Propensity score analysis with local balance.
Most propensity score (PS) analysis methods rely on a correctly specified parametric PS model, which may result in biased estimation of the average treatment effect (ATE) when the model is misspecifie...
Myopathie à axe central : Questions médicales fréquentes
Questions fréquentes et termes MeSH associés
Diagnostic 5
#1
Comment diagnostique-t-on la myopathie à axe central ?
Le diagnostic repose sur l'examen clinique, l'électromyogramme et la biopsie musculaire.
#2
Quels tests génétiques sont utilisés ?
Des tests génétiques peuvent identifier des mutations dans le gène RYR1, associé à cette myopathie.
#3
Quels signes cliniques sont observés ?
On observe souvent une faiblesse musculaire proximale et des anomalies dans les biopsies musculaires.
#4
L'IRM est-elle utile pour le diagnostic ?
Oui, l'IRM peut montrer des anomalies musculaires caractéristiques de la myopathie à axe central.
#5
Quel rôle joue l'historique familial ?
Un historique familial de myopathies peut orienter le diagnostic vers une origine génétique.
Symptômes 5
#1
Quels sont les principaux symptômes ?
Les symptômes incluent faiblesse musculaire, fatigue et parfois des douleurs musculaires.
#2
La myopathie affecte-t-elle tous les muscles ?
Elle touche principalement les muscles proximaux, comme ceux des hanches et des épaules.
#3
Y a-t-il des symptômes respiratoires ?
Dans certains cas, la faiblesse musculaire peut affecter les muscles respiratoires.
#4
Les symptômes varient-ils selon l'âge ?
Oui, les symptômes peuvent apparaître dès l'enfance ou à l'âge adulte, selon les cas.
#5
Des troubles de la marche sont-ils fréquents ?
Oui, la faiblesse musculaire peut entraîner des difficultés à marcher ou à se lever.
Prévention 5
#1
Peut-on prévenir la myopathie à axe central ?
Étant génétique, il n'existe pas de prévention, mais un diagnostic précoce aide à la gestion.
#2
Le dépistage est-il recommandé ?
Le dépistage génétique peut être conseillé pour les familles à risque de transmission.
#3
Des conseils de vie peuvent-ils aider ?
Des conseils sur l'exercice et la nutrition peuvent améliorer la qualité de vie des patients.
#4
Les activités physiques sont-elles bénéfiques ?
Des activités adaptées peuvent aider à maintenir la force musculaire et la mobilité.
#5
Les consultations régulières sont-elles nécessaires ?
Oui, des suivis réguliers permettent d'ajuster les traitements et surveiller l'évolution.
Traitements 5
#1
Quels traitements sont disponibles ?
Il n'existe pas de traitement curatif, mais la physiothérapie aide à maintenir la force musculaire.
#2
Les médicaments sont-ils efficaces ?
Des médicaments peuvent être prescrits pour gérer les symptômes, mais leur efficacité varie.
#3
La chirurgie est-elle une option ?
La chirurgie n'est généralement pas indiquée, sauf pour des complications spécifiques.
#4
Comment la rééducation aide-t-elle ?
La rééducation physique aide à améliorer la fonction musculaire et la qualité de vie.
#5
Y a-t-il des traitements expérimentaux ?
Des essais cliniques explorent des thérapies géniques et des traitements ciblés.
Complications 5
#1
Quelles complications peuvent survenir ?
Les complications incluent des problèmes respiratoires et des déformations musculo-squelettiques.
#2
La myopathie peut-elle affecter la vie quotidienne ?
Oui, la faiblesse musculaire peut limiter les activités quotidiennes et l'autonomie.
#3
Y a-t-il un risque de cardiomyopathie ?
Certaines formes de myopathie peuvent être associées à des problèmes cardiaques.
#4
Les infections sont-elles plus fréquentes ?
Les infections peuvent survenir en raison de la faiblesse musculaire et de l'immobilité.
#5
Comment gérer les complications ?
Une prise en charge multidisciplinaire est essentielle pour gérer les complications.
Facteurs de risque 5
#1
Quels sont les facteurs de risque génétiques ?
Les antécédents familiaux de myopathies augmentent le risque de développer cette maladie.
#2
L'âge est-il un facteur de risque ?
