ABSTRACT We study how a first heart-failure hospitalization – an adverse health shock – changes patients’ care, and whether a nurse-led chronic-care programme sustains those post-shock investments. Using linked population-wide administrative records from Italy’s Romagna Local Health Authority (2017–2023), we anchor event time at each patient’s first CHF admission and exploit staggered timing to estimate dynamic effects. The shock triggers a sharp post-discharge surge: beta-blocker adherence, cardiology follow-up, and echocardiography rise immediately, while emergency-room use spikes just before admission and then stabilizes. We then estimate the incremental impact of enrolment in the Nurse-led Program for Chronic Patients (NPCP) using the interaction-weighted event-study estimator for staggered adoption. Under conventional diff-in-diffs inference, NPCP strengthens long-run preventive engagement, with little detectable change in emergency-room use. HonestDiD sensitivity analysis indicates these gains are economically meaningful but not statistically definitive under modest departures from parallel trends.

Testing data for normality before applying parametric statistics has become a routine procedure in biomedical research. This commentary argues that such tests provide little inferential value, may mislead analytical choices, and reflect outdated thinking from a pre-computational era. Parametric procedures are robust to modest departures from normality, and the Central Limit Theorem makes most normality checks unnecessary. According to this Theorem, the sampling distribution of the mean approaches a normal shape as sample size increases, regardless of the original distribution of the data. Outlier panic and indiscriminate data ranking further undermine the meaning of measurement and prediction. The obsession with distributional purity has replaced the logic of inference with statistical rigor. It is time to abandon this ritual and refocus on design, representativeness, and modeling – the true pillars of inference.

Robert A. Rigby, Mikis D. Stasinopoulous, Achim Zeilis, Sanja Stanojevic, Gillian Heller, Fernanda de Bastiani, Thomas Kneib, Andreas Mayr, Reto Stauffer, and Nikolaus Umlauf contend that segmented linear regression (SLR) is inadequate for spirometry reference equations and over-/underdiagnoses abnormality compared with Generalized Additive Models of Location, Scale, and Shape (GAMLSS). Using a refined NHANES 2007-2012 dataset (n=16,596), I reassessed calibration and the lower limit of normal (LLN) discordance with additional analyses. Out-of-sample root mean square error (RMSE) and correlations were essentially identical across approaches, and overall, the prevalence below the LLN differed by <1 percentage point. Ages 5-80 were resampled to the 2020-2024 U.S. Census age structure, and observed below-LLN counts (z<-1.645) were compared with exact 95% binomial bands; most age-sex strata for FEV1, FVC, and FEV1/FVC fell within expected sampling variability, with modest departures mainly in older men. Age-stratified concordance showed 93.5-93.8% normal by both methods and 4.0-4.8% abnormal by both; discordance was uncommon (GAMLSS-only 0.20-0.78%, SLR-only 1.23-1.65%). Estimated week-to-week measurement variability produced LLN flip rates of ∼3% (FEV1), ∼3.5% (FVC), and ∼6% (FEV1/FVC), exceeding model-driven differences. GAMLSS remains useful, but simpler, transparent regressions can often yield comparable practical interpretation.

ABSTRACTWater intakes entrain large numbers of fish larvae in waterways where drift coincides with large-scale extraction. While modern fish-protection screens can reduce these losses, many are not designed for larvae and were developed or evaluated primarily for juveniles and adults. This study evaluated the effectiveness of Australia's fish screen design criteria (which specify a maximum approach velocity of 0.1 m s−¹ and slot widths of 2–3 mm) for protecting drifting larval Murray cod (Maccullochella peelii). Larvae were tested in a large flume under combinations of approach velocity (0.1 or 0.2 m s−¹), slot width (2 or 3 mm), and proximity. Entrainment rose sharply with velocity; slot size had a smaller interactive effect. The most protective combination (0.1 m s−¹ and 2 mm) reduced entrainment by up to 94% relative to unscreened conditions. Three-dimensional flow measurements helped explain how velocity vectors interact to influence larval fate. The results demonstrate that Australia's current standards, although developed for juveniles, can provide strong larval protection when strictly followed, but that even modest departures can sharply increase risk. More broadly, since the criteria tested here are less conservative than those adopted in many other countries, where empirical evidence on larval behaviour does not exist, targeted research could determine whether existing guidelines warrant revision.

