Analysis of Longitudinal Marginal Structural Models

In this article we construct and study estimators of the causal effect of a time-dependent treatment on survival in longitudinal studies. We employ a particular marginal structural model (MSM), and follow a general methodology for constructing estimating functions in censored data models. The inverse probability of treatment weighted (IPTW) estimator is used as an initial estimator and the corresponding treatment-orthogonalized, one-step estimator is consistent and asymptotically linear when the treatment mechanism is consistently estimated. We extend these methods to handle informative censoring. A simulation study demonstrates that the the treatment-orthogonalized, one-step estimator is superior to the IPTW estimator in terms of efficiency. The proposed methodology is employed to estimate the causal effect of exercise on mortality in a longitudinal study of seniors in Sonoma County

Dynamical Friction in dE Globular Cluster Systems

The dynamical friction timescale for globular clusters to sink to the center of a dwarf elliptical galaxy (dE) is significantly less than a Hubble time if the halos have King-model or isothermal profiles and the globular clusters formed with the same radial density profile as the underlying stellar population. We examine the summed radial distribution of the entire globular cluster systems and the bright globular cluster candidates in 51 Virgo and Fornax Cluster dEs for evidence of dynamical friction processes. We find that the summed distribution of the entire globular cluster population closely follows the exponential profile of the underlying stellar population. However, there is a deficit of bright clusters within the central regions of dEs (excluding the nuclei), perhaps due to the orbital decay of these massive clusters into the dE cores. We also predict the magnitude of each dE's nucleus assuming the nuclei form via dynamical friction. The observed trend of decreasing nuclear luminosity with decreasing dE luminosity is much stronger than predicted if the nuclei formed via simple dynamical friction processes. We find that the bright dE nuclei could have been formed from the merger of orbitally decayed massive clusters, but the faint nuclei are several magnitudes fainter than expected. These faint nuclei are found primarily in M_V > -14 dEs which have high globular cluster specific frequencies and extended globular cluster systems. In these galaxies, supernovae-driven winds, high central dark matter densities, extended dark matter halos, the formation of new star clusters, or tidal interactions may act to prevent dynamical friction from collapsing the entire globular cluster population into a single bright nucleus.Comment: 15 pages, 2 tables, 7 figures; to appear in the Astrophysical Journal, April 20, 200

Cultivation of Industrial Hemp on and Near Airports: Implications for Wildlife Use and Risk to Aviation Safety

Land-use planning on and near airports should consider possible revenue from land covers, associated maintenance costs, and potential for land covers to attract vertebrate species recognized as hazardous to aviation safety. The U.S. Federal Aviation Administration has expressed interest in recent attention given to industrial hemp (Cannabis sativa L.; hemp) as a revenue-producing land cover that might be cultivated on or near airports. Our purpose was to better understand the potential production value of hemp as well as its possible role in affecting aviation safety if cultivated on or near airports. Our objectives were to: (1) review the literature relative to a historical perspective of hemp cultivation in the United States, projected cultivation practices, and anticipated economic viability, (2) use our review to gather information on vertebrate use of hemp cultivars, and (3) revisit U.S. and international regulations on land covers near airports relative to attraction of species recognized as hazardous to aviation safety. We found, via review of peer-reviewed and gray literature, that hemp holds potential as an emerging crop in the United States, contributing to food, medicine, and biomass-derived products as well as evidence that birds will use, if not depredate, the crop. However, future markets promoting cultivation of hemp remain tentative. Further, there has been no objective quantification of bird and other wildlife use of hemp alone or as a component of a land cover matrix on or near airports and relative to implications for aviation safety. We make recommendations for future research on wildlife use of hemp and metrics necessary to inform aviation safety

Cost-effectiveness of routine mediastinoscopy in computed tomography– and positron emission tomography–screened patients with stage I lung cancer

