970 resultados para Diagrama causal
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Este artigo apresenta a gestão da biblioteca escolar com enfoque na aplicação de ferramentas de gestão para avaliação da qualidade dos serviços oferecidos. Aborda as questões de qualidade e de administração como gestão garantindo aos serviços as características das expectativas e necessidades dos usuários da biblioteca escolar. O bibliotecário, como gestor dos serviços prestados na tomada de decisão, tem competência para utilizar as ferramentas que auxiliam a avaliar seus serviços, como brainstorming, diagrama de causa e efeito, diagrama de Pareto, histograma, matriz de priorização GUT, ciclo PDCA, fluxograma e 5W2H. Apresenta ainda algumas situações de problemas e dificuldades no âmbito da biblioteca escolar exemplificadas na utilização das ferramentas e a aplicação da junção de três ferramentas (fluxograma, PDCA e 5W2H) para avaliação dos serviços.
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Intensive research is devoted to unravel the neurobiological mechanisms mediating adult hippocampal neurogenesis, its regulation by antidepressants, and its behavioral consequences. Macrophage migration inhibitory factor (MIF) is a pro-inflammatory cytokine that is expressed in the CNS, where its function is unknown. Here, we show, for the first time, the relevance of MIF expression for adult hippocampal neurogenesis. We identify MIF expression in neurogenic cells (in stem cells, cells undergoing proliferation, and in newly proliferated cells undergoing maturation) in the subgranular zone of the rodent dentate gyrus. A causal function for MIF in cell proliferation was shown using genetic (MIF gene deletion) and pharmacological (treatment with the MIF antagonist Iso-1) approaches. Behaviorally, genetic deletion of MIF resulted in increased anxiety- and depression-like behaviors, as well as of impaired hippocampus-dependent memory. Together, our studies provide evidence supporting a pivotal function for MIF in both basal and antidepressant-stimulated adult hippocampal cell proliferation. Moreover, loss of MIF results in a behavioral phenotype that, to a large extent, corresponds with alterations predicted to arise from reduced hippocampal neurogenesis. These findings underscore MIF as a potentially relevant molecular target for the development of treatments linked to deficits in neurogenesis, as well as to problems related to anxiety, depression, and cognition.
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A Cevada BR 2, criada pela Embrapa-Centro Nacional de Pesquisa de Trigo (CNPT), foi lançada para cultivo em 1989. Originou-se de sete plantas selecionadas em F3 do cruzamento FM 424/TR 206, realizado em 1979, em Passo Fundo, RS. A BR 2 é uma cevada de primavera, do tipo de duas fileiras de grãos, com ciclo precoce, ampla adaptação e porte baixo. É a primeira cultivar brasileira resistente a Pyrenophora teres, agente causal da mancha-reticular, principal moléstia da cevada no Brasil. Em oito anos de avaliação no Ensaio Nacional de Cevada, conduzido em 12 locais da Região Sul, a BR 2 rendeu entre 1.621 e 4.014 kg/ha de grãos de primeira qualidade, superando a cultivar Antarctica 05 em 3% no RS e SC, em 13% no PR, e em 6% na média dos 96 experimentos (12 locais x 8 anos). Na lavoura, a BR 2 tem produzido rendimentos acima de 5.000 kg/ha. Aprovada como cervejeira em 1992, ocupou 30% da área semeada em 1993 e 90% em 1997. A BR 2 representa um marco no progresso do melhoramento genético da cevada no país, contribuindo decisivamente para o aumento da competitividade da produção doméstica.
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A través de este articulo he pretendido exponer una introducción a los Modelos Causales desde las perspectivas histórica, metodológica y estadístico-matemtitica. Asimismo, he planteado las posibilidades que tienen estos modelos, asociados a estructuras de covariancia, como via que puede contribuir a superar la dicotomia metodo experimental/mktodo correlacional. Para la exposición de 10s procesos de especificación, identificación, estimación, prueba de ajuste e interpretación de parámetros de un modelo causal he tomado como referencia el modelo LISREL. Sin embargo, en la sistematización de estos procesos no he intentado presentar solamente la simple descripción del modelo, insistiendo, para ello, en la necesidad de integrar este modelo en el contexto del método cientifico.
