Aligning data with decisions to address the biodiversity crisis.

The planetary outlook for biodiversity is dire. A new collection of articles discusses the disconnect between the data we have and the data we need for more effective action on conservation, as well as how social justice and end-user viewpoints must be centered to ensure a more sustainable future for our planet.

Aligning the logics of inquiry and action to address the biodiversity crisis.

Despite an abundance of research reaffirming biodiversity's importance to the health of the planet and society, species continue to go extinct at an alarming rate. Why has continued research on the value of biodiversity not had the intended effect and what can be done about it? We considered biodiversity loss as a public value failure and the result of a misalignment between the logic of inquiry (which guides scientists) and the logic of action (which guides practitioners). We drew lessons from our own research to propose the creation of a national biodiversity strategy designed to link the logic of inquiry with the logic of action and coordinate the production of actionable conservation science and informed conservation action.

Alineación de la lógica de la investigación y de la acción para abordar la crisis de la biodiversidad Resumen Aunque abundan los estudios que reafirman la importancia de la biodiversidad para la salud del planeta y la sociedad, la tasa de extinción de las especies es alarmante. ¿Por qué no han tenido el efecto previsto los estudios continuos sobre el valor de la biodiversidad y qué se puede hacer al respecto? Consideramos la pérdida de la biodiversidad como un fracaso del valor público y como el resultado del desajuste entre la lógica de la investigación (que guía a los científicos) y la lógica de la acción (que guía a los practicantes). Sacamos lecciones de nuestros propios estudios para proponer la creación de una estrategia nacional de biodiversidad diseñada para conectar ambas lógicas y coordinar la producción de ciencia práctica para la conservación y de acciones de conservación informadas.

Five approaches to producing actionable science in conservation.

The knowledge produced by conservation scientists must be actionable in order to address urgent conservation challenges. To understand the process of creating actionable science, we interviewed 71 conservation scientists who had participated in 1 of 3 fellowship programs focused on training scientists to become agents of change. Using a grounded theory approach, we identified 16 activities that these researchers employed to make their scientific products more actionable. Some activities were more common than others and, arguably, more foundational. We organized these activities into 3 nested categories (motivations, strategies, and tactics). Using a co-occurrence matrix, we found that most activities were positively correlated. These correlations allowed us to identify 5 approaches, framed as profiles, to actionable science: the discloser, focused on open access; the educator, focused on science communication; the networker, focused on user needs and building relationships; the collaborator, focused on boundary spanning; and the pluralist, focused on knowledge coproduction resulting in valuable outcomes for all parties. These profiles build on one another in a hierarchy determined by their complexity and level of engagement, their potential to support actionable science, and their proximity to ideal coproduction with knowledge users. Our results provide clear guidance for conservation scientists to generate actionable science to address the global biodiversity conservation challenge.

Cinco estrategias para producir ciencia práctica en la conservación Resumen El conocimiento producido por los científicos de la conservación debe ser práctico para poder abordar los obstáculos urgentes que enfrenta la conservación. Entrevistamos a 71 científicos de la conservación que participaron en uno de los tres programas de becas enfocados en la formación de científicos como agentes de cambio para entender el proceso de creación de la ciencia práctica. Usamos una estrategia de teoría fundamentada para identificar 16 actividades empleadas por estos investigadores para hacer más prácticos sus productos científicos. Algunas actividades fueron más comunes que otras y, probablemente, más fundamentales. Organizamos estas actividades en tres categorías anidadas: motivaciones, estrategias y tácticas. Con una matriz de co-ocurrencia, encontramos que la mayoría de las actividades estaban correlacionadas positivamente. Estas correlaciones nos permitieron identificar cinco estrategias, encuadradas como perfiles, para la ciencia práctica: la reveladora, enfocada en el acceso abierto; la educativa, enfocada en la comunicación de la ciencia; la interconectora, enfocada en las necesidades del usuario y en construir relaciones; la colaborativa, enfocada en la expansión de las fronteras; y la pluralista, enfocada en la coproducción del conocimiento como el origen de resultados valiosos para todas las partes. Estas estrategias se apoyan entre sí en una jerarquía determinada por su complejidad y el nivel de compromiso, su potencial para apoyar la ciencia práctica y su proximidad a la coproducción ideal con los usuarios del conocimiento. Nuestros resultados proporcionan directrices claras para que los científicos de la conservación generen ciencia práctica para abordar los retos de conservación que enfrenta la biodiversidad mundial.

