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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.
Glyphosate-resistant (GR) canola is a widely grown crop across western Canada and has quickly become a prolific volunteer weed. Glyphosate-resistant soybean is rapidly gaining acreage in western Canada. Thus, there is a need to evaluate herbicide options to manage volunteer GR canola in GR soybean crops. We conducted an experiment to evaluate the efficacy of various PRE and POST herbicides applied sequentially to volunteer GR canola and to evaluate soybean injury caused by these herbicides. Trials were conducted across Saskatchewan and Manitoba in 2014 and 2015. All treatments provided a range of suppression (>70%) to control (>80%) of volunteer canola. All treatments with the exception of the glyphosate-treated control reduced aboveground canola biomass by an average of 96%. As well, canola seed contamination was reduced from 36% to less than 5% when a PRE and POST herbicide were both used. Moreover, all combinations of herbicides used had excellent crop safety (<10%). All PRE and POST herbicide combinations provided better control of volunteer canola compared with the glyphosate-only control, but tribenuron followed by bentazon and tribenuron followed by imazamox plus bentazon provided solutions that were low cost, currently available (registered in western Canada), and had the potential to minimize development of herbicide resistance in other weeds.
Stratigraphic records extending to Marine Oxygen Isotope Stage (MIS) 3 (57,000–29,000 cal yr BP) or older in Beringia are extremely rare. Three stratigraphic sections in interior western Alaska show near continuous sedimentological and environmental progressions extending from at least MIS 3, if not older, through MIS 1 (14,000 cal yr BP–present). The Kolmakof, Sue Creek, and VABM (vertical angle bench mark) Kuskokwim sections along the central Kuskokwim River, once a highland landscape at the fringe of central and eastern Beringia, contain aeolian deposition and soil sequences dating beyond 50,000 14C yr BP. Thick peaty soil, shallow lacustrine, and tephra deposits represent the MIS 3 interstade (or older). Sand sheet and loess deposits, wedge cast development, and very thin soil development mark the later MIS 3 period and the transition into the MIS 2 stade (29,000–14,000 cal yr BP). Loess accumulation with thicker soil development occurred between ~16,000–13,500 cal yr BP at the MIS 2 and MIS 1 transition. After ~13,500 cal yr BP, loess accumulation waned and peat development increased throughout MIS 1. These stratigraphic sequences represent transitions between a warm and moist period during MIS 3, to a cooler and more arid period during MIS 2, then a return to warmer and moister climates in MIS 1.
In recent years, soybean acreage has increased significantly in western Canada. One of the challenges associated with growing soybean in western Canada is the control of volunteer glyphosate-resistant (GR) canola, because most soybean cultivars are also glyphosate resistant. The objective of this research was to determine the impact of soybean seeding rate and planting date on competition with volunteer canola. We also attempted to determine how high seeding rate could be raised while still being economically feasible for producers. Soybean was seeded at five different seeding rates (targeted 10, 20, 40, 80, and 160 plants m−2) and three planting dates (targeted mid-May, late May, and early June) at four sites across western Canada in 2014 and 2015. Soybean yield consistently increased with higher seeding rates, whereas volunteer canola biomass decreased. Planting date generally produced variable results across site-years. An economic analysis determined that the optimal rate was 40 to 60 plants m−2, depending on market price, and the optimal planting date range was from May 20 to June 1.
Major adverse climatic events (MACEs) in heavily-populated areas can inflict severe damage to infrastructure, disrupting essential municipal and commercial services. Compromised health care delivery systems and limited utilities such as electricity, heating, potable water, sanitation, and housing, place populations in disaster areas at risk of toxic exposures. Hurricane Sandy made landfall on October 29, 2012 and caused severe infrastructure damage in heavily-populated areas. The prolonged electrical outage and damage to oil refineries caused a gasoline shortage and rationing unseen in the USA since the 1970s. This study explored gasoline exposures and clinical outcomes in the aftermath of Hurricane Sandy.
Prospectively collected, regional poison control center (PCC) data regarding gasoline exposure cases from October 29, 2012 (hurricane landfall) through November 28, 2012 were reviewed and compared to the previous four years. The trends of gasoline exposures, exposure type, severity of clinical outcome, and hospital referral rates were assessed.
Two-hundred and eighty-three gasoline exposures were identified, representing an 18 to 283-fold increase over the previous four years. The leading exposure route was siphoning (53.4%). Men comprised 83.0% of exposures; 91.9% were older than 20 years of age. Of 273 home-based calls, 88.7% were managed on site. Asymptomatic exposures occurred in 61.5% of the cases. However, minor and moderate toxic effects occurred in 12.4% and 3.5% of cases, respectively. Gastrointestinal (24.4%) and pulmonary (8.4%) symptoms predominated. No major outcomes or deaths were reported.
