Project description:For more than a decade, methotrexate has been known to be an effective therapeutic agent in the treatment of steroid-dependent active Crohn's disease. However, international data on medication utilization suggest that this drug is rarely used in clinical practice for an indication of Crohn's disease. This review investigates the potential reasons for the underuse of methotrexate in patients with inflammatory bowel diseases.
Project description:Since Downs proposed that the act of voting is irrational in 1957, myriad models have been proposed to explain voting and account for observed turnout patterns. We propose a model in which partisans consider both the instrumental and expressive benefits of their vote when deciding whether or not to abstain in an election, introducing an asymmetry that most other models do not consider. Allowing learning processes within our electorate, we analyze what evolutionarily stable strategies are rationalizable under various conditions. Upon varying electorate size, the partisan split of the electorate, and the degree to which an electorate takes underdog considerations into account in its payoff structure, we find that different equilibria arise. Our model predicts comparative statics that are consistent with voter behavior, specifically affirming a "size effect," in which turnout decreases as electorate size increases. Furthermore, relaxing some of our preliminary assumptions eliminates some of the discrepancies between the predictions of our model and empirical voter behavior. In particular, our work demonstrates that misperceptions about the partisan split of an electorate may account for high turnout behavior .Supplementary informationThe online version supplementary material available at 10.1007/s13235-021-00384-1.
Project description:Family health history (FHH) is the most useful means of assessing risk for common chronic diseases. The odds ratio for risk of developing disease with a positive FHH is frequently greater than 2, and actions can be taken to mitigate risk by adhering to screening guidelines, genetic counselling, genetic risk testing, and other screening methods. Challenges to the routine acquisition of FHH include constraints on provider time to collect data and the difficulty in accessing risk calculators. Disease-specific and broader risk assessment software platforms have been developed, many with clinical decision support and informatics interoperability, but few access patient information directly. Software that allows integration of FHH with the electronic medical record and clinical decision support capabilities has provided solutions to many of these challenges. Patient facing, electronic medical record, and web-enabled FHH platforms have been developed, and can provide greater identification of risk compared with conventional FHH ascertainment in primary care. FHH, along with cascade screening, can be an important component of population health management approaches to overall reduction of risk.
Project description:BackgroundThe aim of this investigation is the development of primarily healthy hips in children who have required orthoses/protheses over the long term due to ipsilateral distally located deformities of the leg. These children show ipsilateral in-toeing gait and Duchenne's limping followed by a coxa valga antetorta and facultative hip decentration. A practical question is whether these hips are in danger of decompensation. An additional theoretical question is how the external shape and internal architecture changes if a primarily healthy hip is underused.MethodsTen children with healthy hips who are unilaterally long-term orthotics/prosthetics-dependent agreed to undergo an instrumental gait analysis. The results were analyzed and correlated with clinical findings, a common activity score and planimetric radiographic data.ResultsThe intra-individual comparison revealed a number of significant changes in the hip of the deformed leg (p < 0.05). Clinically, the internal rotation was increased (15° ± 4.2°), while the external rotation was diminished (13° ± 1.3°). Radiologically, the projected caput-collum-diaphyseal angle, the lesser trochanter to articular surface distance and the head-shaft angle were increased by 11.1° ± 15.4°, 5.8 ± 4.2 mm and 11.9° ± 0.6°, respectively. Both the Sharp and acetabular angles were increased, the former by 3.6° ± 0.6° and the latter by 3.2° ± 0.6°. Kinetic gait analysis showed increased stride length (6.8 ± 3.7 cm), shortened stance phase (6.6 ± 1.6 %) and reduced forces transmitted to the ground (92.2 ± 34.3 N). The kinematic analysis showed increased hip abduction (14.0° ± 8.2°), while the pelvic obliquity was not significantly changed (0.01° ± 0.01°).ConclusionsDuchenne's limp and lack of weight-bearing stress are the decisive pathogenic factors of the underused coxa valga and acetabular dysplasia. These changes follow the mechanobiological concept of "function modifies design", which means function influences external shape and internal architecture of bones and joints. As a practical consequence we recommend that one pelvic radiograph be performed as a precaution at the end of puberty of children with these conditions.Level of evidenceLevel II retrospective study.
