자연주의적 탐구조사(Naturalistic Inquiry)

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Using Multivariate Statistics

Co-Planar Stereotaxic Atlas of the Human Brain—3-Dimensional Proportional System: An Approach to Cerebral Imaging, J. Talairach, P. Tournoux. Georg Thieme Verlag, New York (1988), 122 pp., 130 figs. DM 268

Data Mining Practical Machine Learning Tools and Techniques

Preamble and Transition to ACC/AHA Guidelines to Reduce Cardiovascular Risk S2

The goals of the …

/pdf/2013-acc-aha-guideline-on-the-treatment-of-blood-cholesterol-pvngcav7fq.pdf

2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines

Dear Editor, We thank Drs Ritchie‐McLean and Wilmshurst for their comments regarding our study entitled ‘The impact of general anesthesia on child development and school performance: a population‐based study’. The authors suggest that residual confounding has the potential to diminish the conclusions that can be drawn from our study. We agree that residual confounding is a possibility and it is important to recognize when interpreting results. In our study, we acknowledge the demonstrated associations and highlight that causation must be regarded with caution. Similar studies have attempted to reduce the impact of known confounders in various ways. Our study has strived to address confounding factors using multiple methodological and analytical approaches. This includes excluding children with underlying conditions, those undergoing major neurological or cardiovascular surgery or with neurodevelopmental disorders; stratifying analyses by type of surgery or procedure, number, and age of general anesthesia exposure; conducting multivariable statistical analyses and restricting analyses to children with a single exposure to general anesthesia and hospitalization. We would also like to respond to the three specific points highlighted by the authors. First, regarding the identification of children with autism, neurodevelopmental and behavioral conditions, we identified children diagnosed with these conditions and they were excluded from all analyses, as noted in our methods. In addition, children with physical or behavioral disabilities were excluded a priori if they were classified as having special needs in the developmental assessment or were exempt from school tests. While some confounding may persist from children with unidentified conditions in our data, this is likely to be those with milder forms of neurodevelopmental impairment which we have addressed in our discussion. Second, we did not assess a comparison group of children with hospitalization/s not requiring general anesthesia. This was because such a group would be too heterogeneous and may have underlying or experienced conditions such as traumatic brain injury, assault or trauma that may have long‐term neurodevelopmental effects and confound results. We also note the authors’ suggestion that the surgery and other perioperative events such as pain, anxiety and sleep disturbances may play a role in developmental outcomes of children. These perioperative factors were not measured in our study (and, to our knowledge, have not been explored by other similar studies assessing outcomes following exposure to general anesthesia), and may be worthwhile considering in future studies. Third, Ritchie‐McLean and Wilmshurst suggest that the higher proportion of boys exposed to general anesthesia and who were also classified as developmentally high‐risk, may explain our finding of increased risk. We note, however, that the results presented were adjusted for gender. Indeed, additional analyses revealed no interaction by gender and similar results were found when stratified analysis for boys and girls (results not presented). Going forward, population‐based longitudinal studies using linked clinical, operative, and administrative data provide a cost‐effective, timely and comprehensive information on important confounders and mediators (such as child characteristics, perioperative, and procedural factors and anesthetics used) to explore. Combined, these data with appropriate research questions and patient selection, and application of causal inference frameworks and analytical techniques to control for bias and confounding, provide an opportunity to estimate associations and increase our understanding of the possible effect of early exposure to general anesthesia, including the potential impact of repeated or lengthy use on child cognitive development. As Davidson and Sun note in their recent editorial, no amount of adjustment can reduce the possible impact of unknown confounding factors. Nevertheless, future findings may give us an insight as to the other possible causes of poor outcomes and inform clinical trials comparing different strategies to reduce any impact on neurocognitive outcome.

/pdf/reply-to-ritchie-mclean-susanna-wilmshurst-sally-regarding-2eivroo0iu.pdf

Reply to Ritchie-McLean, Susanna; Wilmshurst, Sally, regarding their comment "Can population cohort studies assess the long-term impact of anesthesia in children?"

We have examined the expression on a panel of 22 human kidneys of polymorphic B-cell determinants recognized by mouse monoclonal antibodies. Monoclonal antibodies from a mouse immunized with an antigenic preparation from a DR4 positive B-cell line reacted preferentially with kidneys from DR4 positive donors (p less than 0.005), and the pattern of reactivity with kidney tissues was similar to that of antibodies to monomorphic determinants of class II. However, these antibodies did not show clear specificity for DR4 on lymphocytes in standard serological analyses. These results provide evidence for the expression of polymorphic class II determinants on human kidneys. Reasons for the differences in the apparent specificities of the monoclonal antibodies when tested on kidney sections and lymphocytes are discussed.

Expression of polymorphic B-cell antigens on human kidneys.

Does pelvic organ support deteriorate in the years following a first birth

Musical prodigies and motivation

Abstract Extracellular carbohydrate production is widespread in sea ice microbial communities, being produced by both algae and bacteria. Under stressful conditions, including nutrient limitation and high light, cells may export excess fixed carbon as glucose. Glucose microsensors were used to measure extracellular glucose exudation and consumption in a sea ice algal community. Glucose export increased with increasing irradiance between 15 and 512 µmol photons m −2 s −1 . This export correlated with declining F v F m values and increasing NPQ values, implying that glucose export resulted from exposure to above optimal irradiances. Glucose concentrations in samples treated with DCMU to block photosynthesis, declined at all irradiances. Bacterial consumption of glucose was between 6 and 34% of extracellular export per hour. There have been very few measurements of DOC/glucose in sea ice and the data presented here make an important contribution to our understanding of sea ice microbial processes. 

/pdf/short-note-extracellular-export-and-consumption-of-glucose-3ok1h75r.pdf

Andrew J. Martin

Papers

Reply to Ritchie-McLean, Susanna; Wilmshurst, Sally, regarding their comment "Can population cohort studies assess the long-term impact of anesthesia in children?"

Expression of polymorphic B-cell antigens on human kidneys.

Does pelvic organ support deteriorate in the years following a first birth

Musical prodigies and motivation

Short note: extracellular export and consumption of glucose in Antarctic sea ice