A decision framework for estimating the cost of marine plastic pollution interventions.

Marine plastic pollution has emerged as one of the most pressing environmental challenges of our time. Although there has been a surge in global investment for implementing interventions to mitigate plastic pollution, there has been little attention given to the cost of these interventions. We developed a decision support framework to identify the economic, social, and ecological costs and benefits of plastic pollution interventions for different sectors and stakeholders. We calculated net cost as a function of six cost and benefit categories with the following equation: cost of implementing an intervention (direct, indirect, and nonmonetary costs) minus recovered costs and benefits (monetary and nonmonetary) produced by the interventions. We applied our framework to two quantitative case studies (a solid waste management plan and a trash interceptor) and four comparative case studies, evaluating the costs of beach cleanups and waste-to-energy plants in various contexts, to identify factors that influence the costs of plastic pollution interventions. The socioeconomic context of implementation, the spatial scale of implementation, and the time scale of evaluation all influence costs and the distribution of costs across stakeholders. Our framework provides an approach to estimate and compare the costs of a range of interventions across sociopolitical and economic contexts.

Un Marco de Decisión para Estimar el Costo de Intervenciones en la Contaminación Marina por Plástico Resumen La contaminación marina por plásticos ha emergido como uno de los retos ambientales más prioritarios de nuestro tiempo. Mientras ha habido un aumento en la inversión global para implementar intervenciones para mitigar la contaminación por plásticos, se ha dado poca atención al costo de estas intervenciones. Desarrollamos un marco de soporte a las decisiones para identificar los costos y beneficios económicos, sociales y ecológicos de las intervenciones en la contaminación por plástico para diferentes sectores y partes interesadas. Calculamos el costo neto como una función de 6 categorías de costo y beneficio con la siguiente ecuación: costo de la implementación de una intervención (costos directos, indirectos y no monetarios) menos los costos y beneficios recuperados (monetarios y no monetarios) producidos por las intervenciones. Aplicamos nuestro marco a 2 estudios de caso cuantitativos (un plan de manejo de residuos sólidos y un interceptor de basura) y 4 casos de estudio comparativos evaluando los costos de limpieza de playas y plantas de transformación de desechos a energía en varios contextos para identificar los factores que influyen en los costos de las intervenciones de la contaminación por plástico. El contexto socioeconómico de la implementación, la escala espacial de la implementación y la escala de tiempo de evaluación influyen en los costos y distribución de costos entre las partes interesadas. Nuestro marco proporciona una aproximación para estimar y comparar los costos de una gama de intervenciones en contextos sociopolíticos y económicos.

Global reforestation and biodiversity conservation.

The loss of forest is a leading cause of species extinction, and reforestation is 1 of 2 established interventions for reversing this loss. However, the role of reforestation for biodiversity conservation remains debated, and lacking is an assessment of the potential contribution that reforestation could make to biodiversity conservation globally. We conducted a spatial analysis of overlap between 1,550 forest-obligate threatened species' ranges and land that could be reforested after accounting for socioeconomic and ecological constraints. Reforestation on at least 43% (∼369 million ha) of reforestable area was predicted to potentially benefit threatened vertebrates. This is approximately 15% of the total area where threatened vertebrates occur. The greatest opportunities for conserving threatened vertebrate species are in the tropics, particularly Brazil and Indonesia. Although reforestation is not a substitute for forest conservation, and most of the area containing threatened vertebrates remains forested, our results highlight the need for global conservation strategies to recognize the potentially significant contribution that reforestation could make to biodiversity conservation. If implemented, reforestation of ∼369 million ha would also contribute substantially to climate-change mitigation, offering a way to achieve multiple sustainability commitments at once. Countries must now work to overcome key barriers (e.g., unclear revenue streams, high transaction costs) to investment in reforestation.