Hurricane Sandy significantly increased gasoline exposures. While the majority of exposures were managed at home with minimum clinical toxicity, some patients experienced more severe symptoms. Disaster plans should incorporate public health messaging and regional PCCs for public health promotion and toxicological surveillance.
Slavery, Race, and Conquest in the Tropics challenges the way historians interpret the causes of the American Civil War. Using Abraham Lincoln and Stephen Douglas's famed rivalry as a prism, Robert E. May shows that when Lincoln and fellow Republicans opposed slavery in the West, they did so partly from evidence that slaveholders, with Douglas's assistance, planned to follow up successes in Kansas by bringing Cuba, Mexico, and Central America into the Union as slave states. A skeptic about 'Manifest Destiny', Lincoln opposed the war with Mexico, condemned Americans invading Latin America, and warned that Douglas's 'popular sovereignty' doctrine would unleash US slaveholders throughout Latin America. This book internationalizes America's showdown over slavery, shedding new light on the Lincoln-Douglas rivalry and Lincoln's Civil War scheme to resettle freed slaves in the tropics.
In the early fall of 1859, about a half-year before the Democratic Party was scheduled to hold its national nominating convention in Charleston, South Carolina, three schooners sat at anchor in Cleveland harbor, each one with a flag on its mast bearing the words: “Douglas and Cuba, 1860!” The flags reflected a hope that Stephen Douglas might harness his identification with Manifest Destiny in yet another bid for the American presidency, and they challenge the traditional narrative about the coming of the American Civil War.
According to most accounts, America’s final showdown over slavery’s expansion occurred in the two years after Douglas helped prevent Kansas statehood under the proslavery Lecompton Constitution. Feeling betrayed by the Little Giant, southern Democrats demanded insurance against Douglas’s Freeport Doctrine in the form of a federal “slave code” for the territories, by which Congress would guarantee slave property within a territory should its legislature prove unwilling or unable to do so. Meanwhile, Lincoln and the Republicans made political hay in the North by claiming that Dred Scott and Lecompton demonstrated that a Slave Power plot was afoot to foist slavery on all the western territories. The next step, they predicted, would be to impose slavery on the North itself. In 1860, the Democratic Party fractured from an inability to resolve the territorial dispute. Northern Democrats (or the “National Democrats” as they dubbed themselves) chose Douglas as their presidential candidate; southern Democrats selected Vice President John Breckinridge of Kentucky. The Democrats’ bitter division helped Lincoln get elected president on a Republican platform denouncing popular sovereignty as fraudulent and denying the authority of either territorial legislatures or Congress to legalize slavery in a territory. Reacting angrily to Lincoln’s victory, seven southern states seceded from the Union over the next three months, setting the stage for the Civil War.
On February 1, 1861, three days before delegates from six slave states gathered in Montgomery, Alabama, to create the Confederate States of America, an angry Republican newspaper up north engaged its readers with a cynical editorial. In a flight of fancy entitled “Died too Soon,” the Chicago Tribune imagined the late William Walker taking measure of America’s sectional crisis “from the spirit land.” How frustrated the filibuster would be, the paper mused sarcastically, having forfeited his life commanding a “ragged handful” of men, when he could be still on earth serving the new nation. Were he alive, he might even become “Military Dictator of the Southern Republic.” It was such a disturbing thought, the Tribune editors confessed, that they would hesitate to attend a séance, lest Walker’s spirit appear to “rap” out “his vehement sympathies with Secession.” Surely Walker must feel cheated, “taking off” for the spirit world when he could have had “a scrimmage” under his own flag had he stuck around.
The Tribune’s back-to-the-future moment seems bizarre, but the paper had cause to link William Walker’s invasions of Central America with the formation of the Confederacy. In 1858, the filibuster had attracted press attention by appearing with Alabama’s leading secessionist, William L. Yancey, at the Bethel Church in Montgomery for a rally that initiated a constitution for a Montgomery chapter of the so-called League of United Southerners, a never fully launched organization dedicated to the formation of an independent slave state republic. Certainly, the Tribune’s Republican readers would have grasped the message since their party from its founding had dedicated itself not only against southerners’ spreading slavery westward but also acquiring slave plantation lands in the Caribbean.