L'âge d'apparition peut varier, mais les symptômes se manifestent souvent dans l'enfance.
#3
Le sexe influence-t-il le risque ?
Les myopathies peuvent affecter les deux sexes, mais certaines formes sont plus fréquentes chez les hommes.
#4
Des facteurs environnementaux jouent-ils un rôle ?
Actuellement, les facteurs environnementaux ne sont pas clairement établis comme des risques.
#5
Les maladies associées augmentent-elles le risque ?
Certaines maladies auto-immunes peuvent coexister avec la myopathie, mais leur lien n'est pas direct.
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Expert en Médecine, Optimisation des Parcours de Soins et Révision Médicale
Validation scientifique effectuée le 01/03/2025
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Auteurs principaux
David Lacomis
7 publications dans cette catégorie
Affiliations :
- Departments of Neurology and Pathology (Neuropathology), University of Pittsburgh School of Medicine, Pittsburgh, PA.
Publications dans "Myopathie à axe central" :
-
What is in the Myopathy Literature?
Journal of clinical neuromuscular disease
-
What Is in the Myopathy Literature?
Journal of clinical neuromuscular disease
-
What is in the Myopathy Literature?
Journal of clinical neuromuscular disease
-
What Is in the Myopathy Literature?
Journal of clinical neuromuscular disease
-
What is in the Myopathy Literature?
Journal of clinical neuromuscular disease
Ichizo Nishino
5 publications dans cette catégorie
Affiliations :
- Department of Neuromuscular Research, National Center of Neurology and Psychiatry (NCNP), National Institute of Neuroscience, 4-1-1 Ogawahigashi, Tokyo 187-8502, Japan; Medical Genome Center, NCNP, Tokyo, Kodaira, Japan. Electronic address: nishino@ncnp.go.jp.
Publications dans "Myopathie à axe central" :
-
A review of core myopathy: central core disease, multiminicore disease, dusty core disease, and core-rod myopathy.
Neuromuscular disorders : NMD 2021-09-17
-
Pathogenic Variants in the Myosin Chaperone UNC-45B Cause Progressive Myopathy with Eccentric Cores.
American journal of human genetics 2020-11-19
-
X-linked Myotubular Myopathy Manifesting Carrier with Central and Peripheral Nervous System Involvement.
Internal medicine (Tokyo, Japan) 2024-04-16
-
Evaluation of the Core Formation Process in Congenital Neuromuscular Disease With Uniform Type 1 Fiber and Central Core Disease.
Journal of neuropathology and experimental neurology
-
ADSSL1 myopathy is the most common nemaline myopathy in Japan with variable clinical features.
Neurology 2020-07-09
John Rendu
3 publications dans cette catégorie
Affiliations :
- INSERM, GIN-U1216, CHU Grenoble Alpes, Grenoble Institut Neurosciences, University Grenoble Alpes, Bat EJ Safra, Chemin Fortuné Ferrini, La Tronche, Grenoble, France.
Publications dans "Myopathie à axe central" :
-
In vivo RyR1 reduction in muscle triggers a core-like myopathy.
Acta neuropathologica communications 2020-11-11
-
'Dusty core disease' (DuCD): expanding morphological spectrum of RYR1 recessive myopathies.
Acta neuropathologica communications 2019-01-05
-
Pathogenic Variants in the Myosin Chaperone UNC-45B Cause Progressive Myopathy with Eccentric Cores.
American journal of human genetics 2020-11-19
Julien Fauré
3 publications dans cette catégorie
Affiliations :
- INSERM, GIN-U1216, CHU Grenoble Alpes, Grenoble Institut Neurosciences, University Grenoble Alpes, Bat EJ Safra, Chemin Fortuné Ferrini, La Tronche, Grenoble, France.
Publications dans "Myopathie à axe central" :
-
In vivo RyR1 reduction in muscle triggers a core-like myopathy.
Acta neuropathologica communications 2020-11-11
-
'Dusty core disease' (DuCD): expanding morphological spectrum of RYR1 recessive myopathies.
Acta neuropathologica communications 2019-01-05
-
Pathogenic Variants in the Myosin Chaperone UNC-45B Cause Progressive Myopathy with Eccentric Cores.