Reforestación Mundial y Conservación de la Biodiversidad Resumen La pérdida de los bosques es una de las causas principales de la extinción de especies y la reforestación es una de las dos intervenciones establecidas para revertir esta pérdida. Sin embargo, el papel de la reforestación en la conservación de la biodiversidad todavía se debate, además de que hay una falta de evaluación de la contribución potencial que podría dar la reforestación a la conservación mundial de la biodiversidad. Realizamos un análisis espacial del traslape de la distribución de 1,550 especies obligadas de bosque que se encuentran amenazadas y el suelo que podría utilizarse para reforestar después de considerar las restricciones socioeconómicas y ecológicas. El análisis predijo que la reforestación en al menos el 43% (∼ 369 millones de ha) del área que se puede reforestar beneficiará potencialmente a los vertebrados amenazados. Esto es aproximadamente el 15% del área total en donde están presentes los vertebrados amenazados. Las oportunidades más grandes para conservar a las especies amenazadas de vertebrados se encuentran en los trópicos, particularmente en Brasil y en Indonesia. Aunque la reforestación no es un sustituto para la conservación de los bosques, y aunque la mayoría del área que contiene vertebrados amenazados todavía tiene flora original, nuestros resultados resaltan la necesidad de tener estrategias mundiales de conservación para reconocer la contribución potencialmente significativa que podría dar la reforestación a la conservación de la biodiversidad. Si se implementa, la reforestación de ∼369 millones de ha también contribuiría significativamente a la mitigación del cambio climático, ofreciendo así una manera de cumplir varios compromisos de sustentabilidad a la vez. Los países ahora deben trabajar para sobreponerse a las barreras importantes (p. ej.: flujos inciertos de ingresos, costos elevados de las transacciones) que enfrentan las inversiones para la reforestación.

Conservation triage or injurious neglect in endangered species recovery.

Listing endangered and threatened species under the US Endangered Species Act is presumed to offer a defense against extinction and a solution to achieve recovery of imperiled populations, but only if effective conservation action ensues after listing occurs. The amount of government funding available for species protection and recovery is one of the best predictors of successful recovery; however, government spending is both insufficient and highly disproportionate among groups of species, and there is significant discrepancy between proposed and actualized budgets across species. In light of an increasing list of imperiled species requiring evaluation and protection, an explicit approach to allocating recovery funds is urgently needed. Here I provide a formal decision-theoretic approach focusing on return on investment as an objective and a transparent mechanism to achieve the desired recovery goals. I found that less than 25% of the $1.21 billion/year needed for implementing recovery plans for 1,125 species is actually allocated to recovery. Spending in excess of the recommended recovery budget does not necessarily translate into better conservation outcomes. Rather, elimination of only the budget surplus for "costly yet futile" recovery plans can provide sufficient funding to erase funding deficits for more than 180 species. Triage by budget compression provides better funding for a larger sample of species, and a larger sample of adequately funded recovery plans should produce better outcomes even if by chance. Sharpening our focus on deliberate decision making offers the potential to achieve desired outcomes in avoiding extinction for Endangered Species Act-listed species.

Designing connected marine reserves in the face of global warming.

Marine reserves are widely used to protect species important for conservation and fisheries and to help maintain ecological processes that sustain their populations, including recruitment and dispersal. Achieving these goals requires well-connected networks of marine reserves that maximize larval connectivity, thus allowing exchanges between populations and recolonization after local disturbances. However, global warming can disrupt connectivity by shortening potential dispersal pathways through changes in larval physiology. These changes can compromise the performance of marine reserve networks, thus requiring adjusting their design to account for ocean warming. To date, empirical approaches to marine prioritization have not considered larval connectivity as affected by global warming. Here, we develop a framework for designing marine reserve networks that integrates graph theory and changes in larval connectivity due to potential reductions in planktonic larval duration (PLD) associated with ocean warming, given current socioeconomic constraints. Using the Gulf of California as case study, we assess the benefits and costs of adjusting networks to account for connectivity, with and without ocean warming. We compare reserve networks designed to achieve representation of species and ecosystems with networks designed to also maximize connectivity under current and future ocean-warming scenarios. Our results indicate that current larval connectivity could be reduced significantly under ocean warming because of shortened PLDs. Given the potential changes in connectivity, we show that our graph-theoretical approach based on centrality (eigenvector and distance-weighted fragmentation) of habitat patches can help design better-connected marine reserve networks for the future with equivalent costs. We found that maintaining dispersal connectivity incidentally through representation-only reserve design is unlikely, particularly in regions with strong asymmetric patterns of dispersal connectivity. Our results support previous studies suggesting that, given potential reductions in PLD due to ocean warming, future marine reserve networks would require more and/or larger reserves in closer proximity to maintain larval connectivity.

Testing the feasibility of a hypothetical whaling-conservation permit market in Norway.