Abstract An irreducible complete atomic oml of infinite height cannot be algebraic and have the covering property. However, modest departure from these conditions allows infinite-height examples. We use an extension of Kalmbach’s construction to the setting of infinite chains to provide an example of an infinite-height, irreducible, algebraic oml with the 2-covering property, and Keller’s construction provides an example of an infinite-height, irreducible, complete oml that has the covering property and is completely hereditarily atomic. Completely hereditarily atomic omls generalize algebraic omls suitably to quantum predicate logic.

Rossby waves are found at several levels in the Sun, most recently in its supergranule layer. We show that Rossby waves in the supergranule layer can be excited by an inverse cascade of kinetic energy from the nearly horizontal motions in supergranules. We illustrate how this excitation occurs using a hydrodynamic shallow-water model for a 3D thin rotating spherical shell. We find that initial kinetic energy at small spatial scales inverse cascades quickly to global scales, exciting Rossby waves whose phase velocities are similar to linear Rossby waves on the sphere originally derived by Haurwitz. Modest departures from the Haurwitz formula originate from nonlinear finite amplitude effects and/or the presence of differential rotation. Like supergranules, the initial small-scale motions in our model contain very little vorticity compared to their horizontal divergence, but the resulting Rossby waves are almost all vortical motions. Supergranule kinetic energy could have mainly gone into gravity waves, but we find that most energy inverse cascades to global Rossby waves. Since kinetic energy in supergranules is three or four orders of magnitude larger than that of the observed Rossby waves in the supergranule layer, there is plenty of energy available to drive the inverse-cascade mechanism. Tachocline Rossby waves have previously been shown to play crucial roles in causing seasons of space weather through their nonlinear interactions with global flows and magnetic fields. We briefly discuss how various Rossby waves in the tachocline, convection zone, supergranule layer, and corona can be reconciled in a unified framework.

BackgroundNon-proportional hazards are common with time-to-event data but the majority of randomised clinical trials (RCTs) are designed and analysed using approaches which assume the treatment effect follows proportional hazards (PH). Recent advances in oncology treatments have identified two forms of non-PH of particular importance - a time lag until treatment becomes effective, and an early effect of treatment that ceases after a period of time. In sample size calculations for treatment effects on time-to-event outcomes where information is based on the number of events rather than the number of participants, there is crucial importance in correct specification of the baseline hazard rate amongst other considerations. Under PH, the shape of the baseline hazard has no effect on the resultant power and magnitude of treatment effects using standard analytical approaches. However, in a non-PH context the appropriateness of analytical approaches can depend on the shape of the underlying hazard.MethodsA simulation study was undertaken to assess the impact of clinically plausible non-constant baseline hazard rates on the power, magnitude and coverage of commonly utilized regression-based measures of treatment effect and tests of survival curve difference for these two forms of non-PH used in RCTs with time-to-event outcomes.ResultsIn the presence of even mild departures from PH, the power, average treatment effect size and coverage were adversely affected. Depending on the nature of the non-proportionality, non-constant event rates could further exacerbate or somewhat ameliorate the losses in power, treatment effect magnitude and coverage observed. No single summary measure of treatment effect was able to adequately describe the full extent of a potentially time-limited treatment benefit whilst maintaining power at nominal levels.ConclusionsOur results show the increased importance of considering plausible potentially non-constant event rates when non-proportionality of treatment effects could be anticipated. In planning clinical trials with the potential for non-PH, even modest departures from an assumed constant baseline hazard could appreciably impact the power to detect treatment effects depending on the nature of the non-PH. Comprehensive analysis plans may be required to accommodate the description of time-dependent treatment effects.

