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The number of patient preference studies in health has increased dramatically. There is growing use of patient preferences in a wide variety of contexts, including health technology assessment. Patient preference studies can help inform decision makers on the needs and priorities of patients and the tradeoffs they are willing to make about health technologies.
Methods
This International Society for Pharmacoeconomics and Outcomes Research (ISPOR) Task Force included international experts, health preference researchers and others from diverse backgrounds, including regulatory, health technology assessment, medicine, patient advocacy, and the pharmaceutical industry. The report underwent two rounds of written reviews by ISPOR Preferences Special Interest Group members until a final consensus was reached. The Task Force focused on developing a roadmap that would: (i) apply to the wide variety of preference methods, (ii) identify key domains to guide researchers and other stakeholders in making patient preference studies more useful to decision makers, and (iii) detail important questions to guide researchers conducting preference studies and those critically appraising them.
Results
This Task Force report provides a novel roadmap that invites patient-preference researchers to work with decision makers, patients and other stakeholders to do even more to ensure that studies are useful and impactful. The ISPOR Roadmap consists of five key elements: (i) Context; (ii) Purpose; (iii) Population; (iv) Method; and (v) Impact. In this report, we define these five elements and provide good practices on how patient-preference researchers can actively contribute to increasing the usefulness and impact of patient preference studies in decision-making. We also present a set of key questions that can support researchers and other stakeholders in assessing efforts that promote preference studies’ intended and unintended impact.
Conclusions
This roadmap can help increase the usefulness and impact of patient preference studies in decision-making by challenging researchers to engage and partner with decision makers, patients and others, and together consider the intended and unintended impacts of patient preference studies on decision-making while actively fostering positive impact.
Fontan survivors have depressed cardiac index that worsens over time. Serum biomarker measurement is minimally invasive, rapid, widely available, and may be useful for serial monitoring. The purpose of this study was to identify biomarkers that correlate with lower cardiac index in Fontan patients.
Methods and results
This study was a multi-centre case series assessing the correlations between biomarkers and cardiac magnetic resonance-derived cardiac index in Fontan patients ⩾6 years of age with biochemical and haematopoietic biomarkers obtained ±12 months from cardiac magnetic resonance. Medical history and biomarker values were obtained by chart review. Spearman’s Rank correlation assessed associations between biomarker z-scores and cardiac index. Biomarkers with significant correlations had receiver operating characteristic curves and area under the curve estimated. In total, 97 cardiac magnetic resonances in 87 patients met inclusion criteria: median age at cardiac magnetic resonance was 15 (6–33) years. Significant correlations were found between cardiac index and total alkaline phosphatase (−0.26, p=0.04), estimated creatinine clearance (0.26, p=0.02), and mean corpuscular volume (−0.32, p<0.01). Area under the curve for the three individual biomarkers was 0.63–0.69. Area under the curve for the three-biomarker panel was 0.75. Comparison of cardiac index above and below the receiver operating characteristic curve-identified cut-off points revealed significant differences for each biomarker (p<0.01) and for the composite panel [median cardiac index for higher-risk group=2.17 L/minute/m2 versus lower-risk group=2.96 L/minute/m2, (p<0.01)].
Conclusions
Higher total alkaline phosphatase and mean corpuscular volume as well as lower estimated creatinine clearance identify Fontan patients with lower cardiac index. Using biomarkers to monitor haemodynamics and organ-specific effects warrants prospective investigation.
Many areas of the US recently endured a severe drought and management strategies to cope with the lack of forage production varied. A multi-period mathematical model is presented that estimates the outcomes of two common producer responses to changes in precipitation, partial liquidation and purchasing hay, given fluctuating cattle prices over a long term planning horizon. Results were further summarized with regression analysis and selected elasticities were calculated to reflect the sensitivity of outcomes to variability in precipitation and livestock prices. Although little impact was seen from utilizing additional hay as a strategy during drought, producers who follow this strategy are in a position to market more animals immediately post drought in general, resulting in better long run financial outcomes. Elasticity estimates suggest that profitability is more sensitive to variability in prices but that optimal choices of management strategies are more sensitive to variability in precipitation.