A cap-and-trade system for managing whale harvests represents a potentially useful approach to resolve the current gridlock in international whale management. The establishment of whale permit markets, open to both whalers and conservationists, could reveal the strength of conservation demand, about which little is known. This lack of knowledge makes it difficult to predict the outcome of a hypothetical whale permit market. We developed a bioeconomic model to evaluate the influence of economic uncertainty about demand for whale conservation or harvest. We used simulations over a wide range of parameterizations of whaling and conservation demands to examine the potential ecological consequences of the establishment of a whale permit market in Norwegian waters under bounded (but substantial) economic uncertainty. Uncertainty variables were slope of whaling and conservation demand, participation level of conservationists and their willingness to pay for whale conservation, and functional forms of demand, including linear, quadratic, and log-linear forms. A whale-conservation market had the potential to yield a wide range of conservation and harvest outcomes, the most likely outcomes were those in which conservationists bought all whale permits.

Statin use is associated with decreased prostate cancer recurrence in men treated with brachytherapy.

PURPOSE/OBJECTIVE(S): Recent in vitro and in vivo evidence has suggested that statin medications may have anticancer activity. We sought to determine whether statin use was associated with improved clinical outcome in men treated with brachytherapy for prostate cancer. MATERIALS/METHODS: A database of men with prostate cancer treated with permanent Iodine-125 brachytherapy between January 1999 and February 2009 was retrospectively analyzed. Standard guidelines (i.e., American Brachytherapy Society selection criteria) were used for selecting patients for brachytherapy. Biochemical failure was defined using the Phoenix definition. RESULTS: From a total of 247 men with prostate adenocarcinoma treated with brachytherapy, 174 patients (70 %) were identified as using statin medications, either during initial visit or during follow-up. Median PSA follow-up was 51 months after date of implant (range 9.4-140.35). Overall biochemical failure rate was 7.3 % (18 patients). On univariate analysis, statin use was associated with significantly improved freedom from biochemical failure [hazard ratio (HR) 0.28; 95 % CI 0.10-0.72; p < 0.01 by log-rank test]. In multivariate Cox analysis performed with the variables statin use, pretreatment PSA, clinical T stage, Gleason score, and D90 or V100, statin use remained significantly associated with improved freedom from biochemical failure (HR 0.288; 95 % CI 0.086-0.886; p = 0.0299). CONCLUSIONS: Statin use was associated with a significant improvement in freedom from biochemical failure in this cohort of men treated with brachytherapy for prostate cancer. Further investigation into the favorable effect of statin use on brachytherapy and radiation therapy in general is warranted, including prospective trials.

Assessing the impact of the U.S. Endangered Species Act recovery planning guidelines on managing threats for listed species.

The Endangered Species Act (ESA) of the United States was enacted in 1973 to prevent the extinction of species. Recovery plans, required by 1988 amendments to the ESA, play an important role in organizing these efforts to protect and recover species. To improve the use of science in the recovery planning process, the Society for Conservation Biology (SCB) commissioned an independent review of endangered species recovery planning in 1999. From these findings, the SCB made key recommendations for how management agencies could improve the recovery planning process, after which the U.S. Fish and Wildlife Service and the National Marine Fisheries Service redrafted their recovery planning guidelines. One important recommendation called for recovery plans to make threats a primary focus, including organizing and prioritizing recovery tasks for threat abatement. We sought to determine the extent to which results from the SCB study were incorporated into these new guidelines and whether the SCB recommendations regarding threats manifested in recovery plans written under the new guidelines. Recovery planning guidelines generally incorporated the SCB recommendations, including those for managing threats. However, although recent recovery plans have improved in their treatment of threats, many fail to adequately incorporate threat monitoring. This failure suggests that developing clear guidelines for monitoring should be an important priority in improving ESA recovery planning.

Baseline prostate inflammation is associated with a reduced risk of prostate cancer in men undergoing repeat prostate biopsy: results from the REDUCE study.

