Early clinical features in Systemic Lupus Erythematosus: can they be used to achieve earlier diagnosis?: a risk prediction model

OBJECTIVES: 1) To compare the primary care consulting behaviour prior to diagnosis of people with Systemic Lupus Erythematosus (SLE) with controls, 2) to develop and validate a risk prediction model to aid earlier SLE diagnosis. METHODS: 1,739 incident SLE cases practice-matched to 6,956 controls from the UK Clinical Practice Research Datalink. Odds ratios were calculated for age, gender, consultation rates, selected presenting clinical features and previous diagnoses in the 5 years preceding diagnosis date using logistic regression. A risk prediction model was developed from pre-selected variables using backward stepwise logistic regression. Model discrimination and calibration were tested in an independent validation cohort of 1,831,747 patients. RESULTS: People with SLE had a significantly higher consultation rate than controls (median 9.2 vs 3.8/year) which was in part attributable to clinical features that occur in SLE. The final risk prediction model included the variables age, gender, consultation rate, arthralgia or arthritis, rash, alopecia, sicca, Raynaud's, serositis and fatigue. The model discrimination and calibration in the validation sample was good (Receiver operator characteristic curve: 0.75, 95% CI 0.73-0.78). However, absolute risk predictions for SLE were typically less than 1% due to the rare nature of SLE. CONCLUSIONS: People with SLE consult their GP more frequently and with clinical features attributable to SLE in the five years preceding diagnosis, suggesting that there are potential opportunities to reduce diagnostic delay in primary care. A risk prediction model was developed and validated which may be used to identify people at risk of SLE in future clinical practice. This article is protected by copyright. All rights reserved

The challenge for genetic epidemiologists: how to analyze large numbers of SNPs in relation to complex diseases

Genetic epidemiologists have taken the challenge to identify genetic polymorphisms involved in the development of diseases. Many have collected data on large numbers of genetic markers but are not familiar with available methods to assess their association with complex diseases. Statistical methods have been developed for analyzing the relation between large numbers of genetic and environmental predictors to disease or disease-related variables in genetic association studies. In this commentary we discuss logistic regression analysis, neural networks, including the parameter decreasing method (PDM) and genetic programming optimized neural networks (GPNN) and several non-parametric methods, which include the set association approach, combinatorial partitioning method (CPM), restricted partitioning method (RPM), multifactor dimensionality reduction (MDR) method and the random forests approach. The relative strengths and weaknesses of these methods are highlighted. Logistic regression and neural networks can handle only a limited number of predictor variables, depending on the number of observations in the dataset. Therefore, they are less useful than the non-parametric methods to approach association studies with large numbers of predictor variables. GPNN on the other hand may be a useful approach to select and model important predictors, but its performance to select the important effects in the presence of large numbers of predictors needs to be examined. Both the set association approach and random forests approach are able to handle a large number of predictors and are useful in reducing these predictors to a subset of predictors with an important contribution to disease. The combinatorial methods give more insight in combination patterns for sets of genetic and/or environmental predictor variables that may be related to the outcome variable. As the non-parametric methods have different strengths and weaknesses we conclude that to approach genetic association studies using the case-control design, the application of a combination of several methods, including the set association approach, MDR and the random forests approach, will likely be a useful strategy to find the important genes and interaction patterns involved in complex diseases

Can Perceived Support for Entrepreneurship Keep Great Faculty in the Face of Spinouts?

Despite the recent increase in academic entrepreneurship research, we still know relatively little about the degree of involvement of academic inventors in university spinouts. In this study, we distinguish between academic inventors who leave the university after the creation of a spinout (academic exodus) and those who maintain their university affiliation (academic stasis). Drawing from the literature on innovation-supportive climates and from organizational support theory, we argue that perceptions of institutional support and departmental norms regarding entrepreneurship are associated with the exodus versus stasis decision. We find that inventors who have higher perceptions of institutional support for entrepreneurship are less likely to leave. This relationship is enhanced by perceptions of favorable departmental norms toward entrepreneurship. We discuss the implications of our work for the literature on academic entrepreneurship, innovation-supportive climates, and perceived organizational support. Our study has clear policy implications for universities, policymakers, and funders who aim to stimulate academic entrepreneurship, but are concerned about losing entrepreneurial faculty. Specifically, we advise universities and policymakers to actively support academic inventors wishing to spin out and to monitor this support in a customer-friendly manner, in order to ensure that the inventors' perceptions of support are favorable. It is also important for universities to look out for inconsistencies between a supportive environment for entrepreneurship at the institutional level and unfavorable norms toward entrepreneurship at the departmental level; such inconsistencies can lead good faculty members out of academia. More broadly, universities can pursue an aggregation strategy that aims to retain both a research and commercialization identity while building strong links between them

IPCC reasons for concern regarding climate change risks

The reasons for concern framework communicates scientific understanding about risks in relation to varying levels of climate change. The framework, now a cornerstone of the IPCC assessments, aggregates global risks into five categories as a function of global mean temperature change. We review the framework's conceptual basis and the risk judgments made in the most recent IPCC report, confirming those judgments in most cases in the light of more recent literature and identifying their limitations. We point to extensions of the framework that offer complementary climate change metrics to global mean temperature change and better account for possible changes in social and ecological system vulnerability. Further research should systematically evaluate risks under alternative scenarios of future climatic and societal conditions

Planned repeat cesarean section at term and adverse childhood health outcomes: a record-linkage study

