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While involving patients in health technology assessment (HTA) has become increasingly common and important around the world, little is known about the optimal methods of evaluating patients’ involvement (PI) in HTA. This scoping review was undertaken to provide an overview of currently available methods for the evaluation of PI, specifically the impact of PI on HTA recommendations.
A literature search was conducted using nine databases as well as a grey literature search of the websites of 26 organizations related to the conduct, practice or research of HTA to identify articles, reports and abstracts related to the evaluation of PI impact in HTA.
We identified 1,248 unique citations, six of which met our eligibility criteria. These six records (five articles, and one report) were all published after 2012. Four assessed the impact of patient experience submissions on final HTA recommendations; one evaluated the impact of direct involvement on HTA committees, and one assessed impact of multiple forms of involvement. Methods of evaluation included quantitative analyses of reimbursement decisions, qualitative interviews with those directly involved in an assessment, surveys of patient groups and committee members, and the review of HTA reports.
Quantitative evaluation of PI based on associations with funding decisions may not be feasible or fully capture the relevant impact of PI in the assessment of health technologies. Rather, a combination of both qualitative and quantitative strategies may allow for the most comprehensive assessment of the impact of PI on HTA recommendations when possible.
Solar coronal dimmings have been observed extensively in the past two decades and are believed to have close association with coronal mass ejections (CMEs). Recent study found that coronal dimming is the only signature that could differentiate powerful flares that have CMEs from those that do not. Therefore, dimming might be one of the best candidates to observe the stellar CMEs on distant Sun-like stars. In this study, we investigate the possibility of using coronal dimming as a proxy to diagnose stellar CMEs. By simulating a realistic solar CME event and corresponding coronal dimming using a global magnetohydrodynamics model (AWSoM: Alfvén-wave Solar Model), we first demonstrate the capability of the model to reproduce solar observations. We then extend the model for simulating stellar CMEs by modifying the input magnetic flux density as well as the initial magnetic energy of the CME flux rope. Our result suggests that with improved instrument sensitivity, it is possible to detect the coronal dimming signals induced by the stellar CMEs.
In September 2016, the annual meeting of the International Union for Quaternary Research’s Loess and Pedostratigraphy Focus Group, traditionally referred to as a LoessFest, met in Eau Claire, Wisconsin, USA. The 2016 LoessFest focused on “thin” loess deposits and loess transportation surfaces. This LoessFest included 75 registered participants from 10 countries. Almost half of the participants were from outside the United States, and 18 of the participants were students. This review is the introduction to the special issue for Quaternary Research that originated from presentations and discussions at the 2016 LoessFest. This introduction highlights current understanding and ongoing work on loess in various regions of the world and provides brief summaries of some of the current approaches/strategies used to study loess deposits.
Improving neurocognitive outcomes following treatment for brain metastases have become increasingly important. We propose that a brief telephone-based neurocognitive assessment may improve follow-up cognitive assessments in this palliative population. Aim: To prospectively assess the feasibility and reliability of a telephone based brief neurocognitive assessment compared to the same tests delivered face-to-face. Methods: Brain metastases patients to be treated with whole brain radiotherapy (WBRT) were assessed using a brief validated neurocognitive battery at baseline, at 1 month and 3 months following WBRT (in person and over the phone). The primary outcome was feasibility and inter-procedural (in person versus telephone) reliability. The secondary objective was to evaluate the change in neurocognitive function before and after WBRT. Results: Out of 39 patients enrolled, 82% of patients completed the baseline in-person and telephone neurocognitive assessments. However, at 1 month, only 41% of enrolled patients completed the in-person and telephone cognitive assessments and at 3 months, only 10% of patients completed them. Results pertaining to reliability and change in neurocognitive function will be updated. Conclusion: The pre-defined definition of feasibility (at least 80% completion for face to face and telephone neurocognitive assessments) was met at baseline. However, a large proportion of participants did not complete either telephone or in person neurocognitive follow-up at 1 month and at 3 months post-WBRT. Attrition remained a challenge for neurocognitive testing in this population even when a telephone-based brief assessment was used.
In support of the Radioactive Waste Management (RWM) safety case for a geological disposal facility (GDF) in the UK, there is a regulatory requirement to consider the likelihood and consequences of nuclear criticality. Waste packages are designed to ensure that criticality is not possible during the transport and operational phases of a GDF and for a significant period post-closure. However, over longer post-closure timescales, conditions in the GDF will evolve.
For waste packages containing spent fuel, it can be shown that, under certain conditions, package flooding could result in a type of criticality event referred to as 'quasi-steady-state' (QSS). Although unlikely, this defines a 'what-if' scenario for understanding the potential consequences of post-closure criticality. This paper provides an overview of a methodology to understand QSS criticality and its application to a spent fuel waste package.