BACKGROUND: The current study was performed to evaluate whether baseline acute and chronic prostate inflammation among men with an initial negative biopsy for prostate cancer (PCa) increased the risk of subsequent PCa detection in a clinical trial with systematic biopsies. METHODS: A retrospective analysis was performed of 6238 men aged 50 years to 75 years with prostate-specific antigen levels between 2.5 ng/mL and 10 ng/mL and a prior negative biopsy in the REduction by DUtasteride of PCa Events study who completed a 2-year biopsy. PCa, acute prostate inflammation, and chronic prostate inflammation were assessed by central review. The association between inflammation in baseline prostate biopsies and positive 2-year and 4-year repeat biopsies was evaluated with the chi-square test and logistic regression analysis adjusting for baseline covariates. RESULTS: Acute and chronic inflammation and both were detected in 46 baseline biopsies (1%), 3931 baseline biopsies (63%), and 892 baseline biopsies (14%), respectively. Acute and chronic inflammation were found to be significantly associated with each other (P<.001). Acute inflammation at baseline biopsy was associated with younger age, lower prostate-specific antigen levels, and a smaller prostate (all P<.01), whereas chronic inflammation was associated with older age and larger prostate glands (all P<0.01). At the 2-year biopsy, the prevalence of PCa was 14% (N=900 patients). On univariable and multivariable analysis, both acute and chronic inflammation were found to be significantly associated with a lower PCa risk (acute univariable: odds ratio [OR], 0.65 [P<.001] and multivariable: OR, 0.75 [P=.012] and chronic univariable: OR, 0.61 [P<.001] and multivariable: OR, 0.65 [P<.001]). At the time of 4-year biopsy, only acute inflammation was found to be associated with a lower PCa risk. CONCLUSIONS: Baseline acute and chronic inflammation were both found to be independently associated with a lower PCa risk. From a clinical standpoint, inflammation in negative biopsies for PCa may lower the risk of subsequent PCa detection.

Prognostic utility of the cell cycle progression score generated from biopsy in men treated with prostatectomy.

PURPOSE: The cell cycle progression score is associated with prostate cancer outcomes in various clinical settings. However, previous studies of men treated with radical prostatectomy evaluated cell cycle progression scores generated from resected tumor tissue. We evaluated the prognostic usefulness of the score derived from biopsy specimens in men treated with radical prostatectomy. MATERIALS AND METHODS: We evaluated the cell cycle progression score in cohorts of patients from the Martini Clinic (283), Durham Veterans Affairs Medical Center (176) and Intermountain Healthcare (123). The score was derived from simulated biopsy (Martini Clinic) or diagnostic biopsy (Durham Veterans Affairs Medical Center and Intermountain Healthcare) and evaluated for an association with biochemical recurrence and metastatic disease. RESULTS: In all 3 cohorts the cell cycle progression score was associated with biochemical recurrence and metastatic disease. The association with biochemical recurrence remained significant after adjusting for other prognostic clinical variables. On combined analysis of all cohorts (total 582 patients) the score was a strong predictor of biochemical recurrence on univariate analysis (HR per score unit 1.60, 95% CI 1.35-1.90, p=2.4×10(-7)) and multivariate analysis (HR per score unit 1.47, 95% CI 1.23-1.76, p=4.7×10(-5)). Although there were few events (12), the cell cycle progression score was the strongest predictor of metastatic disease on univariate analysis (HR per score unit 5.35, 95% CI 2.89-9.92, p=2.1×10(-8)) and after adjusting for clinical variables (HR per score unit 4.19, 95% CI 2.08-8.45, p=8.2×10(-6)). CONCLUSIONS: The cell cycle progression score derived from a biopsy sample was associated with adverse outcomes after surgery. These results indicate that the score can be used at disease diagnosis to better define patient prognosis and enable more appropriate clinical care.

Conservation markets for wildlife management with case studies from whaling.

Although market-based incentives have helped resolve many environmental challenges, conservation markets still play a relatively minor role in wildlife management. Establishing property rights for environmental goods and allowing trade between resource extractors and resource conservationists may offer a path forward in conserving charismatic species like whales, wolves, turtles, and sharks. In this paper, we provide a conceptual model for implementing a conservation market for wildlife and evaluate how such a market could be applied to three case studies for whales (minke [Balaenoptera acutorostrata], bowhead [Balaena mysticetus], and gray [Eschrictius robustus]). We show that, if designed and operated properly, such a market could ensure persistence of imperiled populations, while simultaneously improving the welfare of resource harvesters.

PTEN loss in biopsy tissue predicts poor clinical outcomes in prostate cancer.

