Recurrence rates for SIDS - the importance of risk stratification

Objective: To investigate the importance of stratification by risk factors in computing the probability of a second SIDS in a family. Design: Simulation Study Background: The fact that a baby dies suddenly and unexpectedly means that there is a raised probability that the baby’s family have risk factors associated with Sudden Infant Death Syndrome (SIDS). Thus one cannot consider the risk of a subsequent death to be that of the general population. The Confidential Enquiry into Stillbirths and Deaths in Infancy (CESDI)6 identified three major social risk factors: smoking, age1, and unemployed/unwaged as major risk factors. It gave estimates of risk for families with different numbers of these risk factors. We investigate whether it is reasonable to assume that, conditional on these risk factors, the risk of a second event is independent of the risk of the first and as a consequence one can square the risks to get the risk of two SIDS in a family. We have used CESDI data to estimate the probability of a second SID in a family under different plausible scenarios of the prevalence of the risk factors. We have applied the model to make predictions in the Care of Next Infant (CONI) study7. Results: The model gave plausible predictions. The CONI study observed 18 second SIDS. Our model predicted 14 (95% prediction interval 7 to 21). Conclusion: When considering the risk of a subsequent SIDS in a family one should always take into account the known risk factors. If all risks have been identified, then conditional on these risks, the risk of two events is the product of the individual risks However for a given family we cannot quantify the magnitude of the increased risk because of other possible risk factors not accounted for in the model

Community Based Pilot Study of Diagnostic Paths to the Gluten Free Diet

Wheat consumption is increasing worldwide and also increasing is the frequency of celiac disease (CeD), a pathological response to wheat protein (gluten) in genetically susceptible individuals. Non-celiac gluten sensitivity (NCGS) is another, less studied wheat-induced pathology. The treatment for both is a gluten-free diet (GFD). More individuals choose the diet than predicted by the epidemiological 1-2% prevalence. A preliminary survey by questionnaire asked members and attendees of the local gluten information group (GIG) meetings and functions about their diagnostic experiences and symptom levels in order understand the increased demand for gluten-free foods. Same-aged and -sex friends participated as a comparative “control”. Mixed methods were used including content analyses of prose narratives and independent and paired t tests of symptom levels measured with Likert scales. This convenience sample, surveyed in 2011-2012, is mostly female (54 F, 5 M) with an average age of 54.6 ± 2.0 years. Most participants consulted medical professionals with mean time to diagnosis of 7 years determined mostly from “classic” presenting symptoms. Negative biopsies or blood tests and atypical symptoms that overlap other conditions delayed diagnosis. There were 43 and 16 participants with CeD and NCGS, respectively differing little in symptom levels. Self-diagnosis and use of naturopaths account for some of the “excess” individuals. General practitioners should be encouraged to get additional nutrition training and to discuss with patients dietary choices that support wellness and minimize the risk for pathological immune responses. Patients with CeD particularly need support and follow-up in the transition to a GFD

In Defense of Competition During Syntactic Ambiguity Resolution

In a recent series of publications (Traxler et al. J Mem Lang 39:558–92, 1998; Van Gompel et al. J Mem Lang 52:284–07, 2005; see also Van Gompel et al. (In: Kennedy, et al.(eds) Reading as a perceptual process, Oxford, Elsevier pp 621–48, 2000); Van Gompel et al. J Mem Lang 45:225–58, 2001) eye tracking data are reported showing that globally ambiguous (GA) sentences are read faster than locally ambiguous (LA) counterparts. They argue that these data rule out ‘constraint-based’models where syntactic and conceptual processors operate concurrently and syntactic ambiguity resolution is accomplished by competition. Such models predict the opposite pattern of reading times. However, this argument against competition is valid only in conjunction with two standard assumptions in current constraint-based models of sentence comprehension: (1) that syntactic competitions (e.g., Which is the best attachment site of the incoming constituent?) are pooled together with conceptual competitions (e.g., Which attachment site entails the most plausible meaning?), and (2) that the duration of a competition is a function of the overall (pooled) quality score obtained by each competitor. We argue that it is not necessary to abandon competition as a successful basis for explaining parsing phenomena and that the above-mentioned reading time data can be accounted for by a parallel-interactive model with conceptual and syntactic processors that do not pool their quality scores together. Within the individual linguistic modules, decision-making can very well be competition-based

Minimal muscle damage after a marathon and no influence of beetroot juice on inflammation and recovery

This study examined whether beetroot juice (BTJ) would attenuate inflammation and muscle damage following a marathon. Using a double blind, independent group’s design, 34 runners (~16 previous marathons completed) consumed either BTJ or an isocaloric placebo (PLA) for 3 days following a marathon. Maximal isometric voluntary contractions (MIVC), countermovement jumps (CMJ), muscle soreness, serum cytokines, leucocytosis, creatine kinase (CK), high sensitivity C-reactive protein (hs-CRP) and aspartate aminotransferase (AST) were measured pre, post, and on the 2 days after the marathon. CMJ and MIVC were reduced after the marathon (P0.05). Muscle soreness was increased in the day after the marathon (BTJ; 45±48 vs. PLA; 46±39 mm) and had returned to baseline by day 2, irrespective of supplementation (P=0.694). Cytokines (Interleukin-6; IL-6, interleukin-8, tumour necrosis factor-α) were increased immediately post-marathon but apart from IL-6 had returned to baseline values by day 1 post. No interaction effects were evident for IL-6 (P=0.213). Leucocytes increased 1.7 fold after the race and remained elevated 2 days post, irrespective of supplement (P<0.0001). CK peaked at 1 day post marathon (BTJ: 965±967 & PLA: 1141±979 IU·L-1) and like AST and hs-CRP, was still elevated 2 days after the marathon (P<0.05); however, no group differences were present for these variables. Beetroot juice did not attenuate inflammation or reduce muscle damage following a marathon, possibly because most of these indices were not markedly different from baseline values in the days after the marathon