ObjectiveAccurate preoperative staging is essential for the optimal management of patients with lung cancer. An important goal of preoperative staging is to identify mediastinal lymph node metastasis. Computed tomography and positron emission tomography may identify mediastinal lymph node metastasis with sufficient sensitivity to allow omission of mediastinoscopy. This study utilizes our experience with patients with clinical stage I lung cancer to perform a decision analysis addressing whether mediastinoscopy should be performed in clinical stage I lung cancer patients staged by computed tomography and positron emission tomography.MethodsWe retrospectively reviewed our thoracic surgery database for cases between May 1999 and May 2004. Patients deemed clinical stage I by computed tomography and positron emission tomography were chosen for further study. Individual computed tomography, positron emission tomography, and operative and pathology reports were reviewed. The postresection pathologic staging and long-term survival were recorded. A decision model was created using TreeAgePro software and our observed data for the prevalence of mediastinal lymph node metastases and for the rate of benign nodules. Data reported in the literature were also utilized to complete the decision analysis model. A sensitivity analysis of key variables was performed.ResultsA total of 248 patients with clinical stage I lung tumors were identified. One hundred seventy-eight patients (72%) underwent mediastinoscopy before resection, and 5/178 (3%) showed N2 disease. An additional 9 patients were found to have N2 metastasis in the final resected specimen, resulting in a total of 14/248 patients (5.6%) with occult mediastinal lymph node metastases. Benign nodules were found in 19/248 (8%) of patients. Decision analysis determined that mediastinoscopy added 0.008 years of life expectancy at a cost of $250,989 per life-year gained. The outcome was sensitive to the prevalence of N2 disease in the population and the benefit of induction versus adjuvant therapy for N2 lung cancer. If the prevalence of N2 disease exceeds 10$100,000 per life-year gained.ConclusionPatients with clinical stage I lung cancer staged by computed tomography and positron emission tomography benefit little from mediastinoscopy. The survival advantage it confers is very small and is dependent on the prevalence of N2 metastasis and the unproven superiority of induction therapy over adjuvant therapy

A thoracic surgery clinic dedicated to indeterminate pulmonary nodules: Too many scans and too little pathology?

ObjectiveWidespread application of computed tomographic scans has increased detection of asymptomatic pulmonary nodules. A dedicated clinic was established to encourage referral and manage large numbers of patients with such nodules.MethodsPatients were evaluated periodically by a nurse practitioner with surgeon oversight, and follow-up imaging was centralized. Patients were rescanned at intervals on the basis of radiologist recommendation.ResultsA total of 414 patients, 189 male and 225 female with a median age of 60.2 years (20.7–84.1 years), were evaluated since April 2000. Median follow-up was 1.51 years (0–6.65 years). Thirty-seven percent (153/414) were older than 60 years with at least 10 pack-years of tobacco use, whereas 30% (123/414) had never smoked. A total of 286 patients completed at least 2 years of follow-up computed tomographic evaluation. After 2 years, 24.2% (69/286) were deemed in stable condition and were discharged from further follow-up, whereas 22.4% (64/286) of patients were followed up longer than 2 years owing to the development of new nodules. Forty-five percent (127/286) of patients did not complete their recommended follow-up at our clinic. Overall, 3% (13/414) of our patients have been shown to have a malignant tumor. Only 5 patients underwent curative resection of a primary lung cancer.ConclusionIn a population of patients with indeterminate nodules in routine clinical practice, few patients required intervention and few cancers were detected. Although the benefits of a “nodule” clinic may include patient reassurance and convenience to referring physicians, a significant number of patients did not complete their follow-up in our clinic

Experiment Description and Results for Arrival Operations Using Interval Management with Spacing to Parallel Dependent Runways (IMSPiDR)

The predicted increase in the number of commercial aircraft operations creates a need for improved operational efficiency. Two areas believed to offer increases in aircraft efficiency are optimized profile descents and dependent parallel runway operations. Using Flight deck Interval Management (FIM) software and procedures during these operations, flight crews can achieve by the runway threshold an interval assigned by air traffic control (ATC) behind the preceding aircraft that maximizes runway throughput while minimizing additional fuel consumption and pilot workload. This document describes an experiment where 24 pilots flew arrivals into the Dallas Fort-Worth terminal environment using one of three simulators at NASA?s Langley Research Center. Results indicate that pilots delivered their aircraft to the runway threshold within +/- 3.5 seconds of their assigned time interval, and reported low workload levels. In general, pilots found the FIM concept, procedures, speeds, and interface acceptable. Analysis of the time error and FIM speed changes as a function of arrival stream position suggest the spacing algorithm generates stable behavior while in the presence of continuous (wind) or impulse (offset) error. Concerns reported included multiple speed changes within a short time period, and an airspeed increase followed shortly by an airspeed decrease

Resummation of transverse energy in vector boson and Higgs boson production at hadron colliders

We compute the resummed hadronic transverse energy (E_T) distribution due to initial-state QCD radiation in vector boson and Higgs boson production at hadron colliders. The resummed exponent, parton distributions and coefficient functions are treated consistently to next-to-leading order. The results are matched to fixed-order calculations at large E_T and compared with parton-shower Monte Carlo predictions at Tevatron and LHC energies.Comment: 24 pages, 15 figure

Epidemiologic investigation of immune-mediated polyradiculoneuropathy among abattoir workers exposed to porcine brain

