All-cause mortality following a cancer diagnosis amongst multiple sclerosis patients: A Swedish population-based cohort study

Background and purpose: A reduced cancer risk amongst patients with multiple sclerosis (MS) has been reported. Theoretically, this could represent a genuine reduction in risk or, alternatively, 'diagnostic neglect', where cancer is undiagnosed when symptoms are misattributed to MS. Objective: Assess all-cause mortality risk following a cancer diagnosis in patients with MS compared with a cohort without MS. Patients: A cohort of MS patients (n = 19 364) and a cohort of the general population (n = 192 519) were extracted from national Swedish registers from 1969 to 2005. All-cause mortality after cancer in MS was compared with the general population. Poisson regression analysis was conducted in the MS and non-MS cohorts separately. The models were adjusted for follow-up duration, year at entry, sex, region and socioeconomic index. The two cohorts were combined and differences in mortality risk were assessed using interaction testing. Results: The adjusted relative risk (and 95 confidence interval) for all-cause mortality following a cancer diagnosis in MS patients (compared with MS patients without cancer) is 3.06 (2.86-3.27; n = 1768) and amongst those without MS 5.73 (5.62-5.85; n = 24 965). This lower magnitude mortality risk in the MS patients was confirmed by multiplicative interaction testing (P < 0.001). Conclusions: A consistent pattern of lower magnitude of all-cause mortality risk following cancer in MS patients for a range of organ-specific cancer types was found. It suggests that cancer diagnoses tend not to be delayed in MS and diagnostic neglect is unlikely to account for the reduced cancer risk associated with MS. The lower magnitude cancer risk in MS may be due to disease-associated characteristics or exposures. © 2015 EAN

A method to polarise antiprotons in storage rings and create polarised antineutrons

An intense circularely polarised photon beam interacts with a cooled antiproton beam in a storage ring. Due to spin dependent absorption cross sections for the reaction gamma+antiproton > pi- + antineutron a built-up of polarisation of the stored antiprotons takes place. Figures-of-merit around 0.1 can be reached in principle over a wide range of antiproton energies. In this process antineutrons with Polarisation > 70% emerge. The method is presented for the case of 300 MeV/c cooled antiproton beam

Appendicectomy and multiple sclerosis risk

Background: Appendicectomy for acute appendicitis, but not for other causes, is inversely associated with immune-mediated diseases such as ulcerative colitis, suggesting appendicitis is a marker of immune characteristics influencing immune-mediated disease risk. This study investigated the association of appendectomy and its underlying diagnosis with multiple sclerosis (MS). Methods: Swedish general population registers and the Swedish MS register provided information on 20542 cases with MS diagnosed between 1964-2006 and 204157 controls matched for age, sex, period and region. Appendicectomy prior to MS diagnosis was identified in 673 cases and 6518 controls. Conditional logistic regression, with adjustment for socio-economic index, assessed the association of diagnosis underlying appendicitis with MS risk. Results: A perforated appendix, the best indicator of acute appendicitis in this material, was inversely associated with MS, although not statistically significantly, with an odds ratio (and 95% confidence interval of 0.86 (0.70-1.04). The odds ratios are 1.04 (0.94-1.16) for appendicitis without perforation and 1.14 (0.98-1.33) for appendectomy without appendicitis. Conclusion: Although inconclusive in terms of assessing the hypothesis, these results may help to explain why earlier studies of appendicitis and MS risk have been inconsistent, as there may be variation in association by diagnosis underlying appendicectomy. © 2010 The Author(s). European Journal of Neurology © 2010 EFNS

Similar familial risk in multiple sclerosis subgroups Introduction

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Premorbid Sociodemographic Status and Multiple Sclerosis Outcomes in a Universal Health Care Context