American journal of human genetics 2020-11-19
Satoru Noguchi
3 publications dans cette catégorie
Affiliations :
- Department of Neuromuscular Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, 187-8502 Tokyo, Japan; Department of Genome Medicine Development, Medical Genome Center, National Center of Neurology and Psychiatry, 187-8551 Tokyo, Japan.
Publications dans "Myopathie à axe central" :
-
Pathogenic Variants in the Myosin Chaperone UNC-45B Cause Progressive Myopathy with Eccentric Cores.
American journal of human genetics 2020-11-19
-
Evaluation of the Core Formation Process in Congenital Neuromuscular Disease With Uniform Type 1 Fiber and Central Core Disease.
Journal of neuropathology and experimental neurology
-
ADSSL1 myopathy is the most common nemaline myopathy in Japan with variable clinical features.
Neurology 2020-07-09
Ingrid E Lundberg
3 publications dans cette catégorie
Affiliations :
- From the Department of Learning, Informatics and Medical Education, Karolinska Institutet; Function Area Occupational Therapy and Physical Therapy, Allied Health Professionals Function, Karolinska University Hospital, Department of Neurobiology, Care Science and Society, Division of Physiotherapy and Department of Medicine, Karolinska Institutet; Division of Rheumatology, Rheumatology Unit, Department of Medicine, Karolinska Institutet, Solna, Sweden; Division of Rheumatology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA; Division of Rheumatology, Department of Internal Medicine, Medical Research Center, College of Medicine, Department of Molecular Medicine and Biopharmaceutical Sciences, Seoul National University, Seoul, Korea; Division of Rheumatology, Fiona Stanley Hospital, Institute for Immunology and Infectious Diseases, Murdoch University, Perth; The Notre Dame University Fremantle, Fremantle, Australia; Amsterdam UMC, University of Amsterdam, Department of Neurology, Amsterdam Neuroscience, Amsterdam, the Netherlands; Center for Global Health, University of Ottawa, Ottawa, Ontario, Canada.
- M. Regardt, PhD, Occupational Therapist, Department of Learning, Informatics and Medical Education, Karolinska Institutet, and Function Area Occupational Therapy and Physical Therapy, Allied Health Professionals Function, Karolinska University Hospital; C.A. Mecoli, MD, Division of Rheumatology, Department of Medicine, Johns Hopkins University; J.K. Park, MD, PhD, Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital; I. de Groot, Patient Research Partner; C. Sarver, Patient Research Partner; M. Needham, MD, Division of Rheumatology, Fiona Stanley Hospital, Institute for Immunology and Infectious Diseases, Murdoch University, and The Notre Dame University; M. de Visser, MD, PhD, Amsterdam UMC, University of Amsterdam, Department of Neurology, Amsterdam Neuroscience; B. Shea, MSN, Center for Global Health, University of Ottawa; C.O. Bingham III, MD, Division of Rheumatology, Department of Medicine, Johns Hopkins University; I.E. Lundberg, MD, PhD, Division of Rheumatology, Rheumatology Unit, Department of Medicine, Karolinska Institutet; Y.W. Song, MD, PhD, Division of Rheumatology, Department of Internal Medicine, Medical Research Center, College of Medicine, Department of Molecular Medicine and Biopharmaceutical Sciences, Seoul National University; L. Christopher-Stine, MD, Division of Rheumatology, Department of Medicine, Johns Hopkins University; H. Alexanderson, PhD, Physiotherapist, Department of Neurobiology, Care Science and Society, Division of Physiotherapy and Department of Medicine Solna, Karolinska Institutet, and Function Area Occupational Therapy and Physical Therapy, Allied Health Professionals Function, Karolinska University Hospital. M. Regardt and Dr. C. Mecoli are co-first authors.
Publications dans "Myopathie à axe central" :
-
OMERACT 2018 Modified Patient-reported Outcome Domain Core Set in the Life Impact Area for Adult Idiopathic Inflammatory Myopathies.
The Journal of rheumatology 2019-02-15
-
Idiopathic Inflammatory Myopathies.
Rheumatic diseases clinics of North America
-
Idiopathic inflammatory myopathies.