Quantum probability: A new method for modelling travel behaviour

Many outcomes derived from electronic health records (EHR) not only are imperfect but also may suffer from exposure-dependent differential misclassification due to variability in the quality and availability of EHR data across exposure groups. The objective of this study was to quantify the inflation of type I error rates that can result from differential outcome misclassification. We used data on gold-standard and EHR-derived second breast cancers in a cohort of women with a prior breast cancer diagnosis from 1993 to 2006 enrolled in Kaiser Permanente Washington. We simulated an exposure that was independent of the true outcome status. A surrogate outcome was then simulated with varying sensitivity and specificity according to exposure status. We estimated the type I error rate for a test of association relating this exposure to the surrogate outcome, while varying outcome sensitivity and specificity in exposed individuals. Type I error rates were substantially inflated above the nominal level (5%) for even modest departures from nondifferential misclassification. Holding sensitivity in exposed and unexposed groups at 85%, a difference in specificity of 10% between the exposed and unexposed (80% vs 90%) resulted in a 36% type I error rate. Type I error was inflated more by differential specificity than sensitivity. Differential outcome misclassification may induce spurious findings. Researchers using EHR-derived outcomes should use misclassification-adjusted methods whenever possible or conduct sensitivity analyses to investigate the possibility of false-positive findings, especially for exposures that may be related to the accuracy of outcome ascertainment.

Evidence for non-linear metabolism at low benzene exposures? A reanalysis of data

How planar are planar peptide bonds?

Is the discrepancy between the cultural and linguistic rights of immigrants on the one hand and national groups on the other justified, with the latter group typically enjoying a fuller set of such rights than the former category? Patten presents a case for accepting some modest departures from neutrality in the treatment of immigrants’ cultural rights and that of majority and minority national groups. I challenge his thesis by asking whether such departures are justified with respect to already settled (as opposed to prospective) immigrants; whether the situational argument for unequal treatment is inconsistent with the theory of culture offered earlier in the book; and whether contexts of historical injustice against immigrant groups might complicate judgements about the national minority/immigrant dichotomy with respect to minority cultural rights.

Under certain conditions, the collective behavior of a large globally-coupled heterogeneous network of coupled oscillators, as quantified by the macroscopic mean field or order parameter, can exhibit low-dimensional chaotic behavior. Recent advances describe how a small set of "reduced" ordinary differential equations can be derived that captures this mean field behavior. Here, we show that chaos control algorithms designed using the reduced equations can be successfully applied to imperfect realizations of the full network. To systematically study the effectiveness of this technique, we measure the quality of control as we relax conditions that are required for the strict accuracy of the reduced equations, and hence, the controller. Although the effects are network-dependent, we show that the method is effective for surprisingly small networks, for modest departures from global coupling, and even with mild inaccuracy in the estimate of network heterogeneity.

Econometric analysis of present value models when the discount factor is near one

In this study, numerical course scores of second-year dental students in four successive classes in an oral and maxillofacial pathology course were compared. While the course content and teaching methods were essentially unchanged throughout the four years, two modest departures from the sole use of multiple-choice format questions were made in the assessment of student achievements. The modifications consisted of creating a more challenging examination procedure through the inclusion of un-cued short-answer format questions and the institution of correction-for-guessing scoring on multiple-choice examinations. Academically, the students in the four classes were comparable, as indicated by their respective numerical course score distributions in a prerequisite general pathology course in which the course content was unchanged, and all multiple-choice format questions were used to assess student academic achievements. This four-year study demonstrated that two qualitative changes in the educational environment-utilization of un-cued short-answer questions and correction for guessing scoring of multiple-choice questions-separately resulted in significant improvements in student course scores. Our results support the notion that, without any changes in curricular content or emphasis, combinations of qualitative changes in the assessment procedures alter student behavior and, as a consequence, appreciably improve their academic achievements.