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El empleo generalizado de los modelos de ecuaciones estructurales ha llevado al planteamiento de distintas estrategias de trabajo en el ámbito de los diseños no experimentales. Es por ello que este tipo de análisis estadístico está relacionado en su propia configuración con aspectos de carácter estrictamente metodológico. Ello no es en sí mismo una novedad, puesto que técnicas como el Anova presentan esa misma configuración. Sin embargo, no puede pensarse en los sistemas de ecuaciones estructurales en los mismos términos que el resto de pruebas estadísticas. De ahí que en este articulo se pretenda efectuar un análisis de la técnica en cuestión desde una perspectiva teórica y empírica para mostrar algunos de los elementos criticos de este tipo de tratamiento de datos. Así se efectua una revisión del proceso de modelización estadística estructural, comentando la posibilidad de interpretación causal a partir de la estimación de parametros, su adecuación en diseños experimentales y, de forma general, una evaluación de los procedimientos de ajuste global de los datos obtenidos
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SummaryThe alcohol use of adolescents and young adults is one of the world's most important and costliest health problems. Particularly, binge drinking (i.e. drinking an important amount of alcohol in one occasion) among young people increase the risk of detrimental consequences such as blackouts, injuries, at-risk sexual behaviors, involvement in violent acts, academic failure, and suicide attempts. In countries with mandatory conscription mechanisms, such as Switzerland, the army provides a unique opportunity to reach a large portion of this high risk population. We used this sample to evaluate the prevalence of binge drinking among young men, to test the efficacy of brief motivational interventions (BMI) as a primary and secondary preventive measure, and to examine the mechanisms underlying BMI in this age group.We showed that binge drinking among young French-speaking Swiss men is less of an exception than it is the norm. Of those using alcohol, 75.5% had a binge drinking episode at least monthly, and 69.3% of all consumption reported in a one-week diary was due to binge drinking days.We used two different inclusion modes to evaluate the success of alcohol BMI. In the first randomized controlled trial, inclusion relied on a random selection of conscripts. BMI efficacy was evaluated in a sample of conscripts who visited the army recruitment centre that is potentially generalizable to the entire population. In the second randomized controlled trial, we included subjects voluntarily participating in BMI. This venue might be more realistic for young adults; it is more akin to the MI spirit, in which it is crucial for individuals to control their own decisions.Regarding BMI efficacy as a secondary prevention measure (i.e. to help decrease alcohol use among at-risk drinkers, defined here as those having a binge drinking episode at least monthly), it was effective among randomly selected at-risk drinkers, whereas it was not effective among at-risk drinkers who voluntarily showed up. Individuals who showed interest in BMI had more severe patterns of alcohol use, which may have made change more difficult and calls for treatment that is more intensive. BMI demonstrated a 20% reduction in weekly alcohol use among randomly selected participants, indicating potential interest in BMI implementation within similar community settings.Regarding BMI efficacy as a primary prevention measure (i.e. to help maintain low levels of use among low-risk drinkers), it had significant protective effects among low-risk drinkers voluntarily showing up whereas it was not effective among low-risk drinkers randomly selected. This suggests that BMI might help young individuals keep their drinking at low levels, especially when they are interested in discussing their alcohol use. Therefore, BMI has potentially promising uses in primary prevention efforts. The content of these interventions for low-risk drinkers who do not seek BMI on their own should be further evaluated.BMI mechanisms were addressed since little is known about exactly which elements of it work, or which of the counselor and subject communication behaviors are most effective in triggering behavior changes. The causal chain hypothesis developed in the motivational interviewing (MI) theory was followed, and it was found that counselor behaviors consistent with the MI approach (MICO) were significantly more likely to be followed by participant language in favor of change (change talk, CT), while behaviors inconsistent with MI (MIIN) were significantly less likely to do so. Several CT dimensions measured during BMI (particularly Ability, Desire, and Need to change) were predictive of change in alcohol use. Our findings lend strong support for the use of MICO behaviors and the avoidance of MIIN behaviors in eliciting CT, and point out that particular attention should be paid to the utterances in several sub-dimensions of CT and to the strength of expression, since these are good indicators of potential actual behavior change in future.RésuméLa consommation d'alcool chez les adolescents et les jeunes adultes