Incidence of and predictors for antiseizure medication gaps in Medicare beneficiaries with epilepsy: a retrospective cohort study.

BACKGROUND For the two-thirds of patients with epilepsy who achieve seizure remission on antiseizure medications (ASMs), patients and clinicians must weigh the pros and cons of long-term ASM treatment. However, little work has evaluated how often ASM discontinuation occurs in practice. We describe the incidence of and predictors for sustained ASM fill gaps to measure discontinuation in individuals potentially eligible for ASM withdrawal. METHODS This was a retrospective cohort of Medicare beneficiaries. We included patients with epilepsy by requiring International Classification of Diseases codes for epilepsy/convulsions plus at least one ASM prescription each year 2014-2016, and no acute visit for epilepsy 2014-2015 (i.e., potentially eligible for ASM discontinuation). The main outcome was the first day of a gap in ASM supply (30, 90, 180, or 360 days with no pills) in 2016-2018. We displayed cumulative incidence functions and identified predictors using Cox regressions. RESULTS Among 21,819 beneficiaries, 5191 (24%) had a 30-day gap, 1753 (8%) had a 90-day gap, 803 (4%) had a 180-day gap, and 381 (2%) had a 360-day gap. Predictors increasing the chance of a 180-day gap included number of unique medications in 2015 (hazard ratio [HR] 1.03 per medication, 95% confidence interval [CI] 1.01-1.05) and epileptologist prescribing physician (≥25% of that physician's visits for epilepsy; HR 2.37, 95% CI 1.39-4.03). Predictors decreasing the chance of a 180-day gap included Medicaid dual eligibility (HR 0.75, 95% CI 0.60-0.95), number of unique ASMs in 2015 (e.g., 2 versus 1: HR 0.37, 95% CI 0.30-0.45), and greater baseline adherence (> 80% versus ≤80% of days in 2015 with ASM pill supply: HR 0.38, 95% CI 0.32-0.44). CONCLUSIONS Sustained ASM gaps were rarer than current guidelines may suggest. Future work should further explore barriers and enablers of ASM discontinuation to understand the optimal discontinuation rate

Ring-Like Structure in the Radio Lobe of MG0248+0641

We present radio and optical observations of MG0248+0641, which contains a kiloparsec-scale ring-like structure in one of its radio lobes. The radio observations show a typical core-double morphology: a central core between two lobes, each of which has a hotspot. The western radio lobe appears as a nearly continuous ring, with linear polarization electric field vectors which are oriented in a radial direction from the ring center. We consider several different interpretations for the nature of this ring, including gravitational lensing of a normal jet by a foreground galaxy. Even though simple lensing models can describe the ring morphology reasonably well, the high linear polarization seen around the ring cannot be easily explained. The chance interposition of a galactic supernova remnant, nova, planetary nebula, or H II region, has been ruled out. The highly polarized ring of MG0248+0641 is much like the prominent ring seen in 3C219, and the multiple ones in 3C310 and Hercules A, suggesting that similar physical processes are producing shell structures in these radio galaxies. The ring in MG0248+0641 may be caused by the formation of ``bubbles'', as a result of instabilities in the energy flow down the western radio jet. It may also be possible that the required instabilities are triggered by the infall of gas, via tidal interaction of the central source with a nearby galaxy. This scenario may be indicated by our marginal detection of an optical source close to the western hotspot.Comment: 21 pages. Submitted to AJ Aug 15, 1997; Accepted Sep 30, 1997. Minor changes in conten

Antiseizure medication withdrawal risk estimation and recommendations: A survey of American Academy of Neurology and EpiCARE members

