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Very few practical frameworks exist to guide the formulation of recommendations at hospital-based health technology assessment (HTA) units. The objectives of our study were: (i) to identify decision criteria specific to the context of hospital-based health technologies and interventions, (ii) to estimate the extent to which the expert community agrees on the importance of the identified criteria, (iii) to incorporate the identified criteria into a decision-aid tool, and (iv) to illustrate the application of a prototype decision-aid tool.
Relevant decision criteria were identified using existing frameworks for HTA recommendations, our past experience, a literature search, and feedback from a survey of diverse stakeholders.
Based on the survey results, twenty-three decision criteria were incorporated into the final framework. We defined an approach that eschewed a scoring system, but instead relied on a visual means for arriving at a final recommendation, by juxtaposing the importance rating for each criterion against the results of the health technology assessment. For a technology to be approved, a majority of criteria considered important should also have received favorable findings.
We created a simple and practical decision-aid tool that incorporates all decision criteria relevant to a hospital-based HTA unit. With its ease of use and accessibility, our tool renders the subjective decision-making process more structured and transparent.
Hookworms of the genus Uncinaria parasitize pinniped pups in various locations worldwide. Four species have been described, two of which parasitize pinniped pups in the southern hemisphere: Uncinaria hamiltoni parasitizes Otaria flavescens and Arctocephalus australis from the South American coast, and Uncinaria sanguinis parasitizes Neophoca cinerea from the Australian coast. However, their geographical ranges and host specificity are unknown. Uncinaria spp. are morphologically similar, but molecular analyses have allowed the recognition of new species in the genus Uncinaria. We used nuclear genetic markers (internal transcribed spacer (ITS) and large subunit (LSU) rDNA) and a mitochondrial genetic marker (cytochrome c oxidase subunit I (COI)) to evaluate the phylogenetic relationships of Uncinaria spp. parasitizing A. australis and O. flavescens from South American coasts (Atlantic and Pacific coasts). We compared our sequences with published Uncinaria sequences. A Generalized Mixed Yule Coalescent (GMYC) analysis was also used to delimit species, and principal component analysis was used to compare morphometry among Uncinaria specimens. Parasites were sampled from A. australis from Peru (12°S), southern Chile (42°S), and the Uruguayan coast, and from O. flavescens from northern Chile (24°S) and the Uruguayan coast. Morphometric differences were observed between Uncinaria specimens from both South American coasts and between Uncinaria specimens from A. australis in Peru and southern Chile. Phylogenetic and GMYC analyses suggest that south-eastern Pacific otariid species harbour U. hamiltoni and an undescribed putative species of Uncinaria. However, more samples from A. australis and O. flavescens are necessary to understand the phylogenetic patterns of Uncinaria spp. across the South Pacific.
It is increasingly essential for medical researchers to be literate in statistics, but the requisite degree of literacy is not the same for every statistical competency in translational research. Statistical competency can range from ‘fundamental’ (necessary for all) to ‘specialized’ (necessary for only some). In this study, we determine the degree to which each competency is fundamental or specialized.
We surveyed members of 4 professional organizations, targeting doctorally trained biostatisticians and epidemiologists who taught statistics to medical research learners in the past 5 years. Respondents rated 24 educational competencies on a 5-point Likert scale anchored by ‘fundamental’ and ‘specialized.’
There were 112 responses. Nineteen of 24 competencies were fundamental. The competencies considered most fundamental were assessing sources of bias and variation (95%), recognizing one’s own limits with regard to statistics (93%), identifying the strengths, and limitations of study designs (93%). The least endorsed items were meta-analysis (34%) and stopping rules (18%).
We have identified the statistical competencies needed by all medical researchers. These competencies should be considered when designing statistical curricula for medical researchers and should inform which topics are taught in graduate programs and evidence-based medicine courses where learners need to read and understand the medical research literature.
A brief summary of the observed infrared and other properties of interstellar dust is given. Chemical, physical and morphological criteria are discussed concerning the degree to which there are constraints relating comets to interstellar dust chemistry representative of the presolar nebula. Results of theoretical modelling of dust and gas evolution in dense clouds are used to compare with observed dust composition. Sources of the distribution of simple as well as complex molecules in the coma are related to what is presently known about the volatile ices in interstellar dust and to processes leading to evaporation of organic “refractory” grain mantle material represented by laboratory residues produced by photoprocessing of ices. The criterion of preservation of interstellar volatiles in comets leads to the further criterion that the ice in comets is amorphous. Criteria for relating interstellar dust volatiles to asteroids are discussed.
A cyclic evolutionary picture is presented which follows the sources and nature of organics from interstellar space to comets. The three major organic components discussed are the grain mantles, the carbonaceous particles responsible for the 216 nm hump in the extinction, and the large molecules/small particles polycyclic aromatic hydrocarbons (PAHs). The variability in the oxygen and hydrogen abundances relative to carbon is followed.
