A simulation approach for power calculation in large cohort studies based on multistate models

Realistic power calculations for large cohort studies and nested case control studies are essential for successfully answering important and complex research questions in epidemiology and clinical medicine. For this, we provide a methodical framework for general realistic power calculations via simulations that we put into practice by means of an R‐based template. We consider staggered recruitment and individual hazard rates, competing risks, interaction effects, and the misclassification of covariates. The study cohort is assembled with respect to given age‐, gender‐, and community distributions. Nested case‐control analyses with a varying number of controls enable comparisons of power with a full cohort analysis. Time‐to‐event generation under competing risks, including delayed study‐entry times, is realized on the basis of a six‐state Markov model. Incidence rates, prevalence of risk factors and prefixed hazard ratios allow for the assignment of age‐dependent transition rates given in the form of Cox models. These provide the basis for a central simulation‐algorithm, which is used for the generation of sample paths of the underlying time‐inhomogeneous Markov processes. With the inclusion of frailty terms into the Cox models the Markov property is specifically biased. An “individual Markov process given frailty” creates some unobserved heterogeneity between individuals. Different left‐truncation‐ and right‐censoring patterns call for the use of Cox models for data analysis. p‐values are recorded over repeated simulation runs to allow for the desired power calculations. For illustration, we consider scenarios with a “testing” character as well as realistic scenarios. This enables the validation of a correct implementation of theoretical concepts and concrete sample size recommendations against an actual epidemiological background, here given with possible substudy designs within the German National Cohort.     

Hierarchical Perception of Stimuli During Case Construction in the Bagworm Moth Eumeta crameri (Lepidoptera: Psychidae)

We studied case construction behavior of bagworm moth, Eumeta crameri (Lepidoptera: Psychidac) in the host plant, Acacia nilotica, at two sites. At the time of the study, Site A had 1-year-old A. nilotica saplings only, whereas Site B had full grown trees. The larva of bagworm moth used either thorns or cut-twigs or both as the materials for building its case. It renovated its case three times, and during each instance it increased the volume of its case by replacing older thorns or cut-twigs by newer and longer ones. However, it exhibited a spectacular predilection for thorns, irrespective of the sites, during the first-instar stage of its development. Thereafter, at Site A it used exclusively cut-twigs, whereas at Site B it preferably used thorns provided they were available in the range of the required length and within the threshold distance. It appears that the bagworm has an ability to process thorn length and distance signals hierarchically to fulfill its priority, that is, case building. Thus it optimizes time and energy expenditures during the period of its larval growth leading to pupation by toggling its preference between thorns and cut-twigs.     

Energy and Carbon Management Systems

This article examines an important class of information system that serves as the foundation for corporate energy and greenhouse gas (GHG) accounting: energy and carbon management systems (ECMS). Investors, regulators, customers, and employees increasingly demand that organizations provide information about their organizational energy use and GHG emissions. However, there is little transparency about how organizations use ECMS to meet such demands. To shed light on ECMS implementation and application, we collected extensive qualitative interview data from two service‐sector organizations: one that uses a spreadsheet‐based ECMS and another that implemented an ECMS provided by a third‐party vendor. Our analysis of collected data revealed numerous challenges in the areas of business processes, managerial capabilities, data capture and integration, and data quality. Though our study is built on only two organizations and requires confirmation in large‐sample surveys, we provide several recommendations for organizations regarding ECMS. We also provide suggestions for future studies to build on our tentative results.     

浙江省首例人禽流感病例的病原学与分子生物学研究

为确认浙江省首例疑似人禽流感病例,进行病原学分析,对患者气管吸出物进行核酸RT-PCR、荧光定量RT-PCR检测以及病毒分离,并对患者血清进行HI抗体测定。结果表明:患者气管吸出物H5N1亚型和A型流感病毒特异核酸均呈阳性,分离到禽流感病毒A/Zhejiang/16/06(H5N1)株;双份血清中禽流感病毒(H5N1)HI抗体滴度分别为1:320和1:640,从病原学和血清学上证实为人禽流感病例。分离毒株测序结果显示,A/Zhejiang/16/06(H5N1)株在HA裂解位点为多个碱性氨基酸,符合高致病性禽流感病毒特征;该毒株的HA、NA、PB2、NP、M和NS基因序列均为禽源,与2005年我国福建、安徽等地禽流感病毒分离株高度同源,而与越南、泰国以及香港1997年分离到的禽流感病毒株之间存在明显差异。     