Nature reviews. Disease primers 2021-12-02
Masashi Ogasawara
2 publications dans cette catégorie
Affiliations :
- Department of Neuromuscular Research, National Center of Neurology and Psychiatry (NCNP), National Institute of Neuroscience, 4-1-1 Ogawahigashi, Tokyo 187-8502, Japan; Medical Genome Center, NCNP, Tokyo, Kodaira, Japan; Department of Pediatrics, Showa General Hospital, Tokyo, Kodaira, Japan.
Publications dans "Myopathie à axe central" :
-
A review of core myopathy: central core disease, multiminicore disease, dusty core disease, and core-rod myopathy.
Neuromuscular disorders : NMD 2021-09-17
-
Evaluation of the Core Formation Process in Congenital Neuromuscular Disease With Uniform Type 1 Fiber and Central Core Disease.
Journal of neuropathology and experimental neurology
Aurora Fusto
2 publications dans cette catégorie
Affiliations :
- Department of Neuroscience, University of Padua, Padua 35128, Italy.
Publications dans "Myopathie à axe central" :
-
Cored in the act: the use of models to understand core myopathies.
Disease models & mechanisms 2019-12-19
-
Expanding the clinical-pathological and genetic spectrum of RYR1-related congenital myopathies with cores and minicores: an Italian population study.
Acta neuropathologica communications 2022-04-15
Elena Pegoraro
2 publications dans cette catégorie
Affiliations :
- Department of Neuroscience, University of Padua, Padua 35128, Italy elena.pegoraro@unipd.it.
Publications dans "Myopathie à axe central" :
-
Cored in the act: the use of models to understand core myopathies.
Disease models & mechanisms 2019-12-19
-
Expanding the clinical-pathological and genetic spectrum of RYR1-related congenital myopathies with cores and minicores: an Italian population study.
Acta neuropathologica communications 2022-04-15
Angela Berardinelli
2 publications dans cette catégorie
Affiliations :
- Child Neuropsychiatry, IRCCS Mondino Foundation, Pavia, Italy.
Publications dans "Myopathie à axe central" :
-
Case report: A creatine kinase-borg scale values-based approach to tailor physical training in a central core myopathy patient.
Frontiers in physiology 2024-07-23
-
Expanding the clinical-pathological and genetic spectrum of RYR1-related congenital myopathies with cores and minicores: an Italian population study.
Acta neuropathologica communications 2022-04-15
Julie Brocard
2 publications dans cette catégorie
Affiliations :
- INSERM, GIN-U1216, CHU Grenoble Alpes, Grenoble Institut Neurosciences, University Grenoble Alpes, Bat EJ Safra, Chemin Fortuné Ferrini, La Tronche, Grenoble, France.
Publications dans "Myopathie à axe central" :
-
In vivo RyR1 reduction in muscle triggers a core-like myopathy.
Acta neuropathologica communications 2020-11-11
-
'Dusty core disease' (DuCD): expanding morphological spectrum of RYR1 recessive myopathies.
Acta neuropathologica communications 2019-01-05
Norma B Romero
2 publications dans cette catégorie
Affiliations :
- Neuromuscular Morphology Unit, Center for Research in Myology, Myology Institute, Sorbonne University, GH Pitié-Salpêtrière, Paris, France.
Publications dans "Myopathie à axe central" :
-
In vivo RyR1 reduction in muscle triggers a core-like myopathy.
Acta neuropathologica communications 2020-11-11
-
Pathogenic Variants in the Myosin Chaperone UNC-45B Cause Progressive Myopathy with Eccentric Cores.
American journal of human genetics 2020-11-19
Isabelle Marty
2 publications dans cette catégorie
Affiliations :
- INSERM, GIN-U1216, CHU Grenoble Alpes, Grenoble Institut Neurosciences, University Grenoble Alpes, Bat EJ Safra, Chemin Fortuné Ferrini, La Tronche, Grenoble, France. isabelle.marty@univ-grenoble-alpes.fr.
Publications dans "Myopathie à axe central" :
-
In vivo RyR1 reduction in muscle triggers a core-like myopathy.
Acta neuropathologica communications 2020-11-11
-
'Dusty core disease' (DuCD): expanding morphological spectrum of RYR1 recessive myopathies.
