Adjusting for bias introduced by instrumental variable estimation in the Cox Proportional Hazards Model

Instrumental variable (IV) methods are widely used for estimating average treatment effects in the presence of unmeasured confounders. However, the capability of existing IV procedures, and most notably the two-stage residual inclusion (2SRI) procedure recommended for use in nonlinear contexts, to account for unmeasured confounders in the Cox proportional hazard model is unclear. We show that instrumenting an endogenous treatment induces an unmeasured covariate, referred to as an individual frailty in survival analysis parlance, which if not accounted for leads to bias. We propose a new procedure that augments 2SRI with an individual frailty and prove that it is consistent under certain conditions. The finite sample-size behavior is studied across a broad set of conditions via Monte Carlo simulations. Finally, the proposed methodology is used to estimate the average effect of carotid endarterectomy versus carotid artery stenting on the mortality of patients suffering from carotid artery disease. Results suggest that the 2SRI-frailty estimator generally reduces the bias of both point and interval estimators compared to traditional 2SRI.Comment: 27 pages, 8 figures, 4 table

The United States Chiropractic Workforce: An alternative or complement to primary care?

UnlabelledBackgroundIn the United States (US) a shortage of primary care physicians has become evident. Other health care providers such as chiropractors might help address some of the nation's primary care needs simply by being located in areas of lesser primary care resources. Therefore, the purpose of this study was to examine the distribution of the chiropractic workforce across the country and compare it to that of primary care physicians.MethodsWe used nationally representative data to estimate the per 100,000 capita supply of chiropractors and primary care physicians according to the 306 predefined Hospital Referral Regions. Multiple variable Poisson regression was used to examine the influence of population characteristics on the supply of both practitioner-types.ResultsAccording to these data, there are 74,623 US chiropractors and the per capita supply of chiropractors varies more than 10-fold across the nation. Chiropractors practice in areas with greater supply of primary care physicians (Pearson's correlation 0.17, p-value < 0.001) and appear to be more responsive to market conditions (i.e. more heavily influenced by population characteristics) in regards to practice location than primary care physicians.ConclusionThese findings suggest that chiropractors practice in areas of greater primary care physician supply. Therefore chiropractors may be functioning in more complementary roles to primary care as opposed to an alternative point of access

Nematic Fermi Fluids in Condensed Matter Physics

Correlated electron fluids can exhibit a startling array of complex phases, among which one of the more surprising is the electron nematic, a translationally invariant metallic phase with a spontaneously generated spatial anisotropy. Classical nematics generally occur in liquids of rod-like molecules; given that electrons are point-like, the initial theoretical motivation for contemplating electron nematics came from thinking of the electron fluid as a quantum melted electron crystal, rather than a strongly interacting descendent of a Fermi gas. That such phases exist in nature was established by dramatic transport experiments in ultra-clean quantum Hall systems in 1999 and in Sr3Ru2O7 in a strong magnetic field in 2007. In this paper, we briefly review the theoretical considerations governing nematic order, summarize the quantum Hall and Sr3Ru2O7 experiments that unambiguously establish the existence of this phase, and survey some of the current evidence for such a phase in the cuprate and Fe-based high temperature superconductors.Comment: 30 pages, 7 figures (some in color); to appear in Annual Reviews of Condensed Matter Physics. Edited version

The United States Chiropractic Workforce: An alternative or complement to primary care?

UnlabelledBackgroundIn the United States (US) a shortage of primary care physicians has become evident. Other health care providers such as chiropractors might help address some of the nation's primary care needs simply by being located in areas of lesser primary care resources. Therefore, the purpose of this study was to examine the distribution of the chiropractic workforce across the country and compare it to that of primary care physicians.MethodsWe used nationally representative data to estimate the per 100,000 capita supply of chiropractors and primary care physicians according to the 306 predefined Hospital Referral Regions. Multiple variable Poisson regression was used to examine the influence of population characteristics on the supply of both practitioner-types.ResultsAccording to these data, there are 74,623 US chiropractors and the per capita supply of chiropractors varies more than 10-fold across the nation. Chiropractors practice in areas with greater supply of primary care physicians (Pearson's correlation 0.17, p-value < 0.001) and appear to be more responsive to market conditions (i.e. more heavily influenced by population characteristics) in regards to practice location than primary care physicians.ConclusionThese findings suggest that chiropractors practice in areas of greater primary care physician supply. Therefore chiropractors may be functioning in more complementary roles to primary care as opposed to an alternative point of access

Plasma prekallikrein levels are positively associated with circulating lipid levels and the metabolic syndrome in children.

Plasma prekallikrein (PK) has been shown to be associated with cardiovascular disease (CVD) and its risk factors, but these associations have not been investigated in children. The present study examined PK activity in relation to well-established cardiovascular risk factors in a cohort of children aged 9–11 years (N = 97). We found a significant and positive association between PK and fasting levels of total cholesterol (p \u3c 0.01), non-high-density lipoprotein cholesterol (p \u3c 0.01), and triglycerides (p \u3c 0.001). In addition, there was a significant association between PK activity and the metabolic syndrome, a clustering of risk factors considered to have an impact on atherosclerosis and CVD mortality. Finally, we found that children with a family history of CVD had significantly elevated PK activity. These novel findings warrant further investigations into the relationship between circulating PK levels and CVD risk factors because PK may be involved in the progression of the disease state. Il est bien connu que la pre´kallicre´ine (PK) est associe´e a` la maladie cardiovasculaire (CVD) et a` ses facteurs de risque, mais ces associations n’ont pas e´te´ ve´rifie´es chez les enfants. Cette e´tude se propose de ve´rifier l’association entre l’activite´ de la PK et les facteurs de risque de CVD aupre`s d’une cohorte d’enfants aˆge´s de 9 a` 11 ans (N = 97). On observe une corre´lation positive significative entre la PK et les variables suivantes : la concentration totale de choleste´rol a` jeun (p \u3c 0,01), les concentrations des lipoprote´ines non a` haute densite´ (p \u3c 0,01) et la concentration des triglyce´rides (p \u3c 0,001). De plus, on observe une corre´lation significative entre l’activite´ de la PK et le syndrome me´tabolique constitue par un ensemble de facteurs ayant un effet sur l’athe´roscle´rose et la mortalite´ due a` la CVD. En dernier lieu, les enfants avec des ante´ce´dents familiaux de CVD pre´sentent une plus importante activite´ de la PK, et ce, de fac¸on significative. Ces premie`res observations sugge`rent d’autres e´tudes sur la relation entre la concentration sanguine de PK et les facteurs de risque de CVD, car la PK pourrait eˆtre implique´e dans la progression de la malad