est un des problèmes de santé les plus importants et les plus coûteux dans le monde. En particulier, les consommations importantes d'alcool en une occasion (binge drinking) parmi les jeunes adultes ont été liées à des conséquences telles que pertes de connaissance, accidents et blessures, comportements sexuels à risque, violences, difficultés scolaires et tentatives de suicide. Les pays qui, comme la Suisse, connaissent un processus de recrutement obligatoire pour l'armée offrent une opportunité unique d'atteindre une large portion de cette population à hauts risques. Nous avons utilisé cet échantillon pour évaluer la prévalence du binge drinking parmi les jeunes hommes, pour tester l'efficacité de l'intervention brève motivationnelle (IBM) comme mesure de prévention primaire et secondaire, et pour examiner les mécanismes sous-tendant ce type d'interventions.La première partie de cette étude montre que le binge drinking est moins une exception que la norme parmi les jeunes hommes suisses francophones. 75.5% des personnes consommant de l'alcool avaient au moins un épisode de binge drinking par mois et 69.3% du total des boissons alcoolisées reportées comme consommation de la semaine précédant le questionnaire avaient été consommées lors d'épisodes de binge drinking.Pour évaluer l'efficacité de l'IBM dans ce cadre, nous avons utilisé deux modes d'inclusion. Dans une première étude randomisée contrôlée, nous avons inclus des personnes sélectionnées au hasard parmi toutes celles se présentant au centre de recrutement, créant ainsi un groupe potentiellement représentatif de l'ensemble du collectif. Dans la deuxième étude randomisée contrôlée, nous avons inclus des sujets se présentant volontairement pour recevoir une IBM, prendre des volontaires pouvant être plus proche de la réalité et plus proche de l'esprit motivationnel dans lequel il est crucial que l'individu contrôle ses décisions.En regardant l'IBM comme mesure de prévention secondaire (c'est-à-dire aider à diminuer la consommation d'alcool chez les consommateurs à risque, définis ici comme au moins un épisode de binge drinking par mois), l'IBM était efficace lorsque les participants étaient inclus au hasard et inefficace lorsqu'ils étaient volontaires. Les jeunes hommes volontaires pour un IBM avaient un mode de consommation particulièrement sévère qui pourrait être plus difficile à changer et nécessiter un traitement plus intensif. Parmi les personnes sélectionnées au hasard, l'IBM permettait une diminution de 20% de la consommation hebdomadaire d'alcool, montrant l'intérêt potentiel d'une implémentation de ce type de mesures dans des contextes communautaires similaires.En ce qui concerne l'IBM comme mesure de prévention primaire (c'est-à-dire aider à maintenir une consommation à bas risque chez les consommateurs à bas risque), l'IBM avaient un effet protectif significatif parmi les jeunes hommes volontaires pour une IBM, mais pas d'effet chez ceux sélectionnés au hasard. Ces résultats suggèrent que l'IBM pourrait aider de jeunes personnes à maintenir un niveau de consommation à bas risque si celles-ci s'intéressent à discuter cette consommation et aurait ainsi un potentiel intéressant comme mesure de prévention primaire. Le contenu de l'IBM pour des consommateurs à bas risque non-volontaires pour une IBM devra encore être évalué.Nous avons ensuite examiné les mécanismes de l'IBM car son fonctionnement est encore peu expliqué et les comportements de l'intervenant et du sujet les plus à même de provoquer le changement ne sont pas bien définis. En suivant l'hypothèse d'une chaine causale développée dans la littérature de l'entretien motivationnel (EM), nous avons pu montrer qu'un discours en faveur du changement chez le sujet était plus probable après des comportements de l'intervenant recommandés dans l'EM et moins probable après des comportements à éviter dans l'EM ; et que plusieurs dimensions de ce discours en faveur du changement (notamment la capacité, le désir et le besoin de changer) prédisaient un changement effectif dans la consommation d'alcool. Ces résultats encouragent donc à utiliser des comportements recommandés dans l'EM pour favoriser un discours en faveur du changement. Ils montrent aussi qu'une attention particulière doit être portée à la fréquence et à la force avec laquelle sont exprimées certaines dimensions de ce discours car ceux-ci indiquent un potentiel changement effectif de comportement.Résumé vulgariséLa consommation d'alcool chez les adolescents et les jeunes adultes est un des problèmes de santé les plus importants et les plus coûteux dans le monde. En particulier, les consommations importantes d'alcool en une occasion (binge drinking) parmi les jeunes adultes augmentent fortement les risques de conséquences telles que pertes de connaissance, accidents et blessures, comportements sexuels à risque, violences, difficultés scolaires et tentatives de suicide. Les pays qui, comme la Suisse, connaissent un processus de recrutement obligatoire pour l'armée offrent une opportunité unique d'atteindre une large portion de cette population à hauts risques. Nous avons utilisé cet échantillon pour évaluer l'importance du phénomène de binge drinking, pour tester l'efficacité de l'intervention brève motivationnelle (IBM) comme mesure de