Background In October 2007, a cluster of patients experiencing a novel polyradiculoneuropathy was identified at a pork abattoir (Plant A). Patients worked in the primary carcass processing area (warm room); the majority processed severed heads (head-table). An investigation was initiated to determine risk factors for illness. Methods and Results Symptoms of the reported patients were unlike previously described occupational associated illnesses. A case-control study was conducted at Plant A. A case was defined as evidence of symptoms of peripheral neuropathy and compatible electrodiagnostic testing in a pork abattoir worker. Two control groups were used - randomly selected non-ill warm-room workers (n = 49), and all non-ill head-table workers (n = 56). Consenting cases and controls were interviewed and blood and throat swabs were collected. The 26 largest U.S. pork abattoirs were surveyed to identify additional cases. Fifteen cases were identified at Plant A; illness onsets occurred during May 2004–November 2007. Median age was 32 years (range, 21–55 years). Cases were more likely than warm-room controls to have ever worked at the head-table (adjusted odds ratio [AOR], 6.6; 95% confidence interval [CI], 1.6–26.7), removed brains or removed muscle from the backs of heads (AOR, 10.3; 95% CI, 1.5–68.5), and worked within 0–10 feet of the brain removal operation (AOR, 9.9; 95% CI, 1.2–80.0). Associations remained when comparing head-table cases and head-table controls. Workers removed brains by using compressed air that liquefied brain and generated aerosolized droplets, exposing themselves and nearby workers. Eight additional cases were identified in the only two other abattoirs using this technique. The three abattoirs that used this technique have stopped brain removal, and no new cases have been reported after 24 months of follow up. Cases compared to controls had higher median interferon-gamma (IFNγ) levels (21.7 pg/ml; vs 14.8 pg/ml, P<0.001). Discussion This novel polyradiculoneuropathy was associated with removing porcine brains with compressed air. An autoimmune mechanism is supported by higher levels of IFNγ in cases than in controls consistent with other immune mediated illnesses occurring in association with neural tissue exposure. Abattoirs should not use compressed air to remove brains and should avoid procedures that aerosolize CNS tissue. This outbreak highlights the potential for respiratory or mucosal exposure to cause an immune-mediated illness in an occupational setting

Epidemiologic investigation of immune-mediated polyradiculoneuropathy among abattoir workers exposed to porcine brain

Background In October 2007, a cluster of patients experiencing a novel polyradiculoneuropathy was identified at a pork abattoir (Plant A). Patients worked in the primary carcass processing area (warm room); the majority processed severed heads (head-table). An investigation was initiated to determine risk factors for illness. Methods and Results Symptoms of the reported patients were unlike previously described occupational associated illnesses. A case-control study was conducted at Plant A. A case was defined as evidence of symptoms of peripheral neuropathy and compatible electrodiagnostic testing in a pork abattoir worker. Two control groups were used - randomly selected non-ill warm-room workers (n = 49), and all non-ill head-table workers (n = 56). Consenting cases and controls were interviewed and blood and throat swabs were collected. The 26 largest U.S. pork abattoirs were surveyed to identify additional cases. Fifteen cases were identified at Plant A; illness onsets occurred during May 2004–November 2007. Median age was 32 years (range, 21–55 years). Cases were more likely than warm-room controls to have ever worked at the head-table (adjusted odds ratio [AOR], 6.6; 95% confidence interval [CI], 1.6–26.7), removed brains or removed muscle from the backs of heads (AOR, 10.3; 95% CI, 1.5–68.5), and worked within 0–10 feet of the brain removal operation (AOR, 9.9; 95% CI, 1.2–80.0). Associations remained when comparing head-table cases and head-table controls. Workers removed brains by using compressed air that liquefied brain and generated aerosolized droplets, exposing themselves and nearby workers. Eight additional cases were identified in the only two other abattoirs using this technique. The three abattoirs that used this technique have stopped brain removal, and no new cases have been reported after 24 months of follow up. Cases compared to controls had higher median interferon-gamma (IFNγ) levels (21.7 pg/ml; vs 14.8 pg/ml, P<0.001). Discussion This novel polyradiculoneuropathy was associated with removing porcine brains with compressed air. An autoimmune mechanism is supported by higher levels of IFNγ in cases than in controls consistent with other immune mediated illnesses occurring in association with neural tissue exposure. Abattoirs should not use compressed air to remove brains and should avoid procedures that aerosolize CNS tissue. This outbreak highlights the potential for respiratory or mucosal exposure to cause an immune-mediated illness in an occupational setting