Joint Modeling of Multivariate Survival Data With an Application to Retirement

The Cox proportional hazards model has been pervasively used in many social science areas to examine the effects of covariates on timing to an event. The standard Cox model is intended to study univariate survival data where there is a singular event of interest, which can only be experienced once. However, we may additionally wish to explore a number of other complexities that are prevalent in survival data. For example, an individual may experience events of the same type more than once or may experience multiple types of events. This study introduces innovations in recurrent (repeatable) event analysis, jointly modeling several endogenous survival processes. As an example and an application, we simultaneously model two types of recurrent events in the presence of a dependent terminal event. This model not only correctly handles different types of recurrent events but also explicitly estimates the direction and magnitude of relationships between recurrences and survival. This article concludes with an example of the model to examine how the timing of retirement is associated with the risks of multiple spells of employment and childbearing. The theoretical discussions and empirical analyses suggest that the multivariate joint models have much to offer to a wide variety of substantive research areas.

Epilepsy in spinocerebellar ataxia type 8: a case report

Background Spinocerebellar ataxia type 8 is an uncommon genetic condition and presents with gait disturbances, ataxia, dysarthria, nystagmus, and cognitive and psychiatric abnormalities. Seizures are extremely uncommon in the spinocerebellar ataxias and have been reported only once before in a patient with spinocerebellar ataxia type 8. This case report highlights the need to evaluate spells in patients with a known neurodegenerative or genetic disease to exclude seizures, and it stresses the importance of timely diagnosis and therapy. Case presentation The patient was a 22-year-old Caucasian woman with known spinocerebellar ataxia 8 since age 10 years. She was admitted to our hospital with new-onset left hemiparesis and encephalopathy in addition to chronic occurrence of multiple spells of confusion and oromanual automatisms with postictal lethargy. Testing confirmed that she was having recurrent seizures with episodes of nonconvulsive status epilepticus. Urgent treatment with antiepileptic therapy was initiated; her seizures resolved shortly thereafter, and her mental status improved. Her left hemiparesis has improved; she remains seizure-free; and she has returned to her baseline antiepileptic medications following physical therapy. Conclusions Seizures have been reported extremely rarely in association with spinocerebellar ataxia 8, but they must be considered in the differential diagnosis of patients with spells of altered awareness, especially in those with a known neurodegenerative or genetic condition. Clinicoradiological correlation with symptoms can help expedite diagnosis and treatment. Expert consultation with epileptologists at the earliest signs can help establish the diagnosis quickly, minimize morbidity, and enhance recovery.

Speech Acts and Embedded Narrative Structure in the Getty Hexameters

The Getty Hexameters are an enigmatic text that reveals a conception of the pragmatic force underlying mythic narratives. Although some scholars have concluded that the text is a composite of multiple spells, this paper argues for reading the text as a unified narrative marked by a hierarchy of authoritative speech acts that draw on the authority of three apotropaic divinities: Paean, Hecate, and Heracles. These layers of narrative acts follow a sequence of revelation, mythological analogy, and aitiology, all of which come together to demonstrate the efficacy of the text as an apotropaic charm.