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To describe the implementation of multi-criteria decision analysis (MCDA) into a Canadian public drug reimbursement decision-making process, identifying the aspects of the MCDA approach, and the context that promoted uptake.
Narrative summary of case study describing the how, when, and why of implementing MCDA.
Faced with a fixed budget, a pipeline of expensive but potentially valuable drugs, and potential delays to drug decision making, the Ministry of Health (i.e., decision makers) and its independent expert advisory committee (IAB) sought alternative values-based decision processes. MCDA was considered highly compatible with current processes, but the ability as a stand-alone intervention to address issues of opportunity cost was unclear. The IAB nevertheless collaboratively voted to implement an externally developed MCDA with support from decision makers. After several months of engagement and piloting, implementation was rapid and leveraged strong pre-existing formal and informal communication networks. The IAB as a whole rates new submissions which serves as an input into the deliberative process.
MCDA can be a highly adaptable approach that can be implemented into a functioning drug reimbursement setting when facilitated by (i) a truly limited budget; (ii) a shared vision for change by end-users and decision makers; (iii) using pre-existing deliberative processes; and (iv) viewing the approach as a decision framework rather than the decision (when appropriate). Given the current limitations of MCDA, implementing an academically imperfect tool first and evaluating later reflects a practical solution to real-time fiscal constraints and impending delays to drug approvals that may be faced by decision makers.
Perfectionism is a transdiagnostic risk factor across psychopathology. The Clinical Perfectionism Questionnaire (CPQ) was developed to assess change in order to provide clinical utility, but currently the psychometric properties of the CPQ with adolescents is unknown.
To assess the factor structure and construct validity of the CPQ in female adolescents.
The CPQ was administered to 267 females aged 14–19 years of age. Confirmatory factor analysis (CFA) was used to examine the validity of the two-factor model and a second-order factor model. Pearson correlations were used to evaluate the relationships between the CPQ and a wide range of measures of perfectionism, psychopathology and personality traits.
The study demonstrated internal consistency, construct validity and incremental validity of the CPQ in a sample of female adolescents. The CFA in the present study confirmed the two-factor model of the CPQ with Factor 1 relating to perfectionistic strivings and Factor 2 representing perfectionistic concerns. The second-order two factor model indicated no deterioration in fit.
The two-factor model of the CPQ fits with the theoretical definition of clinical perfectionism where the over-dependence of self-worth on achievement and concern over mistakes are key elements. The CPQ is suitable for use with female adolescents in future research that seeks to better understand the role of perfectionism in the range of mental illnesses that impact youth.
Emerging research indicates the critical role members of the public can play in saving lives and reducing morbidity at the scene in the immediate aftermath of a disaster. It is anticipated that with training, more members of the public will be ready and able to assist should they be present at mass casualty events or other circumstances in which there are serious injuries or potential loss of life. This article describes a training course developed by multiple federal and nonfederal partners aimed at preparing the public to become “active bystanders” followed by a pilot demonstration project conducted by Medical Reserve Corps Units. The outcomes of the project indicated that the training was comprehensive and appropriate for members of the public with little or no first aid knowledge. National availability of the “Becoming an Active Bystander” training course is currently being planned. (Disaster Med Public Health Preparedness. 2016;10:286–292).
College students are susceptible to upper respiratory infections (URI) due to inadequate sleep, stress and close living quarters. Certain probiotic strains modulate immune function and may improve health-related quality of life (HRQL) during URI. The present study recruited apparently healthy college students and assessed the effect of probiotics on HRQL outcomes (i.e. self-reported duration, symptom severity and functional impairment of URI) in those who developed URI. Missed school and work days due to URI were also considered. Subjects (n 231) were apparently healthy college students living on campus in residence halls at the Framingham State University (Framingham, MA, USA), and were randomised to receive placebo (n 117) or probiotic-containing powder (daily dose of minimum 1 billion colony-forming units of each Lactobacillus rhamnosus LGG® (LGG®) and Bifidobacterium animalis ssp. lactis BB-12® (BB-12®); n 114) for 12 weeks. Subjects completed The Wisconsin Upper Respiratory Symptom Survey-21 to assess HRQL during URI. The final analyses included 198 subjects (placebo, n 97 and probiotics, n 101). The median duration of URI was significantly shorter by 2 d and median severity score was significantly lower by 34 % with probiotics v. placebo (P< 0·001), indicating a higher HRQL during URI. Number of missed work days was not different between groups (P= 0·429); however, the probiotics group missed significantly fewer school days (mean difference = 0·2 d) compared to the placebo group (P= 0·002). LGG® and BB-12® may be beneficial among college students with URI for mitigating decrements in HRQL. More research is warranted regarding mechanisms of action associated with these findings and the cost–benefit of prophylactic supplementation.