Using different measures of constructs in research to develop robust evidence of relationships and effects is seen as good methodological practice. This assumes these measures possess high convergent validity. However, proxies—alternative measures of the same construct—are rarely perfectly convergent. Although some convergence is preferred to none, this study demonstrates that even modest departures from perfect convergent validity can result in substantial differences in the magnitudes of findings, creating challenges for the accumulation and interpretation of research. Using data from published research, the authors find that substantial differences in findings between studies using desired and proxy variables occur even at levels of convergent validity as high as r = .85. Implications of using measures with less-than-ideal convergent validity for the interpretability of research results are examined. Convergent validities above r = .70 are recommended, whereas those below r = .50 should be avoided. Researchers are encouraged to develop and report convergent validity data.

Post-1980 US data trace out a stable long-run money demand relationship of Cagan's semi-log form between the M1-income ratio and the nominal interest rate, with an interest semielasticity below 2. Integrating under this money demand curve yields estimates of the welfare costs of modest departures from Friedman's zero nominal interest rate rule for the optimum quantity of money that are quite small. The results suggest that the Federal Reserve's current policy, which generates low but still positive rates of inflation, provides an adequate approximation in welfare terms to the alternative of moving all the way to the Friedman rule. (JEL E31, E41, E52)

We calculate the CP-violating ratio epsilon'/epsilon in the Littlest Higgs model with T-parity (LHT) and investigate its correlations with the branching ratios for K_L -> pi^0 nu {bar nu}, K_L -> pi^0 l^+ l^- and K^+ -> pi^+ nu {bar nu}. The resulting correlations are rather strong in the case of K_L decays, but less pronounced in the case of K^+ -> pi^+ nu {bar nu}. Unfortunately, they are subject to large hadronic uncertainties present in epsilon'/epsilon, whose theoretical prediction in the Standard Model (SM) is reviewed and updated here. With the matrix elements of Q_6 (gluon penguin) and Q_8 (electroweak penguin) evaluated in the large-N limit and m_s^MS(2 GeV) = 100 MeV from lattice QCD, (epsilon'/epsilon)_SM turns out to be close to the data so that significant departures of Br(K_L -> pi^0 nu {bar nu}) and Br(K_L -> pi^0 l^+ l^-) from the SM expectations are unlikely, while Br(K^+ -> pi^+ nu {bar nu}) can be enhanced even by a factor 5. On the other hand, modest departures of the relevant hadronic matrix elements from their large-N values allow for a consistent description of epsilon'/epsilon within the LHT model accompanied by large enhancements of Br(K_L -> pi^0 nu {bar nu}) and Br(K_L -> pi^0 l^+ l^-), but only modest enhancements of Br(K^+ -> pi^+ nu {bar nu}).

Abstract A model is developed to characterize the vertically linked and concentrated nature of developed‐country food markets. This model is then parameterized and used to simulate the effects of varying food market structures on the benefits to developing‐country exporters of agricultural commodities from trade liberalization by developed countries. Results demonstrate that even relatively modest departures from perfect competition can cause much of the benefits from trade liberalization to flow to marketing firms instead of producers in the developing country. The distributional effects under downstream market power differ significantly from the perfectly competitive case and may result, somewhat paradoxically, in developing countries receiving a lower share of the total value added within the food chain as trade reform occurs.

Greenland (2000, Biometrics 56, 915-921) describes the use of random coefficient regression to adjust for residual confounding in a particular setting. We examine this setting further, giving theoretical and empirical results concerning the frequentist and Bayesian performance of random coefficient regression. Particularly, we compare estimators based on this adjustment for residual confounding to estimators based on the assumption of no residual confounding. This devolves to comparing an estimator from a nonidentified but more realistic model to an estimator from a less realistic but identified model. The approach described by Gustafson (2005, Statistical Science 20, 111-140) is used to quantify the performance of a Bayesian estimator arising from a nonidentified model. From both theoretical calculations and simulations we find support for the idea that superior performance can be obtained by replacing unrealistic identifying constraints with priors that allow modest departures from those constraints. In terms of point-estimator bias this superiority arises when the extent of residual confounding is substantial, but the advantage is much broader in terms of interval estimation. The benefit from modeling residual confounding is maintained when the prior distributions employed only roughly correspond to reality, for the standard identifying constraints are equivalent to priors that typically correspond much worse.