Efficacy of the Revi system in treating urgency urinary incontinence
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No evidence for decision fatigue using large-scale field data from healthcare
Decision fatigue is the idea that making decisions is mentally demanding and eventually leads to deteriorated decision quality. Many studies report results that appear consistent with decision fatigue. However, most of this evidence comes from observed sequential patterns using retrospective designs, without preregistration or external validation and with low precision in how decision fatigue is operationalized. Here we conducted an empirical test of decision fatigue using large-scale, high-resolution data on healthcare professionals’ medical judgments at a national telephone triage and medical advice service. This is a suitable setting for testing decision fatigue because the work is both hard and repetitive, yet qualified, and the variation in scheduling produced a setting where level of fatigue could be regarded as near random for some segments of the data. We hypothesized increased use of heuristics, more specifically convergence toward personal defaults in case judgments, and higher assigned urgency ratings with fatigue. We tested these hypotheses using one-sided Bayes Factors computed from underlying Bayesian generalized mixed models with random intercepts. The results consistently showed relative support for the statistical null hypothesis of no difference in decision-making depending on fatigue (BF0+ > 22 for all main tests). We thus found no evidence for decision fatigue. Whereas these results don’t preclude the existence of a weaker or more nuanced version of decision fatigue or more context-specific effects, they cast serious doubt on the empirical relevance of decision fatigue as a domain general effect for sequential decisions in healthcare and elsewhere.
Racial and ethnic differences in prenatal exposure to environmental phenols and parabens in the ECHO Cohort
Research suggests racial/ethnic disparities in prenatal exposure to endocrine disrupting environmental phenols (EPs) in limited populations. However, no studies have investigated racial/ethnic disparities in prenatal EP exposure across the U.S.
Clinical practice recommendations for the diagnosis and management of X-linked hypophosphataemia
X-linked hypophosphataemia (XLH) is a rare metabolic bone disorder caused by pathogenic variants in the PHEX gene, which is predominantly expressed in osteoblasts, osteocytes and odontoblasts. XLH is characterized by increased synthesis of the bone-derived phosphaturic hormone fibroblast growth factor 23 (FGF23), which results in renal phosphate wasting with consecutive hypophosphataemia, rickets, osteomalacia, disproportionate short stature, oral manifestations, pseudofractures, craniosynostosis, enthesopathies and osteoarthritis. Patients with XLH should be provided with multidisciplinary care organized by a metabolic bone expert. Historically, these patients were treated with frequent doses of oral phosphate supplements and active vitamin D, which was of limited efficiency and associated with adverse effects. However, the management of XLH has evolved in the past few years owing to the availability of burosumab, a fully humanized monoclonal antibody that neutralizes circulating FGF23. Here, we provide updated clinical practice recommendations for the diagnosis and management of XLH to improve outcomes and quality of life in these patients.
Derivation of human toxicokinetic parameters and internal threshold of toxicological concern for tenuazonic acid through a human intervention trial and hierarchical Bayesian population modeling
Tenuazonic acid (TeA), a mycotoxin produced by Alternaria alternata, contaminates various food commodities and is known to cause acute and chronic health effects. However, the lack of human toxicokinetic (TK) data and the reliance on external exposure estimates have stalled a comprehensive risk assessment for TeA.
The urothelium: a multi-faceted barrier against a harsh environment
All mucosal surfaces must deal with the challenge of exposure to the outside world. The urothelium is a highly specialized layer of stratified epithelial cells lining the inner surface of the urinary bladder, a gruelling environment involving significant stretch forces, osmotic and hydrostatic pressures, toxic substances, and microbial invasion. The urinary bladder plays an important barrier role and allows the accommodation and expulsion of large volumes of urine without permitting urine components to diffuse across. The urothelium is made up of three cell types, basal, intermediate, and umbrella cells, whose specialized functions aid in the bladder’s mission. In this review, we summarize the recent insights into urothelial structure, function, development, regeneration, and in particular the role of umbrella cells in barrier formation and maintenance. We briefly review diseases which involve the bladder and discuss current human urothelial in vitro models as a complement to traditional animal studies.
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