OBJECTIVES: To determine whether PTEN status in prostate biopsy represents a predictor of intermediate and long-term oncological outcomes after radical prostatectomy, and whether PTEN status predicts response to androgen deprivation therapy. METHODS: In a retrospective analysis of 77 men treated by radical prostatectomy who underwent diagnostic biopsy between 1992-2006, biopsy samples were stained for PTEN expression by the PREZEON assay with >10% staining reported as positive. Cox proportional hazards and log-rank models were used to assess the correlation between PTEN loss and clinical outcomes. RESULTS: During a median follow-up period after radical prostatectomy of 8.8 years, 39 men (51%) developed biochemical recurrence, four (5%) had castration-resistant prostate cancer, two (3%) had metastasis and two (3%) died from prostate cancer. PTEN loss was not significantly associated with biochemical recurrence (hazard ratio 2.1, 95% confidence interval 0.9-5.1, P = 0.10), but significantly predicted increased risk of castration-resistant prostate cancer, metastasis and prostate cancer-specific mortality (all log-rank, P < 0.0001), and time from androgen deprivation therapy to castration-resistant prostate cancer (log-rank, P = 0.003). No patient without PTEN loss developed metastases or died from prostate cancer. CONCLUSIONS: PTEN loss at the time of biopsy seems to predict time to development of metastasis, prostate cancer-specific mortality and, for the first time, castration-resistant prostate cancer and response to androgen deprivation therapy after radical prostatectomy. If confirmed by larger studies, this would support the use of PTEN loss as an early marker of aggressive prostate cancer.

Identifying opportunities for high resolution pesticide usage data to improve the efficiency of endangered species pesticide risk assessment.

The US pesticide registration and review process requires regular re-assessment of the risk of pesticide use to species listed under the Endangered Species Act (ESA), yet current assessment methods are inefficient when applied to hundreds of pesticides potentially impacting multiple species across a continent. Thus, many pesticides remain on the market without complete review. We assessed the value of using high resolution pesticide usage data in the risk assessment process to rapidly improve process efficiency. By using data available only in California, we found that high resolution data increased the number of species deemed not likely to be adversely affected by pesticides from <5 % to nearly 50 %. Across the contiguous US, we predicted that 48 % of species would be deemed not likely to be adversely affected using high resolution data, compared to 20 % without. However, if such data were available in just 11 states, 68 % of the available gains in efficiency could be obtained. Overall, using existing high-resolution data in California and a focused collection of such information from 11 other states could reduce risk assessment burden across the contiguous U.S. by one-quarter.

Prioritizing resource allocation to reduce adverse effects of pesticide risk for endangered species.

The use of pesticides promotes food security because of the multiple benefits it brings to agriculture, such as reduction in crop losses. However, the use of pesticides can be potentially harmful to non-target species. In the U.S., the Environmental Protection Agency regulates the use of pesticides to manage the risks associated with these agents and to protect species under the Endangered Species Act. As part of these regulations, pesticides must be registered and then reviewed every 15 years to ensure the use conditions are updated with the best available data. The registration and review process can invoke corrective measures to ensure protection of endangered species. However, the registration review process is highly resource and time consuming. There is currently a backlog of unreviewed pesticides, leaving a large quantity of pesticides without updated use conditions to protect species. Identifying ways to streamline this process is urgently needed. We develop a sequencing approach to address the risk assessment bottleneck in the pesticide registration and review process and identify species that would benefit most from detailed assessments. We then demonstrate the magnitude of potential efficiencies using this sequencing process for 61 terrestrial listed species in the state of California. Our results show a consistent ranking of listed species according to their relative benefits from assessment, with 90 % of the species being robustly classified across scenarios in the sensitivity analysis. We found that prioritizing the assessment of a small group of species could potentially result in high conservation benefits, and identify species in need of more detailed data for a robust sequencing. We examine how a sequencing approach can guide decisions about what species might benefit most from different levels of assessment. Our results demonstrate the conservation benefits of employing a sequencing approach to prioritize the allocation of limited resources for endangered species.

Association between exercise and primary incidence of prostate cancer: does race matter?

