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Does Multimorbidity Influence the Occurrence Rates of Chronic Conditions? A Claims Data Based Comparison of Expected and Observed Prevalence Rates
Ingmar Schfer
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0045390
Abstract: Objective Multimorbidity is a complex phenomenon with an almost endless number of possible disease combinations with unclear implications. One important aspect in analyzing the clustering of diseases is to distinguish between random coexistence and statistical dependency. We developed a model to account for random coexistence based on stochastic distribution. We analyzed if the number of diseases of the patients influences the occurrence rates of chronic conditions. Methods We analyzed claims data of 121,389 persons aged 65+ using a list of 46 chronic conditions. Expected prevalences were simulated by drawing without replacement from all observed diseases using observed overall prevalences as initial probability weights. To determine if a disease occurs more or less frequently than expected by chance we calculated observed-minus-expected deltas for each disease. We defined clinical relevance as |delta| ≥ 5.0%. 18 conditions were excluded because of a prevalence < 5.0%. Results We found that (1) two chronic conditions (e.g. hypertension) were more frequent than expected in patients with a low number of comorbidities; (2) four conditions (e.g. renal insufficiency) were more frequent in patients with many comorbidities; (3) six conditions (e.g. cancer) were less frequent with many comorbidities; and (4) 16 conditions had an average course of prevalences. Conclusion A growing extent of multimorbidity goes along with a rapid growth of prevalences. This is for the largest part merely a stochastic effect. If we account for this effect we find that only few diseases deviate from the expected prevalence curves. Causes for these deviations are discussed. Our approach also has methodological implications: Naive analyses of multimorbidity might easily be affected by bias, because the prevalence of all chronic conditions necessarily increases with a growing extent of multimorbidity. We should therefore always examine and discuss the stochastic interrelations between the chronic conditions we analyze.
Unitarity Cutting Rules for Hard Processes on Nuclear Targets
Sch fer, W.
High Energy Physics - Phenomenology , 2008,
Abstract: Unitarity cutting rules for the multiplicity of cut Pomerons, or topological cross sections, have been obtained within the framework of nonlinear k_t factorisation. Proper account for the color coupled channel aspects of the problem leads to the emergence of two types of cut Pomerons. This is illustrated on the example of topological cross sections in deep inelastic scattering on a nucleus.
Multipomeron Cuts and Hard Processes on Nuclei
Sch fer, W.
High Energy Physics - Phenomenology , 2008, DOI: 10.1063/1.3122214
Abstract: With nuclear targets comes a new scale into the pQCD description of hard processes - the saturation scale. In the saturation regime, the familiar linear k_\perp-factorization breaks down and must be replaced by a nonlinear k_\perp-factorization, which accounts for absorptive and multiple scattering corrections to the hard process. Predictions for partial cross sections corresponding to a fixed number of cut Pomerons (the topological cross sections) can be obtained in a surprisingly straightforward manner. We discuss some applications to deep inelastic scattering.
Unitarity cutting rules for hard processes on nuclei
Sch fer, W.
High Energy Physics - Phenomenology , 2008,
Abstract: Heavy nuclei introduce a new scale into the pQCD description of hard processes on nuclei, the saturation scale, and the familiar linear k_\perp-factorization breaks down. It is replaced by a new concept, the nonlinear k_\perp-factorization. Here we give a brief overview how topological cross sections for hard processes on nuclei are obtained from nonlinear k_\perp-factorization.
Reconfiguring Area Studies for the Global Age
Wolf Schfer
Globality Studies Journal : Global History, Society, Civilization , 2010,
Abstract: Area studies developed in the crucible of the Cold War. Yet when globalization became the context of contemporary history, area studies responded inadequately to the challenge. Unlike world history, which transformed into global history, area studies did not adapt sufficiently to the new global environment of weakened and deconstructed geopolitical and academic borders. Vital supporters like the Ford Foundation failed to reconfigure area studies for the Global Age. Hence, this essay argues for a strategic defragmentation of area studies into comparative studies of global problems in local contexts and vice versa (global/local studies). Following the proposition that area studies without global studies are blind and global studies without area studies are empty, the article identifies and reviews the contributions since Open the Social Sciences (Wallerstein et al. 1996) that can leverage the field’s progressive interdisciplinary structure and lead it toward the advanced transdisciplinary enterprise of global/local studies.
Unnatural Disasters
Wolf Schfer
Globality Studies Journal : Global History, Society, Civilization , 2008,
Abstract:
Lean Globality Studies
Wolf Schfer
Globality Studies Journal : Global History, Society, Civilization , 2007,
Abstract: This article calls for lean globality studies based on a definition of globality as a local condition that results from at least one globalization. The exposition covers the cosmopolitan privileges of English, the global technoscientific civilization, the pluriverse of local cultures, and the key terms of globality studies: globalization, globalism, and globality. The terminological discussion includes a critical review of pertinent statements by Albrow, Shaw, and Robertson, as well as a critique of the tendency to overload the meaning of globality. Clarifying the mundane and historical nature of globality, this article notes that globalities are plural, comparable, and measurable, and that they arrange on a spectrum and must not be restricted to the present time. In closing, the modus operandi of lean globality studies is outlined theoretically.
Respiratory pathophysiology: sleep-related breathing disorders
Schfer, Thorsten
GMS Current Topics in Otorhinolaryngology, Head and Neck Surgery , 2006,
Abstract: A widespread network of respiratory-related neurons within the brainstem controls the regular respiratory cycle, which is dependent upon unspecific and specific drives like hypoxia or hypercapnia. This respiratory network and its respiratory drives are subjects to typical changes during the transition from wakefulness to sleep and within the various sleep states, which favor a destabilization of breathing during sleep. There is also a respiratory-related innervation of the dilating and stiffening pharyngeal muscles as well as a local reflex control of the basic tone of upper airway muscles, both of which are influenced by the different states of wakefulness and sleep. These sleep-related changes cause an increase in upper airway resistance during sleep. In healthy subjects, however, these features during sleep are almost completely compensated and the gas exchange is hardly hindered. However, in the case of illness, severe disordered breathing, disturbed gas exchange and interrupted sleep may occur. The central hypoventilation syndrome, central apnea-hypopnea syndromes, as well as the obstructive sleep apnea syndrome belong to these diseases. Because of the intense research, we have a detailed picture of the pathophysiological mechanisms of the origin and the maintenance of sleep-related breathing disorders.
World into Globe IV: History as a Tool of Foresight
Wolf Schfer
Globality Studies Journal : Global History, Society, Civilization , 2012,
Abstract: Revisiting Bruce Mazlish’s The Railroad and the Space Program (1965), a pioneering study of history as a tool of foresight, this contribution to World into Globe asks: Why is learning from history not the main objective of professional historiography? Recalling the Ciceronian dictum of history as the teacher of life, the opposition to this earlier status of history is traced back to Leopold von Ranke. In turn, Ranke’s anti-Ciceronian stance is explained with recourse to Reinhart Koselleck’s theory of the Sattelzeit. Koselleck’s “saddle time” posits an epochal transition between 1750 and 1850 in which a new temporality privileging the future supplanted the traditional temporality that had elevated the past. The essay concludes with a renewal of the question that prompted it.
Toward a Global Critical Theory: Our Sisyphean Task
Wolf Schfer
Globality Studies Journal : Global History, Society, Civilization , 2009,
Abstract: A Review of Eduardo Mendieta, 2008. Global Fragments. Globalizations, Latinamericanisms, and Critical Theory. Albany: SUNY Press, 226 pp. ISBN: 978-0791472583 (paperback; a hardcover edition was published in 2007).
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