The power of such a hypothetical criticality event is typically estimated to be a few kilowatts: comparable with international studies of similar systems and the decay heat for which waste packages are designed. This work has built confidence in the methodology and supports RWM's demonstration that post-closure criticality is not a significant concern.
An overview of the Czech national R&D project HiLASE (High average power pulsed laser) is presented. The project focuses on the development of advanced high repetition rate, diode pumped solid state laser (DPSSL) systems with energies in the range from mJ to 100 J and repetition rates in the range from 10 Hz to 100 kHz. Some applications of these lasers in research and hi-tech industry are also presented.
In support of the disposal system safety case for a geological disposal facility (GDF) there is a requirement to consider 'what-if' hypothetical scenarios for post-closure nuclear criticality. Although all such scenarios are considered very unlikely, one 'what-if' scenario is the mobilization of fissile material from a number of waste packages and its slow accumulation within the GDF or the immediate surroundings. Should sufficient fissile material accumulate a quasi-steady-state (QSS) transient criticality event could result. A computer model has been developed to understand the evolution and consequences of such an event.
Since a postulated QSS criticality could persist for many millennia, building confidence in the modelling approach is difficult. However, the Oklo natural reactors in Africa operated for similar durations around two billion years ago, providing a natural analogue for comparison. This paper describes the modelling approach, its application to hypothetical criticality events for a GDF, and how the model can be compared to Oklo. The model results are found to be in agreement with the observational evidence from Oklo, building confidence in the use of the QSS model to simulate postulated post-closure criticality events in GDFs.
The formation of the chemical products produced in an
atmospheric glow discharge fed by a N2-CH4 gas mixture has been
studied using Fourier Transform InfraRed (FTIR) and Optical Emission
Spectrometry (OES). The measurements were carried out in a flowing regime at
ambient temperature and pressure with CH4 concentrations ranging from
0.5% to 2%. In the recorded emission spectra the lines of the second
positive system CN system and the first negative system of N2 were
found to be the most intensive but atomic H
, and C
(247 nm) lines were also observed. FTIR-measurements revealed HCN and
NH3 to be the major products of the plasma with traces of
C2H2. These same molecules have been detected in Titan's
atmosphere and the present experiments may provide some novel insights into
the chemical and physical mechanisms prevalent in Titan's atmosphere with
these smaller species believed to be the precursors of heavier organic
species in Titan's atmosphere and on its surface.
It is suggested that routine tests for infectious mononucloosis in a large number of apparently unrelated syndromes would disclose a frequent common aetiology and perhaps modify the present conception of the course of the disease.
A technique is suggested for a simple test involving tho demonstration of ox cell haemolysins which would make the testing of large numbers of sera practicable.
The results in sixty cases of infectious mononucleosis and 200 controls are evaluated. The test does not reduce significantly the proportion of serologically negative cases but may confirm the diagnosis before the characteristic sheep cell agglutinins are demonstrable.
The test is as sensitive and as specific as other serological tests for infectious mononucleosis and is very much easier to perform.
Epidemiological evidence suggests a link between cannabis use and psychosis. A variety of factors have been proposed to mediate an individual's vulnerability to the harmful effects of the drug, one of which is their psychosis proneness. We hypothesized that highly psychosis-prone individuals would report more marked psychotic experiences under the acute influence of cannabis.
A group of cannabis users (n=140) completed the Psychotomimetic States Inventory (PSI) once while acutely intoxicated and again when free of cannabis. A control group (n=144) completed the PSI on two parallel test days. All participants also completed a drug history and the Schizotypal Personality Questionnaire (SPQ). Highly psychosis-prone individuals from both groups were then compared with individuals scoring low on psychosis proneness by taking those in each group scoring above and below the upper and lower quartiles using norms for the SPQ.
Smoking cannabis in a naturalistic setting reliably induced marked increases in psychotomimetic symptoms. Consistent with predictions, highly psychosis-prone individuals experienced enhanced psychotomimetic states following acute cannabis use.
These findings suggest that an individual's response to acute cannabis and their psychosis-proneness scores are related and both may be markers of vulnerability to the harmful effects of this drug.
Previous studies have reported prefrontal cortex (PFC) pathophysiology in bipolar disorder.
We examined the hemodynamics of the PFC during resting and cognitive tasks in 29 patients with bipolar disorder and 27 healthy controls, matched for age, verbal abilities and education. The cognitive test battery consisted of letter and category fluency (LF and CF), Sets A and B of the Raven's Colored Progressive Matrices (RCPM-A and RCPM-B) and the letter cancellation test (LCT). The tissue oxygenation index (TOI), the ratio of oxygenated hemoglobin (HbO2) concentration to total hemoglobin concentration, was measured in the bilateral PFC by spatially resolved near-infrared spectroscopy. Changes in HbO2 concentration were also measured.