The MINIMAFIOS ECR source at Grenoble has recently produced stable beams of highly charged Al. We have studied electron capture into excited states for Al8+ ions extracted at 10 kV colliding with an H2 molecular target under single collision conditions. Using a grazing incidence spectrometer covering the region 250 Å to 1100 Å, we have made a relative intensity measurement of the radiative decay from excited (nl) states of Al7+ following the charge exchange collision. The Al7+ spectra show known transitions from the ls22s2p3 excited state. We discuss the presence of the ls22s2p2(4P) metastable state in the incidence Al8+ beam. The spectra also show many transitions which up to now are unidentified, in particular transitions for the wavelength region between 300 and 400Å and that between 600 and 700Å. To identify the transitions, we compare our spectrum with preliminary theoretical wavelengths calculated using the multiconfiguration Dirac-Fock method including transitions from n = 3, 4 and 5. These preliminary results reveal transitions from n = 5 to 4 for the observed spectra in the 600Å region and transitions from n = 4 to 3 for the observed spectra in the 300Å region.
The Darwin region in northern Australia has experienced rapid population growth in recent years, and with it, an increased incidence of melioidosis. Previous studies in Darwin have associated the environmental presence of Burkholderia pseudomallei, the causative agent of melioidosis, with anthropogenic land usage and proximity to animals. In our study, we estimated the occurrence of B. pseudomallei and Burkholderia spp. relatives in faecal matter of wildlife, livestock and domestic animals in the Darwin region. A total of 357 faecal samples were collected and bacteria isolated through culture and direct DNA extraction after enrichment in selective media. Identification of B. pseudomallei, B. ubonensis, and other Burkholderia spp. was carried out using TTS1, Bu550, and recA BUR3–BUR4 quantitative PCR assays, respectively. B. pseudomallei was detected in seven faecal samples from wallabies and a chicken. B. cepacia complex spp. and Pandoraea spp. were cultured from wallaby faecal samples, and B. cenocepacia and B. cepacia were also isolated from livestock animals. Various bacteria isolated in this study represent opportunistic human pathogens, raising the possibility that faecal shedding contributes to the expanding geographical distribution of not just B. pseudomallei but other Burkholderiaceae that can cause human disease.
Melioidosis is an infectious disease caused by Burkholderia pseudomallei, a bacterium endemic in Southeast Asia and northern Australia. In New Caledonia, sporadic cases were first described in 2005; since then, more cases have been identified. To improve our understanding of melioidosis epidemiology in New Caledonia, we compared the local cases and B. pseudomallei isolates with those from endemic areas. Nineteen melioidosis cases have been diagnosed in New Caledonia since 1999, mostly severe and with frequent bacteraemia, leading to three (16%) fatalities. All but one occurred in the North Province. Besides sporadic cases caused by non-clonal strains, we also identified a hotspot of transmission related to a clonal group of B. pseudomallei that is phylogenetically related to Australian strains.
Many people experience an ongoing relationship with a deceased loved one. This is called a “continued bond.” However, little is known about the adolescent experience with continued bonds once a parent has died. This study describes three ways that adolescents continue their relationship with a parent after that parent's death.
Individual semistructured interviews were conducted with nine adolescent children of deceased hospice patients from a large hospice in northeastern Ohio as part of a larger grounded-theory study. The interviews were audiotaped, transcribed verbatim, and analyzed using a conventional content analysis approach.
Adolescents continued their bonds with deceased parents in one of three ways: experiencing encounters with the deceased parent, listening to the inner guide of the parent, and keeping mementos to remind them of the parent.
Significance of results:
The ways that the adolescents continued their bond with a deceased parent assisted them in creating meaning out of their loss and adjusting to life without that parent. Our results can be used by health professionals and parents to help adolescents after a parent has died.
This talk summarizes recent work that has been done on cataclysmic variables at Oxford and Cambridge. Full details should be sought elsewhere, either from the authors concerned or from the references given below.
This study aimed to generate an explanatory model of the coping strategies that adolescents employ to manage the stressors they experience in the final months of their ill parent's life and shortly after their death.
The sample included 26 families of adolescents with a parent receiving care in a large hospice program in northeastern Ohio. A semistructured interview was conducted with 14 ill parents, 17 well parents/guardians, and 30 of their adolescent children before the parent's death and, additionally, with 6 of these families after the death. The interviews were audiotaped, transcribed verbatim, and analyzed using a grounded-theory approach.
The participants described two worlds that constituted the lives of the adolescents: the well world of normal adolescence and the ill world of having a parent near the end of life. The adolescents experienced a common challenge of living in two worlds and responded to the challenge with a process we labeled “managing two worlds.” Five stages through which adolescents manage their worlds were identified: keeping the ill world and the well world separate; having the ill world intrude into the well world; moving between the ill world and the well world; being immersed in the ill world; and returning to the well world having been changed by the ill world.