In the spring of 1864, just before General Ulysses S. Grant began the campaign that crushed southern hopes for independence, a Union embarrassment off Haiti’s southwestern coast gave Confederates a rare late Civil War propaganda bonanza. A year earlier, as part of President Abraham Lincoln’s colonization program, four hundred and fifty-three African Americans had boarded the brig Ocean Ranger at Union-held Fortress Monroe on Virginia’s coast, bound for Haiti’s Île-à-Vache, or Cow Island. Nothing had gone right for the emigrants on ship or on the island. Now, a press report of their fate played into Confederate hands (Figure 6.1).
Lincoln’s embarrassment originated in the machinations of a sleazy entrepreneur named Bernard Kock, who in August 1862 signed a contract with Haiti’s government leasing Île-à-Vache for ten years. According to the deal, Kock would deliver 35.25 percent of all timber cut during his lease to Haitian authorities and he would have the work performed by imported laborers “of the African or Indian Race” who would gain Haitian citizenship upon their arrival and later get land. During September and October, Kock had lobbied the Union government to back the scheme. He submitted to Lincoln a synopsis of his contract, a proposal to colonize 5,000 African Americans on the island, and a request that Union authorities provide them with transportation there and subsistence until the immigrants could harvest a crop. On New Year’s Eve, Lincoln gave a short-lived endorsement to Kock’s proposal, changing his mind after Secretary of State William Seward received a negative report about Kock’s character and intentions. On January 6, 1863, Lincoln instructed Seward to withhold the official U.S. seal from the document. Kock then worked around the administration’s displeasure. On March 30, he transferred his contract to Wall Street financiers Paul S. Forbes and Charles K. Tuckerman, and Lincoln approved the scaled-back agreement, which provided the capitalists with $50 per emigrant in federal funds to colonize 500 former slaves.
Ambitious congressmen needed little prodding to join the army when war erupted with Mexico in the spring of 1846. Since the earliest days of the Republic, Americans had promoted war heroes to their highest office. Generals George Washington, Andrew Jackson, and William Henry Harrison all won election as the nation’s chief executive primarily because of their military luster, and many other presidential contenders positioned themselves for presidential bids with martial exploits. No wonder, then, that a mere three days after Congress voted for war with Mexico on May 13 an observer in Washington reported some fifty congressmen had applied to the U.S. president, James K. Polk, for army commissions, in some instances on behalf of relatives, but many of them for themselves.
Caught up in this rage militaire, Stephen A. Douglas joined the ranks of U.S. congressmen clamoring for a commission. Just before the war, Douglas had established a military record by participating in a volunteer militia campaign to pacify Hancock County (in west central Illinois), where disorder had erupted between Mormons and their neighbors. Douglas served there as aide-de-camp at the rank of major to his recent fellow Illinois congressman, the militia general John J. Hardin. When warfare erupted with Mexico, Douglas considered military service again, perhaps partly from a sense of personal responsibility. As chairman of the House of Representatives’ Committee on Territories he had helped enact legislation annexing the independent Republic of Texas to the Union, a cause of the fighting since Mexico had never recognized the Lone Star Republic’s independence and still claimed it. Already known as a strident expansionist, Douglas emerged as the war progressed as one of the country’s most fervent apostles of Manifest Destiny – the new creed that God intended the United States, because of its superior democratic institutions, to possess the entire North American continent. Rather than campaigning with the army, however, Douglas remained in Congress, an arrangement that worked out to his political advantage.
Did she pay any attention to what the president actually said? On March 4, 1865, Cara Kasson, the wife of a Republican congressman from Iowa, made her way to the Capitol through Washington’s muddy streets, as rain poured down, to witness the second inauguration of Abraham Lincoln. Later, when reporting her impressions of the day to a Des Moines, Iowa, paper, Mrs. Kasson was more effusive about the sun’s appearance as Lincoln took his oath than his inaugural thoughts. Observing that the president delivered “his few clear sentences” modestly, she suggested that the timely breaking out of sunshine might be an omen that God was prepared to let Lincoln lead the nation to final victory in the Civil War.
Perhaps Lincoln’s text sped by her too quickly to be absorbed. A mere 703 words, it was several times briefer than the inaugural in 1857 of his immediate predecessor, James Buchanan. Yet, within it, Lincoln boiled down to a few sentences what had caused the horrific conflict that had already taken hundreds of thousands of American lives. Asserting that everybody understood that “somehow” slavery was the problem, Lincoln explained why it so divided Americans: “To strengthen, perpetuate, and extend” slavery had been the purpose of southern disunionists, he contended, while he and fellow Republicans “claimed no right to do more than to restrict the territorial enlargement of it.” The issue of slavery expansion, in other words, brought on the Civil War, not the actual situation of slaves already in the southern states.