Conceptual model for the health technology assessment of current and novel interventions in rheumatoid arthritis

The objective of this study was to evaluate current approaches to economic modeling in rheumatoid arthritis (RA) and propose a new conceptual model for evaluation of the cost-effectiveness of RA interventions. We followed recommendations from the International Society of Pharmacoeconomics and Outcomes Research-Society of Medical Decision Making (ISPOR-SMDM) Modeling Good Research Practices Task Force-2. The process involved scoping the decision problem by a working group and drafting a preliminary cost-effectiveness model framework. A systematic literature review (SLR) of existing decision-analytic models was performed and analysis of an RA registry was conducted to inform the structure of the draft conceptual model. Finally, an expert panel was convened to seek input on the draft conceptual model. The proposed conceptual model consists of three separate modules: 1) patient characteristic module, 2) treatment module, and 3) outcome module. Consistent with the scope, the conceptual model proposed six changes to current economic models in RA. These changes proposed are to: 1) use composite measures of disease activity to evaluate treatment response as well as disease progression (at least two measures should be considered, one as the base case and one as a sensitivity analysis); 2) conduct utility mapping based on disease activity measures; 3) incorporate subgroups based on guideline-recommended prognostic factors; 4) integrate realistic treatment patterns based on clinical practice/registry datasets; 5) assimilate outcomes that are not joint related (extra-articular outcomes); and 6) assess mortality based on disease activity. We proposed a conceptual model that incorporates the current understanding of clinical and real-world evidence in RA, as well as of existing modeling assumptions. The proposed model framework was reviewed with experts and could serve as a foundation for developing future cost-effectiveness models in RA

A terminal assessment of stages theory : introducing a dynamic states approach to entrepreneurship

Stages of Growth models were the most frequent theoretical approach to understanding entrepreneurial business growth from 1962 to 2006; they built on the growth imperative and developmental models of that time. An analysis of the universe of such models (N=104) published in the management literature shows no consensus on basic constructs of the approach, nor is there any empirical confirmations of stages theory. However, by changing two propositions of the stages models, a new dynamic states approach is derived. The dynamic states approach has far greater explanatory power than its precursor, and is compatible with leading edge research in entrepreneurship

Gibbs distribution analysis of temporal correlations structure in retina ganglion cells

We present a method to estimate Gibbs distributions with \textit{spatio-temporal} constraints on spike trains statistics. We apply this method to spike trains recorded from ganglion cells of the salamander retina, in response to natural movies. Our analysis, restricted to a few neurons, performs more accurately than pairwise synchronization models (Ising) or the 1-time step Markov models (\cite{marre-boustani-etal:09}) to describe the statistics of spatio-temporal spike patterns and emphasizes the role of higher order spatio-temporal interactions.Comment: To appear in J. Physiol. Pari

High-p_T pion and kaon production in relativistic nuclear collisions

High-p_T pion and kaon production is studied in relativistic proton-proton, proton-nucleus, and nucleus-nucleus collisions in a wide energy range. Cross sections are calculated based on perturbative QCD, augmented by a phenomenological transverse momentum distribution of partons (``intrinsic k_T''). An energy dependent width of the transverse momentum distribution is extracted from pion and charged hadron production data in proton-proton/proton-antiproton collisions. Effects of multiscattering and shadowing in the strongly interacting medium are taken into account. Enhancement of the transverse momentum width is introduced and parameterized to explain the Cronin effect. In collisions between heavy nuclei, the model over-predicts central pion production cross sections (more significantly at higher energies), hinting at the presence of jet quenching. Predictions are made for proton-nucleus and nucleus-nucleus collisions at RHIC energies.Comment: 26 pages in Latex, 19 EPS figure

Oligarchic growth of giant planets

Runaway growth ends when the largest protoplanets dominate the dynamics of the planetesimal disk; the subsequent self-limiting accretion mode is referred to as ``oligarchic growth.'' Here, we begin by expanding on the existing analytic model of the oligarchic growth regime. From this, we derive global estimates of the planet formation rate throughout a protoplanetary disk. We find that a relatively high-mass protoplanetary disk ($\sim$ 10$\times$ minimum-mass) is required to produce giant planet core-sized bodies ($\sim$ 10 M$_{\oplus}$) within the lifetime of the nebular gas (\la 10 million years). However, an implausibly massive disk is needed to produce even an Earth mass at the orbit of Uranus by 10 Myrs. Subsequent accretion without the dissipational effect of gas is even slower and less efficient. In the limit of non-interacting planetesimals, a reasonable-mass disk is unable to produce bodies the size of the Solar System's two outer giant planets at their current locations on {\it any} timescale; if collisional damping of planetesimal random velocities is sufficiently effective, though, it may be possible for a Uranus/Neptune to form in situ in less than the age of the Solar System. We perform numerical simulations of oligarchic growth with gas, and find that protoplanet growth rates agree reasonably well with the analytic model as long as protoplanet masses are well below their estimated final masses. However, accretion stalls earlier than predicted, so that the largest final protoplanet masses are smaller than those given by the model. Thus the oligarchic growth model, in the form developed here, appears to provide an upper limit for the efficiency of giant planet formation.Comment: ScienceDirect already has the final published version here: dx.doi.org/10.1016/S0019-1035(02)00043-