Significance of results:
The explanatory model of “managing two worlds” outlines a complex and nuanced process that changes over time. The model can be used by health professionals who seek to help adolescents navigate this critical time when their parents are dying or have recently died. These results can also be used to inform the development of interventions that assist families with strategies tailored to an adolescent's specific needs. Future research should investigate associations among the process of “managing two worlds” and outcomes related to adolescent bereavement.
Data-constrained modeling is a method that enables three-dimensional distribution of mineral phases and porosity in a sample to be modeled based on micro-computed tomography scans acquired at different X-ray energies. Here we describe an alternative method for measuring porosity, synchrotron K-edge subtraction using xenon gas as a contrast agent. Results from both methods applied to the same Darai limestone sample are compared. Reasonable agreement between the two methods and with other porosity measurements is obtained. The possibility of a combination of data-constrained modeling and K-edge subtraction methods for more accurate sample characterization is discussed.
This study analyzes gender assignment in Spanish–Basque mixed nominal constructions with nouns in Basque (a language that lacks gender) and determiners in Spanish (a language that marks gender) by using a multi-task approach: (i) naturalistic data, (ii) an elicitation task, and (iii) an auditory judgment task. Naturalistic data suggest cross-language effects under which a morphological marker of Basque (-a determiner) is interpreted as a morphophonological expression of gender marking in Spanish. A preference for feminine determiners was observed in the judgment task, which differs from the masculine default trend observed in Spanish–English bilinguals (Jake, Myers-Scotton & Gross, 2002). Our results point to feminine gender as default in Spanish–Basque mixed DPs, indicating that the resources that bilinguals use for gender assignment can be different from those of monolinguals. We argue that this is an outcome of interacting processes which take place at the interfaces (lexicon, phonology, morphosyntax) of both languages, resulting in cross-language effects.
Research at the end of life tends to focus on the dying patient's symptoms, often overlooking issues associated with family interactions. However, many families struggle just to maintain or initiate these valuable connections. The purpose of our pilot study was to explore family relationships at the end of life and investigate associations among perceived comfort, relatedness states, and life closure.
This descriptive study used a cross-sectional design, and a convenience sample (n = 30; 18 women; mean age = 71 years) was recruited from patients admitted to a large not-for-profit hospice in northeastern Ohio. In-person interviews using the Hospice Comfort Questionnaire, Relatedness States Visual Analog Scales, and the Life-Closure Scale provided data for analyses.
Family interactions that were not associated with the physical tasks of caregiving were related to life closure (r = 0.36, p = 0.001), and life closure and comfort were highly correlated (r = 0.69, p < 0.001). Participants residing in an inpatient setting had higher levels of involvement (t = –2.07, p = 0.05) and comfort in relationships (t = –2.06, p = 0.05) than those in the home setting.
Significance of Results:
This is the first known study investigating the associations among comfort, relatedness, and life closure at the end of life. The majority of participants had high levels of involvement and comfort in their relationships, and they preferred interactions that required minimal effort. Studies that focus on both patients' and family members' perceptions of relationships are needed as well as outcome studies that test simple interventions.
Introduction: Despite smoking fewer cigarettes per day, African American smokers have greater difficulty quitting compared to Caucasian smokers. Further elucidating the impact of smoking motivations on smoking behaviour would contribute to understanding the factors that maintain smoking.
Aims: This study examined the factor structure of a brief assessment examining smoking dependence motives among a sample of African American light smokers.
Methods: Data from a double-blind, placebo-controlled randomised smoking cessation trial involving 540 participants. Results were analysed using an exploratory factor analysis (EFA) and a randomly split EFA.
Results/Findings: Findings from the initial EFA analysis produced an eight-factor model, explaining 69% of the variation in responses. The overall Measure of Sampling Adequacy (MSA) was 0.88 with item level MSA ranging 0.68–0.94 across the 30 items. Results from the randomly split EFA replicated the findings of the original EFA; with the exception of the item ‘I smoke within the first 30 minutes of awakening in the morning’.
Conclusions: These findings support the hypothesis of a multidimensional approach to conceptualising nicotine dependence, and provide information regarding characteristics of nicotine dependence in African American light smokers which may be helpful in identifying targets for cessation treatment in this population of smokers.
Conventional X-ray microcomputed tomography (micro-CT) is not usually sufficient to determine microscopic compositional distributions as it is limited to measuring the X-ray attenuation of the sample, which for a given dataset can be similar for materials of different composition. In contrast, the present work enables three-dimensional compositional analysis with a data-constrained microstructure (DCM) modeling methodology, which uses two or more CT datasets acquired with different X-ray spectra and incorporates them as model constraints. For providing input data for DCM, we have also developed a method of micro-CT data collection that enables two datasets with different X-ray spectra to be acquired in parallel. Such data are used together with the DCM methodology to predict the distributions of corrosion inhibitor and filler in a polymer matrix. The DCM-predicted compositional microstructures have a reasonable agreement with energy dispersive X-ray images taken on the sample surface.