prévention de la consommation à risque d'alcool, et pour examiner comment fonctionne ce type d'interventions.La première partie de cette étude montre que le binge drinking est moins une exception que la norme parmi les jeunes hommes suisses francophones. Trois quart des personnes consommant de l'alcool avaient au moins un épisode de binge drinking par mois. Presque 70% du total des boissons alcoolisées consommées durant la semaine précédant le questionnaire avaient été consommées lors d'épisodes de binge drinking.Nous avons ensuite mené deux études pour évaluer l'efficacité de l'IBM dans ce cadre. Dans une première étude, nous avons sélectionné des personnes au hasard parmi toutes celles se présentant au centre de recrutement, créant ainsi un groupe potentiellement représentatif de l'ensemble du collectif. Dans la deuxième étude, nous avons inclus toutes les personnes se présentant volontairement pour recevoir une IBM, prendre des volontaires pouvant être plus proche de la réalité et plus proche de l'approche motivationnelle dans laquelle il est crucial que l'individu contrôle ses décisions. Dans les deux études, nous testions l'efficacité de l'IBM comme mesure de prévention primaire et secondaire (voir ci-dessous).En regardant l'IBM comme mesure de prévention secondaire (c'est-à-dire aider à diminuer la consommation d'alcool chez les consommateurs à risque, définis ici comme au moins un épisode de binge drinking par mois), l'IBM était efficace lorsque les participants étaient inclus au hasard et inefficace lorsqu'ils étaient volontaires. Les jeunes hommes volontaires pour un IBM avaient un mode de consommation particulièrement sévère qui pourrait être plus difficile à changer et nécessiter un traitement plus intensif. Parmi les personnes sélectionnées au hasard, l'IBM permettait une diminution de 20% de la consommation hebdomadaire d'alcool, montrant l'intérêt potentiel de la mise en place de ce type de mesures dans des contextes communautaires similaires.En ce qui concerne l'IBM comme mesure de prévention primaire (c'est-à-dire aider à maintenir une consommation à bas risque chez les consommateurs à bas risque), l'IBM avaient un effet protectif parmi les jeunes hommes volontaires pour une IBM, mais pas d'effet chez ceux sélectionnés au hasard. Ces résultats suggèrent que l'IBM pourrait aider de jeunes personnes à maintenir un niveau de consommation à bas risque si celles-ci s'intéressent à discuter de cette consommation. Le contenu de l'IBM pour des consommateurs à bas risque non-volontaires pour une IBM devra encore être évalué.Nous avons ensuite examiné le fonctionnement de l'IBM et cherché quels comportements de l'intervenant et du jeune homme pouvaient être les plus à même d'amener à un changement dans la consommation. Nous avons pu montrer que 1) un discours en faveur du changement chez le jeune homme était plus probable après des comportements de l'intervenant recommandés dans l'approche motivationnelle et moins probable après des comportements non-recommandés ; et 2) plusieurs dimensions de ce discours en faveur du changement (notamment la capacité, le désir et le besoin de changer) prédisaient un changement effectif dans la consommation d'alcool. Ces résultats encouragent donc à utiliser des comportements recommandés dans l'EM pour favoriser un discours en faveur du changement. Ils montrent aussi qu'une attention particulière doit être portée à certaines dimensions de ce discours car celles-ci indiquent un potentiel changement effectif de comportement.
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In advanced Parkinson's disease (PD), the emergence of symptoms refractory to conventional therapy poses therapeutic challenges. The success of deep brain stimulation (DBS) and advances in the understanding of the pathophysiology of PD have raised interest in noninvasive brain stimulation as an alternative therapeutic tool. The rationale for its use draws from the concept that reversing abnormalities in brain activity and physiology thought to cause the clinical deficits may restore normal functioning. Currently the best evidence in support of this concept comes from DBS, which improves motor deficits, and modulates brain activity and motor cortex physiology, although whether a causal interaction exists remains largely undetermined. Most trials of noninvasive brain stimulation in PD have applied repetitive transcranial magnetic stimulation (rTMS), targeting the motor cortex. Current studies suggest a possible therapeutic potential for rTMS and transcranial direct current stimulation (tDCS), but clinical effects so far have been small and negligible with regard to functional independence and quality of life. Approaches to potentiate the efficacy of rTMS include increasing stimulation intensity and novel stimulation parameters that derive their rationale from studies on brain physiology. These novel parameters are intended to simulate normal firing patterns or to act on the hypothesized role of oscillatory activity in the motor cortex and basal ganglia with regard to motor control and its contribution to the pathogenesis of motor disorders. Noninvasive brain stimulation studies will enhance our understanding of PD pathophysiology and might provide further evidence for potential therapeutic applications.