Global cesarean section (CS) rates range from 1% to 52%, with a previous CS being the commonest indication. Labour following a previous CS carries risk of scar rupture, with potential for offspring hypoxic brain injury, leading to high rates of repeat elective CS. However, the effect of delivery by CS on long-term outcomes in children is unclear. Increasing evidence suggests that in avoiding exposure to maternal bowel flora during labour or vaginal birth, offspring delivered by CS may be adversely affected in terms of energy uptake from the gut and immune development, increasing obesity and asthma risks, respectively. This study aimed to address the evidence gap on long-term childhood outcomes following repeat CS by comparing adverse childhood health outcomes after (1) planned repeat CS and (2) unscheduled repeat CS with those that follow vaginal birth after CS (VBAC).A data-linkage cohort study was performed. All second-born, term, singleton offspring delivered between 1 January 1993 and 31 December 2007 in Scotland, UK, to women with a history of CS (n = 40,145) were followed up until 31 January 2015. Outcomes assessed included obesity at age 5 y, hospitalisation with asthma, learning disability, cerebral palsy, and death. Cox regression and binary logistic regression were used as appropriate to compare outcomes following planned repeat CS (n = 17,919) and unscheduled repeat CS (n = 8,847) with those following VBAC (n = 13,379). Risk of hospitalisation with asthma was greater following both unscheduled repeat CS (3.7% versus 3.3%, adjusted hazard ratio [HR] 1.18, 95% CI 1.05-1.33) and planned repeat CS (3.6% versus 3.3%, adjusted HR 1.24, 95% CI 1.09-1.42) compared with VBAC. Learning disability and death were more common following unscheduled repeat CS compared with VBAC (3.7% versus 2.3%, adjusted odds ratio 1.64, 95% CI 1.17-2.29, and 0.5% versus 0.4%, adjusted HR 1.50, 95% CI 1.00-2.25, respectively). Risk of obesity at age 5 y and risk of cerebral palsy were similar between planned repeat CS or unscheduled repeat CS and VBAC. Study limitations include the risk that women undergoing an unscheduled CS had intended to have a planned CS, and lack of data on indication for CS, which may confound the findings.Birth by repeat CS, whether planned or unscheduled, was associated with an increased risk of hospitalisation with asthma but no difference in risk of obesity at age 5 y. Greater risk of death and learning disability following unscheduled repeat CS compared to VBAC may reflect complications during labour. Further research, including meta-analyses of studies of rarer outcomes (e.g., cerebral palsy), are needed to confirm whether such risks are similar between delivery groups

‘Subjective resilience’: using perceptions to quantify household resilience to climate extremes and disasters.

How should we measure a household’s resilience to climate extremes, climate change or other evolving threats? As resilience gathers momentum on the international stage, interest in this question continues to grow. So far, efforts to measure resilience have largely focused on the use of ‘objective’ frameworks and methods of indicator selection. These typically depend on a range of observable socio-economic variables, such as levels of income, the extent of a household’s social capital or its access to social safety nets. Yet while objective methods have their uses, they suffer from well-documented weaknesses. This paper advocates for the use of an alternative but complementary method: the measurement of ‘subjective’ resilience at the household level. The concept of subjective resilience stems from the premise that people have an understanding of the factors that contribute to their ability to anticipate, buffer and adapt to disturbance and change. Subjective household resilience therefore relates to an individual’s cognitive and affective self-evaluation of their household’s capabilities and capacities in responding to risk. We discuss the advantages and limitations of measuring subjective household resilience and highlight its relationships with other concepts such as perceived adaptive capacity, subjective well-being and psychological resilience. We then put forward different options for the design and delivery of survey questions on subjective household resilience. While the approach we describe is focused at the household level, we show how it has the potential to be aggregated to inform sub-national or national resilience metrics and indicators. Lastly, we highlight how subjective methods of resilience assessment could be used to improve policy and decision-making. Above all, we argue that, alongside traditional objective measures and indicators, efforts to measure resilience should take into account subjective aspects of household resilience in order to ensure a more holistic understanding of resilience to climate extremes and disasters

Temple Terrace Beacon Newspaper Collection : A Finding Aid

For many years, the Temple Terrace Public Library maintained copies of the Temple Terrace Beacon. This local publication, first published in 1931, focused on news and events in the City of Temple Terrace as well as the surrounding University community. Kelsey Peduzzi, a librarian at the Temple Terrace Public Library, embarked on a project to scan and digitize issues of the newspaper in the library’s possession. After this successful project led to the creation of a digital archive of more than 800 issues of the newspaper on the Hillsborough County Public Library Cooperative’s digital collections webpage, the library decided that it no longer wished to maintain the paper issues. Given the focus of Journalism, Media Studies, Florida Studies, and other liberal arts disciplines offered at the University of South Florida St. Petersburg, Peduzzi arranged for the transfer of these newspapers in February 2017 to the Nelson Poynter Memorial Library. The issues in this collection offer an excellent portrait of community-based journalism over a period of nearly 30 years between 1978 and 2008

Temple Terrace Beacon Newspaper Collection : A Finding Aid

For many years, the Temple Terrace Public Library maintained copies of the Temple Terrace Beacon. This local publication, first published in 1931, focused on news and events in the City of Temple Terrace as well as the surrounding University community. Kelsey Peduzzi, a librarian at the Temple Terrace Public Library, embarked on a project to scan and digitize issues of the newspaper in the library’s possession. After this successful project led to the creation of a digital archive of more than 800 issues of the newspaper on the Hillsborough County Public Library Cooperative’s digital collections webpage, the library decided that it no longer wished to maintain the paper issues. Given the focus of Journalism, Media Studies, Florida Studies, and other liberal arts disciplines offered at the University of South Florida St. Petersburg, Peduzzi arranged for the transfer of these newspapers in February 2017 to the Nelson Poynter Memorial Library. The issues in this collection offer an excellent portrait of community-based journalism over a period of nearly 30 years between 1978 and 2008