Objective Choosing candidates for antiseizure medication (ASM) withdrawal in well‐controlled epilepsy is challenging. We evaluated (a) the correlation between neurologists' seizure risk estimation (“clinician predictions”) vs calculated predictions, (b) how viewing calculated predictions influenced recommendations, and (c) barriers to using risk calculation.MethodsWe asked US and European neurologists to predict 2‐year seizure risk after ASM withdrawal for hypothetical vignettes. We compared ASM withdrawal recommendations before vs after viewing calculated predictions, using generalized linear models. Results Three‐hundred and forty‐six neurologists responded. There was moderate correlation between clinician and calculated predictions (Spearman coefficient 0.42). Clinician predictions varied widely, for example, predictions ranged 5%‐100% for a 2‐year seizure‐free adult without epileptiform abnormalities. Mean clinician predictions exceeded calculated predictions for vignettes with epileptiform abnormalities (eg, childhood absence epilepsy: clinician 65%, 95% confidence interval [CI] 57%‐74%; calculated 46%) and surgical vignettes (eg, focal cortical dysplasia 6‐month seizure‐free mean clinician 56%, 95% CI 52%‐60%; calculated 28%). Clinicians overestimated the influence of epileptiform EEG findings on withdrawal risk (26%, 95% CI 24%‐28%) compared with calculators (14%, 95% 13%‐14%). Viewing calculated predictions slightly reduced willingness to withdraw (−0.8/10 change, 95% CI −1.0 to −0.7), particularly for vignettes without epileptiform abnormalities. The greatest barrier to calculator use was doubting its accuracy (44%). Significance Clinicians overestimated the influence of abnormal EEGs particularly for low‐risk patients and overestimated risk and the influence of seizure‐free duration for surgical patients, compared with calculators. These data may question widespread ordering of EEGs or time‐based seizure‐free thresholds for surgical patients. Viewing calculated predictions reduced willingness to withdraw particularly without epileptiform abnormalities

Planetary Candidates Observed by Kepler, III: Analysis of the First 16 Months of Data

New transiting planet candidates are identified in sixteen months (May 2009 - September 2010) of data from the Kepler spacecraft. Nearly five thousand periodic transit-like signals are vetted against astrophysical and instrumental false positives yielding 1,091 viable new planet candidates, bringing the total count up to over 2,300. Improved vetting metrics are employed, contributing to higher catalog reliability. Most notable is the noise-weighted robust averaging of multi-quarter photo-center offsets derived from difference image analysis which identifies likely background eclipsing binaries. Twenty-two months of photometry are used for the purpose of characterizing each of the new candidates. Ephemerides (transit epoch, T_0, and orbital period, P) are tabulated as well as the products of light curve modeling: reduced radius (Rp/R*), reduced semi-major axis (d/R*), and impact parameter (b). The largest fractional increases are seen for the smallest planet candidates (197% for candidates smaller than 2Re compared to 52% for candidates larger than 2Re) and those at longer orbital periods (123% for candidates outside of 50-day orbits versus 85% for candidates inside of 50-day orbits). The gains are larger than expected from increasing the observing window from thirteen months (Quarter 1-- Quarter 5) to sixteen months (Quarter 1 -- Quarter 6). This demonstrates the benefit of continued development of pipeline analysis software. The fraction of all host stars with multiple candidates has grown from 17% to 20%, and the paucity of short-period giant planets in multiple systems is still evident. The progression toward smaller planets at longer orbital periods with each new catalog release suggests that Earth-size planets in the Habitable Zone are forthcoming if, indeed, such planets are abundant.Comment: Submitted to ApJS. Machine-readable tables are available at http://kepler.nasa.gov, http://archive.stsci.edu/kepler/results.html, and the NASA Exoplanet Archiv

Measurement of Exclusive rho+rho- Production in Mid-Virtuality Two-Photon Interactions and Study of the gamma gamma* -> rho rho Process at LEP

