Seronegative Oligoarthritis Preceding Psoriasis by 9.5 Years

We report a case of psoriatic arthritis where oligoarthritis preceded the skin lesions. A 57-year-old man complained of left third-finger pain. Laboratory examinations were negative for anti-cyclic citrullinated peptide antibodies and rheumatoid factor; he was treated for suspected rheumatoid arthritis. Six years later, X-ray revealed enthesitis of his fingers and wrist joint. At 9.5 years after the initial visit, skin lesions appeared in the left auricular region and buttock and dermatopathology findings indicated psoriasis vulgaris. The final diagnosis was psoriatic arthritis. In cases of seronegative oligoarthritis, psoriatic arthritis must be considered because some patients demonstrate osteoarticular lesions preceding skin lesions

Globally Optimal Algorithms for Fixed-Budget Best Arm Identification

We consider the fixed-budget best arm identification problem where the goal is to find the arm of the largest mean with a fixed number of samples. It is known that the probability of misidentifying the best arm is exponentially small to the number of rounds. However, limited characterizations have been discussed on the rate (exponent) of this value. In this paper, we characterize the optimal rate as a result of global optimization over all possible parameters. We introduce two rates, $R^{\mathrm{go}}$ and $R^{\mathrm{go}}_{\infty}$, corresponding to lower bounds on the misidentification probability, each of which is associated with a proposed algorithm. The rate $R^{\mathrm{go}}$ is associated with $R^{\mathrm{go}}$-tracking, which can be efficiently implemented by a neural network and is shown to outperform existing algorithms. However, this rate requires a nontrivial condition to be achievable. To deal with this issue, we introduce the second rate $R^{\mathrm{go}}_\infty$. We show that this rate is indeed achievable by introducing a conceptual algorithm called delayed optimal tracking (DOT).Comment: fixed title typ

Association between physician-staffed helicopter versus ground emergency medical services and mortality for pediatric trauma patients: A retrospective nationwide cohort study.

BACKGROUND:Helicopter emergency medical services' (HEMS) effectiveness for pediatric trauma patients remains unclear. We aimed to examine the relation between HEMS and reduced mortality in pediatric trauma patients. METHODS:This retrospective cohort study utilized data from the Japan Trauma Data Bank, a national multicenter clinical trauma database. Participants were aged <18 years, admitted between 2004 and 2015, and transported from the scene to the hospital by HEMS or ground emergency medical services (GEMS). We used a standardized mortality ratio (SMR) weight method, and fitted a marginal structural model to adjust for measured confounders. The SMR weight was calculated using the estimation of the propensity scores. A logistic regression model was used with the baseline independent variables to estimate the propensity score. RESULTS:Overall, 5,947 patients were identified in our study: 453 were transported by HEMS and 5,494 by GEMS. The mean injury severity score in the HEMS group was significantly higher than that in the GEMS group17.0 (Standard deviation = 11.0) vs 12.2 (Standard deviation = 9.2), p < .001. In-hospital mortality was higher in the HEMS group than that in the GEMS group in the unadjusted analysis (3.8% vs 1.3%, respectively; p < .001). After adjusting for covariates, HEMS transport was not associated with reduced hospital mortality. (odds ratio = 0.82, 95% confidence interval = 0.42-1.58). CONCLUSIONS:HEMS was not associated with reduced mortality among pediatric trauma patients compared with GEMS in this nationwide study. Further investigation is necessary to determine who clearly benefits from HEMS as compared to GEMS