Comparative Effectiveness of Lithium and Valproate for Suicide Prevention and Associations With Nonsuicide Mortality: A Dissertation

Background: The mood stabilizer lithium has long been reported to be associated with reduced suicide risks, but many studies reporting associations between lithium and reduced suicide risks also have been nonrandomized and lacked adjustment for many potential confounders, active controls, uniform follow-up, or intent-to-treat samples. Concerns also have been raised that medications being considered as potential suicide preventative might increase risks of nonsuicide mortality while reducing risks of suicide. Methods: Three studies of Veterans Health Administration (VHA) patients were conducted combining high-dimensional propensity score matching with intent-to-treat analyses to examine the associations between lithium and valproate and one-year suicide and nonsuicide mortality outcomes. Results: In intention-to-treat analyses, initiation of lithium, compared to valproate, was associated with increased suicide mortality over 0-365 days among patients with bipolar disorder (Hazard Ratio (HR) 1.50 [95% Confidence Interval 1.05, 2.15]) Nonsuicide mortality among VHA patients with or without bipolar disorder was not significantly associated with the initiation of lithium compared to valproate ( HR 0.92 [0.82-1.04]). Rates of treatment discontinuation, however, were very high (≈ 92%). Longitudinal analyses revealed that the increased suicide risks associated with initiating lithium among patients with bipolar disorder occurred exclusively after discontinuation of lithium vii treatment. In secondary analyses restricted to patients still receiving their initial treatment, there was no difference in suicide risk between the initiation of lithium or valproate. Conclusions: Significantly increased risks of suicide were observed at one year among VHA patients with bipolar disorder initiating lithium compared to valproate, related to risks observed after the discontinuation of lithium treatment Since these studies are nonrandomized, confounding may account for some or all of our findings, including the risks observed after lithium discontinuation. Nevertheless, these results suggest that health systems and providers consider steps to minimize any potential lithium discontinuation-associated risk. Approaches might include educating patients about possible risks associated with discontinuation and closely monitoring patients after discontinuation if feasible. Given the obvious importance of any substantive difference between lithium and valproate in suicide or nonsuicide mortality risk, our studies also suggest that further research is needed, especially research that can further minimize the potential for confounding

Dark Before Light: Testing the Cosmic Expansion History through the Cosmic Microwave Background

The cosmic expansion history proceeds in broad terms from a radiation dominated epoch to matter domination to an accelerated, dark energy dominated epoch. We investigate whether intermittent periods of acceleration are possible in the early universe -- between Big Bang nucleosynthesis (BBN) and recombination and beyond. We establish that the standard picture is remarkably robust: observations of anisotropies in the cosmic microwave background exclude any extra period of accelerated expansion between 1 \leq z \lesssim 10^5 (corresponding to 5\times10^{-4}\ {\rm eV} \leq T \lesssim 25\ {\rm eV}).Comment: 7 pages, 5 figure

‘Dominant ethnicity’ and the ‘ethnic-civic’ dichotomy in the work of A. D. Smith

This article considers the way in which the work of Anthony Smith has helped to structure debates surrounding the role of ethnicity in present-day nations. Two major lines of enquiry are evident here. First, the contemporary role of dominant ethnic groups within 'their' nations and second, the interplay between ethnic and civic elements in nationalist argument. The two processes are related, but maintain elements of distinctiveness. Smith's major contribution to the dominant ethnicity debate has been to disembed ethnicity from the ideologically-charged and/or anglo-centric discourse of ethnic relations and to place it in historical context, thereby opening up space for dominant group ethnicity to be considered as a distinct phenomenon. This said, Smith's work does not adequately account for the vicissitudes of dominant ethnicity in the contemporary West. Building on the classical works of Hans Kohn and Friedrich Meinecke, Anthony Smith has also made a seminal contribution to the debate on civic and ethnic forms of national identity and nationalist ideology. As well as freeing this debate from the strong normative overtones which it has often carried, he has continued to insist that the terms civic and ethnic should be treated as an ideal-typical distinction rather than a scheme of classification

The Unique Frequency Spectrum of the Blazhko RRc Star LS Her

The Blazhko effect in RR Lyrae stars is still poorly understood theoretically. Stars with multiple Blazhko periods or in which the Blazhko effect itself varies are particularly challenging. This study investigates the Blazhko effect in the RRc star LS Her. Detailed VRI CCD photometry has been performed on 63 nights during six months. LS Her is confirmed to have a Blazhko period of 12.75+/-0.02 days. However, where normally the side frequencies of the Blazhko triplet are expected, an equidistant group of three frequencies is found on both sides of the main pulsation frequency. As a consequence the period and amplitude of the Blazhko effect itself vary in a cycle of 109+/-4 days. LS Her is a unique object turning out to be very important in the verification of the theories for the Blazhko effect.Comment: Accepted for publication in MNRA

The thermodynamic dual structure of linear-dissipative driven systems

The spontaneous emergence of dynamical order, such as persistent currents, is sometimes argued to require principles beyond the entropy maximization of the second law of thermodynamics. I show that, for linear dissipation in the Onsager regime, current formation can be driven by exactly the Jaynesian principle of entropy maximization, suitably formulated for extended systems and nonequilibrium boundary conditions. The Legendre dual structure of equilibrium thermodynamics is also preserved, though it requires the admission of current-valued state variables, and their correct incorporation in the entropy

Ultraviolet Imaging Observations of the cD Galaxy in Abell 1795: Further Evidence for Massive Star Formation in a Cooling Flow

We present images from the Ultraviolet Imaging Telescope of the Abell 1795 cluster of galaxies. We compare the cD galaxy morphology and photometry of these data with those from existing archival and published data. The addition of a far--UV color helps us to construct and test star formation model scenarios for the sources of UV emission. Models of star formation with rates in the range \sim5-20M_{\sun}yr$^{-1}$ indicate that the best fitting models are those with continuous star formation or a recent ($\sim4$ Myr old) burst superimposed on an old population. The presence of dust in the galaxy, dramatically revealed by HST images complicates the interpretation of UV data. However, we find that the broad--band UV/optical colors of this cD galaxy can be reasonably matched by models using a Galactic form for the extinction law with $E_{B-V}=0.14$. We also briefly discuss other objects in the large UIT field of view.Comment: To appear in the Astrophysical Journal. 14 AAS preprint style pages plus 7 figure