This article investigates the variables that affect the award oftenure in political science departments in the United States. Weexamined two dependent variables: (1) whether a department hasdenied tenure in the past five years, and (2) whether a positivedepartmental tenure recommendation has been reversed by highercollege or university authorities during the same period of time.Five clusters of independent variables were evaluated: (1)college/university and departmental characteristics, (2) theprocedures employed to evaluate tenure cases, (3) the instrumentsused to assess teaching, (4) service expectations, and (5) researchand publication standards. We found that the most important factorsaffecting departmental decisions to deny tenure were whetherteaching and substantive publications were treated as equallyvaluable qualifications, the number of articles a candidatepublished, and the candidate's level of commitment to advising.Interestingly, reversal decisions by higher authorities were notstrongly affected by any of the variables in the analysis.
A new allele of microphthalmia (mi) in the mouse was discovered among the progeny of a male that had been treated with the potent mutagen ethylnitrosourea. Homozygotes have white coats, mildly defective bone resorption and small eyes (about 60% of the normal size) with very little pigmentation. The iris and retina are abnormal, there is no vitreous body and iris pigmentation is restricted to a rim around the pupil. No haematopoietic defect was detected. Genetic studies showed that the mutation is linked to lurcher (Lc) on chromosome 6 and crosses with Miwh/ + and mi/ + mice indicate that the mutation is allelic with these two alleles of the microphthalmia (mi) locus. We designate the new allele microphthalmia-defective iris (midi). Some midi/+ heterozygotes (including the original mutant animal showed a bright ‘red-reflex’ when light was shone directly into the eye and this may have been caused by reduced choroidal pigmentation. Otherwise midi/ + mice appeared normal. The midi/mi compound heterozygotes had white coats, small eyes, and small teeth; bone resorption was more severely defective than in midi/mi homozygotes. The osteopetrosis was corrected by treatment of midi/mi mice with parental mi/ + bone marrow which suggests that the defect is intrinsic to midi/mi marrow cells. The coats of midi/Miwh compound heterozygotes were white; the irises were more symmetrical and iris pigmentation was less severely reduced than in midi/midi homozygotes but pupil dilation appeared to be restricted. Partial complementation occurred in the midi/Miwh compound heterozygotes with respect to eye size, which was usually near normal.
We report a case of severe visuo-spatial neglect consequent upon right-hemisphere stroke. At the time of testing, the patient had no visual field cut and no significant hemiparesis. Conventional testing on cancellation tasks with the right hand revealed reliable left neglect, but performance was significantly improved when the left hand was used. Investigations of (manual) line bisection showed normal performance with the right hand but right neglect when the left hand was used. Right neglect was also observed on a purely perceptual version of the line bisection task. We argue that the attentional vectors of the cerebral hemispheres can be modulated by (perceptual) task-demands and by (motorie) response demands. (JINS, 1996, 2, 412–418.)
Scholars continue to argue about whether Ignatius' epistles give evidence of one or two groups of opponents. It is the claim of this article that Ignatius confronted a single group. We will best understand the characteristics and heritage of its members first by taking care not to overemphasise the systematic character of their thinking about Jesus, and second by setting their Christology within the context of Jewish speculation about divine mediator figures and the varieties of ‘Christian’ beliefs about Jesus. The article also compares Ignatius' positions with characteristics of Jewish Christianity and suggests that the intensity of his polemic may owe more to what he shared with this group than to the differences between them. The article concludes with some observations about the difficulties inherent in the term ‘Jewish Christianity’.
