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On the Use of Clusters to Determine Environmental Influence on DiseaseReply
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Hutchinson and Lebedev have chosen to ignore an essential paragraph on page 1058 of our article. With respect, we quote part of it here again: "It is difficult to demonstrate directly that a group of individuals constitute a cluster in time and space with respect to a disease. In addition to the obvious problem of ascertainment bias associated with the retrospective identification of such groups and the difficulty of defining a suitable control framework for the purposes of comparison, there is a major logical barrier to our attempt to prove the hypothesis that the group constitutes a meaningful cluster."
Hutchinson and Lebedev proceed to argue that "only outliers" have been examined. It is, of course, only the outliers under an assumed distribution that suggest to a researcher the possibility of a mixture of distributions. Ignoring the information contained in extreme outliers may be costly. For example, 2 planes . . . [Full Text of this Article] AUTHOR INFORMATION
Ajit Kumar, DM;
Susan Calne, CM;
Michael Schulzer, MD, PhD;
Edwin Mak, BSc;
Zbigniew Wszolek, MD;
Chris Van Netten, MD;
Joseph K. C. Tsui, MD, FRCPC;
A. Jon Stoessl, MD, FRCPC;
Donald B. Calne, DM, FRSC
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On the Use of Clusters to Determine Environmental Influence on Disease
Michael Hutchinson and Sergey Lebedev
Arch Neurol. 2005;62(2):331.
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