representing Preferences with a Unique Subjective State Space

We extend Kreps' (1979) analysis of preference for flexibility, reinterpreted by Kreps (1992) as a model of unforeseen contingencies. We enrich the choice set, consequently obtaining uniqueness results that were not possible in Kreps' model. We consider several representations and allow the agent to prefer commitment in some contingencies. In the representations, the agent acts as if she had coherent beliefs about a set of possible future (ex post) preferences, each of which is an expected‐utility preference. We show that this set of ex post preferences, called the subjective state space, is essentially unique given the restriction that all ex post preferences are expected‐utility preferences and is minimal even without this restriction. Because the subjective state space is identified, the way ex post utilities are aggregated into an ex ante ranking is also essentially unique. Hence when a representation that is additive across states exists, the additivity is meaningful in the sense that all representations are intrinsically additive. Uniqueness enables us to show that the size of the subjective state space provides a measure of the agent's uncertainty about future contingencies and that the way the states are aggregated indicates whether these contingencies lead to a desire for flexibility or commitment.     

On the economic foundations of decision theory

Theory and Decision - Economics bases the choice theory on the mental experiment that introduces the choice correspondence, which associates to every set of possible actions the subset of preferred...     

Structure of University Education and Education for Social Work in Italy

The single-case design, with its potential integration of practice and research roles, has roots extending back to the “scientific charity” movement of the late 1800s. While the goals of “scientific charity” were never realized, the new research technology bears promise of achieving them. This background, together with the related experiences of behavioral psychology and of medicine, is briefly highlighted and the prospects, pitfalls, and challenges involved are discussed.     

Convergence in weighted supremum norms of the skorokhod representation of the estimated empirical process

Anderson and Darling (1952) introduced their test with a weight function which is the reciprocal of the variance of the empirical process. The fact that this weight function is not integrable was a source of problems, and in spite of the large amount of works that have been done there is no a rigorous proof of the asymptotic distribution of the Anderson-Darling statistics when the parameters are estimated.     

A weighted cramer-von mises statistic derived from a decomposition of the anderson-darling statistic

Two goodness of fit statistics with asymmetric weight function are derived from a decomposition of the Anderson-Darling statistic, For each one, the asymptotic null distribution is found for a simple null hypothesis and some upper percentties are calculated. The asymptotic power of the tests are obtained for some contiguous alternatives around a normal null hypothesis. The tests allow the user to choose to which tail to give more weight and it is intended to be used for that purpose. Therefore it should be not considered as a competitor of the classical goodness of fit tests.     

Probability of Exporting Infected Carcasses from Vaccinated Pigs Following a Foot‐and‐Mouth Disease Epidemic

Emergency vaccination is an effective control strategy for foot‐and‐mouth disease (FMD) epidemics in densely populated livestock areas, but results in a six‐month waiting period before exports can be resumed, incurring severe economic consequences for pig exporting countries. In the European Union, a one‐month waiting period has been discussed based on negative test results in a final screening. The objective of this study was to analyze the risk of exporting FMD‐infected pig carcasses from a vaccinated area: (1) directly after final screening and (2) after a six‐month waiting period. A risk model has been developed to estimate the probability that a processed carcass was derived from an FMD‐infected pig (P_carc). Key variables were herd prevalence (P_H), within‐herd prevalence (P_A), and the probability of detection at slaughter (P_SL). P_H and P_A were estimated using Bayesian inference under the assumption that, despite all negative test results, ≥1 infected pigs were present. Model calculations indicated that P_carc was on average 2.0 × 10^?5 directly after final screening, and 1.7 × 10^?5 after a six‐month waiting period. Therefore, the additional waiting time did not substantially reduce P_carc. The estimated values were worst‐case scenarios because only viraemic pigs pose a risk for disease transmission, while seropositive pigs do not. The risk of exporting FMD via pig carcasses from a vaccinated area can further be reduced by heat treatment of pork and/or by excluding high‐risk pork products from export.     

Exact inference for multivariate ordered alternatives

In this paper we discuss three types of ordered alternatives ordered location, stochastic ordering and quadrant dependence. We prove that quadrant dependence is the more general among the three. Then we consider a conditional tests for the equality of c distributions against quadrant dependence in a multivariate setup. An exact simultaneous testing procedure based on dependent conditional tests is presented. Two applications to real data are also given.     

Representing Preferences with a Unique Subjective State Space: A Corrigendum1

Dekel, Lipman and Rustichini (2001) (henceforth DLR) axiomatically characterized three representations of preferences that allow for a desire for flexibility and/or commitment. In one of these representations (ordinal expected utility), the independence axiom is stated in a weaker form than is necessary to obtain the representation; in another (additive expected utility), the continuity axiom is too weak. In this erratum we provide examples showing that the axioms used by DLR are not sufficient, and provide stronger versions of these axioms that, together with the other axioms used by DLR, are necessary and sufficient for these two representations.     

Measures of risk aversion with expected and nonexpected utility

In the expected utility case, the risk-aversion measure is given by the Arrow-Pratt index. Three proposals of a risk-aversion measure for the nonexpected utility case are examined. The first one sets “the second derivative of the acceptance frontier as a measure of local risk aversion.” The second one takes into account the concavity in the consequences of the partial derivatives of the preference function with respect to probabilities. The third one measures risk aversion through the ratio between the risk premium and the standard deviation of the lottery. The third proposal catches the main feature of risk aversion, while the other two proposals are not always in accordance with the same crude definition of risk aversion, by which there is risk aversion when an agent prefers to get the expected value of a lottery rather than to participate in it.