Importance: Multiple sclerosis (MS) severity may be informed by premorbid sociodemographic factors. Objective: To determine whether premorbid education, income, and marital status are associated with future MS disability and symptom severity, independent of treatment, in a universal health care context. Design, Setting, and Participants: This nationwide observational cohort study examined data from the Swedish MS Registry linked to national population registries from 2000 to 2020. Participants included people with MS onset from 2005 to 2015 and of working age (aged 23 to 59 years) 1 year and 5 years preceding disease onset. Exposures: Income quartile, educational attainment, and marital status measured at 1 and 5 years preceding disease onset. Main Outcome and Measures: Repeated measures of Expanded Disability Status Scale (EDSS) scores and patient-reported Multiple Sclerosis Impact Scale (MSIS-29) scores. Models were adjusted for age, sex, relapses, disease duration, and treatment exposure. Secondary analyses further adjusted for comorbidity. All analyses were stratified by disease course (relapse onset and progressive onset). Results: There were 4557 patients (mean [SD] age, 37.5 [9.3] years; 3136 [68.8%] female, 4195 [92.1%] relapse-onset MS) with sociodemographic data from 1-year preonset of MS. In relapse-onset MS, higher premorbid income and education correlated with lower disability (EDSS, -0.16 [95% CI, -0.12 to -0.20] points) per income quartile; EDSS, -0.47 [95% CI, -0.59 to -0.35] points if tertiary educated), physical symptoms (MSIS-29 physical subscore, -14% [95% CI, -11% to -18%] per income quartile; MSIS-29 physical subscore, -43% [95% CI, -35% to -50%] if tertiary educated), and psychological symptoms (MSIS-29 psychological subscore, -12% [95% CI, -9% to -16%] per income quartile; MSIS-29 psychological subscore, -25% [95% CI, -17% to -33%] if tertiary educated). Marital separation was associated with adverse outcomes (EDSS, 0.34 [95% CI, 0.18 to 0.51]; MSIS-29 physical subscore, 35% [95% CI, 12% to 62%]; MSIS-29 psychological subscore, 25% [95% CI, 8% to 46%]). In progressive-onset MS, higher income correlated with lower EDSS (-0.30 [95% CI, -0.48 to -0.11] points per income quartile) whereas education correlated with lower physical (-34% [95% CI, -53% to -7%]) and psychological symptoms (-33% [95% CI, -54% to -1%]). Estimates for 5-years preonset were comparable with 1-year preonset, as were the comorbidity-adjusted findings. Conclusions and relevance: In this cohort study of working-age adults with MS, premorbid income, education, and marital status correlated with disability and symptom severity in relapse-onset and progressive-onset MS, independent of treatment. These findings suggest that socioeconomic status may reflect both structural and individual determinants of health in MS

Association between clinic-level quality of care and patient-level outcomes in multiple sclerosis

Background: Multiple sclerosis (MS) quality of care guidelines are consensus-based. The effectiveness of the recommendations is unknown.// Objective: To determine whether clinic-level quality of care affects clinical and patient-reported outcomes.// Methods: This nationwide observational cohort study included patients with adult-onset MS in the Swedish MS registry with disease onset 2005–2015. Clinic-level quality of care was measured by four indicators: visit density, magnetic resonance imaging (MRI) density, mean time to commencement of disease-modifying therapy, and data completeness. Outcomes were Expanded Disability Status Scale (EDSS) and patient-reported symptoms measured by the Multiple Sclerosis Impact Scale (MSIS-29). Analyses were adjusted for individual patient characteristics and disease-modifying therapy exposure.// Results: In relapsing MS, all quality indicators benefitted EDSS and physical symptoms. Faster treatment, frequent visits, and higher data completeness benefitted psychological symptoms. After controlling for all indicators and individual treatment exposures, faster treatment remained independently associated with lower EDSS (−0.06, 95% confidence interval (CI): −0.01, −0.10) and more frequent visits were associated with milder physical symptoms (MSIS-29 physical score: −16.2%, 95% CI: −1.8%, −29.5%). Clinic-level quality of care did not affect any outcomes in progressive-onset disease.// Conclusion: Certain quality of care indicators correlated to disability and patient-reported outcomes in relapse-onset but not progressive-onset disease. Future guidelines should consider recommendations specific to disease course..