Acta neuropathologica communications 2019-01-05
Matteo Garibaldi
2 publications dans cette catégorie
Affiliations :
- Neuromuscular Morphology Unit, Myology Institute, Groupe Hospitalier Universitaire La Pitié-Salpêtrière, Paris, France. matteo.garibaldi@uniroma1.it.
- Unit of Neuromuscular Diseases, Neuromuscular Disease Centre, Department of Neurology Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, SAPIENZA University of Rome, Sant'Andrea Hospital, Via di Grottarossa 1035-1039, 00189, Rome, Italy. matteo.garibaldi@uniroma1.it.
Publications dans "Myopathie à axe central" :
-
'Dusty core disease' (DuCD): expanding morphological spectrum of RYR1 recessive myopathies.
Acta neuropathologica communications 2019-01-05
-
Novel ACTA1 mutation causes late-presenting nemaline myopathy with unusual dark cores.
Neuromuscular disorders : NMD 2020-11-30
Edoardo Malfatti
2 publications dans cette catégorie
Affiliations :
- Service Neurologie Médicale, Centre de Référence Maladies Neuromusculaire Paris-Est-Ile de France, CHU Raymond-Poincaré Paris Ouest, Garches, France.
- U1179 UVSQ-INSERM Handicap Neuromusculaire: Physiologie, Biothérapie et Pharmacologie appliquées, UFR des sciences de la santé Simone Veil, Université Versailles-Saint-Quentin-en-Yvelines, Versailles, France.
Publications dans "Myopathie à axe central" :
-
'Dusty core disease' (DuCD): expanding morphological spectrum of RYR1 recessive myopathies.
Acta neuropathologica communications 2019-01-05
-
Pathogenic Variants in the Myosin Chaperone UNC-45B Cause Progressive Myopathy with Eccentric Cores.
American journal of human genetics 2020-11-19
Fabiana Lubieniecki
2 publications dans cette catégorie
Affiliations :
- Servicio de Neurología y Servicio de Patologia, Hospital de Pediatría Garrahan, Buenos Aires, Argentina.
Publications dans "Myopathie à axe central" :
-
'Dusty core disease' (DuCD): expanding morphological spectrum of RYR1 recessive myopathies.
Acta neuropathologica communications 2019-01-05
-
Pathogenic Variants in the Myosin Chaperone UNC-45B Cause Progressive Myopathy with Eccentric Cores.
American journal of human genetics 2020-11-19
Soledad Monges
2 publications dans cette catégorie
Affiliations :
- Servicio de Neurología y Servicio de Patologia, Hospital de Pediatría Garrahan, Buenos Aires, Argentina.
Publications dans "Myopathie à axe central" :
-
'Dusty core disease' (DuCD): expanding morphological spectrum of RYR1 recessive myopathies.
Acta neuropathologica communications 2019-01-05
-
Pathogenic Variants in the Myosin Chaperone UNC-45B Cause Progressive Myopathy with Eccentric Cores.
American journal of human genetics 2020-11-19
Jocelyn Laporte
2 publications dans cette catégorie
Affiliations :
- Institut de Génétique et de Biologie Moléculaire et Cellulaire (IGBMC), 1, rue Laurent Fries, BP 10142, 67404, Illkirch, France.
- INSERM U1258, 67404, Illkirch, France.
- CNRS, UMR7104, 67404, Illkirch, France.
- Université de Strasbourg, 67404, Illkirch, France.
Publications dans "Myopathie à axe central" :
-
'Dusty core disease' (DuCD): expanding morphological spectrum of RYR1 recessive myopathies.
Acta neuropathologica communications 2019-01-05
-
Pathogenic Variants in the Myosin Chaperone UNC-45B Cause Progressive Myopathy with Eccentric Cores.
American journal of human genetics 2020-11-19
Giovanni Antonini
2 publications dans cette catégorie
Affiliations :
- Unit of Neuromuscular Diseases, Neuromuscular Disease Centre, Department of Neurology Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, SAPIENZA University of Rome, Sant'Andrea Hospital, Via di Grottarossa 1035-1039, 00189, Rome, Italy.
Publications dans "Myopathie à axe central" :
-
'Dusty core disease' (DuCD): expanding morphological spectrum of RYR1 recessive myopathies.
Acta neuropathologica communications 2019-01-05
-
Novel ACTA1 mutation causes late-presenting nemaline myopathy with unusual dark cores.