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4.6 Summary and Conclusion In this chapter, we have first tried to make precise the distinctions between the concepts of parthood and coincidence and the concepts of causation and causal influence. These distinc-tions had never been made entirely explicit in the debate on mental causation before, despite the fact that they constantly figure in its background. Section 4.2 then demonstrated that the at-tained definitions are both compatible with all the solutions elaborated in chapters 2 and 3 and that they are even of great help in clarifying both what precisely the mentioned accounts are claiming respectively and what their mutual connections are. In sections 4.3. and 4.4, we have then tried to explore two possible solutions to the problem of mental causation that, at least in these particular versions, have not been explicitly defended in the literature. These solutions we dubbed "overdeteiminationism lite" and "plural determinism". We found the accounts both to bear impressive explanatory capabilities and to be vulnerable to far fewer problems than is commonly supposed. We also found out that they have many corresponding aspects and that their theoretical costs stand in a relation of a relative mutual balance. Our final discussion in section 4.5 revealed, however, that overdetenninationism lite should probably be considered the more successful theory. The fact that it needs to endorse the existence of two kinds of causation, although not unproblematic itself, did not appear as a commitment as strong as that of an ontological hierarchy that extends over all time, which at least the broad version of plural determinism was forced to make.
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Resistant varieties have been the preferred means to control Magnaporthe grisea, the causal organism of the rice blast disease. The objective of this study was to examine the degree of diversity of the pathogen in different rice growing regions of São Paulo State, Brazil. Blast samples collected from rice varieties in three different regions (Tremembé, Mococa and José Bonifácio) were analyzed for race structure employing the Japanese rice differentials. The highest degree of virulence diversity was observed in Tremembé with 22 different races in three different varieties. Furthermore, no resistance gene in the Japanese differentials was effective to all isolates of M. grisea from São Paulo State.
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Changes of functional connectivity in prodromal and early Alzheimer's disease can arise from compensatory and/or pathological processes. We hypothesized that i) there is impairment of effective inhibition associated with early Alzheimer's disease that may lead to ii) a paradoxical increase of functional connectivity. To this end we analyzed effective connectivity in 14 patients and 16 matched controls using dynamic causal modeling of functional MRI time series recorded during a visual inter-hemispheric integration task. By contrasting co-linear with non co-linear bilateral gratings, we estimated inhibitory top-down effects within the visual areas. The anatomical areas constituting the functional network of interest were identified with categorical functional MRI contrasts (Stimuli>Baseline and Co-linear gratings>Non co-linear gratings), which implicated V1 and V3v in both hemispheres. A model with reciprocal excitatory intrinsic connections linking these four regions and modulatory inhibitory effects exerted by V3v on V1 optimally explained the functional MRI time series in both subject groups. However, Alzheimer's disease was associated with significantly weakened intrinsic and modulatory connections. Top-down inhibitory effects, previously detected as relative deactivations of V1 in young adults, were observed neither in our aged controls nor in patients. We conclude that effective inhibition weakens with age and more so in early Alzheimer's disease.
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Objetivou-se avaliar a reação de 58 cultivares de cevada a Drechslera teres, agente causal da mancha-em-rede, bem como a variabilidade patogênica e freqüência de sintomas do patógeno. A reação das cultivares foi estimada com auxílio de uma escala de notas de 0 a 4, em que zero (0) representa a ausência de sintomas, e 4 representa os sintomas típicos da mancha-em-rede. O mesmo método foi utilizado para avaliar a variabilidade patogênica de 25 isolados oriundos do Sul do Brasil. Seis isolados de boa capacidade de esporulação foram utilizados para comparar o número de lesões e a severidade da doença. As cultivares diferiram quanto à reação a D. teres, e identificaram-se as três cultivares, BR 2, EMBRAPA 43 e PFC 8590, como fontes de resistência moderada à doença. Em testes de 25 isolados de D. teres, inoculados na concentração de 1,7x10(4) conídios/mL, detectaram-se diferenças significativas entre os isolados, evidenciando diferenças na sua virulência. Pelo sistema de nomenclatura de Limpert & Müller, foi possível diferenciar padrões de virulência de isolados oriundos de diferentes regiões do Sul do Brasil. O número de lesões e a severidade foram intimamente relacionadas com o local de origem do isolado.