The bipolar group showed slight but significant impairment in performance for the non-verbal tasks (RCPM-A, RCPM-B and LCT), with no significant between-group differences for the two verbal tasks (LF and CF). A group×task×hemisphere analysis of variance (ANOVA) on the TOI revealed an abnormal pattern of prefrontal oxygenation across different types of cognitive processing in the bipolar group. Post hoc analyses following a group×task×hemisphere ANOVA on HbO2 concentration revealed that the bipolar group showed a greater increase in HbO2 concentration in the LCT and in RCPM-B, relative to controls.
Both indices of cortical activation (TOI and HbO2 concentration) indicated a discrepancy in the PFC function between verbal versus non-verbal processing, indicating task-specific abnormalities in the hemodynamic control of the PFC in bipolar disorder.
The present study investigates the species distribution patterns and macrofaunal assemblages along the English Channel and the environmental factors contributing to observed patterns. Seven distinct macrofaunal assemblages were identified based on Hamon grab samples. In the western Channel, an Echinocyamus/Nemertea assemblage dominated, giving way to an Abra/Scalibregma assemblage in inshore waters. A Verruca/Sabellaria assemblage was identified to occupy large regions of the mid-Channel while those of the east Channel were more spatially variable. While variations in depth, sediment particle size and wave and tidal stress were significantly related to variations in assemblage structure, temperature did not appear to be greatly influential. In addition, acoustic data obtained for each station sampled allowed us to determine how representative the observed biological communities are over spatial scales somewhat larger than the sampling points. In contrast to earlier comparable studies using anchor dredges, the biological communities sampled in this study did not exhibit a large east–west distinction; the most abundant species and key assemblages were found to be present along the length of the Channel. The possible reasons for these differences with earlier studies are discussed.
A new extractant for the separation of actinide(III) and lanthanide(III), bis(o-trifluoromethylphenyl)phosphinic acid (O-PA) was synthesized. The synthetic route employed mirrors one that was employed to produce the sulfur containing analog bis(o-trifluoromethylphenyl)dithiophosphinic acid (S-PA). Multinuclear NMR spectroscopy was used for elementary characterization of the new O-PA derivative. This new O-PA extractant was used to perform Am(III)/Eu(III) separations and the results were directly compared to those obtained in identical separation experiments using S-PA, an extractant that is known to exhibit separation factors of ∼100,000 at low pH. The separations data are presented and discussed in terms comparing the nature of the oxygen atom as a donor to that of the sulfur atom in extractants that are otherwise identical.
The origin of this book lies in a series of articles I wrote, mainly for the Edinburgh Law Review, following upon the ground-breaking House of Lords ruling in McFarlane v. Tayside Health Board in 2000. I admit to being amongst those who found that unanimous decision hard to accept and I followed its fallout with increasing interest. Cambridge University Press were kind enough to agree to a proposal that we consolidate the results into a coherent monograph and this has resulted in The Troubled Pregnancy. It will, however, be apparent that what started as a relatively simple fancy rapidly became a major academic exercise. The more I looked at the individual index cases, the more I became involved with the subject both on a historical and an international basis. The result was a major expansion of the anticipated text.
Inevitably, then, the book has taken some time to write – and this has not been helped by the acquisition of the occasional metal joint and of a serious bout of two-fingered repetitive strain injury. It has, therefore, been particularly prone to the well-known hazard that medical law is a moving target. At the same time, it has provided a welcome opportunity to reflect on what has gone before or, so to speak, to ‘learn on the job’ – to put it in perspective, I still think McFarlane was wrong but I doubt if it was as wrong as I thought it was five years ago! I must, therefore, ask the reader's forgiveness if, at times, it looks as though I have changed my mind between Chapters 1 and 8 – indeed, I may well have done so.
As Hale LJ said in her memorable speech in Parkinson:
[T]he invasion of the mother's personal autonomy does not stop once her body and mind have returned to their pre-pregnancy state … The obligation to provide or make acceptable and safe arrangements for the child's care and supervision lasts for 24 hours a day, seven days a week, all year round, until the child becomes old enough to take care of himself.
And, if that be true of the normal child – and probably most of us would agree that it is – how much more does it apply to one who is disabled? Indeed, this compelling passage from Lady Hale convinces me that a study of the troubled pregnancy is incomplete without a consideration of its medico-legally most important aftermath – that is, the management of congenital disease. Thus, the rationale of this chapter, lies in the belief that there is a practical, as well as a conceptual, continuum between pregnancy and early motherhood. Given this premise, however, it will be appreciated that our remit can legitimately cover only those conditions which were present in utero or those in which the seeds of disablement were sown during fetal life – or, put another way, we will be considering only the child whose disability was foreseeable before he or she was born. As a corollary, we are not concerned directly with non-congenital diseases of childhood but we will use such cases when they are needed to illustrate a relevant point.