Project description:We consider a simplified model of a social network in which individuals have one of two opinions (called 0 and 1) and their opinions and the network connections coevolve. Edges are picked at random. If the two connected individuals hold different opinions then, with probability 1 - ?, one imitates the opinion of the other; otherwise (i.e., with probability ?), the link between them is broken and one of them makes a new connection to an individual chosen at random (i) from those with the same opinion or (ii) from the network as a whole. The evolution of the system stops when there are no longer any discordant edges connecting individuals with different opinions. Letting ? be the fraction of voters holding the minority opinion after the evolution stops, we are interested in how ? depends on ? and the initial fraction u of voters with opinion 1. In case (i), there is a critical value ?(c) which does not depend on u, with ? ? u for ? > ?(c) and ? ? 0 for ? < ?(c). In case (ii), the transition point ?(c)(u) depends on the initial density u. For ? > ?(c)(u), ? ? u, but for ? < ?(c)(u), we have ?(?,u) = ?(?,1/2). Using simulations and approximate calculations, we explain why these two nearly identical models have such dramatically different phase transitions.
Project description:Three randomized experiments found that subtle linguistic cues have the power to increase voting and related behavior. The phrasing of survey items was varied to frame voting either as the enactment of a personal identity (e.g., "being a voter") or as simply a behavior (e.g., "voting"). As predicted, the personal-identity phrasing significantly increased interest in registering to vote (experiment 1) and, in two statewide elections in the United States, voter turnout as assessed by official state records (experiments 2 and 3). These results provide evidence that people are continually managing their self-concepts, seeking to assume or affirm valued personal identities. The results further demonstrate how this process can be channeled to motivate important socially relevant behavior.
Project description:We propose a new analytical method to study stochastic, binary-state models on complex networks. Moving beyond the usual mean-field theories, this alternative approach is based on the introduction of an annealed approximation for uncorrelated networks, allowing to deal with the network structure as parametric heterogeneity. As an illustration, we study the noisy voter model, a modification of the original voter model including random changes of state. The proposed method is able to unfold the dependence of the model not only on the mean degree (the mean-field prediction) but also on more complex averages over the degree distribution. In particular, we find that the degree heterogeneity--variance of the underlying degree distribution--has a strong influence on the location of the critical point of a noise-induced, finite-size transition occurring in the model, on the local ordering of the system, and on the functional form of its temporal correlations. Finally, we show how this latter point opens the possibility of inferring the degree heterogeneity of the underlying network by observing only the aggregate behavior of the system as a whole, an issue of interest for systems where only macroscopic, population level variables can be measured.
Project description:Inborn errors of metabolism and diabetes share common derangements in analytes of metabolic networks that are tested for in newborn screening, usually performed 48-72 h after birth. There is limited research examining the metabolic imprint of diabetes on newborn screening results. This paper aims to demonstrate the links between diabetes, biochemical genetics and newborn screening in investigating disease pathophysiology in diabetes, provide possible reasons for the lack of research in diabetes in newborn screening and offer recommendations on potential research areas. We performed a systematic search of the available literature from 1 April 1998 to 31 December 2018 involving newborn screening and diabetes using OVID, MEDLINE, Cochrane and the PROSPERO register, utilizing a modified extraction tool adapted from Cochrane. Eight studies were included after screening 1312 records. Five studies reanalyzed dried blood spots (DBS) on filter paper cards, and three studies utilized pre-existing results. The results of these studies and how they relate to cord blood studies, the use of cord blood versus newborn screening dried blood spots as a sample and considerations on newborn screening and diabetes research is further discussed. The timing of sampling of newborn screening allows insight into neonatal physiology in a catabolic state with minimal maternal and placental influence. This, combined with the wide coverage of newborn screening worldwide, may aid in our understanding of the origins of diabetes.
Project description:Dental autotransplantation (DAT) is a surgical procedure in which a donor's tooth is extracted and transplanted from one site to another in the same person. This treatment modality has received considerable attention worldwide in recent years due to its potential advantages over implants. A survey-based study evaluated dentists' attitudes towards and practice of DAT in Damascus, Syria from September to December 2020. We asked respondents whether they considered this treatment modality when developing treatment plans and whether they view it viable. Only 73 of the 258 respondents (28.3%) stated that they considered DAT as a treatment option. Additionally, 153 respondents (59.3%) either did not view DAT as a viable treatment option or did not know whether it is viable. DAT was underestimated and underused among Syrian dentists. Given this gap in real-world knowledge and practice, academic dental institutions in Syria should place a greater focus on emerging evidence-based knowledge and protocols regarding this treatment option.