Statistics of Microstructure Formation in Martensitic Transitions Studied by a Random-Field Potts Model with Dipolar-like Interactions

We have developed a simple model for the study of a cubic to tetragonal martensitic transition, under athermal conditions, in systems with a certain amount of disorder. We have performed numerical simulations that allow for a statistical study of the dynamics of the transition when the system is driven from the high-temperature cubic phase to the low-temperature degenerate tetragonal phase. Our goal is to reveal the existence of kinetic constraints that arise from competition between the equivalent variants of the martensitic phase, and which prevent the system from reaching optimal final microstructures.Comment: 11 pages, 14 figure

Eutectic Colony Formation: A Stability Analysis

Experiments have widely shown that a steady-state lamellar eutectic solidification front is destabilized on a scale much larger than the lamellar spacing by the rejection of a dilute ternary impurity and forms two-phase cells commonly referred to as `eutectic colonies'. We extend the stability analysis of Datye and Langer for a binary eutectic to include the effect of a ternary impurity. We find that the expressions for the critical onset velocity and morphological instability wavelength are analogous to those for the classic Mullins-Sekerka instability of a monophase planar interface, albeit with an effective surface tension that depends on the geometry of the lamellar interface and, non-trivially, on interlamellar diffusion. A qualitatively new aspect of this instability is the occurence of oscillatory modes due to the interplay between the destabilizing effect of the ternary impurity and the dynamical feedback of the local change in lamellar spacing on the front motion. In a transient regime, these modes lead to the formation of large scale oscillatory microstructures for which there is recent experimental evidence in a transparent organic system. Moreover, it is shown that the eutectic front dynamics on a scale larger than the lamellar spacing can be formulated as an effective monophase interface free boundary problem with a modified Gibbs-Thomson condition that is coupled to a slow evolution equation for the lamellar spacing. This formulation provides additional physical insights into the nature of the instability and a simple means to calculate an approximate stability spectrum. Finally, we investigate the influence of the ternary impurity on a short wavelength oscillatory instability that is already present at off-eutectic compositions in binary eutectics.Comment: 26 pages RevTex, 14 figures (28 EPS files); some minor changes; references adde

Combined LHC/ILC analysis of a SUSY scenario with heavy sfermions

We discuss the potential of combined analyses at the Large Hadron Collider and the planned International Linear Collider to explore low-energy supersymmetry in a difficult region of the parameter space characterized by masses of the scalar SUSY particles around 2 TeV. Precision analyses of cross sections for light chargino production and forward--backward asymmetries of decay leptons and hadrons at the ILC, together with mass information on chi^0_2 and squarks from the LHC, allow us to determine the underlying fundamental gaugino/higgsino MSSM parameters and to constrain the masses of the heavy, kinematically inaccessible sparticles. No assumptions on a specific SUSY-breaking mechanism are imposed. For this analysis the complete spin correlations between production and decay processes are taken into account.Comment: new figure added, updated to match the published versio

Advising adolescents on the use of psychotropic medication: attitudes among medical and psychology students

There is evidence that medical students are more aware of the benefits of psychotropic treatment than are members of the general public, and that the more knowledge students acquire about psychiatry and pharmacology, the more favorable their attitudes become towards psychotropic drugs and other treatments. Objectives: This study among students investigates the relationship between certain aspects of personality and attitudes towards advising adolescents with psychosocial problems about the use of psychotropic medication. Methods: Two groups of healthcare students were recruited from universities in Eastern France. 41 fourth-year medical students (MS) who had completed their psychiatry course, and 76 thirdyear psychology students (PS) in the faculty of human sciences. Respondents completed a selfadministered instrument (20 brief case studies, and a personality inventory) at the end of a lecture. Participation was voluntary and unpaid. Results: MS would recommend psychotropic drugs in 40% of the 20 cases, PS in 27%. MS who would prescribe psychotropic medication differed in personality profile from PS. MS with a tendency to experience anger and related states such as frustration, and who did not see fulfilling moral obligations as important were more likely to prescribe psychotropic drugs. Also more likely to recommend psychotropic drugs, but for different reasons, were PS who were susceptible to stress but not shy or socially anxious, who showed friendliness but little interest in others, and who lacked distance in their decision-making. Conclusion: Health promotion is not simply a matter of educating those young people who take psychotropic drugs – health professionals must also question the criteria that inform their decisions. It is as important to investigate the attitudes of the future health professionals (advisers or prescribers) as it is to focus on consumer-related issues