Molecular Diagnosis of an Ocular Toxocariasis Patient in Vietnam

An ocular Toxocara canis infection is reported for the first time in Vietnam. A 34-year-old man residing in a village of Son La Province, North Vietnam, visited the National Eye Hospital (NEH) in August 2011. He felt a bulge-sticking pain in his left eye and loss of vision occurred over 3 months before visiting the hospital. The eye examination in the hospital showed damage of the left eye, red eye, retinal fibrosis, retinal detachment, inflammation of the eye tissues, retinal granulomas, and a parasitic cyst inside. A larva of Toxocara was collected with the cyst by a medical doctor by surgery. Comparison of 264 nucleotides of internal transcribed spacer 2 (ITS2) of ribosomal DNA was done between our Vietnamese Toxocara canis and other Toxocara geographical isolates, including Chinese T. canis, Japanese T. canis, Sri Lankan T. canis, and Iranian T. canis. The nucleotide homology was 97-99%, when our T. canis was compared with geographical isolates. Identification of a T. canis infection in the eye by a molecular method was performed for the first time in Vietnam.     

Morbidity of Chagas heart disease in the microregion of Rio Negro,Amazonian Brazil: a case-control study

A case-control study on the morbidity of Chagas heart disease was carried out in the municipality of Barcelos in the microregion of the Rio Negro, state of Amazonas. One hundred and six individuals, who were serologically positive for Trypanosoma cruzi infection, as confirmed by at least two techniques with different principles, were matched according to age and sex with an equal number of seronegative individuals. The cases and controls were evaluated using an epidemiological questionnaire and clinical, electrocardiograph and echocardiograph examinations. In the seroepidemiological evaluation, 62% of the interviewees recognised triatomines and most of them confirmed that they had seen these insects in the piassava plantations of the riverside communities of the Negro River tributaries. Of the seropositive patients, 25.8% affirmed that they had been stung by the triatomines and 11.7% denied having been stung. The principal clinical manifestations of the seropositive individuals were palpitations, chest pain and dyspnoea upon effort. Cardiac auscultation revealed extrasystoles, bradycardia and systolic murmurs. The electrocardiographic alterations were ventricular extrasystoles, left and right bundle branch block, atrioventricular block and primary T wave alterations. The echocardiogram was altered in 22.6% of the seropositive individuals and in 8.5% of the seronegative individuals.     

生物化学教学中采用案例教学法之案例设计与分析

案例教学法是被普遍采用的一种教学方式,将其应用于生物化学教学中,并用图解的形式给出案例的归纳与分析,使抽象难懂、错综复杂、生涩冷僻的教学内容变得直观明了。加深了学生对教学内容的理解,增强了课堂教学的趣味性与学生学习的主动性,同时提高了学生分析问题和解决问题的能力。     

适于工程教育的生物化学PBL教学案例设计

工程教育是我国高等教育的重要组成部分,随着新工科人才培养内涵的不断深化,全方位开展课程改革,提高工科人才培养质量正当其时。为了突出新工科人才培养的特色,专业课和实习实践类课程正在成为课程教学改革的重点。但是,在专业基础课中如何突出工科特色人才培养的实践亟待探索。本文以生物化学课程为例,采用问题引导式教学方法,选择合适的教学案例,从科学与技术问题出发探索教学设计,引导学生凝练问题、分析问题并解决问题。实现引导学生从“被动式”到“主动式”学习的转变,提升学生思辨能力的同时,突出科学与技术的工程化应用,并为持续甚至终生学习奠定基础,为新工科背景下应用型人才培养提供参考和借鉴。     

The Breivik case and what psychiatrists can learn from it

In the afternoon of July 22, 2011, Norwegian Anders Behring Breivik killed 77 persons, many of them children and youths, in two separate events. On August 24, 2012, he was sentenced to 21 years in prison. Breivik went through two forensic evaluations: the first concluded that he had a psychotic disorder, thus being legally unaccountable, whereas the second concluded that he had a personality disorder, thus being legally accountable. This article first describes Breivik's background and his crimes. This is followed by an overview of the two forensic evaluations, their methods, contents and disagreements, and how these issues were handled by the court in the verdict. Finally, the article focuses on some lessons psychiatrists can take from the case.