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Advance consent could address many of the limitations traditional consenting methods pose to participation in acute stroke trials. We conducted a series of five focus groups with people with lived experience of stroke. Using an inductive thematic approach, two themes were developed: factors in favour of, and against, advance consent. Participants supported the idea of advance consent and highlighted trust, transparent communication and sufficient time as major factors that would positively affect their decision to provide advance consent. The results will be used to finalise a model of advance consent suitable for testing the feasibility in stroke prevention clinics.
Patients suspected of having a rare genetic disease often experience lengthy and costly diagnostic odysseys. The timing of whole exome sequencing (WES) in the testing sequence, its diagnostic yield and test costs in the sequence all factor into estimates of cost-effectiveness analysis for health technology assessment.
Methods
We modeled the diagnostic pathway using a discrete event simulation model, starting with the first test result. We defined and populated the simulation based on data from the electronic medical records of n=307 from the Care-for-Rare SOLVE multi-center Canadian observational cohort. Five alternative diagnostic pathways were modeled based on the observed data: no WES, and WES as the first, second, third or fourth test in the sequence. WES as the second test in the sequence is considered standard of care in medical genetic centers in Canada. We assessed effectiveness of WES in terms of diagnostic yield, time to diagnosis, and costs as patient-level overall test costs (2020 CAD/USD) across the diagnostic pathway.
Results
Compared to molecular and specialized diagnostic tests only (i.e., no WES), WES increased diagnostic yield from 5 percent to 40 percent. The shortest time to diagnosis for those with a diagnosis was 1.82 years in the diagnostic pathway with WES as the second test. Test costs for each pathway were CAD2,800 (USD2,087, no WES), CAD2,700 (USD2,013, WES as first test), CAD3,500 (USD2,609, WES as second test), CAD4,500 (USD3,354, WES as third test), and CAD5,300 (USD3,951, WES as fourth test).
Conclusions
Placing WES earlier in the diagnostic pathway for patients suspected of having a rare disease is associated with an increased diagnostic yield, reduced time to diagnosis and lower overall test costs with the benefits being greater the earlier in the pathway that WES is implemented.
Advance consent could allow individuals at high risk of stroke to provide consent before they might become eligible for enrollment in acute stroke trials. This survey explores the acceptability of this novel technique to Canadian Research Ethics Board (REB) chairs that review acute stroke trials. Responses from 15 REB chairs showed that majority of respondents expressed comfort approving studies that adopt advance consent. There was no clear preference for advance consent over deferral of consent, although respondents expressed significant concern with broad rather than trial-specific advance consent. These findings shed light on the acceptability of advance consent to Canadian ethics regulators.
This is the first complete publication of the late composer and scholar Ruth Crawford Seeger's major work on American folksongs. It preserves them as well as demonstrates how they should be played so that they remain a living part of the American musical tradition.
This study aimed to examine factors that may have contributed to community disaster resilience following Hurricane Maria in Puerto Rico.
Methods:
In April 2018, qualitative interviews (n = 22) were conducted with stakeholders in 7 Puerto Rican municipalities (9% of total). Transcripts were deductively and inductively coded and analyzed to identify salient topics and themes, then examined according to strategic themes from the Federal Emergency Management Association’s (FEMA) Whole Community Approach.
Results:
Municipal preparedness efforts were coordinated, community-based, leveraged community assets, and prioritized vulnerable populations. Strategies included (1) multi-sectoral coordination and strategic personnel allocation; (2) neighborhood leader designation as support contacts; (3) leveraging of community leader expertise and social networks to protect vulnerable residents; (4) Censuses of at-risk groups, health professionals, and first responders; and (5) outreach for risk communication and locally tailored protective measures. In the context of collapsed telecommunications, communities implemented post-disaster strategies to facilitate communication with the Puerto Rican Government, between local first responders, and to keep residents informed, including the use of: (1) police radios; (2) vehicles with loudspeakers; (3) direct interpersonal communication; and (4) solar-powered Internet radio stations.
Conclusions:
Adaptive capacities and actions of Puerto Rican communities exemplify the importance of local solutions in disasters. Expanded research is recommended to better understand contributors to disaster resilience.
Continuous client feedback aims to increase the effectiveness of therapy by emphasizing common factors in treatment across theories that contribute the most to change. In this paper, we present data using two independent measures, which appears to isolate the influence of social desirability on treatment outcomes.
Methods
Continuous client feedback data was collected in the Student Health Partnership program and compared with independent data reflecting client function (Child Global Assessment of Function). Data was collected at two times by the same staff using two sampling methods. In the first sample, staff preferentially assigned clients to case (continuous client feedback) and comparison treatment as usual) on the basis of preference and convenience whereas in the second sample assignment to case and comparison was random.