BACKGROUND: Exercise is a modifiable lifestyle risk factor associated with prostate cancer risk reduction. However, whether this association is different as a function of race is unclear. In the current study, the authors attempted to characterize the link between exercise and prostate cancer (CaP) in white and black American men. METHODS: Using a prospective design, 307 men (164 of whom were white and 143 of whom were black) who were undergoing prostate biopsy completed a self-reported survey that assessed exercise behavior (metabolic equivalent [MET] hours per week). Crude and adjusted logistic regression analyses were used to estimate the risk of prostate cancer controlling for age, body mass index, digital rectal examination findings, previous biopsy, Charlson comorbidity score, and family history of CaP stratified by self-reported race. RESULTS: There was no significant difference noted with regard to the amount of exercise between racial groups (P = .12). Higher amounts of MET hours per week were associated with a decreased risk of CaP for white men in both crude (P = .02) and adjusted (P = .04) regression models. Among whites, men who exercised ≥ 9 MET hours per week were less likely to have a positive biopsy result compared with men exercising < 9 MET hours per week (odds ratio, 0.47; 95% confidence interval, 0.22-0.99 [P = .047]). There was no association noted between MET hours per week and risk of CaP among black men in both crude (P = .79) and adjusted (P = .76) regression models. CONCLUSIONS: In a prospective cohort of men undergoing biopsy, increased exercise, measured as MET hours per week, was found to be associated with CaP risk reduction among white but not black men. Investigating race-specific mechanisms by which exercise modifies CaP risk and why these mechanisms disfavor black men in particular are warranted.

Androgenetic alopecia at various ages and prostate cancer risk in an equal-access multiethnic case-control series of veterans.

PURPOSE: Epidemiological data are conflicting regarding the association between androgenetic alopecia (AA) and prostate cancer (CaP). We examined the relationship between these two conditions. MATERIALS AND METHODS: We performed a case-control study at a Veterans Affairs Hospital among 708 men: 312 healthy controls, 167 men with CaP, and 229 men without CaP on prostate biopsy. Participants were asked to self-describe hair patterns at ages 30 and 40 and at study enrollment. We tested the association between hair pattern (overall, vertex, or frontal) and CaP status using logistic regression analysis adjusting for multiple clinical features. Disease grade was similarly examined as a secondary outcome. RESULTS: Relative to healthy controls, younger age of AA onset was significantly associated with increased CaP risk (p = 0.008). Similar patterns were noted for frontal (p = 0.005) and not vertex balding (p = 0.22). When compared with biopsy-negative men, a similar pattern was seen with younger age of AA onset having higher risk of CaP, though this was not significant (p = 0.07). A suggestion for younger age of AA onset for frontal (p = 0.07) being associated with CaP versus biopsy-negative men was also observed. Overall balding (yes/no) was associated with greater than twofold increase in high-grade disease (p = 0.02). CONCLUSIONS: Men reporting earlier AA onset were at increased CaP risk and suggestively had more aggressive disease. Contrary to other studies, frontal balding was the predominant pattern associated with elevated CaP risk. Further study is required to confirm these findings in a larger sample and to better understand the role of AA, androgens, and CaP biology.

Emergent ureteric stent vs percutaneous nephrostomy for obstructive urolithiasis with sepsis: patterns of use and outcomes from a 15-year experience.

OBJECTIVES: To characterize the use of emergent JJ ureteric stent placement and percutaneous nephrostomy (PCN) for patients with obstructive urolithiasis with sepsis, and to determine whether outcomes differ between the two treatment methods. PATIENTS AND METHODS: A total of 130 patients with obstructive urolithiasis and systemic inflammatory response syndrome criteria were identified retrospectively from a single health system database from 1995 to 2011. Primary outcomes included stone-related and clinical variables which predicted the use of each treatment method. Secondary outcomes included the length of hospital stay, risk of intensive care unit (ICU) admission, and surgical approach used for definitive stone management. RESULTS: The overall rate of failed procedures was 2.3% (3/130), with one in-hospital death (0.8%). Patients treated with PCN had larger stones (10 vs 7 mm, P = 0.031), and were more acutely ill (acute physiology, age, chronic health evaluation [APACHE] II scores of 15 vs 11, P = 0.036) than those treated with JJ stent placement. Patients treated with PCN were more likely to require ICU admission (odds ratio: 3.23, 95% confidence interval [CI]: 1.24-8.41, P = 0.016), and demonstrated longer length of hospital stay (ß: 0.47, 95% CI: 0.20-0.74, P = 0.001), even when adjusting for age, APACHE II score, and Charlson Comorbidity Index score. After resolution of sepsis, patients treated with PCN were more likely to be treated definitively with a percutaneous approach, while patients treated with JJ stent placement were more likely to be treated ureteroscopically. CONCLUSIONS: Both JJ stent placement and PCN drainage appear effective. Patients with larger stones and who are more acutely ill are more likely to be treated with PCN. Additional randomized clinical trials of adequate power are warranted to define the optimum management of these often complex cases.