Exclusive rho+rho- production in two-photon collisions between a quasi-real photon, gamma, and a mid-virtuality photon, gamma*, is studied with data collected at LEP at centre-of-mass energies root(s)=183-209GeV with a total integrated luminosity of 684.8pb^-1. The cross section of the gamma gamma* -> rho+ rho- process is determined as a function of the photon virtuality, Q^2, and the two-photon centre-of-mass energy, W_gg, in the kinematic region: 0.2GeV^2 < Q^2 <0.85GeV^2 and 1.1GeV < W_gg < 3GeV. These results, together with previous L3 measurements of rho0 rho0 and rho+ rho- production, allow a study of the gamma gamma* -> rho rho process over the Q^2-region 0.2GeV^2 < Q^2 < 30 GeV^2

Measurement of Exclusive rho^0 rho^0 Production in Mid-Virtuality Two-Photon Interactions at LEP

Exclusive rho^0 rho^0 production in two-photon collisions between a quasi-real and a mid-virtuality photon is studied with data collected at LEP at centre-of-mass energies 183GeV < sqrt{s} < 209GeV with a total integrated luminosity of 684.8/pb. The cross section of the process gamma gamma* -> rho^0 rho^0 is determined as a function of the photon virtuality, q^2, and the two-photon centre-of-mass energy, Wgg, in the kinematic region: 0.2GeV^2 < q^2 < 0.85GeV^2 and 1.1GeV < Wgg < 3GeV

Measurement of the quasi-elastic axial vector mass in neutrino-oxygen interactions

The weak nucleon axial-vector form factor for quasi-elastic interactions is determined using neutrino interaction data from the K2K Scintillating Fiber detector in the neutrino beam at KEK. More than 12,000 events are analyzed, of which half are charged-current quasi-elastic interactions nu-mu n to mu- p occurring primarily in oxygen nuclei. We use a relativistic Fermi gas model for oxygen and assume the form factor is approximately a dipole with one parameter, the axial vector mass M_A, and fit to the shape of the distribution of the square of the momentum transfer from the nucleon to the nucleus. Our best fit result for M_A = 1.20 \pm 0.12 GeV. Furthermore, this analysis includes updated vector form factors from recent electron scattering experiments and a discussion of the effects of the nucleon momentum on the shape of the fitted distributions.Comment: 14 pages, 10 figures, 6 table

Measurement of the B+ --> p pbar K+ Branching Fraction and Study of the Decay Dynamics

With a sample of 232x10^6 Upsilon(4S) --> BBbar events collected with the BaBar detector, we study the decay B+ --> p pbar K+ excluding charmonium decays to ppbar. We measure a branching fraction Br(B+ --> p pbar K+)=(6.7+/-0.5+/-0.4)x10^{-6}. An enhancement at low ppbar mass is observed and the Dalitz plot asymmetry suggests dominance of the penguin amplitude in this B decay. We search for a pentaquark candidate Theta*++ decaying into pK+ in the mass range 1.43 to 2.00 GeV/c2 and set limits on Br(B+ --> Theta*++pbar)xBr(Theta*++ --> pK+) at the 10^{-7} level.Comment: 8 pages, 7 postscript figures, submitted to Phys. Rev. D (Rapid Communications

Search for the W-exchange decays B0 --> Ds(*)- Ds(*)+

We report a search for the decays $B^{0} \to D_{s}^{-} D_{s}^{+}$, $B^{0} \to D_{s}^{*-} D_{s}^{+}$, $B^{0} \to D_{s}^{*-} D_{s}^{*+}$ in a sample of 232 million $\Upsilon(4S)$ decays to \BBb ~pairs collected with the \babar detector at the PEP-II asymmetric-energy $e^+ e^-$ storage ring. We find no significant signal and set upper bounds for the branching fractions: ${\cal B}(B^{0} \to D_{s}^{-} D_{s}^{+}) < 1.0 \times 10^{-4}, {\cal B}(B^{0} \to D_{s}^{*-} D_{s}^{+}) < 1.3 \times 10^{-4}$ and ${\cal B}(B^{0} \to D_{s}^{*-} D_{s}^{*+}) < 2.4 \times 10^{-4}$ at 90% confidence level.Comment: 8 pages, 2 figures, submitted to PRD-R