Routine outcome monitoring may improve clinical services but remains
controversial, partly because the absence of a control group makes
To test a computer algorithm designed to allow practitioners to compare
their outcomes with epidemiological data from a population sample against
data from a randomised controlled trial, to see if it accurately
predicted the trial's outcome.
We developed an ‘added value’ score using epidemiological data on the
Strengths and Difficulties Questionnaire (SDQ). We tested whether it
correctly predicted the effect size for the control and intervention
groups in a randomised controlled trial.
As compared with the a priori expectation of zero, the Added Value Score
applied to the control group predicted an effect size of 70.03 (95% CI
70.30 to 0.24, t = 0.2, P = 0.8). As
compared with the trial estimate of 0.37, the Added Value Score applied
to the intervention group predicted an effect size of 0.36 (95% CI 0.12
to 0.60, t = 0.1, P = 0.9).
Our findings provide preliminary support for the validity of this
approach as one tool in the evaluation of interventions with groups of
children who have, or are at high risk of developing, significant
The present study was designed to evaluate the efficacy of different
microwave pretreatment methods to retrieve microtubule-associated
protein 2 (MAP-2) immunoreactivity in formalin-fixed, paraffin-embedded
guinea pig brain sections. Brain sections, microwave pretreated in
boiling sodium citrate, citric acid, Tris hydrochloride, and EDTA
buffers of pH 4, 6, and 8, were labeled with four different clones of
MAP-2 monoclonal antibodies. No MAP-2 immunoreactivity was observed in
control sections processed without microwave pretreatment. Optimal
MAP-2 immunoreactivity was observed only when MAP-2 antibody clone AP18
was used in conjunction with citric acid buffer of pH 6.0. Using this
combination, brain sections from nerve agent soman-exposed guinea pigs
were found to exhibit marked reduction in MAP-2 immunostaining in the
hippocampus. These observations suggest that the clone of the antibody
in addition to the type and pH of antigen retrieval (AR) solution are
important variables to be considered for establishing an optimal AR
technique. When studying counterpart antigens of species other than
that to which the antibodies were originally raised, different antibody
clones must be tested in combination with different microwave-assisted
AR (MAR) methods. This MAR method makes it possible to conduct
retrospective studies on archival guinea pig brain paraffin blocks to
evaluate changes in neuronal MAP-2 expression as a consequence of
chemical warfare nerve agent toxicity.
The soybean aphid, Aphis glycines Matsamura (Hemiptera: Aphididae), is a pest of soybeans in the People's Republic of China, Korea, Thailand, Japan, North Borneo, Malaya, and the Philippines (Blackman and Eastop 2000). It was first identified in North America in 2000 from soybean fields in 10 states in the north-central United States of America, although the route of entry and time of introduction are not known (North Central Regional Pest Alert 2001). Dai and Fan (1991) reported that yield losses caused by soybean aphids on soybeans in the People's Republic of China were greater when the crop was infested soon after planting, and the presence of large populations of the aphid throughout the growing season resulted in 20%–30% yield losses. The soybean aphid can also transmit several viruses that infect soybeans in North America, including alfalfa mosaic, soybean mosaic, bean yellow mosaic, peanut mottle, peanut stunt, and peanut stripe (Hartman et al. 2001). In North America, the soybean aphid is known to transmit soybean mosaic virus and alfalfa mosiac virus (Hill et al. 2001). A survey of Ontario soybean fields revealed the presence of tobacco ring spot virus, soybean mosiac virus, and bean pod mottle virus (Michelutti et al. 2001); all of which could potentially be spread by this newly introduced aphid.
This study examined the relative contributions of peer influence, mothers' influence, depression and life events on the attributional style of 9 to 11 year old children. Questionnaires were administered to 173 Year 5 children and their mothers. It was found that measures of depression, life events, and peer's attributional style were all significantly related to children's attributional style. The attributional style of a child's best friend, a year prior to testing, accounted for significant additional variance after controlling for depression and life events. No significant relationship was found between mothers' attributional style and that of their children. Given the emerging evidence about the effect of peer attributional style on pre-adolescent's attributional style, class group interventions could provide benefit not just directly to individuals but also via the reinforcing potential of the individual's peer group. The implications of peer effects on attributional style and the possibility of a critical period for the development of attributional style are discussed with respect to future research, therapy and systemic approaches to promoting optimistic attributional style and thereby reducing levels of depression.
The crystallizing phases from a BaZn YbTh fluoride glass were a BaYbTh fluoride, ZnF2, and YbF3, as identified with x-ray diffraction and composition-enhanced scanning electron microscopy. Blocky BaYbTh fluoride crystallizes first, at about 450 °C, and ZnF2 excluded from this phase crystallizes at its surfaces. At higher temperatures the BaYbTh fluoride phase decomposes partially to BaThF6 and YbF3 phases. The kinetics and temperatures of crystallization were also followed with differential scanning calorimetry.
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