Results
When the data from the two sample frames was compared, systematically different trajectories in the measured outcomes reflecting continuous client feedback and function were obtained with those in sample one being substantially higher than comparisons or population reference values.
Conclusions
The difference in results emerging from the two sampling frames is explained in terms of social desirability. Outcomes for clients were much better in the first sample, where staff choose clients they apparently liked for specialized treatment.
Let M(u), H(u) be the maximal operator and Hilbert transform along the parabola (t, ut2). For U ⊂ (0, ∞) we consider Lp estimates for the maximal functions sup u∈U|M(u)f| and sup u∈U|H(u)f|, when 1 < p ≤ 2. The parabolas can be replaced by more general non-flat homogeneous curves.
This chapter examines the career of the novelist and advice columnist Walther von Hollander during the Third Reich, setting it in the context of his longer career before and after Nazism and in particular his prominence as an advice columnist in post-war West Germany. It argues that von Hollander’s books and letters to his readers during the Nazi period contained an ambivalent mix of messages. On one hand, he promoted the idea that individual personal happiness could be achieved during self-optimisation and conscious effort applied to personal relationships. This notion, characteristic of contemporary Western societies, was not specific to Nazism. On the other hand, his advice was also tinged with elements of Nazi ideology that promised to dissolve and eradicate the disappointments associated with individuality through an orientation towards the wider community and the nation.
We study the regularity of convolution powers for measures supported on Salem sets, and
prove related results on Fourier restriction and Fourier multipliers. In particular we show that for
$\alpha $ of the form $d\,/\,n,\,n\,=\,2,3,...$ there exist $\alpha $-Salem measures for which the ${{L}^{2}}$ Fourier restriction theorem holds in the range $p\,\le \,\frac{2d}{2d\,-\,\alpha }$. The results rely on ideas of Körner. We extend some of his constructions to obtain upper regular $\alpha $-Salem measures, with sharp regularity results for $n$-fold
convolutions for all $n\,\in \,\mathbb{N}$.
This paper examines how gesturers and signers use their bodies to express concepts such as instrumentality and humanness. Comparing across eight sign languages (American, Japanese, German, Israeli, and Kenyan Sign Languages, Ha Noi Sign Language of Vietnam, Central Taurus Sign Language of Turkey, and Al-Sayyid Bedouin Sign Language of Israel) and the gestures of American non-signers, we find recurring patterns for naming entities in three semantic categories (tools, animals, and fruits & vegetables). These recurring patterns are captured in a classification system that identifies iconic strategies based on how the body is used together with the hands. Across all groups, tools are named with manipulation forms, where the head and torso represent those of a human agent. Animals tend to be identified with personification forms, where the body serves as a map for a comparable non-human body. Fruits & vegetables tend to be identified with object forms, where the hands act independently from the rest of the body to represent static features of the referent. We argue that these iconic patterns are rooted in using the body for communication, and provide a basis for understanding how meaningful communication emerges quickly in gesture and persists in emergent and established sign languages.
Niobium-doped TiO2 films as highly transparent conducting oxidic electrodes were prepared by reactive magnetron sputtering from a titanium target in an argon-oxygen gas flow. As-deposited films were amorphous and exhibited high resistivities ranging from 10 to 1×105 Ω cm in dependence on the deposition parameters. We stabilized the reactive magnetron sputtering deposition by adjusting the magnetron discharge voltage at a constant oxygen gas flow. The precise process control during the preparation of the as-deposited films was essential to gain low resistivities (10-3 Ω cm) and low optical absorption coefficients (α550nm < 2×103 cm-1) after annealing. These polycrystalline TiO2:Nb films on borosilicate glass show a quite high electron concentration > 1×1020 cm-3 and a high carrier mobility (≈ 8 cm2 V-1 s-1).
Dropout is a common and serious problem in psychological research and practice. When participants terminate treatment prematurely, this may have methodological and clinical consequences. The aim of this study was to identify predictors of dropout in a sample of patients (N = 217) with sub-threshold and mild panic disorder treated with a public mental health intervention programme based on cognitive-behavioural principles. Three groups of possible baseline predictors were selected from the literature: (1) socio-demographic, (2) personal, and (3) illness-related variables. A total of 51 (23.5%) participants were classified as dropouts. Dropouts were further subdivided into pretreatment dropouts (n = 17) who attended no course sessions at all and regular dropouts (n = 34) who attended 1–5 course sessions. Multivariable logistic regression analyses were used to identify independent predictors of dropout. Few variables were significantly associated with increased odds of dropout and the total explained variance was small. Fewer years of education was the only independent predictor of total dropout and male gender was associated with more pretreatment dropout. No independent predictors were found for regular dropout. It can be concluded that it is difficult to precisely predict dropout risk in patients participating in a public mental health intervention for panic symptoms.