1,136 research outputs found
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 360âdays 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 (â„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 (>â80% versus â€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 wellâcontrolled epilepsy is challenging. We evaluated (a) the correlation between neurologists' seizure risk estimation (âclinician predictionsâ) 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 2âyear seizure risk after ASM withdrawal for hypothetical vignettes. We compared ASM withdrawal recommendations before vs after viewing calculated predictions, using generalized linear models.
Results
Threeâhundred and fortyâsix neurologists responded. There was moderate correlation between clinician and calculated predictions (Spearman coefficient 0.42). Clinician predictions varied widely, for example, predictions ranged 5%â100% for a 2âyear seizureâfree 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%â74%; calculated 46%) and surgical vignettes (eg, focal cortical dysplasia 6âmonth seizureâfree mean clinician 56%, 95% CI 52%â60%; calculated 28%). Clinicians overestimated the influence of epileptiform EEG findings on withdrawal risk (26%, 95% CI 24%â28%) compared with calculators (14%, 95% 13%â14%). Viewing calculated predictions slightly reduced willingness to withdraw (â0.8/10 change, 95% CI â1.0 to â0.7), 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 lowârisk patients and overestimated risk and the influence of seizureâfree duration for surgical patients, compared with calculators. These data may question widespread ordering of EEGs or timeâbased seizureâfree 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 , , in a sample of 232
million decays to \BBb ~pairs collected with the \babar detector
at the PEP-II asymmetric-energy storage ring. We find no significant
signal and set upper bounds for the branching fractions: and at 90% confidence level.Comment: 8 pages, 2 figures, submitted to PRD-R
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