Neuromuscular disorders : NMD 2020-11-30
Mariz Vainzof
2 publications dans cette catégorie
Affiliations :
- Department of Genetics and Evolutionary Biology, Institute of Biosciences, University of São Paulo, São Paulo 05508-090, SP, Brazil.
Publications dans "Myopathie à axe central" :
Sources (10000 au total)
Prognostic score-based model averaging approach for propensity score estimation.
Propensity scores (PS) are typically evaluated using balance metrics that focus on covariate balance, often without considering their predictive power for the outcome. This approach may not always res... We conduct a series of simulations alongside an analysis of empirical observational data to compare the performances of weighted treatment effect estimates using the proposed and existing approaches. ... The simulation and empirical data analysis reveal that our proposed model-averaging approaches for PS estimation consistently yield lower bias and less variability in treatment effect estimates across... The prognostic score-based model averaging approach for estimating PS can outperform existing model averaging methods. In particular, the estimator using the model averaging prognostic score as a bala... Using the prognostic score as the balance metric for the PS model averaging enhances the performance of the treatment effect estimator, which can be recommended for a wide variety of situations. When ...
An overview of propensity score matching methods for clustered data.
Propensity score matching is commonly used in observational studies to control for confounding and estimate the causal effects of a treatment or exposure. Frequently, in observational studies data are...
Traumatic Injury in Pregnancy: A Propensity Score-Matched Analysis.
Trauma represents the leading cause of nonobstetrical maternal death. How in-hospital outcomes of acutely injured pregnant patients (PP) compares to that of similarly aged nonpregnant control groups (... The American College of Surgeons Trauma Quality Improvement Program (TQIP) was used to identify traumatically injured females between 2017 and 2019. Propensity score matching on age, race, injury seve... A total of 1078 traumatically injured pregnant females were identified. Propensity score matching resulted in 990 patients in the PP and CG cohorts. After matching, PPs were more likely to be assault ... After acute trauma, PPs did not have increased mortality or complications when compared to matched controls, although they were more likely to be victims of assault, directly proceed to the OR, requir...
Parametric and nonparametric propensity score estimation in multilevel observational studies.
There has been growing interest in using nonparametric machine learning approaches for propensity score estimation in order to foster robustness against misspecification of the propensity score model....
Spouse bereavement and brain pathologies: A propensity score matching study.
Spouse bereavement is one of life's greatest stresses and has been suggested to trigger or accelerate cognitive decline and dementia. However, little information is available about the potential brain... A total of 319 ever-married older adults between the ages of 61 and 90 years underwent comprehensive clinical assessments and multimodal brain imaging including [... Spouse bereavement was significantly associated with higher cerebral white matter hyperintensity (WMH) volume compared with no spouse bereavement. Interaction and subsequent subgroup analyses showed t... The findings suggest that the spouse bereavement may contribute to dementia or cognitive decline by increasing cerebrovascular injury, particularly in older individuals and those with no- or low-skill...
Propensity score analysis for health care disparities: a deweighting approach.
Propensity score weighting is a useful tool to make causal or unconfounded comparisons between groups. According to the definition by the Institute of Medicine (IOM), estimates of health care disparit... The present study introduces a deweighting method that uses two types of propensity scores. One is a function of all covariates of health status and SES variables and is used to weight study subjects ... The procedure of deweighting is illustrated using a dataset from a right heart catheterization (RHC) study, where it was used to examine whether there was a disparity between black and white patients ... Deweighting is a promising tool for implementing the IOM-definition of health care disparities. The method is expected to be broadly applied to quantitative research on health care disparities....
Liver transplantation for intrahepatic cholangiocarcinoma: a propensity score-matched analysis.
Liver resection (LR) is the only recommended effective curative treatment for patients with intrahepatic cholangiocarcinoma (ICC), but the prognosis of patients with ICC is still poor even after curat...
Generalized propensity score approach to causal inference with spatial interference.
Many spatial phenomena exhibit interference, where exposures at one location may affect the response at other locations. Because interference violates the stable unit treatment value assumption, stand...
Propensity score methods for observational studies with clustered data: A review.
Propensity score methods are a popular approach to mitigating confounding bias when estimating causal effects in observational studies. When study units are clustered (eg, patients nested within healt...