Stronger instruments and refined covariate balance in an observational study of the effectiveness of prompt admission to intensive care units

Instrumental variable methods, subject to appropriate identification assumptions, enable consistent estimation of causal effects in the presence of unobserved confounding. Near–far matching has been proposed as one analytic method to improve inference by strengthening the effect of the instrument on the exposure and balancing observable characteristics between groups of subjects with low and high values of the instrument. However, in settings with hierarchical data (e.g. patients nested within hospitals), or where several covariate interactions must be balanced, conventional near–far matching algorithms may fail to achieve the requisite covariate balance. We develop a new matching algorithm, that combines near–far matching with refined covariate balance, to balance large numbers of nominal covariates while also strengthening the instrumental variable. This extension of near–far matching is motivated by a case-study that aims to identify the causal effect of prompt admission to an intensive care unit on 7-day and 28-day mortality

Periodic cometary showers: Real or imaginary?

Since the initial reports in 1980, a considerable body of chemical and physical evidence has been accumulated to indicate that a major impact event occurred on earth 65 million years ago. The effects of this event were global in extent and have been suggested as the cause of the sudden demise or mass extinction of a large percentage of life, including the dinosaurs, at the end of the geologic time period known as the Cretaceous. Recent statistical analyses of extinctions in the marine faunal record for the last 250 million years have suggested that mass extinctions may occur with a periodicity of every 26 to 30 million years. Following these results, other workers have attempted to demonstrate that these extinction events, like that at the end of the Cretaceous, are temporally correlated with large impact events. A recent scenario suggests that they are the result of periodic showers of comets produced by either the passage of the solar system through the galactic plane or by perturbations of the cometary cloud in the outer solar system by a, as yet unseen, solar companion. This hypothesized solar companion has been given the name Nemesis

An Examination of Sport Fans’ Perceptions of the Impact of the Legalization of Sport Wagering on Their Fan Experience

Over the years, professional and collegiate organizations have fought attempts to increase the legalization of sport wagering. One argument presented by those in opposition is that increased legalization would negatively alter the manner in which fans and spectators follow, consume, and react to sporting events (Tuohy, 2013). The current research was designed to examine possible changes in fandom by investigating fans’ perceptions of the impact of increasing legalized sport wagering on their fan experience, interest in sport, and sport consumption. Participants (N = 580) completed a questionnaire packet assessing demographics, economic fan motivation, fandom, and perceptions of the impact of increased access to legalized sport gambling. Data and analyses indicated that expected impacts were small and generally positive (e.g., a modest increase in interest in sport and consumption) and that these effects were greatest among groups historically active in sport gambling (e.g., persons higher in economic motivation and sport fandom)

Geophysical characteristics and crustal structure of greenstone terranes: Canadian Shield

Geophysical studies in the Canadian Shield have provided some insights into the tectonic setting of greenstone belts. Greenstone belts are not rooted in deep crustal structures. Geophysical techniques consistently indicate that greenstones are restricted to the uppermost 10 km or so of crust and are underlain by geophysically normal crust. Gravity models suggest that granitic elements are similarly restricted, although magnetic modelling suggests possible downward extension to the intermediate discontinuity around approx. 18 km. Seismic evidence demonstrates that steeply-dipping structure, which can be associated with the belts in the upper crust, is not present in the lower crust. Horizontal intermediate discontinuities mapped under adjacent greenstone and granitic components are not noticeably disrupted in the boundary zone. Geophysical evidence points to the presence of discontinuities between greenhouse-granite and adjacent metasedimentary erranes. Measured stratigraphic thicknesses of greenstone belts are often twice or more the vertical thicknesses determined from gravity modelling. Explantations advanced for the discrepancy include stratigraphy repeated by thrust faulting and/or listric normal faulting, mechanisms which are consistent with certain aspects of conceptual models of greenstone development. Where repetition is not a factor the gravity evidence points to removal of the root zones of greenstone belts. For one region, this has been attributed to magmatic stopping during resurgent caldera activity

A rapid, chromatography-free route to substituted acridine–isoalloxazine conjugates under microwave irradiation

Microwave irradiation was applied to a sequence of condensation reactions from readily available 9-chloroacridines to provide a range of novel acridine–isoalloxazine conjugates. The combination of these two moieties, both of biological interest, was achieved by a chromatography free route

A flashback on the dawn of the meteorite impact/extinction theory

Presented are my personal recollections on some of the major contributions by the Alvarez groups to the birth and development of the meteorite impact/extinction theory

Tumour markers in breast cancer.

The clinical usefulness of 8 potential tumour markers has been evaluated in 69 patients with Stage I and II breast cancer and 57 patients with Stage III and IV. Serum CEA concentrations were raised in 13% of patients with local and 65% of those with advanced breast cancer. In patients with clinical evidence of progression or regression of tumour, serum CEA levels changed appropriately in 83% of cases. Taking 4 of the markers (carcinoembryonic antigen (CEA), lactalbumin, alpha subunit and haptoglobin) serum concentrations of one or more were raised in 33% of patients with local disease and 81% of those with advanced breast cancer. However, marker concentrations were often only marginally raised, and are unlikely to provide sensitive guide to tumour burden. CEA, lactalbumin and alpha subunit were detectable in 68%, 43% and 40% respectively of extracts of primary breast cancers

Measurement properties of the SF-MPQ-2 neuropathic qualities subscale in persons with CRPs: Validity, responsiveness, and Rasch analysis

© 2018 American Academy of Pain Medicine. All rights reserved. Objectives. The purpose of this study was to conduct classical psychometric evaluation and Rasch analysis on the Neuropathic Qualities subscale of the Short-Form McGill Pain Questionnaire-2 utilizing scores from persons with complex regional pain syndrome to consider reliability and person separation, validity (including unidimensionality), and responsiveness in this population. Methods. Secondary analysis of longitudinal data from persons with acute complex regional pain syndrome was utilized for analysis of the psychometric properties and fit to the Rasch model of the Neuropathic Qualities subscale. We followed an iterative process of Rasch analysis to evaluate and address data fitting challenges. Results. Repeated measures from 59 persons meeting the Budapest criteria were used for analysis. Both item-total correlations and unidimensionality analyses supported theoretical construct validity; all convergent construct validity hypotheses were also supported. Responsiveness was demonstrated comparing baseline and one-year data at d ¼ 0.92, with a standardized response mean of 0.97. Data were able to fit the Rasch model, but all Neuropathic Qualities items had disordered thresholds that required rescoring. Additionally, local dependency and differential item function were addressed by “bundling,” suggesting that no further item reduction would be possible. Conclusions. This study provided preliminary support for the validity and responsiveness of the Neuropathic Qualities subscale in persons with complex regional pain syndrome. Rasch analysis further endorses use of the Neuropathic Qualities subscale as a “stand-alone” measure for neuropathic features, but with substantial background data transformations. Replication with larger samples is recommended to increase confidence in these findings