When Vespasian had “pacified” Galilee and the Judaean environs of Jerusalem – razing villages, enslaving inhabitants and survivors, and killing combatants and the unserviceable elderly – and surrounded the holy city of Jerusalem, word came that Nero had died and that Servius Galba had been raised to the imperial purple. Vespasian sent his son Titus westward to greet the new ruler. But while Titus crossed the isthmus at Corinth on his way to the capitol, news came that Galba had fallen, Otho was now hailed by Senate and people as emperor, and Vitellius was leading the German legions in arms against Otho. Tacitus put Titus's dilemma pithily:
If he should go on to Rome, he would enjoy no gratitude for an act of courtesy intended for another emperor, and he would be a hostage in the hands of either Vitellius or Otho; on the other hand, if he returned to his father, the victor would undoubtedly feel offence; yet, if his father joined the victor's party, while victory was still uncertain, the son would be excused; but, if Vespasian should assume the imperial office, his rivals would be concerned with war and have to forget offences.
(Hist. 2.1)
“If … on the other hand … yet … but …”: Titus's need for knowledge outstripped the information available to him through the usual channels of rumor and rumination and, according to Tacitus, Titus sought divine guidance in the sanctuary of Paphian Venus on Cyprus.
Pythium oligandrum is a parasite of cultivated Agaricus bisporus. Infection results in significant yield reductions and a disease referred to as ‘black compost’. In this study, P. oligandrum isolates were isolated from New Zealand mushroom composts, and their ribosomal DNA internal transcribed spacer (ITS) regions were amplified using the polymerase chain reaction (PCR). ITS nucleotide sequences obtained from New Zealand P. oligandrum isolates were compared with those previously identified P. oligandrum isolates and 23 described Pythium species. Although New Zealand P. oligandrum isolates had high ITS nucleotide identity with internationally identified P. oligandrum, the order of nucleotides in some regions varied when compared with other Pythium species. These varied nucleotides within the ITS region were used to design PCR primers (P.OLIG.F1 and P.OLIG.R04) for the specific amplification of a 384-bp fragment from P. oligandrum DNA. P.OLIG.F1 and P.OLIG.R04 were used to identify a major source of P. oligandrum inoculation on a New Zealand mushroom farm. Application of this diagnostic test will assist farming strategies implemented to prevent future P. oligandrum outbreaks. Furthermore, results presented identify a need for species resolution between P. oligandrum and P. hydnosporum.
An outbreak of gastroenteritis caused by Norwalk-like virus occurred in two areas of the hospital: area 1, consisting of three adjacent and interconnected wards, with mostly elderly patients; and area 2, an acute ward in a separate building with elderly patients. In area 1, 40 patients and 20 staff were affected; in area 2, 18 patients and 14 staff were affected. Infection control measures were instituted in consultation with the government health authority. These measures did not appear to affect the course of the outbreak, but may have prevented spread to other wards.
To assess the ability of a protective isolation room ventilation system to reduce patient exposure to airborne infectious agents, using a small-scale model that permits cost-effective and unobtrusive study of relevant indices of performance.
Design:
A one-half scale model of a protective isolation room at the University of Minnesota Hospital was constructed and equipped for tracer gas experiments to assess ventilation efficiency.
Measurements:
Tracer gas (SF6) was injected into the model supply air. Tracer gas concentration was recorded over time and analyzed to determine local and room mean age of air. Age of air is a direct measurement of ventilation efficiency and can be used to predict patient exposure to contamination.
Results:
Although for the room taken as a whole, ventilation efficiency was close to 50% (a value corresponding to perfect mixing), the experimental results for the local mean age of air indicate that some parts of the model were ventilated much better than others.
Conclusion:
Room air exchange rate is only one parameter useful in assessing ventilation in patient areas. Effective distribution of ventilation air also is critical to the control of airborne contamination. Areas of the room with poor ventilation would be expected to have higher concentrations of airborne infectious agents and other contaminants. Patient exposure can be minimized by placing the patient in well-ventilated areas of the room. Improved ventilation designs may reduce patient exposure further without increasing actual airflow rate.