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This paper studies the role coworker-based networks play for individual labour marketoutcomes. I analyse how the provision of labour market relevant information by formercoworkers affects the employment probabilities and, if hired, the wages of male workerswho have previously become unemployed as the result of an establishment closure. Toidentify the causal effect of an individual worker's network on labour market outcomes, Iexploit exogenous variation in the strength of these networks that is due to the occurrenceof mass-layoffs in the establishments of former coworkers. The empirical analysis is basedon administrative data that comprise the universe of workers employed in Germany between1980 and 2001. The results suggest a strong positive effect of a higher employmentrate in a worker's network of former coworkers on his re-employment probability afterdisplacement: a 10 percentage point increase in the prevailing employment rate in thenetwork increases the re-employment probability by 7.5 percentage points. In contrast,there is no evidence of a statistically significant effect on wages.
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The discovery of hypocretins (orexins) and their causal implication in narcolepsy is the most important advance in sleep research and sleep medicine since the discovery of rapid eye movement sleep. Narcolepsy with cataplexy is caused by hypocretin deficiency owing to destruction of most of the hypocretin-producing neurons in the hypothalamus. Ablation of hypocretin or hypocretin receptors also leads to narcolepsy phenotypes in animal models. Although the exact mechanism of hypocretin deficiency is unknown, evidence from the past 20 years strongly favours an immune-mediated or autoimmune attack, targeting specifically hypocretin neurons in genetically predisposed individuals. These neurons form an extensive network of projections throughout the brain and show activity linked to motivational behaviours. The hypothesis that a targeted immune-mediated or autoimmune attack causes the specific degeneration of hypocretin neurons arose mainly through the discovery of genetic associations, first with the HLA-DQB1*06:02 allele and then with the T-cell receptor α locus. Guided by these genetic findings and now awaiting experimental testing are models of the possible immune mechanisms by which a specific and localised brain cell population could become targeted by T-cell subsets. Great hopes for the identification of new targets for therapeutic intervention in narcolepsy also reside in the development of patient-derived induced pluripotent stem cell systems.
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The purpose of the present article is to take stock of a recent exchange in Organizational Research Methods between critics (Rönkkö & Evermann, 2013) and proponents (Henseler et al., 2014) of partial least squares path modeling (PLS-PM). The two target articles were centered around six principal issues, namely whether PLS-PM: (1) can be truly characterized as a technique for structural equation modeling (SEM); (2) is able to correct for measurement error; (3) can be used to validate measurement models; (4) accommodates small sample sizes; (5) is able to provide null hypothesis tests for path coefficients; and (6) can be employed in an exploratory, model-building fashion. We summarize and elaborate further on the key arguments underlying the exchange, drawing from the broader methodological and statistical literature in order to offer additional thoughts concerning the utility of PLS-PM and ways in which the technique might be improved. We conclude with recommendations as to whether and how PLS-PM serves as a viable contender to SEM approaches for estimating and evaluating theoretical models.
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Narcolepsy is a rare sleep disorder with the strongest human leukocyte antigen (HLA) association ever reported. Since the associated HLA-DRB1*1501-DQB1*0602 haplotype is common in the general population (15-25%), it has been suggested that it is almost necessary but not sufficient for developing narcolepsy. To further define the genetic basis of narcolepsy risk, we performed a genome-wide association study (GWAS) in 562 European individuals with narcolepsy (cases) and 702 ethnically matched controls, with independent replication in 370 cases and 495 controls, all heterozygous for DRB1*1501-DQB1*0602. We found association with a protective variant near HLA-DQA2 (rs2858884; P < 3 x 10(-8)). Further analysis revealed that rs2858884 is strongly linked to DRB1*03-DQB1*02 (P < 4 x 10(-43)) and DRB1*1301-DQB1*0603 (P < 3 x 10(-7)). Cases almost never carried a trans DRB1*1301-DQB1*0603 haplotype (odds ratio = 0.02; P < 6 x 10(-14)). This unexpected protective HLA haplotype suggests a virtually causal involvement of the HLA region in narcolepsy susceptibility.